Abstract
To advance understanding of the discrete nature of the communication processes and social interactions occurring in nurse practitioner consultations. Preceding qualitative investigations of nurse practitioner consultations have, when conducting interviews with participants, often exclusively sampled either nurse practitioners or patients. Furthermore, previous qualitative studies of the nature of nurse practitioner consultations have not typically also sampled carers attending with patients for nurse practitioner consultations. Accordingly this study was developed, in part, to address this exclusivity of sampling in qualitative research of nurse practitioner consultations by developing an inclusive sample of patient, carer and nurse practitioner participants of nurse practitioner consultations, so as to conjointly develop an understanding of the multiple perceptions of those participants of communication processes occurring in nurse practitioner consultations. Qualitative component of a larger mixed methods case study of communication processes and social interactions in nurse practitioner consultations, utilising individual semi-structured interviews with the patient (n = 9), carer (n = 2) and nurse practitioner (n = 3) participants of video-recorded consultations derived from a nurse practitioner-led general practice clinic. Interview transcripts were initially analysed via an emergent thematic analysis, followed up by computer-assisted qualitative data analysis with NVivo 9. 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; Nurse practitioner role ambiguity; Creating the impression of time and Expectations for safety netting. The findings identify a need for policy makers to address a perceived ambiguity of the nature of the nurse practitioner role amongst patients and carers. The benefits of nurse practitioners using personable, everyday lifeworld styles of communication for optimising interactions, sharing clinical reasoning and conveying a sense of having time for patients and carers in consultations are also identified.
Highlights
Nurses working in advanced clinical roles such as advanced nurse practitioners or advanced clinical practitioners are increasingly engaging in clinical consultation activities once mostly associated with medical doctors, such as clinical reasoning to establish differential diagnoses for patients’ presenting medical problems and prescribing medicines (Health Education England, 2017; Barratt, 2018)
This study has complemented the findings of other studies of nurse practitioner consultation communication, which all commonly identify the presence and importance of patient-centred, lifeworld style interactions in nurse practitioner consultations, by conjointly examining patients’, carers’ and nurse practitioners’ perceptions of those consultations
From the overview literature searching conducted for the overall case study, it is evident a meta-synthesis of qualitative research in this area of inquiry still needs to be completed (Barratt, 2016)
Summary
Nurses working in advanced clinical roles such as advanced nurse practitioners or advanced clinical practitioners are increasingly engaging in clinical consultation activities once mostly associated with medical doctors, such as clinical reasoning to establish differential diagnoses for patients’ presenting medical problems and prescribing medicines (Health Education England, 2017; Barratt, 2018). Available qualitative studies of participants’ experiences of nurse practitioner consultations have commonly noted nurse practitioners communicate with their patients in a ‘hybrid’ style, combining objective analysis of biomedical information together with discussion of issues from their everyday lifeworld (Brykczynski, 1989; Johnson, 1993; Kleiman, 2004; Barratt, 2005; Seale et al, 2005, 2006; Williams and Jones, 2006; Defibaugh, 2014a, 2014b; Bentley et al, 2016).
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