Origins of difficulty in the nurse-patient encounter
ABSTRACT 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.
- SourceAvailable from: Aled Jones[Show abstract] [Hide abstract]
ABSTRACT: AIM: To report a qualitative study which explores registered nurses' views on the issue of time in the workplace. BACKGROUND: 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. DESIGN: A narrative inquiry. METHOD: 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. FINDINGS: 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. CONCLUSION: 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 · 1.69 Impact Factor
- [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 · 1.05 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: bundgaard k., nielsen k.b., delmar c. & sørensen e.e. (2012) What to know and how to get to know? A fieldwork study outlining the understanding of knowing the patient in facilities for short-term stay. Journal of Advanced Nursing68(10), 2280-2288. ABSTRACT: Aim. To report a descriptive study of nursing in facilities for short-term stay aiming to outline what 'knowing the patient' means in an endoscopic outpatient clinic. Background. 'Knowing the patient' is indispensable to the effort of tailoring nursing to the individual patient's needs. Structural changes in the practice environments, however, reduce the amount of time a nurse spends getting to know the patient. Despite recent years' focus on the subject, no uniform description of 'knowing the patient' in facilities for short-term stay exists. Design. A fieldwork study influenced by practical ethnographic principles was performed in a high-technology endoscopic outpatient clinic during 2008 - 2010. Methods. Data were collected using participant observation for 12 weeks and semi-structured interviews with eight patients and four nurses. Findings. Findings were summarized into two categories 'What to know?' and 'How to get to know?' The former concerned practical issues in relation to gastroscopy and was described in terms of the patient's level of anxiety, wish for medication and previous experiences. The latter 'How to get to know?' concerned instruments employed in getting to know the patient and was described in terms of the use of communication and sensing. Conclusions. 'Knowing the patient' in the endoscopic outpatient clinic was understood in a very practical sense. Conversation and the use of the eyes and physical touch enabled a situational awareness. It helped tailor nursing to the patient's needs and allowed the nurse to treat every patient as a unique individual.Journal of Advanced Nursing 12/2011; 68(10):2280-2288. DOI:10.1111/j.1365-2648.2011.05921.x · 1.69 Impact Factor