Experienced and skilled nurses' narratives of situations where caring action made a difference to the patient

Forty-five skilled and experienced nurses working at long-term, medical and surgical care clinics narrated 88 caring situations. The aim of the study was to interpret these narratives concerning the nurses' caring actions and the type of situations where they experienced that their caring made a difference to the patient. There were eight types of caring actions that were then condensed into three interaction and intervention approaches; 1) deliberate distanced interaction and intervention with the patient; 2) deliberate providing of prerequisites for interaction and intervention with the patient; and 3) deliberate deep interaction with the patient when intervening. These approaches were used when the nurses dealt with the following three types of caring situations: caring focusing on the nurse-patient relationship, on medical intervention, and on practical problem solving. The first two approaches occurred in situations focusing on acute medical intervention and on practical problem solving. All approaches occurred in situations focusing on the nurse-patient relationship. The finding that experienced and skilled nurses described situations where the depth of their contact with the patient varied can be expressed in the phrase "how I act depends on the situation." The skill to find the right level of involvement seems important.