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JOURNAL OF ADVANCED NURSING

What to know and how to get to know? A eldwork study outlining the understanding of knowing the patient in facilities for short-term stay
Karin Bundgaard, Karl Brian Nielsen, Charlotte Delmar & Erik Elgaard Srensen
Accepted for publication 28 November 2011

Correspondence to K. Bundgaard: e-mail: karinmik@rm.dk Karin Bundgaard MScN RN PhD student Department of Production, The Faculties of Engineering, Science and Medicine, Aalborg University and Department of Gastroenterology, Aarhus University Hospital, Denmark Karl Brian Nielsen MScE PhD Professor Department of Production, The Faculties of Engineering, Science and Medicine, Aalborg University, Denmark Charlotte Delmar MScN PhD RN Associate Professor Department of Nursing Science, School of Public Health and Institute of Clinical Medicine, Aarhus University, Denmark Erik Elgaard Srensen MScN PhD RN Postdoc, Clinical Research Unit Science and Innovation Center, Aalborg Hospital, Aarhus University Hospital, Denmark

B U N D G A A R D K . , N I E L S E N K . B . , D E L M A R C . & S R E N S E N E . E . ( 2 0 1 2 ) What to know and how to get to know? A eldwork study outlining the understanding of knowing the patient in facilities for short-term stay. Journal of Advanced Nursing 68(10), 22802288. doi: 10.1111/j.1365-2648.2011.05921.x

Abstract
Aim. To report a descriptive study of nursing in facilities for short-term stay aiming to outline what knowing the patient means in an endoscopic outpatient clinic. Background. Knowing the patient is indispensable to the effort of tailoring nursing to the individual patients needs. Structural changes in the practice environments, however, reduce the amount of time a nurse spends getting to know the patient. Despite recent years focus on the subject, no uniform description of knowing the patient in facilities for short-term stay exists. Design. A eldwork study inuenced by practical ethnographic principles was performed in a high-technology endoscopic outpatient clinic during 2008 2010. Methods. Data were collected using participant observation for 12 weeks and semistructured interviews with eight patients and four nurses. Findings. Findings were summarized into two categories What to know? and How to get to know? The former concerned practical issues in relation to gastroscopy and was described in terms of the patients level of anxiety, wish for medication and previous experiences. The latter How to get to know? concerned instruments employed in getting to know the patient and was described in terms of the use of communication and sensing. Conclusions. Knowing the patient in the endoscopic outpatient clinic was understood in a very practical sense. Conversation and the use of the eyes and physical touch enabled a situational awareness. It helped tailor nursing to the patients needs and allowed the nurse to treat every patient as a unique individual. Keywords: communication, facilities for short-term stay, individualized nursing, knowing the patient, sensing

Introduction
This article focuses on the meaning of knowing the patient in an endoscopic facility for short-term stay. Facilities for short2280

term stay denote a large variety of outpatient clinics and treatment and emergency units at hospitals in todays healthcare setting (Clarke & Rosen 2001, Lynn 2002, Simpson et al. 2005, Timmins 2009).
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The purpose of nursing in this setting is to help patients through a procedure in the best and most safe way possible and with a usable result at the end of the procedure (Allan 2002, Foy & Timmins 2004, Mcilfatrick et al. 2006). The development of a patientnurse relationship is considered of central importance in fullling this purpose and knowing the patient is described as indispensable in the development of a relationship (Radwin 1996, Bassett 2002, Gallant et al. 2002, Macdonald 2008). Although the question of knowing the patient internationally has been considered a challenging topic in nursing research for a long period of time (Tanner et al. 1993, Radwin 1995, 1996, Macdonald 2007, Bolster & Manias 2010), the current literature on knowing the patient in facilities for short-term stay remains decient. Furthermore, extant research (Nystro m et al. 2003, Foy & Timmins 2004, Mcilfatrick et al. 2006) has raised the question if it is at all possible to tailor nursing to the individual patients needs and expectations in the context of facilities for short-term stay where limits on time and space militate against knowing the patient.

