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.