Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

Figures & data

Figure 1 Decision trail of included studies.

Abbreviation: CINAHL, Cumulative Index to Nursing and Allied Health Literature.

Table 1 Summary of included studies

Author(s), year, and country	Design	Purpose	Sample and study population	Data collection method	Method of analysis	Significant findings and outcomes
Adams et al,^Citation24 2012 (USA)	Qualitative	To understand how hospitalists respond to patients’ expressions of negative emotion and to identify how different types of responses influence further communication in the encounter	79 patients, mean age 54 years: 36 males, 43 females; 27 physicians, mean age 35 years: 11 males, 16 females	Audio-recorded interviews	Thematic analysis	Clinicians should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion
Greenberg,^Citation26 2003 (USA)	Qualitative	To explore humor within the context of nurse–patient relationships	Protracted data collection over 14 months; nurse–patient dyadic relationships; 3 nurses, 2 females, 1 male, 26–32 years in age, 1.5–5 years’ experience; 3 patients, 1 male, 2 females	200 hours of observation, 25 hours of formal and informal interviews	Constant comparative method	Empowering clinicians involved in professional relationships a tactic for the development of humor as a caring strategy
Jagosh et al,^Citation23 2011 (Canada)	Qualitative	To convey attitudes, perceptions, thoughts, and feelings about experiences with physician care	26 males, 32 females, ≥18–65 years	Semi-structured interview	Thematic analysis	Listening is an essential component of clinical data gathering and diagnosis; listening as a healing and therapeutic agent; listening as a means of fostering and strengthening the doctor–patient relationship
Jones et al,^Citation21 2011 (Australia)	Qualitative	To explore cancer patients’ perception of communication with their clinician during a supportive care screening and discussion process and the ways in which this process assisted communication	Convenience sample; 3 days after the supportive care discussion; 154 cancer patients: 72 men, 82 women, (4 patients) < 40 years, (128 patients) 40–79 years; (22 patients) >80 years; 36 clinicians conducted supportive care process	Semi-structured and open-ended questions	Thematic analysis	Screening and discussion through supportive care facilitated communication; a patient- centered process of supportive care can assist clinicians to meet the unmet needs of patients with cancer leading to an increased patient satisfaction
Lees,^Citation20 2014 (Australia)	Qualitative	To explore the experiences and needs that mental health care consumers have of suicidal crisis, the degree to which these needs are met, the role that mental health nurse engagement plays and the key factors suggested to impact on the quality of care	Survey population: mental health nurses (n=87); semi-structured interviews: mental health nurses 6 females, 5 males, average age of 48 years, average of 12 years’ mental health experience; consumers: 6 females, 3 males, average age of 41 years	Survey of mental health nurses, semi-structured interviews with subsection of nurses (n=11); semi-structured interviews with consumers recovering from suicidal crisis (n=9)	Survey: descriptive statistics; interviews: data analysis drew upon adapted forms of critical discourse, constant comparative and classical content analysis	Therapeutic interpersonal engagement between nurses and consumers is central to quality care; essential to consider educational preparation, workplace training, clinical supervision, and support available to nurses
Mitchell and McCance,^Citation22 2012 (UK)	Qualitative	To explore nurse–older person encounters and relationships within the context of person centeredness	Disproportionate stratified sampling; 50 inpatients >65 years	Interviews (conversational interviewing style)	Authentic Consciousness Framework	Nurses are often invisible to the patient unless they are delivering care to address a physical need, therefore a notion of “rolelessness” that deprives patients from actively participating in important decisions about their care; person- centered strategies must enhance the capacity of older patients and their ability to assert self; nurses must work to actively engage the patient in all decision making
Nørgaard et al,^Citation27 2012 (Denmark)	Quantitative	To investigate if adult orthopedic patients’ evaluation of the quality of care improves after communication skills training for health care professionals	3,133 patients; hospitalized for >24 hours in two orthopedic wards: Ward A – primarily elderly patients; mean age of men 56.4 years; mean age of women 62.04 years; Ward B – trauma patients; mean age of men 46.68 years; mean age of women 65.92 years	Pre- and post- questionnaires	Statistical analysis STATA, version 11	Increase in patient satisfaction with the quality of care received after attendance at communication skills training course (including attentive listening, silence, and summarizing skills); the necessity for clinicians to be trained in patient- centered communication across the health care spectrum
Sanghavi,^Citation25 2006 (USA)	Mixed method	“What makes for a compassionate patient-caregiver relationship?”	Multidisciplinary caregivers	Questionnaires and transcripts collected at 54 hospitals across 21 states	Theme development	Three major themes: communication, common ground, and respect for individuality; a prescription for change embracing support, regular guidance, repeated reinforcement, specific targeted outcomes, and more innovative care programs
Williams and Irurita,^Citation19 2004 (Australia)	Qualitative	To explore and describe, from the perspective of hospitalized patients, the perceived therapeutic effect of interpersonal interactions experienced during hospitalization	40 recently hospitalized patients, 1 day to more than 15 days, 13 males, 27 females, age ranged from 29 to 93 years; 32 nurses	Semi-structured formal and informal interviews; 78 hours of field across two health care settings; relevant documentation pertaining to nursing care plans and patient notes	Constant comparative analysis; open, axial, and selective coding; NUD*IST software	Personal control is a central feature of emotional comfort, and accounts for the way in which patients interpret therapeutic and nontherapeutic interpersonal interactions encountered during hospitalization; identification of the characteristics of interpersonal interactions that facilitate emotional comfort allows direction for enhancing therapeutic potential in all interpersonal interactions experienced by hospitalized patients
Zandbelt et al,^Citation8 2007 (The Netherlands)	Mixed methods^Citation9,Citation10	To determine the association of specialists’ patient-centered communication with patient satisfaction, adherence, and health status	30 physicians (15 staff physicians and 15 residents), 16 males, 14 females; mean years in practice 8.6 years; 330 patients, 138 males, 192 females, mean age 52 years	Questionnaires/scales and videotaped encounter	Coding behavior; statistical analysis	Patients were more satisfied when their medical specialist displayed more facilitating and less inhibiting behavior

