Relational continuity in nurse–patient contact on hospital wards: An explanatory sequential mixed-methods study

Background Rising care complexity, shorter hospital stays, and nursing shortages limit opportunities for recurrent nurse–patient contact, the structural foundation of relational continuity. While this contact is essential for relationship formation, its frequency in hospital wards remains persistently low. Understanding the mechanisms and contextual factors that shape contact patterns is therefore crucial to support relational continuity in nursing practice. Objective To explore relational continuity in nurse–patient contact on general wards and to examine nurses’ perspectives on the mechanisms and contextual factors underlying current practices. Design Mixed-methods explanatory sequential design. Setting General nursing wards in a teaching hospital in the Netherlands. Participants A total of 126 patient records were included in the quantitative component; three focus groups involving 11 nurses were conducted in the qualitative component. Methods In the quantitative phase, authorship of reports in patient records was used as an indicator of nurse–patient contact. Descriptive statistics were then applied to assess the frequency of recurrent contact as a proxy for relational continuity across seven wards. Subsequently, these observed contact patterns were discussed in focus groups with nurses. Qualitative data were analyzed using thematic analysis to identify contributing mechanisms and contextual factors. Integration of both strands occurred through an integrated interpretation, linking observed contact patterns to nurses’ perspectives. Results Recurrent nurse–patient contact was limited. During an average hospital stay of 6.5 days, authored reports were written by a mean of 11.4 different nurses, with 82.7% representing only a first or second report by the same nurse. While nurses typically maintained contact for two to three shifts, they often withdrew thereafter. This observed contact pattern was shaped by an interplay between organizational constraints and mechanisms of relational regulation, whereby pragmatic rationalizations enabled nurses to mitigate moral distress when professional values regarding relational continuity were compromised. Discussion These findings indicate that relational continuity is not merely an organizational challenge but is also shaped by how nurses navigate their contact with patients. Workforce policies targeting organizational factors in isolation are likely to fall short if they overlook the relational regulation that leads nurses to withdraw when contact becomes emotionally demanding. Effective strategies should therefore integrate support for these emotional demands with organizational adjustments, thereby enabling nurses to better realize professional values in daily practice.