The body of the interview, the interaction phase, was nurse-led and composed largely of a pre-determined sequence of closed questions and some open focussed questions , together with echoing and reflecting by Anne of José. Attentive 'active' listening by nurse Anne - letting José finish each sentence, rather than assuming what he would say - helped encourage and reinforce the patient's verbalisation. Mutual respect by both parties was evident by their careful listening , attentive and without undue fidgeting or other distraction. The good humour of nurse and client helped maintain a sense of equanimity in what could otherwise have been a tedious stress-inducing encounter. Moments of silence ( while Anne was typing the record ) could be seen as beneficial , giving José opportunity for free thought and the possibility of taking initiative to add to the conversation if he wanted. Thus José was able to interject several 'ad lib' remarks - to which Anne responded in lively and ungrudging manner - in between running through sections of the standard questionnaire. Often there appeared moments of brief eye contact, with confirmatory facial expressions, as significant amounts of information passed from person to person and Anne was able quickly to validate information necessary in order to compose a care plan for José, based upon the Roper, Logan & Tierney 'activities of living' model for nursing. ( Roper, Logan & Tierney, 1996 , p33 )

One means that has been devised for understanding the complexity of interpersonal human communication is that developed by the interactionist model ( Fritz et al, 1984 ). From a disparate variety of scenes certain commonalities and rules of discourse have been deduced for a systemic explanation of communication behaviour applicable to the nursing environment. The interactionist model in considering dyad interpersonal communication recognises that important preconditions exist:- e.g. the need for a shared verbal and nonverbal vocabulary, a common frame of reference and compatability of goals and values, the ability to listen and to be able to regulate the rate of information flow, a mutually agreed-upon perception of role relationships, and freedom from ego threat. Both people in this dyad jointly determined the outcomes in a non-competitive cooperative climate, communication being jointly sent and received. Because José perceived Anne as empathising therefore he willingly reciprocated that empathy with increased quantity and quality of personal disclosure. With increased quality of disclosure came increased illumination of the patient's condition, increased knowledge for the nurse and greater professional satisfaction. By generating empathy Anne gained a more satisfactory picture of the patient's world and helped give credence to the self-image. In this interview the preconditions for satisfactory discourse were amply met, so that there appeared no obvious barrier to an effective relating between interviewer and interviewee. The surgical problem for which José had been referred to this ward was perceived by both Anne and her client as relatively minor and unlikely to present complications during treatment, especially due to the age and otherwise general good health of José. José said that he had been favourably reassured during earlier interviews with his doctor specialist, who had already been able to give him a clear understanding of procedures he was to undergo , and who had therefore considerably allayed his fears about having an operation performed in hospital.