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I admit, I envy you, in what you have that I don’t,
Sensing, syncing, affirming with the nurse and with the client and then both.
If it is not a personal trait, then I am willing to be taught…
To unfold the meaning and secrets of rapport; I promise to Nightingale it will be sought.
The research inquired on the lived meaning of rapport among Filipino nurses based on hermeneutic school of phenomenology. In doing such, I utilized Van Manen’s (1990) course of hermeneutic phenomenology of (1) turning to a phenomenon, which seriously interests me and commits me to the world, which is rapport; (2) investigating experience as they live rather than how the nurses conceptualized it; (3) reflecting on the essential themes which characterizes rapport; (4) describing rapport and its meanings through the art of writing and rewriting; (5) maintaining a strong, oriented relation to rapport and (6) balancing the research context by considering the parts and the whole of rapport. The six steps of van Manen gave me a amalgamated scrutiny using my five levels of reflection – pre-reflection, first, second and third level of reflections and re-reflection.
Methods: To gather the most relevant experiences, I purposively chose two groups of nurses (rapport and non-rapport). Rapport nurses those who can easily build rapport with their clients (rapport nurses) who were identified by their superiors, peers and their clients as being able to establish rapport quickly, effortlessly, effectively, and consistently (i.e. nurses who have been rated very satisfactory to excellent by their patients through an institution-based satisfaction survey). Non-rapport nurses were those whom the nurse colleagues, superiors or clients identified who were having a difficult time establishing rapport. Generally, the two groups of nurses satisfied the following criteria: employed in a tertiary hospital as a professional nurse, whether from public or private, for not less than one year and currently providing direct, hands-on patient care in a medical-surgical ward where clients are able to interact to them consciously. The following nurses were excluded: float nurses, nurse preceptors and those in training, nursing supervisors, charge nurses, or other nurse specialists, unless they render direct nursing care. From their narratives, constructs of the inventory will be collated to constitute a single instrument. After the satisfaction of research protocol and ethical considerations, I was able to recruit 14 rapport nurses (out of the initial twenty (20); six (6) withdrew after couple of interviews because of their busy schedule, non-availability, scheduling of interview, among others) and 12 non-rapport nurses (out of the initial seventeen (17); four (4) retracted) based on the criteria that I set in their selection. Only those who completed the synthesis of their experiences were included in the inquiry. To extract relevant experiences from the informants, I utilized hermeneutic interview with the help of audio-recorders, telephone and Facebook, focus-group discussion, personal journal, memos, use of poetry and anecdotes, encoding tools (Microsoft Word, PowerPoint and Excel) and etymological literature. During the synthesis of themes, I used selective or highlighting approach when I searched for the themes and it was consisted of four stages: (1) searching for structures of experience; (2) describing how structures are thematic of the phenomenon; (3) searching for essential and incidental themes; (4) explaining and interpreting essential and incidental themes. The said stages are rigorously done and considered selective. Hermeneutic circle and collaborative analysis also aided in the synthesis of findings. Ethical (respect, confidentiality, privacy, beneficence, justice, etc.) requirements and trustworthiness issues (Lincoln and Guba, 1986) of credibility, transferability, dependability and confirmability) were adequately addressed.
Results: Based from the interpreted lived meaning of rapport by Filipino nurses, the following is the summary of these experiences: (1) Rapport if intended to make the client’s and the nurse’s personal and professional life better; hence, considered therapeutic. (2) Therapeutic rapport is composed of indivisible, interrelated, interdependent, holistic components of sensing, syncing and affirming. Therapeutic rapport is not possible even if one of the constructs is not present. (3) Sensing is the way, process, strategy and goal of the nurse and the client to be sensitive and sensible to the each other. This requires being present and close to the each based on professional and individual standards, interpenetrated feeling and thinking, mutual disclosure of experiences and background and unending search for parallelism and areas for counterpart caring and help. Sensing is composed of four sub-constructs – professional intimacy, empathic concern, shared disclosure and similarity and complementarity. (4) Syncing is the way, process, strategy and goal of the nurse and the client to be in mutually coordinated, harmonious, regular, balanced and predictable relationship. Syncing is characterized by constellation of positive behaviors mirrored by the nurse and the client, which are adaptable and free-flowing grounded on joint commitment of maintain face, achieving goal and definite roles. Syncing is characterized by positive mirroring, spontaneous rhythmicality and shared commitment. (5) Affirming is the way, process, strategy and goal of the nurse to create a nurturing, healing and friendly environment where both the nurse and clients experience positivity in the delivery and outcomes of care, respectively, through a non-judgmental, accepting professional and personal health care setting. Affirming is illustrated by quality nursing care, nuanced light-heartedness, positive health care outcomes and unconditional positive regard. (6) Therapeutic Rapport is a goal, process, strategy and way of (un)knowing (a) Therapeutic rapport as an interactional goal requires a client-to-nurse contact to achieve a certain goal; however, a sense or feeling of rapport can be experienced without contact, if nurse/client had obtain prior information, experience, story, among other about each other through different means (i.e. endorsement, review of records, informal conversations, etc.) (b) Therapeutic rapport as a meaningful interpersonal process is always considered a relationship with significance and all are considered as a caring moment. (c) Therapeutic rapport as a personal strategy towards professional relationship requires baring-of-oneself to enjoy its professional benefits. It is not a personal trait but a talent/ability that can be honed. (d) Therapeutic rapport as a way of inspired (un)knowing of which it rests on the foundation that it is a journey of endless curiosity, mystery and unending search for caring possibilities. (7) Therapeutic rapport is a dyadic phenomenon. It requires both the client and the nurse to move towards each other (the model can be likened to an arrow pointing towards the center); as therapeutic rapport is goal-directed. (8) The client and the nurse upon contact merge and continually know and unknow each other towards therapeutic rapport. (9) Therapeutic rapport is temporal and interactional. It furthers when interaction and time of caring moment increases. However, therapeutic rapport is dynamic, erratic and (uncertain). It can be changed, modified, destroyed or even non-existent. (10) Therapeutic rapport breaks any known boundaries of relationship and professionalism. It is a relational force grounded on the standards of care and individual preferences. As hermeneutically interpreted, based on the lived meaning of Filipino nurses, therapeutic rapport is a complex goal, process, strategy and way of sensing, syncing and affirming. The Lotus Model of Therapeutic Rapport was conceptualized to embody its complex goal, process, strategy and way. A proposed inventory was also developed that intended to measure therapeutic rapport at its core. The said inventory is subject for further validation and reliability-testing.
Conclusion: It is high time for nurses to recognize the power of therapeutic rapport in improving health care outcomes. Nurses must be able to enhance their capacity to establish rapport. It is advised that nurses further their ability to sense, sync and affirm with their clients, starting from education of student nurses to the practice of licensed professionals. In the advent of searching for ways how to increase client satisfaction and improve health care outcomes, looking at rapport as a phenomenon of interest for care policy planners and nursing administrators. Validation and testing of reliability of the constructs discovered in the paper is highly warranted.
The interpretations of the lived meaning of therapeutic rapport among nurses is expected to provide additional body of knowledge to the nursing profession by strengthening the fact that relationship-centered type of partnership in health care setting is indeed highly timely. Filipino nurse must learn how to sense, sync and affirm with their clients as to achieve desired health care outcomes.