A study of practising nurses' perceptions and experiences of intimacy within the nurse-patient relationship

Defining Moments: A Nurse's Touch

In most cultures, touch is the sense we most strongly associate with healing. In this essay, I describe the different ways touch was incorporated into my cancer treatment as well as wonder how touch in the clinical setting might remain changed as the result of COVID-19. More specifically, I narrate my clinical relationship with my oncology nurses and the role of instrumental and empathic touch over the course of six months of treatment and two years of follow-up. Touch in the nurse-patient relationship is necessary, multi-faceted, complicated, and, in the face of a pandemic, amended.

The influence of engaging authentically on nurse-patient relationships: A scoping review

The current international healthcare focus on ensuring the perspectives and needs of individual persons, families or communities are met has led to the core tenet of person-centred care for all. The nurse-patient relationship is central to the provision of care, and enhancing this relationship to ensure trust and respect supports optimal care outcomes for those accessing healthcare services. Engaging authentically is one of the recognised key approaches in person-centred practice, and this scoping review of the literature aims to gain an understanding of the role this process plays in developing effective relationships between nurses and the people they care for. A systematic search of databases and grey literature was undertaken, and twenty-one research papers met the inclusion criteria. A thematic analysis revealed four themes: 'getting to know the patient as a person', 'the complexity of relationship building-it takes time', 'the nurse: characteristics and behaviours that support the nurse-patient relationship' and 'the patient voice'. Nurses and patients both benefit from effective relationships, feeling valued and experiencing greater satisfaction with care. Key elements of engaging authentically were revealed as a nurse-patient relational process through this literature review; however, further research is needed to gain a greater understanding of this concept.

Knowledge and attitudes of nurses regarding patient rights: a Corum/Turkey sample

OBJECTIVE

patient rights are defined as the rules of conduct between the people who benefit from health services and the health institutions and personnel who provide them. As the protection and provision of these rights are closely related to the nursing trade, these professionals must have thorough knowledge about this issue. The purpose of this study was to evaluate the acquaintance and attitudes of working nurses in Corum/Turkey regarding patient rights and to create the basis for a planned educational program.

METHODS

sample selection was not performed in this study, but all nurses (n=939) who were working in the course of this study constituted the sample. Survey forms were used as data collection tools.

RESULTS

the study revealed that 92.3% had received education about patient rights, 2.2% had never heard anything about this term and 86.6% became aware of it through sources from outside of school. It was established that the attitudes of nurses regarding patient rights differ for every patient and that this rate ranges from 35.8 to 98.1%.

CONCLUSION

there is a requirement for more studies on the subject of patient rights, as they play an important role in the development of health services. In that regard, patient rights centers should be established and carried out according to the foreseen model set by national and international health systems. Studies aiming to teach health personnel, patients and their relatives about patient rights must be carried out.

Lived experience, enhanced recovery and laparoscopic colonic resection

AIM

To explore patients' lived experience of undergoing laparoscopic colonic resection on an enhanced recovery programme.

METHOD

Eleven patients were interviewed at home, between 14 and 16 days following discharge. The transcribed interview texts were interpreted with a hermeneutical-phenomenological method.

FINDINGS

Participants were keen to achieve their goals and participate actively in the enhanced recovery programme. They strived to return to full health as soon as possible after surgery, but all participants indicated that it was taking longer than they had expected. As they became more independent regarding their self-care needs during their hospital stay, participants noticed that the nursing presence became more distant, which could result in unmet psychological needs. Their recovery at home was perceived to be taking longer than it should and was often prolonged by symptoms. The minimally invasive approach associated with laparoscopic surgery led the participants to expect a lesser physical and psychological effect from this major surgery.

CONCLUSION

Nurses need to acknowledge and attend not only to the physical but also to the emotional needs of patients on an enhanced recovery programme, right up until the point of discharge. Nurses also need to prepare patients more fully for what to expect after discharge.

Professional values of nurse lecturers at three universities in Colombia

Objective:

To describe the professional values of the nurse lectures according to 241 nursing students, who participated voluntarily, in three different universities of Bogotá.

Methodology:

This is a quantitative, descriptive cross-sectional study that applied the Nurses Professional Values Scale—permission secured—Spanish; three dimensions of values were applied: ethics, commitment, and professional knowledge.

