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Dutta D, Ibrahim H, Cofrancesco J, Archuleta S, Stadler DJ. The Gendered Work/Role of Program Directors in International Graduate Medical Education. QUALITATIVE HEALTH RESEARCH 2023; 33:154-164. [PMID: 36527203 DOI: 10.1177/10497323221145832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Healthcare organizations offer numerous clinical and academic leadership pathways for physicians, among which the position of program director (PD) is considered to be a prominent educational leadership role. As PDs are instrumental in the recruitment and training of the next generations of physicians, PD gender distribution can affect the present and future of a medical specialty. This study offers a dialectical perspective in understanding how international PDs negotiate gendered understanding of their work/role by using the framework of Relational Dialectics Theory 2.0. Thirty-three interviews of PDs from Qatar, Singapore, and the United Arab Emirates were conducted and, using contrapuntal analysis, the competing discourses of meanings of gender in the PD work/role were examined. Competing discourses where structural, cultural, and professional meanings of gender were interrogated revealed inherent multiple meanings of how gender is understood in PD work/roles. In making sense of these meanings of gender, PDs express dilemmas of traditional gender binaries of masculine/feminine work/role meanings to explain the term in different ways in their everyday organizational and cultural struggles. The findings have implications for PD recruitment and retention in teaching hospitals.
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Affiliation(s)
- Debalina Dutta
- School of Communication, Journalism and Marketing, 6420Massey University, New Zealand
| | - Halah Ibrahim
- Department of Medicine Khalifa of Medicine and Health Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Joseph Cofrancesco
- Johns Hopkins Institute for Excellence in Education Professor of MedicineJohns Hopkins University School of Medicine Institute for Excellence in Education, Baltimore, MD, USA
- Johns Hopkins Institute for Excellence in Education Professor of MedicineJohns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophia Archuleta
- Department of Medicine, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore
- Division of Infectious Diseases, National University Health System, Singapore
| | - Dora J Stadler
- 8395Walter Reed National Military Medical Center, Uniformed Services University, Bethesda, MD, USA
- Weill Cornell Medicine-Qatar, Doha, Qatar
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2
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Forsman T, Silberstein S, Keller EJ. Consent in Interventional Radiology-How Can We Make It Better? Can Assoc Radiol J 2023; 74:202-210. [PMID: 35611696 DOI: 10.1177/08465371221101625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Informed consent is an important part of the clinician-patient relationship. However, studies suggest consent practices tend to be limited in consistency and completeness. This may be particularly challenging for interventional radiology given more limited public awareness and the often fast-paced, dynamic nature of our practices. This article reviews these challenges as well as ideal consent practices and potential approaches to improve consent in interventional radiology.
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Affiliation(s)
- Tia Forsman
- 12321The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Eric J Keller
- Division of Interventional Radiology, 6429Stanford University, Stanford, CA, USA
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3
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Peltola M, Isotalus P. Competing Discourses of Professional-patient Relationships in Type 2 Diabetes Management. HEALTH COMMUNICATION 2020; 35:1811-1820. [PMID: 31502472 DOI: 10.1080/10410236.2019.1663586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Type 2 diabetes is a contradictory chronic illness that needs to be managed in cooperation with health care professionals. Despite the significant role of the professional-patient relationship in diabetes management, the meaning of this relationship as part of diabetes management has not yet been studied. The aim of this qualitative study is to describe the competing discourses of professional-patient relationships in type 2 diabetes management. As a background theory, the study applied the relational dialectics theory (RDT) 2.0 by analyzing discourses in patients' interpersonal communication experiences with health care professionals. Overall, 63 experiences were analyzed using contrapuntal analysis. According to the results, both the patients' positive and negative descriptions were connected to three struggling discourses: 1) having the right to care versus deserving care, 2) guidance versus control, and 3) personalization versus standardization. These discourses offered new perspectives to clarify and strengthen the role of professional-patient relationships in type 2 diabetes management.
