A case study of styles of patient self-presentation in the nurse practitioner primary health care consultation

Abstract

This case study explores the patient self-presentational aspects of social interactions occurring during nurse practitioner consultations in primary health care. Previous consultation communication research has revealed that styles of patient self-presentation have an effect on the process and outcomes of consultations. However, it is noted that available consultation communication research is focused on doctor-patient interactions. Accordingly, this research aimed to redress the medically focused imbalance in consultation communication research by investigating and identifying the possible effects of patient self-presentation styles on the process and outcomes of nurse practitioner consultations. An observational case study was undertaken in a nurse-led primary care walk-in clinic, utilizing multiple methods of data collection including: direct observations of nurse practitioner consultations, postconsultation semi-structured interviews with nurse practitioners, and a field journal. Two sample groups were used: a purposive sample of 15 patients attending the walk-in clinic with upper respiratory tract infections (URTI), and a convenience sample of six nurse practitioners employed at the same clinic. Five different styles of patient self-presentation were identified, which all had variant effects on the process and outcomes of the nurse practitioner consultation. These styles included: Seekers (patients seeking treatment); Clinical Presenters (patients presenting clinical histories); Confirmers (patients checking the severity of their illnesses); Seekers to Confirmers (patients who initially seek treatment, but who change to a confirmatory style); Anticipators (patients who anticipate their need for treatment). The nurse practitioner participants were found to be flexibly responding to these styles of patient self-presentation, as an attempt to maximize patient satisfaction with their consultations. It is suggested that the observed nurse practitioners were able to flexibly modify their consultation communication strategies in response to different patient self-presentation styles, which helped resolve the tensions existing between the patients’ own reasons for consultation attendance and their actual clinically assessed needs for treatment.