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UBC Theses and Dissertations

The nurses’ interpretation of the interaction between themselves and elderly, confused patients Blais, Dawn Evelyn


Using symbolic interaction as a theoretical framework, the researcher explored the nurses' interpretation of their interactions with elderly, confused patients for the purposes of understanding nurses' behavior and of implementing more effective nurse-patient interactions. Qualitative data were collected during interviews with 18 registered nurses currently working either full-time or part-time in one of three extended care units. Findings indicated that the nurses perceived specific patient behaviors, nurse behaviors, and external factors as influencing all phases of this interaction. Six categories of patient behaviors emerged from the data. These categories are: (a) disruptive behaviors, (b) contextually inappropriate behaviors, (c) unintelligible behaviors, (d) memory-impaired behaviors, (e) unproductive repetitions, and (f) unpredictable fluctuations. These behaviors influenced the nurse-patient interaction by reducing the frequency with which nurses attached understandable meaning to patients' behavior, thereby reducing the effectiveness of and their satisfaction with the interaction. The nurses' perceived that their behavior influenced the type, frequency, and duration of nurse-patient communication, the degree to which the interaction was individualized and patient focused, and the extent of patient control during the interaction. When patients influenced nursing behaviors in ways that reduced the frequency and person-oriented nature of the interaction, the nurses experienced the interaction as stressful and dissatisfying and subsequently withdrew to some degree. External factors described as personal, interpersonal, and impersonal either facilitated or impeded the nurses' ability to assign understandable meaning to patients' behavior. The amount of understanding that occurred influenced the quality of care and communication and the amount of stress experienced by the nurse. The findings suggest that geriatric nurses should focus their behavior on patients' psychosocial and emotional needs in addition to their physical needs. Nurses must be aware of the impact of behavior identified as confusion on the interaction. In response they must direct their caregiving and communication behaviors toward minimizing the impact of the reduced understanding that occurs during the interaction.

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