All care in nursing practice recognizes two basic prin- ciples. relationship, and must include listening skills, empathy, . Henderson: A definition of nursing. to define caring from different paradigms, the frame of reference is imperative to . 3. the moral ideal of the human care relationship in nursing which includes .. on psychomotor skills and a willingness to follow orders . care, escalating nursing workloads and advanced technologies has changed significantly since Florence very definition, caring is felt to be the central . the transpersonal caring relationship” . require a higher level of skill and knowledge.
The analysis continued with a thematic content analysis inspired by Berg [ 15 ], which meant that the text about relationship was read several times and then divided in meaning units and condensed. The condensed meaning units were sorted according to similarities and differences and the analysis process was stored in NVivo 9 which provides an audit trail from the original interview text during every single step of the analysis to the themes [ 18 ].
Text units were step-vice grouped into categories of content and merged into higher abstraction level. Finally, themes [ 15 ] and a main theme [ 19 ] were interpreted.
To ensure trustworthiness in the analysis process the categories and themes were regularly compared with the original interview text and all authors took part in the process [ 15 ]. RESULTS During the analysis both explicit and implicit themes were identified [ 15 ] that reflect dimensions of relationship in home-based nursing care. Each sub-theme should be viewed as an interpretation of the content in part of the text.
Metaphorically speaking the main theme is the warp that runs through the entire weave of content and the weft are sub-themes that represent different patterns in the weave [ 20 ].
The relationship seemed to be the vehicle through which the nurses could approach and reach the persons in need of care and was essential and a prerequisite for providing good nursing care.
Trust was an important component in a well-functioning relationship and could increase the sense of security, especially when the person was dependent on care.
A trusting relationship could also contribute to make the person feel better. It seemed as the relationship in home-based nursing care was equally important regardless of which phase in life the person was in, palliative care or curative care.
Nurses described that home visits and the relationship seemed to be of more importance for lonely persons with limited supporting social network. Establishing the Relationship in Home-Based Nursing Care The relationship in home-based nursing care was established by the first encounter and the nurse and the person had contact with each other and from there built the relationship. The first encounter and the first contact were characterized by normal socialization and were perceived as important, since it could affect the further development of the relationship between the nurse and the person.
Nurses tried in the first contact to read the person and sense if the person was ready for further contact and a relationship with the nurse. When the first encounter and contact developed well, a good relaxed relationship could be built where the nurse and the person got to know each other.
Knowing each other also meant that the nurse still was professional but the conversation could be more personal without being private. The relationship was growing when nurses made home visits and gave support. The experience was that home visits could give a deeper and more intimate relationship than in hospital-based nursing care.
There were also barriers for a close relationship and it was obvious that each home visit and contact did not develop well. When the nurse and the person had previous knowledge of each other and the relationship was established, remote communication could facilitate the maintenance of the relationship.How to Deal with Relationships? - Sadhguru
The effort meant, among other things, to prioritize the building and maintenance of relationships by nurses. Usually it took time to reach a level where confiding occurred and patience was often necessary to develop the relationship.
To make an effort to show humility, empathy, respect and treat the person well seemed to be the prerequisites for a good working relationship in home-based nursing care. The secure presence was characterized by reciprocity between the nurse and the person and gave an opportunity to share time together and being seen and confirmed.
Being able to sit quietly together meant that the relationship had advanced. Showing interest and commitment meant among other things listening, asking questions and touching. The already developed relationship could be maintained through home visits or by keeping in touch with each other through distance-spanning technology, such as phone calls. The relationship could work when there was a mutual giving and taking between the nurse and the person in need of care. The reciprocal relationship was stimulated by conversations where nurses avoided interviewing the person.
The conversations were about other things than illness and problems and knowledge of people made it easier to find suitable topics of conversation. This kind of conversation meant that the person and the nurse opened up and had a more personal conversation.
This meant that the roles of nurse and care receiver were less pronounced and were characterized by the nurses as being a professional friend. The experience was that reciprocity was hampered when too much focus was on the professional role and tasks.
At the same time tasks could also open the door to the reciprocal relationship. There was an experience that there was a tendency that conversations via distance-spanning technology more often focused on the illness and was more task-oriented than face-to-face encounters and that affected the sense of reciprocity and community. The nurses prioritized the person that she had most contact with and those she felt responsible to solve problems for, answered questions, and those she knew well.
