Nurse Practitioners and the Performance of Professional Competency: Accomplishing Patient-centered Care (Communicating in Professions and Organizations)

This book examines the interactional practices of nurse practitioners (NPs) and the delivery of health care in the US. The author takes a discourse analytic approach, examining the linguistic resources that NPs employ in their interactions with patients. These linguistic features are connected to the concept of professional competency with specific focus on the enactment of the patient-centered approach. Analytic focus is placed on how NPs address organizational responsibilities during medical visits with patients, the form and function of patient education, the use of indirect speech, and the role that small talk plays in health care encounters. The book explores the understudied professional field of nurse practitioners and examines their linguistic practices with an eye on crossing disciplinary boundaries, integrating research from linguistics, discourse analysis and health communication. It will appeal to those interested in medical discourse analysis and health communication, as well as applied linguistics scholars. -- Back cover Preface 6 Acknowledgments 8 Contents 9 List of Transcription Conventions 10 Chapter 1: Introduction 11 1 Introduction 11 2 Nurse Practitioners: A Growing Presence in US Health Care 12 3 Nurse Practitioners: Prior Research 14 3.1 Nurse Practitioner–Patient Interactions 14 3.2 Nurse Practitioners, Patient Satisfaction, and Positive Health Outcomes 16 4 What Is Professional Competency? 19 4.1 Competency and Patient Satisfaction 20 4.2 Competency and Positive Health Outcomes 21 4.3 Communication, Competency, and Medical Accreditation Boards 22 5 Data for the Book 24 5.1 NPs in This Study 25 5.1.1 June 25 5.1.2 Julie 26 5.1.3 Karen, Laura, and Sarah 27 5.2 Transcription Information 28 6 Organization of the Book 28 7 Conclusion 30 References 31 Chapter 2: Frontstage/Backstage: Attending to Organizational Responsibilities 36 1 Introduction 37 2 Frontstage/Backstage in Professional Discourse 37 2.1 EMRs and the Medical ‘Checklist’ 40 2.2 Coordinating Care 41 3 Enacting Organizational Responsibilities 43 3.1 Attending to the Checklist 44 3.1.1 Good, and Uh, Any Heartburn? 44 3.1.2 But Was He a Smoker? 47 3.2 Coordinating Care 51 3.2.1 We Have the Endocrinologist/Let’s Bring a Dietician 51 3.2.2 That’s What Kim Said 54 3.2.3 We Can Do That Ahead of Time 55 3.2.4 The Nurse Can Always Page Me 56 4 Conclusion 57 References 59 Chapter 3: Need to Know: Patient Education and Epistemic Responsibility 62 1 Introduction 63 2 Knowledge and Information Sharing in Medical Visits 63 2.1 Features of Information Sharing 65 2.2 Dimensions of Knowledge 66 2.2.1 Dimensions of Knowledge, Authority, and Accountability in Medical Visits 68 3 Prioritizing Patient’s Primacy over Assessing Prior Access 70 3.1 It’s in Your Best Interest to Get Out of the Big Numbers 71 3.2 How Does That Happen in Just Two Years? 75 3.3 That’s Bread, Pasta Sweets That’s Carbs 78 3.4 I Don’t Tell Too Many People This 80 4 Conclusion 83 References 85 Chapter 4: Treading Lightly: Indirect Speech in Medical Directives 87 1 Introduction 87 2 Defining Indirect Speech/Indirectness 88 2.1 Forms of Indirectness 90 2.2 Explanations for Indirectness 91 2.3 Indirectness in Medical Visits 91 3 Medical Advice, Critiques, and Indirect Speech 92 3.1 Concentrate Your Efforts 93 3.2 Buy It over the Counter 94 3.3 Every Now and Then You Have to Go See a Urologist 96 3.4 A Short Spike Every Now and Then Is Okay 100 3.5 A Lot of People Do It This Way 103 4 Conclusion 105 References 107 Chapter 5: Caring as Competent: Small Talk in Medical Visits 109 1 Introduction 109 2 Defining Small Talk 110 2.1 Small Talk in Medical Visits 113 3 Small Talk Across the Span of the Visit 116 3.1 Are You All Ready for the Holidays? 117 3.2 They Said I Go Next to See the Boss 119 3.3 You Exercise Every Day? 121 3.4 Don’t Go to the Grocery Store 123 4 Conclusion 125 References 127 Chapter 6: Conclusion 129 1 Introduction 129 2 Bringing It All Together 130 3 A Constellation of Linguistic Resources 132 4 Future Directions 135 5 Conclusion 136 References 137 Index 138 Front Matter ....Pages i-xi Introduction (Staci Defibaugh)....Pages 1-25 Frontstage/Backstage: Attending to Organizational Responsibilities (Staci Defibaugh)....Pages 27-52 Need to Know: Patient Education and Epistemic Responsibility (Staci Defibaugh)....Pages 53-77 Treading Lightly: Indirect Speech in Medical Directives (Staci Defibaugh)....Pages 79-100 Caring as Competent: Small Talk in Medical Visits (Staci Defibaugh)....Pages 101-120 Conclusion (Staci Defibaugh)....Pages 121-129 Back Matter ....Pages 131-133