27.3400, Review: Discourse; Language Acq; Corpus Ling: Staples (2015)
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LINGUIST List: Vol-27-3400. Fri Aug 26 2016. ISSN: 1069 - 4875.
Subject: 27.3400, Review: Discourse; Language Acq; Corpus Ling: Staples (2015)
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Date: Fri, 26 Aug 2016 12:20:25
From: Peter Backhaus [backhaup at hotmail.com]
Subject: The Discourse of Nurse-Patient Interactions
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AUTHOR: Shelley Staples
TITLE: The Discourse of Nurse-Patient Interactions
SUBTITLE: Contrasting the communicative styles of U.S. and international nurses
SERIES TITLE: Studies in Corpus Linguistics 72
PUBLISHER: John Benjamins
YEAR: 2015
REVIEWER: Peter Backhaus, Waseda University
Reviews Editor: Helen Aristar-Dry
SUMMARY
_The discourse of nurse-patient interactions_ by Shelley Staples studies
communication between nurses and patients in a US hospital environment. It
applies a mixture of methods including corpus linguistics and discourse
analysis. Special focus is on likely interactional differences between nurses
educated in the US (USNs) and nurses trained outside the country, referred to
as internationally educated nurses (IENs). Most of the latter come from Asian
countries.
After a preface by Douglas Biber, who is one of the author’s mentors, Chapter
1 provides an introduction to the main topics and a brief outline of the
study. Chapter 2 reviews the relevant literature on nurse-patient interaction,
the linguistic, prosodic and nonverbal features to be studied, and ways of
assessing the quality (here termed “effectiveness”) of communication in
healthcare settings.
Chapter 3 introduces the setting of the study, three hospitals in Las Vegas,
and the way the data were collected through video recordings. This is followed
by a detailed description of the data sample and the sophisticated technical
devices and statistical tests to be used in the subsequent analysis. In total,
the corpus consists of 102 dyadic first-encounter interactions between a nurse
(50 USNs and 52 IENs, mostly females) and a “standardized patient” (SP)
recruited from a group of actors “trained to present the same case in the same
way to multiple health care providers” (p.28). A total of seven female SPs
participated, each portraying a woman in her 50s who has been complaining of
chest pain after her father’s recent death and a subsequent family conflict.
As Staples explains, SPs are a common way to evaluate interactions in medical
settings. While she acknowledges that this makes the interactions somewhat
less authentic, using standard patients not only helps circumvent privacy
issues but also assures comparability of the data, as all SPs (are instructed
to pretend to) have an identical patient history. The analysis of the corpus
data is complemented by semi-structured interviews with nurses who did not
participate in the interactions.
Chapter 4 describes the general characteristics of the data, including the
five identifiable phases (opening, complaint, exam, counsel, closing) of an
interaction, the diverse linguistic and cultural backgrounds of the two groups
of nurses, and the inherent asymmetries of the relationship between nurse and
patient. The chapter also identifies first differences with respect to a more
patient-centered interactional behavior by the USNs as opposed to a more
provider-oriented style by the IENs.
In Chapter 5 the author analyzes the main interactional and lexico-grammatical
characteristics of the corpus. Analytical categories include amount of speech,
overlaps, personal pronouns, narrative features (past tense, communication
verbs, etc.), conditionals, and certainty and likelihood verbs, among others.
While the quantitative outcomes clearly testify to the aforementioned
asymmetries between patient and nurse (e.g., higher amount of speech and more
overlaps by the nurses), the analysis also recognizes efforts by the nurses to
mitigate these asymmetries through their speech and deliver more
patient-centered care.
The subsequent three chapters directly compare USN and IEN speech with respect
to interactional characteristics (Chapter 6), lexico-grammatical features
(Chapter 7), as well as fluency, prosody and nonverbal properties (Chapter 8).
As somewhat foreseeable from the preview in Chapter 4, the analysis finds that
“the two nurse groups are using different communicative styles, based on
different sociopragmatic and pragmalinguistic approaches to their interactions
with patients. USNs used a number of features that reflect aspects of
patient-centered approaches to interaction” whereas IENs’ communicative style
“emphasizes the role that the nurse plays in the care of the patient”
(pp.124-125).
Chapter 9 is a short chapter that focuses on the linguistic behavior of the
patients, though again with a view to comparing interactions involving USNs
with interactions involving IENs. Examining various of the previously
discussed aspects of nurse discourse as they occur in the patients’ speech,
Staples observes that “the more provider-centered focus of the IENs is
accompanied by less talk by the patient and less expression by the patient of
her feelings and needs” (p.164).
Chapter 10 is in many respects the core chapter of the book. It explores the
problem of “effectiveness” in nurse -patient interaction, here assessed
through two devices: (1) the model patients’ direct evaluations and (2) third
person observers’ ratings based on a set of evaluation categories commonly
used in the medical sector. The analysis reveals that USNs score significantly
higher on virtually all effectiveness categories. In addition, it was found
that the communicative behavior of IENs with a longer residence in the US
tends to be evaluated more positively than nurses who have only relatively
recently started working in the US.