Ethical consideration:

Project had ethical review and approval from an ethics committee and participants were given information sheets to read before they agreed to participate in the project.

Findings:

It was concluded that nursing students, in general, do perceive these values in their professors, and they give priority to the dimension of ethics, followed by the knowledge dimension, and finally, commitment.

Discussion:

It is evident that professional values are transmitted by professors and students place importance to such values. Values related to the other’s care are paramount in nursing training in Colombia as well as in other countries.

Conclusion:

It was found that participating students observed professors directly in relation to values focused on direct patient care, respect for privacy, respect for life, while matters related to professional improvement, participation in unions were not actually analyzed may be due to poor promotion activities and unions during undergraduate studies. The results obtained are primary approach to the study of values related to nursing, a topic which needs to be researched, something vital to all the country offering nursing training programs.

The Meaning of a Positive Client-Nurse Relationship for Senior Home Care Clients with Chronic Disease

Cette étude a exploré la signification d’une relation positive client-infirmière pour les personnes âgées atteintes de maladies chroniques qui reçoivent les soins à domicile. Pour les besoins de cette étude phénoménologique, huit participants âgés de 65 à 86 ont été sélectionnés à partir du Sud-Ouest Centre communautaire d’accès aux soins [or retain as Southwest Community Care Access Centre (SW-CCAC)]? à London, Ontario. Des données narratives ont été recueillies par des entrevues en profondeur capturé sur cassette audio, tout en utilisant un guide d’entretien semi-structuré. L’analyse et l’interprétation des entrevues ont révélé que le sens d’une relation client-infirmière positive de ces personnes âgées englobait deux tendances de sens: avoir de confort, et étant relié au sein de cette relation. Ces deux modèles ont été contextualisés par être une personne âgée avec une maladie chronique et ont été socialement construits à travers l’expérience d’avoir créé un rapport positif. Bien que des recherches supplémentaires sont nécessaires, les connaissances acquises ajouter à ce que l’on sait déjà au sujet de la théorie et la pratique de la promotion de la santé relationnelle pour les personnes âgées vivant avec des maladies chroniques et recevant les soins à domicile.

Disclosure predicaments arising during the course of patient care: nurses' privacy management

At times, nurses receive patient disclosures that have the potential to create challenges resulting in needs for strategies to manage patient information and expectations. This study examines disclosure predicaments nurses experience in critical care and emergency units at a large urban hospital. Utilizing the constant comparative method to identify disclosure themes guided by the principles of communication privacy management (CPM), the findings show that nurses regulate patient privacy in the role of stakeholder confidants. Second, disclosure predicaments occur in three different contexts: during the course of nurses' professional routine; when the nurses created safe terminals or havens for patients to talk; and when family matters became an inseparable part of caring for the patient. Third, the results indicate that there are several specific strategies that nurses use to manage disclosure predicaments they encounter. The lens of CPM is used to interpret these findings and offers a context in which to better understand the needs of nurses concerning patient disclosive behavior and privacy issues for nurses.

Using diaries to explore midwives' experiences in intrapartum care: an evaluation of the method in a phenomenological study

AIM

finding appropriate ways of obtaining contemporaneous data in acute settings is an ethical and practical dilemma for researchers. Our aim was to evaluate the use of diaries by midwives in a research study informed by a phenomenological approach.

SETTING AND SAMPLE

a purposive sample of 12 midwives working across three Trusts in the North West of England.

METHOD

a phenomenological approach was used to guide a study exploring midwives views of confidence when providing intrapartum care. Two methods of data collection were used; diaries and semi-structured interviews. This is a methodological paper reporting on the usefulness of diaries used with participants who were health professionals in a health-care setting.

RESULTS

participants completing qualitative diaries provided rich data, recording not only a description of events but also their emotional response to such events. A high degree of self-reflection and analysis was also evident. The participants provided contextual and time situated data although remaining focused on the phenomena being explored. Furthermore, the diaries highlighted the data that may not have been uncovered by interview alone.

CONCLUSION

use of diaries for qualitative data collection is feasible and well received by health professionals. Individuals completing diaries were engaged in a reflective process enabling them to address significant events. Hence, diaries may provide benefits to both the researcher and the participant. They proved appropriate to a study requiring an exploration of the lived experience of the participants. Researchers conducting research informed by a phenomenological perspective should consider diaries as a valuable data collection tool.

