Capacity for Care: Meta-Ethnography of Acute Care Nurses’ Experiences of the Nurse-Patient Relationship

Abstract

Aims. To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings. Background. While primary research on nurses' experiences has been reported, it has not been previously synthesized. Design. Meta-ethnography. Data sources. Published 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 methods. Qualitative studies describing nurses' experiences of the nursepatient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method. Results. Sixteen 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. Conclusion. The 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.

Meaning of Caring from Critical Care Nurses Perspective: A Phenomenological Study

“…Leinninger believed that the nurses' ability to express self, perception and interpretation of subjective experiences of patients and creative application of nursing actions, are some requirements for the artistic aspect of nursing Within a critical care environment, caring could take different meaning and domains, which are different from caring in other nursing environments [4]. Various factors such as critical condition of the patient, high technology, level of staffing, mixture of skills and medical professions, may influence dynamics and potential of caring [5].…”

Creating Learning Environments for Compassionate Care

“…capacity to experience empathy and to engage in a caring relationship [3]. Our research also shows that nurses' relational capacity can depend on ward level conditions, and that there is a greater tendency for nurses with low relational capacity to avoid relationships with patients and to burn out, in spite of aspirations to a higher standard of care [4].…”

“…capacity to experience empathy and to engage in a caring relationship [3]. Our research shows that relational capacity can depend on ward conditions with nurses on general hospital wards reflecting lower capacity than critical care nurses, and a greater tendency to avoid relationships with patients and to burn out [4]. Previous research suggests that interventions which foster workplace learning, empathy, peer support and positive culture at ward team level may be more effective than individual interventions but we lack robust research on impact of such interventions on frontline care [5][6][7].…”

“…This leadership and team capacity are key characteristics of the ward-level conditions needed to support nurses' relational work [4] and an important foundation for team activities such as using service user feedback constructively [17]. A recent study on culture change and quality of acute hospital care for older people found that more positive patient and carer assessments of care were correlated with higher staff ratings of team climate in terms of "supporting each other" and "shared philosophy of care" [5].…”

Nursing Practice at a Psychiatric Emergency Service: Evaluation Using Fourth Generation Assessment

“…4,6 The few studies that describe the mental health care process point towards the existence of a high care demand at emergency services, possibly compromising the quality of the health actions offered. 4,[7][8] Concerning the nurses' activities in PES, scientific production is even scarcer, 9 mainly when considering subjective aspects, related to these professionals' activities in the institutional care system [10][11] ; and also aspects based on the perspectives of users, professionals and family members, called stakeholders in this study.…”