Although politeness phenomena in institutional talk have not been studied to any great extent (but see Bogoch 1994; Aaronsson and Rundstrom, 1989; Spiers, 1998), Brown and Levinson’s model of linguistic politeness would predict a preponderance of negative politeness strategies (‘deference’) between clients and professionals due to the degree of social distance between the speakers and the often weighty FTAs involved. However, as has been noted by Aronsson and Rundstrom (1989) sequences of naturally occurring institutional discourse reveal that roles and relationships (involving power and distance) are negotiable and therefore politeness strategies are not so easily predicted as the B & L model might suggest.

In data from interactions between nurses and geriatric patients in a geriatric acute ward, it is clear that there is extensive use of positive politeness strategies, despite the fact that nurses and patients barely know one another, whilst engaged in fairly intrusive care tasks. These co-occur with negative politeness strategies, suggesting that, within the same interaction, nurse and patient construct both a deferential and solidary relationship. In this paper I will explore ‘the interplay between choice and convention’ (Aronsson and Rundstrom, 1989) in linguistic behaviour in this context, and argue that politeness strategies are at once a reflection of the ambiguity of institutional roles (leaving them open to negotiation), as well as an indication of the delicacy of the task at hand, requiring extensive face-work to be carried out throughout the interaction.

Key Words: verbal play, politeness, hospitals, institution, nurse-patient interaction

Introduction

Verbal play, joking and laughter are a common occurrence in everyday talk. Sociolinguistic studies that have examined this phenomenon confirm that joking behaviour serves an important social function, and show how playful use of language and conversational strategies achieve a range of identity and relational effects. However, with certain notable exceptions (such as Ragan 1990), there is not a great deal of sociolinguistic literature on the use of humour in institutional –and in particular, clinical- contexts, despite the fact that it is recognised within nursing that humour is a potentially valuable interactional tool. In the nursing literature, studies of humour tend to lack theoretical constructs within which to analyse its relational implications, however. This paper therefore attempts to bridge a gap in two bodies of literature: firstly to explain nurse-patient verbal play in terms of sociolinguistic theory, and secondly to add to our knowledge of playful discourse by examining it in a particularly under-studied institutional setting. In particular, verbal humour and nurse-patient interaction both invite examination in the light of politeness theory, the former being a highly relational message form, and the latter being a setting potentially rich in face-threatening acts (FTAs).

In this paper, I will examine the use of verbal play in three nurse-patient interactions in the light of concepts from existing studies in the pragmatics of joking, as well as by applying politeness theory. Whereas Brown and Levinson treat humour as a relatively simple matter of positive politeness, my analysis highlights the complexities of joking behaviour and its relational functions. I will show that politeness theory can provide an interpretive framework within which to explain the use of humour in specific interactions but that the analysis is incomplete without taking account of both the wider institutional context and the local interactional context. Many authors argue that in much joking behaviour there is the potential for aggression (impoliteness) and solidarity to be ambiguously present. This is certainly true in my data, but in this context the multiple functions of verbal play are best explained in terms of multiple institutional and personal goals, and as collaborative management of the interaction by the participants. I will further argue that the potential for 'bonding' or 'biting' humour is at least in part the outcome of the cumulative effect of previous turns.

