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Preoperative nurse-patient encounter: interview or conversation?
S16
Individual presentations / Patient Education and Counseling 34 (1998) S5 –S41
cation theory and the approach is that it is through verbal dialogues that we construct reality and that reality is not something separate from our way of structuring it through language. Thus the dialogue between the parents and the staff is a joint construction of action and meaning, and does not take place in a social vacuum. Method. Data collection consisted of audio-tapes of dialogues between parents and district nurses during five home visits made by three district nurses to parents with a new-born child and interviews with the parents as well as the district nurses. Three of these home visits were also videotaped. The analysis focuses on the data from the dialogue during the home visits and was based on the content and the structure of the dialogues. The interviews were used to confirm the results from the dialogue during the home visits. The result showed that there was a pattern in the agenda during the dialogue: ‘the starting point’, ‘the question time’, ‘anamnesis’, ‘the concrete things’ and, the future’. One of the main subject which was focused on was the interaction between the child and the mother. Most subjects were introduced by the district nurses but some also by the parents. The parents asked questions, sometimes invited by the district nurse and their questions were carefully answered. ‘‘The voice of the life-world’’ was heard and was introduced by both parents and district nurses. The district nurses were sensitive to the parents and adjusted their discourse and showed consideration for the parents. The district nurses talked the most during the visits. Fifty-one pieces of advice, most of them initiated by the district nurses, was given during the home visits. Preoperative nurse-patient encounter: interview or conversation? Tarja Kettunen, Marita Poskiparta. University of ¨ ¨ , Department of Health Sciences, PO Box 35, Jyvaskyla ¨ ¨ , Finland. 40351 Jyvaskyla Introduction. This study illustrates reciprocal communication between a nurse anaesthetist and surgery patients. We concentrate on strategies that encourage patients to talk about their anxiety and fears and to ask for information about an impending surgery. Data collection and methods. Ten videotaped nursepatient preoperative interviewing sessions in a Finnish hospital were transcribed verbatim. Interviews of the nurse and patients conducted by the investigator after their conversation were also transcribed. The data coding and analysis were completed using conversation analysis and reported as a case study. Results. In the beginning of the session the nurse implied that the aim of the encounter was an open conversation, during which they would discuss the surgery and the patient could ask about things that were unclear to her or made her anxious. Throughout the session the nurse facilitated patient’s participation by using indirect comments, open questions and softening, words or hesitation to probe tactfully for information.
The nurse’s listening feedback encouraged patient to speak. Her feedback was many-sided and varied: different words, a lot of nodding, watching at the patient, bending toward her and occasionally completing patient’s sentences. In this way, the nurse supported patient’s speech authority. In other words, the nurse selected the topics of the interview but the patient decided the content of the topics. Conclusions. The findings indicate that it is possible to carry out preoperative interviewing as a conversation with patient actively participating. This study shows that, in addition to proper questions, also nurse’s feedback is a contributing factor to a reciprocal nurse patient communication. ‘How is your pain?’ Factors influencing the nurses assessment and management of postoperative pain in adults A.A. Nagtegaal-Booij (a), H. Huijer-Abu Saad, J.P.H. Hamers. (a) Randhoeve 41, 3992 XB HOUTEN, The Netherlands. Introduction. Nurses make different decisions regarding post- operative pain. As one nurse asks frequently about postoperative pain and may give analgesics immediately, another may not ask about the patients’ pain at all and will wait as long as possible before giving analgesics. Since decisions made by the nurse form the basis for adequate assessment and alleviation of the patients pain, research looking at factors influencing the nurses decisions becomes very important. The purpose of this study was to gain insight in the way nurses assess postoperative pain in adults and to explore factors influencing nurses’ pain assessment. The research questions were as follows: Which factors influence the assessment of postoperative pain in adults? The research focused on the question which information do nurses use to assess postoperative pain in adult patients. During the study nurses also gave interesting information about interventions. Therefore the research question was extended afterwards as follows: Which factors influence the nurses assessment and management of postoperative pain in adult patients? Methods. Qualitative research methods were used in this study. Data were collected using participant observations and interviews. Respondents were 9 nurses from 3 surgical wards of a general hospital. Analysis of data took place using the computerprogram Kwalitan 3.1. Results depict the influence of a number of factors on the nurses decisions to assess and manage postoperative pain in adults. These factors include: nurses characteristics such as knowledge, experience and expectations; patient characteristics such as type of operation and verbal and nonverbal expressions of pain. These factors are clustered into internal and external information sources used by nurses to make a decision. These factors will be further elaborated in the presentation.