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Affiliation(s)
- Maija Peltola
- Speech Communication, Faculty of Information Technology and Communication Sciences, Tampere University
| | - Pekka Isotalus
- Speech Communication, Faculty of Information Technology and Communication Sciences, Tampere University
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4
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Nykänen H, Mikkola L. The Discursive Struggles of the Client–Worker Relationship in the Social Services. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2020. [DOI: 10.4081/qrmh.2020.8688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study examines how disability service workers identify the discourses of the client-worker relationships. We studied the clientworker relationship from the perspective of the relational dialectics theory with a focus on relational contradictions and the meanings created within discursive struggles. We analyzed the interview data from 22 social workers using contrapuntal analysis. According to the social workers’ perceptions, two discursive struggles exist in client-worker relationships: i) the struggle of integration, consisting of the contradiction of the ideal and the real and the contradiction of closeness and reservedness and ii) the struggle of certainty, consisting of the contradiction of predictability and novelty and the contradiction of openness and closedness. These struggles and contradictions arranges on the societal and relational frames to fully depict the nature of social work. Overall, our analysis shows that the client-worker relationship is both bound to the norms of a professional and a close interpersonal relationship, making its study particularly interesting.
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Hong SJ, Drake B, Goodman M, Kaphingst KA. Race, Trust in Doctors, Privacy Concerns, and Consent Preferences for Biobanks. HEALTH COMMUNICATION 2020; 35:1219-1228. [PMID: 31167570 PMCID: PMC6893100 DOI: 10.1080/10410236.2019.1623644] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study investigates how patients' privacy concerns about research uses of biospecimen and trust in doctors are associated with their preferences for informed consent and need for control over biospecimens in a biobank. Particularly, this study focuses on the perspectives of Communication Privacy Management theory, precision medicine, and racial health disparities. We recruited 358 women aged 40 and older stratified by race (56% African American and 44% European American). Multivariable linear regression models examined hypothesis and research questions. Individuals' privacy concerns and trust in doctors were significantly associated with their need for control. Although participants' privacy concerns were positively associated with their preference for study-specific model, trust in doctors had no effect on the preference. African American participants needed more control over their sample and were more likely to prefer study-specific model compared to European American participants. Significant interactions by race on the associations between trust and need for control and between privacy concerns and preference for study-specific model were found. These findings suggest that when developing large diverse biobanks for future studies it is important to consider privacy concerns, trust, and need for control with an understanding that there are differences in preferences by race.
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Affiliation(s)
- Soo Jung Hong
- Department of Communications and New Media, National University of Singapore, Singapore
| | - Bettina Drake
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Melody Goodman
- Department of Biostatistics, NYU College of Global Public Health, New York City, NY
| | - Kimberly A. Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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6
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Krebs E, Schoenbauer KV. Hysterics and Heresy: Using Dialogism to Explore the Problematics of Endometriosis Diagnosis. HEALTH COMMUNICATION 2020; 35:1013-1022. [PMID: 31023095 DOI: 10.1080/10410236.2019.1606136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite advances in biomedical technology, endometriosis remains a disease that is inefficiently diagnosed and treated. American women often suffer from debilitating symptoms for a decade before being diagnosed. Addressing this deficiency is crucial if women are to live well with endometriosis. Framed by relational dialectics theory 2.0, the current study analyzes women's experiences of endometriosis diagnoses via online narrative postings. Results reveal two centripetal (dominant) discourses: (a) the discourse of psycho-abnormality, and (b) the discourse of biological normality. Narrators' invocation of the discourse of psycho-abnormality disqualifies women's suffering as imagined and "all in their heads," whereas invocation of the discourse of biological normality naturalizes women's suffering as "just part of being a woman." The discourse of psycho-abnormality and the discourse of biological normality, both rooted in patriarchal influences, hinder diagnosis and subsequently treatment and rehabilitation of endometriosis. Encouragingly, a third (though marginalized) discourse emerged: the discourse of reclaiming expertise. Narrators' invocation of this discourse directly opposes the discourses of psycho-abnormality and biological normality by inciting validation of embodied knowledge in medical encounters and urging patients to enact agency in healthcare settings. This project discusses the interplay of these three discourses, and aims to improve diagnostic efficacy as a result.
