METHODOLOGY

Nurse-Patient Dyads: Linking Nurse & Patient Characteristics to Outcome

Lourdes 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

Abstract
The 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.

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 nursepatient 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.

interactions were explored in terms of openness and engagement, nurse-patient characteristics affecting them, evaluation in 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 conversational 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 nurse and 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 health teaching 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

Results
Quantitative Portion A total of 420 nurses and patients participated in the study. The reliability and validity of the NPBI were established based on 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 teaching had significant path coefficients with nurse-patient bonding scores which 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%) were nurses and 26 were patients. The nurse-patient interaction is the critical incident that served as the focus of the interviews and observations. These

Introduction
The patients sense of well-being, more importantly for the terminally ill, is nestled in 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 characteristics 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 nursepatient 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

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Nurse-Patient Dyads: Linking Nurse & Patient Characteristics to Outcome pp. 13-14

METHODOLOGY

at the same time communicating individuals who can direct their interactions towards bonding or dissonance. This is consistent with symbolic interactionism which 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 determined 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 dyadic relationship 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. For further information, please contact: lmstejero@upm.edu.ph; lourdestejero@yahoo.com

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.

Patient Reported Outcomes