Plenary 3

Susan Bosher Professor and Director of ESL, St. Catherine University

St. Paul, Minnesota

2016 Perspectives Symposium

2016 Perspective SymposiumTouchstone Institute

February 23, 20162016 Perspectives Symposium

2016 Perspectives Symposium

Susan Bosher, PhDProfessor and Director of ESL

St. Catherine University, St. Paul, Minnesota, USA

Communicative CompetenceDefinition: Knowledge that a native speaker has which allows him or her to successfully interact with other speakers (Savignon, 1976)

1) Linguistic competence: syntax, morphology, phonology, orthography, and the lexicon

2) Textual competence: cohesion, coherence, deixis, genre structure, and conversational structures

3) Functional competence: using language for a specific purpose (e.g. teaching, warning, self-expression, persuading, etc.)

4) Socio-cultural competence: rules of appropriateness and politeness, idioms and figurative language, non-verbal communication, cultural knowledge and references, knowledge of social contexts and relationships

5) Strategic competence: planning for effective communication in a given situation, avoiding difficulties in communication, and recovering from communication breakdowns (Pawlikowska-Smith, 2002)

Pronunciation (Bosher & Smalkoski 2002; Cameron 1998; Hussin 2002; Seydow 2012)Phonemes

Initial & final consonantsCommon prefixes & suffixesPhonemic contrasts

WordsMedical terminologyDiagnosesProceduresNames of drugsAcronyms & abbreviations

Pronunciation (Continued)Common words

NumbersWords of frequency

Patients’ namesStress & intonation

Misplaced word stressUnstressed syllablesTone

Vocabulary (Cameron 1998; Hussin 2002; Marston & Hansen 1985; Medlin 2009; Seydow 2012)Medical/nursing terminologyCorrect abbreviations & shortening of wordsWords with different connotationsAppropriate medical termsParaphrasing of technical information; precise

terms for chartingSub-technical vocabulary Idioms & metaphors related to self, pain, emotion,

etc.Physical appearance & emotional statesTwo- & three-word verbs used to describe healthColloquial languageWord forms/parts of speech

Grammar (Cameron 1998; Hussin 2002, 2008; Marston & Hansen 1985; Staples 2015)Asking questions

Primary means of getting informationKey communicative behavior in clinical settingTypes of questions

Open-endedInformationYes/noEllipticalTag Intonation

Grammar (Continued)Other purposes of questions

To confirm, evaluate, provide optionsImperatives or commands

To conduct assessmentsUnderstanding instructions

Explicit vs. implicit Tense & aspect

FuturePast vs. present (present progressive, present

perfect progressive, simple present)Passive vs. active

Grammar (Continued)Modal verbsReported speech in dialogue formWhat-cleft & it-cleft constructionsPronoun usageWord orderDescribing spatial relationships

Passive constructionsPrepositions of location

Using relative clauses

Grammar (Continued)Describing procedures

3rd person subjectsImperativesPassivesExpressions of time

Telegraphic style for chartingAdverbs of time & frequencyPrepositions“I” statements

Functional Competence (Bosher & Smalkoski 2002; Cameron 1998; Epp & Lewis 2008; Hussin 2002, 2008; Malthus, Holmes, & Major 2005; Marston & Hansen 1985; Seydow 2012)How nurses spend their time (Epp & Lewis 2008)With whom?

56% with clients34% with other professionals10% with family

Doing what?22% asking for information21% explaining9% giving instructions

Functional Competence (Continued)7% informing6% responding to questions6% suggesting6% describing5% making small talk5% discussing4% comforting3% making/receiving phone calls2% asking for help2% offering to help1% clarifying1% apologizing

Giving Information (Cameron 1998)To patients & families

Who one isWhat one knowsGood/bad newsAvailable optionsEducate patients about diagnosis & self-care

To other health-care professionals Present casesAdvocate for patients

Language Tasks in Clinical Setting (Hussin 2002)Taking nursing history of patientWriting nursing care plansGiving & receiving change-of-shift reports Writing progress notes, discharge summaries,

incident reports, & referral lettersMaking & receiving phone callsUsing language while providing nursing careTeaching patients & families about health care &

how to provide care after dischargeParticipating in team meetings about patients

Informational Skills (Hussin 2002)Interacting with patients & families

Using interviewing techniquesGiving instructionsAsking for cooperationChecking readinessExplaining medical information in layperson’s

language Explaining proceduresAsking for permissionGiving feedbackUnderstanding colloquial languageUsing teaching techniques

