NICU) Communication in the United States, Denmark, and Sweden

Listening to Other Cultures: Rhetoric, Healthcare, and Neonatal Intensive Care Unit (NICU) Communication in the United States, Denmark, and Sweden by Kristin Bivens, MA A Dissertation in Technical Communication and Rhetoric Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Approved Amy Koerber, PhD Chair of Committee Kelli Cargile Cook, PhD Ken Baake, PhD Mark Sheridan Dean of the Graduate School May, 2015 Copyright © 2015 Kristin Bivens Texas Tech University, Kristin Bivens, May 2015 Acknowledgements Writing this dissertation has been an act of endurance, humility, exploration, and wonder. It has been a pleasant journey, which has taken me from Chicago to Texas to Copenhagen to Sweden and back again. I am indebted to the support and understanding, first and foremost, of my beloved husband Gustav who nurtures and listens and cares beyond all. He has read and participated from the beginning of this journey, which led me to Scandinavia at his invitation. To you, my s.p., tack så mycket. My interest with nursing and nursing communication began with my family of origin: my mother and my father. My mother is a retired neonatal nurse; and it is my privilege to pay homage to my mother through my dissertation study—in each word, on each page, in each chapter, I honor and value her work. She introduced me to neonatal nursing and the emotional labor it entails, while taking the time to answer my questions (along with RNs at SJH in Springfield, Illinois) and inspiring me to be inquisitive and imaginative. I am indebted to my mother and my family of origin, including my three sisters and their families, for their support and challenges. Also, to my second parents, Kjell and Anne-Marie: tack. I am grateful for my urban families in Chicago and Copenhagen—those whom I frequently engaged with while I researched and wrote and prepared to do so, too. For Wi- Fi, espresso, and conversations on writing breaks at Tjili Pop café in Copenhagen and The Kitchen Sink café in Chicago. To individuals at the Rigshospitalet Neonatalklinikken, especially Janne and Ragnhild, for their intellectual generosity and ii Texas Tech University, Kristin Bivens, May 2015 trust in an outsider. To Marie in Mölndal for meeting with me in her excellent NICU in Sweden. And to Alyce Ashcraft at TTU HSC for working with me, as well as Pam in the UMC NICU for her trust and kindness. To the City Colleges of Chicago (CCC) and Harold Washington College (HWC) for a sabbatical leave to research and learn about Denmark and Sweden in Denmark and Sweden. Without the financial support of CCC and HWC, my dissertation study research would not be rich and rooted in my observations. I am also grateful for financial support from the Helen Locke Carter Memorial Grant Research fund. Additionally, I acknowledge funding support during my coursework from the TTU Graduate School, as well as the Helen DeVitt Jones Foundation. I am unbelievably indebted to my academic family, especially my academic mother, Amy Koerber. Without Amy’s support, encouragement, generosity, and kindness every single step of the way—from start to finish—I never would have ventured to be so bold. Amy is a mentor and model to me; and I am grateful for all her efforts, which are immeasurable. To Kelli Cargile Cook: her skills and witty wisdom and intellectual generosity are not (and never will be) lost on me. I am grateful for Ken Baake’s initial questions on rhetorical listening: I wrote those sections with him in mind, and I will continue to do so. To the neonatal nurses, the parents and other legal caregivers, and the babies: Thank you; and I hope this helps. iii Texas Tech University, Kristin Bivens, May 2015 Table of Contents Acknowledgements ii Abstract iv List of Tables iv List of Figures vi Chapter 1 Healthcare, Rhetoric, and the Neonatal Intensive Care Unit (NICU) 1 The Prematurity Problem and Communication 1 Rhetorical and Feminist Roots in Healthcare Communication Research 8 Neonatal Intensive Care Units (NICUs) 16 The Neonatal Nurse and Ward 20 Nursing in the United States 22 Arrangement of the Dissertation 24 Chapter 2 Relevant Literature 28 Inter-, Multi-, and Trans-disciplinarity 33 Neonatal Intensive Care Unit Communication 37 Medical Geography and Medical Anthropology 39 Researcher Ethos and Rhetorical Listening 44 Public Records, Reports, and Documents 52 Intercultural and Cross-Cultural Communication 55 Gesture-Speech Theory 59 Chapter 3 Contextual Inquiry and Grounded Theory Research Design 63 Purposeful and Theoretical Sampling 64 The Participants 67 Contextual Inquiry Research Methodology 69 Grounded Theory Data Analysis: the Theory and the Application 70 Cultural Logics: A Rhetorical Listening Result 77 A Feminist Methodological Strategy: Contextual Inquiry and Informed Consent 79 Research Questions and Contextual Inquiry 88 Chapter 4 Denmark 92 Lytte til Danmark: Listening to Denmark 92 Countrous Københavns : Countours of Copenhagen 93 Texas Tech University, Kristin Bivens, May 2015 Dansk Mad: Danish Food 96 Dansk Køkken: Danish Kitchens 97 Dansk Fængsler og Hospitaler: Danish Prisons and Hospitals 98 Danske Sundhedsvæsen: Danish Health Care 101 Sygepleje i Danmark: Nursing in Denmark 104 Asking Permission and Access 105 Inde i Rigshospitalet: Inside the Rigshospitalet 106 Inde i Neonatalklinikken: Inside the NICU 113 A Grounded Theory Analysis: Conceptual Elements and a Category 117 Eavesdropping as a Conceptual Element 119 Mimesis as a Conceptual Element 127 “The Hospital Way” Category 136 Chapter 5 Sweden 140 Lyssna på Sverige : Listening to Sweden 143 Sveriges Siluett: Sweden’s Silhouette 145 Svensk Grammatik och Mekanik: Swedish Grammar and Mechanics 151 Svensk Mat : Swedish Food 153 Svensk Kök : Swedish Kitchens 155 Svensk Fängelser och Sjukhus: Swedish Prisons and Hospitals 157 Svensk Hälso-och Sjukvård: Swedish Healthcare 161 Omvårdnad i Sverige: Nursing in Sweden 164 Asking Permission and Access 167 Swedish Cultural Logic: A Rhetoric of Equality 169 First Move: A Definition of a Rhetoric of Equality 171 Second Move: Attitudes Concerning the Child in Sweden 176 Third Move: Actions Concerning the Child in Sweden 183 Fourth Move: A Swedish Cultural Logic 185 Chapter 6 United States 193 Listening to the United States 193 The United States 195 Texas and Lubbock, Texas 196 Texas Culture: Food and Trucks 199 Texas Tech University, Kristin Bivens, May 2015 Prisons and Hospitals in the United States and in Texas 201 Healthcare in the United States 206 Healthcare Architecture 213 Nursing in the United States 215 Asking Permission and Access 216 Texas Tech University’s University Medical Center in Lubbock 219 Inside the NICU 220 A Grounded Theory Analysis: Conceptual Elements and a Category 222 Hearing as a Conceptual Element 225 Witnessing as a Conceptual Element 234 The Hospital Clock Category 240 Chapter 7 Discussion 244 Three Countries 244 Denmark 245 Sweden 247 United States 249 The Remaining Research Questions 253 Income Taxation Systems in the United States, Denmark, and Sweden 254 Case Study Comparison: Aural Rhetoric and NICU Design 260 Aural Rhetoric 261 NICU Design 264 Other Communicative Components: Deictic Gestures and Non-Verbal Communication 269 Deictic Gestures 270 Non-Verbal Communication 273 National Culture and Biomedical Culture 276 Danish and U.S. NICU Communication: Openness and Timing 277 Treating Healthcare Communication and Environments as Intercultural Spaces 286 Learning about Other Cultures and Rhetorical Listening 288 The Role of Microwithdrawal in Informed Consent and Ethical Research Practice 292 The WHO’s Call 295 Limitations 296 Future Studies 301 Texas Tech University, Kristin Bivens, May 2015 References 303 Appendix A TTU Institutional Review Board Approval 1 Appendix B Danish Data Protection Agency Approval 2 Appendix C TTU Health Sciences Center Institutional Review Board Approval 3 Appendix D Rigshospitalet’s NICU Theoretical Memos 5 Theoretical Memo #1: “Speak Hospital”; Involvement; and “The Hospital’s Child” 5 Theoretical Memo #2: Strategic Acquisition of Neonatal Biomedical Terminology 13 Theoretical Memo #3: Reaffirmation of the Sensitive and Private NICU Space 18 Advanced Theoretical Memo #1 OPEN CODING + AXIAL CODING = CATEGORIES: (Rhetorical) Eavesdropping, Mimesis and Deictic Gestures, and “The Hospital Way”: Appropriating Actions, as well as “Speak[ing] Hospital” and Appropriating Biomedical Language 20 Appendix E TTU HSC’s NICU Theoretical Memos 30 Theoretical Memo #1: Consents and Witnesses 30 Theoretical Memo #2: Open Concept, Privacy and Transparency, Sound and Design (Healthcare Architecture) 37 Theoretical Memo #3: Reaffirmation of the Sensitive and Private NICU Space; Time, time, time; and Illusions of Consent 43 Advanced Theoretical Memo #2: OPEN CODING + AXIAL CODING = CATEGORIES: Monitoring, Hearing, Witnessing, and Caring 49 Texas Tech University, Kristin Bivens, May 2015 Abstract In this study, I examine neonatal intensive care unit (NICU) communication between nurses and the parents of premature infants from an intercultural perspective using the workplace qualitative methodology, contextual inquiry (CI) and observation, interview, and textual artifacts for data collection at two research sites. The first research site is at the Rigshospitalet’s Neonatalklinikken in Copenhagen, Denmark. The second research site is at the University Medical Center’s NICU in Lubbock, Texas. Data from these research sites was analyzed using grounded theory. A third

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