When the person showed confidence and told the nurse about their thoughts and problems and the nurse could meet their needs, so that a deeper and special relationship occurs. The deeper relationship meant that nurses became more engaged, and reflected more extensive for the person and their situation, which also affected the relationship.
The situation was very different when the nurses worked as a stand-in nurse and or a secondary nurse. In those situations the relationship could also work well but it was often at a different more shallow level compared with the relationship when they were the primary nurse.
I absolutely think without a relationship it will not work…you have to build a relationship with the person you should take care of in order to be able to provide the best care, because otherwise it becomes very superficial…you go in and take care of the wound and then out, by by DN2: Limited time could lead to a limitation of relationships and broken relationships.
It was obvious that the relationship with the person to whom the nurse was a primary nurse was given a higher priority. Good communication was important for the relationship and when the language barrier occurred it was another limitation of the relationship. The experience was that the relationships in home-based nursing care also needed some frames and boundaries.
The relationship was also restricted by nurses when the person came too close and the relationship tended to be too personal and private and they could sense the risk to lose their professionalism.
The caring relationship in this study could be understood as a trusting relationship, which is needed in order to provide good nursing care at home. The finding shows that a personal caring relationship could make trust possible and also that several encounters could create trust on which a relationship can be built.
A concept analysis of nurse-patient trust [ 22 ] defines trust as the optimistic acceptance of a vulnerable situation, following careful assessment, in which the truster believes that the trustee has his best interest as paramount importance. In addition, Hagerty and Patusky [ 23 ] showed that the person in need of healthcare might trust the nurse in one area but not in another.
A trusting relationship is one where the nurse cares for and about the person [ 24 ]. According to Hupcey, Penrod, Morse and Mitcham [ 25 ] the outcome of trust is an evaluation of the congruence between expectations of the trusted person, i. The caring relationship is inherently asymmetrical and means that the person with health problems is a suffering human and the nurse is caring and responsible.
Buber [ 26 ] highlights that a fully reciprocal therapeutic relationship would be at the expense of its healing characteristics. The choice to embrace the approach I-Thou and entering the relationship and abandon the approach I-It [ 26 ] could be understood as an ethical choice [ 27 ] in home-based nursing care.
On the other hand the asymmetry that exists in the caring relationship could potentially be unethical if it is not balanced with reciprocity [ 28 ].
According to the findings in present study it seems that the context of home-based nursing care encourages the reciprocal aspect of the relationship and reduces the asymmetry within the caring relationship. The encouragement of reciprocity in the caring relationship seems to relate to the fact that the nurse enters the home as a guest and has to balance between being personal, and in that encourage reciprocity, and being professional.
This does not mean an equal relationship, and should not be confused with the ethical demand within the relationship [ 8 ].
Interdependence can be understood as what the nurse does for the person the nurse also does to herself. Despite the interdependence the nurse in home-based nursing care cannot, as a professional, demand to receive from the relationship as it is always an ethical relationship where what the nurse gets could be seen as a gift. Buber [ 29 ] asserts that the desire for confirmation and the ability to confirm others is fundamental to human life with others and being personal.
The findings of present study also indicate that nurses work in different levels of the relationship and closeness was not always the primary goal. Using the description by Buber [ 29 ] it can be described that the nurses had two movements, one to enter the relationship with the person in need of care and another to preserve a distance.
The choice of the primary nurses in present study was to consciously chose to enter the relationship and work towards a deeper level of the relationship. This meant that the nurse had more contacts, was engaged with the person, knew the person well, and developed a common story. The importance of a common story could be an argument for a higher continuity with the primary nurse in healthcare at home, in order to protect the caring relationship.
In situations of being the secondary nurse and the stand-in nurse, the movement of preserving distance [ 29 ] often was the choice of the nurses in present study, where they consciously chose to work in a more shallow level of the relationship. We can assume that it could be experienced as unethical for a secondary nurse and a stand-in nurse to ask the person to share deeper feelings and then leave the person without any follow-up.
The choice of level in a relationship in home-based nursing care is also dependent on the will of the person in need of care.
Caring in intimate relationships - Wikipedia
Staff at municipal psychiatric group dwellings described some of their relationships with long-term psychiatric clients as characterized by distance. Reasons for professional distance in a caring relationship could, according to Bergum and Dossetor [ 31 ], be fear of getting too involved or fear of not having the time to get involved at all.
