Structures of District Nurse : Patient Interaction

Abstract: This dissertation is about social interaction between Swedish district nurses and patients when they meet to perform such routine things as to measure blood pressures or give injections. Conversation analytic methodology is used to explicate interactional structures and to understand how they come about; (i) how tests and treatments are achieved; (ii) how concerns are introduced; (iii) how test results are talked about; and (iv) how advice is given and responded to. These interactional structures are also related to the institutional contexts to which nurses and patients are oriented when they interact. Thus, a more traditional ethnographic approach is used as a complement to conversation analytic methodology. Data consists of ethnographic material, primarily nurses’ textbooks, interviews with nurses, and observations of nurses’ meetings with patients. Data also consists of 64 audio and video recordings of encounters between 17 nurses and 58 patients. 32 of these recordings have been transcribed and analyzed in detail. District nurse-patient interactions occur in rather straightforward ways. This interpretation is strengthened by comparisons between these interactions and interactions in other institutional settings (between health visitors and first-time mothers, HIV counselors and clients, doctors and patients). The main reason for the straightforwardnesses is found in the nature of district nurses’ work: They meet patients in order to perform tests and treatments, which are unproblematic manual activities. The verbal activities that are generated during these meetings tend to become rather straightforward.