There is no shortage of sociolinguistic studies examining the use of humour in ‘everyday’ conversation. They apply sociolinguistic concepts and theories of interaction to samples of conversations between equals. Even in these non-institutional data it is clear to most authors that there are many kinds of humour in talk, and that these can have different functions. Norrick (1993), Kotthoff (1996) and Boxer and Cortes-Conde (1997) make a basic distinction between ‘joke-telling’ and ‘conversational humour’, the former being a delineated speech event with its own internal organisation/specific generic qualities (e.g. a punch line), and the latter being a catch-all term for various kinds of verbal ‘playing’. Conversational humour can further be broken down into various other categorisations: Boxer and Cortes-Conde (ibid.) identify teasing (i.e., where someone present is the object of fun), joking about absent others and self-denigration. Norrick (ibid.) looks at anecdotes, joint narratives, word play, mocking, sarcasm and teasing. Whilst there are formal and sequential differences between these types of humour, these authors are primarily concerned with their social functions. Boxer and Cortes-Conde (ibid.) make a distinction between humour which functions as identity display and that which does relational work. According to their analysis, teasing and joking about others have a primarily relational function, whilst joking about oneself is identity display. Generally, it’s assumed that rapport-building humour is inclusive and based on shared experience (e.g. joking about an absent other). Mocking, sarcasm and teasing are often regarded as aggressive because they are non-inclusive. Norrick (ibid.), for example, states that conversational joking in general is rapport building but that forms such as mocking and sarcasm can exert social control. Teasing, however, can be simultaneously inclusive and exclusive (Kotthoff, ibid.). Boxer and Cortes-Conde (ibid.) explain the ambiguous function of teasing by arguing that ‘teasing runs along a continuum of bonding to nipping to biting.’ (279), and because of its potential to ‘bite’, is thought to mostly take place between intimates (Straehle, 1993). This is a generalisation which does not take account of context and, like politeness theory, assumes social distance is a major determinant of sociolinguistic strategy. By examining the use of humour in sequence and in the institutional context we will see how this is not necessarily the case.

Most authors report very little research into humour in health care settings (Astedt-Kurki and Liukkonen 1994; Robinson 1983), and in particular in nursing. However, the limited attention it has received views playful use of language between nurses and patients as an important – potentially therapeutic – part of nursing care. On the whole it is viewed positively , as a way of easing anxiety (Madden 1986; Robinson, ibid.; Bauer and Geront 1999). Robinson (ibid.) describes the ‘levelling’ potential of humour and cites Emerson’s (1963) work where she describes humour as a form of interaction which gives a feeling of familiarity quickly, and allows the nurse to switch quickly between friendly and professional modes of interaction. Similarly, Coser (1959; cited in Robinson, ibid.) claims that patient use of humour decreases social distance and provides an ‘outlet for hostilities’ and ‘ allays anxieties’. As with the non-clinical studies, most authors recognise that joking behaviour can be damaging to social relations if it is not inclusive of all participants (Bauer and Geront ibid.; Robinson, ibid.). Furthermore, Giuffre and Williams (2000) state that it can be used as a form of social control, for example, letting patients know that they are not sexually available. Humour, claims Robinson (ibid.), should play a part in the education of nurses, either to ease their own anxiety, or to teach them to have better relationships with patients.

Studies into playful communication in clinical settings rarely apply conversation analysis or sociolinguistic theory to their findings, so the analysis of the meaning of these interactions (in terms of social behaviour) is, inevitably naïve or limited as far as theorising the processes of interaction is concerned.

There are those in nursing research however, e.g. Spiers (1998), who recognise that a theoretical underpinning would be invaluable:

the current communication frameworks used in nursing are inadequate to explain how communication is directed by basic human and cultural needs... New conceptual frameworks are required to illuminate how communication in interaction is negotiated and mutually constructed and how specific verbal strategies function in multiple ways to respond to the instrumental demands of the situation as well as the interpersonal needs of both participants.’ (25-6)

Ragan’s (1990) study of verbal play during gynaecological exams is worthy of special mention here as it is one of the few studies which looks at the discourse of humorous interaction in a clinical setting from a sociolinguistic point of view, so it bears some similarities to my data. Ragan's terminology is somewhat different to mine, distinguishing as she does between verbal play and ‘joking and teasing’. Verbal play has a purely bonding (inclusive) function, whereas joking and teasing can be interpersonally threatening. In her analysis she concentrates on this kind of inclusive humour, and does not report any instances of exclusive ‘teasing’. She claims that the play sequences in her data ‘reduce the face-threat of the exam’ by sharing an understanding that the procedure is disliked, and as such they are instances of ‘positive politeness’ (Brown and Levinson, 1987). In other words, jokes and laughter are achieved through a feeling of shared beliefs and experience. This alleviates the anxiety surrounding the gynaecological exam.

