Problems and solutions arising during a study in visual semantics of the medical emergency team system

Child-Parent-Provider Interactions of a Child With Complex Communication Needs in an Inpatient Rehabilitation Facility: A Pilot Study

Purpose Children with complex medical needs often require extensive hospitalizations in the first years of life. Many of these children also experience complex communication needs and use augmentative and alternative communication (AAC) strategies to interact with health care staff. Unfortunately, suboptimal communication experiences have been reported among these children, their families, and hospital staff; however, no studies have described the patterns of interactions beyond measures of self-report. The purpose of this study was to describe child-parent-provider interaction patterns that occurred in an inpatient unit. Method Observational techniques were used to systematically describe the interactions of a 28-month-old child with complex communication needs, her parents, and 26 health care providers on an inpatient rehabilitation unit over 10 days. Results Results indicated that substantial variability in the child's routine occurred across days and providers. Interactions were generally short and occurred for only a small proportion of the child's waking hours. The child and her mother actively communicated to varying degrees across sessions, yet health care providers often dominated interactions. The child used multiple modes of communication in each interaction; however, no aided AAC systems were used despite availability. Conclusions Training is urgently required to equip health care providers to (a) incorporate the use of aided AAC strategies during inpatient interactions and (b) increase the active participation of both children with complex communication needs and their parents during these interactions. Supplemental Material https://doi.org/10.23641/asha.13345187.

Emergency care under the magnifying glass: a review of ethnographic studies in the scientific literature on hospital emergency services

The article presents a review of ethnographic studies in the scientific literature on hospital emergency services, with the objective of systematizing the studies and their principal findings, referring to the health-disease-healthcare process in hospital emergency services from an ethnographic perspective. An integrative literature review was performed of studies published in Argentine and international indexed journals and in the following electronic databases: PubMed, VHL, Scopus, Redalyc, and SciELO. The corpus of the analysis consisted of a total of 69 articles, which were submitted to content analysis, having identified the following analytical dimensions: quality of care, communication and bonds, subjectivity, application of information technologies, methodological reflection, patients' experiences and practices, decision-making, and violence. The results allowed identifying a process that differs from guidelines and protocols, in which healthcare workers' subjective aspects, communication and interpersonal relations, and working conditions shape, orient, and condition the treatment and care provided in the hospital. The article thus highlights the approach to subjective aspects in health studies, to understand not only health workers' perspectives and experiences but also the persistent barriers to providing better quality of care, complexifying a problem ignored by a large share of the analyses.

Challenges and opportunities of undertaking a video ethnographic study to understand medication communication

AIMS AND OBJECTIVES

To examine the challenges and opportunities of undertaking a video ethnographic study on medication communication among nurses, doctors, pharmacists and patients.

BACKGROUND

Video ethnography has proved to be a dynamic and useful method to explore clinical communication activities. This approach involves filming actual behaviours and activities of clinicians to develop new knowledge and to stimulate reflections of clinicians on their behaviours and activities. However, there is limited information about the complex negotiations required to use video ethnography in actual clinical practice.

DESIGN

Discursive paper.

METHOD

A video ethnographic approach was used to gain better understanding of medication communication processes in two general medical wards of a metropolitan hospital in Melbourne, Australia. This paper presents the arduous and delicate process of gaining access into hospital wards to video-record actual clinical practice and the methodological and ethical issues associated with video-recording.

CONCLUSIONS

Obtaining access to clinical settings and clinician consent are the first hurdles of conducting a video ethnographic study. Clinicians may still feel intimidated or self-conscious in being video recorded about their medication communication practices, which they could perceive as judgements being passed about their clinical competence. By thoughtful and strategic planning, video ethnography can provide in-depth understandings of medication communication in acute care hospital settings. Ethical issues of informed consent, patient safety and respect for the confidentiality of patients and clinicians need to be carefully addressed to build up and maintain trusting relationships between researchers and participants in the clinical environment.

RELEVANCE TO CLINICAL PRACTICE

By prudently considering the complex ethical and methodological concerns of using video ethnography, this approach can help to reveal the unpredictability and messiness of clinical practice. The visual data generated can stimulate clinicians' reflexivity about their norms of practice and bring about improved communication about managing medications.

