Introduction

Patient experience is a core indicator of healthcare quality and organizational performance; however, improvement efforts often emphasize identifying deficiencies rather than strengthening practices that already work (Wolf et al., 2014). Despite strong clinical outcomes, inpatient units show variability in experience scores not fully explained by survey data alone. Patients’ perceptions of care are shaped not only by clinical results but also by communication, compassion, responsiveness, teamwork, and basic needs such as comfort and dignity. Deficit-focused approaches may overlook these relational and environmental drivers, limiting sustainable improvement (Luxford et al., 2011). Leveraging effective nursing practices offers an opportunity to enhance the inpatient experience while supporting a patient- and family-centered culture.

Background

Qualitative feedback from patients highlighted the need to better understand what patients value most during hospitalization and how nursing practice influences these experiences. Traditional metrics did not fully capture the drivers of trust, safety, and emotional well-being described by patients. A strength-based methodology was needed to elevate patient and staff voices, examine experiences across units, and identify high-impact practices contributing to meaningful care. Appreciative Inquiry was selected to shift the focus from “fixing problems” to amplifying practices that positively influence patient experience and nursing care delivery (Hung et al., 2018).

Methods

This IRB-approved project served as the Plan phase of a PDSA-informed approach using Appreciative Inquiry to identify strengths prior to implementation. Semi-structured interviews were conducted with 50 patients across two units: a medical and a surgical unit. Interviews focused on moments of excellent care, communication, teamwork, emotional support, and opportunities to enhance the care experience. Interviews were audio-recorded, transcribed, and thematically analyzed. Researchers collaboratively reviewed transcripts to identify recurring themes, which were synthesized into shared leverage points and mapped to nursing practice implications to inform future PDSA cycles.

Results

Six shared leverage points emerged from the interviews. Teamwork was most frequently cited, with 30% (n = 15) describing staff working together as central to feeling safe and supported. Medication communication and explanation of plans of care were highlighted by 26% (n = 13) as improving confidence and understanding. Courtesy, respect, and patient-centered communication were each noted by 22% (n = 11), reinforcing the importance of relational care. Compassionate presence and emotional support were described by 16% (n = 8). Notably, food was mentioned by 20% (n = 10), surpassing concerns about response time and call light use (14%, n = 7), underscoring comfort and dignity as key components of the patient experience.

Discussion

Findings support that relational and environmental factors, rather than clinical outcomes alone, shape the patient experience (Wolf et al., 2014). Everyday nursing practices—compassion, communication, teamwork, and responsiveness—were foundational to trust and psychological safety. Environmental elements, particularly food and comfort, played a significant role in emotional and physical well-being. These results highlight nursing’s central role in patient-centered care and support strengths-based approaches, such as Appreciative Inquiry, to complement traditional patient experience metrics.

Future Implications

These findings highlight opportunities for nurses to leverage relational and environmental factors to enhance care delivery. Integrating compassionate presence, clear communication, responsiveness, teamwork, and comfort into routine practice can be supported through education and coaching. Nurse leaders can sustain these practices through huddles, bedside rounding, orientation, and competency validation. Planned PDSA cycles will enable teams to test and refine interventions, with evaluation guiding adaptation or expansion.

Conclusion

Using Appreciative Inquiry to center patient voices revealed actionable strengths shaping the inpatient experience. By intentionally leveraging compassion, communication, teamwork, and comfort-related practices, nursing teams can enhance trust, dignity, and emotional well-being while advancing patient-centered care.

Dr. Joanne McNeil, DNP, RN, MEDSURG-BC, and Dr. Yarisbell Collazo, DNP, RN, MEDSURG-BC, are nurse managers at UF Health and FNA members, respectively. 

Nicole Rossomano, MPH, is a Patient Experience Specialist at UF Health

References

Hung, L., Phinney, A., & Chaudhury, H. (2018). Appreciative inquiry: Bridging research and practice in a hospital setting. Innovation in Aging, 2(suppl_1), 142–142. https://doi.org/10.1093/geroni/igy023.517

Luxford, K., Safran, D. G., & Delbanco, T. (2011). Promoting patient-centered care: A qualitative study of facilitators and barriers in healthcare organizations. International Journal for Quality in Health Care, 23(5), 510–515. https://doi.org/10.1093/intqhc/mzr044

Wolf, J. A., Niederhauser, V., Marshburn, D., & LaVela, S. L. (2014). Defining patient experience. Patient Experience Journal, 1(1), 7–19. https://doi.org/10.35680/2372-0247.1007