"Transition in and between Discourse Communities: One Nurse's Struggle"

Terrie Cole

Terri Cole graduated from Rhode Island College in 2012 with a bachelor’s degree in English literature and a minor in creative writing. She is 26 years old and currently teaches English at an all girls’ middle school in South Korea. Her academic interests are in composition and rhetoric studies, education and ESL. Her future plans are to apply to graduate school after teaching and traveling.

Contents

Introduction</p

Methods

A Framework for Studying

Writing in Nursing

Change of Shift and Genre

Results

Discussion

Conclusion

Works Cited

Writing in Nursing

Nurses have endless amounts of information to learn and tasks to perform. They provide patient care, which in itself consists of administering medication, educating patients and families, bathing, changing, helping patients to the bathroom, restraining patients, calming down family members, and the list continues. Nurses also document patient care, which in comparison to the physical tasks they must complete would appear to be the most simple, hopefully (for the nurse) the easiest part of his or her day.

However, Lena reveals that: “We all [nurses] rely on writing the moment we walk in the door.” In order for nurses and any medical staff to provide constructive care, tasks and procedures must be documented. Nurses record patient care and patient outcomes in order to inform the subsequent nurse or doctor about patient history and treatment plans. Writing, therefore, is crucial in nursing—for patient safety, but also for the hospital accountable for their staff conducting the appropriate measures.

Nurse documentation includes many forms or genres: Care Plans, Admission History, Continuity of Care Forms, Care Documentation Form, Progress Notes, Change-of-Shift Report, Pre-Procedure Check Lists, and other genres that are specific to the nursing unit. Lena, for example, works on the Oncology Unit, so the Chemotherapy Order and the Chemo Medication Form can be added to this list of nursing genres articulated above. Furthermore, nurses are continually shifting between their nursing and documentation roles, and documentation roles are also shifting from the computerized to handwritten.

To discuss in detail all of the effects technology has on the nursing community would go beyond the scope of this study. However, it is necessary to discuss considering the ways in which the emergence of technology has shaped and continues to shape communication and documentation in nursing. The use of technology as the major component of literacy practices in nursing is a fairly recent development in hospitals. The Obama administration recently instituted a mandate for all hospitals to use electronic medical records in order to implement what they call “Meaningful Use Data” and “Pay for Performance” strategies and to invoke reform in hospitals. The Sherwood Hospital, where Lena works, has begun this implementation by use of portable computers which nurses use to document patient care. The portable computer is supposed to be a tool that decreases documentation time, uses funding more productively, and ultimately reduces error. The software is designed in an orderly and standardized structure so that the nurse must complete one priority task in order to proceed to the next. The electronic medical records are used in almost every literacy practice nurses engage in, with the exception of Patient Care Plans, Shift Reports, and Continuity and Care Plans, each of which combines electronic, written, and even verbal modes of communication. By using electronic medical records, Sherwood Hospital and outside political institutions hope to account for the accuracy of measures while providing easier access for data extraction.

Technology affects not just the way documentation is carried out in nursing but also the ways in which nurses negotiate social status within the community. Cook-Gumperz and Hanna (1997) found “the social status of nurses in the hospital hierarchy increased when they started using bedside computer terminals to chart patients’ conditions and accessing database tools for patient assessment” (p. 318). Another scholar, Beaufort (2000), notes:

Turning to more large-scale effects of recent writing practices in workplace settings, one study in particular exemplifies the interface of technologies, writing practices, and social structures in the workplace. Nurses’ use of bedside computers to chart patients’ conditions and access databases for diagnostic purposes (Cook-Gumperz & Hanna, 1997) both depersonalized the writing for the nurses and raised the visibility of the nurses’ observations to the rest of the medical staff. (p. 225)

In sum, technological tools in nursing can result in a lack of authority in documentation practices. This can create an additional level of struggle for neophytes like Lena in a nursing workplace community.