Khamis, 20 November 2008

Discourse Analysis of Nurse-Patient Communication in a Hospital Setting: Implications for Staff Development


This ethnographic study examined the symmetry (active listening)/asymmetry (dominance) of nurse-patient communication. A convenience sample of 20 gendered nurse-patient pairs from two community hospitals participated. Eleven discourse modes emerged from taped conversations between nurses and patients. In many nurse-patient interactions, nurses demonstrated symmetry; however, symmetry and asymmetry changed throughout the conversation. Nurses often missed cues that patients needed someone to listen to their concerns. Staff development implications include teaching strategies that increase symmetrical nurse-patient communication.

Nurse-patient communication is an essential aspect of clinical nursing practice (Finch, 2004; Rogan & Timmins, 2004; Shattell, 2004). Nurses' skilled communication is highly desirable because their jobs involve ongoing interactions with patients in the healthcare setting. Research suggests that those interactions significantly influence patient satisfaction and quality care (Goode, 2004; O'Gara & Fairhurst, 2004; Park & Song, 2005). There is little research, however, that examines how nurses interact with patients (Beach & Anderson, 2003; Jones, 2003). In an effort to learn more about this area so crucial to nursing practice, this study attempts to understand the ways in which nurse-patient communication naturally occurs during clinically based conversations in a hospital setting.

Communication is particularly important to nursing because nurses plan and provide care based on patient needs. Nurses need to elicit from patients what they see as relevant to the patient's own care (Price, 2004). In addition, communication is important when nurses inform, explain, and instruct patients on a range of health matters. The ways in which nurses do so can affect what patients understand and learn (Caress, 2003). Nurses also facilitate encounters with others who can enlighten patient decision making. The nurse's willingness to share control and power and to encourage active participation of the patient during the interaction is important to optimal patient care (Kettunen, Poskiparta, & Karhila, 2003).

Some communication strategies, in which nurses listen to patients, even out the nurse-patient hierarchy; others maximize the power and control of the nurse by the nurse's directing the communication (Leahy, 2004). Symmetrical communication is patient focused. Communication that is symmetrical in nature assists the nurse in time management and resource utilization while still providing patient care because efforts are intentionally directed at meeting identified patient needs. It is through active listening, paraphrasing, and encouraging stories to continue that the nurse hears the patient's voice (Dossey, Keegan, & Guzzetta, 2005).