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dtw0\charscalex116 \ul0\nosupersub\cf1\f2\fs20 ISSUES IN CLINICAL NURSING \par\p
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cf2\f3\fs32 Nurse-patient communication: an exploration of patients\u8217? exper
iences \par\pard\ql \li836\sb0\sl-218\slmult0 \par\pard\ql\li836\sb118\sl-218\sl
mult0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf3\f4\fs22 Catherine McCabe\
ul0\nosupersub\cf4\f5\fs16 MSc, RGN, BNS, RNT \par\pard\ql \li836\sb72\sl-207\s
lmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf5\f6\fs18 Lecturer in Nur
sing, Trinity Centre for Health Sciences, St James\u8217?s Hospital, Dublin, Ire
land \par\pard\ql \li836\sb0\sl-161\slmult0 \par\pard\ql\li836\sb0\sl-161\slmult
0 \par\pard\ql\li836\sb0\sl-161\slmult0 \par\pard\ql\li836\sb68\sl-161\slmult0 \
up0 \expndtw0\charscalex105 \ul0\nosupersub\cf6\f7\fs14 Submitted for publicatio
n: 20 November 2002 \par\pard\ql \li836\sb39\sl-161\slmult0 \up0 \expndtw0\chars
calex105 Accepted for publication: 13 May 2003\par\pard\sect\sectd\sbknone\cols2
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p0 \expndtw-6\charscalex100 \ul0\nosupersub\cf7\f8\fs16 Correspondence:\par\pard
\ql \li836\sb45\sl-184\slmult0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf4\
f5\fs16 Catherine McCabe\par\pard\ql \li836\sb45\sl-184\slmult0 \up0 \expndtw0\c
harscalex106 Lecturer in Nursing\par\pard\qj \li836\ri760\sb7\sl-230\slmult0 \up
0 \expndtw0\charscalex105 Trinity Centre for Health Sciences \up0 \expndtw0\char
scalex104 St James\u8217?s Hospital\par\pard\ql \li836\sb37\sl-184\slmult0 \up0
\expndtw0\charscalex107 Dublin 8\par\pard\ql \li836\sb45\sl-184\slmult0 \up0 \ex
pndtw0\charscalex105 Ireland\par\pard\ql \li836\sb45\sl-184\slmult0 \up0 \expndt
w0\charscalex101 E-mail: camccabe@tcd.ie\par\pard\ql \li836\sb0\sl-253\slmult0 \
par\pard\ql \li836\sb0\sl-253\slmult0 \par\pard\ql \li836\sb0\sl-253\slmult0 \pa
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l-253\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf3\f4\fs22 Introduct
ion\par\pard\ql \li836\sb173\sl-207\slmult0 \up0 \expndtw0\charscalex107 \ul0\no
supersub\cf9\f10\fs18 According to Arnold \up0 \expndtw0\charscalex106 & Bogg
s \up0 \expndtw0\charscalex105 (1995)\par\pard\column \ql \li4183\sb0\sl-207\slm
ult0 \par\pard\ql \li23\sb173\sl-207\slmult0 \up0 \expndtw0\charscalex102 \ul0\n
osupersub\cf8\f9\fs14 M cCABE C . ( 2 0 0 4 )\ul0\nosupersub\cf5\f6\fs18
Jo
urnal of Clinical Nursing\ul0\nosupersub\cf9\f10\fs18 13, 41-49\par\pard\ql \li
20\ri1062\sb11\sl-259\slmult0 \up0 \expndtw0\charscalex107 Nurse-patient communi
cation: an exploration of patients\u8217? experiences \line \up0 \expndtw0\chars
calex108 Background. Patient-centred communication is a basic component of nurs
ing and \up0 \expndtw0\charscalex104 facilitates the development of a positive n
urse-patient relationship which, along with \up0 \expndtw0\charscalex108 other o
rganizational factors, results in the delivery of quality nursing care. Nurses \
up0 \expndtw0\charscalex105 are frequently described in the literature as poor c
ommunicators, however, very few \up0 \expndtw0\charscalex105 studies have examin
ed patients\u8217? experiences of how nurses communicate. \line \up0 \expndtw0\c
harscalex107 Aims and objectives. The aim of the study was to explore and produ
ce statements \up0 \expndtw0\charscalex106 relating to patients\u8217? experienc
es of how nurses communicate.\par\pard\ql \li20\ri1062\sb0\sl-259\slmult0 \up0 \
expndtw0\charscalex104 Design. A qualitative perspective using an hermeneutic p
henomenological approach \up0 \expndtw0\charscalex107 was considered to be the m
ost appropriate methodology for this study. \line \up0 \expndtw0\charscalex104 M
ethods. Using purposeful sampling, eight patients in a general teaching hospita
l in \up0 \expndtw0\charscalex109 the Republic of Ireland were interviewed. Data
were collected using unstructured \up0 \expndtw0\charscalex108 interviews. Data
analysis was a reflective process and the findings were presented \up0 \expndtw
0\charscalex107 through the description and interpretation of themes and sub-the
mes. \line \up0 \expndtw0\charscalex108 Results. Following data analysis four t
hemes emerged. These were, \u8216?lack of com-\line \up0 \expndtw0\charscalex104
munication\u8217?, \u8216?attending\u8217?, empathy\u8217? and \u8216?friendly
nurses\u8217?.\par\pard\qj \li20\ri1061\sb1\sl-258\slmult0 \up0 \expndtw0\charsc
alex110 Conclusions. The findings of this study indicate that, in contrast to t
he literature \up0 \expndtw0\charscalex109 that suggests that nurses are not goo
d at communicating with patients, nurses can \up0 \expndtw0\charscalex109 commun
icate well with patients when they use a patient-centred approach. How-\line \up
0 \expndtw0\charscalex108 ever, health care organizations do not appear to value
or recognize the importance \up0 \expndtw0\charscalex110 of nurses using a pati
ent-centred approach when communicating with patients to \up0 \expndtw0\charscal
ex106 ensure the delivery of quality patient care.\par\pard\qj \li20\ri1062\sb2\
sl-258\slmult0 \up0 \expndtw0\charscalex104 Relevance to clinical practice. The
implication of these findings for clinical practice \line \up0 \expndtw0\charsc
alex110 is that the task-centred approach to patient care that is associated wit
h nursing in \line \up0 \expndtw0\charscalex105 the past, appears to be alive an
d well. If health care management want to ensure that \line \up0 \expndtw0\chars
calex104 patients receive quality nursing care, they will need to consi
der patient-centred \line \up0 \expndtw0\charscalex107 communication to be esse
ntial to encourage and support nurses to communicate in \line \up0 \expndtw0\cha
rscalex107 this manner.\par\pard\qj \li4183\sb0\sl-258\slmult0 \par\pard\qj \li2
0\ri1062\sb3\sl-258\slmult0 \up0 \expndtw0\charscalex108 Key words: communicatio
n, empathy, nurse-patient communication, patient satis-\line \up0 \expndtw0\char
scalex105 faction, phenomenology, socialization\par\pard\ql \li5917\sb0\sl-207\s
lmult0 \par\pard\ql \li5917\sb0\sl-207\slmult0 \par\pard\ql \li1754\sb27\sl-207\
slmult0 \up0 \expndtw0\charscalex109 cation involves more than the transmission
of information;\par\pard\qj \li46\ri1062\sb10\sl-259\slmult0\fi1707\tx1755 \up0
\expndtw0\charscalex109 it also involves transmitting feelings, recognizing

these \line \up0 \expndtw0\charscalex104 and Balzer-Riley \tab \up0 \expndtw0


\charscalex108 feelings and letting the patient know that their feelings
\par\pard\sect\sectd\sbknone\cols2\colno1\colw5757\colsr160\colno2\colw5843\cols
r160\ql \li836\sb38\sl-207\slmult0 \up0 \expndtw0\charscalex104 (1996), communi
cation is \up0 \expndtw0\charscalex103 a reciprocal process of sending\par\
pard\qj \li836\ri150\sb9\sl-259\slmult0 \up0 \expndtw0\charscalex109 and receivi
ng messages using a mixture of verbal and non-\line \up0 \expndtw0\charscalex107
verbal communication skills. However, Sheppard \up0 \expndtw0\charscalex105
(1993)\par\pard\ql \li836\sb42\sl-207\slmult0 \up0 \expndtw0\charscalex105 sugg
ests that, in the nurse-patient relationship, communi-\par\pard\ql \li1015
\sb0\sl-184\slmult0 \par\pard\ql \li1015\sb159\sl-184\slmult0 \up0 \expndtw0\cha
rscalex104 \ul0\nosupersub\cf4\f5\fs16 2004 Blackwell Publishing Ltd\par\pard\co
lumn \ql \li20\sb42\sl-207\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\
cf9\f10\fs18 have been recognized. Peplau \up0 \expndtw0\charscalex105 (1988)
, Severston \up0 \expndtw0\charscalex105 (1990),\par\pard\ql \li20\sb52\sl-207\
slmult0 \up0 \expndtw0\charscalex103 Fosbinder \up0 \expndtw0\charscalex106 (199
4), Wilkinson \up0 \expndtw0\charscalex107 (1999), Attree \up0 \expndtw0\chars
calex109 (2001) and\par\pard\qj \li20\ri1061\sb10\sl-258\slmult0 \up0 \expndtw0
\charscalex105 Thorsteinsson (2002) support this view and indicate that \
line \up0 \expndtw0\charscalex112 communication is a fundamental part of nursin
g and that\par\pard\ql \li10464\sb0\sl-184\slmult0 \par\pard\ql \li4567\sb146\sl
-184\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf4\f5\fs16 41
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rsub\cf9\f10\fs18 the development of a positive nurse-patient relationship is\pa
r\pard\qj \li1265\ri0\sb9\sl-259\slmult0 \up0 \expndtw0\charscalex109 essential
for the delivery of quality nursing care. However, \up0 \expndtw0\charscalex108
Crotty (1985), Reid (1985) and Hodges\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\n
osupersub\cf9\f10\fs18 (1986) also \up0 \expndtw0\charscalex107 highlight that
nurses do not communicate well with patients \up0 \expndtw0\charscalex113 and a
pproach patients only to deal with administrative or \up0 \expndtw0\charscalex10
3 functional activities. Morse (1991), Bergen (1992), Haggman-\line \up0 \expndt
w0\charscalex105 Laitila & Astedt-Kurki \up0 \expndtw0\charscalex107 (1994),
Jarman (1995), Hostutler\par\pard\qj \li1265\ri0\sb1\sl-258\slmult0 \up0 \expn
dtw0\charscalex108 \ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs1
8 (1999) and Jarrett & Payne (2000) suggest that this is \up0 \expndtw0\charsca
lex104 because nurses are not aware of the meaning and significance \up0 \expndt
w0\charscalex113 of the nurse-patient relationship for patients. This lack of \u
p0 \expndtw0\charscalex104 awareness by nurses results in them making ass
umptions \up0 \expndtw0\charscalex103 about what nursing care a patient needs or
wants because they \up0 \expndtw0\charscalex107 do not ask patients (Bergen, 19
92; Booth\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs18 , 1996)
. This \up0 \expndtw0\charscalex109 type of communication is not patient-ce
ntered and can \up0 \expndtw0\charscalex107 adversely affect the development o
f a positive nurse-patient \up0 \expndtw0\charscalex106 relationship that is

