The consumer's voice: nursing implications

Winifred Raphael pioneered survey research into nursing problems. In particular she was interested in what patients thought about their care. Her sympathetic approach and her trust in the motivation of nurses resulted in ready acceptance of her findings and an eagerness of nurses to use these findings as a basis for improving their performance. This article discusses the paradox of patients wanting to talk, but staff being reluctant to listen, especially where emotionally charged topics are concerned. Recognition that it may be therapeutic for patients to discuss painful experiences and an increasing willingness by nurses to listen to patients may call for a system of providing support for the nurses themselves. Unaided, nurses may find the strain excessive and therefore, in spite of the best intention, may feel obliged to cut the patient off. There is evidence that a change has occurred in recent years in nurses' attitudes to researchers. Whereas early reports reveal a defensiveness and a rejection of critical comments by researchers, recent studies show that patients are less critical of nursing care than the nurses are themselves, and that nurses welcome investigations into their work. Lack of communication with patients is most frequently criticized by patients and by nurses. Because of this nurses increasingly believe that patients may need help to make their views known and increasingly incorporate patient-advocacy in their role.