The Key to Me: Seniors' Perceptions of Relationship-Building with In-Home Service Providers

Les données démographiques changeantes et les compressions imposées aux hôpitaux ont exercé de plus en plus de pressions sur le secteur des soins à domicile. Bon nombre des personnes recevant des soins à domicile sont des aînés dont l'état chronique exige une méthode concertée. Les orientations paternalistes des deux fournisseurs envers les clients âgés et la passivité des aînés lors des interactions fournisseur-client pourraient nuire à l'établissement de relations productives. Bien que ces orientations aient été documentées, la façon dont les aînés perçoivent l'établissement de bonnes relations à domicile a reçu peu d'attention. Le but de la présente étude était d'évaluer la façon dont les aînés voient l'établissement des relations avec les fournisseurs de soins à domicile, en mettant l'accent sur les facilitateurs de cette expérience et les obstacles afférents. En ayant recours à la phénoménologie interprétative, nous avons effectué des entrevues approfondies auprès d'un échantillon ciblé de clients âgés, et utilisé une stratégie d'analyse par immersion et cristallisation pour obtenir des résultats. Les résultats ont révélé que les aînés percevaient l'établissement de relations comme un processus dynamique qui englobait les facilitateurs et les obstacles au niveau tant individuel que contextuel. Les résultats interprétatifs donnent une meilleure idée de la façon de procéder pour établir des liens fournisseur-client dans le contexte des personnes à domicile.

Nothing out of the ordinary: Advanced fertility nursing practice

This paper discusses data from a case study of fertility nursing practice. An ethnographic case study approach using participant observation and nine semi-structured interviews with staff and patients was undertaken. The data were analysed thematically and these themes are discussed in this paper. We present the meaning a small group of nurses working in a fertility unit in the UK attach to new roles and the ways in which changes in practice may be influenced. The nurses in this study believed that nature of the task demanded changes to practice and they identified personal, interpersonal and socio-cultural factors which influenced these changes. These new roles facilitated greater continuity of care for patients. This paper discusses the effects of these new roles on knowing and intimacy in nurse - patient relationships. The data suggests that new nursing roles, which are based on "traditional" nursing and "new" technical skills, are fragile and may not be shared across a professional community.

Chinese female nurses' perceptions of male genitalia-related care--Part 2

AIMS

This study was designed to investigate Chinese female nurses' perceptions of certain male genitalia-related care and the influence of their demography and experiences on their perceptions.

BACKGROUND

Several physical conditions, in which male genitalia-related care is required, have been found to have considerable negative impact on male patients, leading to decreased quality of life and psychosocial and sexual dysfunctions. Available studies suggest that Chinese female nurses' conduct during the provision of male genitalia-related care is negative. However, the evidence is weak with respect of the degree of Chinese nurses' negativity and what the contributory factors may be.

DESIGN

Survey.

METHODS

Chinese female nurses in nine units in five hospitals were surveyed. Of 378 returned questionnaires, 312 were usable, and 138 contained textual comments. Numerical data were analysed using spss 14.0, and textual data were analysed using thematic analysis. RESULTS; The majority of participants had never performed genital wound care, perineal area shaving, perineal hygiene, suprapubic and urinary catheterisation. More than half preferred only bladder irrigation and washout to be performed by nurses and preferred the other male genitalia-related care to be performed by a male. Participants tended to agree meatal cleansing, perineal area shaving, perineal hygiene and urinary catheterisation were embarrassing, awkward and intrusive, but to disagree that they were sexual, dirty, stigmatizing or having an impact on the male patient's sexual health.

CONCLUSION

This study suggests that Chinese female nurses play limited roles in the practice of male genitalia-related care, but their perceptions of such care are not negative.

RELEVANCE TO CLINICAL PRACTICE

Given the increasing move of Chinese female nurses to other countries, sexuality, sexual harassment, privacy and the constraints of traditional Chinese beliefs on sexuality over professional nursing conduct should be emphasised in clinical training programmes.

Chinese female nurses' perceptions of male genitalia-related care--Part 1

AIMS

To explore Chinese female nurses' experiences of male genitalia-related care.

