JAN ORIGINAL RESEARCH
‘Caring for’ behaviours that indicate to patients that nurses ‘care about’
them
Amanda Henderson, Mary Ann Van Eps, Kate Pearson, Catherine James, Peter Henderson
& Yvonne Osborne
Accepted for publication 23 May 2007
Correspondence to A. Henderson:
e-mail: Amanda_Henderson@health.qld.
gov.au
Amanda Henderson BSc MScSoc PhD RN
RM
Professor
Griffith Health, Griffith University, Gold
Coast, Queensland, and Nursing Director
(Education), Princess Alexandra Hospital,
Woolloongabba, Queensland, Australia
Mary Ann Van Eps BN MN RN RM
Nurse Educator
Service Improvement, QEII Hospital,
Coopers Plains, Queensland, Australia
Kate Pearson BN MN RN
Nursing Director
QEII Hospital, Coopers Plains, Queensland,
Australia
Catherine James BA MBA RN
Director of Nursing
QEII Hospital, Coopers Plains, Queensland,
Australia
Peter Henderson BSc MN RN RM
Casual Lecturer
University of Ballarat, Ballarat, Victoria,
Australia
Yvonne Osborne EM EdD RN
Lecturer in Nursing
Queensland University of Technology,
Brisbane, Queensland, Australia
146
HENDERSON A., VAN EPS M.A., PEARSON K., JAMES C., HENDERSON P. &
OSBORNE Y. (2007) ‘Caring for’ behaviours that indicate to patients that nurses
‘care about’ them. Journal of Advanced Nursing 60(2), 146–153
doi: 10.1111/j.1365-2648.2007.04382.x
Abstract
Title. ‘Caring for’ behaviours that indicate to patients that nurses ‘care about’ them
Aim. This paper is a report of a study to explore what constitutes nurse–patient
interactions and to ascertain patients’ perceptions of these interactions.
Background. Nurses maintain patient integrity through caring practices. When
patients feel disempowered or that their integrity is threatened they are more likely
to make a complaint. When nurses develop a meaningful relationship with patients
they recognize and address their concerns. It is increasingly identified in the litera-
ture that bureaucratic demands, including increased workloads and reduced staffing
levels, result in situations where the development of a ‘close’ relationship is limited.
Method. Data collection took two forms: twelve 4-hour observation periods of
nurse–patient interactions in one cubicle (of four patients) in a medical and a sur-
gical ward concurrently over a 4-week period; and questionnaires from inpatients of
the two wards who were discharged during the 4-week data collection period in
2005.
Findings. Observation data showed that nurse–patient interactions were mostly
friendly and informative. Opportunities to develop closeness were limited. Patients
were mostly satisfied with interactions. The major source of dissatisfaction was
when patients perceived that nurses were not readily available to respond to specific
requests. Comparison of the observation and survey data indicated that patients still
felt ‘cared for’ even when practices did not culminate in a ‘connected’ relationship.
Conclusion. The findings suggest that patients believe that caring is demonstrated
when nurses respond to specific requests. Patient satisfaction with the service is more
likely to be improved if nurses can readily adapt their work to accommodate
patients’ requests or, alternatively, communicate why these requests cannot be
immediately addressed.
Keywords: caring, empirical research report, interactions, nurses, observation,
patients, survey
 2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd
JAN: ORIGINAL RESEARCH
Introduction
Caring is fundamental to nurses’ work. Through caring acts,
including informing, treating with respect, and showing
concern for personal stress, nurses maintain patients’ self-
worth (Dingman et al. 1999). Major economic, social and
ethical issues confront contemporary nursing practice and
also directly affect ‘caring’ as it has traditionally been
performed.
Background
Caring is a complex phenomena that is the core construct of
many nursing theories (McCance et al. 1999). The concept of
caring has been extensively explored in nursing practice
(McCance et al. 1997, Bassett 2002, Fingeld-Connett 2007).
Through the provision of care nurses argue that they are
receptive and responsive to patients’ needs. As patients are
the recipients of care, it is important to identify their
perceptions of caring (Deary et al. 2002). Four critical
attributes have been identified from a substantial review and
analysis of the caring literature, namely, ‘serious attention’,
‘concern’, ‘providing for’ and ‘getting to know’; these
attributes were consistent across both nurse and patient
groups (McCance et al. 1997, p. 247).
