THE EXPERIENCES OF CHRONICALLY ILL PATIENTS AND REGISTERED NURSES WHEN THEY NEGOTIATE PATIENT CARE IN HOSPITAL SETTINGS
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Positive hospital experiences and health outcomes for chronically ill patients are dependent on effective negotiations of care that are built on partnerships and mutual goal setting. However, studies suggest that many nurse-patient relationships continue to be dominated by paternalistic models of care and lead to negative patient experiences. Nurses are often expected to change their practice with less attention given to the contribution of institutional contexts. Furthermore, little attention has been given to the role of patients in the process. The aim of this study was to look at the experiences of chronically ill patients and registered nurses when they negotiated care in hospital. Feminist post-structuralism informed by discourse analysis was used to explore how social and institutional discourses shaped power relations and negotiation of patient care. A total of 18 indepth interviews were conducted with eight chronically ill patients and ten registered nurses. Five themes emerged from the analysis. These themes were: getting to know each other, they are not the sickest people, the two faces of patriarchy, the challenges of looking after chronically ill patients and finding time to listen. Overall both nurses and patients commented favorably about their experiences. Nurses got to know patients on a personal level, power relations were shared and most negotiations were successful. However, negotiations were not always positive. Certain institutional practices were still based on a patriarchal system that gave priority to acute illness or reinforced the traditional nurse-patient relationship. Patients exercised their agency in creative ways to ensure that they were not marginalized by such discourses. Nurses also faced challenges negotiating care with some chronically ill patients and at times felt compelled to use their authoritative position to ensure positive outcomes. Other nurses listened to patients and effectively addressed their concerns. This approach was rewarding for both patients and nurses. This study offered an innovative way of unpacking negotiation of care between chronically ill patients and registered nurses. It exposed how social and institutional discourses play a pivotal role in shaping negotiations. By shifting the blame from nurses and patients to relations of power and institutional contexts, problematic areas were identified.