Saving face: Expressing and negotiating vulnerability in culturally mis-matched home care nurse-patient dyads
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Judith A. Spiers, PhD, MN, Associate Professor - University of Alberta
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Communication is the medium through which nursing is practiced. Despite the centrality of communication to nursing, there is limited knowledge about how vulnerability is manifested through language. This study aimed to examine the negotiation of vulnerability in the interaction between culturally mis-matched home care nurse-patient dyads. Face work (Brown & Levinson, 1987) was the conceptual framework. The research questions were; identify care-giving activities and patterns of interaction; communicative contexts of vulnerability; manifestation and negotiation of vulnerability, and personal and organizational influences on vulnerability. Three self-selected home care nurses identified culturally mis-matched patients. Eight patients participated, creating ten nurse-patient dyads. Data were collected by video-taping three to five entire home visits for each dyad; 31 visits in total and 19 hours of video data. Participants were interviewed about their perceptions of each visit. Initially, video tapes of the first six visits were transcribed and recursively coded to identify themes. The remaining tapes were analyzed according to these themes and face work strategies described by Wood and Kroger (1993). Nurse-patient interaction occurred in six communication contexts. These were Territoriality, negotiating shared physical space for the visit; Establishing shared perceptions of the situation, referring to goal setting; Establishing amicable working relationships, reflecting cooperation and solidarity; Negotiating roles, determining expectations and evaluating performance; Knowledge, negotiating information, and; Sensitivity to taboo topics. Over 60 challenges that could strengthen or threaten the communicative relationship were identified, for example, compliments, objectification, hedging, and contradictions. The communicative negotiation of these challenges led to positive and negative outcomes; enhanced trust, intimacy, and collaboration, or; mutual or unilateral vulnerability, exclusion or silencing of the patient, and restricted collaboration. Differentials in power and social distance could either facilitate management of, or exacerbate, vulnerability. Participant reactivity to knowledge of being video-taped influenced vulnerability by creating a tangible invisible presence. This study explains how nurses and patients in home settings who may be vulnerable because of cultural mis-matching tend to negotiate interaction and deal with challenges that may constrain or support the relationship. Further study of a range of communication strategies used to meet interactional and instrumental goals is required.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 9996565; ProQuest document ID: 304599592. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
Type | Dissertation |
Acquisition | Proxy-submission |
Review Type | None: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Descriptive/Correlational |
Research Approach | Qualitative Research |
Keywords | Home Care Nurses; Nurse-Patient Interactions; Communication; Culture Beliefs |
Grantor | University of California, San Francisco |
Advisor | Meleis, Afaf; Wilson, Holly S.; Olesen, Virginia; Matsumoto, Yoshiko |
Level | PhD |
Year | 2000 |
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