The purpose of this study was to describe how visiting nurses and their patients communicate about compliance during visits to patients' homes. The three research questions guiding this investigation were designed to elicit the meaning of home care and compliance from both nurse and patient or family member perspectives, and to identify content and relational aspects of nurse-patient communication during home visits.

Participants were 6 nurses and 25 patients from 2 cooperating home care agencies. Participant observation was the primary method of data collection during 25 home visits. Interviews were subsequently conducted with all nurses, 11 patients, and 8 family members.

The results suggest that the nurses and patients held similar views of home care and compliance, although nurses saw themselves playing a more comprehensive role in compliance than was acknowledged by patients. The results also show compliance communication interwoven in an ongoing stream of conversation, with compliance discourse initiated by all parties involved, and compliance-gaining pursued sequentially. Compliance-gaining was situated in the nurse-patient relationship, described as supportive and caring. Further, compliance entailed the negotiation of control within this relationship, with control shifting from nurse to patient over the course of home visits.

The nurses considered education their primary means of helping patients achieve compliance. They also arranged additional support services, removed obstacles to compliance, and used threats and positive reinforcement to enhance compliance. Overall, the compliance-gaining strategies employed were prosocial and collaborative, involving patients and enlisting the help of supportive others, particularly family members.

Conclusions from this investigation suggest that the complexities of compliance communication defy simple causal analyses. Compliance-gaining may not entail a single, tangible, discrete message, but may be sequential, adaptive, nonverbal, interactive, and collaborative. These findings confirm the necessity for research in natural settings to determine the influence of situational variables and identify the range of strategies used in actual situations. This study supports research indicating that intimacy is an important situational variable, and research suggesting that relational communication competencies are important to the development of therapeutic relationships. Moreover, within effective nurse-patient communicative relationships, compliance may be enhanced.