Patient-nurse Relationships Research Articles

CARING OF INPATIENT NURSES WITH THE FAMILY'S READINESS TO RECEIVE MEDICAL INFORMATION ABOUT ADVANCED THERAPY

Background. Caring is the basis for nurses to be able to analyze nursing actions carried out well and appropriately for clients which becomes a reference in further care. In other words, caring is the moral ideal of the nursing profession which refers to the willingness to provide sincere care with seriousness in carrying out actions to care for clients' health. Research Method. A literature search in this research was carried out by identifying all types of national and international articles regarding caring for community nurses and the readiness of families to receive further therapy information The electronic databases used were PubMed, Springer, and Google Scholar with 30 articles then filtered into 3 articles with a search strategy using the PICO method (patient, intervention, comparison and outcome). Findings. Participants expressed that caring is an attitude of empathy, caring about patient needs, providing nursing care not only when patients come to the health center but also when nurses provide home care. Participants expressed caring behavior such as empathy, being friendly to patients who came to the treatment center, caring about patient needs, making home visits to patients, paying attention to the patient's health needs. Conclusion. Caring for inpatient nurses is an effort to improve the performance of nurses in providing nursing services to patients so as to create integrated and comprehensive care for patients. By increasing professional patient-nurse relationships, participants said they were helped by getting to know the many patients who came for treatment at the health center.

Critically ill patients' experiences of nursing care and the effect on their personhood: A retrospective study.

This study aims to report patients' experiences of nursing care in the critical care unit and the resulting effect of such care on the personhood of patients. The study adopted a qualitative design and aimed to include both descriptive and exploratory information. It involved a single participant group comprising ten previously critically ill patients with whom retrospective, semi-structured interviews were conducted in a natural setting during 2018. Private hospitals in Gauteng, South Africa, were targeted for data collection. The findings of this study were categorised and described according to Kitwood's conceptualisation of person-centred care. Five categories were identified by patients as impacting their personhood and perceived person-centred care. Nurses ability to support perceived personhood of patients during person-centred care is integral to the betterment of the patient. Patient's experiences of nursing care can often be affected if they perceive their personhood as not being valued by nurses. This study creates increased awareness of these components to ensure that patient-nurse relationships are established adequately to meet both the patients' and the nurses' needs.

Adult patient communication experiences with nurses in cancer care settings: a qualitative study

BackgroundThe patient communication experience is an important outcome measure that guides quality improvements in healthcare settings specifically in cancer care. Therefore, this study aimed to explore the patient’s communication experiences with nurses in cancer care settings.MethodsSemi-structured face to face interviews were conducted with 21 participants who received cancer care at two Saudi Arabian tertiary healthcare facilities between Aug 2019 to Dec 2019. The study used a qualitative descriptive design. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data using six stages of Braun and Clarke.ResultsFour major themes were identified and a total of eleven sub-themes. The major themes were; (1) The importance of patient-nurse relationships, (2) Providing appropriate information to patients, (3) Responding to patients emotional needs and (4) Verbal communication between nurses and cancer patients.ConclusionsSome participants felt that their communication with nurses was limited, but generally, most felt that communication was acceptable irrespective of barriers such as language, culture, religion, gender, workload and healthcare preferences. Participants drew a comparison between Saudi and non-Saudi nurses as well as between nurses and doctors communication skills. They felt that Saudi nurses had good communication skills, but non-Saudi nurses were more competent in some aspects such as kindness, politeness, respectful and non-verbal communication. They also felt that doctors were more accurate in their information than nurses.

Calling nurses to care for burn victims after color-dust explosion.

Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse-patient relationships. This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. A qualitative descriptive study using a phenomenological approach. Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi's method. This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient-nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.

