Epistemics in an Intensive Care Unit: The practice of informing in nurse-physician interaction

As many institutional domains of clinical practice, nurse-physician interaction is “marbled through the exercise of authority” (Heritage, 2005, p. 83) and still organized around the cultural primacy of medical knowledge. Nevertheless, little is known about the details through which this medical interprofessional interaction is organized and epistemics is managed (Drew, 2018; Heritage, 2012). How nurses and physicians negotiate assessments, treatment options, yet also organizational hierarchy, access to domains of expertise and types of knowledge? What conversational and multi-modal practices do they rely on? Following these interrogatives and in line with an embryonic line of research (Manias & Street, 2001; Paradis, 2014), our paper analyzes the management of knowledge and expertise (i.e. the knowledge-and-experience based competence for evaluating information and copying with practical circumstances by anticipating the possible coursse of action as well as their possible consequences) at stake in nurse-physician interaction. We focus on one of the most frequently used nurses’ conversational activities: informing (Caronia & Saglietti, 2018). Drawing on an intensive ethnographic research of an Italian Intensive Care Unit and adopting a CA-informed approach on a corpus of video-recorded morning briefings, we illustrate how even one of the less agency-implicative activities is a meaningful resource in interprofessional encounters. Particularly, we illustrate how “informing” is performed through different conversational practices that differ according to the turn taking, turn design and sequential position: from “giving information when asked” to “initiating a sequence by giving unrequested information”. We show how these different conversational practices imply different degrees of agency and therefore differently impact on the unfolding of the diagnostic reasoning by the interprofessional team. Our findings suggest that the nurses indubitably align with (and therefore contribute in maintaining) the socially sanctioned distribution of knowledge as well as the doctors’ deontic rights and the medical cultural authority, However, the ways in which they perform the activities they are entitled to perform, display their capacity to make a difference in the unfolding of the interaction from within the boundaries of their epistemic domain (Broom et al., 2016).