Savage (1995) identifies the importance of ‘closeness’
(physical presence) which assists the establishment of a
rapport that enhances the ‘attention’, ‘concern’ and ‘getting
to know’ between nurse and patient in the acute hospital
setting. Effective communication practices such as paying
attention and appropriate feedback are important if close-
ness is to be sustained (Caris-Verhallen et al. 1999).
However, while consideration and concern are important
for both nurses and patients, the priority of specific caring
acts may differ between nurses and patients. Competency
in physical skills and the performance of tasks is highly
desired by patients. This is in contrast to nurses who often
rate humanistic behaviour as most important (Bassett
2002).
Consistent across studies into the nurse–patient interac-
tion is the presence of factors that facilitate relationship
building (Fosbinder 1994, Caris-Verhallen et al. 1999,
Johnston & Smith 2006). Bureaucratic demands, including
financial and resource constraints, can severely limit the
demonstration of and ability to practise ‘closeness’ (Savage
1995, Maben et al. 2006). The erosion of environmental
factors can affect care and, accordingly, whether patients
feel respected (Irurita 1999). Respect is recognized as
integral to the provision of care (McCance et al. 1997).
 2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd
‘Caring for’ behaviours that indicate nurses ‘care about’ patients
Recognition by nurses that patients are individuals is
important for the maintenance of respect: Coyle (1999)
identified that, when patients voiced their ‘dissatisfaction’, it
related to individual accounts of their problems with health
care where they felt disempowered, dehumanized and
devalued. Such feelings prevailed regardless of other positive
factors experienced within the healthcare service (Coyle
1999). Maintaining patients’ integrity during their associ-
ation with the healthcare service is imperative to patient well-
being. Arguably, through caring practices, nurses are well
positioned to ensure the maintenance of respect and integrity.
Clearly explicating components of interest to patients is
beneficial in understanding why they sanction and support
the health service.
Working environments must be conducive to the enact-
ment of caring (Fingeld-Connett 2007). It is increasingly
identified in the literature that bureaucratic demands, such as
increased workloads and reduced staffing levels, result in
situations where the relationship basis of nursing is unable to
be sufficiently developed for nurses to anticipate patients’
needs (Maben et al. 2006). This can ultimately affect how
patients view nursing care. An Australian study of patients
undergoing colorectal surgery rated nursing staff’s willing-
ness to help patients and provide prompt service the second
most important feature after ‘nursing staff’s ability to
perform the promised service dependably and accurately’
(Lumby & England 2000, p. 143).
In studies that explore patients’ expectations of health care,
responsiveness contributes significantly to patients’ feelings of
safety and well-being regarding their care (Irurita 1999,
Middleton & Lumby 1999, Lumby & England 2000).
A nurse’s visit, when not elicited by the patient, is a
significant component of care; however, if this is not
forthcoming, patients will often give excuses, such as they
know the nurses are busy (O’Connell et al. 1999).
What is important to patients during their episode of care
was of interest in this study. Two different perspectives, that
is observations and questionnaires, were sought as just asking
questions and seeking opinions is limited in explicating the
complex and contextual nature of what constitutes caring
practices (McCance et al. 2001).
The study
Aim
The aims of this study were to explore what constitutes
nurse–patient interactions and to ascertain patients’ percep-
tions of these interactions.
147
A. Henderson et al.
Design
Two forms of data collection were used to explore caring
practices in this study:
• Observation of nurse–patient interactions.
• Patient surveys.
Qualitative data together with descriptive statistics were
used as numerical data can be informative about the
prevalence of a situation (Sandelowski 2001). The settings
were two general wards of a 160-bed public Acute Care
Adult Hospital in south-east Queensland, Australia in 2005.
The region served by the hospital includes both low and high
socioeconomic groups.
Participants
Observation phase
A convenience sample of nurses and patients across two general
medical and surgical wards were observed. Participants were
those patients and nurses in the cubicle that was randomly
selected at the time that the observation was occurring.
Questionnaire
A purposive sample of patients was asked to complete the
questionnaire. These patients were purposefully targeted as
they were patients in the two wards who were discharged
during the 4-week data collection period.
Data collection
Observation
Observation of nurse–patient interactions occurred in one
medical and one surgical ward concurrently over a 4-week
period. Twelve observation sessions of 4-hour duration were
undertaken by two observers. As an observer can become
complacent with activities being observed, observation took
place during 4-hour sessions. An initial observation of four
4-hour sessions was undertaken to pilot the positioning of
the researcher and clarification of the information to be
collected before the general data collection period. Following
the pilot observation periods (that were included in the
overall data as the procedures for data collection continued
unchanged after this period) eight periods of observation
were undertaken.
