Abstract

Nurses are aware that nursing is holistic, that every action taken in the care of a patient has consequences; and they like to believe that those consequences have a positive impact on the patient and their family's ultimate health. For nurses, gaining an understanding of patients' expectations regarding holistic care, to include spiritual care, is essential to entering into a truly holistic caring relationship with patients. The purpose of this phenomenological study was to explore the expectations patients have of nurses and how patients describe good nursing care. Specifically, questions were geared to reveal participants' perceptions of spiritual care as part of holistic care.

Using Paterson and Zderad's (1988) framework of humanistic nursing, 11 participants were interviewed. Data were analyzed using the Giorgi method. Methodological rigor was insured by use of the trustworthiness criteria (Lincoln & Guba, 1985).

Four themes emerged: (1) definitions of “good” and “bad” nursing care, (2) expectations of surveillance and competence, (3) spiritual care expectations and definitions, and (4) the concept of time and the nursing shortage. Findings revealed that patients saw nursing presence as important and elements of nursing presence were used to describe good nursing care. Nursing competence and nursing surveillance were universal expectations. The existential spiritual element of nursing presence was the most defining characteristic of good nursing care, but was not expected. Sharing of self by nurses was appreciated from the patients' perspective. All participants were able to define spirituality, most frequently in terms of religiosity, and religious elements of spirituality were not expected, nor wanted by the participants. Participants revealed that they perceived that nurses were busy and this perceived lack of time was offered as a rationale for not expecting existential spiritual care.

Recommendations included the need to address patient expectations in both nursing practice and education as well as to develop strategies for informing patients about what they can expect from their nurse when hospitalized.