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Wyer M, Hor SY, Ferguson PE, Morath A, Barratt R, Priestley CM, Polak A, Gilbert GL. Using Video-Reflexive Methods to Develop a Provider Down Protocol for the New South Wales Biocontainment Center. Health Secur 2024; 22:S34-S44. [PMID: 39134067 DOI: 10.1089/hs.2023.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
The New South Wales Biocontainment Centre is a statewide referral facility for patients with high-consequence infectious disease (HCID). The facility collaborates with researchers to adapt existing HCID procedures such as donning and doffing of personal protective equipment (PPE). However, information on how to respond safely to collapse of a healthcare provider in full PPE within a contaminated zone is scarce. To address this gap, we adapted Nebraska Medicine's "provider down" protocol on paper and then simulated and video recorded the process, iteratively, in the facility. Clinicians analyzed the recordings collaboratively in researcher-facilitated reflexive discussions. Our primary aim was to ascertain how to maintain optimal infection prevention and control while providing urgent care for the healthcare provider. We tested participants' suggested modifications, in repeated video recorded simulations, until consensus on optimal practice was achieved. Our secondary aim was to assess the utility of video-reflexive methods to enhance clinicians' awareness and understanding of infection prevention and control in a rare and complex scenario. Six adaptations and simulations were discussed in video-reflexive sessions before consensus was reached; the final version of the protocol differed considerably from the first. Viewing footage of simulations in situ enabled participants to (1) identify infection and occupational risks not identified on paper or during verbal postsimulation debriefs and (2) test alternative perspectives on safe procedure. Video-reflexivity enables context-sensitive and consensus-building codesign of policies and procedures, critical to protocol development in a new unit. It contributes to a culture of teamwork, preparedness, and confidence before, rather than in the heat of, a crisis.
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Affiliation(s)
- Mary Wyer
- Mary Wyer, PhD, RN, is a Nurse Educator, New South Wales Biocontainment Centre (NBC) at Westmead Hospital, Westmead, New South Wales (NSW), Australia; Mary Wyer is also a Postdoctoral Researcher at the Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW, Australia
| | - Su-Yin Hor
- Su-Yin Hor, PhD, MEd, is a Senior Lecturer, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Patricia E Ferguson
- Patricia E. Ferguson, PhD, FRACP, is Associate Director, NBC, and an Infectious Diseases Physician, Infectious Diseases at Westmead Hospital, Westmead, New South Wales (NSW), Australia
| | - Arwen Morath
- Arwen Morath, MBBS, FACEM, is a Visiting Medical Officer, Emergency Department at Westmead Hospital, Westmead, New South Wales (NSW), Australia; Arwen Morath is also an Emergency Department Staff Specialist, Auburn Hospital, Auburn, NSW, Australia
| | - Ruth Barratt
- Ruth Barratt, PhD, NZRN, MAdvPrac, is an Infection Prevention and Control Specialist, Health Quality and Safety Commission New Zealand, Wellington, New Zealand
| | - Catherine M Priestley
- Catherine M. Priestley, BN, MPHTM, is a Nurse Educator, NBC at Westmead Hospital, Westmead, New South Wales (NSW), Australia
| | - Alice Polak
- Alice Polak, BSN, GradCertNP, MANP, is a Nurse Educator and Clinical Nurse Consultant, NBC at Westmead Hospital, Westmead, New South Wales (NSW), Australia
| | - Gwendolyn L Gilbert
- Gwendolyn L. Gilbert, MD, FRACP, FRCPA, M. Bioethics, FASM, is a Senior Researcher at the Sydney Infectious Diseases Institute, The University of Sydney, Westmead, NSW, Australia
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Paxino J, Molloy E, Denniston C, Abdelmotaleb R, Woodward-Kron R. The work performed through interprofessional meeting discourse: an observational study. J Interprof Care 2024; 38:652-663. [PMID: 38678369 DOI: 10.1080/13561820.2024.2343833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