As we shall see below, her study differs in at least two important respects from my own: firstly, her data are taken from a gynaecology clinic on a university campus, hence the participants are all young women, whereas my data are from elderly people and younger nurses on a hospital ward; secondly, whilst I recognise that there is a need to distinguish between inclusive and exclusive humour, my data suggest there is no clear pragmatic dividing line between different forms of humour: teasing, as well as jokes about the procedure, can be both inclusive and exclusive. I have therefore used the term ‘verbal play’ as a cover term.

As we have seen, verbal humour is a highly relational message form and as such has been likened to phatic communion (Kotthoff 1996). It therefore invites examination in the light of Brown and Levinson’s politeness theory, whose fundamental purpose is to explain the connection between linguistic form and social behaviour and intentions:

  …we see interaction as at once (a) the expression of social relationships and (b) crucially built out of strategic language use, we identify strategic message construction as the key locus of the interface of language and society. (Brown and Levinson, 1987, 56)

In their model ‘joke’ is considered to be a positive politeness strategy which is part of a sub-strategy of ‘claim common ground’:

Many authors analyses fit this explanation of the relational role of joking, including Ragan’s account of 'verbal play' summarised above. Norrick (1993) also follows Brown and Levinson, stating that ‘aggressive’’ forms of joking, such as teasing, build solidarity by flouting politeness conventions. He states that:

That is to say, superficial rudeness produces an inference that the opposite of what is said is meant, and the shared knowledge of this inference creates a bond between the interlocutors.

Other research suggests that Brown and Levinson’s characterisation of joking as a positive politeness strategy is an oversimplification. Zajdman (1994), for example, looks at the way FTAs can be committed through jokes and finds that while many jokes do indeed redress face through positive politeness, some can be on-record (unredressed) or off-record strategies. Kotthoff (ibid.), while finding the notion of ‘face work’ useful in analysing humour, is also critical of the politeness model. She says ‘it is doubtful that teasing should be regarded as positive politeness merely because…in a certain way it communicates solidarity.’ Furthermore, she says, politeness theory fails to consider the ability of humour to form ‘out-groups’ and hence to have a distancing function. She concludes therefore, that while humour clearly affirms familiarity, it is also a way of being impolite. Kotthoff also assumes that surface rudeness is a clear ‘violation’ of politeness norms. This is at odds with Norrick’s explanation (see above) that these are instances of flouting (not violating) politeness norms (cf. Grice,1975) in order to reduce the relational distance in the interaction.

Brown and Levinson (ibid.) do in fact account for the humorous use of insults (bald-on-record face threats), claiming that these have a constructive role to play within the interaction:

This analysis of joking behaviour is particularly relevant to the occurrence of teasing in the hospital context, as we shall see in the data analyses below.

When we examine politeness phenomena in a particular setting, such as a hospital ward, it becomes obvious that while the theory has interpretive value, it does not take into account contextual factors, so it cannot predict what politeness phenomena will occur in any one interaction. According to the theory, one might predict that an interaction involving the bathing of one non-intimate adult by another in Western culture would give rise to extreme distancing due to the extent of the FTA, that is to say, a ‘negative politeness culture’ (Aronsson and Rundstrom, 1989). However, in this context, and in other professional caring settings it is more common to find strategies of positive politeness characterising the discourse (Grainger, 1990). I would argue that this is because of the nature of the face threat in this situation, which gives rise to a need to construct a familiarity between the participants which would permit such an imposition to take place. In other words, the activity of bathing another person would normally (i.e. outside the institution) take place where social distance is minimal. In this ‘community of practice’ (Wenger, 1998, in Holmes and Meyerhoff, 1999) however, minimal social distance must be created. One effective way of achieving this is through the use of play (another is through the use of baby-talk which I have discussed elsewhere, e.g. Grainger 1993). Although Brown and Levinson’s notion of ‘re-ranking’ (above) acknowledges the potential of politeness strategies to construct and negotiate relationships, the decontextualised nature of their data means that I concur with Aronsson and Rundstrom (ibid.) and Spiers (ibid.), who criticise Brown and Levinson’s model for being too deterministic. That is to say, B & L state that the interaction of social distance (D), power (P) and the extent of the face threat (Rx) determine the nature of the politeness strategy used in a particular speech event. Even in a case where a speaker may attempt to re-rank the social distance, the model does not account for contextual factors that may motivate such re-ranking, either in terms of the macro (institutional) context or in terms of the local, turn-by-turn conversational context. As I have pointed out elsewhere (Grainger, ibid.), the nature of the institutional setting is such that the spoken discourse is instrumental in constructing a particular ‘reality’ for the participants, which enables the institutional and personal goals to be simultaneously achieved. In the case of medical setting, the personal and institutional goals may indeed be conflicting (Ragan, ibid), so arguably participants have to achieve a balancing act between goals. Ragan states that:

