Learning Objective #1: The learner will be able to understand limitations of idealized textbook scenarios.

Learning Objective #2: The learner will be able to specify features of natural limited-language care client enocunters.

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Introduction: Studies in care outcomes have indicated that care clients lacking fluency in the language of the health care delivery systems are placed at increased risk of poor outcomes. These poor outcomes partially stem from increased errors within the care setting. Education of nurses, therefore must include adequate preparation for the additional complexities of interacting with at-risk language-limited clients.

Purpose: This study examined the range of encounter types and their communication features in the conversations of nursing English textbooks used in Japan. Relevant literature indicates that complexities occur commonly (routinely) in both NS-NS and NS-NNS encounters and are managed by participants through learned strategies. Anecdotal evidence, however, suggests that the lexically and grammatically error-free conversation model of second-language instruction may lack key elements of natural communicative events. The study sought to determine if nursing English textbooks in Japan provide adequate exposure to the actual complexities of this type of care encounter.

Methods: Printed conversations were analyzed for strategic indictors including code switching, negotiating, repairing, checking, rejecting, and redirecting. Indicators were analyzed in relation to the number of participant turns and idea units within and across conversations. Strategies were analyzed into their lexical/grammatical or pragmatic classes. These strategies were correlated to features indicating the cultural and intensity of the encounters. Additionally, participants were identified in terms of their professional titles, functional roles, and their NS/NNS status.

Results: Results indicated that the analyzed conversations lacked many natural language strategies normally associated with encounters with language-limited care receivers. Notably absent were the types of natural strategies expected when understanding is lacking in unfamiliar and critical encounters.

Conclusion: Renewed investigation may well be in order into the use of idealized conversation models and acquired communicative competence given the key role of failed communications in producing health care errors.