van Erp Heleen, de Man-van Ginkel Janneke, Nederend Anouk, Rense Anouschka, Slager Meralda, Bussemaker Jet
Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Haga Teaching Hospital, The Hague, the Netherlands.
Scand J Caring Sci. 2025 Sep;39(3):e70104. doi: 10.1111/scs.70104.
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.
This systematic integrative review explores the expectations and experiences of patients and nurses regarding their relationship and which mechanisms influence its development.
As this study did not involve human subjects, ethical approval was not required.
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.
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.
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.
护士与患者的关系在护理理论和伦理中被认为很重要。然而，在综合医院病房中，这种关系往往难以实现。在探讨如何建立令人满意的护患关系之前，首先必须了解所发生的关系类型以及塑造这些关系的动态因素。
本系统综合综述探讨了患者和护士对他们之间关系的期望和经历，以及哪些机制影响这种关系的发展。
由于本研究不涉及人类受试者，因此无需伦理批准。
在Medline、Embase、PsycInfo和CINAHL数据库中进行了系统检索（2021年2月；2023年11月进行定向更新）。纳入了19项关于西方国家普通病房护患关系的研究。采用惠特莫尔和克纳夫的综合综述方法指导该过程。使用布劳恩和克拉克的方法对数据进行主题分析，并遵循PRISMA指南进行报告。
确定了四个核心主题：关系需求、力场、关系能力和关系模式。关系需求反映了患者和护士双方的期望。各种力场会阻碍关系的建立，而关系能力会影响护士的人际能力。发现了三种关系模式。以相互情感投入为特征的情感连接关系被认为是理想典型的，但难以维持。情感疏离关系缺乏有意义的人际联系，往往会导致负面体验。然而，以短暂但真诚的人际接触且无过度情感暴露为特征的社会连接关系，满足了护士和患者的关系需求。
虽然情感连接关系难以实现，情感疏离关系不可取，但社会连接关系为医院病房提供了一种可行且有意义的选择。在机构限制内加强关系技能、职业认同感并重视人际联系，可以改善护理实践、为教育提供信息、指导关系护理政策，并培育优先考虑以患者为中心护理的病房文化。
