Illustrating the Theory of the Dynamic Nurse-Patient Relationship

Saturday, 28 October 2017

Cynthia A. Gaudet, PhD, RN, CNE
College of Nursing, University of Massachusetts, Amherst, Amherst, MA, USA

The value of interpersonal communication and the communication skills of the nurse cannot be underestimated. While working with nursing students, this author found that the bedside computer distracted them from their patients, as their attention was diverted to the computer. The purpose of Orlando’s Theory of the Dynamic Nurse-Patient Relationship was to identify the strategies for teaching nursing students how to apply effective nursing practice, including communication. There are three major concepts associated with the theory: the patient’s behavior, the nurse’s reaction to the behavior, and the nurse’s subsequent action. To put the theory into practice, the nurse derives the patient’s need for assistance based on observation and patient behaviors, including a need for help or need for improvement. Patients who are cognitively or physically impaired are not able to express their needs. In these instances, the nurse determines the need for help through observation of patient behavior, such as restlessness, or by noting an adverse change in vital signs. Although some patients may experience little trepidation in expressing their needs, other patients may need encouragement to articulate their problem. Nurses, while performing a functional task such as a physical assessment, will initiate communication with the patient, which in turn may lead to identifying a patient’s need. The nurse’s reaction occurs internally, within the nurse. The nurse’s reaction consists of three components that occur in the sequence of perception, thought, and feeling. The reaction is generated through the nurse’s perception of the patient’s behavior. The theory is expressed in simple language that breaks down the communication between the nurse and the patient into two primary categories, automatic and deliberative action. When a deliberative action takes place, the patient’s immediate need is met after validation and discussion between the nurse and the patient. An automatic action is explained as an action that is carried out without any discussion or input from the patient. If the nurse uses a deliberative approach and validates the patient’s distress or unmet need, a helpful, trusting relationship is established. This work proposes a model that affords a visual demonstration of Orlando’s Theory of the Dynamic Nurse-Patient Relationship that can act as a framework to support the examination of patient interactions with both nurses and student nurses.