Patterns and Influencing Factors in the Nurse-Patient Relationship in Hospitals' General Wards: An Integrative Review

Abstract

Background: The nurse-patient relationship is considered important in nursing theories and ethics. Yet, on general hospital wards, such relationships are often not achieved. Prior to addressing developing satisfactory nurse-patient relationships, it is essential to first understand the types of relationships that occur and the dynamics that shape them.

Aim: This systematic integrative review explores the expectations and experiences of patients and nurses regarding their relationship and which mechanisms influence its development.

Ethics statement: As this study did not involve human subjects, ethical approval was not required.

Methods: A systematic search was conducted in Medline, Embase, PsycInfo and CINAHL (February 2021; targeted update November 2023). Nineteen studies on the nurse-patient relationship in general wards in Western countries were included. Whittemore and Knafl's integrative review methodology guided the process. Data were analysed thematically using Braun and Clarke's approach, and PRISMA guidelines were followed for reporting.

Results: Four central themes were identified: relational needs, force fields, relational abilities and relationship patterns. Relational needs reflect expectations of both patients and nurses. Various force fields can hinder relationship building, while relational abilities influence nurses' interpersonal capacity. Three relationship patterns were found. Emotionally connected relationships, marked by mutual emotional involvement, are considered ideal-typical but difficult to sustain. Emotionally detached relationships lack meaningful human connection and often lead to negative experiences. Socially connected relationships, characterised by brief but genuine human contact without emotional overexposure, however, meet both nurses' and patients' relational needs.

Conclusion: While emotionally connected relationships are difficult to achieve and emotionally detached ones are undesirable, socially connected relationships offer a feasible and meaningful alternative on hospital wards. Strengthening relational skills, professional identity and valuing human connection within institutional constraints can enhance nursing practise, inform education, guide relational care policy and foster ward cultures that prioritise person-centred care.

Keywords: emotions; hospital; inpatients; literature review; nurse–patient relations; nursing; nursing staff.

FIGURE 1

Literature search, PRISMA flow diagram [28].