Doctor Nurse Patient
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https://www.globalpremeds.com/2012/07/04/the-doctor-nurse-patient-relationship
Перевести · 04.07.2012 · Patients are more likely to feel comfortable with a nurse, doctor or other professional that is friendly, and yet, there is a fine line between friendliness and appearing over-familiar. …
https://nurseslabs.com/doctors-vs-nurses-differences
Перевести · As a nurse, you will be more intimate with your patient as you stay with them for the most part of their medical management, while being a physician would mean having a lot of census in your turf to even consider spending a lot of quality time per patient. Physicians treat the disease, while nurses treat the illness or your experience of the ...
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https://www.cambridge.org/.../doctornurse-relationship/58955464243EBC1684F3B38FC7408F2E
Перевести · 02.01.2018 · The in-patient setting highlights an essential aspect of the doctor–nurse relationship: its mutual interdependence. Neither can function independently of the other. If the psychiatrist is the responsible medical officer and a patient is on section under the Mental Health Act, that psychiatrist is dependent on the nurses for the containment and safe care of the patient …
https://pubmed.ncbi.nlm.nih.gov/26010340
Перевести · Objective: Nurse practitioners (NPs) have an established role for delivering competent care to patients in the primary care setting. The aim of this study was to compare satisfaction of patients managed by NPs vs. physicians …
https://pmj.bmj.com/content/76/894/212
Перевести · 01.04.2000 · Overall patients preferred to see a specialist nurse in five areas. On one occasion the nurse and dietitian were equal. Scenarios where nurses were significantly preferred to doctors related to diet, housing and social issues, obtaining leaflets, and who would spend the most time discussing patient …
https://www.straitstimes.com/singapore/tan-tock-seng-hospital-nurse-doctor-and-three...
Перевести · 03.05.2021 · The Straits Times understands that one of the patients found to have tested positive for the virus is a 72-year-old woman who had been warded at the hospital since April 20. She had been admitted ...
https://www.hipaajournal.com/nurse-patient-communication
Перевести · Nurse Patient Communication and Patient Satisfaction A study by C. McCabe in 2004, Nurse-patient communication: an exploration of patients’ experiences , explored the key elements of nurse patient communication from the perspective of the patient and found that the most important factors to patients …
Which is better to see a nurse or a doctor?
Which is better to see a nurse or a doctor?
Scenarios where nurses were significantly preferred to doctors related to diet, housing and social issues, obtaining leaflets, and who would spend the most time discussing patient focused problems. Patients preferred to see a consultant on three occasions and this was significantly so when it concerned problems with IBD and for an annual review.
What patients preferred to see a nurse?
What patients preferred to see a nurse?
Overall patients preferred to see a specialist nurse in five areas. On one occasion the nurse and dietitian were equal. Scenarios where nurses were significantly preferred to doctors related to diet, housing and social issues, obtaining leaflets, and who would spend the most time discussing patient focused problems.
What is the difference between a physician and a nurse?
What is the difference between a physician and a nurse?
Physicians treat the disease, while nurses treat the illness or your experience of the disease. [easy-tweet tweet=”Physicians treat the disease, while nurses treat the illness or your experience of the disease. ” user=”nurseslabs”] Then again, nurses turning doctors and vice versa is also becoming a common thing.
nurseslabs.com/doctors-vs-nurses-differen…
Can a psychiatrist function independently of a nurse?
Can a psychiatrist function independently of a nurse?
Neither can function independently of the other. If the psychiatrist is the responsible medical officer and a patient is on section under the Mental Health Act, that psychiatrist is dependent on the nurses for the containment and safe care of the patient while in hospital care.
www.cambridge.org/core/journals/advance…
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Published online by Cambridge University Press: 02 January 2018
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In this article on getting on with colleagues in the workplace we explore how the nurse–doctor relationship in psychiatry has evolved and discuss its current status in both the in-patient ward and community mental health teams. In particular, we outline the changed roles and expanding responsibilities of nurses in the UK today. We suggest ways in which doctors can improve the relationship and give areas of possible future collaboration between doctors and nurses.
Copyright
Copyright © The Royal College of Psychiatrists 2003
‘[A nurse] must begin her work with the idea firmly implanted in her mind that she is only the instrument by whom the doctor gets his instructions carried out; she occupies no independent position in the treatment of the sick person.’
‘No matter how gifted she may be, she will never become a reliable nurse until she can obey without question. The first and most helpful criticism I ever received from a doctor was when he told me I was supposed to be simply an intelligent machine for the purpose of carrying out his orders.’
Hopefully, things have moved on since the above descriptions were prevalent. None the less, many issues that affect how doctors and nurses work alongside each other stem from that traditional association.
