Nursing Care through the Eyes of the Patient
Ethnographic methods were used to examine the nurse-patient interaction for the purpose of developing descriptive and explanatory theory of patient satisfaction based on patients' perceptions regarding their nurses' interpersonal skills. A private acute care hospital was the setting for 40 patients and 12 nurses who were study participants. Four processes provided the framework for the themes that emerged: "translating," "getting to know you," "establishing trust," and "going the extra mile." I labeled the action of nurses informing, explaining, instructing, and teaching patients the translation process. Informing and explaining were described by both patients and nurses as very important to the patient's well being. In the process of "getting to know you," personal sharing and kidding were techniques nurses engaged in almost continuously. Both patients and nurses perceived personal sharing as central in the development of the nurse-patient relationship. Many patients verbalized their appreciation for kidding. Being friendly, and understanding were other nurse characteristics that helped patients feel comfortable in the nurse-patient relationship. Patients described three elements that helped establish trust: First, the nurse "in charge" was defined by patients as a nurse who "knew what she was doing." Second, patients felt confident when the nurse was prompt, followed through, and kept them informed. Third, the nurse who enjoyed her job was perceived by patients as, "Her concern is for me." During interviews, patients identified a characteristic they labeled "going the extra mile." Three themes emerged: "clicking," an immediate rapport between patient and nurse, developing friendship, and "doing the extra." Both patients and nurses mentioned the clicking that happens in the nurse-patient relationship, whereas only patients described the nurse who acted as a friend. One patient's description of a nurse who did the extra was, "She's being over nice, beyond the point of no return." A conceptualization of patient satisfaction with nursing care, grounded in the data, may be considered as a beginning for others wanting to explore this phenomenon. The conceptualization may be useful in quality of care issues for nursing managers and clinical staff.
Ethnography, Interpersonal communication, nurse-patient relationship, nursing, patients
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