Balancing and compromising: nurses and patients preserving integrity of self and each other.

This paper brings together the perspective of both nurses and patients of the experience of nursing care delivery in acute care hospital settings. Initially, two grounded theory studies of the phenomenon of high-quality nursing care were conducted concurrently and in the same settings; one focussed on patients' experiences (Irurita, 1993. From person to patient: nursing care from the patient's perspective. Department of Nursing Research, Sir Charles Gairdner Hospital), the other on those of nurses (Williams, 1994. Unpublished report, Department of Nursing Research Sir Charles Gairdner Hospital, Perth, Western Australia). Similarities between the findings of both studies led the authors, using grounded theory methods, to re-examine and compare the findings and raw data, with additional data collected by theoretical sampling. The previous findings were integrated and extended, resulting in the development of a theory of Balancing and Compromising in response to the shared problem of threats to integrity, especially encountered when broader environmental and contextual conditions were unfavourable. This reciprocal process used by nurses and patients to preserve their own and each other's integrity involved: contributing to care--cooperating; prioritising and rational sacrificing; justifying compromised care and lowering expectations; and protecting self by attracting or repelling. Both positive and negative outcomes resulted.