The effectiveness of work performed through interprofessional practice is contingent on the nature and extent of communication between professionals. To date, there is little research exploring how the patterns of communication may impact interprofessional work. This study focused on communication during interprofessional meetings to better understand the interprofessional work performed through these encounters. Specifically, it examined how interactional discourse, that is, the patterns of language, influenced work performed during interprofessional meetings. A series of four interprofessional meetings in a rehabilitation unit were observed. Twenty-one participants were observed, including medical, nursing, allied health clinicians, and health professions students. Follow-up stimulated-recall interviews were conducted with five meeting participants. The data collection consisted of video and audio recordings and detailed field notes. Data were analyzed using a combination of genre analysis, a form of discourse analysis, and activity system analysis, drawing on Cultural Historical Activity Theory. This facilitated an in-depth examination of the structure of discourse and its influence on meeting outcomes. The meeting structure was defined and predictable. Two distinct forms of discourse were identified and labeled scripted and unscripted. Scripted discourse was prompted by standardized documents and facilitated the completion of organizational work. In contrast, unscripted discourse was spontaneous dialogue used to co-construct knowledge and contributed to collaboration. There was constant shifting between scripted and unscripted discourse throughout meetings which was orchestrated by experienced clinicians. Rather than fragmenting the discussion, this shifting enabled shared decision making. This research provides further insights into the interprofessional work performed during interprofessional meetings. The scripted discourse was highly influenced by artifacts (communication tools) in meetings, and these were used to ensure organizational imperatives were met. Unscripted discourse facilitated not only new insights and decisions but also social cohesion that may influence work within and outside the meeting.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Elizabeth Molloy
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Charlotte Denniston
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | | | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Australia
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Wyer M, Hor SY, Barratt R, Garrahy P, Moore C, Williams Veazey L, Degeling C, Gilbert GL. Exploring the safety and quality of mobile X-ray imaging in a new infectious disease biocontainment unit: an in situ simulation and video-reflexive study. BMJ Open 2024; 14:e080152. [PMID: 38382961 PMCID: PMC10882301 DOI: 10.1136/bmjopen-2023-080152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES During a precommissioning inspection of a new biocontainment centre, radiographers noted structural features of quarantine rooms that could compromise staff and patient safety and the X-ray image quality, even after significant modifications had been made to an earlier radiography protocol. The aim of this study was to explore the safety and effectiveness of the modified protocol, in the new space, and identify improvements, if required. DESIGN A qualitative study using in situ simulation and video-reflexive methods. SETTING A newly built biocontainment centre, prior to its commissioning in 2021, in a large, tertiary hospital in Sydney, Australia. PARTICIPANTS Five radiographers, and a nurse and a physician from the biocontainment centre, consented to participate. All completed the study. INTERVENTIONS Two simulated mobile X-ray examinations were conducted in the unit prior to its commissioning; simulations were videoed. Participants and other stakeholders analysed video footage, collaboratively, and sessions were audio recorded, transcribed and analysed thematically. Problems and potential solutions identified were collated and communicated to the hospital executive, for endorsement and actioning, if possible. RESULTS Four themes were identified from the data: infection exposure risks, occupational health and exposure risks, communication and X-ray image quality. Facilitated group reviews of video footage identified several important issues, across these four areas of risk, which had not been identified previously. CONCLUSIONS In situ simulation is used, increasingly, to evaluate and improve healthcare practices. This study confirmed the added value of video-reflexive methods, which provided experienced participants with a richer view of a familiar protocol, in a new setting. Video footage can be examined immediately, or later if required, by a broader group of stakeholders, with diverse experience or expertise. Using video reflexivity, clinicians identified potential safety risks, which were collated and reported to the hospital executive, who agreed to implement modifications.
