Engaging nurses in patient care: Clinical reflection by a student nurse

Abstract

I stood by, the endless student nurse observer, as a woman (let’s call her Joan) was transferred by trolley from the helicopter into emergency following an acute period of respiratory distress. Two nurses from the department were present for hand-over, and three ambulance persons brought her in. Joan’s condition appeared stable, as far as I could tell; her bed was at a ninety-degree angle and her oxygen-assisted breathing was very laboured, but she seemed aware of her immediate surroundings. Joan traveled on the helicopter trolley into the emergency ward, was transferred to an emergency bed, the necessary tubes and wires were re-organised, her hand-over was verbalised and the personal weekends of the treating team were discussed amongst themselves. To my increasing frustration, not one staff member looked Joan in the eye, said hello, or did anything to acknowledge her presence as anything other than another technical detail.This paper was inspired by the above incident, viewed as a nursing student in the emergency department. The clinical reflection that developed around this particular incident was how easily care by nurses could be limited to the physical needs of the patient. This paper is premised on the clinical reflection that engagement by nurses with patients is necessary for optimal patient care. The literature was reviewed, and the concept of ‘engagement’ was used to refer to the actual connection of one person to another via honest care and dedicated communication. I suggest, with literary support, that this lack of engagement extends from the inability of the nurse to provide sufficient care to fulfill the needs of the patient. The current mismatch between duty and ability for nurses is cited as being due to an increasing number of stressors. Major stressors include a lack of support from senior staff; insufficient staff; having too much work and too little time, and the inability to meet patients’ needs (McNeely 1996). Accumulated stress has detrimental effects on nursing care, namely the nurse’s lack of energy and emotional resources due to the stress. These stressors result in coping mechanisms that can additionally affect the manner in which nurses engage their patients. Nursing is an emotional art form, and factors affecting the creation of such an art form are potentially debilitating to nurses and patients alike. This paper will clinically reflect on the implications of such a lack of engagement to both the patient and the nurse, and on the opportunity for individuals and organisations to realise their responsibility in the promotion of nurse–patient engagement.