About the PhD thesis

The nurse-patient relationship is central to delivering person centered, safe, and high-quality care in the ICU. Conscious mechanically ventilated patients often experience emotional distress, psychological suffering, physical weak-ness, and inability to speak. Such experiences are associated with anxiety, frustration, delirium, and compromised recovery. The nurse–patient relation-ship has been shown to protect patients and mitigate such negative experi-ences, yet existing knowledge remains fragmented and sparse.

This PhD project unfolds the complexities of the nurse-patient relationship with conscious mechanically ventilated patients in the ICU, through three studies: 1) a scoping review mapping descriptions of the nurse-patient rela-tionship in the ICU 2) an ethnographic study exploring how this relationship is enacted in clinical practice, and 3) qualitative interviews exploring nurses’ ex-periences.

Guided by the MRC framework for complex interventions, focusing on the identification and development phase, and grounded in a hermeneutic per-spective, findings from the three studies were integrated through thematic synthesis. The review uncovered the relationship as underexplored and de-scribed in fragmented terms, identifying six relational elements and five influ-encing factors. The ethnographic study identified how nurses dynamically and contextually integrate both technical-instrumental and relational focus in clin-ical practice, responding sensitively to patients’ pace and subtle cues within shifting ICU contexts. The interviews revealed the relationship as complex, emphasizing personal engagement, the use of senses, and knowing the per-son behind the patient while balancing emotional presence and professional distance.

The integrated findings demonstrate that the nurse-patient relationship is po-sitioned along the Continuum of Relational Orientation through a dynamic in-terplay between relational elements, the abilities of both nurses and patients, and the broader ICU context. Patient vulnerability and communication chal-lenges heighten the need for nurses’ use of senses and commitment to care.

Taken together, the findings underscore the central role of the nurse-patient relationship in the ICU and demonstrate that relational practice is not an in-herent consequence of proximity or technical expertise. But is a situated pro-cess enacted through nurses’ navigation of relational elements within contex-tual constraints and possibilities of intensive care.