A grounded theory study of patient/nurse interaction in a community practice setting

Abstract

This thesis is about patient/nurse interaction in a community practice. My aim is to advance sociologically informed understandings about patient/nurse interaction. The key areas of inquiry in my grounded theory study are: The meanings and understandings expressed in patient/nurse interaction. The influence of socio-cultural characteristics in patient/nurse interaction. My study was conducted in a community practice setting using the traditional discovery methodology of Glaser and Strauss (1967). The community practice setting is four health centres with social and geographical differences. The participants in the study are patients attending those health centres and practice nurses who work there. Research methods are observations, informal interviews and semi-structured interviews. Constant comparative analysis supports my research process. My substantive theory is constructed from the generation of two categories: Investment and Experience. The category of Investment relates to the social assets and resources brought to patient/nurse interaction. The category of Experience relates to the historically crafted meanings and understandings that individuals bring to patient/nurse interaction. Together, these categories contribute to understandings of patient/nurse interaction in a community practice setting. I argue in this thesis that the meanings and understandings that patients and nurses bring to interaction provide the social dimension that is quintessential and foundational in their relationship. I also argue that the social construction of reality of being a patient or a nurse is related to the socio-cultural characteristics that they bring to their performance in patient/nurse interaction. I show that performance as a patient or a nurse is initiated and achieved via processes of acting and reacting to each other in relation to socio-cultural characteristics. I demonstrate that the meanings and understandings patients and nurses generate from experiences beyond and including their situated need/care interaction are pivotal in the negotiation of their relationship. Empowerment plays a central role in processes of negotiation and is connected to the social construction of reality in patient/nurse interaction. My substantive theory contributes to understanding of patient/nurse interaction and raises the visibility of negotiation, empowerment, and the influential role of socio-cultural characteristics. The implications of my substantive theory relate to the involvement and participation of stakeholders in health care practice and delivery. In nurse education, the standards of proficiency for eligibility to register with the NMC should be revised to include the social dimension of patient/nurse interaction as a domain of practice. I conclude by arguing that sociologically informed understandings need to be expanded and applied in health care and nursing with contemporary social policy and current priorities for health in mind.