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Affiliation(s)
- Mary Wyer
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- K7c-NSW Biocontainment Centre, Westmead Hospital, Westmead, New South Wales, Australia
| | - Su-Yin Hor
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Ruth Barratt
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillip Garrahy
- Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Cameron Moore
- Radiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Leah Williams Veazey
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Degeling
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - G L Gilbert
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, New South Wales, Australia
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Herasevich S, Pinevich Y, Lipatov K, Barwise AK, Lindroth HL, LeMahieu AM, Dong Y, Herasevich V, Pickering BW. Evaluation of Digital Health Strategy to Support Clinician-Led Critically Ill Patient Population Management: A Randomized Crossover Study. Crit Care Explor 2023; 5:e0909. [PMID: 37151891 PMCID: PMC10158897 DOI: 10.1097/cce.0000000000000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
To investigate whether a novel acute care multipatient viewer (AMP), created with an understanding of clinician information and process requirements, could reduce time to clinical decision-making among clinicians caring for populations of acutely ill patients compared with a widely used commercial electronic medical record (EMR). DESIGN Single center randomized crossover study. SETTING Quaternary care academic hospital. SUBJECTS Attending and in-training critical care physicians, and advanced practice providers. INTERVENTIONS AMP. MEASUREMENTS AND MAIN RESULTS We compared ICU clinician performance in structured clinical task completion using two electronic environments-the standard commercial EMR (Epic) versus the novel AMP in addition to Epic. Twenty subjects (10 pairs of clinicians) participated in the study. During the study session, each participant completed the tasks on two ICUs (7-10 beds each) and eight individual patients. The adjusted time for assessment of the entire ICU and the adjusted total time to task completion were significantly lower using AMP versus standard commercial EMR (-6.11; 95% CI, -7.91 to -4.30 min and -5.38; 95% CI, -7.56 to -3.20 min, respectively; p < 0.001). The adjusted time for assessment of individual patients was similar using both the EMR and AMP (0.73; 95% CI, -0.09 to 1.54 min; p = 0.078). AMP was associated with a significantly lower adjusted task load (National Aeronautics and Space Administration-Task Load Index) among clinicians performing the task versus the standard EMR (22.6; 95% CI, -32.7 to -12.4 points; p < 0.001). There was no statistically significant difference in adjusted total errors when comparing the two environments (0.68; 95% CI, 0.36-1.30; p = 0.078). CONCLUSIONS When compared with the standard EMR, AMP significantly reduced time to assessment of an entire ICU, total time to clinical task completion, and clinician task load. Additional research is needed to assess the clinicians' performance while using AMP in the live ICU setting.
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Affiliation(s)
- Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
- Department of Anesthesiology, Republican Clinical Medical Center, Minsk, Belarus
| | - Kirill Lipatov
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Health Systems, Eau Claire, WI
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Bioethics Research Program, Mayo Clinic, Rochester, MN
| | - Heidi L Lindroth
- Department of Nursing, Mayo Clinic, Rochester, MN
- Center for Health Innovation and Implementation Science, Center for Aging Research, School of Medicine, Indiana University, Indianapolis, IN
| | | | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Gionfriddo MR, Dadich A. 'The Obstacle is the Way': Methodological Challenges and Opportunities for Video-Reflexive Ethnography During COVID-19. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2023; 22:16094069231165710. [PMID: 37041766 PMCID: PMC10079893 DOI: 10.1177/16094069231165710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The COVID-19 pandemic greatly impacted research. In this article, we explore the opportunities and challenges presented by the pandemic to a group of researchers using video-reflexive ethnography (VRE) - a methodology used to understand practices, grounded in: exnovation, collaboration, reflexivity, and care. To understand how the pandemic impacted researchers using VRE, we facilitated two focus groups with 12 members of the International Association of Video-Reflexive Ethnographers. The findings suggest the pandemic exacerbated existing methodological challenges, yet also provided an opportunity reflect on our own practices as researchers, namely: accessing sites, building relationships, facilitating reflexive sessions, and cultivating care. Due to public health measures, some researchers used insiders to access sites. While these insiders shouldered additional burdens, this shift might have empowered participants, increased the salience of the project, and enabled access to rural sites. The inability to access sites and reliance on insiders also impeded researcher ability to build relationships with participants and generate the ethnographic insights often associated with prolonged engagement at a site. In reflexive sessions, researchers had to learn how to manage the technological, logistical, and methodological challenges associated with either themselves or participants being remote. Finally, participants noted that while the transition to more digital methodologies might have increased project reach, there needed to be a mindfulness around cultivating practices of care in the digital world to ensure psychological safety and protect participants data. These findings reflect the opportunities and challenges a group of researchers using VRE had during the pandemic and can be used to stimulate future methodologic discussions.
