More than ‘information provider’ and ‘counselor’. Constructing and negotiating roles and identities of nurses in genetic counseling sessions.

Abstract

This paper contributes to research on genetic counseling by exploring the complexity of this activity from the angle of identity construction. We argue that an analysis of the processes through which healthcare providers construct and negotiate their roles and identities in these encounters may contribute to a better understanding of the complexities of genetic counseling. Drawing on more than 150 video-recorded genetic counseling encounters between nurses and clients in Hong Kong, we illustrate that the discursive processes involved in the construction of the nurses' identities are complex, overlapping and at times contradictory as the nurses respond to the (sometimes) competing norms and expectations of their institution, their clients and their own. They manage to solve these tensions by drawing on the roles traditionally assigned to nurses in these encounters such as information provider and counselor, as well as creating the new roles of co-decision maker and cultural broker/mediator.

本文從身份建構觀點出發,探討醫療言語行為中的遺傳輔導/諮詢服務複雜性。深入探索醫護人員與病人溝通時如何建構自己的角色和身份,並從中總結其複雜性。透過分析超過150個香港的護士與病人會診對話的錄影,我們發現在會診過程中,護士的身份具有多重意義,甚至互相矛盾。這現象源於護士受到他們的機構,病人和自己的期望和規範所限制。為了處理這些矛盾,他們會擔任傳統的角色,如提供諮詢和輔導服務,以及創造新的角色,如與病人共同決策和協調與病人間不同的文化差異。