Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
the boundaries of the hierarchal relationship, the relationship may
swing from good to bad and the nurse may fall into a pattern of
avoidance.
Culture
Self-concept
Relationship
Episode
Message
Figure 7. Levels of Hierarchy in CMM
Hierarchy. The hierarchy heuristic is a concept used within a
specific context to imagine what level of importance events have for
an individual or group. Therefore, the hierarchy heuristic can
provide a visual context of themes and respective level of
importance from an individual and group perspective (Pearce,
2007).
Using the hierarchy concept the nurse becomes trapped within
the hierarchy, the flux of a decision between the concepts of self,
the contextual existence of the relationship, the actual reflection of
the episode, and the meaning within the conversational space. If
the nurse finds the correct way to phrase the communication in that
the communication remains within the construct of the hierarchal
paradigm and thus contributes to a non-confrontational relationship
between nurse and physician, the relationship can then be kept safe
or thought of as a good relationship. So, it is when the nurse
challenges the physician that risk is assumed and where the
communicative relationship is at stake.
The social world of healthcare communication stems from the
many hierarchies that exist in this setting. There is a medical
hierarchy between nurse, physician, technologist and non-clinical
personnel. There are hierarchies found within the many groups of
nurses and physician specialties and within the operating room
personnel. Within nursing there are hierarchies concerning skill level
as related to specialty training and medical unit cultures, time in the
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