Psychiatric practice depends to a substantial degree on a good understanding between nurses and doctors. When this does not exist or is under threat, clinical care is impaired. Historically, the doctor–nurse relationship has aquired the status of a special relationship. This is particularly true in the in-patient setting and in the treatment of people with serious mental illnesses, where it becomes the dominant dyad, affecting other multidisciplinary interactions and, in particular, the nature of the association with patients.
This relationship has undergone major changes since the in-patient ward was the main focus of care. These are sumarised in Box 1, and discussed in more detail below.
Box 1 Factors of change in the doctor–nurse relationship
• The status and experience of doctor and nurse
• Risk management and defensive practice
Perhaps the most obvious difference is that the context of the workplace has changed. Modern psychiatry now takes place in a number of different locations in addition to the acute in-patient ward. These include community mental health centres, patients’ homes and a variety of institutional and residential units caring for individuals with psychiatric disorders. These different milieux affect the nature of the relationship, simply because they result in different styles of working arrangements and determine different roles for the participants.
A consequence of this is that the nurse–doctor pairing is no longer exclusive. Most of psychiatry operates within a multidisciplinary framework, and interactions with other professionals, such as psychiatric social workers, occupational therapists, psychologists, outside agencies and service managers, have an impact on the doctor–nurse dimension, diluting its ‘specialness’.
Changes in the workplace are reflected in professional and institutional norms (e.g. medico-legal responsibilities and working shifts), and these define the nature of the interaction, setting expectations and requirements.
Nursing and medical education are undergoing major changes in direction, making the boundaries between doctors as diagnosticians and prescribers of treatment and nurses as obeyers of orders and dispensers of treatment less clear and more permeable.
The relationship between doctor and nurse is to some extent affected by what the patients think of them. Reference RadcliffeRadcliffe (2000) argued that the power within it is mediated by the patient: ‘If in doubt ask the patient who is in control. The public may love its angels but it holds its medics in awe’. This reflects the traditional, popular view of doctor and nurse roles. However, patients’ expectations of what nurses and doctors do and do not do is changing very quickly. Increasing publicity of medical and nursing fallibility and use of the internet have removed some of the magical aura and gloss from these professions (Reference Stein, Watts and HowellStein et al, 1990).
Patients and their families are also major players in the current culture of litigation, and the consequent emphasis on risk management can induce defensive practices on the part of both doctors and nurses.
In this evolving world of psychiatric practice, how well have doctors and nurses coped with these changes? Has the dilution of the ‘specialness’ of their relationship been more difficult for nurses or for doctors? How will future changes, such as those that will be determined by the European Working Directive, affect nurses’ and doctors’ roles, and thereby, their interaction? And how do new areas of collaboration between nurses and doctors become established so that improvements in patient care can take place?
Traditional relationships have been slow to change in the in-patient environment. Institutional and professional norms still defer to medical decision-making, the nurses’ code of conduct and management lines of accountability. The in-patient setting highlights an essential aspect of the doctor–nurse relationship: its mutual interdependence. Neither can function independently of the other. If the psychiatrist is the responsible medical officer and a patient is on section under the Mental Health Act, that psychiatrist is dependent on the nurses for the containment and safe care of the patient while in hospital care. Nurses rely on aspects of the doctor’s authority and medico-legal responsibility to support them and help contain the situation.
Nevertheless, doctors in psychiatry still hold essential powers and responsibilities that have an impact on this interdependence: for example, doctors are the ones who decide, either formally or informally, whether a patient is admitted and discharged. Under Section 12 of the Mental Health Act 1983, doctors have specific responsibilities that are not shared with other professional groups.
Daily decisions such as agreeing to a patient’s leave or the need for close observation are rarely delegated to nurses, even though in these areas doctors may have no more knowledge than their nursing colleagues. If anything, they are probably less able to make appropriate judgements because of their more distant contact with in-patients, and yet deference is paid to their ‘expertise’.
Current pilot studies delegating some of these responsibilities to nurses have shown no major difficulties, and have in fact reduced the need for expensive close nursing observations and reliance on agency staff (T. Reynolds & L. Dimery, personal communication, 2003).
The closer relationship with community mental health centres has produced some shifts in the balance of power. Community staff, whether associated with community mental health teams, assertive outreach or home treatment teams, now have more say in admission and discharge arrangements, altering what was once the exclusive province of doctors.
Although the decision to admit rests finally with doctors, it is helpful to make explicit that different staff will be able to contribute different knowledge to the decision-making process.
Senior doctors appointed to cover a catchment area are likely to be more familiar with past events in a patient’s life than most other members of the team, simply by virtue of having worked in that catchment area for longer. They therefore use experience of previous psychiatric interventions to guide their thinking when a new episode occurs. There is some suggestion that nursing turnover, especially in metropolitan districts, is increasing, making it even more likely that doctors will ‘hold the history’ of patients. Conversely, in the ‘here and now’ of an in-patient stay, nurses will be much more in touch with a patient’s current state and preoccupations. Depending on the attitudes of those involved, the nurses’ knowledge can contribute to clinical care or can become a source of contention in the battle about who knows the patient best and whose decision should prevail.
