Breaching the nurse-patient therapeutic relationship: A grounded theory study

Abstract

The therapeutic nurse-patient relationship is the core of nursing practice. This grounded theory study used symbolic interactionism, identity theory and ethics as a theoretical perspective to examine nurse-patient relationships. The opinions and experiences of twelve professional nurses were explored to discover the process and events involved when a nurse engaged in a nontherapeutic relationship with a patient. A core process, Breaching the Nurse-Patient Relationship, was identified from the interviews. The core process identified three stages in the process with conditions in each stage that showed progression from each condition in each stage to the next stage. The first stage in the process revealed five conditions that make the nurse vulnerable for engaging in nontherapeutic activities with a patient. Stage one, with the five conditions, was the preliminary process that lead to stage two. In stage two, the nurse engaged in nontherapeutic activities/relationships with the patient. The nurse was either under-involved or over-involved in the nurse-patient relationship but clearly the nurse deviated from the therapeutic realm of the relationship. There were eight conditions in stage two that identified the process of the nurse leaving the therapeutic role to engage in a nontherapeutic role with the patient. The last stage was characterized by the consequences that the nurse, patient and profession of nursing had to face as a result of the nontherapeutic nurse-patient relationship.