Background
Knowing the patient in terms of understanding the patients needs, expectations and preferences is essential to nursing and the provision of an individualized care (Radwin & Alster 2002, Finfgeld-Connett 2008a, 2008b, 2008c, Suhonen et al. 2010, Bolster & Manias 2010). It is also described as one of the most important aspects of providing a safe patient care because knowing the patient enables nurses to make good clinical judgment (Beyea 2006, Macdonald 2008). In Radwins (1995) model for individualized nursing interventions, knowledge of the patient derives from an understanding of the patients experiences, behaviours, feelings and/or perceptions. Radwins model emanated in the description of the four care strategies empathizing, matching a pattern, developing the bigger picture and balancing preferences with difculties. The situation determines the choice of strategy and strategies may in some situations interact. Familiarity is seen as a property and time as a condition of knowing the patient and both are considered when choosing a care strategy. Familiarity and time, rank the lowest in the empathizing and the matching a pattern strategies and thus the care choices are not interpreted as highly individualized. In developing the bigger picture and balancing preferences with difculties familiarity and time rank higher and the care choices are more individualized. Knowing the patient (Radwin 1996) may aid nurses recognize and treat patients as unique
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individuals; facilitate nurses decision-making, assessment and evaluation of patient responses; and endorse a positive patient outcome. The process of knowing the patient depends on availability of sufcient time, although structural changes in the practice environment like shorter in-hospital stays impose limits on time that can be spent with patients. Research also describes that limits on time in todays healthcare setting militate against knowing the patient (Thorne et al. 2005, Macdonald 2007, 2008, Bolster & Manias 2010). However, no research has yet been conducted into the process of coming to know patients admitted to facilities for short-term stay. Tanner et al. (1993) claims that clinical judgment in nursing rests on knowing the patient which translates into knowing the patients typical pattern of responses and knowing the patient as a person. Furthermore, knowledge is situated and shaped by contextual factors and by the individual nurse-patient interaction. Thorne et al. (2005) and Thorne (2011) translates knowing the patient into recognition of patterns and identication of innite variation in these patterns. Allan and Barber (2005) claim that the nature of a task performed contributes in shaping knowledge of the patient and thus the nature of the patient nurse relationship. Extant research (Murphy 2001, Nystro m et al. 2003, Foy & Timmins 2004, Mcilfatrick et al. 2006, Macdonald 2008) has raised the question if knowing the patient is at all possible in facilities for short-term stay. In this context, the limits on time, the high turn-over, the task-oriented structure and the high level of technology allow only supercial possibilities for knowing the patient. Moreover, research in this eld seems to ignore what knowing the patient actually means. Radwin (1996), for example, suggests that knowing in this context may be understood in other ways than in traditional nursing contexts.

The study
Aim
The aim of the study was to outline what knowing the patient implies in an endoscopic outpatient clinic.

Design
The eldwork study is inuenced by practical ethnographic principles (Hammersley & Atkinson 2007, Srensen et al. 2011). Fieldwork has been shown to be a suitable method in nursing research (Jeppesen 2007, Srensen et al. 2011) and for shedding light on nursing in facilities for short-term stay (Allan 2002).
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Setting and participants

The eldwork was carried out in at a high-technology endoscopic outpatient clinic during 20082010. Field observations were performed over 12 weeks and lasted approximately 4 hours each day. During observation periods, the researcher stayed in the endoscopic clinic, trailed a nurse in her work, talked to patients in the resting and waiting area and talked to nurses, physicians and others in the clinic (Hammersley & Atkinson 2007:5383, 151183). The patients arrived to the endoscopic clinic from their homes, underwent gastroscopy and then returned to their homes. Their stay at the clinic lasted between approximately 20 minutes and 2 hours. Patient interviews were carried out prior to gastroscopy. Patients undergoing gastroscopy at pre-xed times on randomly selected days were asked if they would participate in an interview. The researcher was in contact with ten patients, 9 accepted and one declined. One of the 9 never came for his gastroscopy or the interview; thus, 8 interviews were performed. Interviewees were both men and women, over the age of 18 and uent in Danish. The patients age distribution ranged from 2591 years. This was considered a strength since young and elders may have different expectations (Gadamer 2004). Both patients having gastroscopy for the rst time and patients who had a re-gastroscopy participated in the study under the assumption that they could have different expectations for nursing care (Murphy 2001, Gadamer 2004). The nurses who were interviewed were working in the endoscopic clinic. Participation was based on voluntariness and their nursing experience ranged from 421 years. The interviews were carried out after the researcher had trailed the individual nurse for 1 day; 4 interviews were performed. Participant observations and interviews were interrelated. Thus, the interviews helped focus participant observation which, in turn, informed the subsequent semi-structured interview guide. The duration of participant observations and the number of interviews were not decided in advance. The aim was to achieve data saturation, i.e. to reach a point when what was heard, seen and experienced seemed to repeat itself in recognizable patterns (Delmar 2010).

