The 'difficult' nurse-patient relationship: Development and evaluation of an e-learning package
Scott Brunero
Department of Liaison Mental Health Nursing, Prince of Wales Hospital, Randwick NSW
Scott Lamont
Department of Liaison Mental Health Nursing, Prince of Wales Hospital, Randwick NSW
PP: 136 - 146
Abstract
Nurses in most clinical settings experience difficult 'nurse patient relationships' at various times. Attempts to describe and articulate how to manage such difficult relationships can be found, but often lay blame at the patient level and ultimately leave the nurse less confident to improve patient care.
This study uses an action research approach in working with nurses in a generalist setting in developing an educational strategy that helped to improve their knowledge, skills and confidence in working within the 'difficult nurse patient relationship' paradigm. Through the experiential style learning methodology of scenario based learning and applying this via e-learning, an effective educational approach has been developed.
Using a quasi-experimental design to evaluate the e-learning package, significant increases in knowledge, skill, confidence and reduced nurse stress as measured on the 'difficult patient stress scale' were shown. This approach allows nurses to reflect on their own behaviour and improve their ability to enhance patient care in difficult to manage nursing care situations.
Keywords
nursing; nurse patient relationship; difficult patients; mental health liaison
References
Betts H and Burgess J (2006) A preliminary evaluation of the first e-learning nurse prescribing course in England. Consumer Centred Computer Supported Care for Healthy People 1, 153-157.
Brunero S, Fairbrother G, Lee S and Davies M (2007) Clinical characteristics of people with mental health problems who frequently attend an Australian emergency department. Australian Health Review 31, 462-470.
Carol J, Orehowsky S, Smith-Regojo P, Sikora S, Smith P, Stein J, et al (1997) Interventions used by staff nurses to manage difficult patients. Holistic Nurse Practitioner 11, 1-26.
Chin H and Hamer S (2006) Enabling practice development: Evaluation of a pilot programme to effect integrated and organic approaches to practice development. Practice Development in Healthcare 5, 126-144.
Chitty K and Maynard C (1986) Managing manipulation. Journal of Psychosocial Nursing 24, 9-13.
Coghlan D and Casey M (2001) Action research from the inside: Issues and challenges in doing action research in your own hospital. Journal of Advanced Nursing 35, 674-682.
Collier K (2000) Finding a forum from debriefing role play in adult education. In D Saunders and N Smalley (Eds) The international simulation and gaming research yearbook (Vol. 8, pp.199-208). London: Kogan.
Delpier T (2006) Cases 101: Learning to teach with cases. Nursing Education Perspective 27, 204-209.
Gallop R, Lancee W and Shugar G (1993) Residents' and nurses' perceptions of difficult-to-treat short-stay patients. Hospital and Community Psychiatry 44, 352-357.
Greenwood D and Levin M (2005) Reform of the social sciences and of universities through action research. In N Denzin and Y Lincoln (Eds) The Sage handbook of qualitative research (pp.43-64). Thousand Oaks: Sage Publications.
Groves JE (1978) Taking care of the hateful patient. New England Journal of Medicine 298, 883-887.
Haas L, Leiser J, Magill M and Sanyer O (2005) Management of the difficult patient. American Family Physician 15(72), 2063-2068.
Hahn S, Kroecnke K, Spitzer R, Brady D, William J, Linzer M, et al (1996) The difficult patient. Journal of Geriatric Medicine 11, 1-8.
Hall J (2006) Professionalizing action research - A meaningful strategy for modernizing services? Journal of Nursing Management 14, 195-200.
Hay J and Passik S (2000) The cancer patient with borderline personality disorder: Suggestions for symptom-focused management in the medical setting. Psycho-oncology 9, 91-100.
Huffman J, Theodore S, Harley R and Lundy N (2003) The use of DBT skills in the treatment of difficult patients in the general hospital. Psychosomatics 44, 421-429.
Hummelvoll J and Severinsson E (2001) Coping with everyday reality: Mental health professionals' reflections on the care provided in an acute psychiatric ward. Australian and New Zealand Journal of Mental Health Nursing 10, 156-166.
Katsuyama K and Majima Y (2006) Value and problems with e-learning materials in relation to patient-nurse communication and assessment in a lecture. Consumer Centred Computer Supported Care for Healthy People 122, 253-254.
Kim J, Koh M and Sun, K (2006) Development of e-learning multimedia contents for PBL. Consumer Centred Computer Supported Care for Healthy People 122, 813.
Kolb A and Kolb D (2005) Learning styles and learning spaces: Enhancing experiential learning in higher education. Academy of Management: Learning and Education 4, 193-212.
Lamont S and Brunero S (2009) Personality disorders prevalence and treatment outcomes: A literature review. Issues in Mental Health Nursing 30, 631-637.
