Embracing Disturbances in Clinical Encounters: Understanding the Nurse Practitioner – Patient Relationship

There is a paucity of literature regarding the art of Nurse Practitioner (NP) practice and how it is taught to novice NPs.  It has been established that patient satisfaction with NP visits is closely tied to communication between patient and provider (Buller & Buller, 1987; Hayes, 2007).  Missing from the literature is the what and how of NP – patient encounters.  To further understand the interactions between NPs and patients, King’s nursing theory of goal attainment serves as a conceptual framework for this study.  Fundamental to King’s theory is the concept of disturbances; incongruence between patient and NP perceptions.  Disturbances have the potential to result in a transaction and goal attainment (King, 1981).  Of the 93 practice and research applications of King’s theory, this study is the first to examine NP – patient interactions.

Methodology:  Four NPs with at least one year of clinical experience, and two patients new to each NPs’ practice were recruited using convenience sampling. Videotape recordings of NP – patient dyads over three consecutive clinical encounters were transcribed and entered into the NVIVO data management program.  A triangulated approach to data analysis included transaction analysis based on King’s Theory, discourse analysis, and quantitative analysis using the Davis Observation Code.  The focus of this presentation will be on transaction analysis using King’s Theory. 

Results:  King’s theory of goal attainment describes the process of human interactions that leads to mutual goal setting.  The findings of this study help to further refine King’s theory in the context of advanced practice nursing in the primary care setting. Disturbances in the clinical encounters were found to be pivotal in mutual goal setting.  This information can guide nurse practitioner educators to teach novice NPs to embrace rather than avoid disturbances, ultimately enhancing the partnership.