Improving The Organization Of Nursing Care In Treatment And Prevention Facilities For Patients With Covid-19

The study examined the situation of patients and nurses in Uzbekistan during the COVID-19 pandemic, the nurse and the work process, the proper use of personal protective equipment and the misuse of personal protective equipment. The impact of the nurses’ work process on their personal lives was also partially covered. COVID-19 It also describes the knowledge and skills that nurses have during the pandemic. He sought to understand how disruptions in patient-nurse relationships, as well as the COVID-19 pandemic, affected the mental and emotional well-being of nurses, its negative consequences, and the underlying problems that followed. Psychological instability in nurses during the early stages of the pandemic and changes in attitudes toward patients with COVID - 19 were also reported the difficulties of the work of nurses in clinics specializing in the treatment of a number of COVID-19 diseases, biological and technical problems in the conduct of work, lack of resources were also listed. In the second place, there is a shortage of nursing staff and the fear of infecting family members with the virus in the fight against the pandemic, and the causes of deaths as a result.

Comfort With Touch and Influencing Factors Among Chinese Midwives: A Cross-sectional Survey.

The aim of this study was to identify comfort with touch (CT) and influencing factors among Chinese midwives. Midwives (N = 252) from 7 hospitals in Guangdong, China, were asked to complete a self-report questionnaire between November 2018 and April 2019. The questionnaire included the Nurses' Comfort with Touch Scale (NCTS), the Nurses' Perceived Professional Benefits (NPPB) Scale, the Maslach Burnout Inventory-General Survey (MBI-GS), and a self-designed demographic questionnaire. Multivariate linear regression was used to identify influencing factors for CT. Mean NCTS total score was 88.90 ± 14.40, and the mean item score was 5.23 ± 0.91, which indicated a respectable score. Within the NCTS, CT was highest in the comfort support category (5.32 ± 0.29) whereas CT was lowest in the physical comfort category (4.28 ± 0.28). Multivariate regression analysis demonstrated that CT among Chinese midwives was associated with positive experiences or feelings surrounding the patient-nurse relationship (B = 3.239, P < .001), perceived professional benefit (PPB, positive professional identity) (B = 0.240, P < .001), emotional exhaustion (B = -0.414, P < .001), depersonalization (negative attitude toward the work setting) (B = -0.773, P < .001), and personal accomplishment (evaluation of self-worth) (B = 0.170, P = .015). Touch training and educational programs are recommended for Chinese midwives to enhance awareness and acceptance of touch care. In addition, promoting positive patient-nurse relationships, improving PPB, and reducing burnout are recommended to enhance CT among Chinese midwives. Because of the size and racial homogeneity of the sample, further studies are recommended to identify CT and influencing factors in a larger, more diverse population of midwives worldwide.

Respect and its associated factors as perceived by older patients.

To investigate older hospital patients' perceptions of respect in a patient-nurse relationship and its associated factors. To be cared for with respect is fundamental to ethical nursing care. However, respect has seldom been a main topic of nursing research, and few of these studies have assessed older patients' perceptions of being respected by nurses alongside associated factors. A cross-sectional, descriptive and correlational survey design. Hospitalised older patients (n=200) were interviewed using the ReSpect Scale, measuring respect within the nurse-patient relationship, the EuroQol 5D-5L, measuring perceived health status, and the Patient Satisfaction Scale, measuring satisfaction with nursing care. Sociodemographic characteristics were also collected. Data were analysed using descriptive statistics, Pearson's correlation coefficient, the t test and analysis of variance. The STROBE Statement was used for reporting this research. Older patients reported moderate levels of perceived respect in their patient-nurse relationships. A statistically significant, strong positive correlation between patient satisfaction and their perceptions of respect was found. Poor perceived health status was also statistically significantly associated with older patients' perceptions of respect. No statistically significant associations between patients' other sociodemographic characteristics and their perceptions of respect were found. The identification of factors and their associations with respect is a basic step towards theory generation. Further empirical research is needed to test the preliminary associations found in this study to further develop the current understanding of respect and its associated factors. The older patients' perceptions of respect highlighted in this study show the need for the further consideration, reflection and development of this important aspect of the relationship between patients and nurses. The identification and measurement of respect and its associated factors may help to improve respect in nursing care making it more visible in the care of older people.

The influence of an eHealth intervention for adults with type 2 diabetes on the patient-nurse relationship: a qualitative study.