Whereas multiple task and face goals likely operate in all interpersonal interactions…, the unique medical context of the gynaecological exam suggests that multiple goals are both inherent and potentially in conflict; achieving the medical goal of the exam intrinsically threatens the face needs of both participants. (Ragan 1990, 68)

The same could also said to be true of the geriatric ward, where nursing help with personal hygiene tasks is both medically necessary and personally face-threatening. Thus the macro institutional context is an important factor when accounting for humorous message strategies. Equally important is the influence of the local context (surrounding talk). Whereas, Brown and Levinson (ibid.) seem to assume that joking is a unilateral strategy on the part of the speaker:

‘Joking is a strategy for putting H at ease’ (124)

‘In trying to re-rank D, S may take advantage of on-record strategies and intimacy.’ (229)

it is clear from data such as those presented in this paper that joking is a jointly constructed phenomenon, involving initiation and uptake. The data provide an excellent example of how relationships are negotiated via the discourse in order to manage both face and institutional goals. As I will show below, joking behaviour can have different relational effects depending on local sequential factors such as who initiated the play frame and the degree of reciprocity of the playfulness, as well as what sort of non-play talk occurs.

The data

These data were gathered over a period of 3 weeks in a British National Health Service geriatric acute ward. All participants gave informed consent, and the project was approved by the hospital ethics committee. Nurses were asked to carry a micro audio recorder while they went about their duties with certain patients. A total of twelve interactions were recorded. Most of these took place during bathing or dressing patients, therefore, due to the private nature of these activities, it was not possible to have video data, or for the researcher to be present, observing. However, having been a regular visitor on the ward over the period, the researcher (the author) was familiar generally with ward procedure. A total of four of these interactions involved some kind of verbal play, and three of these had substantial and prolonged sequences of humorous ‘banter’. It is these that I examine in detail for this paper. The transcription used is a modified version of that used by Jefferson (1984).(2)

Looking at my hospital ward data there can be no doubt that, in broad terms, the playfulness creates a sense of familiarity between nurses and patients and thus, in Brown and Levinson’s terms is a positive politeness strategy. In one of the interactions, as with Ragan’s study, this is achieved through joking about the procedure itself. In the following data extract, the nurse is preparing to give the patient a bath:

Extract 1 (Patient 1)(3)

As with many of Ragan’s examples, the ‘play frame’ (Ragan, 1990) is introduced by the patient herself at line 4, with ‘drown ((me is it?))’. The nurse then takes up this theme with ‘I’m gonna pour so much water over your head… and don’t ruin our fun Mary’. Its interesting how this joking about the procedure itself refers to many of the face-threats inherent in the situation: cruelty or abuse is implicit in the comments, ‘don’t ruin our fun Mary’ (line 7), and lack of choice implicit in ‘I’m not coming this place no more’ ( line 6), but by casually mentioning them, the effect is to counteract them. In terms of politeness theory, at a surface level, some of the humorous speech acts are bald-on-record face threats: for example, ‘drown ((me is it?))’ threatens hearers positive face, ‘drown you yeh’ is a threat to hearers negative face as well as speakers positive face; ‘I’m not coming this place no more’ is a threat to hearers positive face. They all of course obtain their humour from the assumed shared knowledge that the opposite of what is being said applies, that is they flout the Co-operative Principle (Grice, 1975). At the level of meaning then (rather than surface form), these are positive politeness strategies, which count on the implicature that ‘we both know this is not true/appropriate’ for the situation. Thus positive face is oriented to (asserting common ground) at the same time as denying any underlying threats to physical well-being or dignity. In the absence of any pre-existing closeness between nurse and patient, a sense of familiarity is jointly created by the participants, motivated by the need to legitimise the intimate help by a non-intimate other, to which the elderly adult is obliged to subject herself.

