The dynamics of nurse-patient interaction : a comparison of spoken interaction with older and younger patients

Lunan, Michaela and Culpeper, Jonathan and Walshe, Catherine (2019) The dynamics of nurse-patient interaction : a comparison of spoken interaction with older and younger patients. PhD thesis, Lancaster University.

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Abstract

The NHS is currently supporting a patient-centred approach to healthcare, but have identified a number of communication issues. Campaigns within the UK have highlighted that even basic steps of communication are lacking and can lead to patients feeling disempowered and dehumanised. For example, it is commonly assumed or indeed claimed that nurses use patronising language with older patients (e.g. Brown & Draper, 2003), but a lack of empirical data comparing the language used with younger and older patients and a need for studies to acknowledge the patients’ perceptions (Shattell, 2004) challenge this supposition. This study discovers the nature of social interactions between nurses and their patients in two GP practices in the Northwest of England. It provides an in-depth account through the use of rich primary data sets. One is a corpus of 100 audio interactions recorded with 10 nurses. Each nurse was recorded with 5 older patients and 5 younger patients in order to draw comparisons in language use. The other consists of 97 interviews reporting nurse and patient perceptions, and thereby allowing us to fill a gap in previous research. Taking an interpersonal pragmatic approach, deploying concepts such as politeness (e.g. Leech 2014), humour (Norrick, 2009), face and mitigation (Brown & Levinson, 1987), the thesis reveals, amongst other things, the differences between how nurses talk to younger patients and older patients, considers how the patients perceive the nurses’ discourse, and examines individual interpersonal practices. An analysis of the openings and closings of the interaction in the first analysis chapter led to the identification of the typical structures of these phases, which differ in form to that of doctor-patient consultations. Greetings, which are typically seen as adjacency pairs (Schegloff & Sacks, 1973), were often not responded to and small talk or phatic communication was usually limited to a small number of turns. The second analysis chapter focusses on requests in the interaction, as patronising talk has been purported to occur largely in requests by nurses (Herman & Williams, 2009a). Analysis of these turns found that there was very little evidence of patronising behaviour, especially when the perceptions of the patients were taken into account. This could be due to a more positive view of the older patients that attend GP surgeries as they may be more independent than patients in care homes. The final analysis chapter shows that patients and nurses both use a large amount of humour but do not always respond to humour in the same way.