Neonatal Intensive Care Unit Discourse Community
Jane Austen (1881) once wrote, “It isn’t what we say or think that defines us, but what we do.” While actions do speak louder than words, it is the thoughts and language we express that dictate those actions. In fact, what we say, think, and the reasons behind what we ultimately do all intertwine closely with one another and contribute to a greater whole. This whole to which is alluded to can be referred to as a discourse community. To varying degrees, every individual you have ever met belongs to a certain discourse community, some belonging to more than one and perhaps belonging to the same one as you. What exactly is a discourse community you may wonder? According to linguistic analyst, John Swales (1990), a discourse community is a group that shares what the name implies: discourse – the term referring to written or spoken communication. Swales emphasizes six key characteristics that embody such a group, demonstrating a wide range of groups that fall under this definition. As a student interested in the medical field, I have had the opportunity to observe various units within the hospital setting, each representing a discourse community of their own. The most fascinating of them all, deserving of further analysis is that of the NICU at Sierra Hospital.
NICU stands for Neonatal Intensive Care Unit. This unit is where newborn babies who experience complications, such as prematurity or illness, go to be taken care of in order to regain health. Many stay there for days, weeks, or maybe even month. It is the responsibility of the NICU team to ensure to the best of their ability that each patient they receive can one day go home and have the chance at a long life. It takes more than one person to achieve such a goal; it does in fact take a team. Consisting of a Neonatologist, Neonatal Nurse Practitioner, and Registered Nurses, this network of people works in close contact with one another, exchanging information regarding their tasks, in which communication definitely is the key to success.
Literature Review
John Swale’s article, “The Concept of Discourse Community,” serves to define what exactly a discourse community is. According to Swales, a social group can be considered a discourse community when and only if it meets six specific criteria. A particular group must include individuals all striving for common goals, mechanisms for communication between its members, informational exchange with feedback, certain genres or standards that they abide to, specific lexis or terminology unknown to outsiders, and its members should have certain degrees of expertise (Swales, 1990).
With that notion, Swales further details what is and is not considered a discourse community. He does so by relating it to and distinguishing it from the concept of a speech community. “A speech community inherits its membership by birth, accident or adoption; a discourse community recruits its members by persuasion, training, or relevant qualification” (Swales, 1990, p. 220). While a discourse community may be considered a speech community, the same does not go when reversed. Speech communities may share common language, rules, and beliefs, but as mentioned, there are six characteristics that define a discourse community (Swales, 1990). A speech community is restricted in this fashion because there lacks a shared goal and overall communication between its members. In addition, discourse communities must have genres to which they shape their approach to the goals at large.
Genres are texts “that are recognizable to readers and writers” (Swales, 1990, p. 216). This can include standard methods of writing such as invitations or professional letters. It is important to note that genres are formed over time as their frequency increases, setting them as recognized standards. According to James Porter’s article, “Intertextuality and the Discourse Community,” every single “text contains traces of other texts” (Porter, 1986, p. 395) in some way or another. While seeming to imply the idea of plagiarism, Porter is indicating that ideas are merely passed down between generations. “All texts are interdependent: We understand a text only insofar as we understand its precursors” (Porter, 1986, p. 396). Ultimately, we unintentionally seek inspiration from other sources. This is exactly how genres within a discourse community are formed. Those who understand and follow a specific genre do so because it is familiar to them, and it has been practiced time and time again by those who came before them.
Discussion
As mentioned, the Neonatal Intensive Care Unit community is a network of people working to care for a particularly fragile group of patients: newborn babies. Because of this, it is vital that every procedure, every protocol, every detail that defines their success is scrutinized and carefully followed. During my visit, I was able to observe this group for an entire shift of 6 hours, which allowed for a great understanding of their practices. With Swale’s six requirements of a discourse community in mind, we can analyze the extent to which this social group qualifies under that category.
