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Tom Sharon
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The Nurse-Patient Relationship

The scope of nursing as the law defines it goes beyond what the public perceives. Most people see nursing as a task-oriented subservient job, assisting patients with their activities of daily living and providing physician-prescribed medications and treatments. While this is true, it is only part of the picture. The uniform state statute that defines the scope of nursing practice actually empowers nurses to diagnose and treat human responses to existing and potential health problems with such services as health counseling and activities restorative to life and well-being. The only restriction is that a nursing action cannot interfere with or alter an existing medical regimen. This translates to a set of duties and responsibilities that includes the following:

- Take a complete health history upon admission.
- Perform a physical assessment upon admission and at the beginning of each shift.
- Review the medical orders to see that they adequately meet the patient's needs.
- Assess the patient to determine the risk of falling.
- Assess the patient to determine the risk of developing bedsores.
- Conduct an interview for behavioral assessment.
- Assess the patient's relationship with significant others.
- Assess the patient's cultural needs and ability to adjust to hospital environment.
- Assess and document the patient's responses to all medications and treatments.
- Observe for changes in clinical condition.
- Observe for changes in behavior.
- Provide periodic pain level assessment.
- Provide health education to patients and family members.
- Encourage patient to verbalize concerns.
- Advocate for patient in the right to receive competent and appropriate medical treatment.
- Provide first line of defense in responding to life-threatening emergencies.
- Design and implement a nursing care plan that helps the patient to set realistic goals.

The Health History
The nurses have to go beyond taking a mere medical history. They have to get a sense of how you have been living your life, how you react to your environment, and whether you have a personal interest in your health.

The Physical Assessment
The nurses have to check your body from head to toes. This includes listening to your chest and abdomen with a stethoscope. They are even supposed to look in your ears. They also have to give you an opportunity to relate any discomfort or problems associated with any part of your body.

Receiving Orders
The nurses are your advocates. They are supposed to take your side if any doctor's order or action or any hospital policy conflicts with your interests. This means that they are required to use every means possible to protect you from any physical or emotional harm. This also includes any problems that visitors might cause.

Assessing Fall Risk
Nurses must be able to predict with reasonable certainty the likelihood of a patient falling out of bed or from a chair. This ability comes from the experience of knowing what conditions predispose a patient to falling. They derive this information from all the other assessments.

Preventing Bedsores
The nurses must assess the possibility of skin breakdown and take all measures available to maintain skin integrity. When breakdown occurs, they must initiate aggressive wound care.

Knowing the Patient
The nurses have to know about who you are. In order to serve you better, they have to know what scares you, what bothers you, what makes you happy, and how you react to both good and bad news. Additionally, they need to know how you perceive your loss of body functions. They also have to find out what understanding you have of your illness.

Understanding Family Dynamics
The nurses have to understand your relationship with your family members and close friends. They have to know how supportive these people are and whether any of them are willing to take responsibility for your care after you leave the hospital.

Understanding Culture and Lifestyle
The nurses have to identify whether you are going to be able to cooperate with hospital routine. This is when they are supposed to find out your personal preferences and make reasonable accommodations. For example, if the patient is an Orthodox Jewish male, there are certain times of day that he must devote to prayer, and at times he must wear certain items. The nurses must know this at the onset so they can adjust the care plans accordingly. Of course, lifesaving measures take priority.

Assessing Responses to Medications and Treatments
Nurses must know what side effects are possible with your medication and what the symptoms are. They must check you for those possible reactions, and they have to know what to do in case any such effects occur. They must also find out what medications you are allergic to. If you have ever had an allergic reaction to any medications, you should tell the nurse without waiting to be asked.

Observing for Physical Changes and Taking Action When Necessary
Your doctor will usually write orders telling the nurses to notify him or her when certain symptoms appear. In addition to that, the nurses have to use clinical judgment to determine whether there are any unforeseen changes. They must then take immediate action in case of emergency.

Observing for Changes in Behavior
The nurses must observe for changes in mental status or emotional responses. They check for orientation to time, person, and place and observe for changes in affect (facial expression) and body language. They need to have the time to open and carry on a conversation with the patient and explore what they might pick up on as being a potential problem.

Assessing Pain
The nurses need to have time to fill out pain assessment forms. The current standard of care prohibits allowing patients to suffer. If there is an increase of pain or new pain, the nurses must evaluate whether this is symptomatic of a change in clinical condition.

Discharge Planning
Since hospitals are dumping patients while they still need skilled care, most hospitalized people have many things to learn before going home. Some have to learn how to manage diabetes or another chronic disease. Others need to learn how to administer intravenous medications. Still others need to know how to change dressings with sterile technique to avoid infection. In short, nurses have to teach many of their skills to patients and family members, or the discharged patients will develop serious complications while at home. There is also a lot of teaching that nurses have to provide during hospitalization so that their patients will have a better understanding of what is going on.

Encouraging Verbalization of Problems
Nurses must be able to start up a conversation to draw out information that might lead to preventing a serious problem. Some people are stoic and do not like to complain. There are often subtle signs of a potential catastrophe waiting to happen. Again, our nurses need to have the time to perform this important skill.

Advocating for the Patient
At times, patients do not get medical care when needed. Nurses need to stop their routine duties and begin a course of patient advocacy. This involves making telephone calls to page the nursing and medical supervisors. Often in these situations, the nurses have to stay with the patient until management resolves the problem.

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