A constructive patient-nurse relationship is beneficial in self-management support approaches. Research indicates eHealth interventions hold a potential for self-management support for adults with type 2 diabetes. However, eHealth may change the patient-nurse relationship. No studies to date have addressed how eHealth self-management support interventions with written asynchronous communication can influence the relationship between patients and nurses. The aim of this study was to explore how an eHealth intervention based on the Guided Self-Determination program (eGSD) influences the patient-nurse relationship from the perspective of patients participating and the nurses conducting the intervention. A qualitative approach with individual semi-structured interviews was used. Ten patients with type 2 diabetes who completed the eGSD and four nurses who delivered the intervention participated. The data were transcribed verbatim, and qualitative content analysis was used to analyse the text. The findings revealed two themes: 'eGSD facilitates a reciprocal understanding and a flexibility in the relationship' and 'eGSD creates a more fragile relationship', reflecting ambiguous experiences with the eGSD. The findings indicate that eGSD influences the patient-nurse relationship by facilitating reciprocal understanding and flexibility. Both patients and RNs acknowledged these outcomes as beneficial. Nevertheless, familiar in-person consultations were expressed as integral for the patient-nurse relationship. As written communication in eHealth is a novelty, it demands new knowledge and expertise that RNs must master. Findings from this study may therefore be acknowledged when developing and implementing eHealth interventions. Education programs in written eHealth communication, as well as guidelines and frameworks on how to professionally and effectively conduct eHealth services while maintaining supportive patient-nurse relationships, should be a priority for institutions that educate healthcare personnel, health institutions and other stakeholders.

Exploring strategies for promoting trauma-informed care and reducing burnout in acute care psychiatric nursing

Psychiatric nurses in inpatient settings provide person-centered and relationship-based care to persons in acute distress from behavioral health and substance use problems. The emotional labor of this highly interpersonal care is further complicated by the high rates of historical trauma among this population. This article summarizes the impact of trauma on patients in acute psychiatric settings, the impact of challenging organizational contexts and patient distress on nurse burnout, and proposes four strategies for promoting trauma-informed care by inpatient psychiatric nurses including a) promoting education of nurses on the impacts of trauma, b) building support among nurse colleagues, c) emphasizing clinical skills in coping with patient distress, and d) implementing mindfulness skills as a core coping strategy for nurses for managing their reactions to patient distress. Trauma-inforced care holds patient safety as primary to clinical effectiveness and is also crucial for promoting supportive patient-nurse relationships. As such, trauma-informed care has the potential to combat nurse burnout and improve outcomes for patients.

The infrastructure of telecare: implications for nursing tasks and the nurse-doctor relationship.

Telecare can offer a unique experience of trust in patient-nurse relationships, embracing new standards for professional discretion among nurses, but also reflects an increasingly complicated relationship between nurses and doctors. The study uses ethnographic methodology in relation to a large 5 million euro project at four hospitals caring for 120 patients with COPD. Twenty screen-mediated conferences were observed and two workshops, centring on nurses' photo elucidation of the practice of telecare, were conducted with a focus on shifting tasks, professional discretion, responsibility and boundaries between nurses and doctors. Analytically, the study draws on Star's notion of 'infrastructure' and Mol, Moser and Pols's ideas of care as 'tinkering'. Infrastructure is understood as human and non-human conduct that is embedded into wider organisational conventions, sites and structures. The analysis demonstrates and proposes that, in telecare, greater accountability, discretion and responsibility are imposed on the nurse, but that they also have less access to the means of clinical decision-making, namely, doctors. The article explores how relational infrastructures ascribe the professions they constitute (nurses and doctors) functions of power and accountability and highlights the ethical problem of the nurse being given greater responsibility while simultaneously becoming more dependent on the doctor.

Nurses' commitment to respecting patient dignity.

