Date of Award


Degree Name

Doctor of Nursing Science


Conceptual metaphor, Ethnography, Intercultural communication, nurse-patient relationship, nursing, patients


The conceptual metaphor has meaning only when understood within the cultural framework which gives rise to the conceptualization. The purpose of this study was to investigate the interaction of cognition (conceptual metaphor) and culture as manifest during intercultural communication in teaching-learning sessions between health care providers and patients. An ethnography of communication (Hymes, 1974; Saville-Troike, 1989) was the method employed to investigate the use of metaphor by patients, nurses and other health care professionals. Patients were viewed as a sojourner group in the health care culture; nurses and their health care partners were seen as a host group. Data were collected during a six month period using participant observation and key informant interviews with groups of sojourners/patients and a host/staff group consisting of six different health care specialties. The communication setting was an outpatient diabetic education program for those with a new diagnosis or whose condition had recently become unstable. The duration of the education program was six sessions, with variable participant attendance rates. Ethnographic findings indicated that the communication of each of the two groups presented a variety of distinctive features, as well as shared features. The sojourner group communication events and acts included the creation of pre- and post-sessions, the creation of personal narratives, and the practice of stopping the communication. Hosts also generated distinct communication events and acts which were stand-alone sessions, the use of a lecture format, a minimized response to the sojourner narratives, as well as confrontation of non-adherent sojourners. They shared several constructs and meanings in the use of several metaphoric domains, as well as the use of the machine metaphor of control (Ting-Toomey, 1987). Both groups also exhibited instances of parallel meanings in regard to the metaphor they used. The two groups shared many of the same source and target domains but some were incongruently interpreted by the groups. The findings have implications for future research into use of machine metaphors in health care communication, as well as implications for those health professionals who implement patient teaching to become more cognizant that their metaphors should be examined for effectiveness. Health communicators, who plan and implement programs, need to recognize that health communication may be more effective when they create a communication partnership toward encouraging the “voice” of patients in the process.

Document Type

Dissertation: Open Access



Included in

Nursing Commons