Traditionally, doctors have been seen as the repositories of clinical knowledge and have been charged with keeping abreast of recent advances and imparting this knowledge not only to their own apprentices, but also to nurses within the team. University education as opposed to hospital experience accounts for the public view that doctors ‘are educated whilst nurses are trained’ (Reference WarelowWarelow, 1996). Purported knowledge, therefore, is a source of the differential power that underpins the doctor–nurse relationship. To some extent this differential has been reduced by increasing university training for nurses, as envisioned in the Department of Health’s Project 2000 (United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986). However, some critics have observed a gap between theory and practice and the creation of a training deficit at graduation, as it does not meet the practical nature of service demand (Department of Health, 1997). Shared learning (with doctors and other professional groups) is beginning to happen in areas such as Mental Health Act legislation, Health of the Nation Outcome Scales (HoNOS) and ethical issues.
A quarter of a century ago, a New Zealand anthropologist studied working relationships in a psychiatric hospital in Otago, New Zealand (Reference ParksParks, 1979). Many of the interactions that she described can still be seen in the UK today. She recognised that the rules operating between different staff groups in terms of lines of authority, responsibility and reciprocity were not explicit. A lot of emphasis was placed on the notion of ‘teamwork’, which implies a democratic structure, but in reality many teams were autocratically led and hierarchically structured. She also analysed the nurses’ notion of ‘supportive’ and ‘unsupportive’ responses by doctors, and found that they thought the doctors’ agreement with their opinions to be ‘supportive’, whereas disagreement was ‘unsupportive’ (rather than a factual correction or a constructive exchange of ideas). The third notion was that of ‘responsibility’: the nurses generally felt that it was the doctors’ responsibility to ensure patient compliance with the treatments they prescribed, even if the treatments were carried out by the nurses. These often unspoken beliefs indicated that there was still an expectation of a paternalistic, hierarchical relationship between doctors and nurses, even though nurses were demanding an equal say and influence. Most of these issues remained implicit and ambiguous, leading to conflict when the discrepancies were exposed.
In a previous publication one of us (L.F.) discussed the apparent contradictory tasks of in-patient psychiatric nurses (Reference FaginFagin, 2001). They are expected to be ‘reality role models’ for patients, organising personal self-care, confronting inappropriate behaviour and encouraging community-mindedness, while at the same time providing care, nurture and emotional support. Nurses wear many different ‘hats’: they uphold institutional norms, contain physical aggression, set boundaries and timetables, and offer informal personal therapy to patients in states of heightened distress. Not surprisingly, nurses become the main recipients of patients’ projections. As a result they are often the targets of either erotic, loving gestures or hostile, aggressive and paranoid responses.
Nurses often comment on the distinction, in the patient’s eyes, between nurses, with their multiple roles, and doctors, who have a more distant and clearly outlined function. These varying roles, both within the nurses’ remit and between nurses and doctors, prompt split transference responses in patients, which can lead to splitting manoeuvres intended by the patients to accentuate disagreements between staff, particularly if these are unspoken.
When conflict arises between nurses and doctors on communication and decision-making, the nurses’ objections are often buttressed by ‘You are not here as much as we are’. A familiar clinical situation is described in Vignette 1 below. The ‘parental’ couple of doctor and nurse are in a conflict generated (or exacerbated) by the pathology of the patient, who has a propensity to idealise paternal figures and vilify maternal ones. Such situations tend to reinforce stereotypical roles and require successful clinical management with some insight into psychodynamic interaction.
Dr S comes into the acute unit on Monday morning to attend a staff meeting and is met by a scowling Nurse T, the ward manager. She tells him that it has been a dreadful weekend, mostly because of a well-known young female patient whom Dr S had admitted in a frank psychotic state.
During the staff meeting, Nurse T launches into an attack on Dr S, stating that he is not listening to nurses. She describes how the patient, who is a crack cocaine addict, has been luring patients and visitors to import drugs into the unit: ‘It’s OK for you doctors. You admit the patient and then go off for the weekend, leaving us nurses to pick up the pieces.’ She reminds him that in previous conversations over her care, the nurses had conveyed to him their disquiet about the patient being readmitted to the unit, because of her positive HIV status, her flirtatiousness towards male patients and her total disregard for the consequences of possible sexual activity with other patients: ‘You’ve gone back on your word. She was up to all those tricks this weekend. She poured hot tea over one of the patients, and a nurse was hurt in the fracas whilst try
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