Negotiation, an essential communication activity in lifestyle counseling, has rarely been studied at the micro level of interaction. Furthermore, the evidence for interpersonal negotiation to occur in counseling practice is inconclusive. In this study, the authors describe how negotiation focused on lifestyle changes was produced in nurse-patient interaction. The research data, 73 videotaped diabetes counseling situations, were analyzed using conversation analysis. The process of negotiation consisted of recognizing the problems in the patients' health behavior, offering proposals as solutions to the problems, and reaching an agreement on them. Negotiation had characteristics similar to those mentioned in the literature, but there were also prominent inadequacies. The authors suggest that nurses might need to become more aware of their counseling practices in routine situations through conscious effort for self-evaluation. In addition, further research would be required to demonstrate the effectiveness of negotiation for facilitating changes in patients' health behavior.
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References
1.
Armitage, C. J., & Conner, M. (2001). Efficacy of a minimal intervention to reduce fat intake. Social Science & Medicine, 52, 1517-1524.
2.
Ballou, M. B., Fetter, M. P., Saleh, K. P., & Litwack L. (1992). Health counseling. Kent, OH: American School Health Association.
3.
Berg-Smith, S. M., Stevens, V. J., Brown, K. M., Van Horn, L., Gernhofer, N., Peters, E., et al., for the Dietary Intervention Study in Children (DISC) Research Group. (1999). A brief motivational intervention to improve dietary adherence in adolescents. Health Education Research, 14, 399-410.
4.
Bourn. D. M., Mann, J. I., McSkimming, B. J., Waldron, M. A., & Wishart, J. D. 1994. Impaired glucose tolerance and NIDDM: Does a lifestyle intervention program have an effect? Diabetes Care, 17, 1311-1319.
5.
Butler, C., Rollnick, S., & Stott, N. (1996). The practitioner, the patient and resistance to change: Recent ideas on compliance. Canadian Medical Association Journal, 154, 1357-1362.
6.
Cali, D. D., & Estrada, C. (1999). The medical interview as rhetorical counterpart of the case presentation. Health Communication, 4, 355-373.
7.
Canga, N., De Irala, J., Vara, E., Duaso, M. J., Ferrer, A., & Martinez-Gonzalez, M. A. (2000). Intervention study for smoking cessation in diabetic patients. Diabetes Care, 23, 1455-1460.
8.
Carroll, J. S., & Payne, J. W. (1991). An information processing approach to two-party negotiations. In M. H. Bazerman, R. J. Lewicki, & B. H. Sheppard (Eds.), Research on negotiation in organizations: A research annual—Handbook of negotiation research (pp. 3-34). Greenwich, CT: JAI.
9.
Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (Or it takes at least two to tango). Social Science & Medicine, 44, 681-692.
10.
Denzin, N. K., & Lincoln, Y. S. (2000). Handbook of qualitative research. Thousand Oaks, CA: Sage.
11.
Drew, P., & Heritage, J. (1998). Analyzing talk at work: An introduction. In P. Drew & J. Heritage (Eds.), Talk at work: Interaction in institutional settings (pp. 3-65). Cambridge, UK: Cambridge University Press.
12.
Dube, C. E., O'Donnell, J. F., & Novack, D. H. (2000). Communication skills for preventive interventions. Academic Medicine, 75, S45-S54.
13.
Feste, C., & Anderson, R. M. (1995). Empowerment: From philosophy to practice. Patient Education and Counseling, 26, 139-144.
14.
Genev, N. M., Flack, J. R., Hoskins, P. L., Overland, J. E., & Turtle, D. K. (1992). Diabetes education: Whose priorities are met? Diabetic Medicine, 9, 475-479.
15.
Greenhalgh, L., & Chapman, D. I. (1995). Joint decision-making: The inseparability of relationships and negotiation. In R. M. Kramer & D. M. Messick (Eds.), Negotiation as a social process (pp. 166-185). Thousand Oaks, CA: Sage.
16.
Haakana, M. (2001). Lääkäri, potilas ja nauru [Doctor, patient and a laugh]. In M.-L. Sorjonen, A. Peräkylä, & K. Eskola (Eds.), Keskustelu lääkärin vastaanotolla [Conversation in a physician's office] (pp. 135-159). Jyväskylä, Finland: Vastapaino.
