Traffic risk work with sleepy patients: from rationality to practice

Abstract

In this article, we aim to contribute to the emerging field of risk-work studies by examining the relationship between risk rationality and risk practices in nurses’ conversations with Obstructive Sleep Apnoea patients about traffic risks. Legislation in Sweden towards traffic risk involves clinicians making risk assessment of patients prone to falling asleep while driving. In contrast to an overall care rationale, this means that the health of the patient is not the only risk object in treatment consultations. However, guidelines on how to implement legislation are missing. To examine the practical reality of nurses’ traffic-risk work, we draw on an analysis of data from a Swedish study in 2015. This study included qualitative interviews with specialist nurses and video-recorded interactions between nurses and Obstructive Sleep Apnoea patients. We found that a lack of clarity in traffic-risk guidelines on how risk should be addressed was evident in both interview accounts and in observed practice. While nurses primarily accounted for risk work as treatment-relevant education, they practised risk work as interrogation. Patients also treated nurses’ inquiries as assessment – not education – by responding defensively. We conclude that while confusing risk work and treatment enables clinicians to treat patients as competent actors, it obscures the controlling aspects of traffic-risk questions for individual patients and downplays the implications of drowsy driving for general traffic safety.

Keywords:

• conversation analysis
• risk
• risk assessment
• risk work
• sleepy patients
• Obstructive Sleep Apnoea
• traffic

Acknowledgements

Earlier versions of this paper were presented at the Third ISA Forum of Sociology in Vienna 2016, in the thematic group session Risk Work: Experiences and Challenges within Organisational, Professional and Policy Contexts“ and at the Welfare and Life-Course Research Group, Uppsala University. We are very grateful to the participants at these venues and the HRS editors and reviewers for their helpful comments.

Clara Iversen is responsible for the original conception and design of the study and has transcribed interactional data and analysed both data sets. Anders Broström and Martin Ulander have been responsible for the collection of the data and transcription of interviews. The manuscript was drafted by the first author Clara Iversen and all authors have revised drafts. All authors have approved the submitted version of the article. The research study on which this article is based was given ethical approval by the Regional Ethics Board in Linköping (2014/232-31).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research for which this article is based was funded in part by the European Research Council [CEV, 263699] and in part by FORSS (Medical Research Council of Southeast Sweden) [DNR. 566401] and [376541].