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UBC Theses and Dissertations

The essential structure of a caring and an uncaring encounter with a nurse -- from the client's perspective Halldorsdottir, Sigridur


This phenomenological study was designed to explore the essential structure of caring and uncaring encounters, as perceived by recipients of nursing care in their interactions with nurses, with the aim of adding to the knowledge and understanding of these phenomena. Data were collected through 18 in-depth interviews with nine former recipients of nursing care. The interviews were tape-recorded and transcribed verbatim for each participant. The researcher saw the participants in the study as coresearchers and through inter-subjective interaction, or dialogue, the essential description of a caring and an uncaring encounter was constructed. The essential structures of both caring and uncaring encounters are composed of three basic components: the approach by the nurse, the presence or absence of relationship formation, and finally, the patient responses to the encounter. The first component in the essential structure of a caring encounter with a nurse — from the client's perspective, is the professional caring nurse approach. The nurse is perceived to be competent, administering her care with genuine concern for the patient as a person, giving him full attention when with him, and constituting a cheerful presence for the patient. The coresearchers reported that these characteristics, which were perceived by them as evidence of caring, had promoted in them a feeling of trust, which had facilitated a development of a nurse-patient relationship. The development of a nurse-patient relationship, or professional attachment, comprises the second essential component of a caring encounter. Developing a nurse-patient relationship was conceptualized in this study as a process involving five phases: initiating attachment, consisting of reaching out and responding by both nurse and patient; mutual acknowledgement of personhood, where nurse and patient recognize each others as persons; acknowledgement of attachment, involving confirmation of attachment; professional intimacy, when the patient feels safe enough in the relationship to reveal to the nurse particulars about his present condition and how he feels about them; and finally negotiation of care, when the nurse works collaboratively with the patient and truely takes his perspective into account when giving nursing care. Throughout the attachment development the professional nurse keeps a distance, an important dimension of professional attachment which the coresearchers clearly articulated had to be present in order to keep the nurse-patient relationship within the professional domain. This combination of intimacy and distance is referred to as nurse-patient attachment with professional distance. The professional caring nurse approach and the resulting nurse-patient attachment with professional distance form the essential structure of professional caring. The patient responses to professional caring comprise the last component in the structure of a caring encounter with a nurse. Five themes were identified in the coresearchers' accounts: sense of acceptance and self-worth; sense of encouragement and support; sense of confidence and control; sense of well-being and healing; and finally sense of gratitude and liking. The essential structure of an uncaring encounter with a nurse — from the client's perspective is also comprised of three basic components: the nurse's approach to the patient, which is perceived by the patient as indifference to him as a person; the resulting nurse-patient detachment with total distance between the nurse and the patient; and finally patient responses to uncaring. Four dimensions of an uncaring nurse approach were identified in the data, characterized by increased indifference, inattentiveness, and insensitivity to the patient and his needs: apathetic inattention, unconcerned insensitivity unkind coldness, and harsh inhumanity. Perceived nurse indifference to the patient as a person makes the patient distrustful of the nurse. The patient often perceives the nurse as an authoritarian person with a need to control, and the patient's encounter with her is characterized by a lack of professional attachment, limited verbal communication, negative nonverbal communication by the nurse, and a lack of collaboration and negotiation of care. This is referred to as nurse-patient detachment with total distance. It was the core searchers' unanimous perception that uncaring encounters with nurses were very discouraging and distressing experiences for them as patients. The coresearchers responses to the uncaring encounters were many-sided. Seven major themes were identified in their accounts: puzzlement and disbelief; anger and resentment; despair and helplessness; feelings of alienation and identity-loss; feelings of vulnerability; perceived effects on healing; and finally long-term effects of uncaring encounters. It was the coresearchers' unanimous perception that the uncaring encounters made an indelible impression on them, had a longer lasting effect than caring encounters, and tended to be both acid edged and memorable unresolved experiences.

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