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Doctor Nurse Patient
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1 Section of General Practice, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland. martina.torppa@helsinki.fi
Martina A Torppa et al.
J Telemed Telecare .
2006 .
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1 Section of General Practice, Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland. martina.torppa@helsinki.fi
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We analysed the interaction in doctor-nurse-patient teleconsultations in primary care. A qualitative analysis was performed of 30 primary care teleconsultations in northeastern Finland. The male doctor was the same in all consultations. One of the trained nurses appeared in 27 consultations. The analysis followed the methodological principles of the grounded theory approach. The interaction in the doctor-nurse-patient triad was complex. The doctor had to concentrate on many things at the same time and undivided attention to the patient was not always possible. The nurse assumed an active role and was a facilitator of the interaction, an advocate for the patient, a secretary for the doctor and a mediator of the doctor's therapeutic influence. The patients frequently turned to the nurse for information. The role of interpersonal dynamics in telemedical encounters is important. Both the doctor and the nurse need to learn new skills to perform teleconsultations jointly.
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Int J Environ Res Public Health
v.17(3); 2020 Feb
PMC7036952
Published online 2020 Jan 29. doi: 10.3390/ijerph17030835
Nursing and Physiotherapy Department, Universitat de les Illes Balears, 07122 Palma, Spain; se.biu@ollag.j
* Correspondence: se.biu@anilom.susej
Received 2019 Dec 26; Accepted 2020 Jan 26.
Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/ ).
Keywords: nurse-patient relationship, decision making, personal autonomy, quality of health care, nurse’s role
Analysing the type of relationship of the nurse with the patient allows establishing strategies to improve the quality of care and the degree of satisfaction of both.
Knowing the impact of the nurse-patient relationship on the autonomy of patients allows to increase their capacity in decision-making.
Evidence of limitations in nurse-patient relationships leads to a change in the patient-centred healthcare model.
Nursing records show an absence of the patient’s autonomy in decisions making about their care. In the interviews, it is evidenced in nurses of more experience and age, a greater degree of participation of the patients.
Nurses prefer a submissive patient, who assumes care without discussion and respecting the work of the nurse.
The patient is labelled, both in the nursing records and in the interviews, as a good or bad patient according to the relationship with the nurse.
Implementing new ways to understand the management of health organizations that favour the relationship between members of the healthcare team with the patient, improve the decision-making capacity of the patient in the clinical setting.
Promoting a good relationship between the nurse and the patient, based on real respect for their decisions, would lead to a less tense in the nurse practice and with fewer limitations in communication and autonomy of the patient.
Until now, the nursing records in the different studies had not provided information on the quality of care and patient autonomy. Although these are a complex source of information, its analysis can provide great richness in the written discourse of nurses.
According to the results obtained, the educational model of the nurses should be modified, directed more towards a patient-centered model.
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