included informing the patients about their right to withdraw at any time. None of the patients, however, exercised this right. Choosing to carry out an interview immediately before a gastroscopic procedure may cause undue distress to patients and add to their anxiety. Special attention was therefore paid to proper behaviour and attitudes in relation to sick and vulnerable persons. For example the interview with Patient 6 was curtailed because of the obvious distress it caused.

Data analysis
Hammersley and Atkinson (2007:333367) offer guidelines which may aid the researcher perform research. The rst step in these guidelines is a conceptual development including a thorough reading of the text (empiricism); identication of patterns, concepts and categories; and processing of categories central to the analysis. The second step is the creation of a typology and, nally, the third step is theory development and testing. In this study, the process of analysis unfolded as a dynamic process that involved a constant movement back and forth between the above steps. Research may involve all steps, but to describe and understand what knowing the patient meant in facilities for short-term stay, most attention was paid to the rst step of conceptual development. The rst author performed the interviews, undertook participant observation and performed the transcriptional work. Field notes were made for each observed patient course in the endoscopic clinic and for each participant report; in the following these notes are referred to as the Report which is followed by a number. The interviews are referred to as Patient or Nurse followed by a number. In this study, patients associated knowing the patient with highly practical issues concerning gastroscopy. As expressed very clearly: All they need to know is that I want drugs (Patient 2). Nurses debated knowing the patient in relation to what they needed to know as professionals to be able to help patients through gastroscopy in the best and most safe way possible. Nurses described knowing as getting a sense of (Nurse 3) and getting an idea of (Nurse 4) the person within the patient. The categories What to know? and How to get to know? emerged from the analysis and is unfolded in the following.

Ethical considerations
The study was conducted in conformity with the ethical guidelines for nursing research in the Nordic countries (SNN 2003). Written informed consent was obtained before each interview and condentiality was assured. Verbal consent was obtained from all participating patients, nurses, physicians and others before each situation of participant observation. This
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Findings
What to know?
The nurses clinical actions were based on what they knew about the patient. Important information was found closely
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connected to practical issues concerning gastroscopy such as, did the patient follow the guidelines for fasting, had he taken his prescribed medication before the gastroscopy, did he need medication, was he anxious and was this his rst gastroscopy? Sometimes information was discovered easily, sometimes with difculty, and sometimes even not at all. The categories of knowledge deemed necessary are described under the concepts anxiety, medication and previous experiences. Anxiety Participants undergoing gastroscopy expressed their anxiety differently. Participants worried about the procedure itself and doubted if there was room for both the endoscope and for breathing at the same time. Some said that they had a very sensitive throat and feared throwing up. Some were convinced that they instinctively would pull out the endoscope. Others worried if they would actually be able to keep still while being examined. The participants having a re-gastroscopy said that anxiety for the procedure itself escalated each time they underwent the procedure. Participants worrying about the outcome of the gastroscopy often feared receiving a malignant diagnosis. Some participants were re-examined because they were diagnosed with in situ oesophageal cancer-stage changes; some because they had experienced difculties swallowing solid food, or maybe had had unexplained loss of weight or were in pain:
I worry its the cancer that has traveled from my leg up to my throat and thats why I experience these difculties swallowing. (Report 38)