essential for the provision of quality \up0 \expndtw0\charscalex104 patient


care. Patient-centred communication is defined by \up0 \expndtw0\charscal
ex102 Langewitz\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs18
(1998, p. 230) as \u8216?communication that invites \up0 \expndtw0\charscalex113
and encourages the patient to participate and negotiate in \up0 \expndtw0\chars
calex104 decision-making regarding their own care\u8217?.\par\pard\ql \li1265\sb
0\sl-218\slmult0 \par\pard\ql \li1265\sb206\sl-218\slmult0 \up0 \expndtw0\charsc
alex105 \ul0\nosupersub\cf10\f11\fs19 Literature review\par\pard\qj \li1265\ri0\
sb137\sl-259\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs18 I
n order to investigate trained nurses\u8217? self-perception of \line \up
0 \expndtw0\charscalex108 their communication skills, Burnard & Morrison \u
p0 \expndtw0\charscalex106 (1988,\par\pard\qj \li1265\ri0\sb0\sl-259\slmult0 \up
0 \expndtw0\charscalex103 1989, 1991) conducted studies using Heron\u8217?s
six-category \line \up0 \expndtw0\charscalex106 intervention analysis. The
findings of these studies were \line \up0 \expndtw0\charscalex111 consistent
, in that the participants generally perceived \line \up0 \expndtw0\charsc
alex109 themselves to be more skilful in the authoritative than \line \u
p0 \expndtw0\charscalex107 facilitative categories. The authoritative interv
entions at-\line \up0 \expndtw0\charscalex111 tempt to direct or control p
atient behaviour while the \line \up0 \expndtw0\charscalex106 facilitative i
nterventions attempt to empower the patient. \line \up0 \expndtw0\charscale
x109 Burnard & Morrison (1988, 1989, 1991) propose that the \line \up0 \expnd
tw0\charscalex108 findings of their studies be used as a basis for planning and
\line \up0 \expndtw0\charscalex107 developing education programmes for training
and research \line \up0 \expndtw0\charscalex104 into nurses\u8217? interperson
al communication skills. However, \line \up0 \expndtw0\charscalex109 the fin
dings of these studies are limited by the use of \line \up0 \expndtw0\c
harscalex107 Heron\u8217?s framework because it does not take account of
\line \up0 \expndtw0\charscalex102 how contextual differences influence whi
ch intervention is \line \up0 \expndtw0\charscalex109 used by nurses and it is
impossible to know to what degree \line \up0 \expndtw0\charscalex105 nurses fo
cused on their intentions or actual behaviour in \line \up0 \expndtw0\cha
rscalex105 nurse-patient interactions. Therefore, the relevance of the \li
ne \up0 \expndtw0\charscalex104 findings for changing or developing nurses\
u8217? interpersonal \line \up0 \expndtw0\charscalex105 communication skills
can only be viewed tentatively. \line \up0 \expndtw0\charscalex109 Ash
more & Banks \up0 \expndtw0\charscalex112 (1997) concur with this view an
d\par\pard\qj \li1265\ri0\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex107 recomm
end that further exploration of patients\u8217? perceptions \line \up0 \expndtw0
\charscalex108 of nurses\u8217? communication skills be conducted. If, as Briggs
\line \up0 \expndtw0\charscalex107 (1982), Macleod Clark (1985), Severston (199
0), Fosbinder \line \up0 \expndtw0\charscalex102 (1994) and Oermann\ul0\nosupe
rsub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs18 (2000) suggest, good
commu-\line \up0 \expndtw0\charscalex108 nication is essential for quality
nursing care, then it is\par\pard\ql \li1265\sb0\sl-184\slmult0 \par\pard\q
l \li1265\sb141\sl-184\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf4\
f5\fs16 42\par\pard\column \ql \li6346\sb0\sl-207\slmult0 \par\pard\ql \li222\sb
100\sl-207\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs18 imp
erative that nursing research elicits patients experiences\par\pard\qj \li222\ri
632\sb9\sl-259\slmult0 \up0 \expndtw0\charscalex106 of nurse-patient communica
tion and identifies what they \up0 \expndtw0\charscalex108 value most in
their interactions with nurses \up0 \expndtw0\charscalex104 (Haggman-\par\par
d\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex106 Laitila & Aste
dt-Kurki, 1994). Such information can inform \line \up0 \expndtw0\charscalex106
nursing theory and education and, therefore, allow nurses \line \up0 \expnd
tw0\charscalex107 to develop patient-centred communication skills that are
\par\pard\ql \li222\sb43\sl-207\slmult0 \up0 \expndtw0\charscalex110 fundamental
to the delivery of quality nursing care.\par\pard\qj \li222\ri632\sb10\sl-259\s
lmult0\fi179 \up0 \expndtw0\charscalex107 Another view presented by Menzies (196
0, 1970), Burton \line \up0 \expndtw0\charscalex108 (1985), McMahon (1990), Telf

ord (1992) and Chant\ul0\nosupersub\cf5\f6\fs18 et al. \line \up0 \expndtw0\ch


arscalex104 \ul0\nosupersub\cf9\f10\fs18 (2002) suggests that nurses do not comm
unicate well because\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\
charscalex109 of the organizational culture. Traditionally nurses were not \line
\up0 \expndtw0\charscalex106 encouraged or supported by ward or hospital manage
ment to \line \up0 \expndtw0\charscalex108 establish therapeutic relationships w
ith patients. According\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndt
w0\charscalex103 to Menzies (1960, 1970) the reason for this is to pro
tect \line \up0 \expndtw0\charscalex104 nurses from difficult emotional situatio
ns, thereby preventing \line \up0 \expndtw0\charscalex104 stress. Studies by Wil
kinson (1991) and McColl\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f
10\fs18 (1996)\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\chars
calex110 conducted 25 years later concur with this. They found that \line \up0 \
expndtw0\charscalex110 nurses have the necessary skills to communicate well with
\line \up0 \expndtw0\charscalex110 patients but choose not to because of the la
ck of organiza-\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\chars
calex109 tional support and encouragement. It appears that, over the \line \up0
\expndtw0\charscalex104 last 40 years, this organizational strategy to prevent s
tress has \line \up0 \expndtw0\charscalex111 resulted in a socialization process
that has perpetuated the\par\pard\qj \li222\ri633\sb0\sl-259\slmult0 \up0 \expn
dtw0\charscalex106 notion in nursing that patient-centred communication should \
line \up0 \expndtw0\charscalex106 be discouraged and is unsupported by managemen
t (Wilkin-\line \up0 \expndtw0\charscalex105 son, 1991; Graham, 1994; Cody,
1998; Williams, 1998).\par\pard\ql \li222\sb42\sl-207\slmult0 \up0 \expndtw0\
charscalex101 Bowles\ul0\nosupersub\cf5\f6\fs18 et al. \up0 \expndtw0\charsca
lex110 \ul0\nosupersub\cf9\f10\fs18 (2001) supports this view and adds tha
t\par\pard\qj \li222\ri632\sb11\sl-259\slmult0 \up0 \expndtw0\charscalex106 crit
icism of nurses\u8217? communication may be unrealistic as no \line \up0 \expndt
w0\charscalex105 benchmark for effective nurse-patient communication cur-\li
ne \up0 \expndtw0\charscalex106 rently exists. However, in order to establish a
benchmark for\par\pard\qj \li222\ri632\sb0\sl-258\slmult0 \up0 \expndtw0\charsca
lex110 effective nurse-patient communication it is essential to \up0 \expn
dtw0\charscalex105 discover patients experiences and views.\par\pard\ql \li6346\
sb0\sl-218\slmult0 \par\pard\ql \li222\sb207\sl-218\slmult0 \up0 \expndtw0\chars
calex106 \ul0\nosupersub\cf10\f11\fs19 Design and method\par\pard\qj \li222\ri63
2\sb136\sl-259\slmult0 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf9\f10\fs18
The purpose of this study was to explore and produce \line \up0 \expnd
tw0\charscalex103 statements relating to patients\u8217? experiences of ho
w nurses \line \up0 \expndtw0\charscalex110 communicate with them. A qualitativ
e perspective using a\par\pard\qj \li222\ri632\sb1\sl-258\slmult0 \up0 \expndtw0
\charscalex105 Heideggarian/Gadamarian hermeneutic phenomenological \line \u
p0 \expndtw0\charscalex109 approach was chosen for this study because it is conc
erned \line \up0 \expndtw0\charscalex113 with reaching a new understanding of th
e meaning of the\par\pard\qj \li222\ri632\sb2\sl-259\slmult0 \up0 \expndtw0\char
scalex105 phenomenon (nurse-patient communication) being studied as \line \up0 \
expndtw0\charscalex107 experienced by the participants (LoBiondo-Wood & Haber, \
line \up0 \expndtw0\charscalex104 1998). The site chosen for this study was a ge
neral hospital in\par\pard\qj \li222\ri633\sb0\sl-259\slmult0 \up0 \expndtw0\cha
rscalex107 the Republic of Ireland and ethical approval was granted by \up0 \exp
ndtw0\charscalex105 the Hospital\u8217?s ethics committee.\par\pard\ql \li6346\s
b0\sl-218\slmult0 \par\pard\ql \li222\sb205\sl-218\slmult0 \up0 \expndtw0\charsc
alex101 \ul0\nosupersub\cf10\f11\fs19 Sampling\par\pard\qj \li222\ri632\sb138\sl
-258\slmult0 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf9\f10\fs18 Using pur
poseful sampling, eight patients agreed to partici-\line \up0 \expndtw0\charscal
ex114 pate in the study. Purposeful sampling is where the\par\pard\ql \l
i6144\sb0\sl-184\slmult0 \par\pard\ql \li20\sb143\sl-184\slmult0 \up0 \expndtw0\
charscalex104 \ul0\nosupersub\cf4\f5\fs16 2004 Blackwell Publishing Ltd,\ul0\nos
upersub\cf7\f8\fs16 Journal of Clinical Nursing\ul0\nosupersub\cf4\f5\fs16 , 13
, 41-49 \par\pard\sect\sectd\fs24\paperw11900\paperh15640\pard\sb0\sl-240{\bkmks
tart Pg3}{\bkmkend Pg3}\par\pard\sect\sectd\sbknone\cols2\colno1\colw5757\colsr1

