Labelling patients

Clinical decisions-making within diagnostic radiography - A scoping review

OBJECTIVES

To describe and synthesise literature on clinical decision-making within diagnostic radiography, to uncover the important elements, and to identify knowledge gaps for further investigation. The scoping review question was: How do diagnostic radiographers make clinical decisions?

KEY FINDINGS

Radiographers make clinical decisions before, during and after examinations. The primary source of information radiographers use is the clinical request, however, if they doubt something, they rely on their colleague's points of view rather than evidence-based practice. Many elements must be considered in the clinical decision-making process; however, lack of autonomy, sparse information on the clinical requests, and lack of time affect the process, which can lead to a barrier to effective decision-making.

CONCLUSION

Clinical decisions are made based on many different elements before, during, and after examinations in combination with different types of knowledge, as well as technical and organisational aspects within radiography clinical practice.

IMPLICATION FOR PRACTICE

There is a need to focus on giving more attention to developing the decision-making elements. In addition, there must be more focus on improving intra-professional work between radiographers and radiologists to facilitate radiographers' opportunities to act on their clinical decisions.

"I don´t put people into boxes, but…" A free-listing exercise exploring social categorisation of asylum seekers by professionals in two German reception centres

Newly arriving asylum seekers in Germany mostly live in large reception centres, depending on professionals in most aspects of their daily lives. The legal basis for the provision of goods and services allows for discretionary decisions. Given the potential impact of social categorisation on professionals' decisions, and ultimately access to health and social services, we explore the categories used by professionals. We ask of what nature these categorisations are, and weather they align with the public discourse on forced migration. Within an ethnographic study in outpatient clinics of two refugee accommodation centres in Germany, we conducted a modified free-listing with 40 professionals (physicians, nurses, security-personnel, social workers, translators) to explore their categorisation of asylum seekers. Data were qualitatively analysed, and categories were quantitatively mapped using Excel and the Macro "Flame" to show frequencies, ranks, and salience. The four most relevant social categorisations of asylum seekers referred to "demanding and expectant," "polite and friendly" behaviour, "economic refugees," and "integration efforts". In general, sociodemographic variables like gender, age, family status, including countries and regions of origin, were the most significant basis for categorisations (31%), those were often presented combined with other categories. Observations of behaviour and attitudes also influenced categorisations (24%). Professional considerations, e.g., on health, education, adaption or status ranked third (20%). Social categorisation was influenced by public discourses, with evaluations of flight motives, prospects of staying in Germany, and integration potential being thematised in 12% of the categorisations. Professionals therefore might be in danger of being instrumentalised for internal border work. Identifying social categories is important since they structure perception, along their lines deservingness is negotiated, so they potentially influence interaction and decision-making, can trigger empathy and support as well as rejection and discrimination. Larger studies should investigate this further. Free-listing provides a suitable tool for such investigations.

Compassionate communication: Keeping patients at the heart of practice in an advancing radiographic workforce

INTRODUCTION

Compassion is a poorly understood concept in diagnostic and therapeutic radiography, but an increase in its focus was recommended in the Francis Report (2013). Much of the healthcare literature including policy and protocol has focussed on benchmarking and individualising compassion. Two separately conducted doctoral research projects, one therapeutic and one diagnostic, aimed to conceptualise compassion in order to understand its meaning and behavioural expression.

METHODS

A constructivist approach was taken with appropriate ethical approval. Patients and carers, student radiographers and radiographers took part in interviews and focus groups and tweets were harvested from a Twitter journal club discussion between radiographers of the second author's published literature review. Data were transcribed and analysed thematically.

FINDINGS

Key aspects of communication are fundamental to giving compassionate patient-centred care. These include verbal and non-verbal cues, actively listening and engaging and establishing rapport with the patient. Specific skills associated with these are also identified in these studies.

CONCLUSION

Keeping the patient as a person at the centre of radiographic practice in the rapidly evolving technical and cultural environment in which it exists requires timely and appropriate behavioural expressions of compassion from radiographers deploying a range of highly specific communication and interpersonal skills.

