medical discourse community essay

Academic Support for Nursing Students

No notifications.

Disclaimer: This essay has been written by a student and not our expert nursing writers. View professional sample essays here.

View full disclaimer

Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. This essay should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date.

Discourse Communities in Nursing

Info: 2638 words (11 pages) Nursing Essay Published: 11th Feb 2020

Reference this

If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help!

Our nursing and healthcare experts are ready and waiting to assist with any writing project you may have, from simple essay plans, through to full nursing dissertations.

• “Introduction to Advanced Public and Community Health Nursing Practice.”  Advanced Public and Community Health Nursing Practice , doi:10.1891/9780826138446.0001.
• Morris, Jenny, et al. “NSW Emergency Department Workforce Research Project and Workforce Analysis Tool.”  Australasian Emergency Nursing Journal , vol. 13, no. 4, 2010, p. 137., doi:10.1016/j.aenj.2010.08.266.
• Potter, Patricia Ann, et al.  Fundamentals of Nursing . Mosby Elsevier, 2017.
• Swales, John M. “Reflections on the Concept of Discourse Community.”  ASp , no. 69, Sept. 2016, pp. 7–19., doi:10.4000/asp.4774.
• Taylor, Pauline, and Narelle Patton. “Practice Communities and Leaders.”  Professional Practice Discourse Marginalia , 2016, pp. 213–222., doi:10.1007/978-94-6300-600-2_25.
• Wardle, Elizabeth.  Writing about Writing: a College Reader . Bedford Bks St MartinS, 2017.

Cite This Work

To export a reference to this article please select a referencing stye below:

Related Services

• Nursing Essay Writing Service

• Nursing Dissertation Service

• Reflective Writing Service

DMCA / Removal Request

If you are the original writer of this essay and no longer wish to have your work published on the NursingAnswers.net website then please:

Our academic writing and marking services can help you!

• Marking Service
• Samples of our Work
• Full Service Portfolio

Related Lectures

Study for free with our range of nursing lectures!

• Drug Classification
• Emergency Care
• Health Observation
• Palliative Care
• Professional Values

Write for Us

Do you have a 2:1 degree or higher in nursing or healthcare?

Study Resources

Free resources to assist you with your nursing studies!

• APA Citation Tool
• Example Nursing Essays
• Example Nursing Assignments
• Example Nursing Case Studies
• Reflective Nursing Essays
• Nursing Literature Reviews
• Free Resources
• Reflective Model Guides
• Nursing and Healthcare Pay 2021

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

Response—A Critical Response to “Discourse Communities and the Discourse of Experience”

Paul macneill.

Sydney Health Ethics, University of Sydney, Sydney, NSW 2006 Australia

In their article Little, Jordens, and Sayers developed the notion of “discourse communities”—as groups of people who share an ideology and common “language”—with the support of seminal ideas from M.M. Bakhtin. Such communities provide benefits although they may also impose constraints. An ethical community would open to others’ discourse and be committed to critique. Those commitments may counter the limitations of discourse communities. Since their paper was published in 2003, the notion of “discourse communities” has been widely adopted and applied in healthcare and beyond. Their ideas were influential in the founding of an ethics centre in Sydney and contributed to articulating the values which underpin this journal. This commentary notes that an ethical community is fragile in responding to current onslaughts on truth and meaning—potencies inherent in discourse communities. The essay takes Bakhtin’s ideas further to explore intrinsic forces at play in dialogue, language, and art. This leads to discussing the centrality of ethics in Bakhtin’s thought. For him, the essence of discourse is a dialogic exchange which comprises both art and ethics. It is art in that self and other are created in the exchange. It is ethical in that “I” am answerable to the other, as a phenomenological reality, in the moment of intersubjectivity.

Introduction

This Critical Response to “Discourse communities and the discourse of experience” (Little, Jordens, and Sayers 2003 ) is presented in the following sections:

• A. Travelling with the authors in exploring discourse communities;
• B. Exploring the nature of those communities, as the authors conceive of them, in terms of both the needs and purposes they serve and their constraints on members;
• C. Considering the extent to which discourse communities may have served the needs and ideals of the authors themselves—which leads into discussing “the possibility of an ethical community”—and what would be required of such a community;
• D. Discussing the ideologies and values (and fragility) of discourse communities in responding to a current onslaught on truth and meaning; and
• E. Returning to the Russian theorist—M.M. Bakhtin—from whom the authors drew seminal ideas in support of their approach to discourse communities.

The commentary concludes by proposing a further journey—to the interior of the terrain that Bakhtin explored—by drawing on his view of ethics and aesthetics in the moment of intersubjectivity.

A. Discourse Communities

In the “Discourse communities” paper, the authors developed a notion of discourse communities as groups of people who share an ideology that is expressed in a common vocabulary of words with meanings that are understood in the same way by members of that group. The examples they give include the medical profession whose members “share common concepts of disease-causation and disease treatment” (74) along with other professions and members of trade groups such as plumbers and electricians. Discourse communities also include less clearly defined groups such as racists or postmodernists; and followers of a particular religion, members of church groups, family groups, and those with sporting affiliations. Membership within each community is “defined by a particular use of language” (74). Understood in this way, it is apparent that most of us belong to many discourse communities: as family members, members of professional or trade groups, religious followers (or resolute atheists), and aficionados of one or more sporting codes.

The authors observe that each of these communities “draw on the same linguistic resources, the same lexicon and grammar, but construe meanings in different ways” (80). Yet we move between these communities easily and understand the same words as having different meanings within the context of each discourse community. A word—such as “shock”—will be understood among family members and friends differently from the way it is understood by doctors, seismologists, or electricians.