Informational Skills (Continued)Interacting with colleagues

Giving & understanding instructions, explanations of procedures, & directions

Asking for repetition & clarificationAsking for assistance & explanationChecking for readinessUnderstanding & presenting verbal

informationMaking & receiving telephone callsAccurately conveying telephone messages

Informational Skills (Continued)Interacting with colleagues (Continued)

Using appropriate medical terminologyCompleting, reading, & interpreting routine

forms, charts, & instructionsCompleting medical historiesReading & interpreting medical records &

historiesWriting, reading, & interpreting notes &

summaries, nursing care plans, letters, & reports

Interpersonal Communication Skills with Patients (Hussin 2002)

Expressing empathy & offering reassuranceInterpreting nonverbal cuesUsing attending behaviorsUsing nonverbal communicationUsing reflective listening techniquesUsing clarification techniquesParaphrasing & summarizingUsing assertive responsesExpressing personal opinion

Social Talk5% of time spent with patients (Epp & Lewis

2008) 60% of time spent with patients (Malthus,

Holmes, & Major 2005) Requires greetings, introductions, compliments,

showing interest, expressing likes and dislikes

Challenges of functional/pragmatic competenceUnderstanding implicit communicative intentInferencing skills requiredInferring patient’s emotional state Inferring relevant social information

Textual Competence (Bosher & Smalkoski 2002; Cameron 1998; Hussin 2002, 2008; Seydow 2012) Conversational structures (opening and closings)Series of speech actsProducing sequence of speech acts (Ex:

Transferring a patient) Offering assistanceRequesting helpExplaining procedureGiving instructionsChecking readinessOffering reassuranceChecking patient’s comfort level

Textual Competence (Continued)Understanding sequence of speech acts

Identifying shift from one speech act to another: Request, complaint, joke, set of instructions

Sequence can become convention or standard procedure When people are expected to follow sequenceTaking vital signs (Example)

Give information to patient Explain procedure Ask for cooperation Encourage patient Reassure patient Give feedback to patient about vital signs

Textual Competence (Continued)Recounting what others have saidNarrating a sequence of eventsDescribing assessment & observations of

patientUsing SBAR (Situation, Background,

Assessment, Recommendation)Making and receiving telephone calls

Identifying numbers, letters, names of people Distinguishing intonation patterns for

questions & statements

Socio-Cultural Competence (Bosher & Smalkoski 2002; Cameron 1998; Hussin 2002, 2008; Malthus, Holmes, & Major 2005; Marston & Hansen 1985; Seydow 2012; Staples 2015)“Saying the right thing” to patients – nursing

students’ primary concern (Kotecki 2002)Sociolinguistic behavior in the clinical setting

Topic choiceDirecting interviewRenewing topicTurn-takingInterrupting politelyCommunicating empathy and confidence

Socio-Cultural Competence (Continued)Social/small talk

To establish rapport with patientsNecessary first step to social interactionNon-task relatedTopics included patients’ hobbies, likes,

dislikes, families Other functions of social interaction

Greetings & leave taking Giving complimentsTelling stories of personal experience

Socio-Cultural Competence (Continued)

Extending invitationsMaking requestsGiving apologiesUsing terms of address appropriatelyRecognizing & deflecting inappropriate

behaviorUsing culturally appropriate nonverbal

behaviorUsing visual clues

Socio-Cultural Competence (Continued)Speaking loudly enoughUsing body language appropriately, e.g., smilingInterpreting non-verbal cues appropriately Adjusting speech based on audience and purposeUsing hedging or softening devicesUnderstanding cultural & dialectal variationBeing assertive and speaking upTaking an active role in interactions Asking questions of instructors and other authority

figures

Strategic Competence (Bosher & Smalkoski 2002; Cameron 1998; Hussin 2002, 2008; Seydow 2012)Strategies to ensure mutual comprehension

Clarifying meaningAsk for repetitionAsk clarification questions

Checking comprehensionParaphrase & reflect back

Demonstrating understandingRepeat key wordsParaphrase instruction in response

Strategic Competence (Continued)Use expansion statements

Statements that add informationUse elaboration questions

Questions that ask for more informationInteractive repairRecognize verbal & nonverbal cues of

understanding & misunderstandingRepairing or rephrasing unclear messagesExpressing non-understandingMaking direct and indirect appeals for help