The above exchange is followed immediately by another, slightly different, example of joking about the procedure:

This time it is initiated by the nurse who flouts Grice’s maxim of quality (i.e. exaggerates ), at line 8, which the patient treats as humorous (line 9). By assuming a tone of voice normally reserved for talk to babies and other ‘incompetents’, the nurse is implicitly mocking the procedure itself. That is to say, she is acknowledging that this situation is similar to one involving a mother and child, but by parodying it she helps to construct the situation as precisely not that. Rather, by laughing at the idea of playing with the bubbles, both nurse and patient simultaneously assert their solidarity in the activity as well as constructing it as something which is permissible in this context. A negative politeness strategy - where respect and distance are foremost in the interaction – would be seriously at odds with the nursing goals in operation here.

I see the examples given above, then, as demonstrating the way in which institutional goals are negotiated in discourse as well as demonstrating Brown and Levinson’s notion of ‘re-ranking’. Nurse and patient do not actually have much of a background in common - they have only known each other a few days at most. What the joking behaviour does is to re-rank the distance between them - assume or convey that distance is actually minimal as this is the only way that the intimate act of bathing a non-intimate other can take place and be interactionally comfortable. In this case, the verbal play is initiated by the patient and immediately taken up by the nurse. In addition to this, the object of fun is mostly the procedure itself, therefore a sense of collaboration is achieved over the definition of this situation, reducing the potential for any ‘bite’ in this humour.

Another form of verbal play that was present in all three interactions examined here, could be described as ‘teasing’. Boxer and Cortes-Conde (1997) say that ‘teasing requires that the conversational joking be directed at someone present.’ (page 279).

Although the extracts displayed above also have characteristics of teasing (i.e. the patient teasing the nurse), there is a degree of reciprocity and absence of personal - only institutional - face threat which arguably gives less of a sense of a specific target of the humour. Hence, local sequential factors in the context are important in defining the nature of the teasing. However, within this same interaction, and similarly in another interaction, there is some mild patient-oriented teasing which could be placed at the ‘bonding’ end of the relational continuum (Boxer and Cortes-Conde, 1997) and which when viewed both in the general context of the hospital ward, as well as in the local context of the interaction, can be seen as part of the construction of at least a semblance of a familiar relationship between nurse and patient.

In this extract, the nurse teases the patient at line 39 about what she must have been like as a child. In terms of the whole interaction this comment reinforces a feeling of familiarity, not only because it implies that the nurse knows enough about the patient to be able to guess what she was like as a child, but also because it is mildly face-threatening (suggesting that P was badly behaved) and therefore, as with the examples above, the distance between them is ‘re-ranked’ by virtue of committing an FTA.

However, it is important to take into account preceding, non-humorous talk (lines 20-28) where the nurse, although not joking, is assuming a high level of intimate knowledge about the patient (‘mind you you invariably have a bit of er (.) wind don’t you first thing in the day (.) you?(.) and lunch time as well’). Perhaps more significantly, the nurse’s comment ‘your mother must have had hell with you’) is preceded by the patient’s self-denigrating comment ‘cheeky isn’t I?’ which not only is face-threatening to herself, but also invites the nurse to threaten her positive face wants. Any possibility of ‘bite’ to this teasing is therefore reduced as the relationship is ‘set up’ as intimate, and the patient positions herself as the less powerful (child-like) participant with a reference to ‘cheeky’ behaviour (Eugenie Georgaca, personal communication) . The nurse’s subsequent reference to her childhood (line 39) is then the result of a collaboration on the negotiation of their roles as intimates but with the patient in a slightly subservient (though irreverent) position. This collaboration is achieved through both playful and non-playful interaction.

