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Title: A case study of the nurse practitioner consultation in primary care : communication processes and social interactions
Author: Barratt, Julian
Awarding Body: London South Bank University
Current Institution: London South Bank University
Date of Award: 2016
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Background: Nurse practitioners are increasingly conducting consultations with patients on the same basis as medical doctors. However little is known about communication within nurse practitioner consultations. Research on communication in nurse practitioner consultations has identified nurse practitioners communicate with patients in a hybrid style, combining biomedical information with the discussion of subjective information from everyday life. Research has not fully explained why this hybrid style occurs in nurse practitioner consultations, nor determined its links to consultation duration, patient expectations, satisfaction, and enablement. This study was developed to address these gaps in research of communication in nurse practitioner consultations. Aim: This study aims to advance understanding of the discrete nature of the communication processes and social interactions occurring in the nurse practitioner consultation, including explicating the reasons for the occurrence of the particular communication processes and interaction styles observed in those consultations. Methods: The study was conducted in a nurse-led primary care clinic providing general practice care. Within a case study research approach mixed methods were utilised, combining structured analysis of video recorded observations of nurse practitioner consultations, questionnaire-based measures of patient expectations, satisfaction, and enablement, and interviews with some of the participants of the consultations. The sample for video recording comprised three nurse practitioners employed at the clinic, and 30 patients registered at the clinic. Questionnaire responses were provided by 71 patients, including 26 whose consultations had been video recorded. All three nurse practitioners participated in post-consultation individual interviews, and 11 patient / carers participated in post-consultation individual interviews. The video recorded consultations were analysed with the Roter Interaction Analysis System (RIAS), a method of quantified interactions frequency analysis. The questionnaire responses were analysed with descriptive statistics. Transcripts of the interviews were analysed using computerised qualitative data analysis with NVivo. Findings: A significant majority of observed social interaction in the consultations used patient-centred communication styles (p=0.005), with neither nurse practitioners nor patients or carers being significantly more verbally dominant. Nurse ii practitioners guided the sequence of consultation interaction phases, but patients and carers participated through asking questions and involvement in negotiations for care planning. Patient / carers were highly satisfied with their consultations, and significantly higher general satisfaction was noted when participants expected the nurse practitioners to be able to diagnose their presenting problem (p=0.043). Patient / carers expressed significantly higher levels of enablement than have been seen in previous studies of enablement with other types of clinicians (p=0.003). The mean consultation time length of 10.97 minutes is comparable with studies of general practitioners. The participants’ perceptions of nurse practitioner consultation communication processes and social interactions were represented through six themes; Consulting style of nurse practitioners; Nurse practitioner – GP comparisons; Lifeworld content or lifeworld style issues; Nurse practitioner role ambiguity; Creating the impression of time; and Expectations for safety netting. Contribution to knowledge: This study reveals nurse practitioner consultations comprise collaborative openness to peoples’ agendas and questions, expressions of everyday lifeworld experiences, expanded impressions of time, clear explanations augmented by integrated clinical reasoning, and participatory negotiations. These communicative features arise from a combination of social, ideological, and epistemological factors, prompting nurse practitioners to privilege how they interact with patients and carers, and to adopt a hybrid patient-centred style combining the nursing ideology of holism and their knowledge of biomedicine. This form of communication has been characterised as a stylistic exemplar for good consultation communication practice, which potentially facilitates shared decision-making. This research has resulted in new knowledge of the communication processes and social interactions used in nurse practitioner consultations, which demonstrates the importance of clinicians giving precedence to how they communicate and interact with patients so as to optimise their therapeutic outcomes without compromising the duration of consultations.
Supervisor: Chrichton, N. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
Keywords: Case study ; mixed methods ; nurse practitioners ; patient satisfaction ; patient enablement ; consultations ; communication processes ; social interactions ; lifeworld