17.
Heritage, J., & Sefi, S. (1998). Dilemmas of advice: Aspects of the delivery and reception of advice in interaction between health visitors and first time mothers. In P. Drew & J. Heritage (Eds.), Talk at work: Interaction in institutional settings (pp. 359-417). Cambridge, UK: Cambridge University Press.
18.
Jaatinen, J. (1997). Terapeuttinen keskustelutodellisuus: Diskurssianalyyttinen tutkimus alkoholiongelmien sosiaaliterapeuttisesta hoidosta [Therapeutic conversational reality: Discourse analytical study of social therapeutic care of alcohol problems] (Stakes: Tutkimuksia, 72). Jyväskylä, Finland: Gummerus Oy.
19.
Kettunen, T. (2001). Neuvontakeskustelu: Tutkimus potilaan osallistumisesta ja sen tukemisesta sairaalan terveysneuvonnassa [Health counseling conversation: A study of patient participation and its support by nurses during hospital counseling] (Studies in Sport, Physical Education and Health, 75). Jyväskylä, Finland: University of Jyväskylä.
20.
Kettunen, T., Poskiparta, M., & Liimatainen, L. (2001). Empowering counseling: A case study—Nurse patient encounter in a hospital. Health Education Research, 16, 101-112.
21.
Kinmonth, A.-L., Spiegal, N., & Woodcock, A. (1996) Developing a training programme in patient-centred consulting for evaluation in a randomised controlled trial: Diabetes care from diagnosis in British primary care. Patient Education and Counseling, 29, 75-86.
22.
Kinmonth, A.-L., Woodcock, A., Griffin, S., Spiegal, N., & Campbell, M., on behalf on the Diabetes Care from Diagnosis Research Team. (1998). Randomised controlled trial of patient centred care of diabetes in general practice: Impact on current wellbeing and future disease risk. British Medical Journal, 317, 1202-1208.
23.
Krouse, H. J., & Roberts, S. J. (1989). Nurse-patient interactive styles: Power, control and satisfaction. Western Journal of Nursing Research, 11, 717-725.
24.
Lazovich, D., Curry, S. J., Beresford, S. A. A., Kristal, A. R., & Wagner, E. H. (2000). Implementing a dietary intervention in primary care practice: A process evaluation. American Journal of Health Promotion, 15, 118-125.
25.
Le May, A. (1998). Empowering older people through communication. In S. Kendall (Ed.), Health and empowerment: Research and practice (pp. 91-110). Bristol, UK: Arnold.
26.
Lewicki, R. J., Saunders, D. M., & Minton, J. W. (2001). Essentials of negotiation (2nd ed.). New York: McGraw-Hill.
27.
Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford.
28.
Norris, S. L., Engelgau, M. M., & Venkat Narayan, K. M. (2001). Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care, 24, 561-587.
29.
Patton, M. G. (1990). Qualitative evaluation and research methods. Beverly Hills, CA: Sage.
30.
Peräkylä, A. (1997a). Institutionaalinen keskustelu [Institutional conversation]. In L. Tainio (Ed.), Keskustelunanalyysin perusteet [Basics on conversation analysis] (pp. 177-203). Tampere, Finland: Vastapaino.
31.
Peräkylä, A. (1997b). Reliability and validity in research based on transcripts. In D. Silverman (Ed.), Qualitative research: Theory, method and practice (pp. 201-220). London: Sage.
32.
Peräkylä, A., Sorjonen, M.-L., Tammi, T., Raevaara, L., & Haakana, M. (2001). Potilaan elämäntavoista keskusteleminen [Discussing the patient's lifestyle habits]. In M.-L. Sorjonen, A. Peräkylä, & K. Eskola (Eds.), Keskustelu lääkärin vastaanotolla [Conversation in a physician's office] (pp. 161-182). Jyväskylä, Finland: Vastapaino.
33.
Polit, D. F., & Hungler, B. P. (1995). Nursing research: Principles and methods (5th ed.). Philadelphia: J. B. Lippincott.
34.
