Constructing reassurance and alignment: a discursive study of nurse-patient communication in transplant preparation

Patient education for autologous stem cell transplantation (ASCT) is a complex, high-stakes process that requires both clear communication and emotional support. One cancer center implemented a supplementary video-based education (VBE) program to prepare patients and caregivers before in-person nurse-led sessions.

Using discursive psychology, this study examined how nurses structured talk during education sessions, particularly in response to patients' prior engagement with the videos. Twelve audio-recorded sessions (totaling 1,011 minutes) were transcribed and analyzed with a six-stage discursive psychology framework. Data were collected between January-2019 and March-2020; as a discourse-analytic method, DP does not employ the saturation principle used in thematic qualitative research.

Patients had a median age of 61, were evenly split by gender, and were mostly White (57%). Analysis identified three recurring discursive patterns: (1) nurses used pronouns to shift alignment between representing the medical team and partnering with patients; (2) references to institutional experience normalized procedures and conveyed reassurance; and (3) prior VBE exposure enabled more personalized and collaborative discussion.

Findings show how language functions to manage accountability, construct authority, and build empathy in clinical education. VBE did not shorten sessions but fostered richer, more dialogic interactions, demonstrating how hybrid education shapes patient engagement. These results provide new insight into nurse-patient communication and the relational work required to balance authority with empathy in high-stakes educational encounters.