Accommodative competence: A Communication Accommodation Theory approach to language and communication training in nursing

Date: 20 November 2018

Venue: Stadscampus, Grauwzusters Barokzaal - Lange Sint-Annastraat 7 - 2000 Antwerpen (route: UAntwerpen, Stadscampus)

Time: 5:00 PM - 7:30 PM

PhD candidate: Marilize Pretorius

Principal investigator: Prof Kris Van de Poel

Short description: PhD defence Marilize Pretorius (Linguistics) - Faculty of Arts


Accommodative competence: A Communication Accommodation Theory approach to language and communication training in nursing

Effective and appropriate communication in the nursing context is essential to the safety, care, treatment and well-being of patients. Language-discordance (i.e. where one or both interactants use an additional language) in the healthcare context is becoming nearly unavoidable due to the high mobility of both nursing professionals and patient populations. When language discordance impedes nurse-patient interaction, negative consequences can ensue. There is extensive descriptive research on the problems and consequences of language-discordant nurse-patient interactions in the healthcare, applied linguistic and communication literature, which has repeatedly emphasised the need for language and communication training for nursing (pre-)professionals. By comparison, research that puts forward and defends solutions to the problems outlined in the literature is scarce. Furthermore, the utility and validity of training programmes that have been reported on remain in question.

In this thesis I test a model for the design of language- and communication-training programmes for nursing (pre-)professionals based on communication accommodation theory. Communication accommodation theory can be conceptualised as a theory pertaining to competence in adjusting communicative behaviour to accommodate others. The purpose of accommodation is to manage comprehension, communicative efficiency, identity and social distance. Accommodating to patients in communication can be seen as an essential part of providing nursing care. Competently accommodating to patients when using an additional language to communicate, requires at least two types of accommodative resources: 1) communicative competence in an additional language, and 2) awareness and perspective-taking skills to enable nursing (pre-)professionals to gauge whether the use of their communicative behaviour in the additional language has been perceived as accommodative. This thesis focuses on the factors that may determine or influence whether nursing (pre-)professionals’ use of an additional language is perceived as accommodative.

The participants consisted of nursing (pre-)professionals working in multilingual, multicultural hospitals in South Africa, nursing students from Belgium undergoing English language and communication training, and internationally educated nurses, who speak English as an additional language, working in the United Kingdom. Various methodologies and tools were employed to investigate factors that affect perceptions and evaluations of the language-discordant nurse-patient interactions and the interactants as (non)accommodative

The factors identified can be grouped into two categories: 1) awareness of context and 2) perceptions of self and others. Awareness of context includes tapping into a) intergroup and b) interpersonal history. The former relates to being sensitive to intergroup identities, such as linguistic and cultural identities, as well as the roles that patients and nursing (pre-)professionals take on in the healthcare context. Interpersonal history, which pertains to the degree of nurse-patient rapport that already exists, can mitigate the effects of potentially negative associations with cultural or linguistic identities, and with healthcare-specific roles.

Nursing (pre-)professionals’ perceptions of patients’ affect and evaluations in language-discordant nurse-patient interactions, in comparison to their own affect and evaluations, motivates the nursing (pre-)professionals’ to develop and use strategic competence to solve communication problems caused by language discordance. Also, nursing (pre-)professionals tend to be unaware of their actual communicative competence; self-perceived communicative competence affects the manner in which they draw from their limited communicative competence to accommodate to their patients. However, raising nursing (pre-)professionals’ awareness about their actual communicative competence can lead to increased communicative confidence and self-efficacy beliefs; it can also increase the use of previously under-utilised communicative competence resources, which is the result of an under-estimation of competence. Also, gaining a more accurate perspective of their communicative competence can point nursing (pre-)professionals to their language and communication learning needs, while curtailing potentially noncaccommodative communicative behaviour resulting from an over-estimation of competence.

The salient factors and components have been incorporated into a model of accommodative competence for nursing (pre-)professionals. From the model, pedagogic implications and guidelines have also been derived for the design and implementation of training in accommodative competence. The training model focuses not only on communicative competence, but also on the awareness and perspective-taking skills that facilitates the strategic use of their communicative competence to accommodate to patients. In this way, the accommodative competence training model can be used to help nursing (pre-)professionals become more competent, confident and accommodative professionals.

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