Clinicians’ narratives in the era of evidence-based practice
A sociolinguistic exploration of the role of narratives in staff meetings
In evidence-based practices, narratives are the vehicle through which medical knowledge is shared and clinical
judgment is grounded. This paper explores narratives as a sanctioned social practice that help a group of clinicians in a
healthcare institution in New Zealand build and negotiate expertise and accountability, as they discuss clinical cases. To this
end, the paper investigates narratives in six staff meetings, which were video and audio recorded. The paper presents a discursive
analysis of the functions of narratives in this context to show how narratives are interactional achievements that are pivotal to
clinical decision-making and to building and contesting professional stances. Finally, the paper reflects on the value of
narratives as shared resources that are sometimes revisited and reframed over time and that help construct a common thread of
history that becomes part of the cultural capital of the organization and positions clinicians as core members of their
community.
Article outline
- 1.Introduction
- Medical case presentation in reflective practice
- Method and data
- Analysis
- Discussion and conclusions
- Notes
- Transcription conventions
-
References
References
Baker, D.
(
2019)
Using narrative to construct accountability in cases of death after police contact.
Australian & New Zealand Journal of Criminology, 52(1), 60–75.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Barone, S. and Lazzaro-Salazar, M.
(
2015)
‘Forty bucks is forty bucks’: An analysis of a medical doctor’s professional identity.
Journal of Language and Communication, 431, 27–34.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Bamberg, M., & Georgakopoulou, A.
(
2008)
Small stories as a new perspective in narrative and identity analysis.
Text & Talk, 28(3), 377–396.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Cappuccio, A., Latella, M., Pelaia, G., Menzella, F., Pellegrini, G., & Marini, M. G.
(
2017)
Narrative medicine to evaluate the relationship between clinicians and patients living with severe asthma. Eur Respir J., 50 (suppl 61):A2779.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Castonguay, J., Filer, C., & Pitts, M.
(
2016)
Seeking help for depression: applying the health belief model to illness narratives.
Southern Communication Journal, 81(5), 289–303.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Charon, R.
(
2001)
Narrative medicine: form, function, and ethics.
Annals of Internal Medicine, 134(1), 83–87.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Fook, J., Ryan, M., & Hawkins, L.
(
2000)
Professional expertise: Practice, theory and education for working in uncertainty. London: Whiting & Birch.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Goffman, E.
(
1959)
The Presentation of Self in Everyday Life. New York: Doubleday Anchor Books.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Greenhalgh, T.
(
1999)
Narrative based medicine in an evidence based world.
British Medical Journal, 318(7179), 323–325.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Hardy, S., Garbett, R., Titchen, A., & Manley, K.
(
2002)
Exploring nursing expertise: nurses talk nursing.
Nursing Inquiry, 9(3), 196–202.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Hartwell, S.
(
2002)
Classes and Collections: How Clinicians Feel Differently.
Clinical Law Review, 91, 463–493.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Holmes, J., & Meyerhoff, M.
(
1999)
The community of practice: Theories and methodologies in language and gender research.
Language in Society, 28(2), 173–183.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Holmes, J., & Stubbe, M.
(
2003)
Doing disagreement at work: A sociolinguistic approach.
Australian Journal of Communication, 30(1), 53–77.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Holmes, J., Marra, M., & Vine, B.
(
2011)
Leadership, Discourse, and Ethnicity. Oxford: Oxford University Press.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Holmes, J., Marra, M. and Lazzaro-Salazar, M.
(
2017)
Negotiating the Tall Poppy Syndrome in New Zealand workplaces: women leaders managing the challenge.
Journal of Gender and Language, 11(1), 1–29.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Hunter, K., & Montgomery, K.
(
1993)
Doctors’ stories: The narrative structure of medical knowledge. Princeton: Princeton University Press.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Johnstone, B.
(
2016)
‘Oral versions of personal experience’: Labovian narrative analysis and its uptake.
Journal of Sociolinguistics, 20(4), 542–560.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Khan, M.
(
2019)
The Perspective of Medical Communication on the Biomedical Model of Practice and Patient Centeredness: A Review of the Language of Medical Case Presentation Genre.
International Journal of Linguistics, Literature, and Translation, 2(3), 71–80.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Kjaerbeck, S.
(
2008)
Narratives as a resource to manage disagreement: Examples from a parents’ meeting in an extracurricular activity center.
Text & Talk, 28(3), 307–326.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Labov, W., & Waletzky, J.
(
1967)
Narrative analysis: Oral versions of personal experience. In
Jean Helm (ed.),
Essays on the verbal and visual arts, (pp. 12–44). Seattle: University of Washington Press.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Lazzaro-Salazar, M.
(
2013)
Investigating Nurses’ Professional Identity Construction in Two Health Settings in New Zealand (Unpublished doctoral dissertation). Victoria University of Wellington, New Zealand.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Lazzaro-Salazar, M.
(
2016)
Downscaling culture in intercultural communication: The case of nurses’ professional values in New Zealand. In
Dorottya Cserző,
Argyro Kantara &
Jaspal Singh (Eds.),
The journey is its own reward: Downscaling culture in Intercultural Communication Research (pp. 114–140). Cambridge: Cambridge University Press.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Lazzaro-Salazar, M.
(
2017)
Ingroups and outgroups in complaints: Exploring politic behaviour in nurses’ discourse.
Logos: Revista de Lingüística, Filosofía y Literatura, 27(2): 319–333.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Lazzaro-Salazar, M.
forthcoming).