There is also a suggestion in this paper, that membership of different discourse communities may shape the way in which we experience events in our lives or at least the way in which we describe those experiences, although they step carefully around the “epistemological status of experience” whilst acknowledging experience is important as “the matrix upon which meaning and values are mounted” (77, 78). 1 The authors remark that “extreme experience,” such as torture, natural disasters, or suffering cancer, can alter one’s thinking, perceptions, and memories and be accompanied by an immediacy of intense emotions “that cannot be freely communicated to others who have not had similar experiences” (76). Extreme experience “challenges our sense of identity in all its elements” (76) leaving us vulnerable and exposed.

The paper emerged from the authors’ work with cancer survivors and their carers. They observed different discourse communities in that context and differences in the discourse of those communities in speaking of cancer. Cancer patients and their lay-carers spoke of their experience as “victims of circumstance, people to whom things happen” (78) and as being caught in systems “over which they have little control” (78). By contrast Little et al. found that “Administrators, bureaucrats, business people, lawyers and insurance representatives” spoke “as agents of change to the systems in which they work” and of how “they made events into opportunities” (77-78). Doctors and other healthcare workers however, “tell stories which sit somewhere betwixt and between” (78). Whilst they are “clearly agents of change for their patients” and are “involved morally with the extreme experiences of their patients”, they are also “profoundly affected by the vagaries and demands of the administrative and economic systems within which they must work” (78). The proposition that emerges from this analysis is that the “basic division between discourse communities has to be recognized and understood before there can be any prospect of real dialogue between the representatives of different interests in health care” (79).

Since this paper was published, the idea of discourse communities has been adopted widely in the literature. There have been numerous citations. 2 Many of them relate directly to its basic proposition—the need for recognition of differences between different discourse communities within healthcare as a means for promoting dialogue between them (Christine, 2016 ; Kvarnström and Cedersund, 2006 ; Torjuul, 2009 ). The notion has been applied to indigenous health in a study of cultural differences between health professionals providing cancer care to Aboriginal people (Newman et al. 2013 ).

Beyond health, the “Discourse communities” paper has been referred to across a wide variety of topics. These include the “troubles” in Ireland (McAuley and Tonge 2011 ; Tonge et al. 2013 ); alcohol use among college students in the mid-West of the United States (Russell and Arthur 2016 ); masculinity, crime, and culture in Australia (Seidler 2010 ); and theology: understanding the reintegration of marginalized widows in the Old Testament (Ruth and Naomi) in terms of their acceptance into discourse communities (Matthews 2006 ). It is readily apparent that the notion of discourse communities has broad appeal and application. It is an idea that—having been disseminated—appears blindingly obvious. Yet it was not (apparently) so obvious back then, or had not been so clearly articulated, prior to its publication by Little, Jordens, and Sayers in 2003.

B. Discourse Communities: Needs and Purposes and Concomitant Constraints

Discourse communities fulfil a basic need in that, as “social and societal animals,” most of us “feel the need to be members of communities” and belong to groups “that ‘speak the same language’. There is comfort in belonging” (74, 80). However, there are also risks. As they put it, “Membership … potentially constrains what we should think” (74) or at least constrains what we say we think. The authors refer to this as a colonizing process in which we are obliged to understand and speak in words with fixed meanings and limited usages. In some cases, “discourse communities … can easily slip from benign intent into exploitation” (82) leading vulnerable people, such as those discussed above, to a sense of being “victims of circumstance” (73). This is also reported by patients with Type 2 diabetes (Parry et al. 2006 ); and by injured, unwell, and disabled employees in an international IT company (Allender, Colquhoun, and Kelly 2006 ).

The authors note that the communicative problems between different discourse communities in health are sustained by a “demotic, centrifugal force” which supports difference and keeps things apart. This is a reference to the work of Russian literary critic M.M. Bakhtin. The authors also refer to a counter force as “a multiplicity of social voices and a wide variety of their links and interrelationships”—again a reference to Bakhtin (Bakhtin and Holquist 1981 263). These include “healing narratives which may restore autonomy to the disempowered” (Little, Jordens, and Sayers 2003 , 75). Although the authors draw on Bakhtin’s ideas, I have left a more detailed treatment of his ideas until the last two sections of this critical response because I want to place Bakhtin in the context of his discourse, rather than confine his ideas to supporting the notion of discourse communities, as the authors have done—as was appropriate to their purpose. 3

My point here is that there are other forces at work which counter the pull toward identifying solely with a particular community. We could refer to them as “centripetal forces that strive to make things cohere” (Bakhtin and Holquist 1981 , xviii). A “centripetal force” moves toward a centre (OED), which is an apt description of the force prompting these authors to explore the possibility of an ethical community.

C. The Possibility of an Ethical Community

The biographical notes which accompany this paper describe Emma-Jane Sayers as a cancer survivor. She has been on the executive of “an organization that provides support services for young adults diagnosed with cancer. She represents cancer survivors on a number of national organizations in Australia” (86). One might assume that Emma-Jane had opportunities to share her experience of cancer with others who had similar experiences—an opportunity which (in the authors’ words) “can be liberating, and even therapeutic” (83). This is an example of a benefit that derives from belonging to a discourse community.

Emma-Jane was also uniquely placed to gain from speaking across discourse communities in that her work (with Miles Little and Christopher Jordens) included analysing interviews with cancer patients, clinical carers, and health policymakers. One benefit, from this broader view, is the “possibility of creative dialogue.” One can imagine that participating in their research provided Emma-Jane with the opportunity to understand what “care” meant within those different discourse communities, an understanding not easily gained by fellow members of a cancer survivor discourse community.

