Confidential Conversations in Palliative Care: An Ethnographic Exploration of Trust and Interpersonal Relationship Between Nurse and Patient

TL;DR

This study examines how trust and relationships develop between nurses and patients during private conversations in palliative care, highlighting the importance of presence, small talk, and silence.

Contribution

The study uses rare observational methods to explore the dynamic nature of trust in palliative care nursing, addressing a research gap in relational aspects of care.

Findings

Trust in confidential conversations is fragile and develops dynamically through consistent nurse-patient interactions.

Small talk, presence, and silence are essential for initiating and maintaining trust in palliative care.

Healthcare environments should prioritize privacy and communication training to support these relationships.

Abstract

To explore aspects of interpersonal relationships in palliative care nursing, focusing on confidential conversations between patients and registered nurses (RN).

A qualitative study employing focused ethnography.

Data were collected through unstructured participant observations, field notes and interviews with patients and RN in specialist palliative care. Data were analysed using reflective thematic analysis.

Confidential conversations in palliative care are founded on trust that is fragile and develops dynamically through consistent interactions. Small talk, presence and silence are essential for initiating and maintaining trust and the interpersonal relationship. The environment, patient condition and RN emotional presence and competence shape these conversations. As the relationship evolves, conversations adapt to the patient's changing needs. Missed signals or interruptions can disrupt flow, but the potential for repair remains, allowing for restoration and strengthening of trust and connection.

Confidential conversations in palliative care are grounded in fragile, dynamic trust, necessitating ongoing presence, sensitivity and adaptability from RN. To support these interactions, healthcare environments must prioritise privacy, relational continuity and communication training. Future research should investigate how organisational structures and clinical settings influence confidential conversations.

Healthcare environments should facilitate confidential conversations by ensuring relational continuity and minimising distractions. Communication training that emphasises presence and management of silence can strengthen nurse–patient relationships, enhancing patient care and emotional support.

This study explores key aspects of confidential conversations in palliative care, emphasising trust and emotional sensitivity. It addresses a research gap in palliative care using rare observational methods to deepen understanding of nursing relational aspects. The findings offer practical guidance for enhancing communication and relational skills, informing training and policy development and ultimately, improving emotional support and care.

Findings are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

This study did not involve patient or public participation in its design, conduct or reporting.

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