Ethnomethodology. II: A study of the Community Psychiatric Nurse in the patient's home.

The former paper delineated the main points of ethnomethodology and its implications for nursing research. This paper describes a research study into the home visits of Community Psychiatric Nurses using the framework of ethnomethodology. Relevant sociological, psychological, medical and nursing literature is briefly reviewed. Home visits are found to be socially constructed events in which the sense of the talk is dependent upon the setting and context. The context of being in the home is shown to exert pressure upon how the developing events of the visit are construed by the participants. In particular, it is discovered that being a visitor in the patient's home tends to define the occasion of a Community Psychiatric Nurse visit as that of a meeting of friends. This is oriented to by the participants who draw upon their stock of typified knowledge of conduct of guests and hosts to make visible their desired definitions of the situation. The dynamics of power and control by the nurse are also altered by the location of the visit in the patient's home. Being in the home puts the patient firmly in charge, allowing him to take the lead at every turn. The nurse uses the strategies of persuasion and negotiation which can be enacted in the patient's home without fracturing the intersubjective understandings of the visit. Only in matters seen by both participants as clearly medico-psychiatric will the nurse become more assertive. Attention is drawn to some implications of these findings for the practice of Community Psychiatric Nursing.