title: Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient?
abstract: OBJECTIVE
  The aim of this study was to describe the nurse-patient relationships and to study how caring behaviours were described. The review question was: What factors influence the caring relationship between a nurse and patient?
  
  
  BACKGROUND
  There is a growing perception that nurses fail to provide compassionate and competent care. Policy documents prescribe compassion as an essential aspect of care; however, the evidence drawn on remains unclear and without clear applications to practice.
  
  
  METHODS
  Umbrella review methodology, informed by the Joanna Briggs Institute guidelines, was employed and adapted to enable the inclusion of systematic reviews that were of sufficient methodological quality.
  
  
  METHODS
  An extensive PsychInfo, Pubmed, CINAHL, Scopus, WoS and Embase search was conducted for literature published from January 2000-March 2014. Key words included 'nurse', 'patient' and 'relationship' in combination with index terms to find literature published from 2000 onward.
  
  
  METHODS
  Critical appraisal, data extraction and synthesis were carried out according to existing guidelines for undertaking umbrella reviews.
  
  
  RESULTS
  Twelve reviews (representing over 290 studies) were included following critical appraisal. Forty-seven findings were extracted, resulting in 14 categories and six synthesized findings; 'Expectations of the relationships' 'Values', 'Knowledge and skills', 'Communication', 'Context and environment' and 'The impact of the relationship'.
  
  
  CONCLUSIONS
  A substantial body of evidence demonstrates that both patients and nurses have expectations about the nature and importance of the caring relationship. Nurses should be mindful that their behaviours and attitudes need to align with what patients value about the relationship. Context shapes the relationship in positive and negative ways.
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.
authors.forename: Rick
authors.initials: R
authors.lastname: Wiechula
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Conroy
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Kitson
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.
authors.forename: Rhianon J
authors.initials: RJ
authors.lastname: Marshall
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.
authors.forename: Nancy
authors.initials: N
authors.lastname: Whitaker
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.
authors.forename: Philippa
authors.initials: P
authors.lastname: Rasmussen
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003142:Communication; D004645:Empathy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology / Q000592:standards; D009732:Nursing Care / Q000592:standards; D010348:Patient Care Team; D012931:Social Environment; D035502:Trust
keywords: care; communication; nurse-patient interaction; nurse-patient relationship; quality of care; systematic review and meta-analysis