Marte Meo Counselling: a promising tool to support positive interactions between residents with dementia and nurses in nursing homes

Marte Meo Counselling (MMC) is an educational video-based counselling method developed to improve interactions between persons. This study aimed at investigating whether changes could be identified in the interactions between people with dementia and their nurses during morning care, following MMC. An intervention study based on video recordings before and after a MMC intervention was used. Thirteen nurses and 10 residents from six dementia-specific care units at six different institutions in Norway participated. Data were collected through video recording of six pairs (nurse and resident) in interaction before and after the staff received MMC. Four pairs participated as controls. The findings suggest that nurses who received MMC succeeded, to a greater degree than did the comparison nurses, in providing care consistent with promoting positive interactions. We found clearer indications of increased positive interactions and a reduction in inappropriate interactions in the intervention group. In the control group, the variation was greater, with both good and poor interactions present in the same cases.

This study indicates that MMC can serve as a facilitator for positive interactions and can also lead to a reduction in inappropriate interactions. Further research is needed to evaluate the effect of MMC.

Reflexivity in midwifery research: the insider/outsider debate

OBJECTIVE

To explore the challenges of conducting an observational study of postnatal interactions, between midwives and women, when the researcher was a midwife observing in familiar midwifery settings.

BACKGROUND

Participant observation conducted by researchers who are themselves midwives raises questions regarding the influence of 'identity' and 'insider' knowledge on the conduct of such projects. The insider/outsider status of researchers has been explored in other disciplines, yet this is an area which is underdeveloped in the midwifery literature where few attempts have been made to subject this issue to sustained analysis.

DESIGN

A qualitative study (investigating the provision of breast-feeding support in the first week after birth) provided the opportunity for reflexive exploration of the tensions faced by midwife researchers.

SETTING

Two maternity units in New South Wales, Australia.

PARTICIPANTS

Participants included 40 midwives and 78 breast-feeding women.

FINDINGS

Possessing 'insider' midwifery knowledge was advantageous in the 'getting in' and 'fitting in' phases of this research study however unanticipated role ambiguity, and moral and ethical challenges, arose as a result of this 'insider' knowledge and status. Prolonged periods of observation challenged the midwife researcher's preconceived ideas and early decisions about the advantages and disadvantages of being an 'insider' or an 'outsider' in the research setting.

KEY CONCLUSIONS

Reflexive analysis of insider/outsider experiences revealed the middle ground which participant observers tend to navigate. Whilst professional insider knowledge and status offered many advantages, especially at the first study setting, some of the inherent embodied, and socially constructed features of the 'midwife' observer role, were unanticipated. Cultural competence, in these observational study settings, translated into role ambiguity, and at times, culturally entrenched role expectations.

IMPLICATIONS FOR PRACTICE

Midwifery observation of clinical practice, for research, or practice development purposes, requires a degree of juggling of insider knowledge to facilitate observation and analysis. Prior to conducting observations midwives should consider how best to occupy the middle ground between insider and outsider. Within the middle ground the midwife can draw on those aspects of 'self' required to negotiate respectful relationships with colleagues, whilst also ensuring the maintenance of an analytical degree of distancing.

How do CNCs construct their after hours support role in a major metropolitan hospital

AIM

To explore how CNCs who provide hospital wide support after hours (AHCSs) construct their role.

METHODS

This is an ethnographic study involving two AHCSs as participants. Audio visual data was collected in 2007 at a Major Metropolitan Hospital, Sydney during after hours shifts. The data was coded using the standards defined in the Nurse Practitioner (NP) competencies.

RESULTS

Four hours of videotape (observed clinical practice) and 2 h of audio tape (interviews) were coded. They performed procedures (22%), gathered information to identify at risk patients (21%), conducted patient assessments (20%) and relayed information/findings to ward nurses (12%) and doctors (12%). The roles/responsibilities of AHCSs were similar to those defined for NPs. For the domain "dynamic practice" 388 activities were identified. The two participants used advanced and comprehensive assessment skills and demonstrated a high level of proficiency in performing procedures/interventions. For the domain "professional efficacy" 174 activities were coded, for "clinical Leadership" there were 135 activities. "Pro-actively identifying at risk patients in general wards" was added as a new performance indicator within the domain "clinical leadership". An analysis of the interviews corroborated the results derived from the visual data.

CONCLUSION

A significant capacity for critical thinking and clinical decision making were the hallmarks of the performance of the two AHCSs; their style of practice was collaborative, flexible and autonomous. While their formal role were as CNCs the two participants operationalised their roles/responsibilities as would a Nurse Practitioner. Their practice demonstrated a new competency: "the pro-active identification of at risk patients".