UNIT 2 HUMAN RELATIONS IN NURSING

Sturucture
2.1 Objectives
2.2 Introduction
2.3 Concept of I-Iuman Relation
2.4 Helping Patient to Adjust to Illness
2.4.1 Recognizing the Effects of Illness on the Patient and Family
2.5 Therapeut~cAttitude Towards the Patient
2.6 Defensive Technique Used by the Nurse
2.7 Ways of Helping the Patient who is Considered "difficulty'
2.8 Let Us Sum Up
2.9 Answers to Check Your Progress
2.10 Further Readings

2.1 OBJECTIVES
After studying the unit you should be able to:
discuss the concept of human relation;
explain the various ways of helping the patient to adjust to sickness;
develop therapeutic attitude towards the patient;
identify the defensive techniques used by the nurse to avoid interaction with the
patient; and
develop skills in helping the patient who is considered as "Difficult".

2.2 INTRODUCTION
The most urgent concern of nursing services is the relationship of the hospital
personnel and services with the patient. In the hospital and community
environment one comes across many difficult situations. There are many groups
of health workers in the hospital setting, but the role of nurses in particular is
very significant. Though the quality of patient care is infiuenced substantially by
the nurse's competence in giving care, ye+ face-to-face communication and
nurse's ability in handling interpersonal relationship adds to the quality nursing
care. In this unit the discussion will be on the concept of human relationship,
the efforts made by the nurse in helping patient to adjust to illness as a human
being, while becoming an effective member of the team and developing positive
attitude towards the patient. Certain situations where a nurse may use defensive
technique so 'that s h e does not have to answer the questions of patient are also
illustrated. You will also read in this unit on how to help these patients who
are considered as difficult.

2.3 CONCEPT OF HUMAN FWLATION

Human relation in nursing is a very significant aspect. The nurse is dealing
with the human beings who have complex needs. They have their identity, life
style, status and background. When they fall sick and are dependent on others for
care, they need to be considered as unique human being. Nurse and the hospital
team need to use effective communication skills so that the patient feels that they
are being considered as an individual and not merely another patient suffering from
a particular disease.
Legal and Ethlcal Issues in
Nursing Administration 2.4 HELPING PATIENT TO ADJUST TO ILLNESS
Illness is a stressful situation for the patient as well as family. As a nurse one needs to keep
the following factors in mind while helping the patient.

2.4.1 Recognizing the Effects of Illness on the Patient and Family

The patient comes to the hospital with the effects of illness added to their usual problems,
and illness becomes an additional source of stress for the patient and family. As a nurse one
is familiar with the hospital set up, equipment and routine activities, but for the patient the
whole place may be very frightening. As the patient is a central figure in the hospital the
following efforts may be made to help herlhim feel like an important human being.

a) Out Patient Department

A patient's first impression about the health workers and hospital will help herhim in
forming the opinion about the hospital and its workers. If the patient is received well at the
reception, guided towards the OPD and is attended by physician properly, shelhe feels there
will be warmth and friendliness in the ward where shehe is going to be admitted.
If the patient has come to the hospital for the first time, s h e may be slow to understand
instructions. A nurse needs to develop an attitude of patience and understanding in
explaining the questions asked by patient and relatives.

b) Reducing the Waiting Time

You must have come across some patients attending OPD. By the time patient is able to
understand where shelhe needs to go for laboratory investigation (the geographical
location) it is the closing time. Imagine the stress the patient and the relatives have gone
through in terms of money, time, physical e&orts in coming to the hospital OPD and going
away without investigation. If guidance is given.properly to this patient the timely
investigation would help herhim to start the treatment early.
For example in the ward a patient is informed that he has to undergo some investigation i.e.
X-ray abdomen, if the patient is prepared on time, informed the details of investigation and
the time at which he has to go for the x-rays, explanation about who will be going with the
patient. All these information would nxke the patient feel comfortable and give him a
sense of being an individual with different needs.

c) Reducing Stress of Admission

As the patient and family are undergoing immense anx!ety,a?d stress which shoots up the
moment they come to know that admission is required, it is very difficult for the patient to
locate hislher ward. Hence, it is important for 3 P D nurse to send the patient with a hospital
escort and handover'+e patient to the ward incharge. The clear, effective communication
and direction given by the nurse in the patient's language will definitely reduce the anxiety
and stress of the patient and family.

