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Chiara Fuller

Megan Keaton

ENC2135-0007

28 July 2015

Healthcare as a Community

As an undergraduate nursing student here at Florida State University, I take a great

interest in the healthcare community as a whole. This semester, I endeavored on a research

journey to analyze the community of Tallahassee Memorial Healthcare (TMH), a prominent

hospital in Tallahassee. In this essay, I will first analyze Tallahassee Memorial Healthcare as a

discourse community and then discuss the genres that they use to communicate externally and

within their group and how these genres interact with their community.

Introducing the community.

According to John Swales, a discourse community is a group of people who share a set of

skills, knowledge, interests, or values. I an interview with Claudia Han, a registered nurse at

Tallahassee Memorial, and important part of the healthcare community, I learned that all of the

members at her hospital share “a passion for helping others and a desire to deliver quality

treatment to patients who may otherwise die.” A key attribute in a discourse community is

specificity. The characteristics that are aligned with a discourse community are their specific

ways of distributing information to members, specific genres used to further their aims, jargon

(or lexis) specific to the community, and a minimal degree of expertise specific to the

community (Swales).

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The healthcare community exists to provide treatment to injured, diseased and dying

patients (Alana Walker, interview). Their purpose is to foster a caring environment for patients

as they work toward health and wellness. They do this by implementing clean, safe and efficient

health practices as a unit (Han). There are various roles that need to be fulfilled in order for a

healthcare community to function and carry out its purposes. Each of these roles, no matter how

small, requires a level of expertise in order to function in the healthcare community.

Starting from the top are the doctors and surgeons. At Tallahassee Memorial, the doctors

function in the community to examine and diagnose. Patients come to them with health

complaints, and based on the person’s description of symptoms and their own physical and

auditory observations, the doctor decides what is wrong and provides a solution. It is the doctor’s

responsibility to inform the patient on the risks and benefits of anything they might do that could

interfere with their health (C.F. Donovan). Surgeons operate on patients to correct internal organ

issues and fix injuries, deformities, and diseases (Bureau of Labor Statistics). If a doctor

diagnoses something that could lead to permanent damage or that may be potentially fatal, for

instance kidney failure, he communicates the patient’s diagnostic results to the surgeon. Both

work to communicate potential risks and factors associated with both the disease and whatever

operation to the patient and help them decide what route they want to take towards treatment.

They also obtain information, such as vital signs and progressive condition of the patient from

nurses, and determine what further treatment, if any, needs to be administered.

While doctors and surgeons are a huge part of the diagnostic and treatment process,

registered nurses are equally important. They are the medium between doctors and patients.

Their job is to record patients’ medical histories, set up care plans as prescribed by the doctor

and to assist with letting patients know how to continue treatment once they are discharged from

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the hospital (Bureau of Labor Statistics). Most registered nurses work in a team, overseeing

licensed practical nurses and certified nursing assistants in patient care. They play a huge role in

communication between the physician, the hospital and the patient.

One of the key communicators between nurse and patient are certified nursing assistants.

Certified nursing assistants function in the healthcare community to carry out delegated tasks

from the registered nurse. Nursing assistants have the most contact with patients. They are

responsible for bathing patients and cleaning their living quarters, they assist with bathroom use,

repositioning patients in bed and transporting them to different areas around the hospital, and

help with feeding if needed (Bureau of Labor Statistics). They observe any changes in a patient’s

condition and communicate it to the nurse via lab reports. Alana Walker says that as a certified

nursing assistant at Tallahassee Memorial Healthcare, she is the “main communicator to keep

patients moving efficiently without overlap, conflict, and/or discrepancies”.

