MULTIPLE SPOKEN AND WRITTEN CHANNELS OF COMMUNICATION: AN ETHNOGRAPHY OF A MEDICAL UNIT IN A GENERAL HOSPITAL (SPOKEN COMMUNICATION, WRITTEN COMMUNICATION, MEDICAL RECORDS).
Contributors: State University of New York at Buffalo.
Published: 1993
Number of pages: 297
Subjects: Speech Communication.; Health Sciences, Nursing.; Health Sciences, Health Care Management.
Description: This dissertation is an ethnographic study of spoken and written communication in an acute care hospital setting. Social communication theory, on which this dissertation is based, posits that the world we live in is created by communication. It suggests that institutions such as hospitals emerge from, or are constituted by, communication.

Communication is a multi-channel phenomenon which can be looked at across persons, time frameworks and contexts. Social communication theory suggests that communication is a continuous system and each moment or episode of communication is connected to others (Sigman, 1987). Examples in this study of structures that constitute and maintain hospital units as continuous phenomena include the nurses' intershift reports, physician rounds, and "on-call" help systems (e.g., clergy).

Health care personnel communicate information through speaking and writing. They make choices as to what is documented and where. Choices are also made as to what is communicated orally. These choices contribute to a document (the medical record) that is invariably incomplete.

A variety of methods were used for data collection, combining traditional field work methods (observation, informal interviews, field notes) with other techniques (document analysis, structured taped interviews, and analysis of audio-taped intershift reports).

The data show that patient concerns, mostly absent from the medical record, are documented to some degree by nurses in the nursing care plan or in the nurses' Kardex. One rationale nurses provide for needing a separate place for nursing documentation is the ongoing problem of monopolization of patient charts by physicians.

Physicians were observed to be selective in their use of charts. Physicians reported reading what other physicians wrote, and sometimes reading the notes of others based on the importance of individual non-physician care providers to the care of a particular patient. Physicians assumed that most care providers read physicians' chart notes, which the observational data confirm.

Physician rounds were shown to be a forum for house staff teams to engage in dialogue, question, challenge and learn from one another. The nurses' intershift report is akin to house staff rounds. However, the atmosphere for, and opportunity to engage in collegial sharing is not built into the system of the nurses' intershift reports.
Notes: Source: Dissertation Abstracts International, Volume: 54-02, Section: A, page: 0369.

Thesis (PH.D.)--STATE UNIVERSITY OF NEW YORK AT BUFFALO, 1993.

School code: 0656.