The Comforting Interaction: Developing a Model of Nurse-Patient Relationship

Article excerpt

In this article we argue that the separate literatures on the nurse-patient interaction and the nurse-patient relationship artificially fragment a unified process, and a model incorporating both interaction and relationship is critically needed. The Comforting Interaction-Relationship Model, in which the nurse-patient interaction is proposed as a means for the nurse and the patient to negotiate and establish a desired therapeutic relationship is presented. Nursing actions are described as three interrelated levels: 1) comforting strategies, or separate discrete actions which together form nurses' styles of care, 2) styles of care, or sets of comforting strategies, and 3) patterns of relating, or normative, professional behaviors. These three processes are provided in response to patient signals of distress, indices of discomfort, and patterns of relating that form patient actions. It is through this interaction of nursing actions and patient actions that the nurse-patient relationship is negotiated. This model is patient-led, dynamic, interactive, and context dependent. Even though the model is driven by the patient's behavioral state, actions, and reactions, both the nurse and the patient maintain control-the nurse selects the strategy or style to be used, and the patient, in negotiating, relinquishing, and accepting care, maintains control. Suggestions for future research are presented.

Despite the large amount of research on nurse-patient interaction and the nurse-patient relationship, this research remains fragmented, providing only partial representations of the actual nurse-patient interaction and limited perspectives on the nurse-patient relationship. These gaps are unfortunate. The interaction between the nurse and the patient and the relationship that is established subsequently are crucial for understanding the nature of nursing itself. It is at this juncture that all significant comforting interactions take place and at which nursing per se occurs. Therefore, examination and reconstruction of a comprehensive model representing the nurse-patient interaction and relationship is both crucial and urgent.

The fragmentation of the two phenomena, i.e., the nurse-patient interaction and nurse-patient relationship, is perhaps due in part to the distinction between the interaction and the relationship, which has resulted in two separate but interrelated literatures. This distinction has led, for example, to a very awkward first paragraph (above) and to tunnel vision and an artificial delineation of the problem on the part of researchers. Investigators who examine patient interaction often examine a snapshot, a scene, without considering its history, outcomes, antecedents, or consequences-yet they pay extraordinary attention to minute detail, observing behaviors, analyzing dialogue, and noting the immediate intent of the interaction. Researchers examining the relationship explore perceptions and interpretations attributed to the relationship, but they do not, and cannot, attend to the detail described in the interaction literature. The numerous "actors"-the nurse and the patient (although the literature as a whole tends to focus on the nurse) and sometimes the family, the physician, or other health care professionals-compound the problems of analysis and further fragment the literature. Clearly it is time that these literatures were linked and brought together in a single comprehensive model.

In this article, we present a model that accounts for all nurse-patient interactions and relationships. This conceptualization is derived from an analysis of the research literature describing nurse-patient interaction and the nurse-patient relationship, and it encompasses the particular characteristics of the context of the nurse-patient relationship.

REVIEW OF THE LITERATURE

At the present time the literature describing the nurse-patient interaction and relationship is not well integrated. To examine this interrelationship, each of these literatures is reviewed. …