Nonverbal communication between registered nurses and patients in general practice during lifestyle risk reduction conversations

Problem

Increases in the chronic disease necessitate a shift towards effective approaches to lifestyle risk reduction. Behaviours such as smoking, poor nutrition, harmful alcohol intake, inadequate physical activity and obesity or overweight are modifiable. However, individuals often require ongoing targeted lifestyle risk communication and management from clinicians to achieve lasting behaviour change. General practice nurses (GPNs) often have prolonged community-based engagement with patients, ideally placing them to implement prevention and self-management strategies.While health education comprises a large proportion of nurse-patient encounters, our understanding of these interactions is limited. Nonverbal interactions represent the majority of communication and indicate how people behave with or without speech. Effective nonverbal behaviour assists in the strengthening relationships, rapport and person-centred communication leading to greater patient trust, understanding and engagement. Understanding lifestyle risk communication in this way aims to better inform clinicians of nonverbal behaviour impact and interventions empowering behaviour change.

Approach

This paper forms part of a mixed methods study about how GPNs perceive and communicate lifestyle risk. Using non-participatory video observation methods and descriptive statistics, we sought to understand GPN-patient nonverbal communication during chronic disease management (CDM) consultations. Fifteen GPNs and 36 patients were recruited from South Eastern Australia. The Nonverbal Accommodation Analysis System (NAAS) was used to understand nonverbal communication and how participants modified nonverbal communication over the course of the consultation. Additionally, GPN computer-eye contact time was measured.

Findings

Paraverbal and nonverbal behaviours were categorised into joint convergence, asymmetrical convergence, joint divergence asymmetrical divergence and joint maintenance using established definitions. Convergence indicated behavioural similarity to the other party where as divergence showed accentuation of difference. Person-centred communication was most frequently categorised (44.0%) through joint convergent behaviours (talk time 44.4%, pauses 41.7%, simultaneous speech 33.3%, interruptions 38.9%, smiling 58.3%, laughing 66.7%, gesturing 36.1%, nodding 47.2%, eye contact 50%). However, speech rate showed that largely patients responded convergently (30.6%) or divergently (27.8%) potentially indicating GPN active listening or dominance. The majority of nurse computer eye contact (58.3%) decreased over the course of the consultation (mean beginning consult 0.30, end 0.25) but this did not translate to a marked increase in GPN-patient eye contact (mean beginning consult 0.45, end 0.46).

Consequences

Effective communication techniques between patients and health professionals are known to support sustained behavioural change. Nonverbal behaviours used effectively are linked to patient, health professional and communication outcomes and satisfaction. The findings in this study show higher levels of convergence than previous research amongst medical practitioners. Utilising and expanding this person-centred approach by GPNs has the potential to improve CDM and the prevention of lifestyle risk. These findings can inform health policy, GPN education and practice to improve health outcomes for lifestyle risk reduction.