Negotiation in Type 2 Diabetes Counseling: From Problem Recognition to Mutual Acceptance During Lifestyle Counseling

Abstract

Negotiation, an essential communication activity in lifestyle counseling, has rarely been studied at the micro level of interaction. Furthermore, the evidence for interpersonal negotiation to occur in counseling practice is inconclusive. In this study, the authors describe how negotiation focused on lifestyle changes was produced in nurse-patient interaction. The research data, 73 videotaped diabetes counseling situations, were analyzed using conversation analysis. The process of negotiation consisted of recognizing the problems in the patients' health behavior, offering proposals as solutions to the problems, and reaching an agreement on them. Negotiation had characteristics similar to those mentioned in the literature, but there were also prominent inadequacies. The authors suggest that nurses might need to become more aware of their counseling practices in routine situations through conscious effort for self-evaluation. In addition, further research would be required to demonstrate the effectiveness of negotiation for facilitating changes in patients' health behavior.

Evidence produced by qualitative investigations on type 2 diabetes: a review of the literature

“…Onze estudos adotaram técnicas múltiplas, geralmente, complementando entrevistas com observação direta. Esta técnica seguiu os parâmetros clássicos da etnografia, relativos à observação participante, ainda que um estudo tenha analisado consultas gravadas em vídeo (Karhila et al, 2003). Dois estudos (Lawton, Peel, Parry, 2008;Lawton et al, 2005) realizaram seguimento longitudinal dos sujeitos pesquisados, por meio da observação direta ou de entrevistas sucessivas, procurando compreender como o itinerário terapêutico e as fases do adoecimento crônico influenciam a visão dos pacientes a respeito do diabetes e do cuidado.…”

A Longitudinal Study of Interactions Between Health Professionals and People With Newly Diagnosed Diabetes

“…6,20 In some consultations, the focus was on simply providing information, 40 with relatively little emphasis on the structured negotiation techniques noted previously to effect lifestyle change. 29 Furthermore, the requirement to use a structured checklist approach can lead to loss of more engaged communication technique, as was seen in the interaction of NS13 and PT03. We concur with previous patient interview 16 and individual nurse observation 41 studies that consultations were most effective when practitioners actively remained within a patient frame of reference, and encouraged narrative, as seen in the exchange between GP17 and PT01 showing patient-centric questioning.…”

“…23,24 Audio-taping and videotaping of consultations 25,26 are being increasingly used to explore the management of diabetes [27][28][29][30][31] and antecedents such as overweight and obesity. 32 Further research has been called for, 23 including exploration of physicians and patients "talking past one another" 33 and interactions between nonphysician health care professionals and patients.…”

Informing choice: The organization of institutional interaction in clinical midwifery care

“…See Epperson & Zemel, 2008;Forrester, Ramsden, & Reason, 1997;Solomon, 1997;Ulvik & Salvesen, 2007;Yakel, 1997), conversation analysts have considered how speakers' talk performs a number of actions of potential interest to LIS scholars. These include "troubles telling" (Jefferson & Lee, 1992), raising new topics (Button & Casey, 1984), informing (Heritage, 1984;Schiffrin 1999), news giving (Maynard, 2003), advice giving (Heritage & Sefi, 1992;Pilnick, 2001), agreeing or disagreeing with prior talk (Kuo, 1994), claiming and challenging authority (Garcia & Parmer, 1999), managing discrepant perspectives (Lehtinen & Kääriäinen, 2005), counselling Silverman, 1997;He, 1995), negotiating (Karhila, Kettunen, Poskiparta, & Liimatainen, 2003), disclosing and responding to fears (Beach, Easter, Good, & Pigeron, 2005), presenting and discussing problems (Gill & Maynard, 2006;Robinson, 2006;Shaw & Kitzinger, 2007), repairing miscommunications (Ridley, Radford, & Mahon, 2002), making indirect requests (Gill, Halkowski, & Roberts, 2001;Weijts, Widdershoven, Kok, & Tomlow, 1993), discussing difficult or sensitive issues (Epperson & Zemel, 2008;Kinnell, 2001;Parry, 2004;Pilnick & Coleman, 2006), accounting for behavior (Fisher & Groce, 1990), making assessments (McHoul & Rapley, 2002;Jones, 2001), instructing (Epperson & Zemel, 2008), expla...…”