Professor Little, on retiring as a practising surgeon, set up the Centre for Values, Ethics and the Law in Medicine (VELiM) at the University of Sydney in 1996, as its Director (until 2003). It is apparent that the “Discourse Communities” paper is an expression of his deep commitment to open discourse. He had previously published Humane Medicine , a book which argued for a shift in emphasis from biomedicine to humane medicine (Little 1995 ). The values that are important to him were captured in the name of the Centre—with particular emphasis on values and ethics . Christopher Jordens joined the Centre in 1997, initially as a researcher on the various studies referred to in the “Discourse” paper. From 2006 he played a key role in setting up and running the postgraduate coursework programme in bioethics including major units of study. He was committed to the values of the Centre and particularly to the practice of conversation as “openness to one’s interlocutor: an openness that entails a risk: a risk that you’ll be changed by what they say” (Jordens 2021 ). Although their paper focusses on discourse , that can be understood within a wider commitment to open conversation . Chris Jordens, in a recent tribute to Miles Little, described him as “a practitioner of conversation.” This found expression in the Centre “in its research; in its teaching; in its consultation and public engagement and, more generally, in its collegial culture” (ibid). This has been my experience of the Centre also: conversation among colleagues sharing a common interest, conversation of the best kind—about important issues in medicine and healthcare—skilfully facilitated by Miles who invited and encouraged many perspectives within a supportive atmosphere.

These brief glimpses from the authors’ biographies provide some background and understanding of their commitment to the values expressed in the paper, most clearly in the section “The possibility of an ethical community.” An ethical community is presented as a “species of discourse community” which interrogates ideologies including its own. As an interdisciplinary community it would “not be committed to any one model of ethics” but would be committed to “processes of ethical examination using many models.” Its members would be open-minded and dedicated to examining “underlying values that sustain and justify ethical endeavour of all kinds.” It would also be practical in testing “its conclusions by political and social action … in the light of actual happenings and interactions” (82).

It is a remarkable achievement that VELiM—recently renamed “Sydney Health Ethics” (SHE)—has been sustained as an ethical community (in just this way) for twenty-five years. All things change however. Recent events threaten to undermine the community as a discrete entity. SHE has lost its formal status as a Centre, and its staff members have been relocated from a separate building and combined with staff of the School of Public Health. Whether or not it survives as an entity, its manifestation and its maintenance for twenty-five years has “spread … its sphere of influence” (Little, Jordens, and Sayers 2003 , 83). As Chris expressed this idea, it is an accomplishment that has created “the possibility of an enduring centre that is constituted if not through institutional recognition, then through (among other things) the practice of genuine conversation” (Jordens op. cit.).

D. Ethical Community in Relation to a Current Issue of Truth and Meaning

In the spirit of their paper, I want to test the “possibility of an ethical community” in responding to a current onslaught on truth and meaning. Mark Danner ( 2021 ) recently wrote of “Trump’s Big Lie that the election was stolen” and the subsequent ransacking of the Capitol Hill building. Yet “we have thus far ignored the truth.” The evidence of Trump’s complicity “did not persuade most of his supporters to abandon their overwhelmingly partisan version of events” (Section 1, ¶8 and 9). This is an example of the dark side of discourse communities, with dire consequences. “[T]here is no shared reality” about Capitol Hill. “Nor is there a shared reality about the integrity of the election or of the legitimacy of the president it produced. To millions of Americans the legitimate president remains Donald Trump” (Danner 2021 , Section 1, last para). This raises a profound question: Is there any basis for determining truth or facts upon which we may agree—beyond partisanship?

I have been considering that question in relation to the “the possibility of an ethical community.” Little, Jordens, and Sayers describe an ethical community as having “no special intellectual domain in which it operates. It would hold equal engagement with science, aesthetics, the spiritual, the human sciences and philosophy” (82-83). Whilst I applaud that as an ideal, it offers no firm foundation for determining a shared reality or even a basis for finding agreement over historical “facts” such as the holocaust or the ransacking of Capitol Hill. Admittedly, this is to raise fraught issues of epistemology and ontology going back to the beginnings of Greek philosophy. It is an issue that is well captured in the debate between Gadamer and Habermas last century (Mendelson 1979 ). I side with Habermas and accept that we are capable, through reflecting on our own prejudices (embedded as we are in an historical, cultural, and social position), of lessening their influence (Daniels 2020 ). As I read their paper, Little, Jordens, and Sayers also put their faith in this kind of reflection. Clearly (as they state) there are prerequisites: an open mind; a commitment to continual, reflexive critique; and a willingness to be seek out and replace fault and weakness. Not all of us possess those dispositions. Consequently, an ethical community is fragile, as is democracy in the face of the marauding herds. In a similar vein, the authors note that “Habermas has for many years examined the possible interface between discourse and ethics, and he knows well the difficulties of maintaining the force of critique in the interactions of politics” (83). Yet it is important to recognize these fragilities in order to bolster and maintain the virtues of openness and critique.

E. Discourse in the Novel: M.M. Bakhtin

The authors draw on M.M. Bakhtin for concepts relating to language, to substantiate their approach to discourse communities. Mikhail Mikhailovich Bakhtin (1895—1975) was a Russian philosopher, literary critic, and linguist who wrote voluminously, although much of his writing has been lost. That which has survived has garnered a late following among linguists and literary theorists beyond Russia. The lost material, and publication of his remaining texts, out of their chronological sequence, has however, “led to a partial view of Bakhtin, which obscured the centrality of ethics in his thought” (Çalişkan 2006 , 2).

Little et al. quote from Bakhtin’s essay “Discourse in the novel” which was published in English as one of four essays in The Dialogic Imagination (Bakhtin and Holquist 1981 ). They take the concept monoglossia from this essay to mean the particular language and expression that evolves within a single discourse community, and they contrast this with heteroglossia which recognizes discourse across many different communities. 4 In “Discourse in the novel” however, Bakhtin used the term heteroglossia as a characteristic feature of novels. Bakhtin was a critic of all previous attempts to systematize the novel as a genre—and drew attention to what is novel about novels: they break the conventions that traditional scholars had previously tried to impose on the novel (ibid 263). Discourse in the novel is heteroglossic in that the “novel orchestrates … the speech of characters” and many other elements and permits them to “enter the novel.” For Bakhtin, the “fundamental condition, that which makes a novel a novel … is the speaking person and his discourse ” (ibid, 332, italics in the original). This critique of literary analysis also extends to language itself. “Every concrete utterance of a speaking subject” contains a tension between conforming with normative standards of language ( monoglossia ) whilst also participating in “speech diversity” ( heteroglossia ) in that it is individualized (ibid, 272). Subjected to these dynamic forces, language is constantly evolving and breaking from the moulds of conventional analysis. It refuses to be confined by rules (of meaning, style, or grammar). This critique is equally applicable to ethics.

