Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
Good Relationship Bad Relationship
Trust Avoidance
No Risk: No Dilemma/Confidence
Collaboration attempted and not accepted
Figure 6. Strange loop of healthcare communication.
Within the frame of the analysis and then in viewing the
strange loop (refer to figure 6) having a good relationship versus
having a bad relationship within the nurse-physician paradigm is
based in the prefigurative and practical forces. These contexts
promote how the nurse and physician relate as collaborators. Using
the example and context of the nurse and physicians, if the nurse
has a good communicative relationship with a physician there is not
a dilemma in speaking to the physician. Also, when the nurse has a
good relationship with the physician, it is associated with
communication that includes trust and respect. However, if there is
a bad or poor communicative relationship then the nurse may want
to avoid the physician.
The contextual interaction is the movement between the
nurse and physician. The implicative force and practical forces are
aligned with risk/dilemma or no risk/no dilemma. Thus, within the
context of the implicative and practical forces, the nurse will make
an attempt to speak in a way that will be accepted within the nursephysician
paradigm and medical hierarchy. The nurse will speak
within the context of speaking the truth for the patient’s sake and
the notion of trying to develop or keep the professional nurse ideals
of self at the forefront. Yet, the nurse knows that confrontation is
not acceptable in the nurse-physician relationship and it is in this
controversial conversational space where nurses are caught
between the two concepts of non-dilemma versus a dilemma.
The nurse wants to maintain a good relationship with the
physician. However, the nurse has an obligation as the patient
advocate to speak for the patient’s sake. If the nurse speaks out of
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Risk: Dilemma/Lack of
Confidence
(Pushes the RN to attempt collaboration)