Chapter 11 summarizes the similarities and main differences in the interactive
style of the two nurse groups and discusses the study’s implications for
policy and training. It also critically reviews the limitations of the study
and points out additional research directions.
EVALUATION
_The Discourse of Nurse-Patient Interactions_ provides valuable insights into
communication between nurse and patients. Quite in contrast to the large
amount of literature on doctor-patient interaction (e.g., Heath 1986,
Ainsworth-Vaughn 1998), this is a topic that has been only marginally studied
so far (see Weinhold 1997 for a notable exception). Staples addresses this
topic by using a well-devised mixture of quantitative and qualitative
approaches, supplemented by semi-structured interviews that allow occasional
glimpses into the nurses’ first-hand experiences. This ethnographic angle
provides the whole analysis with an important additional edge.
Staples’s analysis of her corpus data demonstrates how discursive features can
be quantitatively approached in a meaningful way. Her approach will certainly
contribute to the recent outreach of corpus linguistics to the study of talk
in interaction (e.g. Rühlemann 2007, O'Keeffe & Walsh 2012). Of special note
is the inclusion of non-verbal features (handshake, therapeutic touch) as part
of the analysis, and particularly the novel attempt to study prosody within a
corpus linguistic framework.
Another strong point of the analysis is its careful consideration of the
different interactional phases, without which many of the identified phenomena
would likely remain undiscovered. For example, Staples shows that the use of
first person pronouns in the exam phase fulfils a totally different function
than in the counsel phase, and hence needs to be evaluated differently across
the different phases.
One thought-provoking point is how Staples, with amazingly little ado, arrives
at the politically totally incorrect conclusion that domestic nurses -- at
least in interaction with domestic patients and gauged by domestic standards
-- communicatively clearly seem to do a better job than their international
colleagues. It takes some courage to argue this way, given that such
observations are all but “illegal” in many strands of sociolinguistics and
discourse studies.
The evidence Staples presents to make her point is most convincing when
discussing rather straightforward cases of communication gone wrong, for
instance an IEN completely ignoring a patient’s mentioning of her father’s
recent death (Excerpt 4.8) or bluntly disagreeing with a patient on her
medication (even while the nurse is factually wrong!) (Excerpt 7.31).
More fine-grained evidence based on specific interactional or
lexico-grammatical features is not always as convincing. When comparing use of
backchannelling, for instance, the two extracts that are juxtaposed (Excerpts
10.7 and 10.8) do not make for a good comparison, as in the first case the
patient is the main speaker whereas in the second case it’s the nurse, which
structurally makes backchannels all but impossible for her. All in all,
however, Staples deserves respect for raising such a controversial issue and
solidly backing it up through her analysis, both qualitatively and
quantitatively.
One general problem I had with the data analysis was that it tends to be
directed at only one part of the interactional dyads, normally the nurses, and
does not pay much attention to the give and take of the talk as a whole. To
give just one example, when analyzing communicative effectiveness in Chapter
10, one positively evaluated factor is the frequent use of questions by the
nurses. The discussion would certainly have benefited here if a patient’s
reaction to these questions had been part of the analysis as well. Instead,
some of the extracts do not even present any patient speech but consist solely
of the nurse’s turn, which leaves the qualitative part of the analysis
somewhat shallow. But, to be fair, the book was published in Benjamins’
_Studies in Corpus Linguistics_ series and therefore shouldn’t be judged
predominantly by discourse or conversation analytical standards.
Another point I found somewhat distracting is the high number of typos,
including some rather big and annoying errors (e.g. second paragraph on
p.153). Though this does not weaken the overall achievement of the book, a
little more editorial care would have been appreciated, certainly not only by
this reviewer.
These minor criticisms notwithstanding, the book is a very well-done and
urgently needed approach to the topic of nurse-patient interaction and its
basic discursive features. It will be of interest not only to researchers
studying communication in healthcare and related institutional settings, but
to everyone interested in analyzing discourse within a corpus linguistic
framework.
REFERENCES
Ainsworth-Vaughn, Nancy. 1998. _Claiming power in doctor-patient talk_.
Oxford: Oxford University Press.
Heath, Christian. 1986. _Body movement and speech in medical interaction_.
Cambridge: Cambridge University Press.
O'Keeffe, Anne and Steve Walsh. 2012. Applying corpus linguistics and
conversation analysis in the investigation of small group teaching in higher
education. _Corpus Linguistics and Linguistic Theory_ 8(1). 159-181.
Rühlemann, Christoph. 2007. _Conversation in context: A corpus-driven
approach_. London & New York: Continuum.
Weinhold, Christine (1997) _Kommunikation zwischen Patienten und
Pflegepersonal_. Bern: Verlag Hans Huber.
ABOUT THE REVIEWER
Peter Backhaus is Associate Professor at Waseda University, Tokyo. His main
research interests are sociolinguistics, pragmatics and written language, with
special focus on Japanese. He is currently preparing a book on resident-staff
interaction in a Japanese eldercare facility.
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