Communication and Professional Relationships in Healthcare Practice; Sally Candlin; Peter Roger

Sally Candlin [+–]

Macquarie University

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Sally Candlin, in her position of Honorary Senior Research Fellow in the Department of Linguistics at Macquarie University, taught for a number of years in the Masters program in Communication in Professions and Organisations and supervises the research of postgraduate students. She is the author of Therapeutic Communication: A Lifespan Approach (Pearson Education, 2008). She has taught in nursing and health programs, at both undergraduate and postgraduate levels at the University of Technology, Sydney, The Hong Kong Polytechnic University, and the University of Western Sydney. She is a Registered Nurse, Registered Midwife and a Health Visitor.

Peter Roger [+–]

Macquarie University

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Peter Roger is an Associate Professor in Linguistics at Macquarie University. A medical graduate from the University of Sydney, he worked as a medical practitioner for several years before going on to complete a PhD in communication sciences and disorders.
His research interests include communication in healthcare contexts, and individual differences in second language acquisition. He is co-author (with Sally Candlin) of Communication and Professional Relationships in Healthcare Practice (Equinox,
2013).

Communication and Professional Relationships in Healthcare Practice focuses on the crucial role that spoken interactions play in shaping relationships in contemporary healthcare practice. The authors apply theoretical concepts of communication to the workplace of healthcare, drawing upon scenarios based in the settings of clinical experience. The book presents a range of interactions (including consultations, team meetings, dialogues and casual conversations) between health professionals, their colleagues and their clients or patients in a variety of settings. Drawing on the latest research in applied linguistics and professional communication, the authors introduce readers to a number of approaches that can be used to analyse these interactions. Using these techniques, readers will discover exactly how central themes of healthcare practice (including trust, empathy, expertise and breaking bad news) are constructed through the communicative choices that participants make in these interactions.

Designed specifically for medical, nursing and allied health practitioners with an interest in communication, this book makes the techniques of discourse analysis accessible and provides ample opportunities for individual practitioners to apply this knowledge to their own professional contexts.

Prelims

Foreword [+–]

Sally Candlin,Peter Roger

Macquarie University

Peter Roger is Senior Lecturer in Linguistics at Macquarie University. His teaching spans several Master’s degree programs, including Applied Linguistics, Communication in Professions and Organisations, and Speech Pathology. He studied Medicine at the University of Sydney, and after graduating worked as a medical practitioner for several years before going on to complete a Doctor of Philosophy degree in communication sciences and disorders. He has published in a variety of journals, including Journal of Neurology, Brain Injury, Aphasiology, Neuroradiology, Asia Pacific Journal of Speech, Language and Hearing, and International Journal of Speech-Language Pathology.

Communication and Professional Relationships in Healthcare Practice focuses on the crucial role that spoken interactions play in shaping relationships in contemporary healthcare practice. The authors apply theoretical concepts of communication to the workplace of healthcare, drawing upon scenarios based in the settings of clinical experience. The book presents a range of interactions (including consultations, team meetings, dialogues and casual conversations) between health professionals, their colleagues and their clients or patients in a variety of settings. Drawing on the latest research in applied linguistics and professional communication, the authors introduce readers to a number of approaches that can be used to analyse these interactions. Using these techniques, readers will discover exactly how central themes of healthcare practice (including trust, empathy, expertise and breaking bad news) are constructed through the communicative choices that participants make in these interactions. Designed specifically for medical, nursing and allied health practitioners with an interest in communication, this book makes the techniques of discourse analysis accessible and provides ample opportunities for individual practitioners to apply this knowledge to their own professional contexts.

Acknowledgements [+–]

Sally Candlin

Macquarie University

About the Authors [+–]

Sally Candlin

Macquarie University

Transcription Conventions [+–]

Sally Candlin

Macquarie University

Glossary of Terms [+–]

Sally Candlin

Macquarie University

Introduction

Introduction to the Book [+–] 1-3

Sally Candlin,Peter Roger

Macquarie University

1. A Framework for the Study of Interactions in Healthcare Settings

1.1 Introductory discussion of key concepts 1.2 An approach to understanding the complexity of the communication process 1.3 The World of Communication model 1.4 Applying your learning to practice situations 1.5 Reﬂection and problem solving 1.6 Commentary 1.7 Discussion: issues to consider in the application of discourse concepts 1.8 Summary [+–] 5-18

Sally Candlin,Peter Roger

Macquarie University

The present chapter presents some theoretical models of communication the complexities of the communication process, reﬂecting on the application of these models to professional practices. The TSF approach, the role of independent learning and exploration as a means of enhancing learning have been briefly discussed.