A standpoint of distance in a caring relationship means the risk of not being able to establish and build a trusting relationship with the person in need of nursing care at home and thereby no fruitful caring relationship. A study [ 32 ] shows that time and geographical distance are important factors when building relationships between nurses and persons in home-based nursing care. Another study [ 33 ] shows that time and the continuity between the nurse and the person are preconditions for establishing a trusting relationship.
It is especially the first visit that requires time to build the base for a trusting relationship. It is also important that the person can reach the nurse by a telephone call. Present study shows that the trusting relationship could be maintained through contacts by distance-spanning technology which also meant that the continuity could be supported.
This means that nurses are responsible in home-based nursing care to protect the trusting relationship when different technology applications for distance communications are used in contemporary home-based care. A previous study [ 35 ] shows that when the person trusts the DNs they also felt confident with the use of technology in healthcare at home.
The development of different distance-spanning technologies can open up new solutions to perform care and maintain relationships at home [ 3637 ]. As a reaction to this development of increased use of distance-spanning technology, Meleis [ 1 ] argues that many theorists in nursing are going back to basics in human relationships, where the sharing of information during situations of health and illness and the interaction is a tool for building relationships.
This emphasis on the importance of basic human interaction highlights the importance when implementing distance-spanning technology in home-based healthcare to work consciously to build and protect the trusting relationship in order to provide good healthcare.
Methodological Consideration The data about relationships in present study was elicited from interview text where nurses were narrating about their experiences about encounters in home-based nursing care. During the narrations the nurses made detailed descriptions of the relationship and its importance for good nursing care at home. However, it is obvious that the narrations contained limited experiences of harmful or negative relationships in home-based nursing care.
This can be seen as a limitation and might have emerged if the nurses had received specific questions about these kinds of relationships. The authors are well-versed in the nursing literature and have extensive experience in the methodology.
The authors have consciously used their theoretical orientation in nursing and their understanding of the text and discussed the different steps of the analysis thoroughly [ 15 ]. In addition, the rigor of the process was supported by using NVivo 9 computer program [ 18 ], which altogether strengthen the trustworthiness of the analysis [ 15 ].
The topic of the study relates to common human phenomenon and is therefore possible to transfer to other similar context in home-based care. The finding could be transferred in the manner of naturalistic generalization [ 38 ] where the reader interprets and determines which findings can be generalized to another context and also adds to previous knowledge.
The transferability is also supported by the fact that it is supported in other nursing literature. In order for nurses to build a trusting relationship in home-based nursing care they have to accept that they enter the home as a guest and communicate something about themself as the person in need of healthcare needs to know who is entering and visiting the home, or who is communicating through distance-spanning technology.
The relationship in home-based nursing care requires conscious efforts from the nurse and a choice of a suitable level of the relationship when maintaining the relationship through home visits as well as through distance-spanning technology. The working context of home-based care is anticipated to change, with the introduction of new technology and revised templates of care.
In this process nurses have to safeguard the possibilities of building trusting relationships with the persons in need of home-based care. Elstad I, Torjuul K. This tailoring of caregiving efforts to the particular characteristics of the specific situation is essential for effective care. They found that the law students exhibited heightened levels of depression on days they reported receiving support, but lowered levels of depression on the days when their partners reported providing more support than the law students reported receiving.
That is, participants in this study gained most psychological benefits from support they were not explicitly aware of having received. However, other researchers have argued that the responsiveness of enacted support is a more important factor than the visibility of the support. Secure base function of caregiving[ edit ] See also: Michelangelo phenomenon Definition and functions[ edit ] In addition to giving support and reassurance during distress, another important function of caregiving within intimate relationships is the provision of support for a relationship partner's personal growth, exploration, and goal strivings.
This can include actions such as removing obstacles to the partner's goal pursuit for example, taking over some household chores to free up time for the partner to engage in a new activitybeing sensitive and responsive to the partner's communications of distress, and communicating readiness to help in the event that support becomes needed. Second, effective caregiving does not unnecessarily interfere with exploration.
Caring in intimate relationships
That is, effective caregivers do not provide support when it is neither needed nor desired, attempt to take over or control the activity, or disrupt the partner's goal strivings. Third, partners should communicate encouragement and acceptance of exploration i.
Partners' communications of enthusiasm are related to better performance, heightened enthusiasm, better mood, increases in state self-esteem, enhanced self-perceptions, greater enjoyment, and more positive feelings toward the partner.
Dependency paradox[ edit ] All humans have a fundamental, evolutionarily-rooted need to feel socially connected to other people i. Specifically, receipt of such support increases feelings of trust and the endorsement of a more prosocial orientation i.