This book provides a detailed analysis of the linguistic features of a corpus of fifty nurse-patient interactions involving experienced US nurses (USNs) and fifty-two involving internationally educated nurses (IENs) working in US hospitals. The interactions involve a single scenario in which a standardized patient (actors used for training and assessment) receives an initial assessment after hospital admission. The analysis distinguishes six discourse phases (opening, complaint, exam, counsel, and closing), and focuses on forty-two relevant linguistic and nonverbal features, subcategorized according to communicative association (i.e. characteristics of interaction, involvement, narrative, and stance) or descriptive category (fluency, prosody, and nonverbal behaviour). These analyses are supported by effectiveness ratings provided by the patients and assessors, and information provided by informants in semi-structured interviews. Staples’ framework draws particularly upon the quantitative register approach to discourse of Douglas Biber and the qualitative communicative styles approach of John J. Gumperz.
The findings demonstrate numerous ways in which the features of IEN discourse differs from that of the USN discourse, with many of these differences accounted for in relation to communicative style. Of particular importance is the emphasis on patient-centred care and therapeutic discourse in the US (and other western) healthcare systems, where nurse-patient power asymmetry is mitigated and the psychosocial needs of the patient are emphasized; in contrast, the IENs had been trained in provider-centred systems in which greater status is claimed by the medical professional. This leads to particular interactional moves that are characteristic of USN discourse but frequently absent from IEN discourse, such as those associated with rapport building, counselling, and addressing patient grief, and these result in differences in, for example, how advice is given and how interactions are brought to a close. Such differences are reflected in the frequency with which a wide range of lexico-grammatical features are used. Also briefly discussed are differences in the discourse that is produced by patients when interacting with the two nurse groups. Findings are amply illustrated with extracts of discourse, and interpretations of the data are supported by findings from semi-structured interviews with relevant informants.
Of particular interest is chapter 10, in which Staples focuses on the effectiveness of discourse produced by the two groups, presenting findings from patient satisfaction responses and interpersonal skills assessments, and correlating these with the linguistic and interactional features associated with each phase. Contrasts are made not only between the IENs and USNs, but also between low-scorers and high-scorers within each group. The effectiveness levels of the USNs proved significantly higher, and this is attributed to patient-centred communicative style; IENs with a communicative style approaching that of the USNs also rated more highly. The final chapter concludes with a number of well-supported recommendations for international healthcare training programmes.
This work, derived from the first corpus-based analysis of USN and IEN discourse, will be particularly valued by healthcare educators. Of additional methodological interest is that this study includes one of the few corpus-based analyses of fluency and prosody, and that the overall study represents a highly convincing application of the analytical frameworks.