2. Managing the Interaction

2.1 Introduction 2.2 Application of theory to professional discourse practice 2.3 Conversation analysis: a theory to give explanatory value to the organisation of discourse 2.4 Summary [+–] 19-38

Sally Candlin,Peter Roger

Macquarie University

The chapter explores the contribution that conversation analysis (CA) makes to our understanding of using discourse to achieve our goals. In this respect it examines the interactions between nurses and patients at various sites of engagement. The idea of an increasing ‘discourse experience’ raises the question of how persons who engage with the health community for the ﬁrst time come to know what these ‘rules’ are, and how they contribute to the smooth running of the system of the healthcare institution, and what the unwritten rules are for what is permissible or impermissible in health discourse. Considering the complexities of the discourse of the interlocutors and exploring the rule-governed nature of the interactions, the chapter has also analysed the discourse resources.

3. Common Purposes or Cross Purposes?

3.1 Introduction 3.2 Interactive frames and knowledge schemas 3.3 Frames and footings illustrated 3.4 Trust 3.5 Summary [+–] 39-52

Sally Candlin,Peter Roger

Macquarie University

The chapter highlights the fact that both knowledge and expectations play a key role in communication in healthcare settings. . Framing such knowledge and expectations turns out to be very relevant when exploring interactions between members of a team who have worked together for a long time or professionals who are working together for the first time. Footing provides a means of describing the particular alignment adopted by one participant at any given moment with respect to the other participants. Another concept grounded in expectations about another person’s behaviour is trust. Trust is considered here just one example of the way in which trust is built up or eroded through interactional choices of participants.

4. Respecting Feelings and Perspectives

4.1 Introduction 4.2 Empathy: What is it and how is it conveyed? 4.3 Empathy in context 4.4 Face and facework 4.5 Summary [+–] 53-65

Sally Candlin,Peter Roger

Macquarie University

This chapter focuses on the ways in which people demonstrate understanding and respect for the feelings and perspectives of others. The way empathy is displayed in discourse and how this varies according to the larger context in which an interaction is taking place, is further being discussed. Also,the linguistic concepts of face and facework are introduced.

5. Polite, Persuasive or Pushy?

5.1 Introduction 5.2 Submissive, assertive and aggressive communication behaviours 5.3 Politeness: solidarity vs deference 5.4 Assertion and aggression through a linguistic lens 5.5 Persuasion 5.6 Convincing or coercive (persuasive or pushy)? 5.7 Summary [+–] 66-75

Sally Candlin,Peter Roger

Macquarie University

This chapter explores the ways in which concepts such as assertiveness and aggression can be understood from a linguistic point of view. Also, the way in which communication in professional contexts involves the concurrent need to attend to ‘face wants’ through the performance of ‘facework’ throughout the interaction, is further analyzed. It highlights the fact that communication is much more than simply exchanging information.

6. Projecting an Identity to Others

6.1 Introduction: impression management 6.2 Impression management 6.3 Professional discourse and interdiscursivity 6.4 Summary [+–] 79-92

Sally Candlin,Peter Roger

Macquarie University

This chapter presents the way in which speakers project an impression (intentionally or not) toothers during the course of an interaction. Moreover, it analyzes the ways in which participants might seek to manage the impression of themselves that they put across. Contextualisation cues provide a way of ‘signalling’ to another person the way in which a particular utterance should be interpreted; however, such cues often rely on shared cultural assumptions, and their signiﬁcance can therefore be missed (or misunderstood) in situations where people do not share the same underlying assumptions and expectations. Finally, the many levels at which discourse can be deﬁned and analysed are considered and examined.

