For patients, hospital emergency departments (EDs) are unfamiliar, institutional contexts involving high-stakes communication in heightened emotional circumstances. This study examines laughter, as one expression of emotion, in an existing 649,631-word corpus of naturally occurring clinician-patient interactions recorded in five Australian hospitals. A mixed methods approach revealed (1) the spread, frequency and producers of laughter, and (2) the functions of laughter in unfolding interactional contexts. First, a corpus analysis showed that laughter in the ED was most frequently produced by nurses and patients, but relatively infrequently by doctors. Secondly, two case studies comprising all the interactions of two patients for the whole duration of their ED visits were analysed in detail to explore the individuals’ contrasting patterns of laughter. The analysis revealed how laughter can be a cue to the affective dynamics of patient-clinician interactions about serious matters, for example, signalling difficult topics and managing anxiety in the ED context. Laughter, and any related humour, can indicate the achievement of mutuality, which is considered a cornerstone of genuine shared decision-making and patient participation in their own care. Therefore, the findings suggest that a sensitive responsiveness to patient-initiated laughter, and any associated humour, may promote patient-centred relationships in clinical interactions.

中文翻译：

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医院急诊科的笑声

对于患者来说，医院急诊科 (ED) 是陌生的机构环境，涉及在高度情绪化的情况下进行高风险的沟通。这项研究在澳大利亚五家医院记录的自然发生的临床医患互动的现有 649,631 个单词的语料库中检验了作为情感表达之一的笑声。混合方法揭示了（1）笑声的传播、频率和产生者，以及（2）笑声在展开互动情境中的功能。首先，语料库分析显示，急诊室中最常发出笑声的是护士和病人，但医生发出的笑声相对较少。其次，详细分析了两个案例研究，其中包括两名患者在整个急诊就诊期间的所有互动，以探索个体对比的笑声模式。分析揭示了笑声如何成为患者与临床医生在严肃问题上互动的情感动态的线索，例如，在急诊室中传达困难的话题和管理焦虑。笑声和任何相关的幽默都可以表明相互的实现，这被认为是真正共同决策和患者参与自己护理的基石。因此，研究结果表明，对患者发起的笑声以及任何相关幽默的敏感反应可能会促进临床互动中以患者为中心的关系。