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Affiliation(s)
- Michael R Gionfriddo
- Division of Pharmaceutical, Administrative
and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Ann Dadich
- School of Business, Western Sydney
University, Parramatta, Australia
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Brewster DJ, Butt WW, Gordon LJ, Sarkar MA, Begley JL, Rees CE. Leadership during airway management in the intensive care unit: A video-reflexive ethnography study. Front Med (Lausanne) 2023; 10:1043041. [PMID: 36873881 PMCID: PMC9980339 DOI: 10.3389/fmed.2023.1043041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Effective leadership is crucial to team performance within the intensive care unit. This novel study aimed to explore how staff members from an intensive care unit conceptualize leadership and what facilitators and barriers to leadership exist within a simulated workplace. It also aimed to identify factors that intersect with their perceptions of leadership. This study was underpinned by interpretivism, and video-reflexive ethnography was chosen as the methodology for the study. The use of both video recording (to capture the complex interactions occurring in the ICU) and team reflexivity allowed repeated analysis of those interactions by the research team. Purposive sampling was used to recruit participants from an ICU in a large tertiary and private hospital in Australia. Simulation groups were designed to replicate the typical clinical teams involved in airway management within the intensive care unit. Twenty staff participated in the four simulation activities (five staff per simulation group). Each group simulated the intubations of three patients with hypoxia and respiratory distress due to severe COVID-19. All 20 participants who completed the study simulations were invited to attend video-reflexivity sessions with their respective group. Twelve of the 20 participants (60%) from the simulations took part in the reflexive sessions. Video-reflexivity sessions (142 min) were transcribed verbatim. Transcripts were then imported into NVivo software for analysis. The five stages of framework analysis were used to conduct thematic analysis of the video-reflexivity focus group sessions, including the development of a coding framework. All transcripts were coded in NVivo. NVivo queries were conducted to explore patterns in the coding. The following key themes regarding participants' conceptualizations of leadership within the intensive care were identified: (1) leadership is both a group/shared process and individualistic/hierarchical; (2) leadership is communication; and (3) gender is a key leadership dimension. Key facilitators identified were: (1) role allocation; (2) trust, respect and staff familiarity; and (3) the use of checklists. Key barriers identified were: (1) noise and (2) personal protective equipment. The impact of socio-materiality on leadership within the intensive care unit is also identified.
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Affiliation(s)
- David J Brewster
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Warwick W Butt
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lisi J Gordon
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Mahbub A Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jonathan L Begley
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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Dace W, Purdy E, Brazil V. Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators. Adv Simul (Lond) 2022; 7:35. [PMID: 36303245 PMCID: PMC9615167 DOI: 10.1186/s41077-022-00229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
Many clinicians working in healthcare simulation struggle with competing dual identities of clinician and educator, whilst those who harmonise these identities are observed to be highly effective teachers and clinicians. Professional identity formation (PIF) theories offer a conceptual framework for considering this dilemma. However, many clinician simulation educators lack practical guidance for translating these theories and are unable to develop or align their dual identities. An unusual experience involving the first author’s suspension of disbelief as a simulation facilitator sparked a novel reflection on his dual identity as a clinician and as a simulation educator. He re-framed his clinician and simulation ‘hats’ as cooperative and fluid rather than competing and compartmentalised. He recognised that these dual identities could flow between clinical and simulation environments through leaky ‘blended boundaries’ rather than being restricted by environmental demarcations. This personal story is shared and reflected upon to offer a practical ‘hats and boundaries’ model. Experimenting with the model in both clinical and simulation workplaces presents opportunities for PIF and alignment of dual identities. The model may help other clinician simulation educators navigate the complexities of merging their dual identities.
