Nursing Research and Nurse Patient Interaction
Nurse Patient Interaction
Nurse patient interaction refers to the dyadic reciprocal interactions that occur between nurses and patients in the context of providing and receiving nursing care.
Early nursing theorists such as Peplau, Orlando, Travelbee, and Widenbach, who drew attention to the process of interaction in nursing practice, prompted researchers to describe, operationalize, and measure the efficacy of nursing interactions.
In 1977, Diets and Schmidt classified the rapidly expanding research on nurse patient interaction as descriptive or correlational studies, studies that measure the indices of nursing by using hypothetical interactions, and studies that describe or evaluate nursing interactions using conception or interaction frameworks borrowed from other disciplines (e.g., counseling psychology).
These initial research efforts were largely focused on single channels of communication (e.g., nurse conversation or touch) and produced only partial information about the interaction. Resulting failures to capture relevant clinical data prompted the redesign of instruments and studies specifically for examining nurse patient interactions. As one example, the Nurse Orientation System developed by Diets was used by researchers to examine the effect of nursing on patient experiences of pain (Diets, Schmidt, McBride, & Davis, 1972).
Aspects of Nurse Patient Interaction
Researchers continued to study those aspects of the nurse patient interaction that were quantifiable, using predominantly deductive approaches; and despite the use of increasingly sophisticated techniques, the results of many studies raised concern about the quality of nurse patient interactions.
Some researchers attempted to explain their findings in terms of nurses’ lack of communication skills or their busy workloads; others pointed to problems inherent in the research, citing a lack of attention to the patient’s role in nurse patient interaction, unsubstantiated assumptions about the nature of nurse patient interactions, and failure to take into consideration important contextual factors that influence nurse-patient interactions as major issues.
In addition, in the absence of adequate definitions of nurse-patient interaction or its components (e.g., touch) researchers used. narrow and simplistic conceptualizations.
As a result, in deciding a priori what
behaviors. were important to study, researchers risked missing important
behaviors or focusing on insignificant behaviors; as a consequence, they ended
up with incomplete or invalid descriptions.
Interaction as Caring Relation
As support for “caring” in nursing developed in the 1980s, theorists drew attention to the complexities inherent in the process of providing nursing care, stimulating a resurgence of interest in examining nurse patient interactions with a variety of new approaches, such as grounded theory, conversational analysis, ethology, and discourse analysis.
By using inductive approaches, researchers identified nurse and patient behaviors that were important to study (rather than deciding this a priori), explored interaction patterns from the perspective of the nurse and patients, and considered important factors of context and relationship.
Studies completed by researchers such as Carl May, Maura Hunt, Jocalyn Lawler, and Janice Morse are representative examples.
Using these new approaches, researchers identified
exceptional nursing interaction skills, such as “tactics,” “comfort talk,”
“minifisms,” and other previously unrecognized interaction strategies that
nurses typically used in clinical settings skills that were rarely part of
communication courses and often devalued.
Resources of Data for Evaluation of Nurse Patient Interaction
One of the most important developments in the study of nurse-patient interactions is the use of video technology. Videotaping observations preserves the observational context, verbal content, nonverbal behaviors, and interactive processes for analysis and coding.
Of particular advantage is the ability to repeatedly review videotapes, both in real time and in slow motion. This facilitates indepth study of a wide range of simultaneous behaviors, including rarely occurring events and subtle or rapid changes in behavior.
Videotaped observations are particularly useful when
studying interactions with patients who are preverbal, unconscious, or
otherwise unable to recall interactions with sufficient detail.
Importance of Components and Patterns of Nurse Client Interaction
Although new lines of research show promise and appear to be unraveling some of the unique complexities inherent in nurse patient interaction, much work remains to understand nursing interactions as they occur in health care settings, including patients’ homes or other community settings.
Far more attention has been given to identifying and describing components and patterns of nurse patient interaction than studying the efficacy of different types of interactions in relation to patient outcomes.
It appears that some
patterns of interaction may be powerful therapeutic tools, yet more systematic
investigation is needed to demonstrate these effects. Furthermore, negative or
undesirable psychological and physiological sequalae associated with
interaction patterns should be documented.
Although the definition of nurse patient interaction has not received careful attention, the focus has been on the verbal and nonverbal behaviors of the nurse. Yet increasingly, patients are being encouraged to take an active role in decision making and their nursing care.
To develop innovative and supportive strategies to foster collaboration in care and involvement in decision making, a sound understanding of the nature of interactions between nurses and patient, with a strong focus on the role of patient behavior in these inter- actions, is necessary.
In addition, the links between nurse-patient interaction and types of nurse-patient relationships must be explored.
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