Discussion and Conclusion

In the Introduction I proposed a further journey—to the interior of the terrain that Bakhtin explored—by drawing on his view of ethics and aesthetics in the moment of intersubjectivity.

For Bakhtin, heteroglossia has a primary sense as a feature of any communicative exchange between two (or more) people. The word is a translation of the Russian raznorečie —from raznyĭ (meaning “other,” “separate,” “different,” or “various”) and reč (meaning “word” or “speech”). Any “speech act” or “utterance” is understood by Bakhtin as one side of a dialogue with an other “I.” If one is to relate to another “I” as a subject, not just as an object, then there is an “aesthetic invention” or act of creativity “that occurs between subjects in actual dialogues” (Nielsen 1995 , 807). Moreover, this is also an ethical exchange in the sense that one is answerable to the other. This is based on the phenomenological experience of dialogue with another. I speak in anticipation of the other’s response, and likewise that other anticipates mine. Without that “answerability” there is no genuine engagement. For Bakhtin, dialogue is both ethical and aesthetic. It is ethical in that one is answerable for one’s utterances and actions in relation to another (Bøe et al. 2013 ). And it is aesthetic in that the exchange is also an act of self and other creativity. More precisely, the dialogue is “trans-subjective” in the sense that both self and other are subjects (ibid). Yet both are also objects to each other. My image of you, and yours of me, are influential and creative in the exchange.

The implications of Bakhtin’s view of self, art, and answerability, are radical. 5 In one of his earlier works, Bakhtin had asked, “what guarantees the inner connection of the constituent elements of a person? Only the unity of answerability” (Bakhtin 1990 , 1). His conception is also radical in that self is ever in flux: “I occupy a place in once-occurrent Being that is unique and never-repeatable, a place that cannot be taken by anyone else and is impenetrable for anyone else” (Bakhtin 1993 , 40). These ideas are consistent with his critique of all attempts to systematize the novel as a genre and to systematize language itself. There are opposing and dynamic forces at work in the very instant of discourse, and these forces break the containment of any system. He is similarly critical of grand systems in ethics. There could be no authentic ethics founded on morality external to oneself (such as Kant’s categorical imperative) because it would require dying as an individual. For Bakhtin “ethics must start from the unique and once-occurent human deed—my own individually” (Çalişkan 2006 , 4).

I have previously argued for balancing normative ethics by sensing the aesthetic and by understanding ethics as art (Macneill 2014 , 2017 , and 2020 ). Bakhin takes such notions much further. Ethics is art in a profound sense, in that one’s self and others are created (and re-created) in dialogical exchanges. What makes that art profoundly ethical is that “I” am answerable to others in those exchanges, and continue to be answerable across a flux of time. In this sense, Bakhtin’s ideas are revolutionary. In putting them forward, I am emboldened by Little, Jordens, and Sayers’ open-minded commitment to examining many models of ethics. The influence of these authors and the values of the community they founded—along with the values of the Otago Bioethics Centre—are evident in the commitment of the Journal of Bioethical Inquiry to ethics as “dialogue” and to promoting understanding by listening to “diverse voices in a global conversation [across] geographical borders” ( Journal of Bioethical Inquiry 2021 ). Given those values, Bakhtin’s ethical understandings are worthy of examination by the journal’s wide community of readers.

Open Access funding enabled and organized by CAUL and its Member Institutions.

1 To express that idea through the words of one commentator: experience is “a template upon which people’s personal values and subjective feelings are based” (Samanhudi 2020 , 50).

2 From a search, across both ResearchGate and Google Scholar, I substantiated 54 references comprising 33 journal articles (not including those by the authors and associates), 10 books, and 11 theses (including PhD and Masters dissertations) from across widely dispersed geographical areas.

3 Little et al. are not the first authors to appropriate Bakhtin to their purpose. His ideas are “malleable” which is “part of the reason” that his “concepts can be revised, appropriated, and adapted” for other purposes (Cobb 2019 , 42).

4 Monoglossia derives from “mono” (single) and “glossia” (tongue, speech, or language). Heteroglossia derives from hetero (“other”) and means other language or speech. Bakhtin however, uses the term heteroglossia in a number of different senses.

