Relational messages of control in nurse-patient interactions with terminally ill patients with AIDS and cancer

When dying patients are young adults or have a contagious disease, nursing staff may feel acutely uncomfortable and the patients may become isolated and alone. Nurses who work in palliative care units (PCU) develop special interactive skills that are generally acknowledged but not clearly defined or understood. Admission of patients with Acquired Immune Deficiency Syndrome (AIDS) to the PCU was expected to provide a unique opportunity for study. The project was an analysis of nurse-patient verbal interactions during physical care for the purpose of understanding communication patterns during the longest usual block of uninterrupted time nurses spend with patients. Included were six terminally ill patients with AIDS in an acute medical unit and nine other patients of differing ages in the medical unit and PCU. Data were tape recordings of up to six hours with each patient, a total of 78 days of taping. These were transcribed and analyzed to examine the content of interactions and communication techniques for identification of themes. The major overall themes were control, well-being, humor, uncertainty, and routines. The process themes identified were validation, problem solving, and therapeutic interaction. A framework for analysis of the relational messages of control was developed and detailed analysis conducted. The most frequent behavior was that of nurses offering control. Nurses and patients took control with approximately the same frequency, and by far the least frequent situation was that of the patient offering control to the nurse. The complexities of dying with a disease such as AIDS have made the care of these patients extremely demanding for all concerned. This analysis will help to delineate the content and process of nurse-patient interaction which is basic to comprehensive care of all patients.