Nurse-patient relationships in home care : preliminary results of a grounded theory study

Background and Objectives: In home care, relationships can last many years and are important for patients as part of their living environment. Nurses are confronted with patients’ expectations, their own demands on the relationship, guidelines and laws as well as the actual possible relationship in everyday care. Research illustrates a discrepancy between the relationship desired by nurses and patients and the relationship that is possible due to the framework conditions. Moreover, little is known about the shaping of relationships in outpatient care. The aim of the PhD project is to analyse how relationships between nurses and patients are constituted in home care settings. Design and Methods: Following a qualitative design and social constructivist perspective, the grounded theory methodology according to Charmaz is applied. The data collection includes interviews with nurses, patients and relatives. In addition, participant observations of care encounters in homecare are carried out. The analysis comprises coding procedures, memo writing and constant comparison. To date, 20 interviews and 32 observation sequences have been analysed. This abstract reports on partial results concerning mainly the nursing perspective on the shaping of caring relationships. Results: To date 3600 codings were set. One key concept is the relational framework each nurse has. This individual framework is limited by characteristics of the working environment such as laws, service orientation, employment, frequency and duration of contact with a patient, and the scope of agreed services. Within this framework, nurses act autonomously to varying degrees. This variation depends on their own beliefs and expectations as well as externally perceived expectations. Accordingly, every relationship or interaction can be different. This can result in performance-focused, situation-optimised or relationship-focused care. The type of care is primarily decided by the nurse and only takes the patient's wishes into account to a limited extent. This illustrates the existing power asymmetry. For example, nurses can display behaviours based on sympathy or antipathy or phenomena such as private involvement beyond care. Conclusions: The results show that nurses need to be sensitised to relationship development. The ability to reflect and set boundaries should be promoted during training in order to enable conscious shaping of relationships. At the same time, the results provide a basis for discussion on the organisation of care relationships.