5 In the space available, I am unable to more fully develop those implications, although I am doing so in a paper in preparation.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Allender S, Colquhoun D, Kelly P. Competing discourses of workplace health. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine. 2006; 10 (1):75–93. doi: 10.1177/1363459306058989. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bakhtin MM. Art and answerability: Early philosophical essays . Austin: University of Texas Press; 1990. [ Google Scholar ]
• ———. 1993. Toward a philosophy of the act . Austin: University of Texas Press.
• Bakhtin MM, Holquist M. The dialogic imagination: Four essays by M.M. Bakhtin . Austin: University of Texas Press; 1981. [ Google Scholar ]
• Bøe TD, Kristoffersen K, Lidbom PA, et al. Change is an ongoing ethical event: Levinas, Bakhtin and the dialogical dynamics of becoming. Australian and New Zealand Journal of Family Therapy. 2013; 34 (1):18–31. doi: 10.1002/anzf.1003. [ CrossRef ] [ Google Scholar ]
• Çalişkan S. Ethical aesthetics /Aesthetic ethics: The case of Bakhtin. Journal of Arts and Sciences. 2006; 5 :1–8. [ Google Scholar ]
• Christine J. Reconstructing medical practice: Engagement, professionalism and critical relationships in health care . London: Taylor and Francis; 2016. [ Google Scholar ]
• Cobb C. Theoretical foundations: Bakhtin and feminism. In: Cobbs C, editor. Slavery, gender, truth, and power in Luke-acts and other ancient narratives . Cham: Springer International Publishing; 2019. pp. 39–80. [ Google Scholar ]
• Daniels, N. 2020. Reflective equilibrium. In The Stanford Encyclopedia of Philosophy , edited by E.N. Zalta . Stanford, California: Stanford University. https://plato.stanford.edu/archives/sum2020/entries/reflective-equilibrium/ . Accessed July 12, 2021.
• Danner, M. 2021. Reality rebellion. The New York Review of Books, July 1. www.nybooks.com/articles/2021/07/01/reality-rebellion/ . Accessed November 12, 2021.
• Jordens, C.F.C. 2021. Tribute to Miles Little . Unpublished. Sydney Health Ethics, University of Sydney.
• Journal of Bioethical Inquiry . 2021. About us. https://bioethicalinquiry.com/about/ . Accessed July 12, 2021.
• Kvarnström S, Cedersund E. Discursive patterns in multiprofessional healthcare teams. Journal of Advanced Nursing. 2006; 53 (2):244–252. doi: 10.1111/j.1365-2648.2006.03719.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Little JM. Humane medicine . United Kingdom: Cambridge University Press; 1995. [ Google Scholar ]
• Little M, Jordens CFC, Sayers E-J. Discourse communities and the discourse of experience. Health. 2003; 7 (1):73–86. doi: 10.1177/1363459303007001619. [ CrossRef ] [ Google Scholar ]
• Macneill P, editor. Ethics and the arts . Netherlands: Springer; 2014. [ Google Scholar ]
• Macneill P. Balancing bioethics by sensing the aesthetic. Bioethics. 2017; 31 (8):631–643. doi: 10.1111/bioe.12390. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• ———. 2020. Biomedical ethics and the medical humanities: Sensing the aesthetic. In Handbook of medical humanities, edited by A. Bleakley, 332-343. New York and United Kingdom: Routledge.
• Matthews VH. The determination of social identity in the story of Ruth. Biblical Theology Bulletin. 2006; 36 (2):49–54. doi: 10.1177/01461079060360020101. [ CrossRef ] [ Google Scholar ]
• McAuley JW, Tonge J. The old order changeth—or not? Modern discourses within the Orange Order. In: Hayward K, O’Donnell C, editors. Political discourse and conflict resolution . London: Routledge; 2011. pp. 121–137. [ Google Scholar ]
• Mendelson J. The Habermas-Gadamer debate. New German Critique. 1979; 18 :44–73. doi: 10.2307/487850. [ CrossRef ] [ Google Scholar ]
• Newman CE, Gray R, Brener L, et al. One size fits all? The discursive framing of cultural difference in health professional accounts of providing cancer care to Aboriginal people. Ethnicity & Health. 2013; 18 (4):433–447. doi: 10.1080/13557858.2012.754408. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nielsen G. Bakhtin and Habermas: Toward a transcultural ethics. Theory and Society. 1995; 24 :803–835. doi: 10.1007/BF00994066. [ CrossRef ] [ Google Scholar ]
• Parry O, Peel E, Douglas M, Lawton J. Issues of cause and control in patient accounts of Type 2 diabetes. Journal of Health Education Research. 2006; 21 (1):97–107. doi: 10.1093/her/cyh044. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Russell LD, Arthur T. That’s what “college experience” is: exploring cultural narratives and descriptive norms college students construct for legitimizing alcohol use. Health Communication. 2016; 31 (8):917–925. doi: 10.1080/10410236.2015.1018700. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Samanhudi, U. 2020. New knowledge claims in discussions in applied linguistics research articles: A contrastive investigation of Indonesian and International journals . PhD dissertation. Queen’s University Belfast.
• Seidler K. Crime, culture & violence understanding how masculinity and identity shapes offending . Bowen Hills, Queensland: Australian Academic Press; 2010. [ Google Scholar ]
• Tonge J, Shirlow P, McGlynn C, McAuley J. Abandoning historical conflict?: Former political prisoners and reconciliation in Northern Ireland . Manchester University Press; 2013. [ Google Scholar ]
• Torjuul, K. 2009. Living with ethical dilemmas: The ethical reasoning of surgeons and nurses in surgical units. PhD dissertation. Universitetet i Tromsø, Tromsø, Norway.

FYC Journal

Juan Zarate – The Discourse Community of Rural Medicine

The Discourse Community of Rural Medicine

Juan Zarate

Introduction

A discourse community is “a group of people who share ways to claim, organize, communicate, and evaluate meanings” (Schmidt and Kopple 1). In other words, a discourse community is a group of people engaging in a topic of interest. Your friends, your family, your major field of study constitute a discourse community. A discourse community has an agreed set of ultimate purposes or goals. A group of biology students have common goals—to navigate the study of life and living organisms. A discourse community has varying forms of communications. For example, you will communicate with your friends in a different manner than communicating with your professors. Generally, we will text our friends and write papers and send emails for our professors in regards to the same topic. At home we learn to communicate in a different way that may be deemed as inappropriate in a professional/work/school setting. So how do we effectively communicate with different discourse communities? It all boils down to the art of rhetoric, “an art that enhances communication both within and between discourse communities” (Schmidt and Kopple 3). In my words, I think this means to step outside your discourse community and acknowledge the differences in order to comprehend the purpose of another discourse community. These groups of individuals develop and construct their own line of communication to address their needs that need to come to fruition to advance their main objective. For example, there are strikingly differences within the culture of medicine and each difference leads to a unique discourse community within the medical realm.