60\colno2\colw5843\colsr160\ql \li836\sb0\sl-184\slmult0 \par\pard\ql \li836\sb0


\sl-184\slmult0 \par\pard\ql \li836\sb50\sl-184\slmult0 \up0 \expndtw0\charscale
x104 \ul0\nosupersub\cf4\f5\fs16 Issues in clinical nursing\par\pard\qj \li836\r
i149\sb247\sl-258\slmult0 \up0 \expndtw0\charscalex109 \ul0\nosupersub\cf9\f10\f
s18 participants are selected prior to the study on the basis that \line \up0 \e
xpndtw0\charscalex108 they have experience of the phenomenon being studied and \
line \up0 \expndtw0\charscalex109 can articulate this experience (Holloway & Whe
eler, 1996; \line \up0 \expndtw0\charscalex107 Mays & Pope, 1996). Each par
ticipant provided written \line \up0 \expndtw0\charscalex106 consent and chose
a pseudonym that was the only identifica-\line \up0 \expndtw0\charscalex112 tio
n used on any documentation related to the study, thus \line \up0 \expndtw0\char
scalex105 ensuring their anonymity. The participants included three \line
\up0 \expndtw0\charscalex104 males and five females whose ages ranged from the m
id-20\u8217?s \line \up0 \expndtw0\charscalex107 to early 70\u8217?s and who had
been inpatients for a minimum of \line \up0 \expndtw0\charscalex111 4 days. Thi
s meant that each participant would have com-\line \up0 \expndtw0\charscalex107
municated regularly with nurses during their stay.\par\pard\ql \li836\sb0\sl-218
\slmult0 \par\pard\ql \li836\sb206\sl-218\slmult0 \up0 \expndtw0\charscalex106 \
ul0\nosupersub\cf10\f11\fs19 Data collection\par\pard\qj \li836\ri149\sb137\sl-2
59\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs18 Data were c
ollected using unstructured interviews that were \up0 \expndtw0\charscalex111 ta
pe recorded and lasted \up0 \expndtw0\charscalex109 30 minutes on average.
Each\par\pard\qj \li836\ri149\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex112 i
nterview began with me asking the participant to tell me \line \up0 \expndtw0\ch
arscalex108 about his/her experiences of how nurses communicated \line \up
0 \expndtw0\charscalex116 with her/him during their time as an inpatient.
The \line \up0 \expndtw0\charscalex111 participants were asked to clarify and
elaborate on certain \line \up0 \expndtw0\charscalex111 issues as this helped
the researcher to understand the \line \up0 \expndtw0\charscalex107 meanin
g of the experience of how nurses communicated for \line \up0 \expndtw0\charscal
ex111 individual patients. At some stage during most of the \line \up0 \
expndtw0\charscalex110 interviews the participants talked about issues unrelated
to \line \up0 \expndtw0\charscalex108 nurse-patient communication. Holloway & W
heeler (1996) \line \up0 \expndtw0\charscalex109 refer to this as \u8216?dross\u
8217? and say that unstructured interviews \line \up0 \expndtw0\charscalex108 wi
ll always contain a certain amount of irrelevant material. \line \up0 \expndtw0\
charscalex107 In order to re-focus the participants during interviews I
\line \up0 \expndtw0\charscalex111 asked the same question \up0 \expndtw0\cha
rscalex113 \u8216?If you had to describe the\par\pard\qj \li836\ri149\sb0\s
l-259\slmult0 \up0 \expndtw0\charscalex110 qualities required to be a good commu
nicator, what would \up0 \expndtw0\charscalex106 you say they were\u8217?? T
his was sufficient to re-focus the \up0 \expndtw0\charscalex109 direction o
f the interview.\par\pard\ql \li836\sb0\sl-218\slmult0 \par\pard\ql \li836\sb203
\sl-218\slmult0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf10\f11\fs19 Data
analysis\par\pard\qj \li836\ri149\sb138\sl-259\slmult0 \up0 \expndtw0\charscalex
107 \ul0\nosupersub\cf9\f10\fs18 The aim of data analysis in phenomenological re
search is to \line \up0 \expndtw0\charscalex102 reveal the meaning of the lived
experience of the phenomenon \line \up0 \expndtw0\charscalex106 being studied
for the participants. According to Bergum \line \up0 \expndtw0\charscalex10
3 (1991) and Ray (1994) data analysis in hermeneutic phe-\line \up0 \exp
ndtw0\charscalex106 nomenological research is a reflective process. Data analysi
s \line \up0 \expndtw0\charscalex108 in this study was a reflective process usin
g the metaphor of \line \up0 \expndtw0\charscalex103 the \u8216?hermeneutic ci
rcle\u8217? to explain the dynamic nature of \line \up0 \expndtw0\charscal
ex108 gaining an understanding of a phenomenon (Annells, 1996) \line \up0 \expnd
tw0\charscalex108 and reference to Gadamer\u8217?s \u8216?fusion of horizons\u8
217? to explain \line \up0 \expndtw0\charscalex106 how the researcher came t
o a new understanding of the \line \up0 \expndtw0\charscalex105 meaning for
patients of nurse-patient communication. This is \line \up0 \expndtw0\charscale
x110 presented through the description and interpretation of \line \up0 \e

xpndtw0\charscalex111 themes and sub-themes. In order to demonstrate trustwor-\l


ine \up0 \expndtw0\charscalex109 thiness in this study Sandelowski\u8217?s (198
6) framework was \line \up0 \expndtw0\charscalex112 used. This framework comp
rises four factors that are\par\pard\column \ql \li5917\sb0\sl-184\slmult0 \
par\pard\ql \li5917\sb0\sl-184\slmult0 \par\pard\ql \li2650\sb50\sl-184\slmult0
\up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf7\f8\fs16 Nurse-patient communic
ation\par\pard\qj \li20\ri1061\sb247\sl-259\slmult0 \up0 \expndtw0\charscalex105
\ul0\nosupersub\cf9\f10\fs18 essential for demonstrating trustworthiness. T
hese factors \line \up0 \expndtw0\charscalex103 are: credibility, fittingness
, auditability and confirmability. \line \up0 \expndtw0\charscalex111 The cre
dibility of this study was achieved by including an \line \up0 \expndtw0\charsca
lex104 interview transcript and a thick description of one of the \line
\up0 \expndtw0\charscalex110 themes in the final report. As no personal informa
tion was \line \up0 \expndtw0\charscalex106 recorded during the interviews, all
audiotapes used to record \line \up0 \expndtw0\charscalex105 the interviews ha
ve been retained by the researcher as a \line \up0 \expndtw0\charscalex10
7 record of data authenticity. Fittingness occurs when the \line \up0 \ex
pndtw0\charscalex102 findings of a study \u8216?fit\u8217? into similar contexts
outside the study. \line \up0 \expndtw0\charscalex110 The literature used to di
scuss the findings demonstrates its \line \up0 \expndtw0\charscalex110 fittingne
ss. Auditability of this study was achieved by \line \up0 \expndtw0\chars
calex106 recording details explaining and justifying any decisions \line \
up0 \expndtw0\charscalex110 made regarding the study in a reflective journal and
incor-\line \up0 \expndtw0\charscalex108 porating this information into the fin
al report as a \u8216?decision \line \up0 \expndtw0\charscalex111 trail\u8217?.
The confirmability of this study arises from its \line \up0 \expndtw0\ch
arscalex105 credibility, fittingness and auditability (Sandelowski, 1986).\par\p
ard\ql \li5917\sb0\sl-253\slmult0 \par\pard\ql \li20\sb141\sl-253\slmult0 \up0 \
expndtw0\charscalex101 \ul0\nosupersub\cf3\f4\fs22 Findings\par\pard\qj \li20\ri
1061\sb131\sl-259\slmult0 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf9\f10\f
s18 Four main themes relating to aspects of nurses communica-\line \up0 \expndtw
0\charscalex107 tion emerged from the data analysis.\par\pard\ql \li5917\sb0\sl218\slmult0 \par\pard\ql \li20\sb205\sl-218\slmult0 \up0 \expndtw0\charscalex108
\ul0\nosupersub\cf10\f11\fs19 Theme 1 - lack of communication\par\pard\qj \li20
\ri1061\sb138\sl-258\slmult0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf9\f1
0\fs18 The participants in this study frequently referred to how \line \
up0 \expndtw0\charscalex112 nurses did not provide enough information and
many \line \up0 \expndtw0\charscalex108 commented on how nurses were more conce
rned with tasks \line \up0 \expndtw0\charscalex107 than with talking to them. Ho
wever, all the participants said \line \up0 \expndtw0\charscalex106 that it was
not the nurse\u8217?s fault as they were too \u8216?busy\u8217?. This \line \up0
\expndtw0\charscalex107 theme will be discussed under two sub-themes, pa
tient-\line \up0 \expndtw0\charscalex106 centred communication and task-centred
communication.\par\pard\ql \li5917\sb0\sl-207\slmult0 \par\pard\ql \li20\sb96\sl
-207\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf5\f6\fs18 Patient-c
entred communication\par\pard\qj \li20\ri1061\sb11\sl-258\slmult0 \up0 \expndtw0
\charscalex107 \ul0\nosupersub\cf9\f10\fs18 Patients in this study were reassure
d when the nurses used a \up0 \expndtw0\charscalex107 personal approach when com
municating with them:\par\pard\qj \li20\ri1060\sb132\sl-258\slmult0 \up0 \expndt
w0\charscalex103 \ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs1
6 she\u8217?d say \u8216?how are you today John?\u8217?\ul0\nosupersub\cf11\f12\
fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 it\u8217?s things like that that help \l
ine \up0 \expndtw0\charscalex107 to cheer you up, particularly when you\u8217?re
in hospital. (Mr Clinton)\par\pard\qj \li20\ri1061\sb131\sl-259\slmult0\fi179 \
up0 \expndtw0\charscalex109 \ul0\nosupersub\cf9\f10\fs18 Some of the participant
s felt that nurses did not commu-\line \up0 \expndtw0\charscalex108 nicate in a
patient-centred way because they made assump-\line \up0 \expndtw0\charscalex106
tions about their concerns and needs. This view is supported \up0 \expndtw0\char
scalex104 by the literature (Bergen, 1992; Booth\ul0\nosupersub\cf5\f6\fs18 et
al.\ul0\nosupersub\cf9\f10\fs18 , 1996; Nordgren \up0 \expndtw0\charscalex108 &

