Search

For patients, hospital emergency departments (EDs) are unfamiliar, institutional contexts involving high-stakes communication in heightened emotional circumstances. This study examines laughter, as one expression of emotion, in an existing 649,631-word corpus of naturally occurring clinician-patient interactions recorded in five Australian hospitals. A mixed methods approach revealed (1) the spread, frequency and producers of laughter, and (2) the functions of laughter in unfolding interactional contexts. First, a corpus analysis showed that laughter in the ED was most frequently produced by nurses and patients, but relatively infrequently by doctors. Secondly, two case studies comprising all the interactions of two patients for the whole duration of their ED visits were analysed in detail to explore the individuals’ contrasting patterns of laughter. The analysis revealed how laughter can be a cue to the affective dynamics of patient-clinician interactions about serious matters, for example, signalling difficult topics and managing anxiety in the ED context. Laughter, and any related humour, can indicate the achievement of mutuality, which is considered a cornerstone of genuine shared decision-making and patient participation in their own care. Therefore, the findings suggest that a sensitive responsiveness to patient-initiated laughter, and any associated humour, may promote patient-centred relationships in clinical interactions.

Aims: The research explores (a) nurses’ views of the change to mandatory bedside handovers, and (b) these nurses’ perceptions of their skills in managing this new practice in an Australian hospital. Background: In Australia, nursing bedside handovers are now considered essential in many hospitals, although most nurses received minimal training at the time this policy was instituted. This research establishes a unique quantitative tool to investigate nurses’ views of, and self‐reported actions related to, bedside handovers. Method: Prior to the implementation of mandatory bedside handovers in a hospital in Canberra, Australia, nurses in two wards (n = 66) were recruited to complete the new Bedside Handover Attitudes and Behaviours (BHAB) questionnaire. Results: Most nurses strongly value bedside handovers and have confidence in their ability to lead this clinical practice. Conclusions: Researchers identified a high level of alignment between the nurses’ acceptance of bedside handovers and nurses’ self‐reported actions in conducting this communication process. Implications for Nursing Management: Future research should explore the links between nurses’ views of, and skills in, the management of bedside handovers, as well as the effects of professional training for this practice. Furthermore, the BHAB questionnaire may be employed in different nursing contexts in future research.

Background: This study investigates clinicians’ views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong. Methods: Researchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs. Results: The clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians’ engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills. Conclusions: These communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the pr