As a medical student, I am often required to reflect on my experiences during my time on clinical placements. There are a wide variety of themes on which these reflective pieces can focus, and the experiences can be good, bad or both. It can be difficult to select individual experiences and concisely articulate them. However, an area that gained my interest was the nurse-patient relationship.
Looking back on these experiences, empathy and patient advocacy played an integral part in instances when there was a good nurse-patient relationship. It is critical that these facets of patient care are implemented by all members of the multidisciplinary team (MDT).
A great deal of my time on wards is spent clerking patients. In doing so, you not only gain extensive information about their lives, but you also get an invaluable insight into their experiences in the hospital. At times, patients would mention that they have reservations about voicing concerns because they know how busy health professionals are. They can feel as though they are a burden, and so keep these concerns to themselves. I noticed how nurses, understanding this, were able to create the perception that they had a great deal of time to speak with the patient, even when they were busy.
A simple word of reassurance was very effective in achieving this. For example, by replying ‘Of course that's not a silly question’ to a patient who deemed their query to be one not worth asking, seemed to encourage the patient to find their voice, which had a positive impact on their care.
Following this, I witnessed occasions where nurses would advocate for the patients. This was particularly important for patients who otherwise may not have felt comfortable expressing themselves. Part of effectively advocating for patients requires demonstrating empathy for them, which in turn, helps them trust that they are being listened to. They would then be more forthcoming in conveying things that were worrying them.
‘Part of effectively advocating for patients requires demonstrating empathy for them, which, in turn, helps them trust that they are being listened to’
The morning handover was a time when I observed nurses advocating for the patients who were under their care. They were able to communicate with confidence any new concerns the patients had, to the rest of the team. Ultimately, this provided clarity on any problems that needed to be addressed and thus ensured good care was being provided. This was achieved because the nurses endeavoured to facilitate an environment where patients felt comfortable expressing themselves.
For many people, hospitals can be an environment that makes them feel anxious. They can be an unfamiliar and intimidating place. This feeling of unfamiliarity has likely been further exacerbated by the COVID-19 pandemic, where visitors have often been prevented from entering the wards. Patients I spoke with on my clinical placements expressed sadness that their loved ones were unable to visit them. Having friends or family members present can be helpful in giving confidence to patients to voice their concerns, and share in their decision making. Therefore, in their absence, it is even more critical that health professionals cultivate an atmosphere where patients feel encouraged to articulate any issues. Having empathy is crucial in achieving this.
Finally, it is important to acknowledge that all members of the MDT play a role in advocating for patients—even students. We can discover information about a patient's worries that has not yet come to light during our consultations. Devoting time to ask about concerns is essential and this is commonly abbreviated to ICE—ideas, concerns and expectations. Personally, I have found this to be a very helpful reminder to actively enquire into what aspects of their condition or care may be distressing a patient.
As a student, speaking up can be a daunting prospect. Often you are new to a department and surrounded by people with far more experience than you. There can be a fear of saying something in the wrong way, or at the wrong time. Unfortunately, I'm yet to find the solution to completely eradicating these feelings. However, from my experience, the fears that we hold about making our voices heard rarely manifest. This is some comfort to me when I find myself overthinking the possible negative outcomes of articulating information on behalf of a patient. In fact, there can be a feeling of satisfaction when you have positively impacted the care of a patient in this way.
There are many skills that are required to deliver good care. Empathy and patient advocacy are two aspects that particularly resonated with me when reflecting on my experiences. It is the responsibility of each member of the MDT to implement these concepts. The lessons that I have learnt would not have been possible without my time on clinical placements. It is a reminder that there is so much to gain from reflecting on our experiences. It can be a difficult exercise to carry out, but an exercise well worth doing. I hope to put these principles learnt into practice throughout my clinical placements and future career.