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Progressively engaging : how nurses, patients and family members manage relationships in acute care hospital settings Segaric, Cheryl Ann

Abstract

This grounded theory study, informed by symbolic interactionism, explains how nurses, patients, and family members manage relationships in order to plan and provide care in acute care hospital settings. The study also explains the effects of contextual and systemic features associated with acute care environments and participants' personal characteristics on their efforts to manage relationships. Data collection included thirty three hours of participant observation and forty interviews. Seventeen interviews were conducted with nurses, ten with family members, and thirteen with patients. Participants were recruited from a total of ten acute care units across four community hospitals in the Fraser Health Authority of British Columbia; there were four medical units, three surgical units, two transitory care or activation units, and one community hospital intensive care unit. I constructed the basic social psychological process of progressively engaging. The process describes how nurses, patients, and family members manage their relationships during patient care by developing varying levels of engagement. The levels of engagement are represented by three stages, including: focusing on tasks, getting acquainted, and building rapport. Structural conditions and personal factors, relevant to nurses, patients, and family members, facilitate or constrain their efforts to progressively engage by contributing to or detracting from their shared perspectives. Levels of engagement ranged from 'just doing the job' to 'doing the job with heart' or making a deep human connection. Higher levels of engagement achieved in nurse, patient, and family member relationships correspond with more satisfaction expressed by participants about their relationships and nursing care. The substantive theory of progressively engaging makes a significant contribution to the family nursing theory. The process has implications for nursing education, practice, research, and administration.

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