Person-Centered Relational Care Experienced by Critical Care Nurses: An Interpretative Phenomenological Analysis Study

Myoung Sun Jang; Sungjae Kim

doi:10.4040/jkan.2019.49.4.423

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Jang and Kim: Person-Centered Relational Care Experienced by Critical Care Nurses: An Interpretative Phenomenological Analysis Study

Original Article

J Korean Acad Nurs 2019;49(4):423-436.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.4.423

Person-Centered Relational Care Experienced by Critical Care Nurses: An Interpretative Phenomenological Analysis Study

Myoung Sun Jang¹, Sungjae Kim^2,

¹College of Nursing, Seoul National University, Seoul

²College of NursingㆍThe Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Address reprint requests to : Kim, Sungjae College of NursingㆍThe Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8814 Fax: +82-2-765-4103 E-mail: sungjae@snu.ac.kr

Received 21 January 2019 Revised 10 May 2019 Accepted 21 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The aim of the study was to explore nurses’ experience of person-centered relational care in the context of critical care.

Methods

Key interview questions were developed based on the human-to-human relationship model suggested by Travelbee. Data were collected through in-depth interviews with a purposive sample of 11 nurses having more than 2 years of working experience in intensive care units. An interpretative phenomenological analysis was conducted to analyze the data.

Results

Four super-ordinate and nine sub-ordinate themes were identified. Emerged super-ordinate themes were as follows: (1) encountering a live person via patient monitoring systems; (2) deep empathic connection; (3) humanistic and compassionate care, and (4) accompanying the journey to the end. Study findings revealed that nurses in intensive care units experienced ‘balancing emotions’ and ‘authenticity’ in caring when entering human-to-human relationships with dying patients. The phenomenon of person-centered relational care in intensive care units was found to subsume intrinsic attributes of empathy, compassion, and trust, similar to the central concepts of Travelbee's theory.

Conclusion

The interpretative findings in this study provide deeper understanding of Travelbee's human-to-human relationship model. The technological environment in intensive care units did not hinder experienced nurses from forming human-to-human relationships. These themes need to be emphasized in critical care nursing education as well as in nursing management. The results of this study will contribute to understanding nurse-patient caring relationships in depth, and help improve the quality of nursing care in intensive care units.

Keywords: Critical Care, Empathy, Intensive Care Units, Nurse-Patient Relations, Qualitative Research

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Figure 1.

Data analysis procedure based on Interpretative phenomenological analysis.

Figure 2.

Study findings of person-centered relational care experienced by intensive care unit nurses.

Table 1.

Participant Characteristics

ID	Gender	Age (yr)	Religion	Education	Type of ICU	Length of time in profession (yr)	Length of time in ICU (yr)
P01	Female	31	None	Graduate school	MICU	5.25	5.25
P02	Female	31	None	University	CCU	4.25	3.25
P03	Female	30	Christianity	University	MICU	9.00	6.40
P04	Female	30	None	University	SICU	9.16	9.16
P05	Female	27	None	University	MICU	5.00	5.00
P06	Female	29	Catholic	Graduate school	CPICU	5.75	5.75
P07	Female	26	Christianity	University	SICU	4.58	4.58
P08	Female	28	Buddhism	University	PICU	5.16	5.16
P09	Female	44	Buddhism	Graduate school	SICU	21.00	16.00
P10	Female	32	None	Graduate school	MICU	7.83	7.83
P11	Female	27	None	University	CPICU	2.50	2.50

P=Participant; CCU=Cardiac (Coronary) Care Unit; CPICU=Cardiopulmonary Intensive Care Unit; ICU=Intensive Care Unit; MICU=Medical Intensive Care Unit; PICU=Pediatric Intensive Care Unit; SICU=Surgical Intensive Care Unit.

Table 2.

Key Interview Questions

Interview questions	Related concepts of Travelbee’s human-to-human relationship model
Tell me about your work in ICU
• Could you describe typical day in the ICU for me?
Could you tell me about a memorable experience in relationships or interactions with patients in ICU?	Human-to-human relationship;
• Why do you remember the patient?	Human being, Perception
• How did you feel?
Could you tell me how you get to know your patients in the ICU?	Human-to-human relationship;
• How long does it take to build a relationship with a patient?	Perception
Could you tell me about your experience in fostering a therapeutic relationship with your patient?	Rapport; Therapeutic self
• Are there any barriers to forming a relationship with patients in the ICU?
• What does it mean to you to preserve this relationship?
Do you think the ICU environment affects the way you develop a relationship with patients?	Interaction; Communication;
• If so, why?	Relationship
• How?
Have you ever talked to an unconscious patient?	Interaction; Relationship
• If so, what did you say? If not, why?
• What did relationships mean to you?
Have you ever been sympathetic (or empathetic) to patients?	Sympathy; Empathy
• If so, could you tell me how you felt?
• Did it affect patient care?
How did you relieve the patient’s suffering?	Sympathy; Empathy; Suffering;
• If so, what did you do or say?	Nursing needs
• What did you think of patient’s suffering?
Does caring for a patient in the ICU affect your life?	Finding a meaning
• What changes have been made in your work life?
• What does it mean to you take care of a patient in the ICU?

