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.

Purposes/Aims: This study described the unique relationships that develop while providing cancer care to American Indian (AI) populations and the underlying meaning that nurses ascribed to these experiences. Rationale/Conceptual Basis/Background: The establishment of caring relationships in order to provide high quality cancer care is particularly challenging for nurses who engage with ethnic minority populations as they contend with cultural and contextual influences different from those found in the majority population. AIs represent an Indigenous minority group in the U.S. facing a considerable cancer care inequity. Nurses who care for AI patients frequently encounter population-specific issues that impact the caring dynamic, yet their experiences and the meaning they ascribe to them are largely unknown. Methods: This was an interpretive phenomenological study with iterative data collection and analysis. Nine cancer care nurses with a minimum of three years of experience working with AI patients participated by engaging in 2-3 exploratory, open-ended, reflective interviews over a period of 9 months. Thematic reduction was completed to explicate the fundamental structures of nurse-patient relationships during cancer care. Phenomenological and hermeneutical reflective writing resulted in linguistic transformation illuminating the essential meaning for nurses within this patient-nurse phenomenon. Results: Findings include individually-situated wholistic descriptions capturing the existential experiences of each of the participants. Reduction of individually-situated themes into seven shared meta-themes included From Task to Connection; Unnerving Messaging; We Are One; the Freedom of Unconditional Acceptance; Attuning and Opening; Atoning for the Past, One Moment at a Time; and Humanizing the Inhumane. Themes were explicated in a comprehensive general structural description followed by the reconstitution of the data and self-reflection into a deeply introspective essential description, suggesting that the meaning of the AI patient-cancer care nurse relationship was expressed in contradictory yet simultaneous patterns of joy and sorrow; ease and difficulty; obligation and vocation. From one moment to the next, nurses sought synchronicity with their patient as they danced to a life rhythm that revealed and concealed; enabled and limited; connected and separated. Being in relationship provided nurses great purpose within the universal human context of caring. Implications: Results contribute to the development of interventions designed to improve both the AI cancer care experience and the support and training of the nurses who serve this population. Refinement of our praxis will result in improved outcomes for both nurses and AI patients, reflecting the inseparability of the two entities within the cancer care relationship. The complimentary and mutually dependent nature of the patient-nurse relationship implies that strengthening and improving support for one entity may in turn positively impact the other. Further research into the AI patient’s perspective of their relationships with cancer care nurses is called for.

M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2011 / In this present study, the instrument cardiac patients learning needs inventory (CPLNI) was assessed for validity and reliability by four cardiology doctors, two critical care nurses, and one patient with a history of myocardial infarction (stage one of the study). The instrument was not modified as a result of non modified CPLNI used in the pilot study which consisted of thirty seven items of information grouped into eight clusters (constructs). The aim of the study was to describe and compare intensive care nurses and patients perceptions of information needs of acute myocardial infarction patients at a public sector tertiary hospital in Johannesburg. The study has made recommendations for clinical practice and education of intensive care nurses. A quantitative, non experimental, descriptive, prospective two-part design using questionnaires was utilized in this study to find out what information out of that commonly given following myocardial infarction, patients and critical care nurses rated as being most and least important (stage two). These results were then compared with the results obtained from patients and nurses who were given the same instrument to complete. Seventy six subjects were recruited. Results indicated that some similarities existed between the patients and the nurses in terms of what they perceived as the most and least important clusters/constructs of information. The item one (what to do if I get chest pain)was ranked first with a frequency of seventy five(98,68%). The scores for some informational clusters included on the instrument were significantly different between the patient and the nurses groups (p<0.05). The constructs miscellaneous (p=0.0054), physical activity (p=0.0022) and symptom management (p=0.0284) were statistically significant. These findings and others are discussed, and recommendations are made for improving the information given on post myocardial infarction,

Bedside reporting is one way to improve communication among the health care team. At the study site, at least 50% of bedside reporting was being conducted at the door of the patient's room instead of at the patient's bedside. The project question addressed whether a computer-based education and training video on bedside reporting and a standardized bedside reporting checklist would increase the rate of bedside shift-to-shift reporting among a medical surgical unit (MSU) to 100%. The project addressed the implementation of standardizing bedside reporting through education and training using Agency for Health Care Research and Quality's (AHRQ) Guide to patient and family engagement. The project also promoted use of a standardized tool to conduct bedside reporting and a surveillance tool to ensure bedside reporting was being conducted. Data was collected through surveys and surveillance. The data was tabulated for frequencies displayed in percentages. Post-implementation findings indicated that bedside reporting went from 0% to 86% during the 2-week surveillance period. MSU nursing staff improved their knowledge and skill on how to conduct bedside reporting, but their attitude did not change as they thought the practice of bedside reporting was not an effective use of their time. Findings may be used to increase involvement of patients and families in their inpatient health care.