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Affiliation(s)
- Emily Krebs
- Department of Communication, University of Utah
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7
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Bute JJ, Brann M. Tensions and Contradictions in Interns' Communication about Unexpected Pregnancy Loss. HEALTH COMMUNICATION 2020; 35:529-537. [PMID: 30719939 DOI: 10.1080/10410236.2019.1570429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Early miscarriage is an unexpected pregnancy complication that affects up to 25% of pregnant women. Physicians are often tasked with delivering the bad news of a pregnancy loss to asymptomatic women while also helping them make an informed decision about managing the miscarriage. Assessing the communicative responses, particularly the discursive tensions embedded within providers' speech, offers insight into the (in)effective communication used in the delivery of bad news and the management of a potentially traumatic medical event. We observed and analyzed transcripts from 40 standardized patient encounters using Baxter's relational dialectics theory 2.0. Results indicated that interns invoked two primary distal already-spoken discourses: discourses of medicalization of miscarriage and discourses of rationality and informed consent. We contend that tensions and contradictions could affect how women respond to the news of an impending miscarriage and offer practical implications for communication skills training.
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Affiliation(s)
- Jennifer J Bute
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
| | - Maria Brann
- Department of Communication Studies, Indiana University-Purdue University Indianapolis
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8
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Hong SJ, Drake B, Goodman M, Kaphingst KA. Relationships of health information orientation and cancer history on preferences for consent and control over biospecimens in a biobank: A race-stratified analysis. J Genet Couns 2020; 29:479-490. [PMID: 31990114 DOI: 10.1002/jgc4.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 11/11/2022]
Abstract
In this study, we investigated how patients' self-reported health information efficacy, relationship with health providers, and cancer history are associated with their preferences for informed consent and need for control over biobank biospecimens. We recruited 358 women aged 40 and older (56% African American; 44% European American) and analyzed the data using multivariable regression models. Results show that African American participants' health information efficacy was significantly and negatively associated with their need for control over biospecimens and preference for a study-specific model. European American participants' dependency on doctors was a significant and negative predictor of their preference for a study-specific model. Several significant interaction effects, which varied across races, were found with regard to health information efficacy, personal cancer history, need for control, and preference for a study-specific model. The study findings suggest it is important to consider health information efficacy, relationship with providers, and need for control when developing large diverse biobanks.
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Affiliation(s)
- Soo Jung Hong
- Department of Communications and New Media, National University of Singapore, Singapore
| | - Bettina Drake
- Division of Public Health Science, Washington University School of Medicine, St. Louis, MO, USA
| | - Melody Goodman
- Department of Biostatistics, New York University College of Global Public Health, New York, NY, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Communication, University of Utah, Salt Lake City, UT, USA
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9
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Jones M, Scarduzio J, Mathews E, Holbrook P, Welsh D, Wilbur L, Carr D, Cary LC, Doty CI, Ballard JA. Individual and Team-Based Medical Error Disclosure: Dialectical Tensions Among Health Care Providers. QUALITATIVE HEALTH RESEARCH 2019; 29:1096-1108. [PMID: 30957639 DOI: 10.1177/1049732319837224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Researchers from disciplines of education, health communication, law and risk management, medicine, nursing, and pharmacy examined communication tensions among interprofessional (IP) health care providers regarding medical error disclosure utilizing patient simulation. Using relational dialectics theory, we examined how communication tensions manifested in both individual-provided medical error disclosure and IP team-based disclosure. Two dialectical tensions that health care providers experienced in disclosure conversations were identified: (a) leadership and support, and (b) transparency and protectionism. Whereas these tensions were identified in an IP education setting using simulation, findings support the need for future research in clinical practice, which may inform best practices for various disclosure models. Identifying dialectical tensions in disclosure conversations may enable health communication experts to effectively engage health care providers, risk management, and patient care teams in terms of support and education related to communicating about medical errors.
