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METHODOLOGY

PRO NEWSLETTER 42 (Fall Issue)

AbstractThe main goal of this study is to test the

proposed theory asserting that the

nurse-patient dyad mediates between

nurse-patient characteristics and

patient satisfaction. This research paper

utilized methods triangulation. Both

quantitative and qualitative techniques

were employed to describe the

phenomenon of the nurse-patient dyad.

A total of 420 nurses and patients

participated in the quantitative portion of

this study. Through path analysis, the

intermediary role of the nurse-patient

dyad was supported. In the qualitative

part, manifestations of openness and

engagement from nurses and patients

were identified. The formation of the

different dyads was likewise explored.

Introduction

The patients sense of well-being, more

importantly for the terminally ill, is nestledin the interaction between nurse and

patient. The nurse and patient form a dyad

as they interact. The outcome, i.e. patient

satisfaction, ensue not from the character-

istics of the nurse and patient per se but

from the nurse-patient dyad.

The specific aims of this study are to (1)

validate the Nurse-Patient Bonding

Instrument (NPBI) that will be used to

categorize the different nurse-patient

dyads (2) determine the intermediary effect

of nurse-patient dyads between nurse-

patient characteristics and patient

satisfaction through path analysis; (3)

describe further the different dyads in

terms of factors affecting their formation

and development based on the experiences

of nurses and patients through a qualitative

research approach.

Methodology

This study utilized methods triangulation.

Both quantitative and qualitative

techniques were employed to describe the

phenomenon of the nurse-patient dyad.

The quantitative aspect tested the model

indicating the relationship between nurse& patient characteristics to patient

satisfaction, mediated by the nurse-patient

dyad. The qualitative part which used the

critical incident technique (Byrne, 2001)

provided in-depth information on the nurse-

patient dyad, adding more information to

the quantitative findings.

The research was done in the clinical units

of 2 public and 2 private hospitals in Manila,

Philippines. Two trained data collectors

observed nurse-patient interactions and

interviewed the nurses and patients

afterwards. Participants signed a consent

form. This research was approved by the

Ethics Review boards of the participating

institutions.

Results

Quantitative Portion

A total of 420 nurses and patients

participated in the study. The reliability and

validity of the NPBI were established basedon interrater reliability, construct validity

through known-groups technique, and

content validity.

Path analysis results showed that the

patients number of co-morbidities and the

nurses health teachinghad significant path

coefficients with nurse-patient bonding

scoreswhich in turn showed a significant

path coefficient with patient satisfaction.

There were no nurse-patient characteristics

that showed significant paths directly

linking to patient satisfaction. Hence, the

intermediary role of the nurse-patient dyad

is confirmed. The fit of this first model was

evaluated as adequate using several

parameters - CFI, RMSEA, GFI, Chi-Square.

Therefore, the interpretations are deemed

valid.

Qualitative Portion

A total of 55 nurses and patients from the 4

hospitals participated in qualitative portion

of this study. Twenty-nine (53%) werenurses and 26 were patients.

The nurse-patient interaction is the critical

incident that served as the focus of the

interviews and observations. These

interactions were explored in terms of

openness and engagement, nurse-patient

characteristics affecting them, evaluationin terms of satisfaction with the interaction,

etc.

Positive and negative manifestations of

openness and engagement for both nurses

and patients were identified. These were

verbal and non-verbal behaviours. The

qualitative data gathered also involved a

more in-depth exploration on the different

types of dyads, namely the therapeutic,

task-oriented, dysfunctional, and conver-

sational dyads. Specific behaviours of

nurses and patients, positive and negative,

facilitating or non-facilitating, were

analysed.

Discussion

In the merging of analysis of the

quantitative and qualitative portions of the

study, there were variables shown to be

validated by both approaches. The

delineation and characterization of the

types of dyads were established. The

synergistic interaction between the nurseand patient was likewise validated in the

quantitative portion and more deeply in the

qualitative investigations. The mediating

role of the nurse-patient dyad was affirmed

in the path analysis and was further

elucidated in the qualitative portion. More

details were provided especially on the

interplay of the openness and engagement

and the variations in behavior-response

interchange between nurse and patient.

The nurses clinical competence and healthteaching were shown to have significant

path coefficients and which were affirmed

in the qualitative part by both nurses and

patients.

There were findings in qualitative portion

that were not in the quantitative part. The

evolution of the dyad emerged in the

qualitative observations and interviews,

highlighting the dynamic human responses

between the nurse and patient who are

able to steer even negative interactions

towards the formation of a therapeutic

dyad. Even with very short interactions,

these could be made therapeutic. The

nurse and patient are self-determining and

Nurse-Patient Dyads: Linking Nurse &

Patient Characteristics to OutcomeLourdes Marie S. Tejero, PhD, RN

University of the Philippines

College of Nursing

KEYWORDS

NURSE-PATIENT DYADS, NURSE-PATIENT BONDING,

NURSE-PATIENT RELATIONSHIP, PATIENT

SATISFACTION, METHODS TRIANGULATION

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at the same time communicating individuals

who can direct their interactions towards

bonding or dissonance. This is consistent

with symbolic interactionismwhich views

interaction between persons not in a

stimulus-response framework but as a

meaningful and purposive interchange(Shattell, 2004).

The therapeutic dyad is the goal of every

nurse-patient interaction. It is important to

recognize the importance of fostering a

therapeutic interaction in order to bring

about an important outcome: satisfaction.

Moreover, nurses should be conscientious

of their openness and how they could

engender openness from the patients.

The dyadic relationship is a bonding

between the nurse and patient. With a

positive/negative behavior responded with

a positive/negative reaction, the crucial

aspect was the response which deter-

mined the fate of the emerging dyad. The

bonding resulted in mutual respect and

trust, treating each other as friends or

family members. Failure to steer the dyadicrelationship positively ends in dissonance.

It can be deduced that the interaction is

directed by two free and thinking individuals

who can bring about positive results from

even negative events. The nurse, being

healthier and more knowledgeable in

health than patient, has the responsibility to

steer the interaction towards a bonding

relationship. This was shown in how nurses

have dealt with difficult patients and

watchers, in making short interactions

therapeutic. The key to this was empathy

and understanding what nurses and

patients had manifested in words and

actions.

Byrne, M. (2001). Critical incident technique as a qualitative

research method. AORN Journal, October 2001. Retrieved

on October 20, 2008 from http://findarticles.com/p

/articles/mi_m0FSL/is_4_74/ai_80159552

Shattell, M. (2004). Nursepatient interaction: a review of

the literature. Journal of Clinical Nursing, 13, 714722

Streubert-Speziale, H.J. & Carpenter, D.R. (2003).

Qualitative research in nursing: advancing the humanistic

perspective (3rd ed.). Philadelphia: Lippincott Williams &

Wilkins.

METHODOLOGY

Patient Reported Outcomes

Nurse-Patient Dyads:Linking Nurse & Patient Characteristics

to Outcome pp. 13-14

For further information, please contact:

lmstejero@upm.edu.ph;lourdestejero@yahoo.com