Finally, the volunteers play an extremely important role in the healthcare community,

especially in Tallahassee Memorial Healthcare. When help is short, it is beneficial to the

community to have someone who is willing to donate their time and effort to the patients out of

the kindness of their hearts. Volunteers at Tallahassee Memorial help in many areas of the

hospital, from the gift shop, to the childcare center, to rehab and neurology (Tallahassee

Memorial Healthcare Website). Tallahassee memorial has over three hundred volunteers

stationed in various departments of the hospital. "Their help is very appreciated at Tallahassee

Memorial, without our volunteers, I have no idea what we would do" (Han). Volunteers work

directly with health professionals and patients, alleviating the great workload that falls upon the

hospital’s community members, says Walker.

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All of these roles and many more collaborate to create a functional community. In order

for members of any community to communicate efficiently with each other, it is important for

them to have a sort of language that they can understand quickly when speaking to one another.

In the healthcare field, they use many abbreviations and shortened versions of words. Examples

of lexis specific to the healthcare community, according to Walker, are “CVA,” which stands for

cerebrovascular accident, “afib” which means atrial fibrillation, and “RTA” – ready to admit.

“These shorthand words allow us to communicate very quickly, which is important in emergency

situations,” says Han. “Cerebrovascular accident’ or ‘cardiovascular accident’ are quite a

mouthful when you have someone on a stretcher in front of you within minutes of their life."

Using this jargon also helps them to minimize confusion because of either stumbling over words

or simply not being able to hear what another person is saying (Han).

The Tallahassee Memorial Healthcare community involves an array of individuals, from

healthcare professionals and volunteers, to the patients that they care for and the families of these

patients. They communicate with members through bulletins, posters and signage, email, phone

calls, and brochures and handouts. Tallahassee Memorial also reaches out to the general

population of Tallahassee in a variety of ways including fundraisers and other events that are

geared towards bringing unity to the town. They attempt to reach out to the general public,

largely using social media such as Facebook and Twitter, as well as Instagram. A closer look at

the genre ecology of the Tallahassee Memorial Healthcare community shows the interrelations

between each of the genres that they use and how they impact the community and its members

and non-members.

What are the genres implemented by members of Tallahassee Memorial Healthcare?

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Many different genres are used by the Tallahassee Memorial Healthcare community, to

communicate information to members, non-members, and both. Among the most used are: the

employee/volunteer applications (official), employee/volunteer handbooks (official), hospital

website (official), and social media (unofficial), phone calls and emails/text messages

(unofficial), and posters/signage (Han).

The employment or volunteer application is the first genre that they use. It may seem like

nothing but a piece of paper that needs to be filled out, but it is much more than that. According

to Susan Seibert, there are antecedents, or "prerequisites" needed to be a part of any "community

of practice" as she calls it. All members must share and possess interpersonal skills, a good work

ethic and commitment to improve in all aspects of the healthcare practice (Seibert). The

information that is put into an application by an employment or volunteer candidate

communicates to the heads of Tallahassee Memorial human resources and volunteer services

whether or not that candidate meets the threshold requirements for joining the community set

forth by the hospital.

For example, if I were applying to an RN (registered nurse) position within the hospital,

and filled in “cashier” under the Experience section, and “high school diploma” under

Education, the people reviewing my application would understand that I was unfit for the

position. The information on my application would communicate that I lacked the minimum

education (Associate's degree) for the position, and had no relevant experience to the field that I

was pursuing. On the other hand, when I fill out an application that lists numerous health-related

internships and volunteer experiences, a Bachelor's degree in nursing, and skills related to my

field, that communicates to the employer that I am qualified for the position. Moreover, it tells

them that I would be highly capable of helping the Tallahassee Memorial community fulfill its

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purpose of achieving its number one goal of providing quality care to patients. The application

also communicates a lot to the candidate as well. By reading and answering questions on an

application, candidates can get a feel for what attributes matter and are evaluated by the

employer or volunteer coordinator. If they are determined to be a part of the Tallahassee

Memorial Healthcare Community, they can strive to meet those expectations to ultimately

become a part of this community.