Abbreviation: NUD*IST, Nonnumerical Unstructured Data Indexing, Searching, and Theorizing.

Figure 2 Conceptual map of the relationships between the key strategies of therapeutic interpersonal relationships.

AdamsKCiminoJEWArnoldRMAndersonWGWhy should I talk about emotion? Communication patterns associated with physician discussion of patient expressions of negative emotion in hospital admission encountersPatient Educ Couns2012891445022575434

 PubMed Web of Science ®Google Scholar

GreenbergMTherapeutic play: developing humor in the nurse-patient relationshipJ N Y State Nurses Assoc2003341253114639778

 PubMedGoogle Scholar

JagoshJBoudreauJSteinertYMacDonaldMIngramLThe importance of physician listening from the patients’ perspective: enhancing diagnosis, healing, and the doctor–patient relationshipPatient Educ Couns201185336937421334160

 PubMed Web of Science ®Google Scholar

JonesRReganMRistevskiEBreenSPatients’ perception of communication with clinicians during screening and discussion of cancer supportive care needsPatient Educ Couns2011853e20921521251789

 PubMed Web of Science ®Google Scholar

LeesDProcterNFassettDTherapeutic engagement between consumers in suicidal crisis and mental health nursesInt J Ment Health Nurs201423430631524575883

 PubMed Web of Science ®Google Scholar

MitchellEAMcCanceTNurse–patient encounters in the hospital ward, from the perspectives of older persons: an analysis using the Authentic Consciousness FrameworkInt J Older People Nurs2012729510421631873

 PubMedGoogle Scholar

NørgaardBKofoedP-EKyvikKOAmmentorpJCommunication skills training for health care professionals improves the adult orthopaedic patient’s experience of quality of careScand J Caring Sci201226469870422420418

 PubMed Web of Science ®Google Scholar

SanghaviDMWhat makes for a compassionate patient-caregiver relationship?Jt Comm J Qual Patient Saf200632528329216761793

 PubMedGoogle Scholar

WilliamsAMIruritaVFTherapeutic and non-therapeutic interpersonal interactions: the patient’s perspectiveJ Clin Nurs200413780681515361154

 PubMed Web of Science ®Google Scholar

ZandbeltLCSmetsEMAOortFJGodfriedMHde HaesHCJMMedical specialists’ patient-centered communication and patient-reported outcomesMed Care200745433033917496717

 PubMed Web of Science ®Google Scholar

RossLFacilitating rapport through real patient encounters in health care professional educationAustralas J Paramed2014104

 Google Scholar

O’ConnellETherapeutic relationships in critical care nursing: a reflection on practiceNurs Crit Care200813313814318426469

 PubMedGoogle Scholar