Background:Although respecting human dignity is a cornerstone of all nursing practices, industrialization has gradually decreased the attention paid to this subject in nursing care. Therefore, the present study aimed to investigate nurses’ commitment to respecting patient dignity in hospitals of Isfahan, Iran.Methods:This descriptive-analytical study was conducted in hospitals of Isfahan. Overall, 401 inpatients were selected by cluster sampling and then selected simple random sampling from different wards. Data were collected through a questionnaire containing the components of patient dignity, that is, patient-nurse relationships, privacy, and independence. All items were scored based on a five-point Likert scale. The collected data were analyzed using descriptive statistics and Chi-square tests. P < 0.05 were considered significant in all analyses.Findings:Most patients (91%) scored their relationships with nurses as good. Moreover, 91.8% of the participants described privacy protection as moderate/good. Only 6.5% of the subjects rated it as excellent. The majority of the patients (84.4%) believed their independence was maintained. These subjects also approved of taking part in decision-making.Conclusion:According to our findings, nurses respected patient dignity to an acceptable level. However, the conditions were less favorable in public hospitals and emergency departments. Nursing authorities and policy makers are thus required to introduce appropriate measures to improve the existing conditions.

Process of Building Patient-Nurse Relationships In Child And Adolescent Psychiatric Inpatient Care: A Grounded Theory Approach In Japan

Objective: The objective of the present study is to describe the process of building closer patient-nurse relationships in child and adolescent psychiatric inpatient care. Nurses play important roles in psychiatric inpatient care for children and adolescents, and their care can affect every facet of their daily life. The efficacy of treatment depends on the nurses’ ability to build intimate patientnurse relationships. Methods: A qualitative methodology, based on the tenets of grounded theory approach, was taken. Semi-structured in-depth interviews were conducted with 18 expert nurses and analyzed using a constant comparative method. Results: ‘Developing emotional attachment’ was identified as the core category, substantiated by four interrelated stages: ‘Becoming a target of attachment’; ‘Forming an attachment’; ‘Expanding the target of attachment’; and ‘Preparing to be a target of attachment’. We found that in developing emotional attachments with inpatient children or adolescents, expert nurses achieved a balance between appropriate psychological distance from - and their own increased attachment to - those inpatients. Conclusions: The “expert” nurses become a target of attachment for their patients and then successfully extend that to other nurses during professional nursing intervention.

A good patient? How notions of ‘a good patient’ affect patient-nurse relationships and ART adherence in Zimbabwe

BackgroundWhile patient-provider interactions are commonly understood as mutually constructed relationships, the role of patient behaviour, participation in interactions, and characteristics, particularly ideals surrounding notions of ‘good’ and ‘bad’ patients, are under-examined. This article examines social representations of ‘a good patient’ and how these representations affect patient-healthcare provider relationships and antiretroviral treatment (ART) for people living with HIV.MethodsUsing thematic network analysis, we examined interview and focus group transcripts involving 25 healthcare staff, 48 ART users, and 31 carers of HIV positive children, as well as field notes from over 100 h of ethnographic observation at health centres in rural Zimbabwe.ResultsCharacteristics of a good patient include obedience, patience, politeness, listening, enthusiasm for treatment, intelligence, physical cleanliness, honesty, gratitude and lifestyle adaptations (taking pills correctly and coming to the clinic when told). As healthcare workers may decide to punish patients who do not live up the ‘good patient persona’, many patients seek to perform within the confines of the ‘good patient persona’ to access good care and ensure continued access to ART.DiscussionThe notion of a ‘good ART patient’ can have positive effects on patient health outcomes. It is one of the only arenas of the clinic experience that ART patients can influence in their favour. However, for people not conforming to the norms of the ‘good patient persona’, the productive and health-enabling patient-nurse relationship may break down and be detrimental to the patient.ConclusionWe conclude that policy makers need to take heed of the social representations that govern patient-nurse relationships and their role in facilitating or undermining ART adherence.

Are patient-nurse relationships in breast cancer linked to adult attachment style?

