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Surgical nurses' different understandings of their interactions with patients: a phenomenographic study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2011 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, no 3, 533-541 p.Article in journal (Refereed) Published
Abstract [en]

Surgical nurses' different understandings of their interactions with patients: a phenomenographic study The aim of this study was to identify and describe different ways surgical nurses understand their roles and interactions with patients and their families in a surgical care setting. The surgical nurse has an important role in supporting and encouraging the patient during the hospital stay. It can be a challenge for the nurse to quickly establish a trustful relationship with the patient. The assumption is that nurses' interactions with patients are affected by their understanding and expectations of the roles in the nurse-patient relationship. A qualitative interview approach was used and the interviews were analysed using the phenomenographic method. A strategic sample of 17 registered nurses in two hospitals in Sweden was interviewed. In the analysis four ways of understanding the nurse's role in interactions with the patient were identified: (A) Focusing on medical treatment, following prescribed instructions, and maintaining routines; (B) Providing information, giving service, and coordinating care and treatment; (C) Seeing patients as vulnerable people and helping and supporting them as individuals; and (D) Inviting patients to participate in the caring process and encouraging them to take responsibility in their own care. Seeing each patient as a person with individual needs and personal resources. The first way of understanding, A, focuses on the work task; the other three understandings focus on the patients, but differ in how the nurses see them as people. Understanding A represents a restricted and task-oriented approach, whereas the others are more patient-focused, but also more complex. To realise patient-centred care, nurses should pay attention to all aspects of the interaction. Nurses need to have time at ward meetings or in supervision to discuss and become aware of different ways of understanding their interactions and relationships with patients. In this way new areas of professional development may be opened up.

Place, publisher, year, edition, pages
2011. Vol. 25, no 3, 533-541 p.
Keyword [en]
phenomenography, qualitative approaches, nurse-patient interaction, nurse-patient relationships, surgical nursing, professional development, patient participation
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-138701DOI: 10.1111/j.1471-6712.2010.00860.xISI: 000293756500016PubMedID: 21158890OAI: oai:DiVA.org:uu-138701DiVA: diva2:381608
Available from: 2010-12-28 Created: 2010-12-17 Last updated: 2017-12-11Bibliographically approved
In thesis
1. The Patient–Health-professional Interaction in a Hospital Setting
Open this publication in new window or tab >>The Patient–Health-professional Interaction in a Hospital Setting
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the thesis was to describe patient−health-professional interactions in a hospital setting, with a specific focus on the surgical care unit. The thesis consists of four studies and includes both qualitative and quantitative studies. Content analysis and phenomenography were used in the qualitative studies; the quantitative study was an intervention study with a three-phase quasi-experimental design.

The findings of study I showed that patient complaints to a local Patients’ Advisory Committee about negative interactions with health professionals most often concerned the perceived insufficiencies of information, respect, and empathy. The findings of study II showed that experiences of negative interactions with health professionals caused long-term consequences for individual patients and reduced patients’ confidence in upcoming consultations. The findings of the phenomenographic study (III) showed that surgical nurses understand an important part of their work in qualitatively different ways, which can be presented as a hierarchy of increasing complexity and comprehensiveness. In the most restricted understanding, surgical nurses focus on the work task, whereas in the others surgical nurses demonstrate increasing degrees of patient-centeredness. Finally, the results of study IV showed that an uncomplicated intervention that invited patients to express their daily questions and concerns in writing (using the ‘Tell-us card’) improved the patients’ perceptions of participation in their care in a surgical care unit. For further implementation of the Tell-us card to succeed, it needs to be prioritized and supported by leaders in ongoing quality improvement work.

The value of a patient-focused interaction needs to be the subject of ongoing discussions in surgical care units. Patients’ stories of negative interactions could be used as a starting point for discussions in professional reflection sessions. It is important to discuss and become aware of different ways of understanding professional interactions and relationships with patients; these discussions could open up new areas of professional development. Providing patients an opportunity to ask their questions and express their concerns in writing, and using this information in the patient−health-professional interaction, could be an important step towards improved patient participation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 77 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 673
Keyword
The patient–health-professional interaction, relationship, complaints, patient participation, hospital setting, quality of care, content analysis, phenomenography, intervention
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-151420 (URN)978-91-554-8077-6 (ISBN)
Public defence
2011-05-30, Grönwallsalen, Akademiska Sjukhuset, Ing 70, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-05-09 Created: 2011-04-11 Last updated: 2011-07-01Bibliographically approved

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