Abstract
The purpose of this study was to look beyond the patient as the source of difficulty and to examine the context of care encounters for factors that contributed to the construction of difficulty in the nurse-patient encounter. The study explains the origins of difficulty in the nurse-patient encounter. This explanation broadens the thinking limits previously imposed by locating difficulty within the individual. Key elements of this explanation are: knowing the patient minimizes the likelihood of difficulty in the encounter; and families, availability of supplies and equipment, who is working, and care space changes are contextual factors that contribute to the construction of difficulty in the nurse-patient encounter. Awareness of these findings has implications for the strategies nurses employ in difficult encounters.