The first criterion that defines a discourse community is a set of common public goals. The goals of the NICU are to ensure to the best of their ability that all patients receive the care they need and to maintain a safe environment in which they can regain health in the hope of going home as soon as possible. According to Nurse Practitioner Kay Timbreza, the goal of the unit is simple: “to save the lives of those who need it most” (personal communication, March 6, 2015). While observing this group, it was obvious that every healthcare provider in that unit in fact shared the goal described. According to Donna Kain and Elizabeth Wardle’s article, “Activity Theory: An Introduction for the Writing Classroom,” “motives direct [a] subject’s activities” (2005, p. 277). With that being said, it a discourse community’s goal that dictates the actions and effectiveness of its communication.
In order to accomplish a goal in a group where many individuals are involved, there of course must be a means of communication. Communication brings about order, and order in turn establishes a clear path to success. Swale’s requirement of mechanisms of intercommunication between members can be observed here. Like any professional organization, this group had specific methods of communication that involved written and verbal language. Since I was there in the morning, I had the opportunity to observe how they started their day off. To begin with, the NICU team, excluding the Neonatologist, gathered to receive their instructions for the day in the form of an agenda. The Nurse Practitioner distributed the agenda to each nurse, detailing which patients they were assigned to for the day, and what certain tasks were to be done regarding those patients.
As mentioned, the Neonatologist, the doctor, was excluded because he in fact is not often present in the NICU (K. Timbreza, personal communication, March 6, 2015). When he is not there, it is the responsibility of the Neonatal Nurse Practitioner to be in charge of the nurses below her and dictate what must be done. According to the Nurse Practitioner, however, she does not solely decide what to do; she receives written and/or verbal direction in person from the doctor on what to do (K. Timbreza, personal communication, March 6, 2015). She in turn dictates those orders to the nurses. In addition, while in charge, the Nurse Practitioner usually does rounds, in which she checks each patient herself, communicating information with the nurse in charge of that patient. During these rounds, she records the collected data onto paper medical records, which she then enters into the computer database to be retrieved by other nurses or the doctor.
In addition to the communication between its members, there is communication between outsiders. Being an intensive care unit for infants, the NICU allows for visitation by family members, in particular parents. During visiting hours, the Nurse Practitioner communicates verbally with the patients’ families, informing them of the status of their baby and what further must be done (K. Timbreza, personal communication, March 6, 2015). Of course, being outsiders, they do not fully understand many of the terms that are thrown at them. This is because a discourse community has its own lexis, or vocabulary, that is more comprehendible to those within the group.
Lexis refers to the terminology used in a given setting. According to Nurse Practitioner Kay Timbreza, all members must understand certain medical terminology. “We go to school for many years to learn the things we do, and that includes extensive knowledge of medical terms… Latin root words, suffixes, and prefixes are all necessary to get through daily communication” (K. Timbreza, personal communication, March 6, 2015). Entry-level Nurse Lisa Morales, who had been working at the unit for less than a year added, “There’s various abbreviations that as a nurse you must know. It is really life or death for our patients. If you see QDS on a patient’s medicine chart, which means ‘four times a day’ but think it means ‘every four hours’ dosages would be all off” (personal communication, March 6, 2015). As described, written communication is received and feedback is given.
According to Swales, the communication between members requires feedback. “Text constructs meaning” (Swales, 1990, p. 212). As in the example above, when a nurse reads their agenda with patient information such as required dosage measurements, it is vital that the nurse responds in the correct manner to the information he or she receives. They must follow the instructions given by the Nurse Practitioner who follows the instructions of the Neonatologist. It is one thing to read the information or hear it, but it is another to take action on what is said or written. The action that is taken is based on the expectations that the members have of certain situations, which can be referred to as genres.
Genres, as mentioned previously, are expected conventions that “meet the needs of the situation” and “help mediate activities” (Swales, 1990, p. 216). In the hospital setting there are various genres that do not relate to reading or writing as well as those that do. For instance, when entering the NICU, it is mandatory to scrub down, meaning to wash your hands and arms thoroughly. Doing so prevents the spread of infection (L. Morales, personal communication, March 6, 2015). It is a standard procedure in this unit and those who work there know it perfectly, but those who are newcomers, such as family members and myself must be informed upon arrival. It is also a standard to use hand sanitizer before coming in contact with a patient, especially after coming in contact with another. The same went for instruments such as stethoscopes, which had to be wiped clean between uses. After viewing a few of the patient records, which I cannot fully discuss due to patient confidentiality, I was able to observe the writing style that they use. It is a standard, of course, to write using medical terminology and it is expected, whereas writing out long sentences is not expected. This allows for information to get right to the point when it is being communicated.