Once a person joins the healthcare community, either by being hired, or by becoming a

volunteer they are required to attend an orientation, which may be done in person or online, in

which they "learn the ropes" of the healthcare community, says Alice Baldwin, the secretary of

Human Resources. Candidates are expected to read them and understand the expectations that

they are operating under as members of this community. The Tallahassee Memorial Healthcare

employee handbook outlines what new members learn during orientation as well as

communicates to new hires and new volunteers the goals of the healthcare community, which,

upon entering the community, ultimately become their own goals as members.

The handbook is also a way for the leaders of the healthcare community to communicate

the mission and values of the hospital. "We want all of our employees and/or volunteers to

understand what we are trying to achieve, because we are a community, and we are here to give

back to an even bigger community, and it's important to us that every member understands that,"

says Alice Baldwin, the assistant manager of the human resources office at Tallahassee

Memorial. Additionally, the handbook includes a Patient Pledge, a Code of Ethics, and Job

Responsibilities section, each of which communicates the behavioral expectations associated

with the status as a member of the healthcare community. By reading this handbook, for

instance, I know that as an employee of Tallahassee Memorial, it is my responsibility to show up

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to work every day and on time, treat all patients with courtesy, respect, and compassion and keep

patient information confidential, and maintain a positive and comfortable environment for the

patients and my fellow members of the community.

However, the handbook does not function to relay all of the information that an employee

wants to know or must know (Alexander Heron, 126-7). It functions, as I previously stated, as an

outline. It is impossible for an employer to include every facet of information related to a

position in one handbook. So, the handbook is also used as a sort of catalyst for communication

between the person reading it and the heads of one department or other within the community.

For example, it may have a very brief description of the benefits that accompany the position

held, and then an asterisk at the bottom saying “*Contact the Benefits department for more

information” (Heron). This would cause the person wanting to learn more about the benefits

associated with their new job to email, call or speak with someone from the Benefits department,

thus initiating communication.

The next genre is the Tallahassee Memorial healthcare website. This website is the

primary medium for communication between the hospital, the members of its community and the

non-members. Because it is on the world-wide web, it is geared towards one audience: the world.

Given the large and diverse audience that the website must appeal to, it contains an onslaught of

information. The information is organized by labeled tabs, and then sub-categorized from there.

The home page contains news and events held by Tallahassee Memorial. From there you

can navigate to different tabs, which contain information for different categories of audiences,

from patients and visitors, to healthcare professionals. If I wanted to know what the services

were that they provided, I would roll my mouse over the services tab:

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Just the list that comes up by rolling over the tab communicates to me as a prospective patient

the services that this hospital provides.

To illustrate, if I were looking for cancer treatment, either for me or a loved one, I would

go to this site, hover over “services,” and click the designated link. This brings me to a page

labeled “Cancer Services at Tallahassee Memorial.” Here, I can find the cancer treatments and

support services that the hospital offers. I can also find branches within Tallahassee in

surroundings areas where I may be able to receive treatment. There is also information on the

types of cancer that the hospital treats as well as community reports that demonstrate the

effectiveness of cancer treatment on the community at Tallahassee Memorial Healthcare.

Moreover, this section can communicate a lot to a prospective employee of Tallahassee

Memorial. A person fresh out of college for instance, who has studied oncology and is looking

for a job. The community report included under this section would communicate to him the

impact of TMH’s cancer treatment methods as well as the information necessary to contact the

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cancer department in the hospital. I can look at this website and see that this hospital is either a

great fir for me, or a not so great one, depending on the values that I bring to the table.

Moving away from the services tab, let us discuss how the site specifically caters to the

informational needs of a health professional, or a volunteer, looking to obtain a position within

this company. One every page, in the right-hand corner, there is a small menu:

The “Careers” tab contains a wealth of information pertinent to obtaining a position

within. Tallahassee Memorial Healthcare. As a newly graduated oncologist, I can watch a seven-

minute long video (yet another genre), titled “Working at TMH.” This video communicates the

values that Tallahassee Memorial embraces in an employee, as well as what it means to be a part

of the TMH community and what is expected of every member of this community. There is a

link to search engine, so that you can search for career opportunities within the hospital. There is

also an online application for every position that they offer.

