Nurse practitioner-client interaction as resource exchange in a women's health clinic: an exploratory study

Empirical research has thoroughly documented the success of nurse practitioners (NPs) in terms of patient satisfaction and cost-effectiveness. What is missing is the in-depth knowledge of the interactive process through which this is accomplished during a clinic visit. The aim of this study was to understand the special nature and processes of NP and client encounters in the ambulatory primary care context using a resource exchange perspective. An exploratory descriptive design was used to address the following research questions: (i) What do midlife female clients expect in terms of resources to be exchanged prior to a visit with a NP in an ambulatory clinic visit? (ii) What resources are actually exchanged during the clinic visit? (iii) To what extent is there congruence between a woman's expectations and what she is actually receiving from the clinic visit in terms of resources exchanged? The participants included two women health NPs and eight midlife female clients. Data for the study were comprised of audiotaped pre- and postencounter interviews with the clients, audiotapes of the entire clinic visits with the NP and field notes recorded by the researcher of the client visits. Content analysis was conducted using ETHNOGRAPH software. Findings indicated that clients of both NPs had surprisingly similar expectations of receipt of services as well as actual receipt of services. Resources expected and received from the visits included some combination of services, health information, trust, self-disclosure, support, affirmation, time, acceptance and respect. Results of this study suggest that resource exchange theoretical formulations can be applied to NP-client interactions to understand and explain the specific nature of resources the clients expect and receive from a NP during a woman's health clinic visit.