Mutuality in health care: review, concept analysis and ways forward

AIMS AND OBJECTIVES: This paper aims to critically investigate the notion of mutuality in nursing, and explore how to resolve the tension between individualised accounts of mutuality and institutional and political factors. BACKGROUND: The concept of mutuality underlies many theories and models of nursing yet this does not capture the power relations in health care or institutional constraints on mutuality. DESIGN: This is a position paper informed by a narrative literature review. METHODS: A search of the Scopus, PubMed, Web of Knowledge and CINAHL databases for the terms mutual, mutuality and nursing was conducted, to capture English language literature published from 1990 to mid-2015. RESULTS: There is a large literature discussing the nature and value of mutual exchange and mutuality. There is acknowledgement of institutional and professional constraints which limit the potential of mutuality. Yet there is often a reluctance to engage with critical thinking which emphasises the inequalities of power in health care situations. Accordingly, the notion of social capital is introduced, which emphasises the role of social relationships which individuals and groups can deploy to their advantage. Finally the paper explores how new thinking about mutuality and social capital can make health care more effective. CONCLUSIONS: Mutuality and social capital can be enhanced in a variety of ways and may improve client and practitioner outcomes via training, educational and organisational design, and initiatives involving patients and service users, as well as practitioners and service leaders. RELEVANCE TO CLINICAL PRACTICE: The sociologically nuanced account of mutuality advanced here sensitises us to questions of power and domination, as well as enabling us to see mutuality in terms of networks of relationships instead of merely an interpersonal phenomenon. This enables practitioners to enhance clients' and their own capacity for mutuality and develop effective resources to increase resilience and recovery.