d) Helping Patient to Adjust to the Ward

A leaflet may be provided to the patient about ward routine. Time for meals, doctor's round
or any important information i.e. whom to contact in the ward during any problem. The
patient may have several questions but if answered patiently shethe feels happier that
someone is there to tell herhim that where is the lavatory? Where shehe could fill up hot
water, and the meal timings in the ward?
For example one of the patient mentioned to another patient, "that so many people wearing
uniform visit the ward, I am bewildered by the number of people who appeared at my
bedside who are not ready to disclose their names. However pne of the smart young woman
in white overall would ask everyone how are you? Patient wondered whether she is a
Doctor, radiographer, laboratory assistant, a physiotherapist, a senior nurse? Who is she?
Eventually she turned out to be 1st year nursing student".
The above example shows that it is very significant for the health team to interact with the
patient to make them feel nice human being.
 Human Relations
Check Your Progress 1 in Nursing
Give four examples of how you would h'elp the patient to adjust to the hospital.

THERAPEUTIC ATTITUDE TOWARDS

THE PATIENT
Attitude includes mixture of fcelings, belief and behaviour. People have different attitudes
towards other people, surroundings or objects. You have read in BNS-105 that attitudes are
learned early in life through imitation of adults. Many attitudes are formed unconsciously
on the basis of experience. A young nurse who has seen fights between parents because of
father's alcoholism may have a non-helping attitude towards a patient who is alcoholic.

a) Rising Above Your Problem

As described in this section, it is necessary that the problem which you as a nurse have
faced due to an alcoholic father will be seen in other families also. The coping mechanism
of each family is very different. Similarly sometimes you may face personal problems.
These personal problems should not interfere with the patient care. As a nurse you have to
develop habit of putting the personal matters aside while you are on the job.
It is understandable that nurse is also a human being and may be going through various
stresses. It is better that slhe takes leave, resolves the stress factors and comes back full of
energy and concentration to help the patient.

b) Nurse Needs to Adopt herlhis Behaviour

A nurse needs to adapt herself according to the situations and conditions in the hospital. For
example if a patient is agitated, the nurse needs to help the relatives so that they do not get
worried if the patient has high fever. A few words from the nurse will reduce the anxiety. It
may be a very small gesture from the nurse but patient's relatives feel that helshe is under
her care.

c) Attending to Requests of Patient

It is a very important feature in demonstrating the attitude of acceptance of the patient as a
human being. Even though there is a shortage of nurses in the ward, a request from the
patient for a glass of water or assistance sought in getting out of the bed could be met
"immediately" or with an abrupt answer such as "you will have to wait". A sympathetic
answer calms the patient down.

d) Maintaining Respect and Dignity of the Patient

It is very important for a nurse to take care of the dignity of the female patient and ego of
the male patient. For example a nurse may avoid saying that "all those patients who have to
get insulin injection come to the duty room".
Providing privacy to the female patient and presence of nurse during physical examination of
a female patient by a male doctor is a part of dignity which must be priovided to the patient.
Let us read the following illustration and understand what the patients look during
hospitalisation.
P
"A nurse on duty was often remembered in a particular ward as one who is understanding
and reassuring person. Though she was new, she showed genuine interest in doing her best
for the patients. Her attractive smile and kind enquires did a great deal to restore the morale
of patients. She could not spare time for more than a few words, but everyone looked
forward to her visits and missed her on the day when someone else took her place. This
Legal and Ethical Issues in From the above illustration it can be interpreted that the small things done for the patients
Nursing AdministraMon helps thep feel that as if they are being treated as human being.

2.6 DEFENSIVE TECHNIQUE USED BY THE NURSE

To overcome the various demands by the patient or to avoid the interaction with the patient,
a nurse may use the defensive mechanism. Some of the most common defensive techniques
used by the nurse which results in her not developing a rapport with the patient are given as
follows:

i) Nurses' Attitude of Differentiating the Nurse and Patient

Nurse feels that she is a the rapist and does not have much time to spend with the patient.
She thinks that patient may have various needs and become dcmanding and it is not
necessary for a nurse to attend to all the needs of patient.
If the patient is helped by the nurse to become self-reliant with whatever potential he has, it
will not only reduce demands on the health professional but the patient will have the
satisfaction of an early recovery.