Individual presentations / Patient Education and Counseling 34 (1998) S5 –S41
cation theory and the approach is that it is through verbal dialogues that we construct reality and that reality is not something separate from our way of structuring it through language. Thus the dialogue between the parents and the staff is a joint construction of action and meaning, and does not take place in a social vacuum. Method. Data collection consisted of audio-tapes of dialogues between parents and district nurses during five home visits made by three district nurses to parents with a new-born child and interviews with the parents as well as the district nurses. Three of these home visits were also videotaped. The analysis focuses on the data from the dialogue during the home visits and was based on the content and the structure of the dialogues. The interviews were used to confirm the results from the dialogue during the home visits. The result showed that there was a pattern in the agenda during the dialogue: ‘the starting point’, ‘the question time’, ‘anamnesis’, ‘the concrete things’ and, the future’. One of the main subject which was focused on was the interaction between the child and the mother. Most subjects were introduced by the district nurses but some also by the parents. The parents asked questions, sometimes invited by the district nurse and their questions were carefully answered. ‘‘The voice of the life-world’’ was heard and was introduced by both parents and district nurses. The district nurses were sensitive to the parents and adjusted their discourse and showed consideration for the parents. The district nurses talked the most during the visits. Fifty-one pieces of advice, most of them initiated by the district nurses, was given during the home visits. Preoperative nurse-patient encounter: interview or conversation? Tarja Kettunen, Marita Poskiparta. University of ¨ ¨ , Department of Health Sciences, PO Box 35, Jyvaskyla ¨ ¨ , Finland. 40351 Jyvaskyla Introduction. This study illustrates reciprocal communication between a nurse anaesthetist and surgery patients. We concentrate on strategies that encourage patients to talk about their anxiety and fears and to ask for information about an impending surgery. Data collection and methods. Ten videotaped nursepatient preoperative interviewing sessions in a Finnish hospital were transcribed verbatim. Interviews of the nurse and patients conducted by the investigator after their conversation were also transcribed. The data coding and analysis were completed using conversation analysis and reported as a case study. Results. In the beginning of the session the nurse implied that the aim of the encounter was an open conversation, during which they would discuss the surgery and the patient could ask about things that were unclear to her or made her anxious. Throughout the session the nurse facilitated patient’s participation by using indirect comments, open questions and softening, words or hesitation to probe tactfully for information.
The nurse’s listening feedback encouraged patient to speak. Her feedback was many-sided and varied: different words, a lot of nodding, watching at the patient, bending toward her and occasionally completing patient’s sentences. In this way, the nurse supported patient’s speech authority. In other words, the nurse selected the topics of the interview but the patient decided the content of the topics. Conclusions. The findings indicate that it is possible to carry out preoperative interviewing as a conversation with patient actively participating. This study shows that, in addition to proper questions, also nurse’s feedback is a contributing factor to a reciprocal nurse patient communication. ‘How is your pain?’ Factors influencing the nurses assessment and management of postoperative pain in adults A.A. Nagtegaal-Booij (a), H. Huijer-Abu Saad, J.P.H. Hamers. (a) Randhoeve 41, 3992 XB HOUTEN, The Netherlands. Introduction. Nurses make different decisions regarding post- operative pain. As one nurse asks frequently about postoperative pain and may give analgesics immediately, another may not ask about the patients’ pain at all and will wait as long as possible before giving analgesics. Since decisions made by the nurse form the basis for adequate assessment and alleviation of the patients pain, research looking at factors influencing the nurses decisions becomes very important. The purpose of this study was to gain insight in the way nurses assess postoperative pain in adults and to explore factors influencing nurses’ pain assessment. The research questions were as follows: Which factors influence the assessment of postoperative pain in adults? The research focused on the question which information do nurses use to assess postoperative pain in adult patients. During the study nurses also gave interesting information about interventions. Therefore the research question was extended afterwards as follows: Which factors influence the nurses assessment and management of postoperative pain in adult patients? Methods. Qualitative research methods were used in this study. Data were collected using participant observations and interviews. Respondents were 9 nurses from 3 surgical wards of a general hospital. Analysis of data took place using the computerprogram Kwalitan 3.1. Results depict the influence of a number of factors on the nurses decisions to assess and manage postoperative pain in adults. These factors include: nurses characteristics such as knowledge, experience and expectations; patient characteristics such as type of operation and verbal and nonverbal expressions of pain. These factors are clustered into internal and external information sources used by nurses to make a decision. These factors will be further elaborated in the presentation.