Hospital staff corridor conversations: work in passing

Stroke Patients' Free-Time Activities and Spatial Preferences During Inpatient Recovery in Rehabilitation Centers

Objectives:

To investigate which spaces stroke patients visit in their free time while undergoing inpatient recovery in rehabilitation centers, what activities they engage in, and what kind of spaces they want.

Background:

Research studies consistently show that stroke patients are highly inactive during rehabilitation. Much remains unknown about what patients do in their free time and how the built environment might affect their behavior and activities.

Methods:

Patients’ free-time activities were recorded via patient shadowing (n = 70, 840 hr), and their spatial preferences were collected using a survey (n = 60) in seven rehabilitation centers. Each participant was observed over one typical day (12 consecutive hours). Their activities, durations, and locations were recorded using floor plans and time log sheets.

Results:

Six main themes emerged from the analysis of shadowing data and patient surveys: (1) spending most free time in their room, (2) corridor as the overlooked activity hub, (3) food and beverage stations as triggers of activity, (4) wanting to socialize, (5) variety of common spaces for different activities is desired, and (6) common room’s atmosphere, comfort, style, and view are important. Even though socializing with other patients was mentioned as a primary reason for visiting common spaces in the survey, patients spent most of their free time alone.

Conclusions:

Corridor emerged as a space with great potential to motivate and support various activities of patients. Patients’ free-time activities could contribute to their recovery, and the built environment may play a role in facilitating and supporting these activities.

Industry Technicians Embedded in Clinical Teams: Impacts on Medical Knowledge

Advances in implantable medical devices have increased the role for industry-employed allied professionals (IEAPs) in providing training and support during surgical procedures and follow-up care. The effect of these changes on the organization of medical knowledge and the sharing of information remains largely unexplored. Recent work in social epistemology and the conceptualizing of implantable medical device companies as part of a knowledge-based industry provide a framework for engaging with this issue. In this article, we argue that the insertion of industry technicians into hospitals diminishes epistemically valuable knowledge-sharing practices. This is in part a result of health care professionals' increased dependence on IEAPs, who control access to knowledge about devices, limiting opportunities both for independent learning and for dialogic education practices through which participants work toward a common goal. Ultimately, we claim that overdependence on the IEAP as expert undermines a basic social value regarding knowledge sharing for everyone's benefit.

A qualitative study of hospital clinical staff perceptions of their interactions with healthcare middle managers

PURPOSE

The authors explored clinical staff perceptions of their interactions with middle management and their experiences of the uncongeniality of their working environment.

DESIGN/METHODOLOGY/APPROACH

Semi-structured interviews of clinical staff from an Australian public health service's Emergency, Surgery and Psychiatry departments. Volunteer interview transcripts were inductively coded using a reflexive thematic content analysis.

FINDINGS

Of 73 interviews, 66 participants discussed their interactions with management. Most clinicians considered their interactions with middle management to be negative based on a violation of their expectations of support in the workplace. Collectively, these interactions formed the basis of clinical staff perceptions of management's lack of capacity and fit for the needs of staff to perform their roles.

PRACTICAL IMPLICATIONS

Strategies to improve management's fit with clinicians' needs may be beneficial for reducing uncongenial workplaces for healthcare staff and enhanced patient care.

ORIGINALITY/VALUE

This article is among the few papers that discuss interactions with management from the perspective of clinical staff in healthcare. How these perspectives inform the perception of workplace uncongeniality for clinicians contributes greater understanding of the factors contributing to adversarial relationships between clinicians and managers.

Identifying barriers and facilitators to recognition and response to patient clinical deterioration by clinicians using a behaviour change approach: A qualitative study

BACKGROUND

Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct-care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by clinicians in ward settings. To date, no studies have used an integrative theoretical framework in multiple sites to examine why clinicians' delay identification and action on patients' clinical deterioration.

AIM

To identify barriers and facilitators that influence clinicians' absent or delayed response to patient clinical deterioration using the Theoretical Domains Framework.

METHODS

The Theoretical Domains Framework guided: (a) semi-structured interviews with clinicians, health consumers and family members undertaken at two sites; (b) deductive analyses of inductive themes to identify barriers and facilitators to optimal care. This study complied with the COREQ research guidelines.

FINDINGS

Seven themes identified: (a) information transfer; (b) ownership of patient care; (c) confidence to respond; (d) knowledge and skills; (e) culture; (f) emotion; and (g) environmental context and resources.

DISCUSSION

The Theoretical Domains Framework identified traditional social and professional hierarchies and limitations due to environmental contexts and resources as contributors to diminished interprofessional recognition and impediments to the development of effective relationships between professional groups. Communication processes were impacted by these restraints and further confounded by inadequate policy development and limited access to regular effective team-based training. As a result, patient safety was compromised, and clinicians frustrated.

CONCLUSIONS

These results inform the development, implementation and evaluation of a behaviour change intervention and increase knowledge about barriers and facilitators to timely response to patient clinical deterioration.

RELEVANCE TO CLINICAL PRACTICE

Results contribute to understanding of why clinicians delay responding to patient clinical deterioration and suggest key recommendations to identify and challenge traditional hierarchies and practices that prevent interdisciplinary collaboration and decision-making.