The final requirement which dictates a discourse community is that members must have varying degrees of expertise in their given field. The level of expertise ranged between the Neonatologist, Nurse Practitioner, Registered Nurses, and Student Nurses, who I am not so sure are to be considered as part of this community. Registered Nurses require a bachelor’s degree in nursing in order to become part of the discourse community. In order to get to the point in which they are now, as newcomers they had to “observe, practice under supervision, and had to be told what to do by their superiors” (L. Morales, personal communication, March 6, 2015). For Nurse Practitioners, which are more experienced, they need a master’s degree or higher in order to enter the discourse community with such level of expertise. According to Kay Timbreza, it is expected that soon “you’ll need a doctorate in nursing in order to become a Nurse Practitioner” (personal communication, March 6, 2015). As for the Neonatologist, it takes about 14 years of education to gain the highest level of expertise in the unit (K. Timbreza, personal communication, March 6, 2015).
Conclusion
In depth observation and analysis of the NICU community suggests that it is in many ways defined as a discourse community. Having referred to and discussed all six of John Swales’ key characteristics for defining a discourse community, there are definite parallels that make this so. Communication and interpretation shaped by the use of genres, lexis, and expertise all form together toward the accomplishment of a common goal. The NICU’s goal of “saving lives” (K. Timbreza, personal communication, March 6, 2015) is achieved through such a network of thought, communication, and action. Seeing how closely inter-related communities such as this one can be has only served to further my interest in pursuing a career in the medical field. I would like to have the chance to one day be part of the greater whole that is a discourse community, being a contributing factor to a common goal.
References
Austen, J. (1811). Sense and sensibility. Whitehall, LN: Thomas Egerton.
Kain, D., Wardle, E. (2005). Activity Theory: An Introduction for the Writing Classroom. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (p. 277). Boston, MA: Bedford/St. Martin’s.
Porter, J. (1986). Intertextuality and the discourse community. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (p. 395-405). Boston, MA: Bedford/St. Martin’s.
Swales, J. (1990). The concept of discourse community. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (p. 212-227). Boston, MA: Bedford/St. Martin’s.
NICU stands for Neonatal Intensive Care Unit. This unit is where newborn babies who experience complications, such as prematurity or illness, go to be taken care of in order to regain health. Many stay there for days, weeks, or maybe even month. It is the responsibility of the NICU team to ensure to the best of their ability that each patient they receive can one day go home and have the chance at a long life. It takes more than one person to achieve such a goal; it does in fact take a team. Consisting of a Neonatologist, Neonatal Nurse Practitioner, and Registered Nurses, this network of people works in close contact with one another, exchanging information regarding their tasks, in which communication definitely is the key to success.
Literature Review
John Swale’s article, “The Concept of Discourse Community,” serves to define what exactly a discourse community is. According to Swales, a social group can be considered a discourse community when and only if it meets six specific criteria. A particular group must include individuals all striving for common goals, mechanisms for communication between its members, informational exchange with feedback, certain genres or standards that they abide to, specific lexis or terminology unknown to outsiders, and its members should have certain degrees of expertise (Swales, 1990).
With that notion, Swales further details what is and is not considered a discourse community. He does so by relating it to and distinguishing it from the concept of a speech community. “A speech community inherits its membership by birth, accident or adoption; a discourse community recruits its members by persuasion, training, or relevant qualification” (Swales, 1990, p. 220). While a discourse community may be considered a speech community, the same does not go when reversed. Speech communities may share common language, rules, and beliefs, but as mentioned, there are six characteristics that define a discourse community (Swales, 1990). A speech community is restricted in this fashion because there lacks a shared goal and overall communication between its members. In addition, discourse communities must have genres to which they shape their approach to the goals at large.