Some participants acted more insecure in relation to medication, doubted if it would actually help them or if they would wake up again. The participants found it of vital importance that their wishes for medication were accepted and highly prioritized the question on medication in the initial conversation. Participants repeatedly accentuated this wish:
I need medication because I want to feel as little as possible. (Expressed by the patient the minute he entered the examination room) (Report 26)

The nurses took the participants wishes for medication seriously and emphasized that all participants were offered the opportunity to have medication. Nurses understood the discomfort participants experienced during gastroscopy and, if possible, they obliged to the participants wishes. A vocal explanation of how medication could ease the discomfort was delivered as part of the standard information given to patients before the procedure:
Patient: I really dont like it and would like some drugs. Nurse: I can comply with that. Patient: I would like as much as possible. (The nurse nods): The medicine helps you relax, but it may affect your memory of gastroscopy. (Report 7)

The nurses also experienced the participants anxiety. Anxiety was connected to the procedure itself, its potential outcome, and/or to participants previous experiences and imaginations:
Most patients show some degree of anxiety toward the procedure. (Nurse 3) For some patients its not so much the procedure they fear as it is the result that may come of it. (Nurse 1)

Previous experience Participants experiences were found closely connected to their imagination or idea of gastroscopy. Participants often expressed to know someone who had had a gastroscopy and the stories they were told were often terrifying. For example, the endoscope was compared to a garden hose and the patient to a sword swallower:
Ive heard many stories about this procedure from family and friends, and my colleague told me that it was horrifying. (Patient 8)

The ability to uncover the origin of participants anxiety was recognized as an important aspect of nursing and this knowledge was deployed when planning nursing. Medication Some participants very explicitly voiced their wishes for medication and considered it essential for them to get through the gastroscopy:
All they need to know is that I want drugs or else Ill walk out of here. (Patient 2)

Some participants suffered from cancer and others had a family member or a friend whose illness, or maybe death, was caused by cancer. Anxiety over where cancer would strike next was present:
Ive had it (cancer) in my uterus, then in my bowl and I cant help thinking is this the third strike? (Patient 2)

The participants previous experiences translated into the way they interacted with the nurses. Some very quickly put their trust in the nurses and left it entirely up to them to decide what they needed to know. Other participants expressed very clearly what they needed to know. The nurses were not always able to listen well for example when they

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seemed preoccupied by other tasks. In these situations, participants often found excuses for the nurses and blamed the situation on limits on time or on their own inadequacy in explaining themselves:
Its up to the physician and the nurse. They know the agenda, what they need to know, what I need to know and so forth. Theres only so much time. In 10 minutes they have to get to know the most important things about me. (Patient 3)

uncover the needed information. How to get to know the patient is described under the headings the communication and the senses. The communication Participants highly valued nurses who were able to listen and explain the procedure in an understandable way. If nurses truly listened, their main focus was experienced to be on the patient as a person. A lack of focus was felt when the nurse was preoccupied with documenting or with other tasks. If the participants felt that the nurses were rushing, they felt no inclination to communicate:
Id like them to show me that they do have time for me and listen to what I say. I have often experienced that they were too busy to hear my complaints. If they really are there for me they dont do anything else while talking to me (Patient 8) (Laying in a bed the patient is wheeled into the examination room by the physician. Meanwhile, the nurse is hasting around busy at cleaning and preparing the room for him. For a few minutes the patient is watching the nurse with confusion before asking): Am I in the right room? (Report 33)

Some participants explicitly expressed what their expectations were and these often reected their previous experiences:
Patient: I just have to get up on the gurney, reach out my hand, turn to my left and relax and by the way its OK to keep my shoes on. Nurse: You sound like you know the drill so I need not tell you much? Patient: No, I just need some medication so I can close my eyes and sleep and everything is going to be ne. (Report 28)

