Running Head: DISCOURSE COMMUNITITES IN THE HOSPITAL SETTING
Discourse Communities in the Hospital Setting
Callie Hanssen & Crystal Carnes
South Dakota State University English 201
Nathan Serfling
1.
DISCOURSE COMMUNITIES IN THE HOSPITAL SETTING
Abstract
In society today, many career choices are offered, different organizations are formed, exclusive
athletic departments exist, and volunteer groups are shaped. All of these assortments contain
their own variant discourse communities. Within these discourse communities, literacy,
knowledge and technology, along with theories and models are what sets each group apart from
one another. Literacy is used to differentiate the jargon of nurses from that used outside the
hospital setting. Technology is used to assist nurses with their patient care. Knowledge is
needed to prevent medical errors. Last, theories and models are a key component for personal
values and guidelines for the nurse-patient interaction.
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Discourse Communities in the Hospital Setting
An abundant amount of sweat is trickling down the back of a first semester pre-nursing
student as she was thrown into a situation she was not prepared for. Is this really what nursing is
all about? Do I really want to spend my life in panic mode? These are some thoughts that had
arisen in her head. As she looked around, the words Emergency Department had caught her
attention. Doctors were spouting off medical terms she had never heard before. One particular
nurse had thrown a patient’s medical record in her clammy hands. The freshman was expected
to decipher the chart and carry out the proper treatment. This situation discussed previously is a
good example of the nursing discourse community. When distinguishing who is a member of the
nursing community, the first indicator is their name badge. Nurses are given credentials; these
include RN (Registered Nurse) or LPN (Licensed Practical Nurse). Out of all medical personnel,
nurses spend the most time with patients by verbal communication and physical assessments.
Discourse community is an important term to understand. Brought together by similar groupings
of people, discourse communities are structured by interaction through approved channels
(Porter, 2011). Health professionals are educated to cope with high pressured situations. As for
the freshman, pre-nursing college student, she has no prior experience with coping methods to
carry out proper procedures. Those who are not well versed in the nursing discourse
communities would find it difficult to understand the jargon used in hospital settings. Discourse
communities in each profession are unique. The nursing discourse community is important
because it differs drastically from others. Health care professionals experience large diversities;
these include cultural differences, language barriers, medical terminology and abbreviations,
along with computerized and paper documentations. Nursing discourse communities offer
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complex literacy, a background of medical knowledge and technology, along with different
theories and models used in the nurse setting.
To conquer nursing discourse communities, learning the literacy is key. Literacy in
nursing environments consists of verbal communication, non-verbal communication, and written
communication. Starting with verbal communication, nurses must be aware of language barriers,
the medical terminology and therapeutic techniques. Language barriers arise in clinical
situations forcing us to use critical thinking skills to overcome these barriers. When verbally
communicating with our patients we come across different dialects. Craven and Hirnle have
written that in these cases we must call for a translator that the hospital provides, to avoid using
family members, especially children (2009, p. 342). Nurses interact with a wide variety of
ethnicities. With different cultures, an expression can be interpreted differently from what
another culture might view it as.
Along with language, medical terms can also be barriers towards our patients and us as
nurses. Nurses are responsible for knowing medical terms to better communicate with doctors
and other nurses. If nurses are not aware of such terms, miscommunication and medical errors
can occur. Catalano writes that incidences of medical errors account for 44,000 deaths per year.
Seventy percent of these medical errors are due to communication (2009, p.133). Following this
further, when medical terms are used in nurse-patient communication, patients may not
understand what is being said. Nurses are responsible to follow up with the patient and assure all
terms were understood.
Last, therapeutic techniques are vital in communication. Some examples of therapeutic
techniques are: Offering self, using open-ended questions, restatement, and seeking clarification.
Therapeutic techniques engage the client in the conversation and allow them to clarify their
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thoughts and feelings. Each therapeutic technique is used in different situations depending on
the patient’s circumstances. According to Craven and Hirnle, “An open-ended question is one
that elicits more than a ‘yes’ or ‘no’ answer,” (2009, p. 337). Open-ended questions set up the
patient to expound on their thoughts. If a patient needs more time to think about his or her
response a ‘pregnant pause’ is used. A pregnant pause offers the patient more time and does not
rush his or her reply. Nurses should have a firm grasp on communication techniques as each
patient is different.
