This thesis explores nurses' and patients' perceptions of caring relationships in a hospital context. An attempt is made to discover the meaning these caring relationships have for the nurses who provide care and for the patients who participate in this process. The nurses enter into the caring relationship as voluntary and professional participants. The patients come into hospital because of illness. The relationship entered into is claimed to be a caring relationship yet little is known about the personal experiences of the participants. In the first part of the study the repertory grid technique was used to structure interviews with 25 experienced nurses. Personal constructs were elicited and rated during the interviews. Six major themes emerged from a content analysis of the constructs. These were: personal qualities, clinical work style, interpersonal approach, level of motivation, concern for others, and use of time. The personal cost of caring for the nurses surfaced as a significant aspect of the caring relationship. In the second part of the study 10 nurses and 10 hospitalised patients were interviewed. These were analysed by means of a method grounded in interpretive phenomenology which focuses on the informants' lived experiences. Nine general themes emerged which captured the nurses' experiences of caring relationships. The themes were: patient dependency, patient circumstances, effectiveness, emotional involvement, stress, preparedness, ward constraints, role uncertainty, and personal benefits. The patients' experiences of being cared for were embodied in four general themes quite different from the nurses. The themes were: vulnerability, self-presentation, service evaluation, and other concerns. The thesis provides many details about the perceptions of caring relationships through the exploration of the lived experiences of nurses and patients in hospital. An extended picture of caring relationships in nursing has emerged. The need to take account of both the professional and consumer perspective is emphasised as it highlights important discrepancies between the views of carers and those they care for. Professional carers must be able to understand the patient in order to care in a personalised way and the approach used here demonstrates how this understanding can be achieved. Such an approach could also be used in nursing practice. The findings and methods used here should also be of interest to other helping professions and consumers of health care.

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.