Taciturn patients in health counseling at a hospital: passive recipients or active participators?

Patients' Interpersonal Communication Experiences in the Context of Type 2 Diabetes Care

The aim of our study is to determine the relational communication characteristics of professional-patient communication situations that have either facilitated or impeded patients' self-management. Conducted from the perspective of Finnish patients in the context of type 2 diabetes care, we used as our research methods an open e-survey and semistructured interviews. Data were analyzed using inductive qualitative content analysis. The critical incident technique was utilized throughout in all these methods. The results show that both positive and negative experiences described by patients were connected to four multidimensional relational communication characteristics: (a) building trust in the other party in the professional-patient relationship, (b) willingness to communicate, (c) emotional presence, and (d) appropriateness. Although the findings support the recommendations of earlier studies concerning individually tailored patient-centered care, acknowledging the characteristics in question can be used as a communication frame for constructing significant care relationships from the perspective of patients' self-management.

Ethnomethodological studies of nurse-patient and nurse-relative interactions: A scoping review

OBJECTIVES

Researchers in nursing science interested in the study of nurse-patient and nurse-relative interactions have displayed an ever increasing interest in ethnomethodology and conversation analysis. This review assesses the scope of this literature. We categorize the papers in thematic categories determined both inductively and deductively and synthesize the main findings of this literature within category. Finally we discuss the interactional determinants of the lack patient participation, the limitations of the field, and focus on implications.

DESIGN

A scoping review on nurse-patient and nurse-relative interactions.

DATA SOURCES

Forty articles focusing on nurse-patient interactions and nurse-relative interactions. All the articles relied on ethnomethodology and/or conversation analysis.

REVIEW METHODS

A literature search has been carried out on Medline (all articles until June 2016; keywords were: nurs*.ab. and "conversation analysis"; nurs*.ab. and ethnomethodology). A similar search was performed on other platforms. The scope of the literature was identified by inductively and deductively analyzing the themes of the relevant articles.

RESULTS

Six thematic categories emerged: Organization of nurse-patient interaction (eleven articles); Organization of mediated nurse-patient interaction (seven articles); Information, explanation and advice (eight articles); Negotiation and influence asymmetry (six articles); Managing emotions in critical illness (two articles); and Interacting with patients presenting reduced interactional competences (six articles).

CONCLUSIONS

Across most thematic categories it appeared that patient participation is far from ideal as interactional asymmetry was most observed in favor of nurses. When the encounters occurred at the patients' homes this pattern was reversed. Computer-mediated interactions were often reported as non-optimal as the standardized process constrained communication and delayed patients' presentation of their ailments. Micro-analyses of interaction present a clear potential for the development of guidelines for nurse-patient interactions. Implications for practice are described.

Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting

Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.

Maintaining face in the presentation of depression: constraining the therapeutic potential of the consultation

This article discusses the concerns of patients diagnosed with depression to preserve ‘face’ in social and medical encounters. The findings are from a qualitative study of patient and GP accounts of the presentation, recognition and treatment of depression. Medical consultations are difficult encounters to accomplish successfully, especially for patients, who often strive to protect their privacy and personal integrity through the maintenance of face. Face work reveals the concern of participants to contribute to the success of the consultation as a social interaction. Patients' strategy of maintaining face helps to account for the commonly reported underdetection of psychosocial distress in general practice consultations. Many people do not regard the experience of psychosocial distress as an appropriate topic for medical consultation or scrutiny. In this case, face work can function as a means of maintaining privacy and resisting medical diagnosis and intervention. The concept of face has relevance in other areas of clinical care, including chronic and enduring pain, functional disorders, medically unexplained symptoms and even terminal illness. Consideration of face work reveals the extent to which the pressure to contribute to the success of the consultation as a social encounter may constrain participants' capacity to realize its therapeutic potential. The extent to which clinical interactions are governed by social etiquette also helps to explain the continuing inertia of the formal health care system and the difficulty of changing the ways that patients and doctors communicate with each other, and of increasing patients' involvement in medical consultations.