Non-verbal communication is equally important as verbal communication. Eye contact,
facial expressions, body language, and gestures define non-verbal communication. Silence is
one of the non-verbal therapeutic interventions. By waiting quietly and attentively, the nurse
allows the patient to reflect on the pervious conversation (Craven & Hirnle, 2009). Nonpharmacological measures take the patient’s mind astray from their diagnosis and are not ordered
by the physician. Massaging, a non-pharmacological measure, acts as a communication tool for
the nurse to offer his or her own interest in the patient.
Lastly, written communication is another component to nursing literacy. “A means to
document and convey information to others,” defines written communication (Craven & Hirnle,
p. 328). Paper documentation and charting are important sources of information. Nurses use
different writing formats while documenting. Two known formats used for charting and
documenting consist of SOAP and DAR. The acronym SOAP stands for, subjective (S),
objective (O), assessment (A), and plan (P). When dealing with one health problem the best
progress note to use is SOAP; the majority of health care members are familiar with this format
(Craven & Hirnle, p. 213). When completing the SOAP format, nurses being by writing out
SOAP, laterally, on a chart. Following the letter ‘S’ is data said directly by the patient or family
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members. The letter ‘O’ is followed by data observed by the nurse. The condition of your
patient will be documented after the letter ‘A’. Last, your plan of action is listed after the letter
‘P’. Many of the health care members use this format because SOAP is structured and easy to
locate information. On the other hand, DAR stands for data (D), action (A), and response (R).
Also known as the “focus system”, DAR entries can be written about an incident, progress, or an
evaluation of the patient’s response (Craven & Hirnle, p. 214). Like SOAP, DAR is also written
in lateral documentation. The widely used formats, SOAP and DAR, are organized for other
nurses to fully comprehend the data from each patient. Another important aspect of nursing
literacy is medical abbreviations; these are found in the specific formats listed above. The
majority of nurse documentation consists of abbreviations. Abbreviations are important when
reading nursing charts because they are frequently used to describe the condition of the patient.
For example, the abbreviation LOC stands for the patient’s level of consciousness. Medical
personnel use this shortened terminology as a way of communication as it is consistent
throughout all facilities. Not only is it important to understand the correct abbreviations but it is
also important to be aware of different machines used on patients.
By being thrown into a clinical experience like the one listed in the introduction is never
ideal. Knowing the types of machines used in the hospital setting is a key element during a
clinical. Common types of machines include portable vital sign machines, telemetry machines,
barcode scanners, and portable computer systems. Starting with portable vital sign machines,
vital signs are mechanically taken. Technology has changed nursing roles in such ways that vital
signs are seldom taken manually. Nowadays the majority of hospitals provide each unit with
transportable vital sign machines. These allow for accurate, quick, and precise readings. Vital
sign machines measure brachial blood pressure, respirations, pulse oximetery, and the patient’s
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heart rate. Wireless Medical Telemetry services (WMTS) also measure vital signs and important
health parameters (Federal Communications Commission, n.d.). Through WMTS patient’s data
is transported to a remote location, typically a nurse’s station, via radio waves. Portable
transmitters are worn on patients at all times. Four different receptors are usually attached to the
patient’s chest and are spaced at least 20 centimeters apart. If a patient has abnormal heart
patterns, a murmur, or has been discharged from surgery a cardiac heart monitor is used. In
order for hospitals to supply WMTS the machines must be registered with The American Society
for Healthcare Engineering of the American Hospital Association (ASHE/ANA) (Federal
Communications Commission, n.d.). To identify each patient barcodes are on every wristband to
prevent medical errors during a patients hospital stay. With one swipe of the barcode scanner, all
of the patient’s information shows up on the portable computer screen (General Data, n.d.).
Hospitals are moving away from paper charting by placing a computer in each hospital room or
having the nurses push mobile workstations around on carts. After an assessment, it is difficult
to remember and correctly record data (High-Tech Hospital of the Future, n.d.). Mobile
computers in the health care environments put more ease on the nurse and the patient. The nurse
now has access to document his or her findings in an appropriate manner, while the patient can
physically see the nurse document their results.
The technologies above have helped evolve literate practices over time. In the beginning
days of nursing, machines did not track every system of your body. The nurse was solely
responsible for assessing the patient to search for abnormal findings. Now that hospitals have an
abundant supply of technology, nurses now need to recognize when abnormal findings are
present on the machine. Medical personnel are responsible for undergoing educational training
to correctly operate these technologies.
