| Abstrakt: |
QUESTIONS: In home care nurse-patient interactions, what are the interpersonal contexts and social acts through which negotiation occurs? What are the outcomes of unsuccessful and successful negotiation?DesignQualitative ethology for video based research.SettingA large metropolitan home healthcare agency in the western US.Participants10 nurse-patient dyads (3 home care nurses and 8 patients; 2 patients were each paired with 2 nurses). Patients were 25-86 years of age and required home care for acute and chronic conditions. Exclusion criterion was inability to communicate verbally because of cognitive or physical impairment. {The 3 home care nurses, who were case managers and had >/= 6 years of home care experience, were peer nominated as expert practitioners.}Methods31 routine home care visits were videotaped (19 hours of videotape). Nurses and patients participated in separate semistructured interviews before and after the videotaped sessions. The unit of analysis was the communication strategy (verbal or non-verbal action). Data analysis was cyclical, recursive, and verified with colleagues and a conversational analyst.Main findingsCaregiving activities occurred in a complex environment of interpersonal considerations. 6 interpersonal contexts characterised the goals that patients and nurses worked towards by negotiating their needs and expectations. (1) Negotiating territoriality referred to negotiation of shared space in the patient's home to facilitate caregiving. (2) Negotiating shared perceptions of the situation aimed at creating consensus in perceptions of a patient's wellbeing and progress. (3) Establishing an amicable working relationship involved the development of a friendly collaboration, whereby both nurses and patients recognised the individuality of the other beyond immediate caregiving activities. This occurred by volunteering information, sharing stories, and keeping track of events in each other's lives. (4) In synchronising role expectations, nurses and patients recognised each other's particular expertise. Role boundaries were negotiated, which determined relative autonomy, collaboration, or dependence in caregiving activities. Negotiating pain management was an important aspect of role synchronisation, as nurses helped patients find ways to express and manage pain. (5) Negotiating knowledge involved obtaining and providing information within an interpersonal context. Nurses and patients had to find appropriate ways to offer new information without imposing or demeaning, affirm correct knowledge, and identify and supplant incorrect information. (6) Sensitivity to taboo topics referred to the context in which nurses and patients could address sensitive topics such as pain tolerance, private habits, and personal fears. Communication patterns related to such topics tended to be hesitant and indirect. In responding to patient questions, nurses tried to find a balance between accuracy and specificity and tact, often resorting to euphemisms and other indirect strategies.Conclusion6 interpersonal contexts characterised the goals that patients and home care nurses worked towards by negotiating their needs and expectations: territoriality, shared perceptions of the situation, an amicable working relationship, role synchronisation, knowledge, and taboo topics.*Information provided by author. [ABSTRACT FROM AUTHOR] |