Over the past decades, rural medicine has evolved their own unique way of interacting with physicians and their patients. Dr. Acosta states, “I had to learn one language that got to the people because they would not understand what I was talking about. The flipside of that is that I also had to learn language by talking to the other physicians” (Acosta). Learning these two languages are an integral part of rural health discourse communities. Rural health care providers must be able to provide top quality, up to date services to the population, often go to the community to bring awareness of certain illnesses, and must be able to connect with a wide variety of people in the population. Dr. Acosta compares a rural area to a mixed bag which contains professors, teachers, high school dropouts, migrant farmworkers, etc. Bushy notes that there is no common culture among rural patients. Bushy states, “Every rural community is unique, with its own special (sub)groups’” (Bushy 255). Even with these differences, Dr. Acosta and Author Bushy agree that less populated areas experience disparities in regards to health care. Thus, it is imperative to provide health care that is appropriate to address the differences in socioeconomic status. Compared to their urban counterparts, rural health clients suffer from unique social, economic, and geographic elements in addition to shortages of health care professionals. It is these set of characteristics, along with others, which sets apart rural medicine from the broader medical field.

Rural medicine is a discourse community established within the medical field that caters to vulnerable populations that reside in areas with shortages of health professional. For this reason, rural patients tend to have poorer outcomes in their health compared to their urban counterparts. An all-encompassing definition of the term rural is one that includes both low “population density and cultural variations for the people who live there” (Bushy 255). Rural areas tend to have less than 100 people per square mile, are isolated, and have sparse resources. These underserved areas continue to grow every year, requiring more and more health care professionals to address the issues these communities face. The rural health discourse community does this through the use of different types of genres, genres defined as the “distinctive category of discourse of any type, spoken or written, with or without literary aspirations” (Swales 33). The genres to be examined in this study involve a large variety of literacies used within rural communities. The study of this discourse community is of interest to me, as I have been a part of a rural upbringing from a young age. Although I was raised in a rural area most of my life, it was only by studying rural health discourse communities where I began to understand severity of the issues present in many rural settings.

I conducted an interview with Dr. David Acosta, a family medicine physician who has eight years of experience working in rural communities.  Through an interview with Dr. David Acosta, I identified many of the of the genres the rural health community utilize to address issues evident in these rural settings such as, “availability of services, accessibility of services and acceptability of services” (Bushy 257-259). I began to take note of the different forms of communication and lexis the rural community utilizes in its inner workings. The main, overall objective of the interview was to inquire of the main genres that Dr. Acosta was exposed to during his interactions in a rural environment. Additionally, I wanted to learn about the forms of communication the health professionals used to communicate with other physicians and patients and to discuss whether they were effective in furthering the aims of rural medicine.

In addition to the interview, I researched a scholarly article written by Angeline Bushy and a grant writing blueprint offered by the National Rural Health Resource Center. The main objective of the scientific article was to inquire the issues many rural health professionals encounter when delivering health care in rural areas. Using the interview and the article, I was able to note many common themes laden in both sources. From these two sources, I was able to extract the values these two communities possess, along with genres utilized within this discourse community.

Grant Writing

Above is a snapshot of a grant writing checklist issued by the National Rural Health Center to aid grant applicants to write a federal grant proposal. The chart below highlights numerous components rural practitioner’s must contemplate to successful write a federal grant. For instance, the grant writer must have a level of rhetorical knowledge to persuade the grant reviewer to approve the grant proposal by using appropriate language in relation to grant reviewers. In addition, the health care professional must collect, analyze, and evaluate the population’s needs and express them appropriately through the narrative portion of the grant. The federal grant writing manual delves in depth by noting parts of the proposal such as, the project narrative and the budget narrative. The chart above serves as a blueprint for the applicant to stay organized and focused during the grant writing process.

Genres for Patients

One of the main goals of this discourse community is to successfully permeate the medical information from the language of the physicians to the language of the patients. When asked about strategies for communicating with patients, Dr. David Acosta stated, “We wrote a weekly column in the newspaper we had about medicine. I also had to go on the radio and be interviewed by people about the importance of flu shots and the statistics in town” (Acosta). For services to be perceived as available, the target’s population limitations must be carefully considered when producing media to improve knowledge in the community. For instance, due to limited channels on television in rural communities, Dr. Acosta turned to the local newspaper to reach the patient population. In the weekly column titled “To Your Health”, Dr. Acosta informed the rural population about diet, exercise, flu immunizations, and diabetes. Bushy argues the importance of considering the cultural beliefs of the clients to communicate effectively. Beliefs such as the “clients’ ideas about hygiene, nutrition, exercise, when to seek professional health, how to interact with health professionals, and whether to follow medical advice” (Bushy 254). Both Dr. Acosta and Bushy respect the patient’s health beliefs to construct effective ways of communication. To inform patients about health education, Dr. Acosta used genre such as, flyers, pamphlets, and handouts. Within the genres he used for health education, Dr. Acosta had to consider the effectiveness of these genres. For example, Dr. Acosta had to consider numerous issues such as, the reading level of the patient and whether the visuals were effective. In exam rooms, Dr. Acosta made sure the patients were exposed to bullet boards with information on how to take care of themselves. Additionally, like previously stated, he would go on the radio to discuss medical topics with the community.

Genres for Physicians

Besides producing genres for the patient population, Dr. Acosta had to learn the language of the physicians.  Dr. Acosta acknowledged that to assume membership within this discourse community, one needed a certain level of expertise such as a medical degree. Because it was an evidence-based-medical field, some of the older physicians in town did not have the new expertise but relied heavily on the old practice. This, in turn, created animosity between the newer doctors and the older doctors. The trained physicians constantly informed themselves through medical literature and a weekly or monthly subscription to medical journals. From the interview, I gathered that most physicians communicated through a variety of genres. In medical staff meetings, physicians discussed, over lunch, topics or issues facing the rural community. Through state meetings, doctors would compare notes and talk about malpractice coverage. According to Dr. Acosta, it was important to understand the needs of all the groups in the rural community, especially the underprivileged groups. Thus, it is imperative for physicians to serve in leadership roles through the creation of committees in hospitals.