Interestingly, a similar dynamic takes place in the verbal play sequences between nurses and another patient:

Extract 4 (Patient 2)

Occupational therapist:OT

Overall, the humour in this interaction could be described as teasing, but it’s inclusive (and therefore positive politeness, or ‘bonding’) because P starts it off with self-denigration (‘I nag so much don’t I?’). The humour of line 2 (‘you looks glamorous’), arises out of it being counter-factual (Peter Jones, personal communication), the implications of which are actually face-threatening and therefore indicative of an intimate relationship. This is similar to some of the banter in extract 1, which also relies on counter-factuals, but in Extract 1 1 it is the surface form that is face-threatening, while the underlying message is face-saving. At line 10 an intimate relationship is actually explicitly mentioned ('we do love you Lil’). ‘I bet you was the type…’ shows knowledge of the other, and therefore is positive politeness. Notice that for both Patients 1 and 2 the teasing focuses on the patients characteristics as a child. Thus, although this asserts familiarity, it also places the patient in a certain child-like role which, while on the one hand attends to her positive face wants, on the other hand poses a threat to negative face wants by reducing her adult status and her control over her own affairs.

In these cases, then, the politeness or otherwise of an utterance can at least to some extent be judged in the context of previous turns of talk. A sense of familiarity is built up over a number of turns which include counter-factuals about the routine, nurses’ assumed knowledge about the patient, patient self-denigration and teasing. While any aggressive undertones are non-existent or reduced to a minimum, the latter example shows how an element of social control may nevertheless be introduced.

The next data extract also shows the nurses teasing a patient but in this case there is a simultaneous undercurrent of aggression:

Extract 5 (Patient 3)

This patient is treated as being more dependent than the previous two, judging by baby talk, e.g.(line 1) ‘you’re a bit red aren’t you my darling?’. Thus familiarity is assumed here, but not so much in the verbal play. On the surface, many of the jocular speech acts are examples of positive politeness, since they show solidarity with the patient., e.g. lines 3 and 5 fit Brown and Levinson’s positive politeness strategies of ‘convey X as admirable and interesting’ and ‘claim common points of view/opinions‘ respectively (Brown and Levinson, 1987). However, the playful nature of this interaction arises out of the assumption by the nurses that these utterances are not to be taken seriously. The humour (to us and the other nurse present) arises out of the assumption that she does not mean what she says(flouting the co-operative principle), partly because of the setting (where dating between patients and nurses is not possible), and partly because he is old. This ageist assumption is then potentially face-threatening, leading us to the paradoxical conclusion that verbal play, which appears on the surface as positive politeness, can be simultaneously ‘polite’ and threatening. It is the institutional context of these utterances that implies this ambiguous meaning. This is classic ‘teasing’ then, which in this case has a possible ‘bite’ to it because it's questionable how inclusive of the patient it is. Notice that, unlike in the previous examples, it is the nurse who initiates the play, and it is she who does most of the laughing (lines 5, 9, 30). We can see at line 32 that the patient does laugh a little, but notice that this is only when the Auxiliary (also to some extent the brunt of N’s teasing) includes him and excludes N in her utterance: she’s matched us up already hasn’t she?(line 31).