Putnam, L. L., & Roloff, M. (1992). Communication perspectives on negotiation. In L. L. Putnam & M. Roloff (Eds.), Communication and negotiation (pp. 1-17). Newbury Park, CA: Sage.
35.
Pyörälä, E. (2000). Interaction in dietary counselling of diabetic children and adolescents (Publications of Public Health Sciences M173). Helsinki, Finland: Helsinki University Press.
36.
Roberts, S. J., Krouse, H. J., & Michaud, P. (1995) Negotiated and non-negotiated nurse-patient interactions. Clinical Nursing Research, 4, 67-77.
37.
Rollnick, S., Heather, N., & Bell, A. (1992). Negotiating behaviour change in medical settings: The development of brief motivational interviewing. Journal of Mental Health, 1, 25-37.
38.
Roloff, M. E., & Jordan, J. M. (1992). Achieving negotiation goals: The “fruits and foibles” of planning ahead. In L. L. Putnam, & M. Roloff (Eds.), Communication and negotiation (pp. 21-45). Newbury Park, CA: Sage.
39.
Rosal, M. C., Ebbeling, C., Lofgren, J., Ockene, J. K., Ockene, I. S., & Hebert, J. (2001). Facilitating dietary change: The patient-centered counselling model. Journal of American Dietetic Association, 3, 332-341.
40.
Shaikh, A., Knobloch, L. M., & Stiles, W. B. (2001). The use of verbal response mode coding system in determining patient and physician roles in medical interviews. Health Communication, 13, 49-60.
41.
Silverman, D. (1997). Discourses of counselling: HIV counselling as social interaction. London: Sage.
42.
Skinner, T. C., & Cradock, S. (2000). Empowerment: What about the evidence. Practical Diabetes International, 17, 91-95.
43.
Steptoe, A., Doherty, S., Rink, E., Kerry, S., Kendrick, T., & Hilton, S. (1999). Behavioural counselling in general practice for the promotion of healthy behaviour among adults at increased risk of coronary heart disease: Randomised trial. British Medical Journal, 319, 943-947.
44.
Trnobranski, P. H. (1994). Nurse-patient negotiation: Assumption or reality? Journal of Advanced Nursing, 19, 733-737.
45.
Tuomilehto, J., Lindström, J., Eriksson, J., Valle, T. T., Hamalainen, H., Ilanne-Parikka, P., et al., for the Finnish Diabetes Prevention Study Group. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 344, 1343-1350.
46.
Walker, K. L., Arnold, C. L., Miller-Day, M., & Webb, L. M. (2001). Investigating the physician-patient relationship: Examining emerging themes. Health Communication, 14, 45-68.
47.
White, J. C., Rosson, C., Christensen, J., Hart, R., & Lewinson, W. (1997). Wrapping things up: A qualitative analysis of the closing moments of the medical visit. Patient Education and Counseling, 30, 155-165.
48.
Whittemore, R., Chase, S., Mandle C. L., & Roy, S. C. (2001). The content, integrity and efficacy of a nurse coaching intervention in type 2 diabetes. Diabetes Educator, 27, 887-898.
49.
Wing, R. R., Goldstein, M. G., Acton, K. J., Birch, L. L., Jakicic, J. M., Sallis J. F., Jr., et al. (2001). Behavioral science research in diabetes: Lifestyle changes related to obesity, eating behavior, and physical activity. Diabetes Care, 24, 117-123.
50.
Woodcock, A., & Kinmonth, A. L. (2001). Patient concerns in their first year with type 2 diabetes: Patient and practice nurse views. Patient Education and Counseling, 42, 257-270.
51.
Woodcock, A. J., Kinmonth, A.-L., Campbell, M. J., Griffin, S. J., & Spiegal, N. M. (1999). Diabetes care from diagnosis: Effects of training in patient-centred care on beliefs, attitudes and behaviour of primary care professionals. Patient Education and Counseling, 37, 65-79.
52.
Yawn, B., Zyzanski, S. J., Goodwin, M. A., Gotler, R. S., & Stange, K. C. (2001). Is diabetes treated as an acute or chronic illness in community family practice? Diabetes Care, 24, 1390-1396.
