Individual personal relations: effects on service quality

The purpose of this paper is to study patients' attitudes to nurses and investigate what hampering factors occur in the actual nursing situation and what patient features might affect cooperative climates.

In-depth interviews were conducted with 11 male inpatients suffering prostate cancer. The interviews were personal narrations based on open-ended questions. The theoretical basis is founded in sense-making, trust and competence.

Existential issues related to nursing care were interpreted by nurses as a need for (technical) information. However, respondents indicated a need for professional support regarding their whole life. The social climate seems not to be optimal for existential talk owing to hospital routines. Patients' personal traits also affect the propensity to cooperation, and three types were distinguished: cooperating patients; passive patients; and denying patients. Nurses' competence may be regarded as hierarchical levels from optimising single items, over system optimisation and to optimisation from the patient perspective. The study indicates that not even first-level requirements are met.

Only patients' views were studied. Nurses' perceptions would add additional insights. Lack of personal relations and cooperation between patient and nurse may decrease service quality. Patient attitudes seem to be a major obstacle. For some patients, passively receiving technical information may be an excuse for not wanting to participate in mutual sense-making. The supposed need for technical information may also be an excuse for nurses to avoid more sensitive issues.

Better quality of care involves changing patient perceptions and attitudes to what constitutes nursing competence.