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Affiliation(s)
- William Dace
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.
| | - Eve Purdy
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.,Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Victoria Brazil
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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Parker RMN. Planning Library Instruction Research: Building Conceptual Models with Theoretical Frameworks. Med Ref Serv Q 2022; 41:408-423. [PMID: 36394918 DOI: 10.1080/02763869.2022.2131149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Engagement with theories and theoretical frameworks in the planning and conduct of research about library instruction, in conjunction with the existing evidence base, can help researchers develop coherent conceptual models to justify the research approach and importance of the research produced. This column describes some of the limitations of common evaluation approaches that lack explicit theoretical framing and provides definitions of concepts that allow practitioners and researchers alike to explore and understand the complexities of educational encounters. Using an illustrative study with a theoretical framework applying sociomaterialism and related theories, this article presents arguments for in-depth explorations of informatics education through qualitative research.
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Affiliation(s)
- Robin M N Parker
- Dalhousie Libraries, Dalhousie University, Halifax, Nova Scotia, Canada
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Grant MP, Philip JAM, Deliens L, Komesaroff PA. Understanding Complexity in Care: Opportunities for Ethnographic Research in Palliative Care. J Palliat Care 2022:8258597221078375. [PMID: 35167402 DOI: 10.1177/08258597221078375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Ethnography has been used to address a broad range of research questions in health care. With ethnographic research methods it is possible to gain access to the complex realities of health care practice as it occurs, through interpreting the nuances of individual and team behaviours, the roles and dynamics of care provision, and the social impacts and influences of illness. The provision of clinical palliative care is complex, involving multidisciplinary collaboration across different health systems, and is subject to a multitude of personal, cultural and environmental influences. This complexity demands creative methodological approaches to research in palliative care, of which ethnography plays an important, if infrequently utilised, role. Aim: This article aims to explore potential opportunities of ethnographic methods for palliative care research. Findings: Ethnographic methods focuses on behaviour in the 'natural' setting of participants, to create theoretical descriptions of events, cultures, interactions and experiences. In palliative care these methods may provide nuanced understandings of illness, relationships and teams, communication, medical education, complex care provision, and novel or changing health practices. Of particular importance is the potential of these methods to understand complex practices and processes, and engage with under-represented population groups who may be excluded from interview research. Conclusion: Ethnography offers important opportunities for future research in palliative care and should be considered as part of the 'research toolbox' to improve understanding of the complex nature of care provision and the experiences of illness and loss.
