Nurse and parent partnership during children’s vaccinations: a conversation analysis

Abstract

This paper is a report of a study conducted to examine the elements of partnership and communication between nurses and parents during actual events of immunization. Childhood immunizations require collaboration with parents, who may be anxious about immunization safety or subjecting their children to painful procedures. Ten interactions during immunization events from six purposively selected general practices were videoed in 2005, giving 168 minutes of talk. Conversation analysis was conducted on talk during the short phase of injection administration. During the immunization event nurse and mother talked to the baby/toddler rather than each other. Concurrent talk acted as a chorus, marked by sing-sing prosody, shared laughter and talk or reassuring noises. In coordinated talk nurse and parent took turns. Although overlap might occur, the actions accomplished by each speaker were different. Nurses most commonly cued bravery or stoicism to the child and stressed the progress made in administering the injections. In the less common pattern when pain was recognized as inevitable and there was no stress on stoicism and progress towards completion, the child displayed more distress and began crying before the injection. Communication skills and rapport are core to nursing work. What happens at the micro-level of turn-taking, where prosody and the actions achieved in talk, is of key importance. Our study suggests 'small talk' is of major importance - a practical professional skill in which nurses not only align with parents but simultaneously cue both mother and child about how the immunization should be conducted.