ii) CategorizationlDepersonalizationof a Patient

As described in section 2 (d) calling all the diabetic patients to come for insulin injection is
an example of categorization. A nurse calling the patient on bed No. 6 to come for the
dressing is another example of depersonalization~categorization.Patient would feel more
comfortable if he is told "Mr. Shah it is time for you to come for dressing of your wound in
the dressing room".

iii) Detachment and Denial of Feelings by the Patient and Nurse

In some cases, patients demonstrate no feelings towards their sickness. For example, a
person with abdominal cancer may start saying that he has no problem at all and that
everything is fine or he starts consoling the relatives. This is an example of denial of
sickness.
On the other extreme, the p?tient starts thinking that he/she is very sick so it is the end of
the world. S h e may not eat food, does not communicate and socialise with the family
members. This is an example of detachment. The nurse feels that if patient does not have
any hope left she cannot do anything about it.
Denial may be from the nuise's side also. For example, nurse may think that this patient
does not have fever, he/she is eating properly and slept well at night, so there is no need for
her to go and talk to hindher.

iv) Avoiding Decision Making due to Routine Activities

One of the other common defense mechanisms used by the nurse is when a patient asks
"Sister do you think I can go to the bathroom and have bath even when I have fever" and
the nurse replies "as you wish" and gets busy in her work. Instead a nurse could say, let me
check your fever, if it is too high then you can sponge your body sitting on the bed,
otherwise you can go to the bathroom. She checks the temperature of patient and gives
instructions accordingly. Sometimes a nurse may show that she is very busy, walking
briskly, going from one unit to other, attending to routine activities. Finding the nurse so
busy the patient does not ask the question.
The nature of responsibility will also affect on the extent of relationship a nurse is able to
establish with the patient. For example if a nurse has to give injections to all 50 patients in
the ward at 10 o'clock in the morning s h e may be p d e r stress to complete the task. But
while giving injection nurse may talk to the patient about how he is feeling. How the
wound is healing or the backache is depending on the complaint the patient was admitted
with.

v) Underestimation of Personal Developmental Competencies

Many a times a nurse may use defense mechanisms to avoid the patient because she has to
go if the patient calls but she feels that it is not necessary to attend all his calls. Nurse mav
may also think that s h e may not be able to answer all the questions of the patient. A nurse Human Relations
must keep updating her knowledge and skills so that s h e is able to handle various in Numlng
situations in the hospital.

vi) Dependency on the Superior

Any difficult task or decision making opportunity is passed on by staff mrse to the
supervisor. For example the patient says that "some of the patient; kre not getting breakfast
on time". The staff nurse instead of handling the problems says that she would inform to
the ward incharge. This is a situatio11where nurse is trying to escape from responsibilities.

vii) Avoiding Change

The nurse who had been working in a particular nursing care unit avoids going to other
units. As change may put herhim in a situation where efforts are needed to develop skills.
So when the change of unit is suggested she might say '%owbecause she is happy in the
same place.
The defensive technique used by the nurse as described in this section leads to the various
issues in nursing.
A nurse may be using task-centered approach rather than patient centered approach. There
may be stafldissatisfaction due to less number of nurses, lack of equipment and supplies. It
may even lead to rapid turnober of nurses, within the departments of a hospital or to other
hospitals. There may be high wastage and high sichess rates amongst the nursing
personnel.
The role of nurse administrator is very significant in helping nurses overcome the stress and
facilitate them to develop effective human relationships.

