Struggling to find a balance: A grounded theory study of the nurse-patient relationship within an economic context

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Nancy Hogan - Committee Chair


The purpose of the research was to examine the nurse-patient relationship within a context of economics and the changing health care environment. The researcher used the grounded theory method to analyze the nurse-patient relationship from the perspective of nurse, patient, and administrator.A total of 28 participants were interviewed by the researcher. This sample included 10 nurses, 10 patients, and 8 top-level administrators from a for-profit hospital in Southwest Florida. Data analysis consisted of open-coding and constant comparative analysis. The resulting nurse taxonomy included the categories of entering into the relationship, practicing caring and entering a new reality. The resulting patient taxonomy included the categories of being in the relationship, interpreting the caring, and feeling threatened by the new reality. The resulting administrator taxonomy included the categories of viewing the nurse-patient relationship, judging caring and non-caring, recognizing the chaos and profiting in the new reality. The basic social problem encountered by all participants was diminishing health care resources. The emergent substantive theory was struggling to find a balance, which referred to sustaining the caring ideal while facing a new reality controlled by costs. The overall results of this study show that restructuring of health care that proposes to link cost and quality must include the nurse-patient relationship as a value added component. For it was within the realm of the nurse-patient relationship where nurses, patients, and administrators described caring, quality, and their hopes, fears, and expectations for the future.


Psychology, Social; Health Sciences, Nursing; Psychology, Industrial

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