Patient activated nurses' support: A grounded theory of how hospitalized PLWA elicit nurses' support
Social support helps persons living with acquired immunodeficiency syndrome/human immunodeficiency virus (HIV/AIDS) address everyday problems associated with their illness. The healing orientation of nurses and the extensive time that they spend with persons living with AIDS (PLWA) in the hospital pinpoint nurses as likely sources of effective support. The way that nurses provide that support is not described in the literature. The purpose of the study was to explore nurses' support as perceived by PLWA.
A qualitative research design was guided by the tenets of grounded theory. Semistructured interviews were conducted with a theoretical sample of male and female (N = 27) patients admitted to a specialized AIDS hospital unit (SAU). Participant observation was used as a means of validating and refining concepts that emerged from interviews. Interviews were audiotaped and transcribed. Data analysis followed the constant comparative logic of grounded theory.
Findings revealed that nurses' support results from an intricate relationship where patients acknowledge the need for assistance, yet maintain control of both the relationship and the terms of support. PLWA exert control by having plans which change/evolve (learning, planning, implementing, re-evaluating) during the course of the illness. Plans change as PLWA become more experienced with the illness. Terms of support were controlled by the use of clued communication to elicit nurses' assistance. Nurses are able to engage in supportive activities when they correctly interpreted clues. Delivery of nurses' support changes over the course of the illness and progresses, under PLWA control, through the four stages of planning.
Implications for nursing from the findings are that patients want support, but their need for control precludes the use of direct requests. Therefore, PLWA relay their requests through clued communication which must be correctly interpreted by nurses. Nursing activities which result from correct interpretation of clued communication convey that nurses understand patients' strategies. Supportive nursing activities communicate that patients are valued by nurses.