Nurses emphasized the relevance of knowing the participants previous experiences and appreciated the important impact these could have on the course of the patients stay in the clinic. The nurses did not need to hear participants entire life stories, but each little piece of information seemed relevant when they adjusted their information and nursing to the individual patients needs. Occasionally nurses had to cut a conversation short because of limits on time, space or upon the request of the physician or others:
I need them to tell their story using their words by this I nd out what they already know and need to know. (Nurse 1) Some patients are very talkative and you quickly get to know them; others act more reserved and its difcult to get a sense of who they really are. (Nurse 3)

The encounter between the patient and the nurse was initiated with a conversation. Nurses agreed on the importance of such conversation and in combination with proper information dissemination it was instrumental to having well prepared, safe and condent patients. The conversation also served the purpose of learning to know the patient as a person; however, limits on time and space were found to restrict the scope of this conversation:
In the initial contact, I small-talk. Its not just to ll out time; but I use it. I may ask: How did you sleep last night? If they tell me that they have twisted and turned the entire night, I realize, O.K., this patient is denitely scared and may need extra information. (Report 47)

How to get to know?

The principal source of basic information about the patient was the journal or referral records. Such records contained information about the patients identity, health history, diagnosis and the indication for gastroscopy. The participants said that the nurses had such basic knowledge and that they acted upon it during their encounter. Nurses, on the other hand, said that they had little opportunity to read about the participants before the encounter due to limited time and high turn-over. Nurses experienced to be stressed by the fact that the next patient was already awaiting their attention. Rather than relying on available sources of basic information, the nurses used their communication skills and their senses to
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Different tools like humour, metaphors and pictures were employed and were experienced to aid and ease the line of conversation. They were also intentionally used to take the heat out of the situation and to make the patient relax. Through conversation about highly practical issues, nurses became aware of the patients conditions and concerns. For example, a question on dieting before gastroscopy did lead to a conversation on difculties of socializing for a patient who was unable to eat solid food. Patients concerns were also observed to be reected in their behaviour. For example, a participant who was being treated for newly found breast cancer burst into tears before gastroscopy by the prospect that it had spread to her stomach.
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The senses Another instrument employed in getting to know patients was the nurses ability to deploy her senses. Both the participants and the nurses expressed how senses were activated by listening and observing in combination with physical touch. The participants felt recognized when the nurses were present and focused on them as individuals:
I think its very important that they understand where I come from and to be addressed as the person I am. (Patient 1)

Although time and again this presence and focus was lacking which was explained to awaken feelings of hesitation and reservation:
I always see how the land lies before I start telling about myself. I quickly detect if they are ready to listen or not. (Patient 4)

The nurses agreed that knowing started the minute they laid eyes on the patient in the waiting area. Much information was gathered through the use of their eyes, by observing how the patient sat on the chair, where his eyes were looking and how he held his hands. Another contribution to knowing came from listening to the words spoken, the pauses, the intonation and the strength of voice. Furthermore, the nurses considered physical touch to be an important source of information. Touch served to communicate information about the patients condition in the sense that it held information about the patients reaction whether one of anxiousness, shakiness, feverishness or, alternatively, calmness and relaxation:
Sometimes, if they are anxious, I feel it in their handshake. Their handshake makes me think, OK, this patient needs a little extra information and reassurance while others waltz in here and clearly signal; save your breath and lets get on with it. (Nurse 3) It starts in the waiting area, the mere way of sitting on the chair reveals a lot. Often very tiny signals give away how they feel and tell me how to act. I might be wrong, but I often I sense if this is going to be difcult or easy. (Nurse 1) Within the rst couple of minutes, I get an idea of what they need by reading their body language and by listening to what they tell me. (Nurse 4)

Discussion
The study has explored the meaning of knowing the patient in an endoscopic facility for short-term stay. The study has some limitations. When performing research in ones own eld the researcher inevitably affects the ndings (Hammers-

