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Objective This study described nurse-patient communication during health counselling and focused on the linguistic realisations of empowering speech practices that emphasised patient participation. It aimed at a description of nurses' speech practices that facilitated the inclusion of patients' perspectives and preferences and encouraged patients to express themselves. Design and setting Thirty-eight videotaped nurse-patient health- counselling sessions that were conducted in a hospital were transcribed verbatim. Method The analysis of the videotaped data was based on the adaptation of Conversation Analysis (CA) and was carried out on a turn-by-turn basis. Results The research material revealed that affective questions and tentative speech, together with continuers, facilitated active participation by patients. Thus, patients were free to discuss their ideas, concerns, experiences, and knowledge with nurses. The findings indicated that nurses were able to establish collaboration and involve patients in their own frame of reference. Conclusion The results emphasised partnership and reciprocal conversation, with nurses' social and emotional skills at the heart of the ' encounter. The findings may advance professional understanding of patient-centred empowering practice, which has until now remained at a conceptual level. The results may be useful for developing health counselling and for designing training programmes for nurses.

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Negotiation, an essential communication activity in lifestyle counseling, has rarely been studied at the micro level of interaction. Furthermore, the evidence for interpersonal negotiation to occur in counseling practice is inconclusive. In this study, the authors describe how negotiation focused on lifestyle changes was produced in nurse-patient interaction. The research data, 73 videotaped diabetes counseling situations, were analyzed using conversation analysis. The process of negotiation consisted of recognizing the problems in the patients' health behavior, offering proposals as solutions to the problems, and reaching an agreement on them. Negotiation had characteristics similar to those mentioned in the literature, but there were also prominent inadequacies. The authors suggest that nurses might need to become more aware of their counseling practices in routine situations through conscious effort for self-evaluation. In addition, further research would be required to demonstrate the effectiveness of negotiation for facilitating changes in patients' health behavior.

This study illustrates practices that a nurse uses in order to empower patients. The emphasis is on speech formulae that encourage patients to discuss their concerns and to solicit information about impending surgery. The study is a part of a larger research project and a single case was selected for presentation in this article because it differed from the rest of the data by manifesting empowering practice. A videotaped nurse-patient health counseling session was conducted in a hospital and transcribed verbatim. The investigator interviewed the nurse and the patient after the conversation, and these interviews were transcribed as well. The encounter that is presented here as a case study is a concrete example of a counseling session during which the patient is free to discuss with the nurse. The empowering practices that the nurse employed were as follows: encouraging the patient to speak out, tactfully sounding out the patient's concerns and knowledge of impending surgery, listening to feedback, and building a positive vision of the future for the patient. We suggest that nurses should pay attention to verbal expression and forms of language. This enables them to gain self-awareness and discover new tools to work with.