The investigation revealed the main reason behind the success of rural health clinics is the incredible work ethic of rural health professionals. For instance, Bushy states, “[a] Psychiatric nurse is expected to function in the role of case manager for a number of clients as well as grant writer, crisis worker, administrator public relations person, and a therapist” (Bushy 258). The distinct elements that plague rural communities compared to their urban counterparts such as the “spatial distance between people and services” often are overlooked by many individuals (Bushy 260). The success of these rural clinics is attributed to the many genres utilized by this community. For services to be seen as accessible, comprehensive assessments of the target’s population needs must be taken into consideration. The client must first have access to the services and have the means to purchase the services. When producing genres, at the patient level, the physicians must consider the reading level of the patient to encourage client compliance. At the physician level, the physicians must reach a level of expertise in order to stay relevant within this community by immersing themselves in genres that will advance their medical knowledge. In addition, the physician need to communicate effectively with grant writers to obtain the aid needed to meet the demands of the population. This discourse community is a prime example of how genres play an important role in enhancing health care in rural areas.

Acosta, David. Personal Phone interview. 06 February 2017.

“Federal Grant Writing Manual.”  Federal Grant Writing Manual | National Rural Health Resource Center . National Rural Health Resource Center, n.d. Web. 26 Feb. 2017.

Schmidt, Gary D., and William J. Vande Kopple.  Communities of Discourse: The Rhetoric of Disciplines . Englewood Cliffs, N.J.: Prentice Hall, 1993.

Swales, John M.  Genre Analysis: English in Academic and Research Settings . Cambridge [England: Cambridge University Press, 1990. Print.

William Nelson, Gili Lushkov, Andrew Pomerantz, William B. Weeks. (2006)  Rural Health Care Ethics: Is _ There a Literature? .  The American Journal of Bioethics  6:2, pages 44-50.

•  Sign into My Research
•  Create My Research Account
• Company Website
• Our Products
• About Dissertations
• Español (España)
• Support Center

Find your institution

Examples: State University, [email protected]

Other access options

• More options

Select language

• Bahasa Indonesia
• Português (Brasil)
• Português (Portugal)

Welcome to My Research!

You may have access to the free features available through My Research. You can save searches, save documents, create alerts and more. Please log in through your library or institution to check if you have access.

Translate this article into 20 different languages!

If you log in through your library or institution you might have access to this article in multiple languages.

Get access to 20+ different citations styles

Styles include MLA, APA, Chicago and many more. This feature may be available for free if you log in through your library or institution.

Looking for a PDF of this document?

You may have access to it for free by logging in through your library or institution.

Want to save this document?

You may have access to different export options including Google Drive and Microsoft OneDrive and citation management tools like RefWorks and EasyBib. Try logging in through your library or institution to get access to these tools.

• More like this
• Preview Available
• Scholarly Journal

Connecting with the Nursing Discourse Community

No items selected

Please select one or more items.

You might have access to the full article...

Try and log in through your institution to see if they have access to the full text.

Content area

Attending the annual conference of the Academy of Medical-Surgical Nurses (AMSN) reminded me of how precious it is to be part of a community of nurses. This feeling goes beyond an appreciation of my valuable AMSN membership to include the joy of being with nurses who share a commitment to quality care for all persons. Our common interests and language also make all of us part of a vibrant discourse community. I've borrowed this term from English professor John Swales (1990) because it so closely reflects the core of who we are as medical-surgical nurses. Swales identified characteristics of a discourse community that are pertinent for AMSN and all medical-surgical nurses.

Common Goals

First, the discourse community has a broadly agreed upon set of common goals that often appear in publicly available documents (Swales, 1990). These goals may be directly stated, but they also can be implied from what the community values. For example, the AMSN position statement on health literacy holds, "The patient has a right to understand information about available choices and the consequences of action or inaction" (2016, p....

You have requested "on-the-fly" machine translation of selected content from our databases. This functionality is provided solely for your convenience and is in no way intended to replace human translation. Show full disclaimer

Neither ProQuest nor its licensors make any representations or warranties with respect to the translations. The translations are automatically generated "AS IS" and "AS AVAILABLE" and are not retained in our systems. PROQUEST AND ITS LICENSORS SPECIFICALLY DISCLAIM ANY AND ALL EXPRESS OR IMPLIED WARRANTIES, INCLUDING WITHOUT LIMITATION, ANY WARRANTIES FOR AVAILABILITY, ACCURACY, TIMELINESS, COMPLETENESS, NON-INFRINGMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Hide full disclaimer

Suggested sources

• About ProQuest
• Terms of Use
• Privacy Policy
• Cookie Policy

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

An Overview of Medical Discourse Studies: Cultural Variation across Genres and Registers

Discourse is a language context that exists in a dialogue or communication interaction. Discourse is also part of pragmatic analysis. Discourse takes a role in medical side broadly. It exits in medical context about curing, healing, therapy, curative practices, speaking and writing that can help medical institution, social action, and etc. this paper reviews a description about cultural variation in medical discourse and variation between register and genres. This study examines two approaches to analyzing Medical Discourse namely Conversation Analysis (CA) Foucaults' theory.

Related Papers

James Wilce

Discourse plays an important role in medicine, and medical discourse in the broadest sense (discourse in and about healing, curing, or therapy; expressions of suffering; and relevant language ideologies) has profound anthropological significance. As modes of social action, writing and speaking help constitute medical institutions, curative practices, and relations of authority in and beyond particular healing encounters. This review describes cultural variation in medical discourse and variation across genres and registers. It then surveys two approaches to analyzing medical discourse: conversation analysis (CA) and discourse studies echoing Foucault’s work, attempting to spur dialogue between them. Such dialogue could be fruitful because, despite hesitancy to invoke macrosocial variables, conversation analysts as well as Foucaultian discourse analysts have reflected on medical authority. Finally, the article reviews recent attempts to contextualize closely analyzed interactions— written exchanges as well as face-to-face clinical encounters—vis-`a-vis the global circulation of linguistic forms and ideologies.