Periods of observation were of 4-hour duration and
covered different times of the day to incorporate different
activities (e.g. 8 AM –12 PM , often viewed as the busiest time
of day, and 2 PM –6 PM as this includes ‘nurse handover time’)
to ascertain whether peculiarities of these periods affected
nurse–patient interactions. The interactions observed
148  2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd
involved staff and patients in a designated four-bed cubicle.
Each observation period usually occurred in a different
cubicle. Owing to the relatively short stay of patients and
rostering of staff, different patients and staff were observed
during different observation periods.
Observation involved non-participant observers situating
themselves in a strategic location in the four-bed cubicle area.
The observers were situated so they could gain visual access
to a substantial area of the cubicle where practices pertaining
to health care were undertaken, yet not impede the provision
of services. The observers introduced themselves to the staff
and patients in the area as ‘practices’. The intent was that this
general explanation would not result in any changes in the
way that staff undertook their work. The interactions
between staff and patients were observed and recorded in a
notebook as they occurred (refer Appendix 1).
Data collectors
The two data collectors were Registered Nurses with Mas-
ter’s level qualifications. They both had diverse clinical,
education and research backgrounds. They both received
clear instructions about the recording of data as outlined in
Appendix 1. At the completion of each 4-hour session they
would reflect and describe briefly, in general terms, their
impressions and assessment of the nurse–patient interactions.
These were recorded separately from the observations.
Patient questionnaires
All patients who entered the two wards during the 4-week
data collection period were asked to complete the question-
naire before departure from the hospital. Questionnaires
were distributed each day during the data collection period.
Patients were given the form by the ward receptionist just
before leaving. Patients were asked to complete the forms
while they were waiting and deposit them in a box at the
reception area as they left the clinical area.
The patient questionnaire comprised a specific sub-set of
five questions pertaining to nurse–patient interactions from a
standard patient satisfaction survey used in Australian
populations for which reliability and validity had been
established for an Australian patient population (Department
of Human Services, State Government of Victoria 2006). The
five questions the survey asked were During your hospital
stay, how would you rate
• The courtesy of nurses.
• The length of time the nursing nurses took to respond to
the call-bell.
• The availability of nurses when you needed them.
• Respect for privacy during your stay.
• The compassion and reassurance of nurses.
JAN: ORIGINAL RESEARCH
Patients were asked to give one response from the
following: excellent, very good, good, fair, poor, not sure.
For purposes of analysis the responses were graded excellent
[5], very good [4], good [3], fair [2], poor [1], not sure [0].
Therefore, in the following results the highest score possible
is 5 and represents the most ideal response. These questions
yield different results across Australian hospitals depending
on the situational factors at the time of data collection. It was
therefore appropriate to collect these data concurrently with
the observations of nurse–patient interactions to gather
further information from the perspective of patients.
Ethical considerations
Ethical considerations were in accordance with those of the
Human Ethics Committee for the district in which the
hospital is situated. The researchers involved in data collec-
tion adhered to the National Health and Medical Research
Council (2005) guidelines. The nurse observers obtained
consent from participants before recording interactions.
Nurses and patients were not known to the observers, and
findings pertaining to nurses and patients were coded.
Anonymity was assured. Staff and patients were advised they
could withdraw from the study at any time without conse-
quence.
Data analysis
Simultaneous analysis of the findings from both the observa-
tion data and questionnaires assisted in comparing and
contrasting perceptions of nurse–patient care activities. This
enhanced the strength of the conclusions as the implications
of some of the observations could be supported by patient
surveys.
Nurse–patient interactions
The observation of nurse–patient interactions was recorded
as field notes; these included mostly verbatim transcriptions
of conversations during the actual observation period (refer
Appendix 1). The observers also recorded impressions and
assessment of interactions at the completion of the observa-
tion period. Thematic analysis of the general intent of inter-
actions was undertaken contemporaneously (Miles &
Huberman 1994).
Similarity of themes with the existing literature was used
where appropriate (Fosbinder 1994, Savage 1995,
McCance et al. 1997, Johnston & Smith 2006). The
nurse–patient interactions were just a snapshot of patients’
activities. Despite this, trends were observed that gave
insight into the interactions that were most probably
 2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd
‘Caring for’ behaviours that indicate nurses ‘care about’ patients
Table 1 Mean scores of patient responses to survey questions
Question Mean
The courtesy of the nurses 4Æ7
The length of time the nurses took to 3Æ9
respond to the bell
The availability of the nurses 4Æ1
when you needed them
Respect for privacy during your stay 4Æ5
The compassion and reassurance of nurses 4Æ7
indicative of predominant behaviour and practices through-
out patients’ hospitalization.