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Affiliation(s)
- Matthew P Grant
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
- Monash University
| | - Jennifer A M Philip
- Palliative Nexus Research Group, Department of Medicine, University of Melbourne, Parkville Victoria, Australia
- St Vincent's Hospital Melbourne
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Peters G. Metadiscourse in Simulation: Reflexivity of/as Communication Skills Learning. TEACHING AND LEARNING IN MEDICINE 2022; 34:21-32. [PMID: 35100914 DOI: 10.1080/10401334.2021.2004414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 06/14/2023]
Abstract
Phenomenon: I examine simulation-based communication skills training as a practice of metadiscourse (or talk about talk) on three levels: (1) the conceptualization of communication as a skill; (2) the use of simulation-based approaches for teaching and assessing communication skills; and (3) the purposes of communication-skills training, specifically as it relates to outcomes of skilled communication. Within each, I explicate the following tensions: (1) communication as an individual skill vs. communication as a distributed dynamic; (2) communication as a process of information exchange vs. communication as mutual accountability; (3) communication for institutional outcomes vs. communication for multiple purposes. Approach: I use discourse-analytic approaches to reflexively analyze communication-skills training practices. My data are from a communication-skills practice exam for third-year medical students with simulated patients. The purpose of my analysis is to illustrate the metadiscursive tensions as they occur via (1) question-and-answer sequences; (2) repairs; and (3) orientations to institutional protocols. Findings: Through my analysis, I analyze the affordances and constraints of metadiscursive tensions. (1) Communication as an individual skill affords concrete and systematic frameworks for teaching and assessment, while communication as a distributed dynamic emphasizes the joint nature of talk and patient-centeredness. Additionally, simulation is a distinct genre of communication, specifically in how simulated patients communicate differently than actual patients, which can limit their utility for individual assessment. (2) Communication skills and communication-skills teaching embody the paradigm of cause and effect, which is in tension with communication as a process of mutual accountability. Conceptualizing communication skills and communication-skills learning as interventions in the possession of knowledge/skills affords claims of effectiveness but at the risk of essentializing students and patients as data points. (3) The institutional purposes of communication-skills training are often associated with positive outcomes for patients and providers but such findings often oversimplify the multifunctionality of talk, namely who we show ourselves to be through communication. Insights: To draw on the affordances of metadiscursive practices, I suggest incorporating video-based reflexive dialogues as addendums to simulation-based learning sessions. In video-based reflexive dialogues, medical students and simulated patients watch their simulated consultations together and discuss mutual goals, what communication strategies worked toward those goals, and what else talk accomplished. Retooling communication-skills teaching and learning to promote reflexivity as a "meta-skill" provides learners and practitioners the resources to reflect on and act in unison with patients toward mutual goals of health and well-being.
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Affiliation(s)
- Grace Peters
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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11
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Haraldseid-Driftland C, Aase K, Wiig S, Billett S. Developing a collaborative learning framework for resilience in healthcare: a study protocol. BMJ Open 2021; 11:e045183. [PMID: 34373294 PMCID: PMC8354265 DOI: 10.1136/bmjopen-2020-045183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 07/28/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Resilience in healthcare (RiH) can be conceptualised as the adaptive capacities of a healthcare system that allow it to maintain the delivery of high-quality care during and after events that challenge, change or disrupt its activities. These adaptive capacities require collaborative learning and working, as the complexities of changes and challenges can rarely be addressed by individuals alone or single healthcare disciplinary knowledge. So, there is a need to understand how collaborative learning practices can be developed and supported both intra and inter disciplinary in healthcare. The aim of the study is to explore the relationship between collaborative learning, and resilience to establish a framework that supports the development and application of adaptive capacities across diverse healthcare contexts and levels. Collaborative learning is premised on learning as something that occurs continuously through everyday work in the healthcare systems as professionals engaging in clinical work, and interacting with other coworkers, patients and stakeholders making local adaptations in respond to needs. METHOD AND ANALYSIS The study applies a mixed methods design in a two-phased approach to explore and develop the relationship between collaborative learning and resilience. Phase One is exploratory using literature review, meta-synthesis, interviews and focus groups as data collection methods in empirical studies in different healthcare contexts. Phase Two uses participatory approach to develop and test a collaborative learning framework followed by an evaluation to appraise its utility using observation and focus groups as data collection procedures. ETHICS AND DISSEMINATION Phase One of the study is approved by the Norwegian Centre for Research Data (reference no. 864334). The findings will be disseminated through scientific articles, presentations at international conferences and through social media and popular press. This includes establishing a set of learning tools for adaptive use, that is made publicly available in Open Access repositories.