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Affiliation(s)
- Mandy Jones
- 1 University of Kentucky, Lexington, Kentucky, USA
| | | | | | | | | | - Lee Wilbur
- 2 Catholic Health Initiative St. Vincent Infirmary, Little Rock, Arkansas, USA
| | - Douglas Carr
- 3 Indiana University School of Medicine at Bloomington, Bloomington, Indiana, USA
| | - L Curtis Cary
- 4 University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | | | - James A Ballard
- 5 Indiana University School of Medicine, Indianapolis, Indiana, USA
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10
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Olufowote JO, Wang GE. Physician Assimilation in Medical Schools: Dualisms of Biomedical and Biopsychosocial Ideologies in the Discourse of Physician Educators. HEALTH COMMUNICATION 2017; 32:676-684. [PMID: 27355968 DOI: 10.1080/10410236.2016.1167993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although health communication research and popular literature on physicians have heightened awareness of the dualisms physicians face, research is yet to focus on the discourse of physician educators who assimilate students into medicine for dualisms of the biomedical (BMD) and biopsychosocial (BPS) ideologies. The study drew on a dualism-centered model to analyze the discourse of 19 behavioral science course directors at 10 medical schools for the emergence of dualisms in instantiations of BPS ideologies and for the management of dualism in discourse that instantiated both BMD and BPS ideologies as part of the curriculum. Dualism emerged in the BPS ideologies of "patient-centeredness" and "cultural competence." While a dualism between "patients' data" and "patients' stories" emerged in the patient-centeredness ideology, a dualism between enhancing "interaction skill" and "understanding" emerged in the cultural competence ideology. Moreover, the study found educator discourse managing dualism between BMD and BPS ideologies through the strategies of "connection" and "separation." The study concludes with a discussion and the implications for theory and research.
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Affiliation(s)
| | - Guoyu E Wang
- a Department of Communication , The University of Oklahoma
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11
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Nasrabadi AN, Shali M. Informed Consent: A Complex Process in Iran's Nursing Practice. ACTA ACUST UNITED AC 2017. [DOI: 10.11111/jkana.2017.23.3.223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Mahboobeh Shali
- Ph.D Student in Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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12
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van Mulken MRH, McAllister M, Lowe JB. The stigmatisation of pregnancy: societal influences on pregnant women's physical activity Behaviour. CULTURE, HEALTH & SEXUALITY 2016; 18:921-935. [PMID: 26967357 DOI: 10.1080/13691058.2016.1148199] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Many women going through the major life transition of pregnancy experience decreases in physical activity behaviour, which may compromise maternal and infant health and wellbeing. Although research suggests that the social environment plays a large role in influencing women's physical activity behaviour, little is known about the association between societal attitudes and physical activity behaviour during the course of pregnancy. Through a qualitative longitudinal study, we explored women's physical activity experiences throughout pregnancy and how these were formed, supported and/or opposed by their social environment. This research included telephone interviews with 30 pregnant participants, recruited via a regional public hospital. Using a feminist standpoint analysis incorporating modern dialectics, three major tensions were identified, reflecting dominant societal discourses around physical activity and pregnancy: (1) engaging in physical activity and keeping the baby safe, (2) engaging in physical activity and obtaining social approval and (3) listening to oneself and to others. These findings present previously unrecognised opportunities for developing tailored and effective physical activity interventions among pregnant women.
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Affiliation(s)
- Michelle R H van Mulken
- a Centre for Human Factors and Sociotechnical Systems , University of the Sunshine Coast , Sippy Downs , Australia
| | - Margaret McAllister
- b School of Nursing and Midwifery , Central Queensland University , Noosaville , Australia
| | - John B Lowe
- c School of School of Health and Sports Sciences , University of the Sunshine Coast , Sippy Downs , Australia
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13
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Men's use of networks to manage communication tensions related to a potential diagnosis of prostate cancer. Eur J Oncol Nurs 2016; 20:106-12. [DOI: 10.1016/j.ejon.2015.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/06/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022]
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Ripley BA, Tiffany D, Lehmann LS, Silverman SG. Improving the Informed Consent Conversation: A Standardized Checklist that Is Patient Centered, Quality Driven, and Legally Sound. J Vasc Interv Radiol 2015; 26:1639-46. [PMID: 26194737 DOI: 10.1016/j.jvir.2015.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 05/29/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022] Open
Abstract
The informed consent conversation is a key component of patient-centered medicine, a concept that emphasizes the importance of patients actively participating in their care. Studies reveal that many informed consent conversations throughout medical practice lack essential elements and leave patients' needs unmet. This review addresses these deficiencies, discusses solutions, and introduces a standardized checklist that values the patient's role in shared decision making during the informed consent conversation. The checklist could be particularly helpful to interventional radiologists and other consulting physicians who usually obtain informed consent early in their encounters with patients.
