Learning Objectives
At the end of the chapter, the reader will be able to:
Understand how evidence‐based practice requires the nursing associate to listen, inform and involve patients in decision‐making with regards to their care and treatment
Demonstrate an awareness of the two types of knowing
Appreciate the value of gathering information in the development of the therapeutic nurse–patient relationship
Understand the advantages of being physically and mentally present in every interaction and the ability to prioritise relationship building
Test Yourself Multiple Choice Questions
1 Hierarchy of evidence refers to:Legal data onlyA ranking system whereby a range of different methodologies are graded according to the validity of their findingsA system that is based on objective data onlyAll of the above
2 How many types of knowing are there?123
3 Physical knowing relates to the patient’s:Responses, psychological function and body typeResponses and physical functionResponses, physical function and body type
4 Psychological knowing relates to the patient’s:Feelings, perceptions, expectations and beliefsPerceptions, expectations and beliefsExpectations and beliefs
5 The nursing associate is required to:Involve the patient in the decision‐making of his/her care and treatmentAdvise and involve the family in the decision‐making of their care and treatmentListen, inform and involve the patient in the decision‐making of their care and treatment
Introduction
One of the main roles expected of the nursing associate is to deliver hands‐on, evidence‐based patient‐centred care as a part of the nursing team (Health Education England 2019; Nursing & Midwifery Council 2018a). The concept of patient‐centred care refers to the caring of patients in a meaningful and valuable way that is entirely individual to that patient (McCormack & McCance 2010). The Nursing & Midwifery Council’s (2018b) Code is clear in informing the nursing associates that they must act in partnership with those receiving care, and in order to do this effectively, they are required to gather relevant information from the patients and, if appropriate, their family.
The nursing associate has to listen, inform and involve the patient in the decision‐making of his/her care and treatment. Evidence‐based practice refers to the application of appropriate research findings to underpin practice, such as identifying the most effective treatment and management or having a deeper appreciation of the experiences of being a patient. In order to deliver such patient‐centred care, both concepts need to work in harmony, requiring the nursing associate to sift through and gather the relevant information to support any given clinical situation. This chapter looks at how the nursing associate may gather information from a variety of sources. It will consider the theoretical features that allow nursing associates to do this, as ultimately, how and what information we gather will provide the knowledge to support clinical judgements and decision‐making in the delivery of individualised patient care.
Green Flag
Therapeutic Nurse–Patient Relationship
Establishing positive and trusting therapeutic relationships with patients has long been recognised as an essential component of nursing practice and is important for effective care (Freshwater 2007; Mirhaghi et al. 2017). A therapeutic relationship such as this is defined by Feo et al. (2016) as a helping relationship that is based on mutual trust and respect; the nurturing of faith and hope; being sensitive to self and others and assisting with the satisfaction of the patient's physical, emotional and spiritual needs. This type of nursing involves understanding the true meaning of a situation, especially when it is not obvious or expected (Freshwater 2007). Successful interaction of focusing, knowing, anticipating and evaluating are skills used to build and maintain a trusting relationship (Feo et al. 2017).
Blue Flag
Knowing the Patient
Getting to know the patient within the context of his/her specific illness and the context of his/her lives is considered by Dewing et al. (2014) as two types of knowing: the physical and psychological knowing. The physical knowing relates to the patient’s responses, physical function and body type, whereas the psychological knowing reflects the patient’s feelings, perceptions, expectations and beliefs. These will determine the patients’ own health beliefs, including their responses to illness, future life events and experiences.
Knowing the patient is vital in nursing; the nursing associate might state that we ‘know the patient very well’, but what does this really mean? What do we know and how do we know it? Several theories within the literature (Carper 1978; Watson 1985; Swanson 1991) have explored this knowledge for nursing practice, and it is reported that as such a situation as this ‘knowing’ cannot be based on formal scientific knowledge alone. Therefore, knowledge must be seen in another dimension associated with action and decision‐making and is referred to as ‘patterns of knowing’ (Carper 1978). Carper’s (1978) work sets out to bring together all the ways of knowing that are pertinent to nursing, integrating both practical and theoretical knowledge. Conducting a seminal piece of work, Carper (1978) explores the sources that nurses use to develop knowledge and beliefs about their practice and patient care by describing four patterns of knowing: empirical, aesthetic, personal and moral.
The first of Carper’s (1978) four patterns, empirics, refers to the science of nursing, and it is empirical, factual and descriptive in nature. This type of knowing allows the nursing associate to acquire both objective information regarding the patient’s condition and personal information concerning thoughts, feelings and experiences. The second is aesthetics; this refers to the art of nursing. Here, Carper (1978) reflects upon empathy as an important element of aesthetic knowing, suggesting that when a nursing associate learns to empathise, the different perspective of the patient life becomes apparent. The third relates to personal knowledge, and this is concerned with knowing, encountering and actualising of the individual self and in some respects relates to emotional intelligence and can be acquired through the therapeutic use of self (Currid & Pennington 2010).
Yellow Flag
