Effective communication and interpersonal skills have long been recognized as fundamental to the delivery of quality health care. However, there is mounting evidence that the pressures of communication in high stress work areas such as hospital emergency departments (EDs) present particular challenges to the delivery of quality care. A recent report on incident management in the Australian health care system (NSW Health, 2005a) cites the main cause of critical incidents (that is, adverse events such as an incorrect procedure leading to patient harm), as being poor and inadequate communication between clinicians and patients. This article presents research that describes and analyses spoken interactions between health care practitioners and patients in one ED of a large, public teaching hospital in Sydney, Australia. The research aimed to address the challenges and critical incidents caused by breakdowns in communication that occur between health practitioners and patients and by refining and extending knowledge of discourse structures, to identify ways in which health care practitioners can enhance their communicative practices thereby improving the quality of the patient journey through the ED. The research used a qualitative ethnographic approach combined with discourse analysis of audio-recorded interactions. Some key findings from the analysis of data are outlined including how the absence of information about processes, the pressure of time within the ED, divergent goals of clinicians and patients, the delivery of diagnoses and professional roles impact on patient experiences. Finally, the article presents an in-depth linguistic analysis on interpersonal and experiential patterns in the discursive practices of patients, nurses and doctors.
The purpose of this article is to provide insights into the processes of public discourse and how information can be reformulated for public consumption. The article draws on data from readability research of public information documents conducted in Australia. Public information documents need to be understood by members of the public and a lexicogrammatical analysis, centred on a Theme and Rheme analysis, provides a platform through which readability, or a text’s coherence, can be further examined. The readability data combined with text analyses demonstrate readers’ preferences for clearer Theme structures and coherent development of information within the Rheme. The analysis highlights the functional differences between a text-section judged as difficult-to-read and a text-section preferred by the reader-participants, providing insights into the requirements for achieving clearer public discourse.
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