How the nurse–patient relationship is enacted in Danish intensive care units: An ethnographic study of conscious mechanically ventilated patients

Introduction The nurse-patient relationship is crucial for conscious mechanically ventilated patients in the intensive care unit (ICU). While critical illness, immobilisation, and communication barriers challenge this relationship, the knowledge of its enactment in practice remains limited.Aim The aim of this study was to explore how the nurse-patient relationship with conscious mechanically ventilated patients in the ICU is enacted in clinical practice.Methods An ethnographic design was employed. Twenty-five participant observations supported by informal interviews (94 h) were conducted with nurses caring for conscious, nondelirious, mechanically ventilated adults in ICUs in Denmark over a 10-month period (May 2024-March 2025). Data were analysed using inductive reflexive thematic analysis. Reporting followed the Consolidated criteria for Reporting Qualitative (COREQ) guidelines.Results Relational orientation on a continuum, generated as an overarching theme, unfolds through the following subthemes: (i) The importance of navigating attentiveness in patient care; (ii) advocating for patients as a central aspect of establishing trust; (iii) active involvement of patients as a central aspect of care; and (iv) touch as a central aspect of nonverbal communication.Conclusions The nurse-patient relationship with conscious mechanically ventilated ICU patients was enacted along a continuum ranging from technical-instrumental to relational focus, where safety, trust, and collaboration are essential. Nurses dynamically navigate this continuum, balancing attentiveness, advocacy, involvement, and touch with clinical and technical competence while remaining sensitive to patients' pace and capacity as well as managing contextual factors, such as technology and interruptions. This emphasises that nurses' responsibility and commitment to the nursepatient relationship is fundamental to provide quality care.