Strategies used in the pursuit of achievability during goal setting in rehabilitation

We used conversation analysis of six audio- and video-recorded goal-setting meetings that were attended by patients and their respective treating team to explore and describe the interaction of participants during interdisciplinary goal setting, and to identify the strategies used to agree on goals. The health care professionals involved in the six sessions included four physiotherapists, four occupational therapists, four nurses, one speech and language therapist, and one neuropsychologist. The participants included 3 patients with multiple sclerosis, 2 patients with spinal cord lesions, and 1 patient with stroke from an inpatient neurological rehabilitation unit. Detailed analysis revealed how the treating team shaped the meetings. The most notable finding was that there was rarely a straightforward translation of patient wishes into agreed-on written goals, with the treating team leading goal modification so that goals were achievable. Despite professional dominance, patients also influenced the course of the interaction, particularly when offering resistance to goals proposed by the treating team.

Hospitalization for type 2 diabetes: the effects of the suspension of reality on patients' subsequent management of their condition

Hospitalization still plays a major part in the management of uncontrolled type 2 diabetes and its complications. In this article, we assess the effects of self-management education on the individual practices of 42 patients after discharge from specialized diabetes units on the French island of Reunion. Hospitalization offers respite and temporarily suspends the realities of daily life. When patients leave the unit where they have acquired new knowledge and practices, the extent to which the latter can be maintained depends on the practice in question, the individual's circumstances, and his or her social relationships and support systems. In the longer term, therefore, the effects of self-management education interventions can be weak. The study findings reveal the complexities surrounding the acquisition of habits that maintain health and prevent illness. The article makes a significant contribution to the debate on patient support and the role of inpatient educational units.

Factors affecting primary care provider and caregiver concordance for pediatric asthma medications

BACKGROUND

Lack of discussion regarding actual asthma medication use by physicians with caregivers of children with asthma may result in low caregiver and physician concordance about prescribed asthma medications.

OBJECTIVE

The primary objective was to examine the concordance between primary care providers (PCP) and caregivers regarding child asthma medication use.

METHODS

Current asthma medications in the home with verification from each child's PCP were obtained for 231 underserved children with persistent asthma. Kappas and chi-square statistics were calculated to measure the strength of the concordance. Caregiver and PCP dyads were categorized as concordant or discordant based on asthma medication use.

RESULTS

For all asthma prescriptions N = 479, two thirds of caregiver-PCP dyads (67.8) were categorized as concordant with at least one asthma medication. Concordance for asthma medications varied by type of medication ranging from 84% agreement for albuterol and 77% agreement for Flovent. In the final regression model predicting caregiver and PCP concordance, the number of PCP visits within the past 6 months and caregiver report of no limitation of child's activity due to asthma were significantly higher in caregivers who were considered concordant with their child's PCP while controlling for child age and frequency of symptom nights and number of ED visits in prior 6 months. In a model predicting the number of PCP visits, the number of ED visits was the only significant variable associated with the number of PCP visits while controlling for caregiver and PCP concordance.

CONCLUSION

Caregiver and PCP concordance was significantly associated with increased number of PCP visits suggesting that increased exposure to a health care provider may increase agreement between a child's PCP and caregiver regarding prescribed asthma medications. However, there may be other important factors including increased emergency department visits that may also be associated with subsequent pediatric primary care visits for asthma.

Unfolding the invisible of the visible: gendered constructions of patient participation

The article draws attention to the unexploited potentials in using visuals within nursing research and especially in using visuals as data. Initially, the authors give a brief description of what is meant by visual research methods and present a short overview of the different approaches that are possible. Visual methodologies are situated within different theoretical frames, often within a postmodern framework. We present a study using a postmodern approach inspired by the works of Foucault. The study demonstrates the possibilities inherent in using visuals as data by exemplifying how illustrations from health journals from Scandinavia reflect otherwise veiled and/or unconscious gendered attitudes on user participation.

