Bedside Manner in Advanced Practice Nursing: Concept Analysis

Introduction and Aim

One feature of patient-centered care — in which patients are treated as partners — is the handover process conducted with patient participation. It is very important for nurses to understand the thinking and perspectives of their patients, as this understanding can help them adjust their bedside manner to suit patient expectations and needs. This involvement can also enable patients to become more engaged in the decision-making process. There is very little detailed evaluation of bedside manner in the literature, particularly from the perspective of nursing practice. Certain provider behaviors have consistently been identified as either positive or negative through concept analysis. Compassion, care, warmth, and support are among the positive behaviors, while disrespect, arrogance, and indifference are among the negative behaviors. The health status, compliance, and satisfaction of a patient are greatly influenced by the provider's bedside manner and how that manner is perceived. In order to provide effective patient care, it is essential for Advanced Practice Nurses (APN) to cultivate an effective bedside manner. More research is needed to understand patient expectations and to improve the relationship between patients and providers (Finch, 2008).

The aim of this study is to interpret the perceptions that patients hold regarding shift-to-shift bedside manner. The intention behind conducting this study was to use its findings to help nurses adjust their bedside manner according to the expectations and nature of their patients, and to better understand what patients want from them. This kind of nurse engagement will not only help patients recover but will also encourage them to participate actively in the decision-making process. This study examines patients' perspectives on the shift-to-shift bedside nursing handover.

Clinical communication plays a very important role in patient safety: it is miscommunication that is largely responsible for many adverse incidents (Haig et al., 2006).

Review of Literature

A substantial body of nursing research has been conducted on the bedside nursing handover (Chaboyer et al., 2009a; Chaboyer et al., 2009b; McKenna and Walsh, 1997; McMurray et al., 2009; O'Connell and Penny, 2001). One reason why bedside handover has not been adopted on a wider scale is probably the function and structure of most practice settings, which emphasize the expert practice model rather than a partnership between patients and nurses (Gallant et al., 2002; Brown et al., 2006). When Gallant et al. (2002) conducted a concept analysis of the nurse-patient partnership, they found that the term is linked with mutuality, collaboration, citizen involvement, and participation. They further reported that a more empowering environment now exists for patients, driven largely by a shift toward the more patient-enabling participative approach compared with the traditional expert practice model (Gallant et al., 2002).

In line with this changing trend, nurses are now more involved with their patients, listen to them more closely, and have generally become more attentive — all of which has helped build a trusting relationship between patients and nurses (Brown, McWilliam, & Ward-Griffin, 2006). As a result, patient-centered care empowers patients to become as involved in their treatment and medication as their knowledge and abilities allow (Brown et al., 2006). The professional appreciation of these empowering attributes, as described by Gallant et al. (2002), has been discussed and endorsed in the literature review by Hook (2004). However, Hook noted an absence of theoretical connection in her analysis between nurses' delivery of patient care and the nurse-patient partnership (Hook, 2004). In order to address this lack of connection, Hook (2004) recommended an evaluation of clinical situations.

The term "bedside manner" can be traced back to 1869 and refers to the conduct and behavior of a physician with a patient (Dictionary.com, 2014). To clarify the term "manner" further, it can be described as "a way in which one acts," while "bedside" simply means "the side of a bed."

Definition and Defining Attributes

In light of these definitions, it is clear that "bedside manner" can be understood as the way in which an individual behaves toward others. As Merton (1938) explained, human behavior is best understood within social settings — such as groups, organizations, or communities — where people encounter not only opportunities but also various constraints, and their responses to those situations constitute their behavior.

The features that help define a concept and that appear consistently in the literature whenever the concept is discussed are known as defining attributes (Walker & Avant, 2005). The defining attributes of bedside manner can be sub-categorized into three further attributes: care, compassion, and support (Crawford et al., 2011). It is interesting to note that terms such as friendly, gentle, warm, and kind — which are most prominent in Gilbert (2009) — are rarely used in the broader literature.