Fridlund, 2001):\par\pard\qj \li20\ri1061\sb131\sl-258\slmult0 \up0 \expndtw0\ch


arscalex109 \ul0\nosupersub\cf4\f5\fs16 Yea they (the nurses) were all nice - it
was just one nurse taking it \up0 \expndtw0\charscalex106 into her own hand lik
e - changing your medication\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub
\cf4\f5\fs16 not changing it \up0 \expndtw0\charscalex104 like but giving it whe
n she thought - I think she thought she was able \up0 \expndtw0\charscalex105 to
tell me \u8216?me body\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4
\f5\fs16 . (Jane)\par\pard\qj \li20\ri1061\sb132\sl-258\slmult0\fi179 \up0 \expn
dtw0\charscalex105 \ul0\nosupersub\cf9\f10\fs18 This participant goes on to desc
ribe how important it is for \up0 \expndtw0\charscalex107 nurses to talk to them
as individuals: \par\pard\sect\sectd\sbknone \li1015\sb0\sl-184\slmult0\par\par
d\li1015\sb143\sl-184\slmult0\fi0\tx10464 \up0 \expndtw0\charscalex104 \ul0\nosu
persub\cf4\f5\fs16 2004 Blackwell Publishing Ltd,\ul0\nosupersub\cf7\f8\fs16 Jo
urnal of Clinical Nursing\ul0\nosupersub\cf4\f5\fs16 , 13, 41-49\tab \up0 \expnd
tw0\charscalex104 43\par\pard\sect\sectd\fs24\paperw11900\paperh15640\pard\sb0\s
l-240{\bkmkstart Pg4}{\bkmkend Pg4}\par\pard\ql \li1265\sb0\sl-184\slmult0 \par\
pard\ql\li1265\sb0\sl-184\slmult0 \par\pard\ql\li1265\sb60\sl-184\slmult0 \up0 \
expndtw-3\charscalex100 \ul0\nosupersub\cf7\f8\fs16 C. McCabe\par\pard\sect\sect
d\sbknone\cols2\colno1\colw6034\colsr110\colno2\colw5616\colsr160\ql \li1265\sb0
\sl-184\slmult0 \par\pard\ql \li1265\sb128\sl-184\slmult0 \up0 \expndtw0\charsca
lex103 \ul0\nosupersub\cf4\f5\fs16 Yea, like if she\u8217?d had have said to me
\u8216?do you feel that you need them\par\pard\qj \li1265\ri0\sb14\sl-259\slmult
0 \up0 \expndtw0\charscalex108 now? It doesn\u8217?t matter how you look\ul0\nos
upersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 you could say either ye
a or \up0 \expndtw0\charscalex105 no. (Jane)\par\pard\ql \li1265\sb0\sl-207\slmu
lt0 \par\pard\ql \li1265\sb96\sl-207\slmult0 \up0 \expndtw-3\charscalex100 \ul0\
nosupersub\cf5\f6\fs18 Task-centred communication\par\pard\qj \li1265\ri0\sb9\sl
-259\slmult0 \up0 \expndtw0\charscalex111 \ul0\nosupersub\cf9\f10\fs18 Many of t
he participants identified how nurses were more \up0 \expndtw0\charscalex109 con
cerned with doing their work than communicating with \up0 \expndtw0\charscalex10
5 them personally:\par\pard\qj \li1265\ri0\sb131\sl-258\slmult0 \up0 \expndtw0\c
harscalex109 \ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 es
pecially after nine in the morning and they\u8217?re coming around, \up0 \expndt
w0\charscalex109 em, after your breakfast and they\u8217?re rushing the beds. Yo
u know I \up0 \expndtw0\charscalex103 heard one woman saying, \u8216?Oh you migh
t have let me drink me cup of \up0 \expndtw0\charscalex105 tea\u8217?. (Mrs Brow
n)\par\pard\qj \li1265\ri0\sb132\sl-258\slmult0\fi179 \up0 \expndtw0\charscalex1
04 \ul0\nosupersub\cf9\f10\fs18 Patients did not blame nurses for having a
task-centred \up0 \expndtw0\charscalex104 approach. However, this approach res
ulted in patients feeling \up0 \expndtw0\charscalex110 that the tasks were more
important than they were. Conse-\line \up0 \expndtw0\charscalex107 quently, they
did not like to bother the \u8216?busy nurse\u8217?:\par\pard\qj \li1265\ri0\sb
131\sl-259\slmult0 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf4\f5\fs16 Ever
y few minutes they\u8217?d come in - the only time they\u8217?d sit down was \up
0 \expndtw0\charscalex102 when they were taking your blood pressure\ul0\nosupers
ub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 they\u8217?d sit there for a
few \up0 \expndtw0\charscalex108 minutes and then move on to the next patient.
(Charlie)\par\pard\qj \li1265\ri0\sb128\sl-259\slmult0\fi179 \up0 \expndtw0\char
scalex104 \ul0\nosupersub\cf9\f10\fs18 When asked if the nurses spoke to
him when they sat \up0 \expndtw0\charscalex106 down, Charlie said, \u8216?ver
y little\u8217? and then added:\par\pard\qj \li1265\ri0\sb131\sl-258\slmult0 \up
0 \expndtw0\charscalex105 \ul0\nosupersub\cf4\f5\fs16 I think that\u8217?s the s
lackest part but as I said, they can\u8217?t be sitting down \up0 \expndtw0\char
scalex109 talking with patients - I\u8217?d say they\u8217?d be neglecting their
own work \up0 \expndtw0\charscalex104 then\ul0\nosupersub\cf11\f12\fs16 \u8230?
\ul0\nosupersub\cf4\f5\fs16 (Charlie)\par\pard\qj \li1265\ri0\sb131\sl-259\slmu
lt0\fi179 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs18 A possible i
mpact of nurses using a task-centred approach \up0 \expndtw0\charscalex107 when
communicating with patients is that patients view \up0 \expndtw0\charscal
ex105 nurses as \up0 \expndtw0\charscalex105 \u8216?workers\u8217? not profes

sionals. When asked if he\par\pard\qj \li1265\ri0\sb0\sl-259\slmult0 \up0 \e


xpndtw0\charscalex106 received information about his condition from nurses, Char
-\line \up0 \expndtw0\charscalex103 lie replied:\par\pard\qj \li1265\ri0\sb131\s
l-258\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf4\f5\fs16 Oh well t
hey\u8217?d never tell you that, I suppose bar you ask them, but I\u8217?d \up0
\expndtw0\charscalex107 always wait until the Doctors came around. (Charlie)\par
\pard\qj \li1265\ri0\sb132\sl-258\slmult0\fi179 \up0 \expndtw0\charscalex105 \ul
0\nosupersub\cf9\f10\fs18 Another participant excused nurses lack of communicati
on \up0 \expndtw0\charscalex108 by implying that it was out of their control:\pa
r\pard\qj \li1265\ri0\sb132\sl-258\slmult0 \up0 \expndtw0\charscalex109 \ul0\nos
upersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 you cannot expect nurse
s to hold a conversation with you when \up0 \expndtw0\charscalex104 they see con
sultants coming along\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5
\fs16 . (Sophie)\par\pard\qj \li1265\ri0\sb131\sl-259\slmult0\fi179 \up0 \expndt
w0\charscalex112 \ul0\nosupersub\cf9\f10\fs18 Nurses were seen by these two part
icipants as a disem-\line \up0 \expndtw0\charscalex104 powered and subservient g
roup of people who carried out the \up0 \expndtw0\charscalex109 orders of cons
ultants. Crowe \up0 \expndtw0\charscalex111 (2000) supports this and\par\par
d\qj \li1265\ri0\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex104 suggests that
a task-centred approach to care ensures the \line \up0 \expndtw0\charscal
ex105 standardization and predictability of the nurses\u8217? performance \line
\up0 \expndtw0\charscalex107 in the nurse-patient relationship and is anot
her possible \line \up0 \expndtw0\charscalex110 reason why it is supported by o
rganizational management. \line \up0 \expndtw0\charscalex110 The result is that
the nurse-patient relationship is devalued \line \up0 \expndtw0\charscalex109 by
nurses in favour of a task-centred approach to patient \line \up0 \expndtw0
\charscalex105 care.\par\pard\ql \li1265\sb0\sl-184\slmult0 \par\pard\ql \li1265
\sb154\sl-184\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf4\f5\fs16 4
4\par\pard\column \ql \li6346\sb0\sl-218\slmult0 \par\pard\ql \li222\sb206\sl-21
8\slmult0 \up0 \expndtw0\charscalex110 \ul0\nosupersub\cf10\f11\fs19 Theme 2 - a
ttending\par\pard\qj \li222\ri632\sb138\sl-259\slmult0 \up0 \expndtw0\charscalex
105 \ul0\nosupersub\cf9\f10\fs18 Attending behaviour is described as the p
hysical demon-\line \up0 \expndtw0\charscalex104 stration of nurses\u8217? a
ccessibility and readiness to listen to \line \up0 \expndtw0\charscalex111
patients through the use of non-verbal communication\par\pard\qj \li222\ri
632\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex105 (Stein-Parbury, 1993). Atten
ding is a patient-centred process \line \up0 \expndtw0\charscalex113 and the bas
ic conditions required on the part of the nurse \line \up0 \expndtw0\charscalex1
07 for attending to occur are genuineness, warmth and\par\pard\qj
\li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex106 empathy (Burnard,
1990; Stein-Parbury, 1993). Although \line \up0 \expndtw0\charscalex109 cons
idered an attending behaviour, empathy emerged from \line \up0 \expndtw0\charsca
lex102 this study as a main theme, therefore, is not discussed in\par\
pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex107 relation to
attending. Although the participants of this study \line \up0 \expndtw0\charsca
lex108 did not refer directly to the term \u8216?attending\u8217?, they describe
d \line \up0 \expndtw0\charscalex112 nursing behaviours they valued which a
re specific to\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\char
scalex103 attending. These behaviours will be discussed as the sub-\line
\up0 \expndtw0\charscalex106 themes, \u8216?giving time and being there\u8217?,
\u8216?open/honest commu-\line \up0 \expndtw0\charscalex104 nication\u8217? and
\u8216?genuineness\u8217?.\par\pard\ql \li6346\sb0\sl-207\slmult0 \par\pard\ql
\li222\sb94\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf5\f6\
fs18 Giving time and being there\par\pard\qj \li222\ri633\sb10\sl-258\slmult0 \u
p0 \expndtw0\charscalex105 \ul0\nosupersub\cf9\f10\fs18 According to Pontin & We
bb (1996) this incorporates giving \up0 \expndtw0\charscalex107 attention and sh
owing concern for patients:\par\pard\qj \li222\ri632\sb131\sl-259\slmult0 \up0 \
expndtw0\charscalex107 \ul0\nosupersub\cf4\f5\fs16 They (the nurses) always foun
d some time to talk with you and you \up0 \expndtw0\charscalex103 felt happy whe
n they were gone and they\u8217?d come back again, even on \up0 \expndtw0\charsc

alex104 their busiest days\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\c


