‘Trust me, I’m a nurse’

Abstract

LEARNING OBJECTIVES In this chapter, you will: ➔ Develop your understanding of how, through the therapeutic relationship, the nurse can empower the patient to make decisions about treatment that the patient really wants ➔ Gain an understanding of the nature and role of trust in the nurse– patient relationship ➔ Develop your understanding of the scope of a patient's right to negotiate treatment, including alternative therapies Lena is a patient in the medical ward of a hospital. One day she tells her nurse that she is feeling ‘a bit out of sorts’ because her best friend has left on her honeymoon and won't be visiting her. At handover, the nurse reports that Lena is feeling depressed. The nurse on the incoming shift then writes in the notes that Lena is depressed. The resident doctor reads in the notes that Lena is depressed and informs the specialist doctor the next day, suggesting that he prescribe a medication. In the meantime, he arranges for a social worker to talk with Lena about possible problems at home. Lena is outraged. She marches to the nurse's station and demands to see her file. She demands to know who has decided she is depressed and who has sent a social worker after her, then insists on seeing the resident doctor. The nurse on duty is not experienced in dealing with an angry patient, and when she calls the doctor she tells him that Lena is ‘out of control’. This chapter will further explore the moral and legal aspects of the nurse– patient relationship, with special attention to the role of trust. Lena's situation demonstrates how a patient can be disempowered and rendered increasingly vulnerable through careless use of professional power. Lena's sadness at being parted from her friend (a normal reaction) has been turned into a medical condition (or ‘medicalised’), which is then recorded in her file as if it is a fact about her. Then this purported medical condition is used as a reason to pry into Lena's private life – and all without any consultation with Lena herself. When Lena expresses quite justifiable outrage, she is further cast as a problem patient, and her anger is regarded as part of her emotional instability.