Patients' perceptions of transgressive behaviour in care relationships with nurses: a qualitative study

Aim. To gain insight in the onset and meaning of transgressive behaviour in care relationships with nurses, from the perspective of patients. Background. Aggression and transgressive behaviour in health care have been a focus of research over the last decades. Most studies describe staff experiences on patient aggression. Patient' perspectives on aggression and transgressive behaviour in interactions with nurses are rarely sought. Design. Qualitative interview study. Methods. Twenty patients were purposefully sampled from six wards of two general hospitals. Semi-structured interviews were carried out in 2011. Data were analysed using the constant comparative method influenced by the grounded theory approach. Findings. On elaborating on what constitutes experiences of transgressive behaviour, patients employ a framework of suppositions towards hospital care and nurse-patient relationships. This framework leads to implicit ideas on how competent professional caregivers will be and on how relationships with nurses will be characterized as normal human interactions. When these anticipated ideas are not met, patients feel obliged to address this discrepancy by adjusting their expectations or behaviour. Patients become more vigilant with regard to care given by nurses; search for own solutions; make excuses for nurses or reprioritize their expectations. Because of this adjustment, perceptions of transgressive behaviour are reinforced, mitigated or put into perspective. Conclusion. Patients adjust their behaviour based on what they experience in care relationships with nurses or the hospital care. It is crucial that patients feel free to discuss their assumptions or untoward needs and nurses learn to understand and reflect on those experiences.