Objective: The purpose of this study was to explore hospitalized patients’ experience soliciting nursing care.
Design: To discover what patients were aware of when soliciting nursing care, without directing them to specific aspects pre-judged to be important, a phenomenological design was used, following procedures outlined by Thomas and Pollio (2002).
Sample: Eight participants ranging in age from 29 to 65 were interviewed. Reasons for hospitalizations were mainly medical and surgical in nature.
Concept: The phenomenon of interest was the patient’s experience soliciting nursing care in the hospital setting.
Methods: Nondirective, in-depth phenomenological interviews were conducted, transcribed verbatim, and analyzed for themes.
Findings: Hermeneutic analysis of the interview texts resulted in the following three themes: “make them your friend,” be an easy patient, and try to get them to listen. Hospitalized patients solicit nursing care by strategically building relationships. These relationships were formed in order to get nurses to remember them, hoping the nurses would be more responsive to their needs if they “stood out from the crowd.” Patients used such strategies such as using nurses’ names, being likeable, making them laugh, taking an interest in them, and making them feel liked. Some patients also reported having a sincere desire for establishing a genuine relationship with their nurses. Patients avoided “bothering” or “burdening” nurses in their effort to be an easier patient and often reported making multiple attempts, often unsuccessfully, to get nurses to listen to them. Participants tried to get nurses to listen to them by asking for what they wanted and my asking questions. If these strategies did not result in getting nurses to listen, participants escalated their tactics.
Conclusions: The thematic structure of the experience of the hospital environment (Shattell, 2002) contextualized the experience of soliciting nursing care. In an environment experienced as dangerous, insecure, and disconnecting, patients actively solicit care in an attempt to increase individual security and interpersonal connection.
Implications: Findings from this study have many implications for nursing practice, education, research and theory. Patients have a vested interest in developing relationships with nurses that are based on the model of friendship where social conversation is important. The relationships that patients developed were formed in order to lessen feelings of insecurity and disconnection, and to enhance their chances of receiving quality nursing care. Nurses in practice should be aware of the importance patients place on conversation about topics outside “the world of the hospital.” In patients’ efforts to be an easy patient, patients are hesitant to “burden” or “bother” nurses and often minimize negative care experiences. They don’t want to take nurses away from others with “more serious needs” which leads to many unmet patient needs. Nurses should check in with patients frequently, ask patients directly, and listen actively. Implications for nursing education include reexamining the “social relationship” versus “therapeutic relationship” dichotomy that exists in baccalaureate education programs. Concepts such as “mutuality” should be reviewed; elements of the patient-nurse power structure should be more clearly articulated in all levels of nursing educational programs. The phenomenon of soliciting nursing care in the hospital setting has not been described elsewhere. The phenomenological method is advanced in that the context of the current study of soliciting care is the thematic structure from a previous study of the hospital environment (Shattell, 2002). Further research could investigate soliciting nursing care in other settings or with other patient populations such as 1) psychiatric patients’ experience soliciting nursing care in the hospital, 2) the experience soliciting nursing care in other institutional settings such as rehabilitation and long term care, and 3) the experience soliciting nursing care in outpatient settings. Serendipitous findings from this study related to the patients’ meaning of “nurse” is another fruitful area for further research. This study also has implications for nursing theory. The nurse-patient relationship as described by Hildegard Peplau’s Interpersonal Relations Theory (1952) may not be relevant in today’s world. Findings suggest that the nurse-patient relationship as it was known may not exist and that the patient’s contribution has been widely underestimated.
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