Medical Anthropology Quarterly

Akinola Odebunmi

Mike Prentice , Meghanne Barker

This is an annotated bibliography on intertextuality and interdiscursivity published on Oxford Bibliographies Online. In the article, we organize and summarize over a hundred works related to the two key terms from the fields of linguistic anthropology, sociolinguistics, and critical discourse analysis. This paper is useful for those seeking to understand the history of the terms and contemporary debates and theorizations.

Registers of Communication. Ed. Asif Agha & Frog. Studia Fennica Linguistica 18. Helsinki: Finnish Literature Society.

In any society, communicative activities are organized into models of conduct that differentiate specific social practices from each other and enable people to communicate with each other in ways distinctive to those practices. The articles in this volume investigate a series of locale-specific models of communicative conduct, or registers of communication, through which persons organize their participation in varied social practices, including practices of politics, religion, schooling, migration, trade, media, verbal art, and ceremonial ritual. Drawing on research traditions on both sides of the Atlantic, the authors of these articles bring together insights from a variety of scholarly disciplines, including linguistics, anthropology, folklore, literary studies, and philology. They describe register models associated with a great many forms of interpersonal behavior, and, through their own multi-year and multi-disciplinary collaborative efforts, bring register phenomena into focus as features of social life in the lived experience of people in societies around the world.

Joel Kuipers

A Companion to Linguistic Anthropology

Alessandro Duranti

Annales Universitatis Turkuensis

Antti Lindfors

The dissertation presents stand-up comedy as a genre of embodied verbal art and semiotic interaction. In particular, the study elaborates on how stand-up comics mediate themselves in a public arena and playfully thematize and reappropriate this self-mediation within a performance form founded on the ideals of immediacy, actuality, and self-presence. The dissertation attends to such poetics of self-mediation through the lenses of textuality, reflexivity, and relatability. The perspective of textuality orients the research toward stand-up routines as the foremost texts through which stand-up comics mediate themselves for their audiences’ consumption. The perspective of reflexivity orients the research toward the metapragmatics of stand-up comedy, including both metacommunication in performance and the ideologies and valuations (of communication) embedded in the practice of stand-up. The perspective of relatability orients the research toward the dynamics of stand-up as an economy of attention and affect that depends on intersubjective capture between participants of interaction. http://urn.fi/URN:ISBN:978-951-29-7651-5

Mara Buchbinder

In this paper, I analyze the illness stories narrated by a mother and her 13-year-old son as part of an ethnographic study of child chronic pain sufferers and their families. In examining some of the moral, relational and communicative challenges of giving an account of one’s pain, I focus on what is left out of some accounts of illness and suffering and explore some possible reasons for these elisions. Drawing on recent work by Judith Butler (Giving an Account of Oneself, 2005), I investigate how the pragmatic context of interviews can introduce a form of symbolic violence to narrative accounts. Specifically, I use the term “genre of complaint” to highlight how anthropological research interviews in biomedical settings invoke certain typified forms of suffering that call for the rectification of perceived injustices. Interview narratives articulated in the genre of complaint privilege specific types of pain and suffering and cast others into the background. Giving an account of one’s pain is thus a strategic and selective process, creating interruptions and silences as much as moments of clarity. Therefore, I argue that medical anthropologists ought to attend more closely to the institutional structures and relations that shape the production of illness narratives in interview encounters.

surya dirja

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

RELATED PAPERS

A companion to linguistic anthropology

Patricia Baquedano-López

Companion to Folklore

Richard Bauman

Culture, Medicine, and Psychiatry

Summerson Carr

Oral Tradition

Michael Lempert

Social Anthropology

Firouz Gaini

Jocelyn L Chua

Laura Alba-Juez

Karel Arnaut

Rodney H Jones

Emotion Review

Jane E Goodman

Matt Tomlinson , Justin Richland

International Encyclopedia of Linguistic Anthropology

Benjamin Smith

Paja Faudree

In Nikolas Coupland (ed.), Sociolinguistics: Theoretical Debates

Anthropology of Consciousness

Karen Ann Watson-Gegeo

Journal of Linguistic Anthropology

Linnea Hanell

Mohammed Nasser

caroline goodier

Anthony Kelly

Constantine V . Nakassis

Chaima Benkorichi

Anthropological Quarterly

Literature and …

Marty Kreiswirth

geradine michael

Matthew Wolfgram

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

Home / Essay Samples / Health / Nursing Theory / Exploring Discourse Communities Within the Nursing Field

Exploring Discourse Communities Within the Nursing Field

• Category: Profession , Health
• Topic: Nurse , Nursing Theory

Pages: 3 (1355 words)

Views: 2467

• Downloads: -->

--> ⚠️ Remember: This essay was written and uploaded by an--> click here.

Found a great essay sample but want a unique one?

are ready to help you with your essay

You won’t be charged yet!

Sleep Essays

Alcohol Abuse Essays

Assisted Suicide Essays

Universal Health Care Essays

Substance Abuse Essays

Related Essays

We are glad that you like it, but you cannot copy from our website. Just insert your email and this sample will be sent to you.

By clicking “Send”, you agree to our Terms of service  and  Privacy statement . We will occasionally send you account related emails.

Your essay sample has been sent.

In fact, there is a way to get an original essay! Turn to our writers and order a plagiarism-free paper.

samplius.com uses cookies to offer you the best service possible.By continuing we’ll assume you board with our cookie policy .--> -->