Background: The interpersonal relationship between nurses and clients is seen as the central element or core activity of mental health nursing. Without this relationship therapeutic alliance cannot take place. Concern has been expressed that nurse prescribing could have a negative impact on the nurse patient relationship and result in the nurse sacrificing nursing skills for the prescribing role. Aim: The aim of this study was to explore the nurse patient relationship in the mental health setting when the nurse is a prescriber. In order to do this a comprehensive literature review was undertaken and views of participants were explored and relationships described. Methodology and methods: Nurse prescribers were sent questionnaires to gather demographic data and basic qualitative data. Focus groups and interviews were undertaken within a large NHS Foundation Trust. A constructivist approach was used with 57 participants including nurse prescribers, pharmacist prescribers, nurse managers, clients and doctors. A discussion guide and an iterative approach were used to clarify findings. Data analysis was guided by a Framework approach. Findings: The majority of clients preferred to have their nurse prescribe for them. Trust was highly valued within the pre-established relationship and clients found nurses easier to talk to about their medication than doctors. Nurse prescribers placed high importance on being able to reduce and discontinue medication for the client, terming this ‘un-prescribing’. Nurse prescribers were uncomfortable with the concept of power, preferring to use the term ‘empowerment’. All groups of participants were unanimous that nurse prescribers continued to provide care and that they had not moved from a traditional ‘caring’ role to a ‘medical’ curing role and importance was placed on the therapeutic alliance between nurse prescribers and clients. Conclusion: Rather than detracting from the nurse patient relationship, results from this study suggest that nurse prescribing enables the mental health nurse prescriber to provide more holistic care than previously. The action of ‘un-prescribing’ may indicate a new culture around mental health nurse prescribing

Thesis (Ph.D.)--Duquesne University, 2007. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 84-94).

The research is situated in a busy intensive care unit in a tertiary referral centre university hospital in Scotland. To date no research appears to have been done with a focus on handover in intensive care, across the professions involved, examining how handover is enacted. This study makes an original contribution to the practical and pedagogical aspects of handover in intensive care both in terms of the methodology used and also in terms of its findings. In order to study handover a mixed methods approach has been adopted and fieldwork has been done in the ethnographic mode. Data has been audio recorded and transcribed and analysed to explore the clinical handovers of patients by doctors and nurses in this intensive care unit. Texts of both handover, and the artefacts involved, are reviewed. Material from journals, books, lectures and websites, including those for health care professionals, patients and relatives, and those in industry are explicated. This study explores the role of material artefacts and texts, such as the intensive care-based electronic patient record, the whiteboards in the doctors’ office, and in the ward, in the enactment of handover. Through analysis of the data I explore some of the entanglements and ontologies of handover and the multiple things of healthcare: patients, information, equipment, activities, texts, ideas, diseases, staff, diagnoses, illnesses, floating texts, responsibility, a plan, a family. The doing of handover is framed theoretically through the empirical philosophy of Mol’s identification of multiple ontologies in clinical practice (Mol, 2002). Each chapter is prefaced by a poem, each of which has relevant socio-material elements embedded in it. The significance of the findings of the research for both patient care and clinical education and learning is surfaced.

Bakgrund: När en person drabbas av cancer förändras hela ens livsvärld. Bristande kunskap ger en känsla av att inte få grepp om situationen och därför är det viktigt att sjuksköterskan ger en god omvårdnad med fokus på helhet och kommunikation. Syfte: Syftet med litteraturstudien var att beskriva patienters upplevelser av sjuksköterskans bemötande vid cancerbehandling på sjukhus. Metod: En litteraturstudie som bygger på tio kvalitativa artiklar. Resultat: Genom analys hittades tre huvudkategorier: Vikten av bred kunskap hos sjuksköterskan, Vikten av en bra vårdrelation och Vikten av ett bra omhändertagande som gynnar patientens välbefinnande och viljan att vara delaktig. Metoddiskussion: Att det inte hittades så många artiklar inom ämnet beror på att det mest finns forskning som är ur sjuksköterskans perspektiv. Förförståelsen bekräftades och författarna fick mer insikt i hur viktigt det verkligen är med tvåvägskommunikation. Resultatdiskussion: Patienten vill känna ett intresse från sjuksköterskans sida och en bra relation mellan dessa två uppstår då god kommunikation finns. / Background: When a person suffers from cancer their entire world changes. A lack of knowledge creates a feeling of not being able to adequately grasp the situation, which is why it is important that the nurse provides decent caregiving with emphasis on entirety and communication. Purpose: The purpose of the literature study was to describe patients' experiences of the nurse's approach in relation to cancer treatment at hospital. Method: A literature review that is based on ten qualitative articles. Result: Through analysis, three main categories were found: The importance of wide knowledge by the nurse, The importance of a good nursing relationship and The importance of good caretaking that benefits the patient's well-being and their will to participate. Method of discussion: The reason, as to why there were not many articles found on the subject matter, is due to the fact that there is more research conducted from the nurse's perspective. The preunderstanding was confirmed and the authors get more insight in how important two-way communication is. Discussion of result: The patient wishes to feel involvement from the nurse and a good relationship between the two arises when good communication exists

