USING COMMUNICATION ACCOMMODATION THEORY TO ANALYSE LANGUAGE-DISCORDANT NURSE-PATIENT INTERACTIONS: IMPLICATIONS FOR APPLIED LINGUISTIC DESIGN

Language-discordance in healthcare communication can adversely affect patient treatment and care.[1] Where problems associated specifically with language-discordant nursing communication are concerned, the design of extant language and communication programme for nursing professionals in second language (L2) communication contexts have been criticised for their lack of a solid, theoretical foundations.[2,3] In order to begin to fill this gap, thorough needs analysis is required. As part of such a needs analysis, I use a Communication Accommodation Theory (CAT) [4] approach to analysing pragmatic competence in language-discordant, nurse-patient interactions that were audio recorded during observations at two multilingual South African (SA) hospitals. CAT seeks to explain how interlocutors accommodate others (or not) by adjusting their communicative behaviour to manage comprehension and social distance.[4] CAT proposes that reactions and adjustments to communicative behaviours are influenced by at least three factors: inferences of intentionality, attributions of motives and subsequent evaluations of the interaction and interactant. Thus, the evaluation of and subsequent reaction to specific communicative behaviour is determined by perceived intentionality of the communicative behaviour and the motive attributed to the intentionality. The aim of my analysis is to identify predictors of such perceptions, attributions and evaluations that lead to patients' reactions to nursing professionals' limited pragmatic competence (greetings and honorifics). Based on the analysis of my data, subjective perceptions and attributions are influenced firstly by knowledge of culturally appropriate use of greetings and honorifics. Secondly it is influenced by the existence of a previously established nurse-patient relationship. Finally, the perceived positive intention to pragmatically accommodate outweighs actual competence. Thus, the extent to which these factors were present seemed to determine whether patients perceived incorrect or unfamiliar use of greetings and honorifics as (un) intentional, as well as attributing the (un) intentionality to a positive or negative motive. This in turn influences the evaluation of the speaker and interaction, which determines the reaction. Using a CAT approach provides unique insight that can be used to inform the design of theoretically sound language and communication training or tools for nursing (pre) professionals. Such training should be aimed at not only developing the linguistic resources required to perform greetings and use honorifics, but should also focus on cultural sensitivity in using interactional communicative functions appropriately. In addition, perspective-taking skills should be developed for interactions where the patient may be the one using an L2. This should help nursing professionals to manage language-discordant interactions where their or the patients' pragmatic competence is limited in order to avoid negative evaluations and reactions by either or both interactants.