Reference to Patients in Nurse Shift Handover Meetings: Exploring the Dynamics of Referring Expressions

Abstract

This paper investigates the dynamics of referring expressions in hospital nurse handover meetings when discussing patients. We apply the methods of the Variable Length Markov Chain (VLMC) and network analyses to model the use of referring expressions and evaluate relationships between them. The models reveal second-order dependencies emerging for metonymy and noun phrases. Specifically, metonymy shows a greater association with the beginning of a reference, particularly in the context of other metonymies. In contrast, noun phrases tend to be more strongly associated with later points in the reference. Further, we introduce the notion of referential typicality, which measures the conformity of sequences of referring expressions to anticipated patterns. We show, for example, that consecutive noun phrases fall outside the typical pattern, whereas metonymical sequences and sequences of pronouns are highly typical. The transitions from metonymy or nouns to pronouns also closely align with a highly typical pattern. Using a Generalized Additive Model (GAM), we then track the overall evolution of referential typicality throughout the duration of handover meetings, from their beginning to end. The study reveals a subtle increase in referential typicality towards the end of these sessions, indicating a trend towards more consistent referencing as the discourse unfolds.