Nurse-client interactions in community-based practice: creating common ground

Although research activity is increasingly aimed at examining health outcomes of community health nursing care, little empirical literature systematically describes the nurse-client interaction. In this pilot study nurse-client interactions were evaluated to describe their detailed elements. Nineteen such interactions occurring in a Canadian public health department were videotaped by a professional filming crew. The clinical situations included home visits, school health interviews and screening, health classes, and clinic work. The audio portion of the nurse-client exchanges were transcribed from the videotapes onto a computer and analyzed using content analysis. Semi-structured interviews were conducted with nurses and clients after the filming to elicit their perceptions of the interactions. Field notes describing nonverbal and contextual data were also collected and analyzed. The central process identified during the interactions was called "creating common ground." This integrating conceptual schema captured the give and take as each participant defined territory and revealed information. The process varied depending on care context, process skills of the nurse, and willingness of the client to engage.