Advice-giving in nursing teams: Managing face threats while promoting collaborative work in (inter?)cultural contexts. In
Gillian Martin &
Jonathan Crichton Eds.
The Handbook of Intercultural Communication in Health Care Section 5: Teams and Collaboration Berlin De Gruyter
Lazzaro-Salazar, M., Holmes, J., Marra, M., & Vine, B.
Lazzaro-Salazar, M., & Zayts, O.
forthcoming).
Migrant doctors’ narratives about patients: A study of professional identity in Chile and Hong Kong.
Marra, M., & Lazzaro-Salazar, M.
(
2018)
Ethnographic methods. In
Andreas Jucker,
Klaus Schneider and
Wolfram Bublitz (Eds.),
De Gruyter Handbook of Methods in Pragmatics (pp. 343–366). Berlin: de Gruyter.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Mønsted, T., Reddy, M., & Bansler, J.
(
2011)
The use of narratives in medical work: A field study of physician-patient consultations. In
ECSCW (Ed.), Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24–28 September 2011, Aarhus Denmark (pp. 81–100). London: Springer.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Moore, E.
(
2006)
‘You tell all the stories’: Using narrative to explore hierarchy within a Community of Practice 1.
Journal of Sociolinguistics, 10(5), 611–640.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Norrick, N.
(
2013)
Narratives of Vicarious Experience in Conversation.
Language in Society, 42(4), 385–406.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Orr, J. E.
(
1996)
Talking about machines: An ethnography of a modern job. Ithaca, NY: Cornell University Press.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Patterson, E., McIntire, A., Beecroft, N., Happ, M., & Moffatt-Bruce, S.
(
2019)
Nursing Handovers in Critical Care: A Retrospective Analysis of Information Content and Function. In
Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care (Vol. 8(1), pp. 4–8). Sage, Los Angeles, CA: SAGE Publications.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Peterkin, A.
(
2011)
Primum non nocere: on accountability in narrative-based medicine.
Literature and Medicine, 29(2), 396–411.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Pomata, G.
(
2014)
The medical case narrative: Distant reading of an epistemic genre.
Literature and Medicine, 32(1), 1–23.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Prince, G.
(
1983)
Narrative pragmatics, message, and point.
Poetics, 12(6), 527–536.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Robertson, P., Barnao, M., Ward, T., Birgden, A., Casey, S., & Guardagno, B.
(
2020)
Clinicians’ perspectives of forensic rehabilitation.
Psychiatry, Psychology and Law, 27(1), 138–154.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Sackett, D.
(
1997)
Evidence-based medicine.
Seminars in Perinatology, 21(1), 3–5.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Sarangi, S., & Roberts, C.
(
1999)
Talk, work and institutional order: Discourse in medical, mediation and management settings. (Vol. 1). Berlin: De Gruyter Mouton.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Schiffrin, D.
(
1996)
Narrative as self portrait: The sociolinguistic construction of identity.
Language in Society, 25(2), 167–203.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Schuck, P.
(
2008) “
Tort Reform, Kiwi-Style”. Faculty Scholarship Series.
Paper 1679.
[URL]
Shaw, S., Russell, J., & Greenhalgh, T.
(
2011)
Shaping healthcare planning in England: front stage and back stage language play. Conference Proceedings, The Impact of Applied Linguistics, 109. Proceedings of the 44th Annual Meeting of the British Association for Applied Linguistics, University of the West of England.
Taylor, B.
(
2006)
Reflective Practice: A Guide for Nurses and Midwives. Maidenhead: Open University Press.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Trudgill, P.
(
2003)
A glossary of sociolinguistics. Oxford: Oxford University Press.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
van Leeuwen, T.
(
2008)
Discourse and practice: New tools for critical discourse analysis. Oxford: Oxford University Press.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Wallace, I., Barratt, H., Harvey, S., & Raine, R.
(
2019)
The impact of Clinical Nurse Specialists on the decision making process in cancer multidisciplinary team meetings: A qualitative study.
European Journal of Oncology Nursing, 431, 101674.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Wenger, E., McDermott, R., & Snyder, W.
(
2002)
Cultivating communities of practice: A guide to managing knowledge. Cambridge: Harvard Business Press.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Wittich, C. M., Szostek, J. H., Reed, D. A., Kiefer, J. L., Mueller, P. S., Mandrekar, J. N., & Beckman, T. J.
(
2013)
Measuring Faculty Reflection on Medical Grand Rounds at Mayo Clinic: Associations With Teaching Experience, Clinical Exposure, and Presenter Effectiveness.
Mayo Clinic Proceedings, 88(3), 277–284.
![DOI logo](https://benjamins.com/logos/doi-logo.svg)
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Zayts, O., & Lazzaro-Salazar, M.
(
2020)
Healthcare communication in multicultural contexts: Exploring professional mobility. In
Zsófia Demjén (Ed.),
Applying Linguistics in Illness and Healthcare Contexts (pp. 299–325). London: Bloomsbury.
![Google Scholar](https://benjamins.com/logos/google-scholar.svg)
Cited by
Cited by 1 other publications
Lazzaro-Salazar, Mariana
2021.
Humour as Cultural Capital in Transitions. In
The Palgrave Handbook of Humour Research,
► pp. 113 ff.
![DOI logo](//benjamins.com/logos/doi-logo.svg)
This list is based on CrossRef data as of 11 november 2021. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers.
Any errors therein should be reported to them.