Ascribing patients a passive role: Conversation analysis of practice nurses' and patients' goal setting and action planning talk

Within primary care, nurses are expected to set goals and make action plans with patients. However, little information is available on how this is done. The aim of this study is to gain insight into how nurses set goals and action plans with patients. Data were collected from three practice nurses working in elderly care and five patients in the Netherlands. Practice nurse is the term for the home care registered nurse in the Netherlands. Five home visits for which goal setting and action planning were the main agreed-upon objectives, were video-recorded and transcribed. We found that explicit goal setting was not observable. However, in 16 episodes, action plans were discussed. Action planning was always initiated by the nurse and was oriented toward offering professional help or assistance in order to solve the patient's problems. In response, patients tended to resist the proposed solutions, with the result that action planning was abandoned. By the nurse proposing professional help, patients were positioned as passive rather than active agents. Our results contribute to the understanding of how nurses' communicative behavior influences the extent to which patients feel encouraged to actively participate in goal setting/action planning.