IMPLICATIONS FOR PRACTICE

When undertaking reflective practice, radiographers could consider key aspects of how they communicate with patients, including: verbal (in particular the language they use with patients and their tone of voice); non-verbal (especially eye contact and smiling and their body language). They could also usefully explore and develop skills in reading their patients' body language as well as their own in order to pick up subtle or hidden cues that might suggest a patient is suffering emotionally or psychologically. Finally, they could think about the sort of targeted questions they could ask of patients when welcoming them into the x-ray or treatment room that would both facilitate the procedure and leave the patient feeling that their radiographer had taken a genuine interest in them and their situation. These reflections could then be used to possibly modify their existing communications with their patients.

A model to facilitate the teaching of caring to diagnostic radiography students: Original research

BACKGROUND

Healthcare has moved towards a patient-centred caring environment. Radiography students have described feeling unprepared for daily patient interactions therefore, it is essential for educators to facilitate the development of caring attributes in students.

OBJECTIVE

The objective of this article is to describe the process that was followed in order to develop a model to facilitate the teaching of caring to diagnostic radiography students.

METHOD

A qualitative, theory-generating, exploratory and descriptive research design was used. Phase one was a descriptive, exploratory study that utilized focus group interviews to explore and describe the concept of caring from the perspective of first year diagnostic radiography students. Phase two, the focus of this article, was the theory generation phase of the study which began with identifying a central concept from the focus group interview results. The central concepts were then defined according to dictionary and literature sources and relationships between the identified concepts were created. Thereafter, the model was developed.

RESULTS

The central concept was identified as the "facilitation of a culture of caring". This concept was then defined, classified and described.

CONCLUSION

This model as a framework of reference could assist diagnostic radiography educators in facilitating the teaching of caring among student radiographers.

Ethnographic mosaic approach for health and rehabilitation practitioners: an ethno-radiographic perspective

This methodological commentary focuses on the use of ethnography for health and rehabilitation practitioners. In recent years, ethnography has become a methodology of choice amongst diagnostic radiography researchers at uncovering phenomena pertinent to the clinical setting. This paper adds to the evidence base by providing not only a methodology account from two experienced researchers, but also offers a paradigmatic approach to ethnography that incorporates qualitative and quantitative approaches. It details an alternate ideological discourse in alignment with the role of a diagnostic radiographer, which can be replicated in other disciplines and thus offering an array of empirical opportunity for prospective health and rehabilitation practitioners.IMPLICATIONS FOR REHABILITATIONThis paper provides an introduction into the use of ethnography for health and rehabilitation practitioners.The authors reflect on the value of ethnography in order to satisfy a researcher's aims and objectives.The authors provide an "umbrella strategy" that can be used by other prospective health and rehabilitation researchers.It is argued here that this methodology offers an alternate strategy of uncovering new ideas and research data.

A review of visual ethnography: Radiography viewed through a different lens

INTRODUCTION

The objective of this article is to provide a short review of the research methodology 'visual ethnography'.

METHOD

The review article will provide a summary of the foundations of visual ethnography, outline the key debates and refer to some of the main authors working in this field.

RESULTS

Visual Ethnography is both a methodology and a method of research. It should be selected for research in radiography when research questions seek to focus upon aspects or elements of a culture. A research plan that is designed using a visual ethnographic approach should be flexible and take into account the requirements of the researcher and research participants. Visual methods of research include the use of various images, for example, photographs, collage, film or drawings. Visual methods are commonly employed together with interviews, conversations and observation. The approach enables researchers to generate new and unique insights into cultures.

CONCLUSION

This review of visual ethnography provides background information that informs an introduction to the methodology. It demonstrates a methodology with the potential to explore culture and expand knowledge of radiography practice.

IMPLICATIONS FOR PRACTICE

The authors suggest that for future studies visual ethnography is a methodology that can expand the paradigm of radiography research.

Behaviours of healthcare professionals towards difficult patients: A structural equation modelling study

BACKGROUND

Some patients are stigmatised as difficult patients by healthcare professionals. This phenomenon has great many negative consequences. The behaviours of healthcare professionals towards difficult patients are important.