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Affiliation(s)
- Beth A Ripley
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.
| | - David Tiffany
- Department of Management, California State University San Marcos, San Marcos, California
| | - Lisa S Lehmann
- Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115
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Gilstrap CM, White ZM. Interactional communication challenges in end-of-life care: dialectical tensions and management strategies experienced by home hospice nurses. HEALTH COMMUNICATION 2014; 30:525-535. [PMID: 24991918 DOI: 10.1080/10410236.2013.868966] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study examines the dialectical tensions experienced by home hospice nurses in interactions with patients, families, and health care providers. In-depth, semistructured interviews were conducted with 24 home hospice nurses from a mid-size for-profit hospice organization serving approximately 230 patients on an annual basis. Interviews revealed hospice nurses experience both interpersonal and organizational dialectics during hospice interactions: authoritative-nonauthoritative, revelation-concealment, independence-collaboration, and quality of care-business of care. Dialectics often resulted as a by-product of (a) responding to expectations and care choices of patients and families particular to the emotionally charged home context, (b) obtaining authorization from health care providers who are not members of the interdisciplinary team, and (c) pressures associated with providing quality patient care while fulfilling organizational role requirements. The praxis strategies used to negotiate tensions included segmentation, balance, recalibration, and spiraling inversion. Specifically, nurses employed strategies such as ascertaining family/patient acceptance, using persuasive tactics when communicating with external health care providers, relying on effective time management, and working off the clock to provide more in-person care. Although functional for patients and hospice organizations, nurses who continually rely on these strategies may experience job stress when their interpersonal commitments repeatedly conflict with organizational role demands.
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Krohne K, Torres S, Slettebø Å, Bergland A. Everyday uses of standardized test information in a geriatric setting: a qualitative study exploring occupational therapist and physiotherapist test administrators' justifications. BMC Health Serv Res 2014; 14:72. [PMID: 24528609 PMCID: PMC3927824 DOI: 10.1186/1472-6963-14-72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health professionals are required to collect data from standardized tests when assessing older patients' functional ability. Such data provide quantifiable documentation on health outcomes. Little is known, however, about how physiotherapists and occupational therapists who administer standardized tests use test information in their daily clinical work. This article aims to investigate how test administrators in a geriatric setting justify the everyday use of standardized test information. METHODS Qualitative study of physiotherapists and occupational therapists on two geriatric hospital wards in Norway that routinely tested their patients with standardized tests. Data draw on seven months of fieldwork, semi-structured interviews with eight physiotherapists and six occupational therapists (12 female, two male), as well as observations of 26 test situations. Data were analyzed using Systematic Text Condensation. RESULTS We identified two test information components in everyday use among physiotherapist and occupational therapist test administrators. While the primary component drew on the test administrators' subjective observations during testing, the secondary component encompassed the communication of objective test results and test performance. CONCLUSIONS The results of this study illustrate the overlap between objective and subjective data in everyday practice. In clinical practice, by way of the clinicians' gaze on how the patient functions, the subjective and objective components of test information are merged, allowing individual characteristics to be noticed and made relevant as test performance justifications and as rationales in the overall communication of patient needs.
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Affiliation(s)
- Kariann Krohne
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo 0130, Norway.
