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.
Learning to 'become doctor' requires PhD candidates to undertake progressive public displays -material and social -of knowledge. Knowledge in doctoral pedagogy is primarily realised textually, with speaking and writing remaining as the primary assessment rubrics of progress and of the qualification. Participating textually begins, in a public sense, with the Confirmation of Candidature presentation/paper and culminates in a Viva Voce/dissertation. Drawing on linguistic ethnographic observations and analyses, this paper uses practice-based perspectives to examine a doctoral candidate practising to present knowledge publicly in a university research centre. The paper focuses on sociomaterial shifts in the trial run and final delivery of the two presentations examining how the candidate is initiated into new actions in response to these changes. Findings reveal how the candidate engages with collective understandings of the practice of presenting knowledge provided by feedback from her doctoral 'friends'. Learning a practice through practise highlights the importance of participating as learning and learning as participating. This is particularly so in a time of change for doctoral pedagogy, when honing a practice collectively is argued to be advantageous in a localised setting that recognises and fosters the benefits of participation.
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