7. High Stakes Interactions

7.1 Introduction 7.2 Discourse within the crucial site of health assessment 7.3 ‘Interviewing’ and ‘just talking’ 7.4 The use of metaphor 7.5 Summary [+–] 93-106

Sally Candlin,Peter Roger

Macquarie University

This chapter shows that at a given site of engagement, a high level of communicative skills become necessary for health professionals if they are to determine their discourse and professional goals: identifying health needs through the elicitation of often sensitive information, and in turn imparting information that is understood, so that the end result is the patient’s necessary behaviour change to improve health. thus, health goals will be mutually identiﬁed and agreed.

8. Challenging Situations, Challenging Discourses

8.1 Introduction 8.2 Issues arising in the delivery of news 8.3 Some discourse strategies used when delivering news 8.4 Strategies used in the delivering of bad news 8.5 Discourse strategies used in the structuring of news delivery 8.6 Summary [+–] 107-127

Sally Candlin,Peter Roger

Macquarie University

This chapter discussesthe complexities involved in delivering bad news, and have found that in most instances the disclosure of bad news does not ‘just happen’. The discourse is interactionally structured and strategic to ensure that the desired outcomes in difﬁcult situations are achieved. The difﬁculties confronted by the deliverer of bad news are highlighted when these outcomes have not been achieved, exempliﬁed in a situation where the delivery is stalled.

9. The Expert Practitioner: Professional Expertise and Communicative Expertise

9.1 Introduction 9.2 Developing expertise 9.3 Strategies for developing coherence in the discourse 9.4 Comparing the discourse of the expert practitioner with that of the novice practitioner 9.5 Summary Appendix 9.1 [+–] 128-142

Sally Candlin,Peter Roger

Macquarie University

This chapter considers the concept of expert discourse practice and suggests that discourse coherence is a criterion indicative of the expert discourse practitioner. Moreover, practitioners in the healthcare workplace whose expertise is revealed through their discourse are not necessarily expert clinical practitioners. In the same way, practitioners whose clinical skills demonstrate expertise may not necessarily display expert discourse skills. Experts in one situation are not necessarily experts in other situations.

10. Communication in Healthcare Teams

10.1 Introduction 10.2 Community of practice 10.3 Summary [+–] 143-157

Sally Candlin,Peter Roger

Macquarie University

This chapter refers to the New World Order, drawing on the concept of the community of practice. It explores the the structure of a community of practice through an example of a multidisciplinary team working in an aged care setting. The complexities associated with the workings of such a team are further analyzed and the role of discourse in the achievement of social and professional goals is emphasized.

11. Healthcare Teams: Leadership, Power and Ethical Dilemmas

11.1 Introduction 11.2 Leadership 11.3 Power 11.4 Ethical dilemmas 11.5 Summary [+–] 158-174

Sally Candlin,Peter Roger

Macquarie University

This chapter examines some of the ways that contrasting styles of leadership can be enacted from a discourse perspective. It considers ways in which different types of power are expressed through discourse and analyzes the process of consensus building, an important process in many areas of team-based healthcare practice.

12. Ways Forward: Applying Theory to your Practice

12.1 Introduction 12.2 Exploring relevance 12.3 Discourse and social theory 12.4 Developing frameworks 12.5 Summary [+–] 175-185

Sally Candlin,Peter Roger

Macquarie University

This chapter draws on two related concepts: motivational relevance and practical relevance, in order to enrich the social and professional practice of healthcare through communicating effectively with others.

End Matter

References [+–] 187-194

Sally Candlin

Macquarie University

Index of Authors [+–] 195-196

Sally Candlin

Macquarie University

Index of Subjects [+–] 197-202

Sally Candlin

Macquarie University

Reviews

This book is a must for all levels of healthcare staff. No one in the profession is exempt from this. Staff must take ownership and in order to be effective in communication, this book is key.
Nursing Times.net/http://www.nursingtimes.net/opinion/book-club/book (accessed 07/10/2014)

Refreshingly, the book addresses communication not only in interactions between health professionals and patients, but amongst team members and between health professionals in an array of communicatively challenging real world contexts. It brings home to the reader the complexity of communication in healthcare, and it offers practitioners many tools for reflecting on their own and others’ communicative practices, and for enhancing their professional interactions. Dr Catherine O’Grady, Applied linguist and teacher of health communication

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Communication and Professional Relationships in Healthcare Practice

Sally Candlin [+–]

Macquarie University

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Peter Roger [+–]

Macquarie University

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