Patient questionnaires
Descriptive statistics, such as frequencies and means, were
undertaken (refer Table 1). Further comments were tran-
scribed verbatim.
Findings
Participant profile for nurse–patient interactions
Patients observed were males (n = 11) and females (n = 24).
Age range was 33–91 with a mean age of 74. Types of
diagnoses included heart failure, myocardial infarction,
respiratory failure, dementia, falls, cholecystitis, pneumonia,
hypertension, Parkinson’s, metastatic cancer, hysterectomy,
cystoscopy and urethral obstruction.
In summary, patients with a diversity of medical and
surgical diagnoses were observed. While the age range was
broad, most patients fell in the upper range: mean age was
quite high at 74.
Nurse–patient interactions
Nurses’ practice demonstrated that they ‘cared for’ patients.
Virtually all nurse–patient interactions could be categorized
into one of the following three areas which have been
identified in the literature (Fosbinder 1994, Savage 1995,
McCance et al. 1997, Johnston & Smith 2006). There were a
couple of incidences of negative comments that did not fit
into the categories, for example, comments about delays in
discharge or a member of the medical profession not being
readily available. The three main areas identified in the
literature were:
• Getting to know you (personal sharing, humour/kidding
and being friendly).
• Translating (informing, explaining, instructing and teach-
ing).
149
A. Henderson et al.
• Expert compassion (includes genuine concern and a
‘connection’).
There was a definite trend in the frequency of each group of
observations. Friendly interactions were most frequently
observed while expressions of ‘expert compassion’ were
observed the least.
Also in these groups there were a few incidences of
potentially negative nurse–patient interactions best described
as ‘nurse forgetfulness’. These were incidences where nurses
would put patients on a bedpan then leave them for long
periods or, alternatively, say ‘yes’ to a patient request and not
return to carry it out until some hours later when they
remembered the request. While few in number, they were
noteworthy, possibly because they were the few times when
patients appeared to be overtly dissatisfied.
Getting to know you
Nurses consistently demonstrated welcoming and courteous
attitudes towards patients. Nurses’ most frequent behaviours
were ‘getting to know you’ (Fosbinder 1994, McCance et al.
1997). The morning nurses and usually the afternoon nurses
would say ‘hello’ to their allocated patients. Nurses would
usually inform patients of their imminent departure or arrival
of the next shift. However, patients did get to know the
routine and understood that nurses ‘changed over’ during the
afternoon so, if nurses did not say ‘good-bye’, they under-
stood why a different nurse attended to them after 3:30 PM .
Patients learnt that another group of nurses worked the night
shift.
Translating
In addition to the predominant welcoming interactions that
appeared to generate warmth and well-being with patients
were interactions that demonstrated staff were ‘translating’
(Fosbinder 1994), that is, explaining aspects of episodes of
care for patients. Nurses’ ‘translating’ work that demon-
strated interpersonal competence to patients constituted
interactions that involved the dissemination of information in
the form of instruction and explanation. Most of the nursing
work involved simple exchanges focused on the provision of
patients’ basic needs as part of the medical regimen within the
context of the organization. This informing, instructing and
explaining could largely be categorized into two areas that
have already been extensively identified in the literature
(Mishler 1984):
• routine management of ‘activities of daily living’ and
‘housekeeping tasks’.
• explanation of technical/medical aspects of patient care.
These interactions verified to patients the professional
knowledge of nurses.
150  2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd
These two areas pertain to firstly, assisting the patient
through activities of daily living within the limitations
imposed by their medical situation and secondly, informing
and administering ‘scientific’-based treatments in accordance
with the care regimen.
The routine activities of daily living included tasks such as
sitting patients upright in bed to eat their meals, assisting
patients to the bathroom and in dressing themselves. For
example, when returning to a patient’s bed area, a nurse said
to one patient, ‘OK, you have had a shower – do you want me
to close the screens so you can dress?’
Interactions focused on the explanation of tasks or
procedures that had a medical basis often involved informa-
tion about the therapeutic regimen, for example, explanation
of a medication by a nurse at a level appropriate to a patient’s
understanding, as in ‘That’s your dig[oxin] for your heart’.
