How Examining Our Own Motivation Can Help Us Provide Patient-Centered Care!

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Sometimes I think ‘we’ promote patients’  dependence on ‘us’ and this has an insidious and counterproductive affect on patient empowerment and  patient-centered care! A very complicated and complex topic that is worth reflecting on and discussing and will be helpful in personal growth and shifting our systems in this direction.  So here’s the challenge:

When are we promoting dependence and when are we promoting independence?

Any time that healthcare professionals get secondary gains from helping others we may be contributing to patients being dependent on us.  This is a red flag that we should all be aware of!  I’m not talking about feeling good about being helpful to others, but I am talking about getting our needs met such as a sense of love and belonging in the course of providing care.  For instance, what about when a patient has a preference for a particular nurse or doctor?  Patients may have very good reasons for such a preference and I totally believe that therapeutic relationships and continuity of care are vitally important to outcomes, but if we ever catch ourselves going down a path where WE feel good about that preference, we need to be very careful!  Here’s an example that is oversimplified, but will help bring this point home.

The situation:  Mrs. Jones is an 84 year old widow who has been discharged from the hospital with a new diagnosis of insulin dependent type 2 Diabetes.  She is a retired teacher who has lived alone since her husband died 6 months earlier.  She has been assigned a home health RN, Nurse Smith to monitor her blood glucose and continue patient education regarding her dietary changes and insulin administration.  Nurse Smith is explaining that she is going on vacation the following week and the next home visit will be made by her colleague Nurse Brown when Mrs. Jones gets teary.  “You’re the only nurse that I want to come here.  You’ve been such a good teacher with all of this confusing information.”

The nurse who may be seeking some secondary gains:

This nurse listens to Mrs. Jones and provides a light touch to her arm with one hand and a tissue with the other.  She feels good that Mrs. Jones only wants to have her 60px-Crutch_symbol.svg-1come to her house and it affirms that she is a good nurse and person.  She wonders how she can address this patient’s concern and remembers that her vacation plans involve a late-in-the-day flight the following Monday and offers to make the next visit early in the morning before leaving.

The nurse with healthy professional boundaries:

This nurse also listens to Mrs. Jones and provides a light touch to her arm with one hand and a tissue with the other.  She feels good that her expertise is helping Mrs. Jones make progress in managing her diabetes and recognizes that the patient is vulnerable re: a new diagnosis as well as the recent loss of her spouse.  She also knows that Nurse Brown is very capable of providing effective care and they will need some time and opportunity to build their therapeutic relationship.  She wants to honor the patient’s feelings,  facilitate a positive relationship with Nurse Brown, and preserve her vacation plans.  She shares that she is glad her interventions are helpful and that they have a nice rapport and offers that Nurse Brown has taken a recent workshop on the latest treatments for Diabetes and may have some additional insights to offer.

In the first scenario, the nurse may appear to be providing patient-centered care because she is doing what the patient wants.  In reality the nurse is encouraging the patient to be dependent on her for friendship or social support and lacks faith in both the patient and her colleague.  Care decisions become enmeshed with the nurse’s need for approval or belonging.

In the second scenario, the nurse subtly empowers the patient to engage in a successful therapeutic relationship with another nurse in order to promote her independence with her care.    Care decisions stay focused on the clinical needs of the patient and her therapeutic goals.

I think our ability to recognize our own needs and wants will help us to steer clear of expecting patients to meet them and seek other support, i.e. the needs and wants are totally fine, but inappropriate to seek them from our patients.  In order to do this we must be willing to reflect on our own behaviors and motivation.  As we do this, we’ll have a clearer path towards helping patients identify their own needs, being more receptive to patients challenging our expertise,  and using our expertise to ensure optimal outcomes that are in sync with what patients want.  In other words, by getting our egos out of the picture of clinical decision-making we’ll have a cleaner field from which to meet patients where they are at in ways that will be helpful to them.

Ultimately there are many ways that our healthcare professionals and our systems promote dependency and I suspect we could have some interesting conversations about healthy versus unhealthy dependency affecting individuals and systems.  Consider how doctors are often referred to as “Gods” and nurses as “Angels”.  Do these labels fuel our secondary gains?  Do they keep us in ‘Us’ versus  ‘Them’ mindsets?  And how about these common phrases:

  • If you are sick for more than three days you must have a doctor’s note to come back to work.
  • Make sure to talk with your healthcare professional if you are going to try this exercise program.
  • You must have a referral from your primary care physician if your insurance is going to cover your visit to the specialist.

Don’t they ablog carnivalll have elements of dependency that may be misplaced?  What are your thoughts?

This post was written as part of the Nurse Blog Carnival.

