Interactional trouble and compassion during clinical assessments: A conversation analytic study.: Presenter(s): Rachael Drewery, University of Nottingham, United Kingdom

Compassion has become an overarching value in twenty-first century healthcare policy, with the NHS Constitution (DoH, 2015) stating that compassion is “central to the care we provide”. Both policy and previous research associate compassion with generic communication practices; however, there has been limited exploration of how compassion is enacted within actual interaction. As part of a larger study on compassion in advanced clinical practitioner-patient interaction, the current paper explores effective care and compassion, when there is trouble hearing or understanding patient talk during clinical assessments. To identify and describe how ACPs respond to problems of hearing or understanding patient talk during clinical assessments. Collection of twenty-seven audio-visual recordings of naturally occurring interaction between ACPs and older people in hospital in-patient settings. Analysis uses conversation analysis, a qualitative, inductive approach which aims to understand how participants construct and understand what is happening within the context of turn-by-turn interaction. Fine-grained analysis of audio-visual recordings shows that problems with hearing or understanding a patient’s talk during an assessment can be an interactionally delicate issue. As the ACP needs to obtain accurate information, to ensure safe, effective care, they address the interactional trouble through repair. However, ACP other-initiated repair potentially exposes issues with patient competency, and could cause embarrassment. Using recordings, I will show the interactional practices ACPs use to minimise any potential harm which results from their other-initiated repair. Researching interactional trouble and compassion during clinical assessments shows how ACPs navigate the need to provide safe effective care, which potentially reduces long-term suffering, and compassionate responses within the immediate interactional context. These Findings: have implications for our knowledge regarding the enactment of compassion within its interactional context, and how healthcare professionals navigate the competing demands of providing safe, effective and compassionate care.