OBJECTIVE

To explore the behaviours of all healthcare professionals towards difficult patients.

RESEARCH DESIGN

This study was based on a cross-sectional research design using structural equation modelling.

PARTICIPANTS AND RESEARCH CONTEXT

Two hundred and fifty-four healthcare professionals were involved in the study in Turkey. 'Participant Information Form' and the 'Healthcare Professionals Behaviour Assessment Questionnaire For Difficult Patient' were used to collect data from participants.

ETHICAL CONSIDERATION

Ethical approval was obtained from Gazi University Ethics Committee for the study. Informed consent of the participants in the study was taken and the confidentiality of the participants was ensured.

FINDINGS

It was explored that the behaviours of healthcare professionals towards difficult patients were categorised into ethical, supportive and negative. The highest mean score was supportive behaviour and the least mean score was negative. According to structural equation modelling, the most important predictor of difficult encounters was an ethical dimension. One-unit increase in ethical behaviour contributed to 0.92 unit increase in positive patient behaviour.

DISCUSSION

Patients generally are perceived as 'difficult patient' by the healthcare professionals, so the patients' treatment and care services are affected negatively due to healthcare professionals' negative beliefs and attitudes. The healthcare professionals should behave supportively towards difficult patients.

CONCLUSION

Healthcare professionals should be aware of management strategies in dealing with difficult encounters. The behaviours of healthcare professionals should be improved in a positive way and awareness of ethical dimension of difficult encounters should be increased.

The use of simulation and moulage in undergraduate diagnostic radiography education: A burns scenario

INTRODUCTION

There is a national drive to increase allied health professions simulation training. However, there is a paucity of literature within diagnostic radiography in relation to clinical simulation. No research could be found regarding the impact of simulation in radiography with complex clinical burns scenarios. This research aims to explore the perceptions of radiography undergraduate students regarding their preparedness for the complex care requirements in imaging examinations of clinical burns cases using a mixed methods approach.

METHOD

A small-scale simulation-based teaching session was developed in a Scottish HEI, using role play and moulage to create realism. Twenty-eight undergraduate student radiographers participated in the scenario. Students completed pre and post-scenario questionnaires using Likert scale and free response data. Focus groups were undertaken three months after the simulation to obtain rich qualitative data. Common themes were identified via a process of initial coding and a 6-phase thematic analysis.

RESULTS

Thematic analysis demonstrated a marked increased perception of preparedness post-scenario; students felt more prepared to undertake their role in the imaging of complex care patients (Likert scoring increased with both mode and median post-scenario). Common themes that were identified were patient centeredness, realism and learning.

CONCLUSION

Within this limited pilot project, the use of simulation was an effective means of preparing students to understand their role within the complex care setting (with respect to the traumatic realism of burns) in preparedness for professional practice. Additionally, students related to the practical understanding of the complexity of human factors that exist within clinical practice.

The concept of caring amongst first year diagnostic radiography students: Original research

Student radiographers start their work integrated learning from their first year of studying and they are in constant contact with patients. Based on this interaction, it is imperative for all diagnostic radiography students to be caring professionals. The purpose of this study was to gain an understanding of caring amongst diagnostic student radiographers by exploring and describing their experiences of caring in the clinical environment. A qualitative, exploratory, descriptive and contextual research design was utilized. Focus group interviews were conducted with first year diagnostic radiography students. Purposive sampling was used to ensure information rich data was obtained. In keeping with qualitative research, participants were interviewed until data saturation was reached. Appreciative inquiry was used as an interview technique to encourage storytelling and to engage in narrative - rich communication. The 4-D model of appreciative inquiry, namely; Discovery, Dream, Destiny and Design, formed the basis for the interview questions. Data was analysed and coded and themes were created based on the interpretation of the data. Three themes were identified as being; caring as an integral part of a career choice, unpreparedness for interpersonal interactions and barriers and enablers for the development of a caring identity. Participants expressed an idealistic vision of what caring means to them as a student radiographer. Participants felt unprepared for their daily interpersonal interactions with patients and other staff. Recommendations to radiography educators would be to engage in more role-playing exercises, reflective practices and peer discussions.