|School of Linguistics and Applied Language Studies||
A study of communication based on real interactions in New Zealand workplaces
From 2000 - 2002 the Language in the Workplace team investigated nurse/patient interactions at a New Zealand hospital. The primary objective was to pilot a methodology suitable for collecting data on spoken interactions between a nurse and their interlocuors during different shifts in a given week. Another objective was to investigate the suitability of the methodology as one that could be used in a wide range of professional contexts (for example private homes and medical centres).
Two contrasting features of interaction feature here as foci for analysis, directives and humour.
It is possible to give a directive in a wide variety of linguistic ways. The most direct is to use an imperative form: eg.flex your arm. At the other end of the spectrum, in the least direct form the person addressed usually has to infer what the speaker wants. However, the specific context in which the nurse is talking often means her intention is quite obvious so that not much guesswork is involved:
Less direct forms are generally regarded as more polite. It is also widely accepted that, all other things being equal, the use of more direct forms indicates that people know each other well, or alternatively that one has the right to tell the other to do something eg. staff nurse to nurse aide. Between a nurse and a patient one might expect relatively polite forms, and similarly between a nurse and a doctor, but of course the context is always important. Between a nurse and a patient one might expect relatively polite forms, and similarly between a nurse and a doctor, but of course the context is always important. More polite forms are generally longer, and one would not want to take a lot of time in an emergency, nor even when things were very busy. Moreover, the precise power relationships between particular nurses and particular doctors are not predictable by any formula, because so many different variables may be relevant to the analysis (eg. experience, age, gender, personality, etc). In the analysis which follows, we illustrate the nurses' sociolinguistic skills in taking account of such factors in selecting from a wide range of forms to express directives appropriately in interaction with patients.
Focussing on nurse-patient interaction, among the most interesting findings was
In this preliminary study we identified just 20 directives in the 102 minutes of recorded transcribable interaction between nurses and patients. The small number is interesting since one might have expected many more instructions from nurses to patients in nearly two hours of talk. In fact we found that more than half the talk between nurse and patients was social talk, designed to establish good relations and make the patient feel comfortable and appreciated as an individual.
Directives can be expressed using one of three broadly different structures:
The majority (70%) of the directives used by the nurses in our data were imperative in structure: eg lift your arm, keep pressure on that. This surprised us initially, since imperatives are generally considered a rather authoritarian and “bossy” linguistic structure, and the overall impression of the nurse-patient interactions in our data was quite the opposite. The nurses seemed very polite, considerate and friendly.
When we looked more closely at the data, we discovered that every imperative was softened or attenuated in some way. Further analysis revealed that, in fact, every single directive in the data included at least one pragmatic softening strategy. Moreover, the nurses drew on a wide range of such strategies. In the next section we identify some of the linguistic devices nurses used to soften their directives.
Softening a directive: linguistic strategies
Nurses used a wide range of different kinds of linguistic strategies to soften their directives, including grammatical devices and lexical items. In the examples below, the softening devices are in italics. The unsoftened version of the directive is provided in brackets for comparison.
(ii) Pronoun choice
Most nurses will be unaware of their linguistic choices, yet the effect they have is very significant in terms of making patients feel comfortable and cared for. The very wide range of softening devices used in our small sample of interaction indicates considerable linguistic sophistication, as well as the nurses' sensitivity to the contextual factors relevant in their exchanges with patients.
The second area we have selected in order to illustrate the sociolinguistic skills developed by nurses is the way they use humour in their interactions. Humour serves many functions. It is yet another strategy which can be used to soften a directive, but humour also maintains and develops good relationships between people, and enables them to express feelings or views they might not get away with otherwise. Friendly humour: to help patients feel more relaxed.
One important function of humour in the interactions between nurses and patients was to reduce the stress of a potentially uncomfortable situation, and to help their patients to feel more relaxed. There are many examples of this in our data; here we discuss just one.
In excerpt 1 Sophie, a patient, expresses some anxiety about the anticipated removal of a cannula (a small device giving access to a vein). Earlier in the day, Tara, the nurse, had removed a large drain from a wound which had been a painful and distressing experience for Sophie.
Tara responds to Sophie's worry by reassuring her and then introduces the topic of Sophie's leaving hospital soon. Sophie tells Tara that she will stay with her parents initially, since her flat is being decorated. Excerpt 2 illustrates the way in which Tara skilfully distracts Sophie from the unpleasant medical procedure she is undergoing.
Sophie: so I’m staying with mum and dad
Subversive humour: to soften a criticism
Humour is often used to soften negative messages (Holmes 1999). In many workplaces where we have observed, humour was used to soften criticism, for instance. It is particularly useful when an individual wants to express a critical comment to someone whom they don't wish to offend, such as a close colleague or someone in a position of power, for instance. We found a number of examples of humour used this way by the nurses in our sample.
One example occurred in a context where two staff nurses had been waiting for some time for the doctor to arrive. They were getting very irritated by the fact that he was so late coming up to the ward, as excerpt 3 illustrates.
Subversive humour provides a "socially acceptable cover" for criticisms of individuals, as well as for challenges of other sorts. Humour here allows the nurses to criticise the doctor in a non-threatening and acceptable way, which in turn relieves the tension which has been building up because of his lateness.
Nurses use humour regularly and constructively in their work. There are many examples in the data, with humour serving many different functions. In this section we have briefly illustrated just two contrasting functions: firstly the use of humour to relax a patient and assist the nurse in achieving her work objectives more efficiently; secondly the use of humour to relieve tension and thus maintain good workplace relationships between colleagues.