f4\f5\fs16 (Sophie)\par\pard\qj \li222\ri632\sb129\sl-259\slmult0\fi179 \up0 \e
xpndtw0\charscalex103 \ul0\nosupersub\cf9\f10\fs18 This results in patients
feeling that nurses are regularly \up0 \expndtw0\charscalex107 monitoring th
eir physical condition and also their psycholo-\line \up0 \expndtw0\charscalex10
7 gical and emotional well being (Pontin & Webb, 1996):\par\pard\qj \li222\ri631
\sb131\sl-258\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf11\f12\fs16
\u8230?\ul0\nosupersub\cf4\f5\fs16 they\u8217?d (nurses) call you by your name\
ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 they\u8217?d co
mment, they\u8217?d \up0 \expndtw0\charscalex107 talk to you even if the ward wa
s busy\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 . (Claire
)\par\pard\qj \li222\ri632\sb131\sl-259\slmult0\fi179 \up0 \expndtw0\charscalex1
06 \ul0\nosupersub\cf9\f10\fs18 Benner (1984) suggests that \u8216?expert\u8217?
or senior nurses have \line \up0 \expndtw0\charscalex104 the self-esteem and co
nfidence to recognize the value of their \line \up0 \expndtw0\charscalex109 time
and presence for their patients. However, participants\par\pard\qj \li222\ri632
\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex109 in this study suggest that seni
or nurses did not demonstrate \line \up0 \expndtw0\charscalex104 this because
although they had the skills, they were \u8216?too \line \up0 \expndtw-1\
charscalex100 busy\u8217?:\par\pard\qj \li222\ri631\sb129\sl-259\slmult0\fi0 \up
0 \expndtw0\charscalex103 \ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\c
f4\f5\fs16 the more senior nurse would come and she\u8217?d be good but she had
a \line \up0 \expndtw0\charscalex108 lot of responsibility\ul0\nosupersub\cf11\f
12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 it wouldn\u8217?t be as easy for her
as the others\ul0\nosupersub\cf11\f12\fs16 \u8230? \line \up0 \expndtw0\charscal
ex106 \ul0\nosupersub\cf4\f5\fs16 she had the ward round consultants coming and
going\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 (Sophie):
\par\pard\qj \li6346\sb0\sl-259\slmult0 \par\pard\qj \li222\ri631\sb1\sl-259\slm
ult0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosu
persub\cf4\f5\fs16 the students, they were very understanding and you could actu
ally \up0 \expndtw0\charscalex104 talk to them which was lovely. If there was so
mething worrying you, \up0 \expndtw0\charscalex105 you could actually say it\ul0
\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 (Jane)\par\pard\qj
\li222\ri633\sb128\sl-259\slmult0\fi179 \up0 \expndtw0\charscalex109 \ul0\nosup
ersub\cf9\f10\fs18 A possible reason why student nurses give patients more \line
\up0 \expndtw0\charscalex107 time and allow them to talk to them is that they h
ave not yet \line \up0 \expndtw0\charscalex109 been fully socialized into commun
icating in a task-centred\par\pard\qj \li222\ri632\sb1\sl-258\slmult0 \up0 \expn
dtw0\charscalex114 way or because of their lack of expertise there are not as \u
p0 \expndtw0\charscalex107 many demands made on their time.\par\pard\ql \li6144\
sb0\sl-184\slmult0 \par\pard\ql \li20\sb146\sl-184\slmult0 \up0 \expndtw0\charsc
alex104 \ul0\nosupersub\cf4\f5\fs16 2004 Blackwell Publishing Ltd,\ul0\nosupersu
b\cf7\f8\fs16 Journal of Clinical Nursing\ul0\nosupersub\cf4\f5\fs16 , 13, 41-4
9 \par\pard\sect\sectd\fs24\paperw11900\paperh15640\pard\sb0\sl-240{\bkmkstart P
g5}{\bkmkend Pg5}\par\pard\sect\sectd\sbknone\cols2\colno1\colw5757\colsr160\col
no2\colw5843\colsr160\ql \li836\sb0\sl-184\slmult0 \par\pard\ql \li836\sb0\sl-18
4\slmult0 \par\pard\ql \li836\sb50\sl-184\slmult0 \up0 \expndtw0\charscalex104 \
ul0\nosupersub\cf4\f5\fs16 Issues in clinical nursing\par\pard\ql \li836\sb0\sl207\slmult0 \par\pard\ql \li836\sb82\sl-207\slmult0 \up0 \expndtw-3\charscalex10
0 \ul0\nosupersub\cf5\f6\fs18 Open/honest communication\par\pard\qj \li836\ri149
\sb9\sl-259\slmult0 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf9\f10\fs18 Ac
cording to McCann & Baker (2001), open and honest \up0 \expndtw0\charsca
lex111 communication helps patients to deal positively with their \up0 \expndtw0
\charscalex105 illness. The participants of this study valued open/honest
\up0 \expndtw0\charscalex107 communication from nurses and relied on nurses to
use lan-\line \up0 \expndtw0\charscalex107 guage that they could understand:\par
\pard\qj \li836\ri149\sb130\sl-259\slmult0 \up0 \expndtw0\charscalex112 \ul0\nos
upersub\cf4\f5\fs16 I think no matter how small or how big a persons diagnosis i
s, it \up0 \expndtw0\charscalex105 should be explained from day one\ul0\nosupers
ub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 I think from when doctors co

me \up0 \expndtw0\charscalex108 around they don\u8217?t actually convey a lot of


information and it is left \up0 \expndtw0\charscalex106 probably to the nurses\
ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 I\u8217?d prefer
if someone calm said \u8216?would you \up0 \expndtw0\charscalex107 like to know
?\u8217?\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 and to
be honest and frank\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\
fs16 (Claire)\par\pard\qj \li836\ri149\sb129\sl-259\slmult0\fi179 \up0 \expndtw
0\charscalex107 \ul0\nosupersub\cf9\f10\fs18 One participant described the r
eaction from the nurse \up0 \expndtw0\charscalex105 when she requested analge
sia:\par\pard\qj \li836\ri148\sb129\sl-259\slmult0 \up0 \expndtw0\charscalex104
\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 then one of th
em (staff nurses) would mutter to the other like they \up0 \expndtw0\charscalex1
04 can\u8217?t understand how I\u8217?m getting two drugs together\ul0\nosupersu
b\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 They actually \up0 \expndtw0
\charscalex103 told me they were too strong. \u8216?I don\u8217?t care\u8217? I
said, \u8216?they\u8217?re making my \up0 \expndtw0\charscalex107 pain go away\u
8217? and they were doing nothing to me - like making me \up0 \expndtw0\charscal
ex105 dizzy or anything. (Jane)\par\pard\qj \li836\ri150\sb131\sl-258\slmult0\fi
179 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf9\f10\fs18 When asked how she
felt when the nurses communicated \up0 \expndtw0\charscalex105 like this, Jane
replied:\par\pard\qj \li836\ri149\sb131\sl-259\slmult0\fi0 \up0 \expndtw0\charsc
alex110 \ul0\nosupersub\cf4\f5\fs16 I felt I could trust her all right\ul0\nosup
ersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 it was in my interest tha
t she was \up0 \expndtw0\charscalex111 looking at it\ul0\nosupersub\cf11\f12\fs1
6 \u8230?\ul0\nosupersub\cf4\f5\fs16 but she had no kind of experience with me\u
l0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 I was \up0 \expnd
tw0\charscalex106 kinda getting a bit frightened\ul0\nosupersub\cf11\f12\fs16 \u
8230?\ul0\nosupersub\cf4\f5\fs16 (Jane)\par\pard\qj \li836\ri149\sb130\sl-259\s
lmult0\fi179 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf9\f10\fs18 This com
ment suggests that when nurses use this non-\line \up0 \expndtw0\charscal
ex104 patient-centred type of communication, it can have a negative \up0 \expndt
w0\charscalex105 effect on a patient\u8217?s sense of well-being and security.\p
ar\pard\ql \li836\sb0\sl-207\slmult0 \par\pard\ql \li836\sb94\sl-207\slmult0 \up
0 \expndtw-8\charscalex97 \ul0\nosupersub\cf5\f6\fs18 Genuineness\par\pard\qj \l
i836\ri149\sb11\sl-259\slmult0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf9\
f10\fs18 Egan (1994), p. 55) says that genuineness is \u8216?beyond profes-\line
\up0 \expndtw0\charscalex105 sionalism and phoniness\u8217?. It is an attitude
and behaviour that \up0 \expndtw0\charscalex109 can only be expressed if the nu
rse is self-aware (Burnard, \up0 \expndtw0\charscalex104 1990; Stein-Parbury, 1
993). Participants in this study referred \up0 \expndtw0\charscalex104 to both
the nurses\u8217? verbal and non-verbal communication \up0 \expndtw0\chars
calex105 when identifying genuine behaviours although non-verbal \up0 \expn
dtw0\charscalex108 behaviours predominantly influenced when patients per-\l
ine \up0 \expndtw0\charscalex107 ceived a nurse as genuine or not:\par\pard\qj \
li836\ri149\sb130\sl-259\slmult0\fi0 \up0 \expndtw0\charscalex105 \ul0\nosupersu
b\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 she just had a way about her\
ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 it\u8217?s hard
to put your finger on it but \up0 \expndtw0\charscalex105 she was jolly and I wo
n\u8217?t say \u8216?devil may care\u8217? but once you were all \up0 \expndtw0\
charscalex106 right, that was everything\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul
0\nosupersub\cf4\f5\fs16 (Mr Clinton)\par\pard\qj \li836\ri149\sb129\sl-259\slm
ult0\fi179 \up0 \expndtw0\charscalex109 \ul0\nosupersub\cf9\f10\fs18 The partici
pants valued non-verbal communication as an \up0 \expndtw0\charscalex107 indicat
or of genuineness because it demonstrated emotional \up0 \expndtw0\charscalex110
support, understanding and respect for them as individuals \up0 \expndtw0\chars
calex104 (Bottorff\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs1
8 , 1995).\par\pard\qj \li836\ri150\sb0\sl-259\slmult0\fi179 \up0 \expndtw0\char
scalex104 Many of the participants in this study formed \u8216?special\u
8217? \line \up0 \expndtw0\charscalex108 relationships with the nurses that they
perceived to be most \line \up0 \expndtw0\charscalex102 genuine:\par\pard\colum

n \ql \li5917\sb0\sl-184\slmult0 \par\pard\ql \li5917\sb0\sl-184\slmult0 \par\pa


rd\ql \li2650\sb50\sl-184\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\
cf7\f8\fs16 Nurse-patient communication\par\pard\qj \li20\ri1060\sb233\sl-259\sl
mult0\fi0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf4\f5\fs16 There was one
particular girl, she was lovely\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupe
rsub\cf4\f5\fs16 every morning she\u8217?d \up0 \expndtw0\charscalex102 come in
and ask how you were or if she was going by she\u8217?d wave in to \up0 \expndt
w0\charscalex104 you. (Jane)\par\pard\qj \li20\ri1062\sb131\sl-258\slmult0\fi179
\up0 \expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs18 Participants were abl
e to differentiate quite precisely what \up0 \expndtw0\charscalex106 aspect of a
nurses non-verbal behaviour was unhelpful:\par\pard\qj \li20\ri1061\sb132\sl-25
8\slmult0 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf4\f5\fs16 I wouldn\u821
7?t say it was their body language but their tone was like, em, \up0 \expndtw0\c
harscalex107 \u8216?I like to be the boss\u8217? - the little authority\ul0\nosu
persub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 (Jane)\par\pard\ql \li5
917\sb0\sl-218\slmult0 \par\pard\ql \li20\sb206\sl-218\slmult0 \up0 \expndtw0\ch
arscalex109 \ul0\nosupersub\cf10\f11\fs19 Theme 3 - empathy\par\pard\qj \li20\ri
1061\sb138\sl-259\slmult0 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf9\f10\f
s18 Although the participants in this study did not refer directly \up0 \expndtw
0\charscalex105 to the term \u8216?empathy\u8217? they referred frequently to ma
ny of the \up0 \expndtw0\charscalex109 behaviours that according to Morse\ul0\no
supersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs18 (1992) form the \up0
\expndtw0\charscalex109 basis of empathetic communication. Empathetic communi-\l
ine \up0 \expndtw0\charscalex105 cation is described as communication that
emphasies the \up0 \expndtw0\charscalex107 process of emotional engagement
of the nurse with the \up0 \expndtw0\charscalex106 patient (Morse\ul0\nosup
ersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs18 , 1992).\par\pard\qj \li20
\ri1060\sb129\sl-259\slmult0 \up0 \expndtw0\charscalex104 \ul0\nosupersub\cf4\f5
\fs16 I liked them all, but there was one little girl, she was slightly differen
t \line \up0 \expndtw0\charscalex112 - sympathetic I would say. I think the pati
ent deserves sympathy \line \up0 \expndtw0\charscalex111 when they are hospit
alised, their complaint may not warrant \line \up0 \expndtw0\charscalex105
sympathy but they\u8217?re away from their own environment\ul0\nosupersub\cf11\f
12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 (Sophie)\par\pard\qj \li20\ri1061\sb
128\sl-259\slmult0\fi179 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs
18 According to Morse\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\
fs18 (1992) sympathy is a first-level \line \up0 \expndtw0\charscalex108 empath
etic response and is a verbal and non-verbal expres-\line \up0 \expndtw0\charsca
lex113 sion of the nurse\u8217?s own sorrow or dismay at the patient\u8217?s \li
ne \up0 \expndtw0\charscalex106 situation. When nurses were sympathetic, the par
ticipants in \line \up0 \expndtw0\charscalex103 this study felt that their feeli
ngs were justified and made them \line \up0 \expndtw0\charscalex104 feel like th
e nurses understood their situation and cared about \line \up0 \expndtw0\charsca
lex105 them as a person. It seemed important to the participants that \line \up0
\expndtw0\charscalex108 nurses communicate their recognition and understanding
of \line \up0 \expndtw0\charscalex111 the patient\u8217?s situation. They did no
t expect the nurse to be \line \up0 \expndtw0\charscalex111 able to \u8216?fix\
u8217? everything, but it alleviated their anxiety and \line \up0 \expndtw0\char
scalex106 uncertain feelings when they knew that someone understood \line \up0 \
expndtw0\charscalex105 how they were feeling:\par\pard\qj \li20\ri1060\sb131\sl258\slmult0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf4\f5\fs16 During the
night when I couldn\u8217?t sleep, one (nurse) came over \up0 \expndtw
0\charscalex108 because she noticed that I was still awake, to see if I was OK that \up0 \expndtw0\charscalex103 stuck in my mind\ul0\nosupersub\cf11\f12\fs16
\u8230?\ul0\nosupersub\cf4\f5\fs16 She knew that I was tired and that I wanted
to try \up0 \expndtw0\charscalex106 and sleep but just couldn\u8217?t so she ca
me over\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 (Mary A
nn)\par\pard\qj \li20\ri1061\sb131\sl-259\slmult0\fi179 \up0 \expndtw0\charscale
x105 \ul0\nosupersub\cf9\f10\fs18 The participants trusted nurses who empathized
with them \up0 \expndtw0\charscalex103 and were able to identify specific