The “Ways to Volunteer” tab contains the mission statement of the volunteer services

division of Tallahassee Memorial Healthcare. It has a section for the general requirements for

becoming a volunteer and entering the healthcare community, as well as the necessary steps to

take. As an aspiring volunteer of Tallahassee Memorial, this section communicates to me that I

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need to fill out an application, pass a background check and health screening, and attend

orientation and training to be able to join the volunteer community. I also know from reading this

section of the website that since I am in college, I must apply to the college volunteer group,

rather than the adult volunteer group, even though I am an adult. There is also a list of the

possible areas of the hospital that I will be helping out in, once I become a volunteer. The

website is the main medium of communication for non-members.

The healthcare community also uses social media to communicate with both members

and non-members. They use the websites Facebook and Twitter mainly for the same aim:

publicity. They also use Instagram, a social app used for photo-sharing. After “following” the

Twitter and Facebook pages for a period of two weeks, I observed many things.

First, the page posted daily on the Facebook page, while they posted less frequently for

Twitter. Some of what they posted were events directed towards communities within the

healthcare community at Tallahassee Memorial: such as the photograph displayed below that

was posted on Twitter:

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This particular post appeals to the community of patients under treatment for cancer. Its audience

is not necessarily only cancer patients within the hospital, however; it is meant to bring together

all victims of the disease in the community of Tallahassee as a whole, as well as their supporters

and benefactors, says Claudia Han. “The thing about community is that no one community can

really operate or stand on its own…a large support network is necessary for every community to

reach its goals, no matter how big they are.”

Other things that I noticed a lot of on the Facebook and Twitter profiles were that they

posted a lot of updates. There were also a lot of health tips and links. By clicking on the link in

this Facebook post, for example, a member or non-member can learn the risks associated with

the use of a well-known over-the-counter drug – ibuprofen:

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These kinds of posts communicate to patients, non-patients, employees, and whoever else

may take a look at this post and similar ones, ways that can improve their health and “ ultimately

increase longevity of life,” says Han.

One thing that I found unique about the Facebook page during my observations were the

reviews by non-members of the healthcare community. Facebook allows the audience of a page

to interact with the page administrators by posting on the page’s timeline and by tagging it in

independent posts and photos (Facebook Help Center). Former patients can write reviews and

prospective patients and family members can read them to decide if it is the best choice for

themselves or their loved one to be treated.

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In this way, the social media that is employed by the hospital facilitates communication

between the non-members, such as patients, and members of Tallahassee Memorial. With

patients and former patients being able to voice their opinions and concerns about the hospital,

they are able to communicate to the members what they liked and didn’t like, as in the first post,

by Ms. Fultineer-Hopper. Striving to meet the needs of the patients, the members of the hospital

community will adjust their practices to ultimately achieve their goals of providing quality care

for patients. Furthermore, employees can communicate messages to patients through this

medium as well, which is the purpose of the second post by Ms. Cooper.

The other social media that is used by the hospital community to communicate with

members and non-members is Instagram. The first thing that I noticed about the Instagram

profile is that it was saturated with personality. Using a different approach to bring people in,

they use photographs on this app for emotional appeal – or pathos – which can create an

emotional response from the viewer (Braziller and Kleinfeld). Images like this are used to appeal

emotionally to a viewer.

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They are also used to show the audience that Tallahassee Memorial Has a history of patient care:

Claudia Han says that she follows both the Facebook page and Twitter profile that

Tallahassee Memorial has, and so does Alana Walker. Following these social media pages help

to keep them up to date with the community that they are involved in.

Phone calls, emails, and text messages are often used as genres as well. Co-workers and

volunteers often use them in in times when they cannot come to work, to get them to cover their

shifts. Phones calls are used in emergencies, for example, when am elderly patient has a fall, the

nurse needs to know right away, so the C.N.A. does just that (Walker). Most of the people use

emails only when communicating with human resources, finding phone calls and text messages a

more convenient way to communicate with people that they see every day (Walker).