ley & Atkinson 2007). Therefore, the researcher constantly reected on her own position and role in the eld and thereby challenged her own preconceptions. Discussions with supervisors also challenged the researchers own preconceptions. The interrelated data generation methods participant observations and interviews helped validate the interpretations that were made. The generalizability of the ndings to other facilities for short-term stay may also be questioned, having in mind that the nature of treatment and care in these settings are very different (Bundgaard et al. 2011). Generalizability is here understood as recognizability and the ndings must be accepted in the setting where they are to be used (Delmar 2010). In the endoscopic clinic, every patientnurse encounter was short. There were only approximately 510 minutes from the initial contact until gastroscopy started. This time was used to inform and prepare the patient for gastroscopy while simultaneously getting to know the patient. Priority was given to knowing the patients level of anxiety, request for medication and previous experiences. This seems to be in line with Radwins (1995) model description of knowing which includes a basic knowledge of the patients experiences, behaviours, feelings and perception. The description in the present study of the importance of knowing the participants previous experiences hence equals Radwins experiences. Radwins understanding of knowledge of behaviours could be compared to the example of how participants occasionally acted prematurely, for example by lying down and positioning themselves ready for gastroscopy before even talking to the nurse. A display of feelings was seen as a sign of how participants expressed their anxiety for gastroscopy. Finally, the fear of receiving a malignant diagnosis could be interpreted as the patients perception of the meaning of gastroscopy. Our ndings thereby substantiate Radwins research. During the course of gastroscopy, nurses drew on the knowledge obtained and they were, as we interpret it, able to foresee, understand and read patients reactions and responses to the situation. Research (Nystro m et al. 2003, Mcilfatrick et al. 2006) describes how nurses constantly struggle to balance time spent on knowledge of medical, practical and instrumental aspects against knowledge of social and psychological aspects. In a Swedish emergency care unit, nurses knowledge was interpreted to focus upon facts, principles and medical tasks, whereas no attempts were made to better understand patients caring needs (Nystro m et al. 2003). In an oncological day hospital, nurses paid too little attention to knowing in relation to social, psychological and spiritual aspects. Instead focus was

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targeted at the side effects and physical aspects of chemotherapy (Mcilfatrick et al. 2006). According to these studies, the absence of a focus on knowledge of the former aspects makes nurses unable to recognize and treat patients as unique individuals and thereby deliver what they dub holistic nursing. Instead, the nursing supplied was standardized and even sometimes non-caring, impersonal and creating a distance between patient and nurse. According to Radwin (1995), the choice of care strategy when time periods are short and familiarity rank low are empathizing and/or matching a pattern. Empathizing translates into the nurses ability to imagine what she would feel if she were in the patients situation. In matching a pattern, the care choices reect how patients in similar situations were previously cared for. Developing the bigger picture demands knowledge of the patients life outside the hospital and being able to combine this knowledge with knowledge of the patient inside the hospital. Balancing preferences with difculties demands knowledge of the patients care preferences. Interventions will reect this knowledge and include actions to full the patients requests and wishes while managing potential difculties. The study revealed that knowing the patients medical, practical and instrumental concerns could not be isolated from knowing the patients social and psychological concerns. Knowing the former was found to embrace aspects of knowing the patients requests and wishes and his/her concerns outside the hospital. Thus, the ndings emphasized that the area from which knowledge emanated was found to be unimportant. What mattered was getting to know those aspects that could affect the patients further course in the endoscopic clinic. The data thereby testify to the nurses ability to establish an adequate knowledge base for tailoring nursing to the patients unique care preferences. Furthermore, the study substantiates the importance of prioritizing patients practical concerns because this effort soothes the patients anxiety and hence paves the way for the procedure. This nding is a strong argument for the importance of the time nurses spend on these practical issues. In the endoscopic clinic, communicating and sensing were instruments intentionally deployed to enhance knowing the patient. Communication and sensing were activated the minute the nurse laid eyes on the patient and identied by the way nurses were listening, small-talking, observing, feeling and asking questions. All pieces of information were taken into consideration when nurses adjusted what was interpreted to be the standard information of gastroscopy and their nursing to the patients in front of them. FinfgeldConnett (2008a) describes how insights are disclosed in verbal and non-verbal ways that enhance the nurses ability
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to grasp the patients needs and respond in a caring way. This authenticates the ndings in this study. Communication is a central aspect of human interaction. It is essential for the individuals ability to relate to those around them, make their needs and concerns known and make sense of what is happening to them (Casey & Wallis 2011). Important contributions have been made describing the meaning of communication in nursing, for example, on communication with critically ill patients (Alasad & Ahmad 2005), communication in dementia (Perry et al. 2005) and communication with chronically ill patients (Boscart 2009). However, little research has been identied (Allan 2002, Foy & Timmins 2004) focusing on communication used to enhance knowing the patient in the context of facilities for short-term stay. Foy and Timmins (2004) describe communication as indispensable to knowing the patient and Allan (2002) notes that the use of voice, tone and humour enhance knowing. However, the swift delivery of care and the short patient stay are aspects experienced to militate against this. In the endoscopic clinic, the patientnurse communication was extremely short as it was limited to the 510 minutes before gastroscopy started. Thus, the use of senses was deemed necessary for knowing the patient. In Martinsens (2002, 2005) philosophical caring theory, the use of senses is fundamental to developing an experiencebased knowledge. The nurses ability to activate her senses in the short encounter enables her to relate to the individual patient and create room for caring (Martinsen 2005:150). Sensing in the endoscopic clinic was interpreted to take the form of the nurse using her eyes and ears, and the use of physical touch. For example, a mere handshake could reveal much information about a patients condition and state of mind. The nurses also expressed how their hand on a patients shoulder quickly revealed if he was tense. Thus, the senses evoked by physical touch are interpreted as an example of how the senses enhanced knowing the patient. The endoscopic setting severely challenged knowing the patient; however, the ndings conrmed that knowing the patient was a continuous process that did not stop even if conversation was curtailed because the nurse continuously had the opportunity of listening, observing and sensing. The use of communication and sensing are interpreted to support the nurses understanding of the patients perspective and of patterns unique to that individual.

