How community nurses handle concerns voiced by older adults: A conversation analytic study

Background: Community nurses play an important role in supporting older adults who live at home by encouraging self-determination, autonomy, and self-management, all of which are becoming increasingly important in home care. This study aims to identify and describe the ways in which community nurses deal with the concerns raised by older adults, who live independently at home with care support. Data and method: We analysed a corpus of 21 recorded conversations that took place during home visits conducted in a large Dutch city between 2020 and 2022. To examine the data, we used conversation analysis, an inductive qualitative approach that is particularly suited to the analysis of real-life interactions, including healthcare interactions. Analysis: We identified three different trajectories that characterise how community nurses handle clients' concerns and that yield distinct outcomes. The exploratory trajectory is characterised by nurses stimulating clients both to identify the cause or source of the concern as well as a solution to it. By contrast, the presumptive trajectory involves nurses proposing solutions themselves, while leaving the origins of the concern unexplored. Finally, the reassuring trajectory entails nurses normalising the concern which leads to clients volunteering possible remedies that they have already implemented. Conclusion: Our findings highlight the crucial role of language in how concerns of clients are constructed during home visits and the importance of community nurses in shaping how those concerns unfold and get resolved.