Taking risks: An indicator of expertise?

The achievement of excellence in nursing practice is reflected in the quality of the nurse's discourse. The identifying features of expertise in nurse-patient discourse relate to the ability to construct a coherent text in which the power relations are negotiated between nurse and patient. Data were drawn from nurse-patient interactions using a nursing assessment proforma. In this instance the instrument is used as a means of investigating discourse strategies. The nurses are an experienced registered nurse delivering care to clients in their homes in the community and a nurse who has no formal nursing qualifications but works as an assistant in nursing in an aged-care residential facility (nursing home). The strategies employed involve the expert nurse risking that the interaction will become a social, rather than a therapeutic interaction. An analysis of the texts demonstrates that the interaction between the expert nurse and the patient is rich in appropriate and pertinent information, providing a sound basis for appropriate nursing care. Both expert nurse and patient expand topics so that the health advice given is appropriate to the meaning to the patient of the health situation. This contrasts with the untrained nurse, who is found to control topic management and to disallow patient digressions. Such a conversation cannot be regarded as either a therapeutic interaction or a rich social interaction.