Clinical Communication Strategies of Nurse Practitioners with Patients

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Nurses' awareness of their communication strategies is critically important both in identifying effective patterns in their interaction and in teaching themselves to improve their patient education techniques. Ineffective communication between client and nurse practitioner can result in failure to improve health status or deterioration of health status when recommendations are not followed. Studies of nonverbal aspects of clinical communication tend to count or average types of communication behaviors over the entire interaction rather than use sequential analysis of these behaviors. This paper presents initital results of a pilot study that used a sequential analysis of strategic roles played by nonverbal communication in nurse practitioner-patient interactions involving patient education. Because there is little previous work in applying sequential analysis, the grounded theory approach was used to identify nonverbal communication behaviors. Routine visits that focused on osteoporosis prevention were conducted by three nurse practitioners. Two visits per nurse were videotaped and analyzed for sequential events of nonverbal communication by the researchers alone and then in combination with the nurse conducting the visit. Descriptions of each visit were developed based upon both the verbal and nonverbal characteristics of the nurse-patient interactions as observed in the videotaped visits. From these, vignettes were created that summarized each nurse-patient visit according to the nature of the clinical communication that took place. Interviews of both nurses and patients were conducted before and after the visits to explore osteoporosis knowledge, goals, and strategies for the visit Essentially all consciously stated strategies of both nurses and patients were cognitive (i.e., presenting or seeking information). After viewing their videotaped visits and an open-ended interview with the researchers, the nurses were able to identify many of their nonverbal strategies. Use of videotaped visits can increase nurse practitioners’ awareness of nonverbal communication strategies that may assist them in more effective clinical communication and patient teaching.

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