BACKGROUND

Male patients who require male genitalia-related care may have psychosocial and sexual concerns and needs. Nurses' attitudes and conduct in the provision of male genitalia-related care, if negative, may obviate meeting these needs. Previous research indicates that limited studies have been conducted focusing on nurses' perceptions, responses and attitudes towards male genitalia-related care. There is a dearth of knowledge about the practice of Chinese female nurses delivering male genitalia-related care, particularly given that physical contact between Chinese adults of different genders outside marriage is traditionally prohibited.

DESIGN

This study is an exploratory qualitative study.

METHODS

Through purposive sampling, eight subjects were approached and semi-structured interviews were conducted. Digitally recorded interviews were transcribed verbatim and thematic analysis was conducted. The strategies of long engagement, member checking, peer debriefing and journal writing were used to establish trustworthiness.

RESULTS

Two themes emerged from interviews: 'association with sexuality' and 'consequences'. The theme 'association with sexuality' comprised the sub-themes of 'being sexual', 'impact on intimate relationship' and 'emotional responses'. The theme 'consequences' was constituted by the sub-themes of 'care with preconditions', 'unavoidable responsibilities' and 'limited involvement with implicit approval'.

CONCLUSIONS

This study suggests that Chinese female nurses' perceptions, responses and attitudes towards male genitalia-related care may be negative, with the consequence that the quality of male genitalia-related care might be compromised. The Chinese culture of sexual conservativeness may play a critical role.

RELEVANCE TO CLINICAL PRACTICE

Risks may be embedded in the practice of male genitalia-related care by Chinese female nurses. Particular attention, therefore, should be drawn to the possibility of adverse effects of Chinese female nurses delivering male genitalia-related care on them and their patients.

A review of the psychosocial issues for nurses in male genitalia-related care

AIM

This literature review aimed to highlight psychosocial issues for nurses in the practice of male genitalia-related care so as to guide the improvement of the teaching and practice of male genitalia-related care.

BACKGROUND

Male genitalia-related care is common in hospitals and in the community. In several conditions, e.g. incontinence, postradiotherapy or following operation for cancer of genitalia, bladder, colon or rectum, patients will require male genitalia-related care. Patients who require male genitalia-related care may encounter psychosocial and/or sexual dysfunction. In the holistic approach to men's health, nurses are expected to meet patients' psychosocial and sexual needs, while the literature suggests that nurses' perceptions and attitudes in providing certain male genitalia-related care, e.g. genital hygiene, sexual counselling, are negative.

METHOD

Systematic literature review.

CONCLUSION

Issues surrounding male genitalia-related care for nurses are complicated and may be related to privacy, intimacy, sexuality, dirty work and emotional discomfort. Age, gender, race and social class could compound these issues. Relevance to clinical practice. Nurses' negative perceptions, responses and attitudes towards male genitalia-related care may exacerbate patients' conditions under which male genitalia-related care is required. Appropriate strategies should be developed to overcome these problems.

An overview of patients' preference for, and satisfaction with, care provided by general practitioners and nurse practitioners

AIM AND OBJECTIVES

To assess patients' views on the care provided by nurse practitioners compared with that provided by general practitioners and to determine factors influencing these views.

BACKGROUND

Many countries have sought to shift aspects of primary care provision from doctors to nurses. It is unclear how patients view these skill mix changes.

DESIGN

Cross-sectional survey.

METHOD

Patients (n = 235) who received care from both nurse and doctor were sent a self-administered questionnaire. The main outcome measures were patient preferences, satisfaction with the nurses and doctors and factors influencing patients' preference and satisfaction.

RESULTS

Patients preferred the doctor for medical aspects of care, whereas for educational and routine aspects of care half of the patients preferred the nurse or had no preference for either the nurse or doctor. Patients were generally very satisfied with both nurse and doctor. Patients were significantly more satisfied with the nurse for those aspects of care related to the support provided to patients and families and to the time made available to patients. However, variations in preference and satisfaction were mostly attributable to variation in individual patient characteristics, not doctor, nurse or practice characteristics.

CONCLUSION

Patient preference for nurse or doctor and patient satisfaction both vary with the type of care required and reflect usual work demarcations between nurses and doctors. In general, patients are very satisfied with the care they receive.

