{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:56:07Z","timestamp":1790733367089,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["23K19843"],"award-info":[{"award-number":["23K19843"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To understand how relational processes support nurse\u2013patient synergy when communication is constrained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A qualitative secondary analysis using abductive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An anonymised dataset from five online focus groups conducted in August 2022 with 21 acute and critical care certified nurse specialists was re\u2010analysed. Transcripts and inherited primary analytic products (331 important items and 52 categories) were examined iteratively with the Synergy Model and three culturally informed sensitising perspectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four interlinked themes described synergy in practice: attuning to unspoken needs and relationships to preserve dignity and hope; co\u2010creating support through dialogue and collaboration grounded in relational safety; balancing discipline and flexibility to guide safe, patient\u2010centred judgement; and fostering organisational growth through shared learning, visibility and collaboration. Accounts of voicing uncertainty generated a proposed team\u2010level condition for further testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Synergy was interpreted as a recursive relational process in which cues were tested, meaning was negotiated, care was calibrated to risk and learning was made shareable. Opportunities to voice uncertainty may shape whether perceived concerns lead to action.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for the Profession and\/or Patient Care<\/jats:title>\n                    <jats:p>Critical care teams may use tentative inference, dialogue, accountable adaptation and case\u2010based learning to make expert relational practice more visible and teachable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>Communication constraints can prevent patients' priorities from shaping care. The findings offer four relational processes and a team\u2010level proposition that can be discussed, taught and tested across critical care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This report follows the EQUATOR\u2010listed Standards for Reporting Qualitative Research (SRQR) (O'Brien et\u00a0al. 2014). The completed checklist is provided as File\u00a0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>No Patient or Public Contribution<\/jats:title>\n                    <jats:p>No patients or members of the public contributed to this secondary analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocn.70571","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:16:07Z","timestamp":1790730967000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relational Dynamics of Synergy in Communication\u2010Constrained Intensive Care: A Secondary Qualitative Analysis Proposing a Processual Account of the Synergy Model"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8150-6749","authenticated-orcid":false,"given":"Kohsuke","family":"Sakaki","sequence":"first","affiliation":[{"name":"The Jikei University School of Nursing  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6501-3329","authenticated-orcid":false,"given":"Misuzu","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Nagoya City University Graduate School  Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2024.04.006"},{"key":"e_1_2_15_3_1","unstructured":"American Association of Critical\u2010Care Nurses.2026.\u201cAACN Synergy Model for Patient Care.\u201dhttps:\/\/www.aacn.org\/nursing\u2010excellence\/aacn\u2010standards\/synergy\u2010model. Accessed 17 August 2026."},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/23779608251321365"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc1998.7.1.64"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.2307\/2666999"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ANS.0000000000000367"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.13105"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2022.12.009"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033\u2010295X.98.2.224"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318232da75"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000000388"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11192645"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1473325017700701"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102648.1999.00953.x"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2024.02.012"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.11153\/jaccn.20.0_14"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0320430"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20106576.2007.01292.x"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2024.2348891"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2014573"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.46743\/2160\u20103715\/2022.5340"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijn.12440"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/00491241211067508"}],"container-title":["Journal of Clinical Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocn.70571","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jocn.70571","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocn.70571","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T01:16:09Z","timestamp":1790730969000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocn.70571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":23,"alternative-id":["10.1111\/jocn.70571"],"URL":"https:\/\/doi.org\/10.1111\/jocn.70571","archive":["Portico"],"relation":{},"ISSN":["0962-1067","1365-2702"],"issn-type":[{"value":"0962-1067","type":"print"},{"value":"1365-2702","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-08-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jocn.70571"}}