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Not only are nurses responsible for undergoing educational training, but also are
responsible for the underlying education of diseases and medications. Having pathophysiology
and pharmacology as core classes in the nursing education, nurses are provided with a plethora
of knowledge to apply in the hospital setting. Pathophysiology refers to a cellular level.
According to Mosby’s Dictionary, “the study of the biologic and physical manifestations of
disease as they correlate with the underlying abnormalities and physiologic disturbances”
(p.1402), is the practical definition of pathophysiology. Class material provides us with a good
understanding of diseases and an appropriate amount of knowledge on how to properly treat each
individual patient due to distinctive diagnosis. Pharmacology, on the other hand, is “the study of
the preparation, properties, uses, and actions of drugs,” (p.1439). Medications are important to
understand as they can determine life or death for each patient. Medical errors are caused due to
lack of knowledge on the correct terminology of the medications (as many sound and are similar
in spelling) and each medication has different side effects. In nursing literacy these two terms
are vital to everyday rituals that nurses perform such as, tending for a patient and administering
prescription drugs.
Documenting the care that is performed when administering drugs and performing daily
cares due to the patient’s disease or diagnosis is critical. Computer documentation is set up in a
question answer format. This format eliminates repetitive entries and provides for consistent
language to be used. The literacy provided in documentation is exclusive to other discourse
communities. When documenting, the most important information is charted in a distinctive
manner. For example: J.H. has SOB r/t CVD AEB patient states “out of breath.” To translate
this nursing diagnosis for non-medical personnel the diagnosis says, J.H. (patient’s initials) has
shortness of breath related to Cardiovascular Disease, as evidence by patient states “out of
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breath.” With computer documentation several advantages to this system include automated date
and time, decreased time in charting, and allows for retrieval of specific problems. The main
advantage to computerized charting is that it can be accessed by multiple medical personnel at
once. Every system has its disadvantages as well. Security and confidentiality are a main
concern when it comes to computerized documentation. Confidentiality is disturbed when
nurses do not log out of their patients chart. Passwords are issued to all employees. Therefore
employees must not abuse this tool by sharing it with others. Also, using this password, other
than for work related purposes, is illegal. If these terms are violated unconsciously or
consciously legal action can be taken that could result in revocation of licensure. To avoid
tribulations classes are held for those employed by the hospital to correctly show how the
charting system is used.
Theories and models pertain to documentation, explain and direct nursing action by
providing care in an organized manner. Three most important models, out of six, include The
King Model of Goal Attainment, Neuman Health-Care Systems Model, and Roy Adaptation
Model. Nursing models should address or define four concepts: Client, Health, Environment,
and Nursing. First, The King Model is set up to create health care goals for the clients and direct
client care to meet these goals. The main focus of The King Model is the patient. The client
cannot meet the health care goals alone; he or she requires interaction with others. The
interaction with others ties into the environment by sharing common goals, their decisions,
power, and authority. Health is also important in The King Model, as a patient will reach his or
her highest level of functioning at their optimal health. To obtain optimal health clients must
avoid environmental stressors and set goals for themselves. The nurse comes into play by
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assisting the client with interventions to meet, evaluate, and fulfill their healthcare goals
(Catalano, 2009, pp.68-69).
Second, The Neuman Health-Care Systems Model focuses on the environment of the
individual. Clients will face internal and external environments through system boundaries.
External environmental factors include stressors, which are directly proportional to the internal
environment. As nurses we want to eliminate stressors to maintain a stable body environment.
Marital relationships, atmospheric temperatures, career expectations, and friendships cause
stressors. Health is not considered absolute. It is measured on a continuum while moving from
wellness to illness and back. By staying free of stressors the patient’s health will climb
positively. The nurse is responsible for identifying the stressors and supplying the client with
interventions. Identifying stressors that will disrupt future health or stressors that have already
disrupted health is a nurse’s main responsibility. Three different types of interventions are
associated with The Neuman Health-Care Systems Model. In the primary intervention the nurse
wants to prevent environmental stressors and teach the client how to deal with them. The
secondary interventions are treating symptoms that have already occurred due to stressors.
Tertiary care helps the client prepare to be discharged from the hospital and take actions on his
or her own (Catalano, 2009, pp. 73-74).
