The interpersonal contexts of negotiating care in home care nurse-patient interactions

In this article, the author describes six interpersonal contexts within which care is negotiated between home care nurses and their patients, based on qualitative analysis of 31 videotaped visits. The interpersonal contexts were negotiation of (a) territoriality, (b) shared perceptions of the situation, (c) an amicable working relationship, (d) role synchronization, (e) knowledge, and (f) taboo topics. Analysis of moment-by-moment communication explored how social identity related to care activities is constructed, challenged, or threatened in the flow of events in the encounter. This approach does not problematize negotiation by assuming negative connotations of inequality of power; rather, it examines the therapeutic consequences of specific communication acts. It demonstrates how both nurse and patient are, paradoxically, both empowered and made vulnerable through everyday conversation.