In tandem or in tension? Patient-nurse negotiations from ICU to hospital discharge

Using grounded theory methodology, six intensive care patients were interviewed regarding their perceptions of their own needs, concerns and wants and how nurses responded to those. Each patient was interviewed three times to detect any change in responses during the hospitalization. A theme of patient-nurse negotiation emerged. Patients came into the health care setting with a "generative source," the issues and beliefs they had regarding health-care and nurses in general. This affected patients' definition of themselves, their situation, the caregiver, their relationship with the caregiver, and their own needs and expectations. When a patient's definitions of self or situation varied form the nurse's, negotiation would occur. Two main categories of negotiation were used by both patient and nurse: Personal knowledge & Strategies. If negotiation failed to bring consensus, resulting actions were negative feelings and dissatisfaction, and a sense of vulnerability for the patient. This in turn impacted negatively on the patient's generative source and definitions. As the patient progressed through the hospital system toward discharge, the greatest changes were noted in how they defined themselves and the caregiver, and in the style of negotiation they used