The last genre that I describe in this essay is posters and signage. These can be anything

from large posters to small flyers that are hung around the hospital. Posters are used to

communicate internally to members of the community as well as externally, and to non-

members, such as hospital visitors. The following is an example of a poster that is used to

convey information to members of the healthcare community:

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This image is used to convey to Tallahassee Memorial Healthcare employees and members of

the healthcare communities the importance of hand-washing in the safety of patients. Other signs

are used to let employees know when they are entering into quarantined or otherwise unsafe

areas:

There are also signs posted in the “break room” that inform members of the community about

worker’s unions, job benefits, and crisis hotlines, among other things (Baldwin, interview).

Signage used to communicate with non-members, or new members include hospital directories,

which are meant to help visitors and newcomers find their way around the hospital; “No

smoking,” and “No loitering” signs, which reinforce the strict no-smoking policy upheld by the

hospital; and restroom signs, which communicate to people that there is a restroom at some place

or other at the hospital. All of these are meant to communicate information to people either in the

TMH community, or to people interacting with the TMH community.

How do these genres form connections with each other and the community?

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When all of the different genres that are used by a person or community for one purpose

or composition form relationships with one another, they become a genre ecology (Clay

Spinuzzi). The genres used by the healthcare community of Tallahassee Memorial Healthcare

form a simple genre ecology, though it is nonetheless significant. Moreover, the genres impact

the community, just as the community impacts the genres, in very important ways.

First, the employment application relates to the handbook because they are both used

during introduction into the community. The application is used to evaluate a member before he

or she is welcomed into the community. Once they are admitted into the community, the

handbook is distributed, which teaches the new community member how to utilize the skills and

values that they presented themselves as possessing in their application to best serve the

Tallahassee Memorial healthcare community and fulfill its goals. The handbook, in turn, forms a

relationship with the signage and posters around the hospital. The handbook lists safety

procedures and precautions to be put in practice throughout the hospital and in certain areas. The

posters around the hospital serve as a reminder of the safety regulations set in place by the new

employee or volunteer handbook.

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Works Cited

Baldwin, Alice. Telephone interview. 19 July 2015.

Braziller, Amy, and Elizabeth Kleinfeld. The Bedford Book of Genres: A Guide and Reader.

Boston: Bedford/St. Martins, 2014. Print.

Han, Claudia. Personal Interview. 19 July 2015.

Heron, Alexander R. Sharing Information with Employees. Stanford University, CA: Stanford

UP, 1942. Print.

"Picture." Centers for Disease Control and Prevention. Centers for Disease Control and

Prevention, 17 Mar. 2015. Web. 30 July 2015.

Seibert, Susan. "The Meaning of a Healthcare Community of Practice." Nursing Forum Nurs

Forum 50.2 (2014): 69-74. Web. 25 July 2015.

Spinuzzi, Clay. "Genre Ecologies: An Open-System Approach to Understanding and

Constructing Documentation." ACM Journal of Computer Documentation 24.3 (2000):

172. Web. 25 July 2015.

Stop, Airborne Contact. N.d. N.p.

"Summary." U.S. Bureau of Labor Statistics. U.S. Bureau of Labor Statistics, n.d. Web. 25 July

2015.

Swales, John. ''The Concept of Discourse Community." Genre Analysis: English in Academic

and Research Settings. Boston: Cambridge UP, 1990.21-32. Print.

"Tallahassee Memorial Hospital." Facebook. Tallahassee Memorial Healthcare, n.d. Web. 26

July 2015.

"Tallahassee Memorial Hospital." Instagram. Tallahassee Memorial Healthcare, n.d. Web.

"Tallahassee Memorial Hospital." Twitter. Tallahassee Memorial Healthcare, n.d. Web.

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"Transforming Care. Advancing Health. Improving Lives." Tallahassee Memorial HealthCare.

Tallahassee Memorial Healthcare, n.d. Web. 30 July 2015.

Walker, Alana. Personal interview. 20 July 2015.