English for Specific Purposes xxx (2016) 1–3

Contents lists available at ScienceDirect

English for Specific Purposes

journal homepage: http://ees.elsevier.com/esp/default.asp

Review

The Discourse of Nurse–Patient Interactions: Contrasting the

Communicative Styles of U.S. and International Nurses by Dr. Shelley
Staples
The Discourse of Nurse–Patient Interactions: Contrasting the Communicative Styles of U.S. and International Nurses,
S. Staples. John Benjamins Publishing Company, Amsterdam (2015). xi D 263 pp., Hardcover, ISBN: 978-9-0272-0380-9

The Discourse of Nurse–Patient Interactions: Contrasting the Communicative Styles of U.S. and International Nurses by Shelley
Staples analyses the spoken discourse of Internationally Educated Nurses (IENs) and United States educated nurses (USNs) in
nurse–patient interactions. This book, based on Staples’ (2014) doctoral dissertation, provides a thorough analysis of linguistic
features of IENs and USNs using a register framework (Biber, 1994; Biber & Conrad, 2009), discourse analysis (Heritage &
Maynard, 2011) and the discourse intonation framework (Brazil, 1997). Staples analyses and compares 42 linguistic fea-
tures including prosody (e.g. intonation, speech rate) and non-verbal behaviour (e.g. smiling and therapeutic touch), which
Staples says have rarely been discussed in previous studies. Including prosody and non-verbal behaviour in this study pro-
vides a more complete picture of IENs’ communicative styles, going beyond the descriptions found in the literature of IENs’,
which tend to be in terms of language deficiencies and cultural differences related to previous training. The results show that
a more fruitful approach might be to consider that IENs interact differently than USNs when caring for patients, in both verbal
and non-verbal ways.
The book begins with a preface by Dr. Douglas Biber, who asks several important questions related to Internationally
Educated Nurses (IENs) and how their communicative styles are different from nurses educated in the U.S. These questions as
well as the differences in how patients communicate with nurses are analysed in the eleven chapters that constitute this
book. Chapter 1 gives an overview of the study, and Chapter 2 provides the background, including an informative literature
review of previous studies of linguistic and non-verbal features related to health care providers. Chapter 3 provides a detailed
description of the corpus and the methods of data collection and analysis. The data for the IENs and USNs were collected at
three different hospitals in Las Vegas, Nevada. The speech event was the first meeting between nurse and patient in the
emergency ward after the patient was admitted. The study involved 52 interactions between IENs who were mostly from the
Philippines and standardized patients (SPs), and 50 interactions between USNs and SPs. The SPs in the study were actors
trained for medical scenarios. Staples conducted semi-structured interviews with eight nurses that were not involved in the
nurse–patient interaction discourse analysis. She used special software equipment to code the data, coded some of the data
by hand, and designed her own computer programs to identify certain linguistic features. There are numerous tables which
summarize the linguistic data gathered throughout Staples’ study. At first glance, they may seem intimidating to people
unfamiliar with corpus-based discourse analysis, but the linguistic concepts are presented with detailed and clear expla-
nations, which help elucidate the more technical parts of Staples’ analysis.
Chapter 4 discusses the significance of the situational features of the nurse–patient interaction used in the study, and the
effects they have on how the nurses and the patients communicate with each other, in particular the relationship nurses
develop with patients. The types of shared knowledge in the nurse–patient interaction are also discussed. Chapter 5 gives an
overview of the lexico-grammatical and interactional features used by the USNs, IENs, USNs who spoke to SPs, and IENs who
spoke to SPs. The chapter also discusses how the roles of nurses and patients affect the way nurses and patients communicate
in different phases of the nurse–patient interaction. For example, findings showed that the nurses used prediction modals to
inform the patients of what was going to happen during and after the interaction. Chapter 6 describes the different inter-
actional features of the IENs and the USNs and Chapter 7 describes the different lexico-grammatical features of the IENs and
the USNs. The reason for these differences is in the expectations of the role of nurses and the relationship the nurses have with
the patients. For example, the USNs spent more time counselling patients and asking about their emotional needs than the
IENs. In the counselling phase, the USNs used more Wh-questions than the IENs. The Filipino IENs reported that they were
used to a more provider-centred approach in the Philippines, which may account for why they did not spend as much time

http://dx.doi.org/10.1016/j.esp.2016.04.003
2 Review / English for Specific Purposes xxx (2016) 1–3

