Origins of Difficulty in the Nurse-Patient Encounter

School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
Nursing Ethics (Impact Factor: 1.25). 08/2007; 14(4):510-21. DOI: 10.1177/0969733007077885
Source: PubMed


The purpose of this study was to look beyond the patient as the source of difficulty and to examine the context of care encounters for factors that contributed to the construction of difficulty in the nurse-patient encounter. The study explains the origins of difficulty in the nurse-patient encounter. This explanation broadens the thinking limits previously imposed by locating difficulty within the individual. Key elements of this explanation are: knowing the patient minimizes the likelihood of difficulty in the encounter; and families, availability of supplies and equipment, who is working, and care space changes are contextual factors that contribute to the construction of difficulty in the nurse-patient encounter. Awareness of these findings has implications for the strategies nurses employ in difficult encounters.

2 Reads
    • "This has included recognition of the unique features of the nurse–patient relationship (Hagerty and Patusky, 2003; Jarrett and Payne, 1995; Shattell, 2004) and that the dying process involves challenging interpersonal negotiations for both doctors and nurses (Long-Sutehall et al., 2011). There is also work indicating that a medical centric view of breaking 'bad news' conceals the inter-professional character of communication (and differences across medical and non-medical stakeholders) (Macdonald, 2007; Randall and Wearn, 2005, Tobin and Begley, 2008), with the nursing–patient dynamic offering considerably different potential from the medicine–patient dynamic (Lowey, 2008; Malloy et al., 2010; Tobin and Begley, 2008; Warnock et al., 2010). There has also been some recognition in the literature that, as the end of life nears, the nursing– patient relationship may take on even greater significance and intensity (Mok and Chiu, 2004; Walshe et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The shift from life-prolonging and palliative care can be fraught with interpersonal complexities as patients face dilemmas around mortality and the dying process. Nurses can play a central role in managing these moments, often with a focus on promoting and enhancing communication around: the meaning of palliative care, the nature of futility and the dying process more broadly. These sites of nurse-patient communication can be highly charged and pose unique challenges to nurses including how to balance nursing perspectives versus those of other stakeholders including doctors. Here, drawing on interviews with nurses, we explore their accounts of communication about futility and the process of transitioning to palliative care. The interviews reveal nurses' perspectives on the following: the art of conversing around futility and managing patient resistance, the influence of guilt and individual biographies in shaping communication, the importance of non-verbal and the informal in communication, the impact of conflicting organisational expectations on nurses and the process of learning to effectively communicate. We argue that these transitional moments articulate important, and at times problematic, aspects of contemporary nursing and nurse-medical relations. © The Author(s) 2015.
    Health 07/2015; DOI:10.1177/1363459315595845 · 2.10 Impact Factor
  • Source
    • "Nurses were seen to rally to and 'rescue' individuals with heavy workloads . Macdonald (2007) similarly found that nurses working closely together when confronted with time pressure enabled tasks to be completed and a sense of satisfaction that they had done as much as they could under the circum- stances. When not discussing issues of time pressure, all of the participants described how spending time talking and getting to know patients and their relatives benefitted caregiving and saved time in the long run. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To report a qualitative study which explores registered nurses' views on the issue of time in the workplace. There is a worldwide shortage of healthcare workers, subsequently time as a healthcare resource is both finite and scarce. As a result, increased attention is being paid to the restructuring of nursing work. However, the experience of time passing is a subjective one and there exists little research which, over a prolonged period of time, describes nurses' experiences of working in time-pressurized environments. A narrative inquiry. Five registered nurses were individually interviewed a total of three times over a period of 12 months, amounting to a total of 15 interviews and 30 hours of data. Data were collected and analysed following a narrative enquiry approach during the period 2008–2010. Participants describe how attempts to work more effectively sometimes resulted in unintended negative consequences for patient care and how time pressure encourages collegiality amongst nurses. Furthermore, the registered nurses' account of how they opportunistically create time for communication with patients compels us to re-evaluate the nature of communication during procedural nursing care. Increasingly nursing work is translated into quantitative data or metrics. This is an inescapable development which seeks to enhance understanding of nursing work. However, qualitative research may also offer a useful approach which captures the otherwise hidden, subjective experiences associated with time and work. Such data can exist alongside nursing metrics, and together these can build a better and more nuanced consideration of nursing practice.
    Journal of Advanced Nursing 01/2013; 69(9). DOI:10.1111/jan.12064 · 1.74 Impact Factor
  • Source
    • "'difficulty' in nurse–patient encounters (Macdonald 2007) and 'dramatic' encounters (Person and Friberg 2009) are brought to light. The encounter between nurse and patient is also brought up from the nurse's perspective, focusing on what nurses interpret as the encounter's primary aim—a pedagogic encounter to accomplish lifestyle changes (Person and Friberg 2009) or an attempt to gain control (Tuckett 2005), which is not always in line with patient expectations of the encounter. "
    [Show abstract] [Hide abstract]
    ABSTRACT: GUSTAFSSON L-K, SNELLMA I and GUSTAFSSON C. Nursing Inquiry 2012 [Epub ahead of print] The meaningful encounter: patient and next-of-kin stories about their experience of meaningful encounters in health-care This study focuses on the meaningful encounters of patients and next of kin, as seen from their perspective. Identifying the attributes within meaningful encounters is important for increased understanding of caring and to expand and develop earlier formulated knowledge about caring relationships. Caring theory about the caring relationship provided a point of departure to illuminate the meaningful encounter in healthcare contexts. A qualitative explorative design with a hermeneutic narrative approach was used to analyze and interpret written narratives. The phases of the analysis were naïve interpretation, structure analysis on two different levels (narrative structure, and deep structure through metaphors) and finally a dialectic interpretation. The narratives revealed the meaning of the meaningful encounter as sharing, a nourishing fellowship, common responsibility and coming together, experienced as safety and warmth, that gives, by extension, life-changing moments, a healing force and dissipated insight. The meaningful encounter can be seen as a complex phenomenon with various attributes. Understanding the meaningful encounter will enable nurses to plan and provide professional care, based on caring science, focusing on patient and next-of-kin experiences.
    Nursing Inquiry 11/2012; 20(4). DOI:10.1111/nin.12013 · 1.44 Impact Factor
Show more