Capacity for care: meta‐ethnography of acute care nurses' experiences of the nurse‐patient relationship

Abstract

AimsTo synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings.BackgroundWhile primary research on nurses' experiences has been reported, it has not been previously synthesized.DesignMeta-ethnography.Data sourcesPublished literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.Review methodsQualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method.ResultsSixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.ConclusionThe findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.

Engagement as an Element of Safe Inpatient Psychiatric Environments

“…The majority of research on nurses' sense of engagement with patients is discussed in qualitative studies of nursing role/relationships (e.g., Andes & Shattell, 2006;Bridges et al, 2012;Cleary, Hunt, Horsfall, & Deacon, 2012;Shattell, Andes, & Thomas, 2008). As Cleary et al's (2012) review of 23 qualitative studies points out, nurses have developed communication styles and approaches to forge connections with patients: approaches that are quite sophisticated and fit well with the often challenging inpatient environment.…”

Exploring Nurse’s Communicative Role in Nurse-Patient Relations: A Qualitative Study

“…1 Nurses, through communication skills, can recognize the patient’s healthcare needs, as a meaningful communication with patients enable nurses aspire to enhance a thorough knowledge of individual patients and their personal characteristics. 2 In fact, positive nurse-patient relationship includes a wide range of behaviors in multiple domains of nursing practice and it is an essential factor in high quality nursing care. 3 Therefore, enhancing the communication role of nurses leads to their having a positive opinion of their job and patients.…”

“…Bridges et al, concluded that supportive organizational settings influenced the emotional engagement of nurses with patients. 2 Kim et al, conducted a study to explore enabling factors for nurses in communication effectively with patients. They concluded that the manager should consider a set of clinic-based strategies for improving the nurse-patient relationship beyond the conventional communication skills.…”

Nursing futility, managing medicine: Nurses’ perspectives on the transition from life-prolonging to palliative care

“…As previously illustrated in the scholarly literature on nurse-patient interaction on breaking bad news (e.g. Arber and Gallagher, 2003;Bridges et al, 2013;Dowling, 2006;Long-Sutehall et al, 2011;Malloy et al, 2010), the nurses' self-reported approaches were viewed as very different from medical discussions which were centred on diagnostic, prognostic and supportive care discussions. The nurses often found their role was to engage in highly intimate discussions about 'where they will go' and 'what's for me after' which challenged the nurses in terms of the boundaries between personal relationships and professional advice:…”