Third, The Roy Adaptation Model allows the client to use adaptation to reach his or her
highest level of functioning. Man is used to describe the human being in this model. A human
being is said to be a dynamic system with input and output that adapts to different stimuli by
displaying diverse behaviors. Input is known as the stimuli and output is identified as the
behaviors. The outline portion is most important when dealing with the Roy Adaptation Model
because it provides a baseline for the client. The baseline is found from a nurse performing an
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assessment. The level of the client’s health is not stable; it is defined on a continuum between
perfect health and illness. Health depends on a client’s ability to adapt to stimuli, such as, injury
or disease. The environment is synonymous with the idea of the stimuli. Clients are influenced
internally or externally and these factors manipulate the client’s behavior. Environment can be
placed into three different elements: Focal stimuli, contextual stimuli, and residual stimuli.
First, focal stimuli are the most important and occupy the client’s attention along with changing
the behavior. Second, contextual stimuli are what the client emerges from. For example, the
client emerges from general physical, social, and psychological environments. Third, residual
stimuli have an indirect effect on the client’s health. These stimuli are from the past such as
religious beliefs and personality characteristics. The nurse’s role is to first assess the client by
doing a two-step process. The primary assessment should determine the client’s behavior
(output). The secondary assessment should consist of finding out what types of stimuli are
jeopardizing the client’s health. After performing the assessment the nurse must then come up
with a diagnosis. Then once the diagnosis is completed, goals must be set and an evaluation
appointment is made to determine whether goals have been achieved. Adaptation is a continuous
process because stimuli never stop attacking our body (Catalano, 2009, pp. 65-66).
Gaining membership to any discourse community is difficult. When looking exclusively
at a nursing discourse community, with the jargon, computer programs, and documentation used,
we can see that acquiring membership will be more difficult. With proper education, training,
and experience it will be easier to obtain membership. Coming into a hospital setting with a
four-year baccalaureate degree or a two-year associate’s degree a newly graduated nursing
student will be well prepared. The education, especially pathophysiology and pharmacology, set
students up for success. Nurses also must go through many hours of training depending on the
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stance of the hospital. Types of training include, charting, glucose training, health care
machines, etc. Hospitals are always training and new technology is constantly arising.
Therefore medical personnel will never be done with training classes. If a person wants to gain
membership the only true way to achieve membership is through experience. Penrose and
Geisler (2011) emphasize this point well, “Helping students see themselves as insiders enables
them to engage in types of thinking that are denied them…” (p. 614). Through job shadowing
and clinical experience a person can get a feel of the nursing discourse community and what
being a part of it is all about. By this experience you will then be able to determine if this
discourse community is right for you.
Although experience is an important way to determine whether this discourse community
is suitable for themselves, literacy, knowledge and technology, along with theories and models
will finalize their decision. Literacy shapes the nursing discourse community by providing the
appropriate style of language in the hospital atmosphere. Without verbal, non-verbal, and
written communication nurses would not be able to understand language barriers, therapeutic
techniques, or the written communications. Knowledge and technology also shape discourse by
providing nurses with assistive devices in the communities. Nurses must be knowledgeable on
how to use these devices along with using critical thinking skills. Theories and models act as
guidance for nurse-client interaction. Their purpose serves to improve professional
communication and actions to satisfy the nursing regulations. Learning intricate literacy,
applying educational knowledge to bedside care and technical tools, and utilizing different
theories and models to each patient all compose the nursing discourse community.
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References
Catalano, J. T. (2009). Nursing Now! Today's Issues, Tomorrow's Trends (5th ed.).
Philadelphia, PA: F.A. Davis Company.
Craven, R., & Hirnle, C. (2009). Fundamentals of nursing: Human health and function (6th
ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
Federal Communications Commission. Wireless Medical Telemetry Service (WMTS). (n.d.).
Bureaus & Offices: Wireless Telecommunications. Retrieved from
http://www.fcc.gov/encyclopedia
General Data. Healthcare. (n.d.). Barcode patient Identification and patient Tracking Systems.
Retrieved from http://www.general-data.com/industry/healthcare/patient-identification
High-Tech Hospital of the Future? (n.d.). Technology. Retrieved from
http://abcnews.go.com/Technology/Cybershake
Mosby’s dictionary of medicine, nursing & health professions (2009). (8th ed.). Missouri: St.
Louis.
Penrose, A.M. and Geisler, C. (2011). Reading and writing without authority. In E. Wardle &
D. Downs (Eds.). Writing about writing: A college reader (pp. 602-617). Boston, MA:
Bedford/St. Martin’s.
Porter, J. E. (2011). Intertexuality and the discourse community. In E. Wardle & D. Downs
(Eds.). Writing about writing: A college reader (pp. 86-100). Boston, MA: Bedford/St.
Martin’s.