Hälsorådgivande samtal : kommunikativa strategier i samspel mellan distriktssköterska och patient

Sammanfattning: Health education conversations. Communicative strategies in consultations between district nurse and patient. In recent years, the importance of the patient's point of view and patient participation in health education has been emphasised in policy texts and legislation. These changing policies raise questions as to how life-style messages are communicated in clinical practice. This theses explores the process of advice-giving in consultations between district nurse and patient. To provide an in-depth analysis of advice giving conversations, four cases were studied with complementary techniques. The material consists of video-taped consultations, interviews and stimulated recall with patients and district nurses. The qualitative analysis focuses on the communicative strategies used by the parties in conversations about life style issues. Both district nurse and patient uses a range of direct and indirect strategies to give and respond to advice, as well as to facilitate the interaction. They both define and introduce topics. The district nurse supports patient initiatives, provides information, presents arguments and persuades the patient. The patient presents information, arguments and uses subtle strategies to accept or reject advice. As an overarching strategy, the district nurse draws on everyday experiences presented by the patient, which she re-formulates into pieces of advice. Finally, the patterns of communicative strategies, and the differing goals of the two parties, are discussed in relation to the dilemmas of patient integrity and professional tasks involved in health education.