The purpose of this study, to observe, analyze, and compare extant nurse-patient counseling interactions, was achieved through direct observations and tape recordings of nurse-patient interactions in medical-surgical and psychiatric settings.

The observed settings showed remarkable differences in levels of noise and activities, the numbers and types of people present, and the numbers and types of tasks required of nurses.

One hundred and fourteen incidents of nurse-patient interactions were generated in these settings. Interactions were classified into four levels, briefly described as, Inquiry, Comment, Response, and Elaboration. This model was useful for characterizing each interaction as non-counseling, or as counseling with and without closure.

Analysis revealed that only 30.7 percent of all incidents ended in closure, at the level of Elaboration. Also revealed, was that nurses in psychiatric settings counseled more often and at a higher level than did nurses in medical-surgical settings.

Counseling skills were categorized as proposed by Doyle's Role Communication Skill Model. These skills: attender, clarifier, informer, inquirer, supporter, motivator, evaluator, and problem solver, did not differ when used by nurses in either setting.

Issues related to counseling were discussed with each nurse during a post-observation interview. These issues included, among others, how patients are chosen for counseling, goals of counselings, and which theories of counseling nurses use. These issues, and others, are described and discussed in relation to counseling performances, and in relation to the settings in which counseling was observed.