The aim of this study was to ascertain if patients with breast cancer who have positive attachment models of 'self' and 'other' perceive higher levels of support from nurses than do patients with negative attachment models. Attachment models of 'self' and 'other' develop in childhood and affect relationships throughout life. People with negative attachment models tend to perceive themselves as unworthy of receiving support and to perceive others as incapable or unwilling to offer support. Attachment processes are activated when individuals feel threatened and seek support from those close to them. Breast cancer may represent such a threat and relationships between patients with breast cancer and nurses may therefore be influenced by patients' attachment models. A between-subjects cross-sectional design was used. Explanatory variables were indicators of patients' attachment models. Response variables were patient ratings of nurse support. Covariates were patient age and patient distress levels. One hundred and fifty-three patients with breast cancer, diagnosed 1-3years previously, were recruited when attending follow-up oncology appointments over 51 weeks in 2010-2011. Participants completed questionnaires assessing attachment models, distress and perceived support, from the nurse who was available to support them through their cancer. The hypotheses were tested by logistic regression analysis. Patients with more positive models of 'self' perceived more support from nurses. Patients' perceptions of nurses when being treated for breast cancer are influenced by patients' own models of attachment. Knowledge of this would help nurses further to individualize the emotional support they give patients.

Learning transitions-a descriptive study of nurses' experiences during advanced level nursing education.

BackgroundBuilding capacity in a changing health care system is a challenge for advanced nursing education programs. Master-level nursing education is increasingly becoming the required education level for specialist nurses, and additional studies are needed to learn more about students’ experiences and learning transitions while undertaking such education. This study aimed to explore nursing students’ experience of their learning transitions while undertaking advanced nursing education and to describe how they translated the new knowledge and competence they gained into clinical practice.MethodsWe used a qualitative research design with narrative self-reported reflections. 34 nurses (95 % women) from both urban and rural areas working with children, with adults in outpatient and inpatient endocrinology clinics in hospitals or with adults, including older people, attending primary health care services participated in the study. We collected data at two time points 15 months apart. Time one was the first week of the advanced nursing education, and time two was the completion of the education program. We used Malterud’s modification of Giorgi’s phenomenological analysis, otherwise known as systematic text condensation, to analyze the data.ResultsTwo core themes captured the participants’ experiences. The first theme was “assessing the situation of people with diabetes from a different perspective”, with the subthemes “an expanded perspective of practice and higher level of reflection”, “applying critical thinking in practice” and “changing patient-nurse relationships in diabetes care”. The second core theme was “a change in participants’ perception of their professional position”, with the subthemes “a greater knowledge base enhancing professional confidence” and “a more equal position within the professional team”.ConclusionsThe study provides in-depth information about transition into advanced nursing education and can inform curriculum developers, nurse educators, policy-makers and nursing managers about how nursing education broadened participants’ perspectives of nursing and enhanced their confidence and professional position.

Patients’ Experiences of Trust in the Patient-Nurse Relationship—A Systematic Review of Qualitative Studies

Aims and Objectives: To report a synthesis of the literature on the meaning of trust in the context of patients’ experiences of nursing. The review question was “How do patients describe the meaning of trust in the nursing relationship?” Background: Trust is essential in nursing as it has the potential to create opportunities for the human being to gain faith, hope and meaning in life as well as open up for new experiences. Trust is an interpersonal and essential element of all patient-nurse relationships and requires nurses to create a trusting relationship with the patients. Design: Systematic qualitative literature review. Methods: Systematic searches were conducted for the period January 2002 to December 2012, updated in January 2014. 20 papers were included. Results: Four categories emerged: Attitudes related to trust, indicating that trust is fundamental and existential; Experiences of trust, concerning how trust can be sensed; The patient-nurse relationship, revealing the qualities of the person who creates trust; and Where trust occurs, illuminating the contextual relevancies of trust. Conclusions: Patients’ experiences of trust in nursing are dependent on the nurses’ knowledge, level of commitment in the dialogue to creating and developing the relationship and contextual issues. Implications for nursing practice: Reflection on a trusting relationship with the patient is necessary for a deeper conceptual understanding of trust in nursing. Clinical nurse researchers nurse supervisors, managers and nurse educatorsshould discuss different areas of trust during nursing supervision and focus-group meetings as well as with nursing graduates to ensure that nurses develop knowledge of how to create a trusting patient-nurse relationship.