RELEVANCE TO CLINICAL PRACTICE

In many countries, different aspects of primary care provision have shifted from doctors to nurses. Our study suggests that these skill mix changes meet the needs of patients and that patients are very satisfied with the care they receive. However, to implement skill mix change in general practice it is important to consider usual work demarcations between nurses and doctors.

Client-nurse relationships in home-based palliative care: a critical analysis of power relations

AIM

To elicit an in-depth understanding of the sources of power and how power is exercised within client-nurse relationships in home-based palliative care.

BACKGROUND

As in all social relations, power is present within client-nurse relationships. Although much research has focused on interpersonal relationships in nursing, the concept of power within the client-nurse relationship in palliative care settings has not been extensively investigated.

METHODS

Applying a critical lens, secondary qualitative data analysis was conducted. Seventeen nurse and 16 client transcripts from a primary study were selected for secondary data analysis. These 33 transcripts afforded theme saturation, which allowed for both commonalities and differences to be identified. Data analysis involved analytic coding.

RESULTS

Study findings help make explicit the underlying power present in the context of home-based palliative care and how this power is used and potentially abused. In analysing the sources and exercise of power, the linkage between macro and micro levels of power is made explicit, as nurses functioned within a hierarchy of power. The findings suggest that educational/occupational status continues to be a source of power for nurses within the relationship. However, nurses also experience powerlessness within the home care context. For clients, being able to control one's own life is a source of power, but this power is over-shadowed by the powerlessness experienced in relationships with nurses. The exercise of power by clients and nurses creates experiences of both liberation and domination.

CONCLUSIONS

Nurses who are willing to reflect on and change those disempowering aspects of the client-nurse relationship, including a harmful hierarchy, will ultimately be successful in the health promotion of clients in home-based palliative care. Additionally, it should be recognized that nurses work within a specific health system context and, therefore, their practice is influenced by policies and funding models implemented at various levels of the health care system.

RELEVANCE TO CLINICAL PRACTICE

The insights gained through this investigation may assist nurses and other health professionals in reflecting on and improving practices and policies within home-based palliative care and within home care in general.

About the Culture of In-Home Nursing

As nurses assume a multitude of roles in health care, public and professional perspectives of nursing vary and, consequently, both clients and providers, including nurses themselves, do not fully appreciate the nature of in-home nursing. In this study ethnographic methods were used to capture participants' perspectives of the actions, practices, values, and beliefs that collectively comprise the culture of nursing in the context of home nursing services in rural Australia. Findings reveal how nurses' and clients' experiences of in-home nursing differ from the textbook picture, and how interactions between nurses' practice approaches and care recipients' enactment of the client role create a cultural context affecting clients' health and well-being. Given similar findings in other countries, the insights gained merit consideration by all professionals concerned about refining home care service approaches in keeping with currently espoused valuing of client-centered, empowering care partnerships.

Intimacy in nursing

There are many definitions of intimacy in nursing but what they all have in common is the need for communicated empathy, for nursing that is not just caring for but also caring about.

Encountering touch: a path to affinity in psychiatric care

The idea of physical contact and touching in psychiatric care has, in many instances, been considered inappropriate. Psychiatry is often perceived as a verbal process and it has been generally believed that touching can provoke both aggressiveness and destructive manifestations of sexuality. However, recent research has suggested that touching can play an important role in psychiatric treatment once a caring relationship has been established. The aim of this study is to investigate the meaning of physical contact for patients who have been treated for psychosis. Through four in-depth interviews and a life-world analysis the results show that touching means to be in need, to yearn, and to belong. Furthermore, touching also communicates feelings between bodies and, as such, it can be a path through which one feels acknowledged as a human being. The results indicate that a feeling of affinity can originate through physical contact, which can be regarded as a driving force in the search to feel a sense of belonging to the community.

Coordination in nurses' listening activities and communication about patient-nurse relationships

The purpose of this analysis was to examine whether nurses' listening behavior, especially the coordination of their nonverbal involvement activities with those of their patients, communicates information about patient-nurse relationships. Participants were 126 college women who responded to a 30-item instrument measuring relational information that was communicated to them by nurses' behavior in videotaped segments of interactions between a patient/actress and 12 nurses. Participants' responses to two consecutive interaction segments were selected for this analysis. The research team coded the patient's and nurses' listening activities, and they calculated coordination and activity rates for all interaction segments. Multiple regression analysis revealed that nurses' verbal listening activities, such as reflection, their nonverbal involvement activities, and their simultaneous coordination of nonverbal involvement activities with those of the patient predicted relational information dimensions of trust/receptivity, depth/similarity/affection, composure, and non-formality. Thus, nurses' listening behavior, including coordination, may contribute to communication about patient-nurse relationships.