Genres are texts “that are recognizable to readers and writers” (Swales, 1990, p. 216). This can include standard methods of writing such as invitations or professional letters. It is important to note that genres are formed over time as their frequency increases, setting them as recognized standards. According to James Porter’s article, “Intertextuality and the Discourse Community,” every single “text contains traces of other texts” (Porter, 1986, p. 395) in some way or another. While seeming to imply the idea of plagiarism, Porter is indicating that ideas are merely passed down between generations. “All texts are interdependent: We understand a text only insofar as we understand its precursors” (Porter, 1986, p. 396). Ultimately, we unintentionally seek inspiration from other sources. This is exactly how genres within a discourse community are formed. Those who understand and follow a specific genre do so because it is familiar to them, and it has been practiced time and time again by those who came before them.
Discussion
As mentioned, the Neonatal Intensive Care Unit community is a network of people working to care for a particularly fragile group of patients: newborn babies. Because of this, it is vital that every procedure, every protocol, every detail that defines their success is scrutinized and carefully followed. During my visit, I was able to observe this group for an entire shift of 6 hours, which allowed for a great understanding of their practices. With Swale’s six requirements of a discourse community in mind, we can analyze the extent to which this social group qualifies under that category.
The first criterion that defines a discourse community is a set of common public goals. The goals of the NICU are to ensure to the best of their ability that all patients receive the care they need and to maintain a safe environment in which they can regain health in the hope of going home as soon as possible. According to Nurse Practitioner Kay Timbreza, the goal of the unit is simple: “to save the lives of those who need it most” (personal communication, March 6, 2015). While observing this group, it was obvious that every healthcare provider in that unit in fact shared the goal described. According to Donna Kain and Elizabeth Wardle’s article, “Activity Theory: An Introduction for the Writing Classroom,” “motives direct [a] subject’s activities” (2005, p. 277). With that being said, it a discourse community’s goal that dictates the actions and effectiveness of its communication.
In order to accomplish a goal in a group where many individuals are involved, there of course must be a means of communication. Communication brings about order, and order in turn establishes a clear path to success. Swale’s requirement of mechanisms of intercommunication between members can be observed here. Like any professional organization, this group had specific methods of communication that involved written and verbal language. Since I was there in the morning, I had the opportunity to observe how they started their day off. To begin with, the NICU team, excluding the Neonatologist, gathered to receive their instructions for the day in the form of an agenda. The Nurse Practitioner distributed the agenda to each nurse, detailing which patients they were assigned to for the day, and what certain tasks were to be done regarding those patients.
As mentioned, the Neonatologist, the doctor, was excluded because he in fact is not often present in the NICU (K. Timbreza, personal communication, March 6, 2015). When he is not there, it is the responsibility of the Neonatal Nurse Practitioner to be in charge of the nurses below her and dictate what must be done. According to the Nurse Practitioner, however, she does not solely decide what to do; she receives written and/or verbal direction in person from the doctor on what to do (K. Timbreza, personal communication, March 6, 2015). She in turn dictates those orders to the nurses. In addition, while in charge, the Nurse Practitioner usually does rounds, in which she checks each patient herself, communicating information with the nurse in charge of that patient. During these rounds, she records the collected data onto paper medical records, which she then enters into the computer database to be retrieved by other nurses or the doctor.
In addition to the communication between its members, there is communication between outsiders. Being an intensive care unit for infants, the NICU allows for visitation by family members, in particular parents. During visiting hours, the Nurse Practitioner communicates verbally with the patients’ families, informing them of the status of their baby and what further must be done (K. Timbreza, personal communication, March 6, 2015). Of course, being outsiders, they do not fully understand many of the terms that are thrown at them. This is because a discourse community has its own lexis, or vocabulary, that is more comprehendible to those within the group.