Expert compassion
During patients’ hospitalization in the acute setting, interac-
tions mostly fell into the two categories of ‘getting to know
you’ and ‘translating’. A further category, premised on
themes such as ‘establishing trust’, ‘connecting’, ‘serious
attention’ and ‘going the extra mile’ (Fosbinder 1994, Savage
1995, McCance et al. 1997, Johnston & Smith 2006), that
demonstrated closeness and possibly facilitated expert com-
passion was not as readily observed. This observation was
made independently by both researchers. They mostly
observed short conversations between nurses and patients,
and little evidence of nurses following up on concerns ex-
pressed by patients.
‘Going the extra mile’ was displayed in situations where
nurses interacted in a positive manner with patients that was
not directly required as part of their treatment. It was often
demonstrated by nurses who undertook interactions with
patients that were not dictated in their care regimen, but
which benefited patients. These interactions, while not
mandated in patients’ care, potentially benefited both
patients and nurses through the establishment of mutual
well-being, for example:
The nurse-in-charge asked a patient – ‘do you want a
walk’. The woman replied ‘Yes, but be honest, if you don’t
want to – say so’. The nurse replied, ‘I’ll just finish writing in
the notes – yes I will – that’s good for you’ [to go for a walk].
Arguably, while interactions demonstrating an expert
compassionate approach did not dominate the observed
interactions, patients still believed that nurses ‘cared about’
them. This was evident in the responses of patients to nurses
and the general demeanor and behaviour of patients.
Nurses demonstrated through familiar everyday interac-
tions such as ‘getting to know you’ and ‘translating’ that they
JAN: ORIGINAL RESEARCH
‘cared for’ patients. While closeness, as discussed, was not as
readily observed, patients did not express a specific need or
desire to the nurses for these types of interactions. Demands
on nurses’ time became apparent to the patients through the
expedient manner in which nurses regularly undertook their
work. Strategies used by nurses to maximize expediency in
their tasks were evident through practices such as closed
questioning and leaving patients’ immediate vicinity before
they completed their response to a question.
Overview of patient surveys
The response rate from the questionnaires was 31 from a
possible 129 (number of patient discharges from the two
wards where observations were being conducted during the
4-week period). This represented 24% of the target popula-
tion. While an attempt to increase the response rate was
undertaken through a personal approach to patients, a
breakdown in how this communication was to be undertaken
affected the response rate.
Definite trends emerged from the questionnaires. As with
patient satisfaction data in general (Fitzpatrick 1984, Avis &
Arthur 1995), these results rated the facility as very good to
excellent in most areas. The two lowest scores were obtained
by question three: ‘The length of time the nursing staff took
to respond to the bell’ (3Æ9) and question four: ‘The
availability of the nursing staff when you needed them’
(4Æ1). When it is recognized that patients generally rate
satisfaction highly and given the variation in these scores
compared to the other values – these figures clearly indicate
that patients believed nurses could have been more responsive
to requests that were not part of the routine or, for whatever
reason, fell outside usual practice.
Discussion
The nurse–patient observations identified that patients’
immediate needs, such as nourishment, hygiene, pain relief
and mobilizing, were attended to (mostly in a timely manner).
The nurse–patient interactions while attending to physical
needs typically demonstrated interpersonal and professional
expertise, such as ‘getting to know you’ and ‘translation’ of
everyday patient episodes of care. Feedback from the
questionnaires and observation data indicated that these
interactions mostly satisfied patients. A higher rating of
courteousness of nurses, respect for privacy, and demonstra-
tion of compassion and reassurance was reported on the
questionnaires. Patient observations suggested that patients
were satisfied through cues such as a calmness in their voices
and their relaxed demeanour.
 2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd
‘Caring for’ behaviours that indicate nurses ‘care about’ patients
While the literature on ‘caring’ in nursing proposes the
importance of closeness and intimacy, these facets may have
had limited impact on well-being for the particular popula-
tion in this study. Patients reported high levels of satisfaction
despite an expert professional approach commensurate with
caring (Fosbinder 1994, McCance et al. 1997, Caris-Verhal-
len et al. 1999, Johnston & Smith 2006) not dominating the
observations. It is possible that, through nurses meeting
patients’ basic needs in an appropriate manner and context,
patients were reassured. Accordingly, patients may have felt
that their needs were anticipated and largely met, contribu-
ting to their feeling of being ‘cared for’.
The importance of basic needs being met became apparent
when patients’ requests were not attended to in a timely
manner. These instances were observed infrequently during
the nurse–patient interactions and reported as ‘nurse forget-
fulness’. Despite the relatively infrequent observations of
‘nurse forgetfulness’, it appears patients value nurses
responding within a suitable timeframe to meet their needs –
it was nurses’ responsiveness that patients did not rate as
positively on the questionnaire. These ratings indicated that
patients noticed that nurses were not always responsive in a
timely manner.