Exploring the significance of place in community nursing

There has been a dramatic shift in emphasis in health care in the UK in recent years towards the community setting. Care for someone in his or her own home takes place in a different context from caring for them in hospital, and requires a different approach. This article highlights a number of issues raised by this change, and suggests that there needs to be a focused effort to understand the impact of these issues on practice.

Ten Australian ICU nurses' perceptions of organisational restructuring

The Australian healthcare system underwent radical reform in the 1990s as economic rationalist policies were embraced. As a result, there was significant organisational restructuring within hospitals. Traditional indicators, such as nursing absenteeism and attrition, increase during times of organisational change. Despite this, nurses' views of healthcare reform are under-represented in the literature and little is known about the impact of organisational restructuring on perceived performance. This study investigated the perceived impact of organisational restructuring on a group of intensive care unit (ICU) nurses' workplace performance. It employed a qualitative approach to collect data from a purposive sample of clinical nurses. The primary method of data collection was semi-structured interviews. Content analysis generated three categories of data. Participants identified constant pressure, inadequate communication and organisational components of restructuring within the hospital as issues that had a significant impact on their workplace performance. They perceived organisational restructuring was poorly communicated, and this resulted in an environment of constant pressure. Organisational components of restructuring included the subcategories of specialised service provision and an alternative administrative structure that had both positive and negative ramifications for performance. To date, there has been little investigation of nurses' perceptions of organisational restructure or the impact this type of change has in the clinical domain. Participants in this study believed reorganisation was detrimental to quality care delivery in intensive care, as a result of fiscal constraint, inadequate communication and pressure that influenced their workplace performance.

Mental health nursing students' rationales for self-disclosure: 1

This study explored mental health nursing students' rationales for choosing whether or not to self-disclose in therapeutic encounters with patients. Using a two-item questionnaire, data were collected from a convenience sample of 162 preregistered students recruited from two universities in the UK. Content analysis of the data produced three categories for using self-disclosure: "building a therapeutic relationship", "similar experiences" and "appropriate information". Reasons for not self-disclosing fell into four categories: "crossing the line", "unhelpful", "name, rank and serial number" and "students' vulnerability". The research findings suggest that both therapeutic and personal reasons are involved in the decision to use self-disclosure. This article, the first of a two-part series, outlines the background, research methods and nurses' reasons for using self-disclosure. The second article will present students' reasons for not using self-disclosure and a discussion of the findings and their implications.

The nurse-client relationship in a stress management clinic

The methodological perspective of symbolic interactionism and interpretive research emphasizes the complexity and importance of the nurse-client relationship. In a nurse-managed stress management clinic, 18 clients were interviewed at various points during their treatment trajectory, along with 6 clinicians. Clients and providers were emphatic about the importance of a broad, holistic perspective. Spiritual aspects were discussed, but not prominently. Status differential was minimized; however, this did not make participants define the relationship as less professional. The importance of trust was a key element in the nurse-client relationship.

Self-disclosure in adult and mental health nursing students

Self-disclosure, the process whereby people verbally reveal themselves to others, is an important interpersonal skill in initiating, developing, maintaining, and terminating therapeutic relationships. Studies of this interpersonal skill in nursing have, primarily, focused on adult nurses. They are dated, make no comparisons between this and other nursing specialisms, and have not considered the patient as a focus for nurses' self-disclosure. This study attempts to address these issues in relation to student nurses by: replicating a previous study of self-disclosure in adult nursing students (ANS) and offering a comparison of two nursing specialisms, reporting on the use of this skill in relation to the patient. A matched sample of 25 ANS and 25 mental health nursing students (MHNS) were asked to complete a modified version of Jourard's 25-item self-disclosure questionnaire. The findings suggest that: ANS were more self-disclosing than students sampled in an earlier study (Burnard and Morrison, 1992); both sets of students disclosed significantly less items to the patient as target-person than to other categories; and MHNS disclosed significantly more items than the ANS to the patient category.