Strategic Competence (Continued)Planning for effective communication

SBAR (situation, background, assessment, and recommendation)

Determine who the audience is, what they need to know

Evaluate whether communication goal was metInteracting with difficult patients requires

assessment, planning and goal settingMaintain control of conversationDeal with patients with communication barriersRegain authority and reestablish communication

ConclusionFramework of communicative competence

(linguistic, textual, functional, socio-cultural, strategic) helps to understand the various components of using language effectively in the clinical setting

Framework provides useful structure for developing instructional and assessment materials that address all aspects of communicating effectively in English in the clinical setting

ReferencesBachman, L. (1990). Fundamental considerations in language testing.

Oxford: Oxford University Press.Bosher, S., & Smalkoski , K. (2002). From needs analysis to

curriculum development: Designing a course in health-care communication for immigrant students in the USA. English for Specific Purposes, 21, 59-79.

Brown, S. (1994). Communication strategies used by an expert nurse Clinical Nursing Research, 3(1), 43-56.

Cameron, R. (1998). Language-focused needs analysis for ESL-speaking nursing students in class and clinic. Foreign Language Annals, 31, 203-218.

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Canale, M., & Swain, M. (1980). Theoretical bases of communicative approaches to second language teaching and testing. Applied Linguistics, 1, 1-47.

References (Continued)Celce-Murcia, M., Dörnyei, Z., & Thurell, S. (1995). Communicative

competence: A pedagogically motivated model with content specifications Issues in Applied Linguistics, 6(2), 5-35.

Crystal, D. (1987). The Cambridge encyclopedia of language. Cambridge, U.K.: Cambridge University Press.

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Epp, L., & Lewis, C. (2008). Innovation in language proficiency assessment: The Canadian English Language Benchmark Assessment for Nurses (CELBAN). In S. Bosher & M. Dexheimer Pharris (Eds.), Transforming nursing education: The culturally inclusive environment (pp. 285-310). New York: Springer Publishing.

Hedge, T. (2000). Teaching and learning in the language classroom. Oxford:  Oxford University Press.

References (Continued)Hussin, V. (2002). An ESP program for students of nursing. In T.

Orr (Ed.), English for Specific Purposes (pp. 25-39). Alexandria, VA: TESOL.

Hussin, V. (2008). Facilitating success for ESL nursing students in the clinical setting: Models of learning support. In S. Bosher & M. Dexheimer Pharris (Eds.), Transforming nursing education: The culturally inclusive environment (pp. 363-386). New York: Springer Publishing.

Kotecki, C. (2002). Baccalaureate nursing students’ communication process in the clinical setting. Journal of Nursing Education, 41(2), 61-68.

Krautscheid, L. (2008). Improving communication among healthcare providers: Preparing student nurses for practice. International Journal of Nursing Education Scholarship, 5(1), 1-15.

Marston, J., & Hansen, A. (1985). Clinically speaking: ESP for refugee nursing students. MinneTESOL Journal, 5, 29-52.

References (Continued)Malthus, C., Homes, J., & Major, G. (2005). Completing the circle:

Research-based classroom practice with EAL nursing students. New Zealand Studies in Applied Linguistics, 11(1), 65-89.

Medlin, L. (2009). English for Specific Purposes (ESP): Nursing in the U.S. hospital. Unpublished project. California State University, Chico.

Pawlikowska-Smith, G. (2002). Canadian language benchmarks theoretical framework. Canada: Centre for Canadian Language Benchmarks, 1-108.

Savignon, S. (1976). Communicative competence: Theory and classroom practice. Central states conference on the teaching of foreign languages. University of Illinois, Urbana-Champaign. 23 April 1976. Keynote Address.

Staples, (2015). Examining the linguistic needs of internationally educated nurses: A corpus-based study of lexico-grammatical features in nurse-patient interactions. English for Specific Purposes, 37, 122-136.

References (Continued)Seydow, A. (2012). Describing communicative competence

in a college nursing degree program. Unpublished capstone, Hamline University, St. Paul, MN.

Tuohy, D. (2003). Student nurse-older person communication. Nurse Education Today, 23, 19-26.

Yates, L. (2004). The ‘secret rules of language’: Tackling pragmatics in the classroom. Prospect, 19(1), 3-21.

Plenary 3

Susan Bosher Professor and Director of ESL, St. Catherine University

St. Paul, Minnesota