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"I've just got to ask you some questions": An exploration of how nurses and patients accomplish initial nursing assessments in hospitals. / Aled R Jones
Swansea University Author: Aled R Jones
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Nurse-patient communication and interaction has long been written about as one of the most important ingredients of good quality patient care. Furthermore, nurse- patient interaction during the initial assessment interview, which occurs when a patient is admitted into hospital, has been promoted in...
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Nurse-patient communication and interaction has long been written about as one of the most important ingredients of good quality patient care. Furthermore, nurse- patient interaction during the initial assessment interview, which occurs when a patient is admitted into hospital, has been promoted in nursing literature as an important first step towards building a meaningful and therapeutic relationship with patients. This present study is the first study of its kind to investigate, in detail, the interaction between hospital nurses and patients during the initial assessment or admission interview. Data collected include audio-recordings, observations and documents relating to the interview. Applying the techniques of conversation analysis, the study reveals how certain rules of normal conversation, a style of talk to which the assessment interview is favourably compared to in nursing literature, fail to apply during assessment interviews accomplished on busy hospital wards, and offers original empirical evidence to show what actually happens. The study demonstrates, for example, that nursing assessment interviews can only be understood as products of the contingencies of the interview situation, and not, as is usually assumed in the nursing literature, the unmediated expressions of nurses and patients. The description produced by the analysis is of encounters which, despite differences related to the individuality of the contexts of the interviews, are remarkably similar in structure and organisation. The implications of this study stem from the fact that CA has made visible the weakness of the links between nursing theory, policy, and the situated working practices of nurses in the real world. The implications for theorists and policy makers are that a little more realism in their work may make for more sustainable and usable strategies and policies. In light of this, future nursing research which focuses, as this study does, on the actual practices of nurses and health service users has an important contribution to make as a bridge between practice and policy/theory. Nurses undertaking initial assessments of patients need to be aware of the limitations imposed on the patient when undertaking assessments as "question-answer" sessions. Instead nurses would do well to encourage patient participation during the interview through, for example, providing the patient with a copy of the paper-work being completed, a move which would foster a more open and less restrictive style of interaction.
College of Human and Health Sciences