Bakgrund: Det finns ingen enskild orsak till att en människa hamnar i ett substansmissbruk. Ett missbruk medför vissa hälsorisker vilket gör att den här gruppen människor sannolikt kommer komma i kontakt med vården. I samhället har substansmissbrukare stigmatiserats vilket kan påverka sjuksköterskans bemötande. Syfte: Att belysa aspekter som bidrar till sjuksköterskors attityder till patienter med substansmissbruk och hur attityderna påverkar vården. Metod: Litteraturöversikten är baserad på tolv vetenskapliga studier. Studierna analyserades för likheter och skillnader. Dessa diskuterades och när författarna var överens skrevs det in i litteraturöversiktens resultat. Resultat: Resultatet visade att sjuksköterskors tidigare erfarenheter hade en stor inverkan på hur sjuksköterskorna såg på patienterna och hur deras attityder gav sig uttryck. Sjuksköterskornas tidigare erfarenheter bidrog till en rädsla och osäkerhet hos många dem. Den professionella kompetensen visade sig spela in då kunskapen om hur ett missbruk påverkar patienterna inte var tillräcklig hos många sjuksköterskor vilket hindrade dem att se människan. Sjuksköterskor med en hög vårdvetenskaplig medvetenhet klarade av det bättre. Diskussion: Diskussionen har Erikssons teori om lidande och konsensusbegreppet vårdande som teoretisk utgångspunkt. Sjuksköterskans attityder påverkar vårdrelationen och negativa attityder skapar ett onödigt vårdlidande och sjukdomslidande på grund av att information riskerar att missats. Samhällets stigmatisering påverkar hur sjuksköterskan ser på missbrukaren som patient. Ett paternalistiskt förhållningssätt kan vara nödvändigt för att patienten ska få en framtida autonomi. / Background: There is no singular reason why a person ends up in substance abuse. Substance abuse poses health risks, which means that they will come in contact with health services. In the society the substance abusers are stigmatized which may affect the nurses’ behavior towards them. Aim: Highlighting the aspects that contribute to the nurse’s attitudes towards patients with a substance abuse problem and how the attitudes affect the health care. Method: The literature review is based on twelve scientific studies. The studies were analyzed toillustrate the similarities and differences. These were discussed and when the authors agreed it was written into the literature review's results. Results: The results showed that the nurse’s previous experiences had a big impact on how the nurses saw patients and how their attitudes influenced their expression. Previous experience contributed to fear and insecurity among many of the nurses. The professional competence turned out to have an impact because the nurse’s lack of knowledge of how an addiction affects prevented them to see the patient as a human being. Nurses with a high level of caring awareness managed this better. Discussion: The discussion includes Ericsson’s theory of suffering and the metaparadigm caring. Nurses’ attitudes affect the care relationship and that negative attitudes create an unnecessary suffering related to care and illness because there is a risk of information being overlooked. Social stigma affects how the nurses perceive the addict as a patient. A paternalistic approach may be necessary to increase the patients’ chances to have a future autonomy.

Information ska ses som en integrerad del i god omvårdnad av den patient som befinner sig i det akuta skedet av en hjärtinfarkt och är en förutsättning för en god vård. Sjuksköterskans bemötande och kommunikation är en viktig del i omvårdnaden av patienten. Det är av betydelse att sjuksköterskan har en förmåga att förmedla kunskap, förståelse under de stressade förhållanden som ibland kan råda på en akutmottagning. På så sätt ges förutsättningar för att patienten att kunna vara delaktig och ha inflytande över sin egen vård och behandling. Syftet med studien är att belysa informationens betydelse för patienten i den akuta fasen av en hjärtinfarkt. Metoden som använts är en litteraturstudie och resultatet består av 12 artiklar, 10 kvalitativa och 2 kvantitativa. I resultatet finns fem kategorier: patientens upplevelse av information, sjuksköterskans roll vid information, kommunikation mellan sjuksköterska och patient, sjuksköterskans stöd till patienten samt patientens oro och rädsla. Resultatet i litteraturstudien belyser att bra information som talas i klartext minskar patientens oro, reducerar ångest och ökar patientens förståelse för sin sjukdom. Patienter som får relevant och individuell information känner även tillfredställelse med vården och upplever ökat välbefinnande. / Information should be seen as an integrated part in caring for patients´ that suffer from acute myocardial infarction. The nurse´s support and communication is an important part in caring for the patient. It is of significance that the nurse has an ability to provide knowledge and understanding under busy conditions in the emergency ward. In that way the patient can participate and have ability to take part in their own care and treatment.The aim with the study is to elucidate the information's importance for the patient at the acute phase of his myocardial infarction. The method that has been used is a literature study and the result comprizes in 12 articles, 10 qualitative and 2 quantitative. In the result, five categories has shown. These are: The patient´s experience of the information, the nurse´s roll when giving information, communication between the nurse and the patient, the nurses support to the patient and the patient´s anxiety and fear. The result in the literature study shows that good information in plain language reduces the patient´s worries and anxiety and increases the patient´s understanding of his/her condition. Patients who are given relevant and individual information feel satisfaction with the care and experience an increased well-being.