To find out what other Nurse Bloggers are writing about ‘Patient-Centered Care’ check out Greg Mercer, MSN’s  Host Post with summaries and links to all of this month’s related posts!

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16 Responses to How Examining Our Own Motivation Can Help Us Provide Patient-Centered Care!

  1. Jim Murphy says:

    Extremely good reading! This “dependency-heroism” syndrome applies to many professions besides nursing. Consultants would be another example.

  2. Beth, your certainly pin points a problem within our healthcare system – promoting dependence, which along with being a disservice to our patients, it also increases healthcare costs. It reminds me of an interesting article I read by the Huffington Post newspaper in December. It shared a pic of a letter from a physician in Nova Scotia, Canada. This physician requires $30 as reimbursement of services with a bill sent to employers requiring a written “out sick” note from a healthcare provider in order for the patient to return to work. As your article highlights, these behaviors promote dependence on healthcare and increase healthcare costs.

    http://www.huffingtonpost.ca/2014/12/12/sick-day-note-nova-scotia_n_6317128.html

    • Beth Boynton, RN, MS says:

      Thanks for your feedback, great point about dependency increasing costs and a very interesting article. It highlights the extra burden the medical system has to take on which I can totally see. I think it is ironic that the correspondence between the employer and physician still leaves out the patient/employer! Who’s body is it anyways. And if some one is malingering, is that a medical issue? Oh how complicated it gets.

  3. You share some crucial points we don’t think about. I’m guilty of; “Make sure to talk with your healthcare professional if you are going to try this exercise program.”
    Maybe I imagine if they brake an ankle, I can say I referred them to their Dr. But in the mean time, I’m promoting dependence which is the exact opposite of what I am hoping to achieve! -Preventive Health. Something for me to think deeply about. Thanks Beth.

  4. MINDWAYS Solutions says:

    Amazing post. Such a thoughtful and true perspective. You definitely made me look in the mirror at my practice. Well done! Thank you for sharing. Take care, Dave.

    • Beth Boynton, RN, MS says:

      Thanks so much, Dave. In my own experience, it is one of those things that gets clearer with time, experience and reflection so here’s to your willingness to grow!

  5. Oh wow, that is thought provoking and makes me think deeply about my own actions sometimes, it is any easy thing to fall into. Great post.

  6. Elizabeth Scala says:

    A wonderful post to point out the ways to effectively empower the patient, without creating dependent relationships. I love the examples and suggestions for how to provide patient centered care in the most appropriate way. Being aware of ourselves and how we show up in the relationship is key to making the most of the care we provide.

    • Beth Boynton, RN, MS says:

      Thanks, Elizabeth…amazing how powerful self-awareness is…in so many ways. I think the work you do with your book and other materials/talks re: ‘Nursing from Within” helps us take positive and joyful steps in this direction.

  7. Gregmercer601 says:

    Such an important point, Beth, thanks! We think of such issues often in psych work, but in a much narrower sense: folks tend to focus on not getting sucked in or tripped up by patient “manipulation.” We do see patients who make it something of a lifestyle, but I tell people it’s not the manipulation that gets our attention or bothers people: it’s that they’re not very good at it. Instead of making connections and meeting needs, they often burn bridges and attract blame. All people do lots of manipulaton, of course: that’s part of being human and getting your needs met. You show how it’s nurses’ are at risk to mess it up too, accidentally or otherwise. We’re all people, after all! Again, thanks – Greg

    • Beth Boynton, RN, MS says:

      Thanks for your insights and feedback, Greg. So true…we are all people and have lots of learning opportunities…I do believe that we fill find ways to have our needs met and voices heard…we have to in order to survive I think. I think in an ideal world we’ll all be able to ask for and get what we need, but that is a big oversimplification as you know! But anything that contributes to more awareness and discussion is progress! 🙂 You Psych nurses, I suspect are, in general, quicker to recognize manipulation. Do you agree? And if you learn to recognize it in others it isn’t a huge step towards recognizing your own tendencies. Anytime there is a dynamic like this I know I learn more about myself!

  8. Nurse Beth says:

    Thank you, Beth, for sharing a compelling point of view as always. Self-awareness, when lacking in a nurse or provider, puts the healthcare professional’s needs before those of the patient.

    • Beth Boynton, RN, MS says:

      Thanks for your feedback Beth. It can be tricky, especially if we don’t have healthy channels and opportunities to get our needs met. In my opinion, it is another way that leadership can indirectly take care of patients and systems by helping nurses in self-care efforts. Lots to discover and talk about, isn’t there?

  9. Pingback: Greg Hosts the Nurse Blog Carnival : Patient – Centered Care! | Big Red Carpet Nursing

What are your thoughts?