Talking About Patients: Nurses' Language Use During Hand-offs.

Abstract

Miscommunication during end of shift hand-offs between hospital nurses has been implicated as a source of errors in patient care, yet little research evaluates the structure of language during communication in an attempt to understand potential communication errors. Although the functions and meaning of hand-offs for nurses has previously been examined, there is little information about the current state of the structure and language of hand-offs. This research begins to fill that gap in by using genre analysis of transcripts of 43 end-of-shift hand-offs between nurses at four hospitals in the Midwestern United States. Two analytic techniques common in linguistics research were carried out: a move analysis to determine the structure of the hand-offs, and corpus analysis to identify the lexical and grammatical features used by nurses during hand-offs. In addition, two methods used for hand-offs (audio-taped and face-to-face) were compared. Findings from the analyses demonstrated that hand-offs were structured as (a) Introducing the Patient; (b) Relating the Shift's Events; (c) Looking Ahead; and (d) Wrapping Up. Further, analysis identified specific vocabulary and grammatical features upon which nurses rely as well as temporal components of nurses’ language. The comparison of hand-off methods supports earlier findings that audio-taped hand-offs take less time than face-to-face hand-offs, but also identified that audio-taped hand-offs contain significantly fewer indicators of non-literal and interactive communication than face-to-face hand-offs. Findings suggest that opportunities exist within the hand-off process to enhance patient safety in the areas of medication reconciliation, fall risk, pain management, and identification of goals and outcomes for patient care.