nursing behaviours that \up0 \expndtw0\charscalex106 demonstrated empathetic


communication:\par\pard\qj \li20\ri1061\sb130\sl-258\slmult0 \up0 \expndtw0\char
scalex112 \ul0\nosupersub\cf4\f5\fs16 I think the reassurance from the nurse wit
h me at the time of my \up0 \expndtw0\charscalex103 diagnosis \up0 \expndtw0\cha
rscalex107 \ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 she
made me feel at ease straight away\ul0\nosupersub\cf11\f12\fs16 \u8230?\u
l0\nosupersub\cf4\f5\fs16 She just\par\pard\qj \li20\ri1060\sb1\sl-259\slmult0
\up0 \expndtw0\charscalex104 organised everything and was really relaxed and was
n\u8217?t watching her \up0 \expndtw0\charscalex108 watch to see was she running
late - she was just awfully concerned \up0 \expndtw0\charscalex105 and at the s
ame time, very professional. She added the human touch, \up0 \expndtw0\charscale
x106 like as if she knew what it was like in my shoes\ul0\nosupersub\cf11\f12\fs
16 \u8230?\ul0\nosupersub\cf4\f5\fs16 (Claire) \par\pard\sect\sectd\sbknone \li
1015\sb0\sl-184\slmult0\par\pard\li1015\sb142\sl-184\slmult0\fi0\tx10464 \up0 \e
xpndtw0\charscalex104 2004 Blackwell Publishing Ltd,\ul0\nosupersub\cf7\f8\fs16
Journal of Clinical Nursing\ul0\nosupersub\cf4\f5\fs16 , 13, 41-49\tab \up0 \ex
pndtw0\charscalex104 45\par\pard\sect\sectd\fs24\paperw11900\paperh15640\pard\sb
0\sl-240{\bkmkstart Pg6}{\bkmkend Pg6}\par\pard\ql \li1265\sb0\sl-184\slmult0 \p
ar\pard\ql\li1265\sb0\sl-184\slmult0 \par\pard\ql\li1265\sb60\sl-184\slmult0 \up
0 \expndtw-3\charscalex100 \ul0\nosupersub\cf7\f8\fs16 C. McCabe\par\pard\sect\s
ectd\sbknone\cols2\colno1\colw6034\colsr110\colno2\colw5616\colsr160\ql \li1265\
sb0\sl-207\slmult0 \par\pard\ql \li1444\sb100\sl-207\slmult0 \up0 \expndtw0\char
scalex104 \ul0\nosupersub\cf9\f10\fs18 Morse\ul0\nosupersub\cf5\f6\fs18 et al.\
ul0\nosupersub\cf9\f10\fs18 (1992) describe this communication as second\par\pa
rd\ql \li1265\ri0\sb9\sl-259\slmult0\tx1444 \up0 \expndtw0\charscalex105 level
empathetic communication response. The nurse has \up0 \expndtw0\charscalex1
05 communicated her understanding of Claire\u8217?s predicament \up0 \expnd
tw0\charscalex110 and is reassuring Claire by sharing her \u8216?self\u8217?. T
his type of \up0 \expndtw0\charscalex108 empathy is considered to be \u8216?pati
ent-focused\u8217? and results in \up0 \expndtw0\charscalex105 patients feeling
secure and reassured (Morse\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nosupersub\cf
9\f10\fs18 , 1992). \line\tab \up0 \expndtw0\charscalex106 This participant al
so described her experience of non-\line \up0 \expndtw0\charscalex106 empat
hetic communication from nurses which made her feel \up0 \expndtw0\charscalex108
frustrated and uncared for:\par\pard\qj \li1265\ri0\sb129\sl-259\slmult0 \up0 \
expndtw0\charscalex104 \ul0\nosupersub\cf4\f5\fs16 I didn\u8217?t have a shower
for the first two days at all\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersu
b\cf4\f5\fs16 it just would have \line \up0 \expndtw0\charscalex110 taken somebo
dy sensitive enough to understand\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosup
ersub\cf4\f5\fs16 I mean you can \line \up0 \expndtw0\charscalex105 imagine wha
t you feel like when you can\u8217?t even wash yourself. \line \up0 \ex
pndtw0\charscalex102 (Claire)\par\pard\ql \li1265\sb0\sl-218\slmult0 \par\pard\q
l \li1265\sb205\sl-218\slmult0 \up0 \expndtw0\charscalex108 \ul0\nosupersub\cf10
\f11\fs19 Theme 4 - friendly nurses and humour\par\pard\qj \li1265\ri0\sb136\sl259\slmult0 \up0 \expndtw0\charscalex105 \ul0\nosupersub\cf9\f10\fs18 All the pa
rticipants in this study commented on how friendly \up0 \expndtw0\charscalex107
and happy the nurses were:\par\pard\qj \li1265\ri0\sb129\sl-259\slmult0 \up0 \ex
pndtw0\charscalex106 \ul0\nosupersub\cf4\f5\fs16 I found them absolutely wonderf
ul\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 they were goo
d crack and very \up0 \expndtw0\charscalex105 friendly, made you feel at home\ul
0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 (Mrs Brown)\par\p
ard\qj \li1265\ri0\sb131\sl-258\slmult0\fi179 \up0 \expndtw0\charscalex111 \ul0\
nosupersub\cf9\f10\fs18 Many of the participants in this study also expressed an
\up0 \expndtw0\charscalex107 appreciation of \u8216?humour\u8217? in nurse-pati
ent interaction:\par\pard\qj \li1265\ri0\sb131\sl-259\slmult0 \up0 \expndtw0\cha
rscalex104 \ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\f5\fs16 when
they\u8217?re coming around with the medicines, they are laughing \up0 \expndtw
0\charscalex109 and joking with everyone on the ward\ul0\nosupersub\cf11\f12\fs1
6 \u8230?\ul0\nosupersub\cf4\f5\fs16 I\u8217?d have a great joke with \up0 \expn
dtw0\charscalex104 them\ul0\nosupersub\cf11\f12\fs16 \u8230?\ul0\nosupersub\cf4\

f5\fs16 (Mrs Brown)\par\pard\qj \li1265\ri0\sb129\sl-259\slmult0\fi179 \up0 \ex


pndtw0\charscalex104 \ul0\nosupersub\cf9\f10\fs18 In this study, humour appe
ared to improve the partici-\line \up0 \expndtw0\charscalex110 pants\u8217?
self-esteem when they could make others laugh and \line \up0 \expndtw0\charscale
x112 when they could laugh with the nurses. It seemed that the \line \up0 \expnd
tw0\charscalex106 nurses who used humour appeared more approachable to the \line
\up0 \expndtw0\charscalex106 participants:\par\pard\qj \li1265\ri0\sb131\sl-258
\slmult0 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf4\f5\fs16 They\u8217?d (
staff nurses) have a laugh and a joke with you\ul0\nosupersub\cf11\f12\fs16 \u82
30?\ul0\nosupersub\cf4\f5\fs16 that\u8217?s what \line \up0 \expndtw0\charscalex
104 impressed me an awful lot about them. They were very friendly, very \line \u
p0 \expndtw0\charscalex113 nice, you could have a good talk, you could even have
a joke on \line \up0 \expndtw0\charscalex102 them\ul0\nosupersub\cf11\f12\fs16
\u8230?\ul0\nosupersub\cf4\f5\fs16 they\u8217?d know when you\u8217?d be doing a
bit of slagging. (Mr Kelly)\par\pard\ql \li1265\sb0\sl-253\slmult0 \par\pard\ql
\li1265\sb141\sl-253\slmult0 \up0 \expndtw0\charscalex102 \ul0\nosupersub\cf3\f
4\fs22 Discussion\par\pard\qj \li1265\ri0\sb132\sl-259\slmult0 \up0 \expndtw0\ch
arscalex103 \ul0\nosupersub\cf9\f10\fs18 \u8216?Lack of communication\u8217?
was the theme referred to most \line \up0 \expndtw0\charscalex105 frequentl
y by the participants in this study. They commented \line \up0 \expndtw0\charsca
lex109 on how nurses were more concerned with completing their \line \up0 \expnd
tw0\charscalex110 \u8216?tasks\u8217? than talking to them. Some of the particip
ants were \line \up0 \expndtw0\charscalex109 frustrated by this and felt that th
e nurses did not care about \line \up0 \expndtw0\charscalex110 them as individua
ls. Other participants acknowledged that \line \up0 \expndtw0\charscalex110 nurs
es were more concerned with their work and accepted \line \up0 \expndtw0\charsca
lex113 this as being normal, although they did indicate that they \line \up0 \ex
pndtw0\charscalex111 would have liked to be treated as an individual. However, \
line \up0 \expndtw0\charscalex105 regardless of how the participants felt
about how nurses\par\pard\ql \li1265\sb0\sl-184\slmult0 \par\pard\ql \li1265\s
b142\sl-184\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf4\f5\fs16 46\
par\pard\column \ql \li6346\sb0\sl-207\slmult0 \par\pard\ql \li222\sb100\sl-207\
slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs18 communicated,
they did not blame them. They all attributed\par\pard\qj \li222\ri632\sb9\sl-259
\slmult0 \up0 \expndtw0\charscalex103 the nurses\u8217? poor communication s
kills to them being \u8216?too \line \up0 \expndtw0\charscalex105 busy\u8217
?. Pontin & Webb (1995) and Attree (2001) suggest that \line \up0 \expndtw0\char
scalex108 patients are reluctant openly to criticize nurses because of a\par\par
d\qj \li222\ri632\sb1\sl-259\slmult0 \up0 \expndtw0\charscalex107 fear of retrib
ution or the passive nature of the patient role or \line \up0 \expndtw0\charscal
ex104 acceptance of the national health care delivery. They propose \line \up0 \
expndtw0\charscalex104 that instead patients \u8216?wrap up\u8217? their c
riticisms in socially\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndt
w0\charscalex107 acceptable responses (Pontin & Webb, 1995). This type of \lin
e \up0 \expndtw0\charscalex107 communication is particularly evident in the resp
onses from \line \up0 \expndtw0\charscalex106 the participants in this study. Ho
wever, it remains very clear\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \e
xpndtw0\charscalex111 from the participants\u8217? responses that nurses do not
always \line \up0 \expndtw0\charscalex109 communicate in a patient-centred way.
According to Sines \line \up0 \expndtw0\charscalex107 (1995) patients become
empowered by a patient-centred\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \u
p0 \expndtw0\charscalex105 approach to communication. It allows them to be a par
tner in \line \up0 \expndtw0\charscalex106 making decisions about their own
needs rather than the \line \up0 \expndtw0\charscalex103 nurses making assum
ptions about what their needs are (Sines,\par\pard\qj \li222\ri632\sb0\sl-259\sl
mult0 \up0 \expndtw0\charscalex105 1995). Patient-centred communication does not
take up more \line \up0 \expndtw0\charscalex103 of the nurses\u8217? time or re
quire extra resources (Astedt-Kurki & \line \up0 \expndtw0\charscalex105 Haggman
-Laitila, 1992; Williams, 1998), it is initiated by\par\pard\qj \li222\ri63
2\sb0\sl-259\slmult0 \up0 \expndtw0\charscalex110 nurses in the words and body l

