Technology and talk in calls to NHS Direct
2010-04-20T08:38:51Z (GMT) by
This thesis is a conversation analytic investigation of the social organisation of talk in telephone and computer-mediated calls to NHS Direct, a telephone health helpline in England. The data represent fifty-six routinely audio recorded telephone consultations between nurses and callers between June 2003 and June 2004 at one NHS Direct call centre. Data were transcribed using the Jefferson (2004) transcription system. Data analysis follows the broad trajectory of the call. Chapter three illustrates the overall structural organisation of the call as mediated by the Clinical Assessment System (CAS); Chapter four examines how CAS prompted history taking questions are tailoured and delivered by the nurse; Chapter five examines the delivery by the nurse, of the CAS output in the form of the 'disposition' or course of action the caller may take to manage their concern, and Chapter six examines caller's responses to the disposition. The results draw attention to the complexities of telephone and computer-mediated help in which nurses and callers must design their talk to take account of the CAS as a 'third party'. Analysis reveals that nurses typically orient to the CAS output as potentially troublesome. First nurses regularly deviate from and modify CAS prompted questions which works to 'cushion' the system and build rapport between the nurse and the caller. Second nurses regularly simultaneously produce and labour to deny hearably candidate diagnoses. Third callers regularly respond to the CAS produced disposition as dispreferred. In conclusion, this research has revealed how nurses and callers employ a range of interactional practices which work to skilfully tailor and fashion 'embodied help' from an otherwise disembodied CAS technical system. Thus, we can observe nurses and callers artfully displaying through talk the ordinary practical methods for accomplishing telephone and computer-mediated help in this setting.