Lifestyle counseling in type 2 diabetes prevention: a case study of a nurse's communication activity to produce change talk

As a case study, this article describes a nurse's communication activity, focusing on change talk during lifestyle counseling in primary healthcare. All videotaped counseling sessions with a single patient within a period of two years were transcribed verbatim. In the analysis, an emphasis was placed on the nurse's communication activity that produced change talk, how the nurse initiated change talk, and how the patient received it. The observations provide evidence that the dilemma of simultaneously maintaining professional authority and patient perspective leads to sensitivity in lifestyle counseling. Three categories of change talk were identified: rejected, restrictive, and expansive change talk. Producing change talk is a very demanding task for counselors. It is best produced when the nurse stays within the patient's frame of reference with a combination of reflective, change-inducing questions, encouraging assessments and conversational space. On the basis of our results, we suggest that nurses need training to identify and to encourage patients' change talk and to communicate flexibly according to patients' values during lifestyle counseling. In addition, in order to insist on change talk, we need to demonstrate how change talk could be carried out so that nurses could orient to it.

[The use of videotaping in qualitative research]

Considering advancements in data collection methods, we explore the use of videotaping in qualitative research. This bibliographical study aims at developing reflections on the possibilities of using videotapes in research and at providing material to researchers. The video is used as an instrument of data collection and generation. We mention technical aspects, such as the utilization of a mobile or fixed camera. By means of the latter, the authors report their experience, emphasizing compliance with the neutrality principle and the possibility of editing the images obtained as a means of generating new data. The authors highlight that it was possible to detect contradictions between discourse and behavior through the use of videotaping and interviews. The authors also discuss the ethical principles set by CNS Resolution 196/96 and other ethical questions, whose solutions should be based on the agreement between researchers and subjects.

The uses of photography in clinical nursing practice and research: a literature review

AIMS

The aim of this paper is to report a study to identify themes and provide a 'snap-shot' of the scope and uses of photography in clinical nursing practice and research.

BACKGROUND

Despite the dominance of vision as a way of understanding the world in Western societies, the applications of photography in clinical nursing practice and research have not been well synthesized or reported in the literature.

METHODS

A computerized search of CINAHL database was performed using the terms photographs, photography, photographic, photovoice, videorecording and videotaping. Hand searching for additional citations was also undertaken.

FINDINGS

The identified papers on photography were categorized into broad themes that reflected the different applications to which photography had been applied: documentation and surveillance; therapeutic intervention; teaching, learning and evaluating performance; research methods; and descriptive and instructional literature. Approaches to the use of photography, as recorded in the nursing literature, are broad and include: wound surveillance, covert patient surveillance, photo essay, art therapy, self-portraits, life albums, simulated recall, participant observation, photovoice, photo hermeneutics, production of research scenarios, and video modelling.

CONCLUSIONS

The most common applications of photography in nursing and related journals include photo elicitation to promote understanding in research, videorecording as a method of teaching and learning, and as a method of observation, with more creative approaches tending to be employed in health professions other than nursing. Few reports gave explanations of how researchers negotiated ethical concerns when seeking approval for studies in clinical settings, and few gave details of the processes of data analysis.

Quality assessment of health counseling: performance of health advisors in cardiovascular prevention

Quality assessments of interventions are seen as essential in optimizing their implementation, interpreting their effectiveness, and illuminating their underlying processes. In Hartslag Limburg, a cardiovascular prevention project, the quality of a health counseling intervention was assessed as part of the process evaluation. Four health advisors each video-taped 16 counseling sessions, all of which were assessed by three independent observers. Health counseling was found to be a very difficult skill, but, all things considered, the overall quality was evaluated as rather encouraging. No indication was found of quality improvement over time. The interpretation of the findings was complicated by limited absolute interobserver agreement, but reliable relative distinctions could be made between the health advisors' performance and their application of various counseling skills. Future quality investigators are advised to carefully match study goals with study methods, and practitioners planning a health counseling project should take the complexity of the task into account.

Nurse-patient power relationship: preliminary evidence of patients' power messages

The interactive relationship that is based on sharing power and control is the goal of health counseling practice. This research examined the nurse-patient power relationship and emphasized the patient's perspective. Health counseling sessions, 38 in number, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversation analysis (CA). The purpose of this research was to describe in detail how patients' minimized power asymmetry during hospital counseling. The results indicate that power is a complex and polysemic phenomenon that can be created jointly. Nurses' power is associated with their medical knowledge, which also patients construct. However, patients have several options to construct their power and influence the flow of interaction, for example, directing the counseling with questions, interruptions, and extensive disclosure, in which also nurses participated. The results are discussed in terms of earlier research on power messages and implications for a future power sharing practice.