anguage that they choose to \up0 \expndtw0\charscalex107 use when approaching pa


tients.\par\pard\qj \li222\ri632\sb0\sl-259\slmult0\fi179 \up0 \expndtw0\charsca
lex106 A possible reason why nurses do not always communicate \line \up0 \expndt
w0\charscalex107 in a patient-centred way is that although they have th
e \line \up0 \expndtw0\charscalex104 necessary communication skills, they ch
oose to use task-\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\
charscalex110 centred communication as a protection mechanism against \up0 \expn
dtw0\charscalex108 emotional or advocacy aspects of their work (Sines, 1995; \
up0 \expndtw0\charscalex102 Kruijver\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\no
supersub\cf9\f10\fs18 , \up0 \expndtw0\charscalex108 2001). This could be be
cause they feel\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw0\cha
rscalex108 unsupported or even discouraged from communicating in a \line \up0 \e
xpndtw0\charscalex109 patient-centred way by management \up0 \expndtw0\charsc
alex107 (McMahon, \up0 \expndtw0\charscalex107 1990;\par\pard\ql \li222\sb41\sl207\slmult0 \up0 \expndtw0\charscalex106 Wilkinson, 1991; Telford, 1992).\par\pa
rd\qj \li222\ri632\sb10\sl-259\slmult0\fi179 \up0 \expndtw0\charscalex112 The s
econd theme that emerged from the data was \line \up0 \expndtw0\charscale
x109 \u8216?attending\u8217?. When the participants experienced some or all \lin
e \up0 \expndtw0\charscalex106 of these behaviours they felt reassured, safe and
cared for as\par\pard\qj \li222\ri632\sb1\sl-259\slmult0 \up0 \expndtw0\charsca
lex104 an individual. Attending behaviours as experienced or valued \line \up0 \
expndtw0\charscalex108 by the participants in this study do not require extra ti
me or \line \up0 \expndtw0\charscalex105 resources. Knowing that they can trust
the nurses to be open/\par\pard\qj \li222\ri632\sb0\sl-259\slmult0 \up0 \expndtw
0\charscalex108 honest, understanding and be available if they needed them \line
\up0 \expndtw0\charscalex111 was the level of commitment required by the partic
ipants. \line \up0 \expndtw0\charscalex105 However, the effective use of attendi
ng behaviours by nurses\par\pard\qj \li222\ri633\sb0\sl-259\slmult0 \up0 \expndt
w0\charscalex110 requires that they value patient-centred communication \up
0 \expndtw0\charscalex102 (Arnold & Boggs, 1995) and have a strong sense
of self-\line \up0 \expndtw0\charscalex106 awareness (Burnard, 1990).\par\par
d\qj \li222\ri633\sb0\sl-258\slmult0\fi179 \up0 \expndtw0\charscalex107 The thir
d theme that emerged from the data is \u8216?empathy\u8217?. \line \up0 \expndtw
0\charscalex107 Empathy is defined by Reynolds & Scott (2000), p. 226) as:\par\p
ard\qj \li222\ri632\sb132\sl-259\slmult0 \up0 \expndtw0\charscalex114 \ul0\nosup
ersub\cf4\f5\fs16 the ability to perceive and reason as well as the ab
ility to \up0 \expndtw0\charscalex107 communicate understanding of the other pe
rson\u8217?s feelings and their \up0 \expndtw0\charscalex104 attached meanings\u
l0\nosupersub\cf11\f12\fs16 \u8230?\par\pard\qj \li222\ri632\sb131\sl-258\slmult
0\fi179 \up0 \expndtw0\charscalex106 \ul0\nosupersub\cf9\f10\fs18 Reynolds & Sco
tt (2000) describe empathy as an essential \line \up0 \expndtw0\charscalex108 pr
erequisite for good nursing practice. If nurses fail to\par\pard\ql \li6
144\sb0\sl-184\slmult0 \par\pard\ql \li20\sb143\sl-184\slmult0 \up0 \expndtw0\ch
arscalex104 \ul0\nosupersub\cf4\f5\fs16 2004 Blackwell Publishing Ltd,\ul0\nosup
ersub\cf7\f8\fs16 Journal of Clinical Nursing\ul0\nosupersub\cf4\f5\fs16 , 13,
41-49 \par\pard\sect\sectd\fs24\paperw11900\paperh15640\pard\sb0\sl-240{\bkmksta
rt Pg7}{\bkmkend Pg7}\par\pard\sect\sectd\sbknone\cols2\colno1\colw5757\colsr160
\colno2\colw5843\colsr160\ql \li836\sb0\sl-184\slmult0 \par\pard\ql \li836\sb0\s
l-184\slmult0 \par\pard\ql \li836\sb50\sl-184\slmult0 \up0 \expndtw0\charscalex1
04 \ul0\nosupersub\cf4\f5\fs16 Issues in clinical nursing\par\pard\qj \li836\ri1
49\sb247\sl-259\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosupersub\cf9\f10\fs1
8 empathize with their patients, then they cannot help them to \line \up0 \expnd
tw0\charscalex103 understand or cope effectively as individuals with their illne
ss \line \up0 \expndtw0\charscalex105 (Morse\ul0\nosupersub\cf5\f6\fs18 et al.\
ul0\nosupersub\cf9\f10\fs18 , 1992; Peplau, 1997; Reynolds & Scott, 2000). \line
\up0 \expndtw0\charscalex109 Most of the participants had positive experiences
of empa-\line \up0 \expndtw0\charscalex110 thetic communication by nurses. Howev
er, one participant \line \up0 \expndtw0\charscalex105 also experienced non-empa
thetic communication. This made \line \up0 \expndtw0\charscalex107 her feel unha
ppy, uncomfortable and uncared for. Although \line \up0 \expndtw0\charscalex105

the issues that she refers to are physical needs, it is important \line \up0 \ex
pndtw0\charscalex106 to note that, by not meeting the participants\u8217? physic
al needs, \line \up0 \expndtw0\charscalex105 the nurses were failing to com
municate to her that they \line \up0 \expndtw0\charscalex105 understood her
predicament or needs. This supports the view \line \up0 \expndtw0\charscalex110
that empathetic communication is an essential prerequisite \line \up0 \expndtw0\
charscalex106 for the delivery of quality nursing care. Because of the
\line \up0 \expndtw0\charscalex104 positive influence that empathetic commun
ication and the \line \up0 \expndtw0\charscalex105 negative influence non-em
pathetic communication has on \line \up0 \expndtw0\charscalex107 patients, it
is essential that nurses are aware of the impact of \line \up0 \expndtw0\charsc
alex110 the way they choose to communicate has on their patients. \line \up0 \ex
pndtw0\charscalex106 The implications are that nurses who chose to use
non-\line \up0 \expndtw0\charscalex109 empathetic communication favour task-cent
red rather than \line \up0 \expndtw0\charscalex107 patient-centred communication
. According to Gould (1990) \line \up0 \expndtw0\charscalex109 the professional
socialization of nurses encourages them to \line \up0 \expndtw0\charscalex112 lo
se their individuality and lose the natural ability to \line \up0 \expnd
tw0\charscalex108 empathize. This concurs with the literature (Menzies, 1960, \l
ine \up0 \expndtw0\charscalex110 1970; Burton, \up0 \expndtw0\charscalex110 198
5; McMahon, \up0 \expndtw0\charscalex109 1990; Telford, \up0 \expndtw0\charsca
lex106 1992;\par\pard\qj \li836\ri149\sb2\sl-258\slmult0\tx1015 \up0 \expndtw0\c
harscalex104 Graham, 1994; McColl\ul0\nosupersub\cf5\f6\fs18 et al.\ul0\nos
upersub\cf9\f10\fs18 , 1996) which suggests that \line \up0 \expndtw0\charsc
alex104 the professional socialization of nurses results in task-centred \line \
up0 \expndtw0\charscalex107 communication rather than patient-centred communicat
ion. \line\tab \up0 \expndtw0\charscalex110 The fourth theme that emerged from t
he data referred to\par\pard\qj \li836\ri149\sb2\sl-259\slmult0 \up0 \expndtw0\c
harscalex107 \u8216?friendly nurses\u8217?. All of the participants in the study
praised \line \up0 \expndtw0\charscalex105 the nurses for being friendly,
chatty and humorous. This \line \up0 \expndtw0\charscalex108 fulfilled an imp
ortant social function by relaxing the partic-\line \up0 \expndtw0\charscalex104
ipants, passing the time and helping them to forget their \line \up0 \
expndtw0\charscalex108 troubles. A possible reason why all the nurses used humou
r \line \up0 \expndtw0\charscalex108 and were friendly and chatty was that they
perceived it as a \line \up0 \expndtw0\charscalex103 superficial level of commun
ication that creates an atmosphere \line \up0 \expndtw0\charscalex108 that altho
ugh relaxed and sociable, is unsuitable for dealing \line \up0 \expndtw0\charsca
lex107 with emotional or difficult issues. The nurses, therefore, felt \line \up
0 \expndtw0\charscalex109 relatively safe communicating this way with all the pa
rtici-\line \up0 \expndtw0\charscalex112 pants. In contrast, although they can b
e superficial, social \line \up0 \expndtw0\charscalex107 interactions give patie
nts the opportunity to step out of their \line \up0 \expndtw0\charscalex106 sick
role and according to Sumners (1990) and Astedt-Kurki \line \up0 \expndtw0\char
scalex106 (2001) humour in the nurse-patient relationship helps to \line
\up0 \expndtw0\charscalex108 establish rapport and trust, relieves anxiety and t
ension and \line \up0 \expndtw0\charscalex106 conveys unspoken emotional message
s. This is evident from \line \up0 \expndtw0\charscalex106 the findings of this
study. The participants appeared to value \line \up0 \expndtw0\charscalex104 hig
hly the informal humorous exchanges with the nurses. \line \up0 \expndtw0
\charscalex111 This type of communication can help to pass the time and \line \u
p0 \expndtw0\charscalex108 deflect from mundane, routine hospital life and patie
nts are \line \up0 \expndtw0\charscalex106 frequently instrumental in creating s
uch interactions (Hollo-\line \up0 \expndtw0\charscalex107 way\ul0\nosupersub\cf
5\f6\fs18 et al.\ul0\nosupersub\cf9\f10\fs18 , 1998; Jarrett & Payne, 2000).\pa
r\pard\column \ql \li8547\sb0\sl-184\slmult0 \par\pard\ql \li8547\sb0\sl-184\slm
ult0 \par\pard\ql \li2650\sb50\sl-184\slmult0 \up0 \expndtw-1\charscalex100 \ul0
\nosupersub\cf7\f8\fs16 Nurse-patient communication\par\pard\ql \li5917\sb0\sl-2
18\slmult0 \par\pard\ql \li20\sb188\sl-218\slmult0 \up0 \expndtw0\charscalex104
\ul0\nosupersub\cf10\f11\fs19 Implications\par\pard\qj \li20\ri1061\sb138\sl-258