Conclusion
Knowing the patient is conceptually the same process whether undertaken in facilities for short-term stay or in traditional nursing contexts. However, the depth of knowing
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What is already known about this topic

Knowing the patient is indispensable to the effort of tailoring nursing to the individual patients needs. Structural changes in the practice environments such as shorter lengths of stay in hospitals reduce the amount of time a nurse spends with patients. Nurses question if it is at all possible to come to know the patient in facilities for short-term stay because limitation on time, high turn-over and high levels of technology allow them to become only supercially acquainted with the patients.

patient, be present in the situation and linger in their attentiveness towards the patient. It thus enabled a situational awareness. How well nursing is tailored to the individual patient in facilities for short-term stay depends on how successful nurses are at employing all available instruments in getting to know the patient.

Acknowledgements
We thank the Danish Society for Nursing Research for nancial support for language revision of the article.

Conict of interest What this paper adds

The importance of knowing the patients practical concerns related to the procedure he or she is facing. There is a link between knowledge of the patients practical concerns and knowledge of the patient as a unique individual. The intentional use of communication and sensing enhance knowing and add a supportive dimension to the process of coming to know the patient in facilities for short-term stay. No conict of interest has been declared by the authors.

Author contributions
KB was not only responsible for the study conception and design but also performed the data collection and the data analysis besides being responsible for the drafting of the manuscript and aided KBN, CD and EES who supervised the study and made critical revisions to the article for important intellectual content.

Implications for practice and/or policy

How well nursing is tailored to the individual patient in facilities for short-term stay depends on how successful nurses are at getting to know the patient. How well the nurse is able to focus on the individual patient, be present in the situation and linger in their attentiveness in facilities for short-term depends on how successful nurses are at communicating and at using their senses. achievable in the two contexts may differ. In facilities for short-term stay, knowing the patient was understood in the sense of knowing their practical concerns about gastroscopy; i.e. their wishes for medication, their level of anxiety, etc., because such knowing paved the way for further knowledge about the patient as an individual, i.e. their unique characteristics, physical and emotional. The study revealed that the deliberate use of communication and sensing enhanced knowing the patient in the endoscopic clinic. Conversation about highly practical issues concerning gastroscopy and the use of eye sight and physical touch aided the nurses in identifying and responding to recognizable patterns into the unique situation. Communication and sensing enabled the nurses to focus on the
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