A Conversation Analysis Of Formulation In Chinese Nurse-patient Interaction

Formulation is a common conversational practice that is crucial in overcoming communication obstacles and highlighting significant viewpoints.With its origin in the 1970s by Garfinkel and Sacks,formulation has been extensively studied in both institutional and mundane settings.Its use in institutional settings has been shown to enhance communication efficiency and quality,leading to better outcomes.However,research on the use of formulation in nurse-patient conversations,particularly in China,is limited.Specifically,there is a lack of knowledge about how formulation is employed in specific nursing activities,such as nurse instruction,physical examination,and patient requests to facilitate communication.This study employs conversation analysis and analyzes 73 audio-recorded naturally occurring nurse-patient conversations in a surgical department to investigate the utilization of formulation by nurses and patients.The study aims to investigate how formulation promotes nurse-patient conversation by discussing the types of formulation used in Chinese nurse-patient conversations across different nursing activities,the sequence organization of formulation,and the actions performed through formulation from an epistemic perspective.With this aim in mind,the research questions addressed are:(1)What types of formulation are employed in Chinese nurse-patient conversation and how are they distributed across different nursing activities?(2)What are the sequence organizations of formulation in Chinese nurse-patient conversation across different nursing activities?(3)What actions are performed through formulation in Chinese nurse-patient conversation and how to understand these actions from an epistemic perspective?The major findings of the study are as follows:(1)Both nurses and patients utilize self-formulation and other-formulation in their conversations,with nurses performing more self-formulation in nursing instruction activities and patients performing more self-formulation in patient-request activities.Both parties prefer other-formulation in physical examinations.(2)The sequence organization of formulation involves a basic sequence and may include sequence expansions.The basic sequence comprises the formulation source and execution,as well as the response.It is observed in all nursing activities,used by nurses and patients when there are challenges or ambiguities in conversation.Sequence expansion includes insert-expansions triggering formulation moves in nurse instruction and patient-request activities,and post-expansions providing additional information across all activities.(3)In terms of the specific action performed by formulation,nurses employ formulation in order to promote understanding,express emotional support,and improve communication efficiency.Patients utilize formulation to confirm their understanding and willingness to cooperate,as well as to emphasize their concerns.From the perspective of epistemics,nurses and patients engage in formulation to manage the epistemic asymmetry that can lead to errors,emotional challenges,and ineffective communication,thereby contributing to the successful completion of nursing activities.Moreover,the study provides evidence that formulation in nurse-patient conversations can be interpreted from epistemic notions as it is influenced by the epistemic access,epistemic primacy,and epistemic responsibility of both nurses and patients during their interactions.This study analyzes formulation in Chinese nurse-patient communication.Theoretically,it contributes to the exploration of the application of formulation in medical interactions,providing a more comprehensive understanding of its use and interpretation.Practically,it aims to highlight the significance of utilizing formulation in nurse-patient communication through an in-depth discussion of its use and role,and thus hopefully to benefit nurses and patients by reducing communication barriers,enhancing communication efficacy and efficiency,improving nurse-patient relationships,and ultimately enhancing the quality of nursing services.