\slmult0 \up0 \expndtw0\charscalex101 \ul0\nosupersub\cf9\f10\fs18 The participa


nts in this study indicate that nurses do not always \up0 \expndtw0\charscalex10
1 communicate in a patient-centred way even when they have the \up0 \expndtw0\ch
arscalex109 ability to do so and that nurse-patient interaction is heavily \up0
\expndtw0\charscalex103 influenced by the work and culture of the organization (
Jarrett \up0 \expndtw0\charscalex107 & Payne, 2000). However, the literatur
e (Peplau, 1988; \up0 \expndtw0\charscalex101 Severston, \up0 \expndtw0\charsc
alex107 1990; Fosbinder, \up0 \expndtw0\charscalex111 1994; Redfern & Norman
,\par\pard\qj \li20\ri1061\sb2\sl-259\slmult0 \up0 \expndtw0\charscalex109 1999;
Thorsteinsson, 2002) suggests that a positive nurse-\line \up0 \expndtw0\chars
calex109 patient relationship is essential for quality nursing care and \line \u
p0 \expndtw0\charscalex110 that this can only be achieved through patient
-centred \line \up0 \expndtw0\charscalex110 communication. The implications of t
his are that, if health \line \up0 \expndtw0\charscalex105 care management want
to ensure that patients receive quality \line \up0 \expndtw0\charscalex104 nursi
ng care, they will need to consider positive nurse-patient \line \up0 \expndtw0\
charscalex104 communication as essential and not an optional extra (Attree, \lin
e \up0 \expndtw0\charscalex103 2001; Chant\ul0\nosupersub\cf5\f6\fs18 et al.\ul
0\nosupersub\cf9\f10\fs18 , 2002). Spending long periods of time with \line \up0
\expndtw0\charscalex112 patients does not always result in a positive nurse-pat
ient \line \up0 \expndtw0\charscalex103 relationship. Astedt-Kurki & HaggmanLaitila (1992) sug-\line \up0 \expndtw0\charscalex105 gest that patient-cent
red communication does not require \line \up0 \expndtw0\charscalex106 additi
onal resources. This implies that staff shortages or \line \up0 \expndtw0
\charscalex106 being \u8216?too busy\u8217? cannot be used as an excuse for poor
nurse-\line \up0 \expndtw0\charscalex112 patient communication. It is the quali
ty of the interaction \line \up0 \expndtw0\charscalex107 that determines whether
the relationship is a positive one or \line \up0 \expndtw0\charscalex103 not a
nd it is the nurse who has the greatest influence on \line \up0 \expnd
tw0\charscalex104 whether this happens (Milne & McWilliam, 1996). Com-\li
ne \up0 \expndtw0\charscalex111 mitment to providing patient-centred care and a
change in \line \up0 \expndtw0\charscalex103 individual, professional and organi
zational values is sufficient \line \up0 \expndtw0\charscalex104 (Attree, 2001)
in order to result in the delivery of high quality \line \up0 \expndtw0\charscal
ex105 nursing care.\par\pard\ql \li20\ri1061\sb0\sl-259\slmult0\fi179\tx209 \up0
\expndtw0\charscalex106 At an undergraduate and postgraduate level, educa
tion \line \up0 \expndtw0\charscalex110 relating to patient-centred communicatio
n should focus on \line \up0 \expndtw0\charscalex107 illustrating that this type
of communication does not require \line \up0 \expndtw0\charscalex109 a great
deal of time. Role-play and the use of critical \line \up0 \expndtw0\cha
rscalex103 incidences is an ideal way of helping students and staff nurses \line
\up0 \expndtw0\charscalex109 to critically reflect on how they communicate with
patients \line \up0 \expndtw0\charscalex104 (Quinn, 1995). This would also help
to develop their sense of \line \up0 \expndtw0\charscalex107 self-awareness an
d subsequently increase their ability to \line \up0 \expndtw0\charscalex104
communicate using attending and empathetic communication \line \up0 \expndtw0\c
harscalex105 behaviours. The consequence of this in conjunction with \lin
e \up0 \expndtw0\charscalex111 other organizational factors is the delivery of h
igh quality \line \up0 \expndtw0\charscalex111 nursing care. This type of teachi
ng strategy would require \line \up0 \expndtw0\charscalex106 small group teachin
g and this has implications for how large \line \up0 \expndtw0\charscalex109 und
ergraduate groups of students are organized for the \line \up0 \expndtw0\
charscalex103 effective use of such strategies. The findings of this study and \
line \up0 \expndtw0\charscalex103 similar patient-focused studies could, how
ever, be used to \line \up0 \expndtw0\charscalex104 inform even large grou
ps of nursing students about what \line \up0 \expndtw0\charscalex108 patien
ts value about nurse-patient communication. \line\tab \up0 \expndtw0\charscalex1
10 There is a need to conduct further research that explores \line \up0 \expndtw
0\charscalex105 patients\u8217? experiences of how nurses communicate rather tha
n \line \up0 \expndtw0\charscalex108 conducting studies that examine nurses\u821

7? views of what they \par\pard\sect\sectd\sbknone \li1015\sb0\sl-184\slmult0\pa


r\pard\li1015\sb142\sl-184\slmult0\fi0\tx10464 \up0 \expndtw0\charscalex104 \ul0
\nosupersub\cf4\f5\fs16 2004 Blackwell Publishing Ltd,\ul0\nosupersub\cf7\f8\fs1
6 Journal of Clinical Nursing\ul0\nosupersub\cf4\f5\fs16 , 13, 41-49\tab \up0 \
expndtw0\charscalex104 47\par\pard\sect\sectd\fs24\paperw11900\paperh15640\pard\
sb0\sl-240{\bkmkstart Pg8}{\bkmkend Pg8}\par\pard\ql \li1265\sb0\sl-184\slmult0
\par\pard\ql\li1265\sb0\sl-184\slmult0 \par\pard\ql\li1265\sb60\sl-184\slmult0 \
up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf7\f8\fs16 C. McCabe\par\pard\sect
\sectd\sbknone\cols2\colno1\colw6034\colsr110\colno2\colw5616\colsr160\ql \li126
5\sb0\sl-207\slmult0 \par\pard\ql \li1265\sb100\sl-207\slmult0 \up0 \expndtw0\ch
arscalex104 \ul0\nosupersub\cf9\f10\fs18 perceive good nurse-patient communic
ation to be. Patient\par\pard\qj \li1265\ri0\sb9\sl-259\slmult0 \up0 \expndtw
0\charscalex105 focused studies may identify specific nursing behaviours that \l
ine \up0 \expndtw0\charscalex109 patients value highly in terms of patient-centr
ed communi-\line \up0 \expndtw0\charscalex107 cation. This kind of informati
on would allow nurses to \line \up0 \expndtw0\charscalex105 demonstrate and
develop specific interpersonal skills that are \line \up0 \expndtw0\charscalex10
5 patient-centred.\par\pard\qj \li1265\ri0\sb1\sl-258\slmult0\fi179 \up0 \expndt
w0\charscalex105 A possible limitation to this study is that the small number \l
ine \up0 \expndtw0\charscalex105 of participants means that the findings cannot
be generalized \line \up0 \expndtw0\charscalex109 to a wider context or populati
on, however, the findings are \line \up0 \expndtw0\charscalex108 useful in that
they can be used to inform undergraduate and \line \up0 \expndtw0\charscalex109
postgraduate nursing students about the possible impact of \line \up0 \expndtw0\
charscalex104 their communication behaviour on the delivery of quality \l
ine \up0 \expndtw0\charscalex105 nursing care.\par\pard\ql \li1265\sb0\sl-253\sl
mult0 \par\pard\ql \li1265\sb141\sl-253\slmult0 \up0 \expndtw0\charscalex104 \ul
0\nosupersub\cf3\f4\fs22 Conclusion\par\pard\qj \li1265\ri0\sb132\sl-259\slmult0
\up0 \expndtw0\charscalex103 \ul0\nosupersub\cf9\f10\fs18 The findings of th
is study indicate that in contrast to the \line \up0 \expndtw0\charscalex
110 literature that suggests that nurses are not good at commu-\line \up0 \expnd
tw0\charscalex104 nicating with patients, nurses can communicate well wit
h \line \up0 \expndtw0\charscalex105 patients when they use a patient-centred ap
proach. However, \line \up0 \expndtw0\charscalex105 health care organizations do
not appear to value or recognize \line \up0 \expndtw0\charscalex111 the importa
nce of nurses using a patient-centred approach \line \up0 \expndtw0\charscalex10
7 when communicating with patients to ensure the delivery of \line \up0 \expndtw
0\charscalex104 quality patient care. Another reason why nurses may not
\line \up0 \expndtw0\charscalex113 communicate in a patient-centred way is that
they do not \line \up0 \expndtw0\charscalex110 know what patients value about nu
rse-patient interactions. \line \up0 \expndtw0\charscalex105 This lack of eviden
ce also limits the way in which nurses are \line \up0 \expndtw0\charscalex114 ed
ucated in relation to how to communicate in a patient-\line \up0 \expndtw0\chars
calex104 centred way. Unless health care organizations and nurses \line \
up0 \expndtw0\charscalex105 recognize the importance of communicating in a
patient-\line \up0 \expndtw0\charscalex109 centred way in order to deliver goo
d quality care, the task-\line \up0 \expndtw0\charscalex108 centred approach t
o patient care as experienced by the \line \up0 \expndtw0\charscalex107 pa
rticipants in this study will continue.\par\pard\ql \li1265\sb0\sl-253\slmult0 \
par\pard\ql \li1265\sb141\sl-253\slmult0 \up0 \expndtw0\charscalex107 \ul0\nosup
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0 \expndtw0\charscalex109 \ul0\nosupersub\cf9\f10\fs18 Study design: CM; data an
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