Examining nurse/patient relationships in care coordination: A qualitative metasynthesis

Abstract

Background: The combination of education, experience, skill mix, and frequency of nursing care provided has not been broadly studied from a systems theory perspective, in the care coordination process, or within transitions of care.

Purpose: To examine nurse/patient relationships (as a proxy for nurse dose) in the care coordination experience through a qualitative metasynthesis using a systems theory approach.

Design: The study was a qualitative metasynthesis with four sequential processes; (1) a systematic literature search to answer the structured research question, (2) formal quality appraisal and data immersion, (3) interpretive synthesis of the data within and across studies, and (4) re-situating the derived themes through reciprocal translation to each of the primary studies. CINHAL, Cochrane Library, Embase and PubMed were searched, and 159 articles retrieved. Eight articles remained after inclusion/exclusion criteria and quality review criteria were applied.

Results: Key themes were organized using a systems theory perspective (Structure, Process and Outcomes). The need for a coordinated nurse-patient relationship and the ability of the nurse to calm the complexity that occurs forms the structure of the relationship. The process includes having an awareness of challenges of the coordinated nurse-patient relationship and the transitions that occur, nurses going above and beyond, providing meaningful communication, and navigating system complexity. The outcomes are the value of a coordinated nurse-patient relationship and managing the illness/wellness journey.

Conclusions: The information from this metasynthesis provides an integrated view for nursing leaders and insight into factors that promote an effective and coordinated nurse-patient relationship.

Keywords: Care coordination; Nurse patient relationships; Systems theory.