Laskowski C (2001) The mental health clinical nurse specialist and the difficult patient: Evolving meaning. Issues in Mental Health Nursing 22(1), 5-22.
Lin I, Chien Y and Chang I (2006) Quality evaluation on an e-learning system in continuing professional education of nurses. Consumer Centred Computer Supported Care for Healthy People 122, 220-224.
Maatsuda Y, Takeuchi T, Takahashi Y, Ozawa K, Nishmoto Y and Terauti H (2006) Development and evaluation of the e-learning teaching materials for surgical nursing training. Consumer Centred Computer Supported Care for Healthy People 122, 811.
Macdonald M (2003) Seeing the cage: Stigma and its potential to inform the concept of the difficult patient. Clinical Nurse Specialist 17, 305-310.
Macdonald M (2007) Origins of difficulty in the nurse patient encounter. Nursing Ethics 14(4), 510-521.
Majima Y and So Y (2006) Development of e-learning for problem solving approach of nursing students. Consumer Centred Computer Supported Care for Healthy People 122, 881.
Merrill H (2005) Case study, problem based learning and simulation in online graduate courses. 19th Annual conference on Distance Teaching and Learning. Retrieved 18 February 2008 from www.uwex.edu/disted/conference/
MHCLNA (2009) Mental Health Consultation Liaison Nurses Association. Retrieved 23 February 2009 from http://www.mhclna.org.au
Morales-Mann E and Kaitell C (2001) Problem-based learning in a new Canadian curriculum. Journal of Advanced Nursing 33, 13-19.
Morton-Cooper A (2000) Action research in healthcare. Oxford: Blackwell Science.
Muirhead R (2007) E-learning: Is this teaching at students of teaching with students? Nursing Forum 42, 178-184.
Nield-Anderson L, Minarik PA, Dilworth JM, Jones J, Nash PK, O'Donnell KL, et al (1999) Responding to 'difficult' patients. American Journal of Nursing 99(12), 26-34.
Nolan M and Grant G (1993) Action research and quality of acre: A mechanism for agreeing basic values as a precursor to change. Journal of Advanced Nursing 18, 305-311.
Ritchie R (2006) Experimential learning cycles. Training and Development in Australia 8, 20-21.
Robinson-Wolf Z and Robinson-Smith G (2007) Strategies used by Clinical Nurse Specialists in ''Difficult'' clinician-patient situations. Clinical Nurse Specialist 21(2), 74-84.
Rutledge C, Barham P, Wiles L and Benjamin R (2008) Integrative simulation: A novel approach to educating culturally competent nurses. Contemporary Nurse 28, 119-128. http://www.contemporarynurse.com/archives/vol/28/issue/1-2/article/2337/integrative-simulation
Santammaria N (1996) The difficult patient stress scale Australian. Journal of Advanced Nursing 13, 22-29.
Schafer S and Nowlis D (1998) Personality disorder among difficult patients. Archives of Family Medicine 7, 1-4.
Schitai A (2007) Caring for Hispanic patients; Interactive simulations and practices for allied health professionals. Journal for Nurses in Staff Development 20, 50-55.
Sharrock J and Happell B (2001) An overview of the role and functions of a psychiatric liaison nurse: An Australian perspective. Journal of Psychiatric and Mental Health Nursing 8, 411-417.
Sharrock J and Rickard N (2002) Limit setting: A useful strategy in rehabilitation. Australian Journal of Advanced Nursing 19, 21-24.
Shikiraishi Y, Norikane K and Majima Y (2006) Development of e-learning materials for psychiatric nursing education. Consumer Centred Computer Supported Care for Healthy People 122, 812.
Simpson A, Reynolds L, Light I and Attenborough J (2008) Talking with the expert: Evaluation of an online discussion forum involving mental health service users in the education of mental health nursing students. Nurse Education Today 28, 633-640.
Steinmiller E (1999) Responding to difficult patients. American Journal of Nursing 99, 26-34.
Stein-Parbury J (2005) Patient and person (3rd edn). Sydney: Elsevier.
Trimpey M and Davidson S (1998) Nursing care of personality disorders in the medical surgical setting. Nursing Clinics of North America 33, 173-186.
William A (1999) An antipodean evaluation of problem-based learning by clinical educators. Nurse Education Today 19, 659-667.
William B (2006) Qualitative analysis of undergraduate paramedic students' perceptions of using case-based learning in an online environment. Journal of Emergency Primary Health Care 4, 1-5.
Wong F, Cheung S, Chung L, Chan K, Chan A, To T, et al (2008) Framework for adopting a problem based learning approach in a simulated clinical setting. Journal of Nursing Education 47, 508-514.
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