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Amati R, Hannawa AF. Relational dialectics theory: Disentangling physician-perceived tensions of end-of-life communication. HEALTH COMMUNICATION 2013; 29:962-973. [PMID: 24345181 DOI: 10.1080/10410236.2013.815533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Existing literature evidences the centrality of interpersonal communication during end-of-life care, but several barriers currently compromise its effectiveness. One of them is a common lack of communication skills among physicians in this challenging context. Several strategies have been suggested to enhance end-of-life interactions; however, a solid theoretical framework is needed for the development of effective systematic guidelines and interventions that can facilitate this goal. The present research study addresses this gap, choosing to focus particularly on the physician's perspective. It relies on Baxter and Montgomery's (1996) Relational Dialectics Theory to illuminate the complexity of reality doctors commonly face in interactions with their patients during end-of-life care. Semistructured interviews were conducted with 11 physicians in a southern canton of Switzerland who had experienced at least one end-of-life encounter with a patient. The interviews probed whether and under what conditions Baxter and Montgomery's theoretical contradictions translate to physicians' end-of-life communication with their patients and the patients' family members. The results replicated and extended the original theoretical contradictions, evidencing that Relational Dialectics Theory is very applicable to end-of-life conversations. Thus, this study adds a theoretically framed, empirically grounded contribution to the current literature on the communicative challenges physicians commonly face during end-of-life interactions with their patients and their patients' family members.
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Affiliation(s)
- Rebecca Amati
- a Institute of Communication and Health (ICH), Faculty of Communication Sciences , University of Lugano
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Krohne K, Torres S, Slettebø A, Bergland A. Individualizing standardized tests: physiotherapists' and occupational therapists' test practices in a geriatric setting. QUALITATIVE HEALTH RESEARCH 2013; 23:1168-78. [PMID: 23863851 DOI: 10.1177/1049732313499073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In assessing geriatric patients' functional status, health care professionals use a number of standardized tests. These tests have defined administration procedures that restrict communication and interaction with patients. In this article, we explore the experiences of occupational therapists and physiotherapists acting as standardized test administrators. Drawing on fieldwork, interviews with physiotherapists and occupational therapists, and observations of test situations on acute geriatric wards, we suggest that the test situation generates a tension between what standardization demands and what individualization requires. Our findings illustrate how physiotherapists and occupational therapists navigate between adherence to the test standard and meeting what they consider to be the individual patient's needs in the test situation. We problematize this navigation, and argue that the health care professional's use of relational competence is the means to reach and maintain individualization.
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Dean M, Oetzel JG. Physicians' perspectives of managing tensions around dimensions of effective communication in the emergency department. HEALTH COMMUNICATION 2013; 29:257-266. [PMID: 23790089 DOI: 10.1080/10410236.2012.743869] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to explore emergency department (ED) physicians' perspectives of guidelines for effective communication. More specifically, the ways in which physicians manage the tensions among effective communication dimensions framed by relational dialectics theory are examined. This study used in-depth interviews with 17 ED physicians and 70 hours of observations to identify five dimensions of effective communication: efficiency, clarity/accuracy, relevance, comprehension, and rapport. Two communication tensions resulted from these dimensions: efficiency versus rapport and efficiency versus comprehension. In almost all instances, physicians chose efficient communication at the expense of comprehension or rapport. In addition, there was a tension between patient and physician perspectives of clarity and relevance that physicians tended to resolve by emphasizing what was relevant and clear from their own perspective. Implications for managing tensions in terms of efficiency and a physician-centered approach are discussed.
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Affiliation(s)
- Marleah Dean
- a Department of Communication , Texas A&M University
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20
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Olufowote JO. Local resistance to the global eradication of polio: newspaper coverage of the 2003-2004 vaccination stoppage in northern Nigeria. HEALTH COMMUNICATION 2011; 26:743-753. [PMID: 21667367 DOI: 10.1080/10410236.2011.566830] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Successful global health initiatives are executed on the recognition that globalization involves simultaneous pulls between global unification and fragmentation. This article responds to the need for more understanding of the role of fragmentation in global health initiatives through analyses of 52 northern Nigerian newspaper reports of the 2003-2004 northern Nigerian stoppage of the Global Polio Eradication Initiative. By 2009 the stoppage had resulted in an epidemic in Nigeria and polio importations in 20 previously polio-free countries. Findings pointed to beliefs in contemporary forms of Western control and abuse through global organizations (nongovernmental organizations and for-profits), understandings of the "philanthropy" of the West and global organizations as self-serving and malevolent, and doubts about the polio vaccine product.
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