Ascribing patients a passive role: Conversation analysis of practice nurses’ and patients’ goal setting and action planning talk

Abstract

Within primary care, nurses are expected to set goals and make action plans with patients. However, little information is available on how this is done. The aim of this study is to gain insight into how nurses set goals and action plans with patients. Data were collected from three practice nurses working in elderly care and five patients in the Netherlands. Practice nurse is the term for the home care registered nurse in the Netherlands. Five home visits for which goal setting and action planning were the main agreed‐upon objectives, were video‐recorded and transcribed. We found that explicit goal setting was not observable. However, in 16 episodes, action plans were discussed. Action planning was always initiated by the nurse and was oriented toward offering professional help or assistance in order to solve the patient's problems. In response, patients tended to resist the proposed solutions, with the result that action planning was abandoned. By the nurse proposing professional help, patients were positioned as passive rather than active agents. Our results contribute to the understanding of how nurses’ communicative behavior influences the extent to which patients feel encouraged to actively participate in goal setting/action planning.

Goal setting in group programmes for long-term condition self-management support: experiences of patients and healthcare professionals

“…The 'determinants of health' approach shows that societal organization has a profound and dynamic effect on both intentional and unintentional health behaviours that should not be ignored when considering the goals of individuals (Short and Mollborn, 2015). Indeed, participants in our study who rejected goal setting as an activity, described in the literature as patient resistance or passivity (Lenzen et al 2018), were actively questioning of its relevance.…”

Strategies for using non-participatory video research methods in general practice

“…"Insider" knowledge is known to assist recruitment by encouraging rapport and collaboration with participants (Blythe et al, 2013). While other nursing settings and international primary care nursing literature indicates acceptability of the video technique (De Leeuw et al, 2014, Griep et al, 2016, Happ et al, 2011, Lenzen et al, 2018, Noordman et al, 2013, Spelten et al, 2015 our target population were much more challenging to recruit. This may, however, reflect the small business nature of Australian primary care and the subsequent complexity in accessing potential participants.…”

“…While video-based medical research has been conducted in general practice since the 1970's (Roland, 1983), it has only recently been used in GPN consultations (Dowell et al, 2018, Griep et al, 2016, Lenzen et al, 2018, Macdonald et al, 2013. To assist nurse researchers' understanding of collecting data via video observation this paper describes our experience of using this technique, examining the advantages, disadvantages and challenges for use.…”

Engaging older adults in self-management talk in healthcare encounters: a systematic review protocol

“…This process can enable greater patient engagement in healthcare decision-making [10], greater self-management abilities, increased trust in healthcare professionals, and improved patient health outcomes, including on physiological measures, health status, and measures of functional ability [11]. Establishing patient goals is a widely recommended strategy for engaging patients with multimorbidity in shared decision-making, but there is little evidence to support its use in routine clinical practice [12][13][14][15]. Goal setting is typically defined as "a process by which healthcare professionals and patients agree on a health-related goal" [12].…”