Lexis refers to the terminology used in a given setting. According to Nurse Practitioner Kay Timbreza, all members must understand certain medical terminology. “We go to school for many years to learn the things we do, and that includes extensive knowledge of medical terms… Latin root words, suffixes, and prefixes are all necessary to get through daily communication” (K. Timbreza, personal communication, March 6, 2015). Entry-level Nurse Lisa Morales, who had been working at the unit for less than a year added, “There’s various abbreviations that as a nurse you must know. It is really life or death for our patients. If you see QDS on a patient’s medicine chart, which means ‘four times a day’ but think it means ‘every four hours’ dosages would be all off” (personal communication, March 6, 2015). As described, written communication is received and feedback is given.
According to Swales, the communication between members requires feedback. “Text constructs meaning” (Swales, 1990, p. 212). As in the example above, when a nurse reads their agenda with patient information such as required dosage measurements, it is vital that the nurse responds in the correct manner to the information he or she receives. They must follow the instructions given by the Nurse Practitioner who follows the instructions of the Neonatologist. It is one thing to read the information or hear it, but it is another to take action on what is said or written. The action that is taken is based on the expectations that the members have of certain situations, which can be referred to as genres.
Genres, as mentioned previously, are expected conventions that “meet the needs of the situation” and “help mediate activities” (Swales, 1990, p. 216). In the hospital setting there are various genres that do not relate to reading or writing as well as those that do. For instance, when entering the NICU, it is mandatory to scrub down, meaning to wash your hands and arms thoroughly. Doing so prevents the spread of infection (L. Morales, personal communication, March 6, 2015). It is a standard procedure in this unit and those who work there know it perfectly, but those who are newcomers, such as family members and myself must be informed upon arrival. It is also a standard to use hand sanitizer before coming in contact with a patient, especially after coming in contact with another. The same went for instruments such as stethoscopes, which had to be wiped clean between uses. After viewing a few of the patient records, which I cannot fully discuss due to patient confidentiality, I was able to observe the writing style that they use. It is a standard, of course, to write using medical terminology and it is expected, whereas writing out long sentences is not expected. This allows for information to get right to the point when it is being communicated.
The final requirement which dictates a discourse community is that members must have varying degrees of expertise in their given field. The level of expertise ranged between the Neonatologist, Nurse Practitioner, Registered Nurses, and Student Nurses, who I am not so sure are to be considered as part of this community. Registered Nurses require a bachelor’s degree in nursing in order to become part of the discourse community. In order to get to the point in which they are now, as newcomers they had to “observe, practice under supervision, and had to be told what to do by their superiors” (L. Morales, personal communication, March 6, 2015). For Nurse Practitioners, which are more experienced, they need a master’s degree or higher in order to enter the discourse community with such level of expertise. According to Kay Timbreza, it is expected that soon “you’ll need a doctorate in nursing in order to become a Nurse Practitioner” (personal communication, March 6, 2015). As for the Neonatologist, it takes about 14 years of education to gain the highest level of expertise in the unit (K. Timbreza, personal communication, March 6, 2015).
Conclusion
In depth observation and analysis of the NICU community suggests that it is in many ways defined as a discourse community. Having referred to and discussed all six of John Swales’ key characteristics for defining a discourse community, there are definite parallels that make this so. Communication and interpretation shaped by the use of genres, lexis, and expertise all form together toward the accomplishment of a common goal. The NICU’s goal of “saving lives” (K. Timbreza, personal communication, March 6, 2015) is achieved through such a network of thought, communication, and action. Seeing how closely inter-related communities such as this one can be has only served to further my interest in pursuing a career in the medical field. I would like to have the chance to one day be part of the greater whole that is a discourse community, being a contributing factor to a common goal.
References
Austen, J. (1811). Sense and sensibility. Whitehall, LN: Thomas Egerton.
Kain, D., Wardle, E. (2005). Activity Theory: An Introduction for the Writing Classroom. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (p. 277). Boston, MA: Bedford/St. Martin’s.
Porter, J. (1986). Intertextuality and the discourse community. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (p. 395-405). Boston, MA: Bedford/St. Martin’s.
Swales, J. (1990). The concept of discourse community. In E. Wardle & D. Downs (Eds.), Writing about writing: A college reader (p. 212-227). Boston, MA: Bedford/St. Martin’s.