title: Capacity for care: meta-ethnography of acute care nurses' experiences of the nurse-patient relationship.
abstract: OBJECTIVE
  To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings.
  
  
  BACKGROUND
  While primary research on nurses' experiences has been reported, it has not been previously synthesized.
  
  
  METHODS
  Meta-ethnography.
  
  
  METHODS
  Published literature from Australia, Europe, and North America, written in English between January 1999-October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO.
  
  
  METHODS
  Qualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method.
  
  
  RESULTS
  Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients.
  
  
  CONCLUSIONS
  The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients.
authors.affiliation: University of Southampton, UK. jackie.bridges@soton.ac.uk
authors.forename: Jackie
authors.initials: J
authors.lastname: Bridges
authors.forename: Caroline
authors.initials: C
authors.lastname: Nicholson
authors.forename: Jill
authors.initials: J
authors.lastname: Maben
authors.forename: Catherine
authors.initials: C
authors.lastname: Pope
authors.forename: Mary
authors.initials: M
authors.lastname: Flatley
authors.forename: Charlotte
authors.initials: C
authors.lastname: Wilkinson
authors.forename: Julienne
authors.initials: J
authors.lastname: Meyer
authors.forename: Maria
authors.initials: M
authors.lastname: Tziggili
mesh_terms: D000884:Anthropology, Cultural; D006801:Humans; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology*