Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient?

AIMS: The aim of this study was to describe the nurse-patient relationships and to study how caring behaviours were described. The review question was: What factors influence the caring relationship between a nurse and patient? BACKGROUND: There is a growing perception that nurses fail to provide compassionate and competent care. Policy documents prescribe compassion as an essential aspect of care; however, the evidence drawn on remains unclear and without clear applications to practice. DESIGN: Umbrella review methodology, informed by the Joanna Briggs Institute guidelines, was employed and adapted to enable the inclusion of systematic reviews that were of sufficient methodological quality. DATA SOURCES: An extensive PsychInfo, Pubmed, CINAHL, Scopus, WoS and Embase search was conducted for literature published from January 2000-March 2014. Key words included 'nurse', 'patient' and 'relationship' in combination with index terms to find literature published from 2000 onward. REVIEW METHODS: Critical appraisal, data extraction and synthesis were carried out according to existing guidelines for undertaking umbrella reviews. RESULTS: Twelve reviews (representing over 290 studies) were included following critical appraisal. Forty-seven findings were extracted, resulting in 14 categories and six synthesized findings; 'Expectations of the relationships' 'Values', 'Knowledge and skills', 'Communication', 'Context and environment' and 'The impact of the relationship'. CONCLUSIONS: A substantial body of evidence demonstrates that both patients and nurses have expectations about the nature and importance of the caring relationship. Nurses should be mindful that their behaviours and attitudes need to align with what patients value about the relationship. Context shapes the relationship in positive and negative ways.

Rising to the challenge of health care reform with entrepreneurial and intrapreneurial nursing initiatives.

Health reform worldwide is required due to the largely aging population, increase in chronic diseases, and rising costs. To meet these needs, nurses are being encouraged to practice to the full extent of their skills and take significant leadership roles in health policy, planning, and provision. This can involve entrepreneurial or intrapreneurial roles. Although nurses form the largest group of health professionals, they are frequently restricted in their scope of practice. Nurses can help to improve health services in a cost effective way, but to do so, they must be seen as equal partners in health service provision. This article provides a global perspective on evolving nursing roles for innovation in health care. A historical overview of entrepreneurship and intrapreneurship is offered. Included also is discussion of a social entrepreneurship approach for nursing, settings for nurse entre/intrapreneurship, and implications for research and practice.