This descriptive, correlational study was designed to explore the relationship between the interactive processes of primary nurses and the distress level of their primary patients. The selected interactive processes of primary nurses consisted of their empathy skills and their use of Orlando's deliberative process. Data on empathy skills and the use of the deliberative process were generated from the LaMonica Empathy Profile and the Clinical Vignette Questionnaire designed for this study. Data on patient distress were generated from the Profile of Mood State Inventory and the Distress and Pain Visual Analogue Scale.

The conceptual framework of the study was based on two major theoretical formulations: Orlando's theory of nurse-patient interaction and Roger's theory of personality and psychotherapy.

A non-probability convenience sample of 65 primary nurses employed on surgical primary nursing care units of a large teaching hospital participated in the study. Sixty-five cancer patients assigned to the participating primary nurse subjects also took part in the study.

Descriptive statistics of each variable were examined. Pearson product moment correlations were used to examine the three hypotheses and the nurse and patient demographic variables. Analysis of variance was used to examine relationships among many of the demographic variables. A content analysis of the responses to the Clinical Vignette Questionnaire was conducted.

Major findings indicated a significant relationship between the perceiving/feeling/listening empathy skill and patient distress, however, not in the expected direction. A positive relationship was found between empathy skills and use of the deliberative process. Nurses' age, years of experience, and education were significantly correlated with some empathy skills and use of the deliberative process. Distress levels of female patients were higher than male patients. The major finding was that in general, nurses scored low in the use of empathy skills and the use of the deliberative process and patients scored low in distress.

These results demonstrate that the complex nature of defining and measuring communication skills and relating these skills to patient care outcomes such as distress requires more study. Research questions that ask how and why nurses' interpersonal skills make a difference to patients and their health care outcomes must be generated by nurse administrators, nurse educators, and nurse researchers.