Graduation Year

2018

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

World Languages

Major Professor

Camilla Vasquez, Ph.D.

Committee Member

Amy Thompson, Ph.D.

Committee Member

Nicole Tracy-Ventura, Ph.D.

Committee Member

Wei Zhu, Ph.D.

Keywords

Nursing handover, communicatively effective nursing handoff, communication strategies, discourse pragmatic features

Abstract

A new realm of discourse research has started examining medical interactions in the crowded space – hospitals (Iedema, 2007). Beyond clinical settings and dyadic doctor-patient interactions, scholars have begun investigating doctors’ interactions in various hospital settings including Emergency Rooms and hospitals’ wards (e.g., Eggins & Slade, 2012; Slade & Eggins, 2016; Slade et al., 2015). Other investigations have expanded this scope of discourse research to include other health professionals, such as nurses (e.g., Staples, 2015). Drawing on discourse analytic approaches (Critical Discourse Analysis, Halliday’s Systemic Functional Grammar, and Interactional Sociolinguistics), this study examined nurse-to-nurse handoff interactions in two hospitals in Saudi Arabia. Nursing handoff – the transfer of patient information, professional responsibility, and accountability between departing and incoming nursing teams (Manser et al., 2010; Riesenberg et al., 2010; Slade & Eggins, 2016; Wood et al., 2014) – is a critical communicative practice which ensures the continuity and quality of care provided to hospitalized patients. The aim of this study was to provide detailed analyses of the language used in this type of nursing discourse and its impact on the quality of handoffs. The data included 80 nursing handoff interactions, which were observed and audio-recorded in 7 different wards at two sectors (National Guard Hospital and King Fahad General Hospital) in Saudi Arabia including: Intensive Care Units, General-Adult, General- Pediatric, Oncology-Pediatric, Oncology-Palliative, ENT, Urology and Surgical wards. The nurse participants come from various cultural backgrounds including Philippines, Indonesia, India, Malaysia, Morocco, South Africa, Egypt, Jordan, and Saudi Arabia. The analyses provided a detailed description of this type of nursing discourse including the discourse

pragmatic features (i.e., linguistic, interactional, and interpersonal features) which nurses use while delivering and receiving patient information. In addition, the findings provide insights into the various discourse features that contributed either positively (e.g., using discourse markers, presenting complete thoughts, presenting sufficient detailed patient information) or negatively (e.g., producing questions instead of statements, shifting verb tenses, focusing on one patient issue as opposed to providing detailed patient information report) to the nursing handoff practices in this setting. The findings also point to the vital role that head nurses play in this nursing discourse and its impact on enhancing the quality of nursing handoffs.

Additionally, a six-stage nursing handoff model was developed from the data, which could be used for nursing training in the National Guard Hospital and its branches in Saudi Arabia.

Finally, the findings provide further support for Eggins and Slade’s (2012) claim that communicatively effective handovers are achieved interactionally and with the collaboration of both departing and incoming teams. Furthermore, the use of standardized protocols (like SBAR) alone proved to be insufficient in guaranteeing effective nursing handoff.

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