Implementing humanistic concern in nursing work to build the harmonious relationship between nurses and patients

Objective To improve the patients' satisfaction to the nursing work through implementing the humanistic concern in nursing work. Methods We held some activities to provide the humanistic concern in nursing work, developed the educations to improve the professional quality of the nurses, constructed the criterion of civilized srvice, and strengthened the construction of nursing culture in the service demonstration ward. Meanwhile, we intensified the service ideas to create the harmonious patient-nurse relationships, the harmonious working settings, the harmonious treatment surroundings and the harmonious humanistic environment. Results The whole quality of the nurses was improved. especially the consciousness of active service. The relationship between nurses and patients was more harmonious, and the nursing quality and the degree of patients' satisfaction were elevated. Conclusions to implement the humanistic concern in nursing work is not only the base of building the harmonious relationships between patients and nurses. but also the guarantee of elevating the nursing quality and the degree of patients' satisfaction. Key words: Humanistic concern; Patient-nurse communication; Culture construction; Nurse'

Preconditions needed for establishing a trusting relationship during health counselling – an interview study

To examine the preconditions needed by district nurses to build a trusting relationship during health counselling of patients with hypertension. Trust has been found to be an important aspect of the patient-nurse relationship. Little research has focused on how trust is formed in patient-nurse relationships or the conditions the development process requires when working with health counselling; in particular not in relation to hypertension. Qualitative study. Qualitative data were collected through open-ended interviews with all (10) district nurses from three primary health care districts of western Sweden. All interviewees work with the health counselling of patients with hypertension. A latent content analysis was performed with thematic coding of the content of the interviews. The first theme that emerged from the analysis, the nurses' competence, describes the nurses' consciousness of their method of expression, both oral and non-verbal, as well as their pedagogical competence and their ability to be reliable in their profession. The second theme, the patient meeting, describes the continuity in the patient meeting and creating respectful communication. The results show an awareness of preconditions influencing building a trusting relationship. When creating a trusting relationship the communication and pedagogical competences of district nurses have considerable importance. Despite this awareness they state that it is easy to fall into a routinised way of working. The implications of this study might be used as support and guidance for district nurses when developing their competence in health counselling in relations to patients with hypertension. This knowledge is also important when planning for nurse-led clinics for this patient group.

Does self‐care agency change between hospital admission and discharge? An Orem‐based investigation

To assess whether nursing care improved patients' self-care agency between admission to hospital care and discharge. A pre-test-post-test comparative research design with random subject selection was used. One hundred and sixty patients and 52 nurses rated identical self-care agency assessment forms, based on Orem's framework, both at admission and discharge. Patient satisfaction with nursing care and nurse satisfaction with working conditions were also assessed. Repeated measures ancova as well as paired and independent t-tests were used to test differences at both time points. Level of significance was set at 0.05 in this study. Patients in general reported high self-care agency pre- and post-test. Compared with a reference group of elderly residents, the study sample showed significantly lower levels of self-care agency. We found no difference between patient and nurse assessments of self-care agency on admission and discharge. Better patient-nurse relationships were associated with greater self-care agency reported by patients. Authors found no change in patient self-care agency between hospital admission and discharge. Outcomes may have been due to the inappropriate choice of the conceptual framework applied for acute care settings or to the insufficient length of the study. A longitudinal approach to observe long-term improvement of self-care capabilities is recommended.

Hybrid space: constituting the hospital as a home space for patients

A growing body of nursing writing is engaged in reviewing the material and relational world of nursing using geographical concepts. This paper draws upon research undertaken in hospital settings where nurses constituted the hospital as a home space for patients. Nurses' practices created an equitable and patient-centred use of physical space in the hospital ward, along with the intimate, extended and personal relationships associated by patients with a caring and homely environment. It is suggested that this constitution of space resonates with the geographic notion of the therapeutic landscape and can be read as a challenge to more conventional uses of hospital spaces shaped by biomedical concerns. The implications of merging the distinctly different spaces and places of home and hospital are also explored using the concepts of hybridity and spatial vulnerability. The complex hybrid nursing creation of home space within hospital places works against the grain of usual understandings of hospitals as specialised illness spaces that are the domain of the health professional inhabitants. While there are limitations and dangers in the representation, this constitution of space is an expression of core nursing values privileging patient-nurse relationships and supports the maintenance of identity and personal expression.