Background: Diabetes is a major health issue for individuals and for health services. There is a considerable\r\nliterature on the management of diabetes and also on communication in primary care consultations. However, few\r\nstudies combine these two topics and specifically in relation to nurse communication. This paper describes the\r\nnature of nurse-patient communication in diabetes management.\r\nMethods: Thirty-five primary health care consultations involving 18 patients and 10 nurses were video-recorded as\r\npart of a larger multi-site study tracking health care interactions between health professionals and patients who\r\nwere newly diagnosed with Type 2 diabetes. Patients and nurses were interviewed separately at the end of the\r\n6-month study period and asked to describe their experience of managing diabetes. The analysis used ethnography\r\nand interaction analysis.\r\nIn addition to analysis of the recorded consultations and interviews, the number of consultations for each patient\r\nand total time spent with nurses and other health professionals were quantified and compared.\r\nResults: This study showed that initial consultations with nurses often incorporated completion of extensive\r\nchecklists, physical examination, referral to other health professionals and distribution of written material, and were\r\ntypically longer than consultations with other health professionals. The consultations were driven more by the\r\nnurses� clinical agenda than by what the patient already knew or wanted to know. Interactional analysis showed\r\nthat protocols and checklists both help and hinder the communication process. This contradictory outcome was\r\nalso evident at a health systems level: although organisational targets may have been met, the patient did not\r\nalways feel that their priorities were attended to. Both nurses and patients reported a sense of being overwhelmed\r\narising from the sheer volume of information exchanged along with a mismatch in expectations.\r\nConclusions: Conscientious nursing work was evident but at times misdirected in terms of optimal use of time.\r\nThe misalignment of patient expectations and clinical protocols highlights a common dilemma in clinical practice\r\nand raises questions about the best ways to balance the needs of individuals with the needs of a health system.\r\nVideo- recording can be a powerful tool for reflection and peer review.
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