"Transition in and between Discourse Communities: One Nurse's Struggle"
Terrie ColeTerri 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. ContentsIntroduction</p |
Change of Shift and Genre of the SBARPSherwood Hospital’s change-of-shift report is known as the SBARP-Verbal Communication for Transfer of Care. Essentially, a change-of-shift report (or CoSR) is “information exchange” (Staggers and Jennings, 2009, p. 393) between caregivers; the information concerns the patient’s care and history and the exchange occurs between the nurse entering a shift and the nurse leaving a shift. Generally, this exchange is conducted by the nurse reading what he/she wrote on the CoSR and verbalizing what is written to the nurse entering the shift, who is then supposed to take notes on the information being represented. I found this document particularly interesting because of its written and verbal components. After observing the SBARP forms Lena provided of her writing, it is clear how new nurses entering this community might struggle with communication and, moreover, experience disorientation. Sherwood Hospital’s SBARP technically consists of six pages. The first page (front and back) is the one the nurse actually takes notes on and consists of nineteen sections. Each section consists of a heading with a small narrative space underneath contained by bold black lines. The additional five pages are called “Rounds,” which is basic patient information attached to each SBARP. I asked Lena, why, if patient information is attached, do nurses even need to give reports? She responded “Well, because it doesn’t contain all the information we have to write down throughout the day, just very basic patient information. Besides, most nurses don’t carry them in their pocket anyway because they’re annoying. I like [carry them] just in case I forget something from the beginning of the day.” One can see how carrying these forms would be an inconvenience if each form is five pages and nurses have to carry one per patient and they have 3-5 patients a day. Although structure and delivery of the change-of-shift report varies from hospital to hospital, studies on the CoSR suggest overall concerns regarding communication and information validity. Scholars Staggers and Jennings (2009) and Anderson and Mangino (2006) document the multiple distractions from sounds of alarms, phones and conversations taking place around nurses trying to give report, as well issues arising as a result of location, which vary from the nursing conference room, the hallways, or the patient’s bedside. Nurses on Lena’s unit are supposed deliver their report in the break room, which is directly near the secretaries and also consists of people eating/talking on their break, and others giving reports. Even for experienced nurses, CoSRs can be frustrating due to myriad distractions and also because of the lack of structure and content. Athwal, Fields and Wagnall (2009) describe shift reports as “problematic because the lack of structure lent itself to storytelling about the events of the shift. To compound the situation, each oncoming nurse had a different way and speed of writing down information. Experienced nurses also verbalized frustration with the new nurses because they did not know what was important to present in report or what was important to write down when receiving report” ( p. 144). Although the change-of-shift-report is meant to be an effective form of communication between nurses in order to deliver essential information, its lack of structure and content coupled with chaotic surroundings suggest there are complications in the CoSR as a valid source of communication. As I will show below, Lena’s cycle of transition illustrates the shifting rhetorical situations evident during her SBARP process. |