Working across multiple voices in supportive conversations between nurses and patients: towards a complexity- and context-sensitive model for dialogic communication

‘Patient- or person-centredness’ has become a central principle of social and health care policy discourse globally. According to the discourse, patients and relatives are ‘empowered’ as dialogue partners, together with health professionals, in collaboratively co-creating knowledge and reaching decisions about their care. This paper takes its starting point in the view that dialogue and co-creation have become romanticized as buzzwords. Going beyond the buzzwords, the paper draws on Bakhtin and Foucault to explore the tensions arising from power dynamics in the interplay between voices in the co-creation of knowledge. The practice in focus is an effort to build a dialogic communication model which is sensitive to the dialogic, situated nature of meaning- making. The purpose of the model is to improve supportive conversations between health professionals and patients with chronic illnesses in a Danish person-centred health care initiative entitled “Active Patient Support”. To develop the model, the researchers facilitated workshops in which a group of patients and nurses, together with the researchers, reflexively co-created knowledge about supportive conversations. Using co-creation methods (eg audio reflexive ethnography and forum theatre), knowledge was co-created through reflexive, collaborative analysis. The analysis highlights tensions in play in the interactional accomplishment of “dialogue” as nurses shifted between different dialogue positions and patients responded in different ways. The paper also discusses tensions in collaborative relations between researchers, patients and nurses. A key tension highlighted is the tension between opening up for multiple patient and nursing voices and managing the process in order to produce a communication model.