Abstract
During healthcare visits, medical providers must attend to multiple agendas, including those of their patients and their organizations. A discussion of professional competency, then, must consider how nurse practitioners (NPs) attend to their organizational responsibilities in their interactions with patients. Following from Goffman’s (The presentation of self in everyday life, Random House, 1959) frontstage/backstage dichotomy, this chapter addresses how interactional practices often involve attending to organizational responsibilities and how this ‘backstage’ work gets accomplished in ‘frontstage’ interactions. In outpatient settings, the ‘backstage’ practice of interacting with patients’ electronic medical records overlaps with provider–patient interactions; in inpatient settings, the ‘backstage’ organizational work involves efforts at coordinating care with other providers, family members, and outside organizations, all of which reflects an NP’s professional competency during ‘frontstage’ encounters.
This is a preview of subscription content, log in via an institution to check access.
Notes
- 1.
Karen’s formulation seems to suggest that Mr. Franklin was formerly a drinker but had stopped at some point in the past. As the transcript indicates, the notes in the EMR simply state ‘none.’ One of the critiques of EMRs , by providers, is that they often do not offer space for elaboration or notes (personal communication). This may be case here as Karen either confuses Mr. Franklin with another patient or makes an assumption that he previously drank, and without the opportunity to include these types of notes in his EMR , she only has the word ‘none’ to rely on. Further, because she only sees him once a year, it is likely that she would not remember details of prior conversations with him.
- 2.
The use of ‘we’ in line 3 could also reference the team (‘we got all the confirmation we need’). As discussed in Defibaugh (2014), the use of second-person plural pronouns often have the effect of bringing the patient into the decision-making process. It is unclear, here, whether the ‘we’ refers to June and Mr. Clark, June and Dr. Jacobs, or all three.
- 3.
In line 19, June suggests that there are ‘two different things’ she can do to address Mr. Harris’ prescription needs; however, the conversation moves away from this topic and she never returns to the second option; therefore, it is unclear what her alternate solution is.
References
Atkinson, J. M. (1982). Understanding formality: The categorization and production of ‘formal interaction. British Journal of Sociology, 33(1), 86–117.
Atkinson, P. (1999). Medical discourse, evidentiality, and the construction of professional responsibility. In S. Sarangi & C. Roberts (Eds.), Talk, work, and institutional order (pp. 75–108). Berlin: Mouton de Gruyter.
Boyd, E., & Heritage, J. (2006). Taking the history: Questioning during comprehensive history-taking. In J. Heritage & D. W. Maynard (Eds.), Communication in medicine (pp. 151–184). Cambridge: Cambridge University Press.
Cazden, C., & Beck, S. (2008). Classroom discourse. In A. C. Graesser, M. A. Gernsbacher, & S. R. Goldman (Eds.), Handbook of discourse processes (pp. 165–198). Mahwah, NJ: Lawrence Erlbaum Publishers.
Cook-Gumperz, J., & Messerman, L. (1999). Local identities and institutional practices: Constructing the record of professional collaboration. In S. Sarangi & C. Roberts (Eds.), Talk, work, and institutional order (pp. 145–183). Berlin: Mouton de Gruyter.
Defibaugh, S. (2014). Solidarity and alignment in nurse practitioner/patient interactions. Discourse & Communication, 8(3), 260–277.
Goffman, E. (1959). The presentation of self in everyday life. New York: Random House.
Greatbatch, D. (2006). Prescriptions and prescribing: Coordinating talk- and text-based activities. In J. Heritage & D. W. Maynard (Eds.), Communication in medicine (pp. 313–339). Cambridge: Cambridge University Press.
Hall, C., Sarangi, S., & Slembrouck, S. (1999). The legitimation of the client and the profession: Identities and roles in social work discourse. In S. Sarangi & C. Roberts (Eds.), Talk, work, and institutional order (pp. 293–322). Berlin: Mouton de Gruyter.
Kak, N., Burkhalter, B., & Cooper, M. (2001). Measuring the competence of healthcare providers. Operations Research Issue Paper, 2(1). Bethesda, MD: Published for the U.S. Agency for International Development (USAID) by the Quality Assurance (QA) Project.
Koester, A. (2010). Workplace discourse. London: Continuum.
Mishler, E. (1984). The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex.
O’Malley, A. S., & Cunningham, P. J. (2009). Patient experiences with coordination of care: The benefit of continuity and primary care physician as referral source. Journal of General Internal Medicine, 24(2), 170–177.
Office of the National Coordinator for Health Information Technology. (2016). Office-based Physician Electronic Health Record Adoption. Health IT Quick-Stat No 50. dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php
Ross, A. J., Anderson, J. E., Kodate, N., Thompson, K., Cox, A., & Malik, R. (2014). Inpatient diabetes care: Complexity, resilience and quality of care. Cognition, Technology & Work, 16(1), 91–102.
Sarangi, S., & Roberts, C. (1999). The dynamics of interactional and institutional orders in work-related settings. In S. Sarangi & C. Roberts (Eds.), Talk, work, and institutional order (pp. 1–57). Berlin: Mouton de Gruyter.
Schnurr, S. (2013). Exploring professional communication: Language in action. Abingdon, Oxon: Routledge.
Soudi, A. (2013). Competing lines of action: A sociolinguistic approach to the human-computer interface in doctors’ consultations. Unpublished doctoral dissertation, University of Pittsburgh, Pittsburgh, PA.
Stille, C. J., Jerant, A., Bell, D., Meltzer, D., & Elmore, J. G. (2005). Coordinating care across diseases, settings, and clinicians: A key role for the generalist in practice. Annals of Internal Medicine, 42, 700–708.
Svennevig, J. (2011). Leadership style in managers’ feedback in meetings. In J. Angouri & M. Marra (Eds.), Constructing identities at work (pp. 17–39). London: Palgrave Macmillan.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2018 The Author(s)
About this chapter
Cite this chapter
Defibaugh, S. (2018). Frontstage/Backstage: Attending to Organizational Responsibilities. In: Nurse Practitioners and the Performance of Professional Competency. Communicating in Professions and Organizations. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-68354-6_2
Download citation
DOI: https://doi.org/10.1007/978-3-319-68354-6_2
Published:
Publisher Name: Palgrave Macmillan, Cham
Print ISBN: 978-3-319-68353-9
Online ISBN: 978-3-319-68354-6
eBook Packages: Social SciencesSocial Sciences (R0)