Maternal-child nursing, Nurse-patient relations, Public health nursing, Qualitative research, Vulnerable population



  1. Norris, Joan PhD, RN, FAAN
  2. Howell, Eleanor PhD, RN
  3. Wydeven, Marysue MSN, RN
  4. Kunes-Connell, Mary PhD, RN


Purpose: To describe the nature of how nurses establish and maintain relationships with first-time pregnant, poor teenagers and their families to achieve health and life course outcomes.


Study Design: Qualitative grounded theory was used to develop a conceptual framework for establishing and maintaining nurse-client relationships with a vulnerable population.


Methods: Twelve focus groups were conducted with six nurses who worked in long-term relationships with a diverse and vulnerable group of women. Broad interview questions were used to describe the basic social process and the phases, action processes, and influencing factors in the relationship. The nurse participants and a group of patients confirmed the credibility of the theory. Eight nurses in similar practice settings across the country also confirmed the fit of the theory to their own practices, and an expert consultant verified the auditability of the study.


Results: The grounded theory of "partnering" was found to address phases of engaging the client, working on mutual goals, and disengaging. Trust is a turning point in the relationship and action processes address persevering and managing boundaries. Influencing factors related to client, nurse, and the healthcare system serve as barriers and facilitators.


Clinical Implications: Partnering as a conceptual framework may prove useful for working with other diverse and vulnerable clients after testing in different populations and settings.