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Affiliation(s)
| | - Karina Aase
- SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Stephen Billett
- School of Education and Professional Studies, Griffith University, Mount Gravatt, Queensland, Australia
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Teece A, Baker J, Smith H. Using audiovisual vignettes to collect data remotely on complex clinical care: a practical insight. Nurse Res 2021; 29:41-48. [PMID: 33982528 DOI: 10.7748/nr.2021.e1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vignettes are regularly used in nursing research and education to explore complex clinical situations. However, paper-based vignettes lack clinical realism and do not fully recreate the pressures, sights and sounds of clinical settings, limiting their usefulness when studying complex decision-making processes. AIM To discuss the approach taken by the authors in developing and implementing audiovisual vignettes to collect data remotely in a qualitative study. DISCUSSION The authors describe how they created audiovisual vignettes for a qualitative 'Think Aloud' study exploring how critical care nurses decide whether to restrain agitated patients with varying degrees of psychomotor agitation. They discuss the practicalities of filming, editing and hosting, as well as the theoretical and clinical background that informed the creation of the vignettes. CONCLUSION Audiovisual vignettes are a cost- and time-effective way of remotely exploring decision-making in challenging environments. This innovative method assists in studying decision-making under simulated clinical pressures and captures data about how people make complex decisions. IMPLICATIONS FOR PRACTICE Audiovisual vignettes are an innovative tool for collecting data and could also be used in educational settings and offer the opportunity to explore complex clinical decision making remotely. Clinical accuracy is essential for immersing participants and simulating an environment and its pressures. The method could be further enhanced by making vignettes responsive to participants' decisions.
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Affiliation(s)
- Angela Teece
- School of Healthcare, University of Leeds, Leeds, England
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, England
| | - Helen Smith
- School of Healthcare, University of Leeds, Leeds, England
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Noble C, Young J, Hourn E, Sheehan D. Becoming clinical supervisors: identity learnings from a registrar faculty development program. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:125-129. [PMID: 33369714 PMCID: PMC7952496 DOI: 10.1007/s40037-020-00642-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
This article shares our experiences and surprises as we developed, implemented and evaluated a 12-week faculty development program for registrars as clinical supervisors over three cohorts. The program has consistently been rated highly by participants. Yet, following a comprehensive curriculum review, we were surprised that our goal of encouraging identity development in clinical supervisors seemed to be unmet. Whilst our evaluation suggests that the program made important contributions to the registrars' knowledge, application and readiness as clinical supervisors, challenges linked to developing a supervisor identity and managing the dual identity of supervisor and clinician remain. In this article we describe our program and argue for the importance of designing faculty development programs to support professional identity formation. We present the findings from our program evaluation and discuss the surprising outcomes and ongoing challenges of developing a cohesive clinical educator identity. Informed by recent evidence and workplace learning theory we critically appraise our program, explain the mechanisms for the unintended outcomes and offer suggestions for improving curricular and pedagogic practices of embedded faculty development programs. A key recommendation is to not only consider identity formation of clinical supervisors from an individualist perspective but also from a social perspective.
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Affiliation(s)
- Christy Noble
- Faculty of Medicine and School of Pharmacy, The University of Queensland, Herston, Australia.
| | | | - Ellen Hourn
- Gold Coast Health, Southport, Australia
- School of Medicine, Griffith University, Southport, Australia
| | - Dale Sheehan
- The University of Canterbury, Canterbury, New Zealand
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Møller JE, Christensen MK. Change of practice? Change of research position? MEDICAL EDUCATION 2020; 54:868-870. [PMID: 32515494 DOI: 10.1111/medu.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Jane Ege Møller
- Centre for Health Sciences Education, Aarhus University, INCUBA Skejby, Aarhus, Denmark
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Cantillon P, Dornan T, De Grave W. In Reply to Berjis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1129. [PMID: 32740386 DOI: 10.1097/acm.0000000000003506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Peter Cantillon
- Professor of primary care, Discipline of General Practice, National University of Ireland, Galway, Ireland; ; ORCID: https://orcid.org/0000-0003-3776-9537
| | - Tim Dornan
- Professor of medical education, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Willem De Grave
- Educational psychologist, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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