Analysis of nurse conversation: methodology of the process recording

The study explored elements of effective nurse–client interaction between a nurse and a nursing home resident on the third day of the client's recovery from surgery. The interaction was recorded from memory in the form of a process recording then divided into unique conversation segments. Two nurses independently used seven typologies to classify segments of the conversation. Cohen's coefficient kappa for inter‐rater reliability of the classifications was 0.98. Findings from the study revealed that two‐thirds of the nurse's conversation was effective and consistent with the orientation phase of the nurse–client relationship. The nurse communicated her role through the provision of leadership, resources and help, and technical expertise. Her approaches were rather evenly divided between making requests, giving information, and affirming the client's experience. One‐third of the conversation was oriented toward assessment and diagnosis, one half toward treatment of the client's experiences, and the rest toward planning and evaluation. Themes identified in the client's conversation included issues of dependency, disorientation to time, unresolved grief, separation anxiety, and the client's need for validation. These findings are valuable for illuminating the contribution that nurse conversation makes to evidence‐based clinical practices. They also have implications for further refinements in the use of the process record and multiple coding schemes for the study of the nurse–client relationship.