ICU=Intensive Care Unit.

Table 3.

List of Super-ordinate Themes, Sub-ordinate Themes, and Quotes

Super-ordinate theme	Sub-ordinate theme	Quote (Participant contribution)	Occurrence (%)
Encountering a live	Focusing on patient’s	• I monitor physiological signals first; I attend to patients who are under	81.8
person via patient	life sending vital signs	critical monitoring systems more often (P01).
monitoring systems		• I remember only the hour that comes back every hour because I have to
		monitor the patient’s vital signs every hour (P02).
		• I respond vigilantly to every alarm that sounds (P03).
		• The first thing I do to a hospitalized patient is to connect monitoring
		systems (P04).
		• The sooner I detect abnormal signs of the patients the better I can solve
		problems, avoiding deterioration (P05).
		Other participant contributions: P07, P08, P09, P11
	Perceived anxiety	• Patients are trapped in a closed space that only opens twice a day; they	81.8
		experience fear and estrangement (P01).
		• The patient hated the ICU environment, asking to go home (P03).
		• We are strangers to the patients, even though we care for them. They
		seem to be eager to get out of here (P04).
		• He looked very confused and anxious (P05).
		Other participant contributions: P07, P08, P09, P10, P11
Deep empathic	Feeling of closeness	• I thought of him as my grandfather (P01).	81.8
connection	like family	• I felt like my mom and dad were sick (P03).
		• When I saw the patient’s hands, it looked like my mom’s hand. She’s like
		my mom. I was more attached and I cleaned her face once more (P04).
		• What if my mom and dad was lying like that? (P05).
		• I called older patients ‘grandmother’ or ‘grandfather’ (P06).
		Other participant contributions: P07, P09, P10, P11
	Emotional resonance	• He greeted me and showed concern for me (P01).	90.9
	through thanks and	• The grandmother (Referring to the patient) expressed gratitude to me,
	apologies	calling me an angel (P02).
		• The patient said ‘you are so kind’ (P03).
		• She recognized me, saying ‘hello’, then she told me everything (P04).
		• When patients said “Nurses are also human, you must be tough and I am
		thank you and I am sorry”, Then I felt that I was being respected by the
		patient (P06).
		Other participant contributions: P05, P07, P09, P10, P11
Humanistic and	The body revealing the	• I like talking to unconscious patients, for they are human beings. I just talk	72.7
compassionate care	journey of life	to them while washing their bodies (P02).
		• When I saw his face, and called his name once more, I thought there was
		something in his eye. Then I felt sorry (P03).
		• He (unconscious patient) cannot open his eyes and look at me, but I do
		not feel distanced from him (P04).
		• When suctioning the patient, I tell him I will remove secretion (P05).
		• Although I cannot communicate with unconscious patients, I talk to them
		before providing nursing care like suctioning (P06).
		Other participant contributions: P07, P10, P11
	Understanding	• I read his facial expression and sensed his pain (P01).	100.0
	suffering	• I know what patients want from my experiences (P02).
		• Before patients call me, I have already approached them (P03).
		• I have been hospitalized. After that, I understand patients’ suffering and
		how they feel (P04).
		• If the intubated patient expresses what he wants to say by hand signals,
		neither his mother nor the doctor understand. But I think we can
		understand what he needs (P07).
		Other participant contributions: P05, P06, P08, P09, P10, P11
Accompanying the	Being fully present by	• I am with the patients in the moments that they need me most, and	81.8
journey to the end	trust	making them trust me, enabling them to accept the care I provide (P01).
		• I try to be with them, respond them, and solve problems immediately (P03).
		• I listen to the patient, and try to solve all issues the patient brings up (P05).
		• I fully feel the sadness, I am fully mourning and thinking about the
		relationship with the patient and joining the family mourning (P06).
		• I just thought we are here to help them until the end, to make them feel
		comfortable (P08).
		Other participant contributions: P07, P09, P10, P11
	Balancing emotions	• I felt a sense of closeness toward him, but he had passed away, and there	63.6
		were other patients who needed me (P01).
		• I brace myself against sorrow when my patients’ conditions deteriorate
		(P02).
		• Because I do not want my heart to be sad (P03).
		• I try not to shed tears, trying to concentrate on dying patients (P04).
		Other participant contributions: P06, P09, P11
	Growing in authentic	• Being with the patient in tough moments, gives me a sense of fullness	54.5
	care	(P01).
		• Not thinking I can take care of patients without humaneness, which makes
		me carry out my nursing practice more sincerely (P03).
		• I care for the patients with all my heart so that they can get better and go
		to the ward. When I take care of them sincerely, my satisfaction increases
		(P06).
		Other participant contributions: P07, P08, P09

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