Another pragmatic difference between this extract and the previous two is that the nurse’s speech acts consist of a lot of questions, implying perhaps that shared knowledge does not yet exist, unlike in Extract 1 where the nurse assumes quite intimate knowledge about P’s body, as well as about her personality (you invariably have a bit of wind...; your mother must have had hell with you). Interestingly, the questions themselves are a good example of how this interaction is functioning relationally on several levels. The nature of the questioning is such as to invite and even provoke a response: in line 3 there are at least three different questions asked in quick succession (‘won’t we? have you got any money? to take out? and get them a meal?’), showing that she did seem to require an answer from the patient even though the premise of the question was false. A similar thing happens again at line 9, ’ blondes or brunettes (1.0) eh?’, where the patient is obliged to give a reply. Regardless of the motivations for this behaviour, such questioning can be regarded as powerFUL and mildly aggressive as it leaves the recipient very little choice as to whether to participate in the interaction. On the one hand this could be seen as requiring the patient to participate in his own ridicule, but on the other hand it may be the nurse’s attempt to include the patient in the teasing and so reduce the potentially biting nature of it. Again, this is an example of verbal play having the potential to be both a positive politeness strategy and face-threatening simultaneously. It is perhaps reflective of the setting where intimate social relations are constructed for the sake of getting the job done, but at the same time control is maintained over the situation by the professionals. However, it is not clear whether or not the patient also makes these assumptions (although he does join in laughter with Aux at one point). Verbal play in this instance, then, may not have an over-arching goal of positive politeness (by re-ranking D), but instead may have the opposite function of distancing (negative politeness) and exerting social control (Guiffre and Williams 2000). From this, we can see the way in which verbal play which is teasing can be a risky strategy in terms of constructing relationships. We can also see how an interaction which is superficially benevolent could have malevolent undertones. This is partly a function of the institutional context, and partly of the nature of participation in previous turns. Probably Boxer and Cortes-Conde are close to the truth when they say teasing is on a continuum from bonding to biting and these are not mutually exclusive boundaries – this type of verbal play tends to have ‘unstable frames’ (279) and therefore creates tension and is a risky strategy in terms of relational and identity work.

While the literature on humour takes social relationship into account when assessing the meaning of verbal play (i.e. the extent to which it may be perceived as aggressive vs. bonding), little of it seems to take into account the influence of the situation. Similarly, Brown and Levinson's explanation of 'joking' behaviour within their theory of politeness is decontextualised and does not take account of the dynamism of interaction, although it does provide a useful interpretive model. Their account allows for ‘re-ranking’ of D (distance), but it cannot predict what would motivate such a strategy. A detailed analysis of humour on the hospital ward shows that a sense of familiarity is created collaboratively through the use of verbal play in order to fulfil both personal face-saving goals and institutional goals. Thus, the parameter D is re-ranked because of contextual considerations and achieved as a process of negotiation by both participants. It seems that an understanding of the context is crucial in explaining why interlocutors might collaborate in constructing an intimate relationship which wouldn’t otherwise exist.

We have also seen how the characterisation of joking as simply ‘positive politeness’ is to oversimplify the relational function of humour in this context. Even playful banter which is inclusive of both participants can have a controlling edge to it, while at the same time promoting a feeling of intimacy. And exclusive teasing (which in this analysis is defined by a subtle combination of contextual knowledge, and the dynamics and content of the interaction) can be seen to operate at multiple relational levels: partly creating intimacy, but also carrying aggressive, and therefore non-polite, undertones.

As far as what this study can contribute to the field of nursing is concerned, it shows the turn-by turn processes by which an interactionally delicate situation is managed in order to meet institutional needs and personal face needs. A sense of intimacy can be built up through playful interaction between nurses and patients, but the data also show how some verbal play risks creating tension and distance. The analysis begins to offer an explanation for these phenomena in terms of how participants themselves negotiate their relationships over several turns at talk and within the institutional context. It would seem that whether or not the patient initiates and participates in the playful episodes is particularly important for gauging the level of aggression in superficially light-hearted banter. It is not enough, then for the nursing literature to advocate the use of humour as a therapeutic tool, without understanding the relational dynamics in a particular situation. As we have seen, some verbal play is perhaps best avoided.

¹ Thanks to the discourse Research Group at Sheffield Hallam University (Communication Studies) for their feedback on preliminary data analysis. (back)

² Gail Jefferson’s work in J. Atkinson and J. Heritage (1984), Structures of Social Action: Studies in Conversation Analysis, Cambridge: Cambridge University Press. (back)

³ Notation conventions are as follows:

[ ] overlapping utterances

(.) pause shorter than a second

(number) length of pause in seconds

( ) non-verbal activity or transcriber comment

(( )) unclear speech/transcriber doubt

underlined utterances emphasis

. some talk is omitted from the transcript

N Trained Nurse

Aux untrained auxiliary nurse (support worker)

OT Occupational Therapist

P Patient

The patient involved is identified as 1, 2 or 3 at the beginning of each extract. For each patient, the carers involved were different in each case. (back)

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