providing patient-centred care. Additionally, IENs reported that in their home countries, patients rarely questioned them or
asked them for explanations. In a different study, IENs were perceived not to make the small talk used to manage social
interactions with colleagues and patients (Lum, Dowedoff, Bradley, Kerekes, & Valeo, 2015).
Chapter 8 discusses the differences in fluency, prosody, and non-verbal characteristics between the two nurse groups.
Results showed that the IENs spoke slower and used a broader pitch range. Use of a broader pitch range may affect how
expressions of empathy are perceived. In another study, Lapointe (2014) found in her corpus of empathy/sympathy by
Anglophone nurses in Quebec the use of different types of questions such as tag questions when naming a feeling. She
suggests this as an area of future investigation since one would expect to name a feeling in a statement and not in a
question. The results of Staples’ study also showed that compared to the USNs, the IENs did not smile or use therapeutic
touch as much, which may have made building rapport with patients more difficult. Chapter 9 provides a discussion about
the differences in the lexico-grammatical and interactional features, which are related to the differences in the way the IENs
and USNs interact.
Chapter 10 discusses the relationship between linguistic features and performance of the two nurse groups to measure
interpersonal communication skills and patient satisfaction. Staples used the Interpersonal Skills Assessment (IPS) to
measure the nurse–patient interactions. The USNs received a higher rating on all effectiveness measures, possibly due to
their less formal approach when providing care. Also, results of the IENs with a high effectiveness score may be related to
their length of residence in the U.S. – the longer they have been living in the U.S., the more patient-centred in their practice
they become.
Chapter 11 provides a synthesis of the findings in the previous chapters. Staples says that the similarities and differences
between IENs’ and USNs’ discourse are related to two things: first, sociopragmatic (language use in social situations) and
pragmalinguistic (language use in speech acts) differences and second, differences between English and the IENs’ first lan-
guages. An example of a sociopragmatic difference is the way in which USNs take a more patient-centred approach compared
to the IENs as described in Chapters 6 and 7. Chapter 7 gives examples of how lexico-grammatical differences affect nurses’
discourse. Based on these findings, Staples suggests nurse training programs introduce sociopragmatics and pragmalin-
guistics. More discussion about how trainers could implement sociopragmatic and pragmalinguistic features in training
programs would have been beneficial since the nurse–patient interaction is not purely linguistic, but also influenced by race,
gender, culture, and power relationships. Staples also recommends teaching linguistic features such as the use of past tense
verbs when discussing what patients report about their emotional wellbeing, pitch to express empathy, and yes/no questions
to ask about patients’ concerns. I think these examples highlight the importance of context in profession-specific training,
which supports results in other studies (e.g. see Cheng, Spaling, & Song, 2013).
In Chapter 11, Staples makes suggestions for several future studies, such as researching the effects of perceived IENs’ accent
on patient care. In other studies, patients and staff may perceive IENs to have poor speaking skills, to be incompetent, or even
to be potential risks to the quality of care because they have accents (Shen et al., 2012; Xu, 2008).
In this book, Staples successfully achieves her goal of finding out the linguistic features of IENs’ discourse in the context of a
nurse–patient interaction. The book provides a very detailed and thorough interpretation of the communicative styles of IENs
and USNs, and presents it in a well-organized, well-written and well-researched study. Given that the study employs a mixed
methods approach, the book would appeal to graduate students and researchers interested in combining quantitative and
qualitative methods. Discourse analysts in particular would find the discussion and application of the data coding procedures
insightful. Likewise, nurse educators who train IENs using clinical simulation scenarios would find the discussion and the
results of the IPS to evaluate the satisfaction of provider care enlightening. Finally, this book would be a useful resource for
administrators and developers of IEN training programs. Anyone interested in or concerned about the field of health and
language should read it.

References

Biber, D. (1994). An analytical framework for register studies. In D. Biber, & E. Finegan (Eds.), Sociolinguistic perspectives on register (pp. 31-56). Oxford:
Oxford University Press.
Biber, D., & Conrad, S. (2009). Register, genre, and style. Cambridge: Cambridge University Presshttp://dx.doi.org/10.1017/CB09780511814358.
Brazil, D. (1997). The communicative value of intonation in English. Cambridge: Cambridge University Press.
Cheng, L., Spaling, M., & Song, X. (2013). Barriers and facilitators to professional licensure and certification testing in Canada: Perspectives on internationally
educated professionals. International Migration & Integration, 14, 733-750.
Heritage, J., & Maynard, D. (2011). After 30 years, problems and prospects in the study of doctor-patient interaction. In B. A. Pescosolido, J. K. Martin, J. D.
McLeod, & A. Rogers (Eds.), Handbook of the sociology of health, illness, and healing: A blueprint for the 21st century (pp. 323-342). New York, NY: Springer.
http://dx.doi.org/10.1007/978-1-4419-7261-3_17.
Lapointe, S. (2014). A corpus study of the verbal communication of empathy/sympathy by anglophone nurses in Quebec. Unpublished doctoral dissertation.
Montreal, Quebec: Laval University.
Lum, L., Dowedoff, P., Bradley, P., Kerekes, J., & Valeo, A. (2015). Challenges in oral communication for internationally educated nurses. Journal of Trans-
cultural Nursing, 26(1), 83-91.
Shen, J., Xu, Y., Bolstad, A., Covelli, M., Torpey, M., & Colosimo, R. (2012). Effects of a short-term linguistic class on communication competence of inter-
national nurses: Implications for practice, policy, and research. Nursing Economics, 30(1), 21-28.
Staples, S. (2014). Linguistic characteristics of international and U.S. nurse discourse (Doctoral Dissertation). Retrieved from ProQuest Dissertations & Theses
Global. (3621143).
Xu, Y. (2008). Communicative competence of international nurses and patient safety and quality of care. Home Health Care Management & Practice, 20(5),
430-432.
 Review / English for Specific Purposes xxx (2016) 1–3 3

Marcia Kim is an instructor in the International Foundations Program, Werklund School of Education, University of Calgary. She obtained her MA TESOL from
the School for International Training. She is also a PhD student at the University of Calgary. Her research project focuses on workplace communication of
Internationally Educated Nurses.

Marcia Kim *
University of Calgary, 4919 Nelson Road NW, Calgary, Alberta, T2K 2M1, Canada

Tel.: þ1 (403) 815 5540.

E-mail address: marciakim73@gmail.com

Available online xxx