Challenging the interprofessional epistemic boundaries: The practices of informing in nurse-physician interaction

Interprofessional management of knowledge in health care settings appears to be particularly vital for the ways in which information circulates, medical decisions are taken, and nursing practices are implemented. Drawing on an extensive ethnographic fieldwork in an Italian Intensive Care Unit, this article investigates how the nurses orient to and concurrently challenge the nurse-physician epistemic boundaries by the different ways through which they perform "informing", and make it work as a diagnostic-relevant activity. Adopting an ethnographic-nurtured discursive approach to a dataset of video-recorded morning briefings, we analyze the nurses' informing contributions in terms of sequential position, turn-taking and turn design. We identify five practices of informing and show how they display different degrees of agency and differently impact on the team's "infectious diseases diagnostic reasoning". This article contributes to nurse-physician interaction studies by showing how the epistemic imbalance at play is interactionally accomplished by participants one interaction at a time. Particularly, the analysis demonstrates that the nurses actively contribute to the teamwork by a skillful management of knowledge that precedes the exercise of the physicians' epistemic and deontic rights implied in diagnosing and planning. Our findings illustrate how the nurses: a) exert their interactional agency without crossing the institutionally sanctioned epistemic and deontic boundaries to which they are observably oriented to; b) cautiously challenge the epistemic imbalance at play in nurse-physician interaction and c) actively contribute in setting the premises of the team's collective decisions. Conclusion and practical implications are proposed.

[Interprofessional collaboration between new nursing graduates and social workers: Hospital discharge planning telephone calls.]

INTRODUCTION

In hospitals, the discharge of patients needing home care or going to a care facility is planned interprofessionally, in particular via telephone calls between nurses and social workers.

CONTEXT

During discharge planning, the collaboration between a nurse and a social worker is fraught with tension. When this planning is conducted over the phone and the nurse is a new graduate, the tension can be heightened.

METHOD

Sociological study in an acute-care hospital in French-speaking Switzerland based on analyses of telephone conversations between new nursing graduates and social workers, in addition to observations, interviews and document-gathering.

RESULTS

Discharge planning is fraught with tension related to the timing of the planning and the care requested. The telephone calls are opportunities for new nurses to learn how to present cases, the procedures to follow for discharge planning, and the work logics of the individuals involved.

DISCUSSION

The study confirms the need to prepare new nurses to work with social workers on discharge planning and recommends offering training in this, both in nursing school and in the workplace.

CONCLUSION

Research documenting real work practices provides the keys to perfecting them.

Surgery nurses' telephone communication: a mixed methods study with a special focus on newcomers' calls

Aims

The aim of this study was (i) to document the main features of surgery nurses' telephone calls, with a special focus on newcomers' calls; and (ii) to identify the main activities accomplished during the newcomers' calls.

Design

Mixed methods study.

Methods

We audio recorded telephone calls internal to the hospital in two surgery nursing stations. We performed statistical descriptive analysis of the total collection of calls and of those specifically involving the newcomers and compared both sets. We also performed conversation analysis‐based coding of the main activities accomplished during newcomers' calls.

Results

Surgery nurses' telephone calls are extremely brief, predominantly nurse initiated and take place with a wide range of interlocutors who, for the most part, use mobile phones. The newcomers' calls are only slightly longer, take place with a more limited, but still wide, range of interlocutors and are even more often nurse initiated. The main activities of newcomers' calls are requests and activities related to connecting relevant interlocutors.

Building Situation Awareness on the Move: Staff Monitoring Behavior in Clinic Corridors

We conducted a workplace research project on staff mobility in a Swiss hospital outpatient clinic that involved extensive fieldwork and video recordings. The article describes monitoring practices and routines that staff engage in as they walk through the corridors and in and out of the clinic's rooms. The staff perform checks on on-going activity, share their observations with colleagues, and take responsive action while engaged in away-oriented walk or in specific roaming, action-seeking, rallying, and patrolling walk. We argue that these behaviors are closely associated with building and sustaining situation awareness (SA) with regard to the status of the clinic's functioning. They contribute to the coordination of a spatially distributed team that rapidly accomplishes consequential and closely interrelated activities in constantly changing circumstances.

Ethnomethodological studies of nurse-patient and nurse-relative interactions: A scoping review

OBJECTIVES

Researchers in nursing science interested in the study of nurse-patient and nurse-relative interactions have displayed an ever increasing interest in ethnomethodology and conversation analysis. This review assesses the scope of this literature. We categorize the papers in thematic categories determined both inductively and deductively and synthesize the main findings of this literature within category. Finally we discuss the interactional determinants of the lack patient participation, the limitations of the field, and focus on implications.

DESIGN

A scoping review on nurse-patient and nurse-relative interactions.

DATA SOURCES

Forty articles focusing on nurse-patient interactions and nurse-relative interactions. All the articles relied on ethnomethodology and/or conversation analysis.

REVIEW METHODS

A literature search has been carried out on Medline (all articles until June 2016; keywords were: nurs*.ab. and "conversation analysis"; nurs*.ab. and ethnomethodology). A similar search was performed on other platforms. The scope of the literature was identified by inductively and deductively analyzing the themes of the relevant articles.

RESULTS

Six thematic categories emerged: Organization of nurse-patient interaction (eleven articles); Organization of mediated nurse-patient interaction (seven articles); Information, explanation and advice (eight articles); Negotiation and influence asymmetry (six articles); Managing emotions in critical illness (two articles); and Interacting with patients presenting reduced interactional competences (six articles).

CONCLUSIONS

Across most thematic categories it appeared that patient participation is far from ideal as interactional asymmetry was most observed in favor of nurses. When the encounters occurred at the patients' homes this pattern was reversed. Computer-mediated interactions were often reported as non-optimal as the standardized process constrained communication and delayed patients' presentation of their ailments. Micro-analyses of interaction present a clear potential for the development of guidelines for nurse-patient interactions. Implications for practice are described.