Videos of communication in primary care: a study exploring nurse practitioner and patient consultations in a Walk-in centre
The researcher (an experienced advanced nurse practitioner) examined and interpreted twenty videos of consultations between six nurse practitioners and patients aged between 18 and 65 years. A qualitative visual research method (VS) was used drawing on phenomenology, video elicitation, reflexivity, and narrative hermeneutics. The findings demonstrated shared verbal and visual aspects of conversations. The majority of the videos elicited knowledge-based, rather than predominately emotion or movement-based conversations with both parties both empathic and engaged or task focused. The consultation dynamic in most interviews was harmonious rather than in tension, although there were occasions where the nature of the communication varied during the consultation. Furthermore, each NP demonstrated preferences for one of the three different conversation styles (i.e. knowledge, emotion or movement), as well as different ways of responding to patients who were either active or passively involved in an interaction. This theoretically derived video schema was further developed into a video tool (a process and coding guide along with a coding form). The video tool (VT) provided evidence of good video coding interrater reliability when compared with the results of the VS. The study recommends that WiC NPs could use the video schema to reflect on their personal consultation styles as there is potential to develop greater awareness of emotion, movement and knowledge in shared conversations, and a facilitative approach that asks open questions and encourages active shared and flexible approaches to consultation communication. Additionally, research using the video tool could further investigate the psychometric properties of the VT and ultimately the effect of the different styles on patient outcomes such as compliance and satisfaction.
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