2.7 WAYS OF HELPING THE PATIENT WHO IS

CONSIDERED 66DIFFICULTv *

. I

There is nothing called as dimcult patient. A patient may sound difficult when s h e is not
able to understand what the nurse is trying to explain. It could be due to language barrier,
education21 background, culture variation, general awareness and life style of the patient.
Due to thess reasons the patient may askseveral questions from the nurse i.e. "Sister
should !take this medicine with hot wa,er/cold water." "Should I take the medicine after
breakfast or before breakfast." These questions may sound very simple to the nurse, but
have a lot of meaning for the patient. Some patient in the hospital may become very hostile
due to change of environment or the pain and discomfort they are going through.
In some situations a nurse coxyes and discusses with the ward administrator
about the difficulties s h e is encountering and how s h e can overcome these problems.
Following are some of the waysXanurse administrator may explain so that the nurse can
help the patient:
e Kindness offered by the nurse to the patient will make himher cool down and listen
6 Communication in simple and clear language will reduce anxiety of the patient
e Sometimes patient may look as if s h e is making a fuss and is not eating food. In fact
slhe may be having real distressldiscomfort due to which s h e is not able to eat
properly.
e In the hospital patient becomes dependent and gets worried that what if s h e gets
discharged, she looses support. In such a case a nurse needs to explain to the patient
how he can gradually become more independent and care for himself rather than
making him feel guilty ?that now you are alight still you don't want to do your own
work."
e Sometimes patient is regarded as difficult because s h e has failed to live up to the
high standards and rigid routine of the hospital.
e Nurse must also understand that if the patient is expected to tolerate the staff with her1
his individual characteristics. in return the nursing personnel also try to regard the
patients behaviour with tolerance, specially when s h e is sick.
 6

Legal and Ethical Issues in Sometimes by changing the routine activities of a patient may make himiher feel as a
Nursing Adminlstratlon unique human being and patient actually will be able to adjust. For example
Divide the ~iursingpersonnel in sn?all team5
- Reducing of saying "it is not my job" someone else will come and tell you.
I\ccl711igthc ind~vrdualpatient's need in mind
- Spending more time with patient and for patient rather than on consultants rounds
- Providing of bell and modified bed rest
Nurse can also use the ways and means by which slhe allows the patient to be as
comfortable as the patient wishes to be. For example accepting change in the routine
The best thing for the patient is that the nurse avoids disturbing the patient when
slhe is resting
On discharge allow the patient to ask questions if slhe has doubts. Nurse may spend
more time with the patient when they are being discharged
Avoid giving vague answers. For example take adequate rest. Adequate may be
qualified by saying one hour or two hours in a day etc.
Explain the relatives about the appliances being used for the patient in the hospital
and its use
Explain the relatives about the needs of the patient when s h e is discharged
Discuss with the relatives about how to carryout instructions. as relatives always
carryout the instructions very faithfully if explained properly.
Discuss with the relatives about the community resources and welfare facilities for
the patient
Encourage them to ask questions and clarify doubts

Cheek Y&urProgress 2
List examples of pqients who are considered difficult,
..................................................................................................................................................

2.8 LET US-SUM UP

Now that you have read this unit you must have understood that the emphasis is placed on
the importance of human relation in nursing practice and nursing administration. As you
have read that patients give importance to small things. the way tlie nurse is interacting and
how patient wants the nurse to interact. In this unit the concept of human relation is
discussed with regards to patient as a unique human being having complex needs. The
other important concern of nurses is to help the patient to adjust to hisiher illness by
recognizing the effects of illness. Specifically by attending the patient in outpatient
department, reducing the waiting time. reducing stress of admission and helping patient to
adjust to the ward. Y o t ~ , h v e ~ a lread
s o in the unit that the patient is to be considered as a
unique hutnan being. While working in the ward the nurse needs to rise above herhis own
problems, and adopt the behavicwr according to situations and conditions of the patient,
maintaining respect and dignity of the female patient and ego of male patient. Try using
some of the ways of helping patients to be a unique human being and you will find that you
would be one of those nurses to whom the patient will look forward to interact to whenever
they have any problem.

2.9 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
i) Helping at Outpatient Department
 iii) Reducing Stress of Admission Human Relntions
In Nurslng
iv) Helping Patient to Adjust to Ward

Check Your Progress 2

i) Language barrier
ii) Educational background
iii) Culture variation
iv) General awareness
V) Life style of the patient

b 2.10
-. FURTHER READINGS
Helen M. Donion, Nursing ServlceAdministration Managing the Enterprise, The C.V.
Mosby Co. (1975).
National Productivity Council, Human Relations Management Guide, 14 Lodi Road, New
Delhi.
S. Srinivasan, Management Pracess In H#alth Care, Voluntary Health Association of India.
(1982).
Sheila Hay, Human Relations In Hoxpltal, Intarnational Journal of Nursing Studies, May
1964, Vol. I. Number 2.
W. Lt. Pany Jones, Human Relations h l n i n g in the General Hospital, International
Journal of Nursing Studies, August 1971, Vol. 8, No. 3.