‘Dissatisfaction’ can arise if patients feel dehumanized,
objectified or devalued through interactions (Coyle 1999).
A careful balance of competing demands is therefore required
to ensure patient satisfaction with the provision of care in the
acute context. While patients appeared to accept that nurses
were not always able to ‘spend time’ because of organiza-
tional demands, patients still expected nurses to be responsive
to their immediate needs when requested.
Our findings suggest that nurses should prioritize specific
requests from patients as demonstrating a response seems to
be significant to patients. Accordingly, if requests are not
fulfilled it is of concern to patients, and possibly even a threat
to their integrity. Nurses need to explore to what degree they
are adaptable in the provision of service and, in particular,
address the imposed limitations that they feel lead to requests
not being attended to in an expedient manner.
Caring is complex and contextual (McCance et al. 2001).
In this research, we do not purport to unravel the complexity
of caring but rather to identify those factors that seem to
communicate to patients that nurses care about them. On the
whole, ‘caring for’ practices appear to satisfy patients that
nurses ‘care about’ them.
Study limitations
The major limitation of the study was that the data only
provided a ‘snapshot’. The design of the study meant that the
151
A. Henderson et al.
What is already known about this topic
• Patients are largely passive recipients of care and
generally evaluate health care positively.
• Patients are more likely to complain when they feel
that nurses do not ‘care about’ them.
• In the nursing literature quality care refers to the
development of nurse–patient relationships based on
closeness, connecting and professional intimacy.
What this paper adds
• Patients’ concerns focus more on the availability of a
nurse to attend to their specific requests than on
‘closeness’ with a nurse.
• When nurses are readily available to ‘care for’ patients
this can potentially result in patients believing that
nurses ‘care about’ them.
• Strategies can be readily implemented in busy acute
care contexts to address ‘caring for’ issues so as to
alleviate concerns that patients do not feel nurses ‘care
about’ them, which can be the catalyst for patients to
initiate complaints.
interactions were in the ‘here and now’. Interactions were
therefore not able to be followed through the whole period of
a patient’s hospitalization. Often it is the continuity of
observations that provides insight into the meanings and
comfort that patients derive from nurse interactions in the
facility. Furthermore, the timeliness of nursing staff response
could have been related to finance and resources allocation in
the hospital under study and therefore generalizability is
limited to hospitals with a similar skill mix.
Conclusion
Given the organizational and patient demands placed on
nurses in busy clinical settings, these findings indicate that
nurses should focus on patients’ expressed needs and explain
the context in which health care is provided. Suggestions for
this are as follows:
• Nurses should introduce themselves to patients at the start
of each shift and explain to patients the anticipated routine
for that shift, including information about when, and how
long, nurses will be absent from the immediate clinical
area, for example, for tea and meal breaks.
• Nurses should discuss with patients about appropriate
times when they (the nurses) can interact with patients,
learn about their specific needs and inform them about the
152  2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd
long-term management of their conditions. This could
potentially contribute to trust and connection between
patients and nurses.
• Nurses need to explore how to use their time most effect-
ively. For example, they have competing demands between
patients needs/wants and organizational requirements,
such as administrative work; therefore, they need to pri-
oritize the work in a way that will deliver the best out-
comes.
Patient satisfaction with the service is more likely to be
improved if nurses can readily organize their work to allow
time for informing patients about provision of their care and
negotiate with them about specific requests outside the
immediate care regimen.
Author contributions
AH, MvE, KP and CJ were responsible for the study conception
and design and AH was responsible for the drafting of the
manuscript. AH, MvE, PH and YO performed the data
collection and AH, PH and YO performed the data analysis.
AH, KP and CJ obtained funding and AH provided adminis-
trative support. AH, KP, CJ, PH and YO made critical revisions
to the paper. AH and MvE supervised the study.
Acknowledgement
We would like to thank the Queensland Nursing Council for
monetary support for this project.
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Appendix 1. Recording observations

Time Participants interacting (coded) Conversations* Accompanying observed actions

09:10 P3 fi N1 Would you do me a favour N1 prepares OT clothes for P3

 Could you help me put my hair up?
N1 fi P3 Of course!

OT, operating theatre.

*Conversations were mostly transcribed verbatim as interactions occurred, one at a time, and were mostly short.

 2007 The Authors. Journal compilation  2007 Blackwell Publishing Ltd 153