Medicine and Health Sciences Commons^™

Uptake Of A Team Briefing In The Operating Theatre: A Burkean Dramatistic Analysis, Sarah Whyte, Carrie Cartmill, Fauzia Gardezi, Richard Reznick, Beverley Orser, Diane Doran, Lorelei Lingard

Lorelei Lingard

Communication among healthcare professionals is a focus for research and policy interventions designed to improve patient safety, but the challenges of changing interprofessional communication patterns are rarely described. We present an analysis of 756 preoperative briefings conducted by general surgery teams (anesthesiologists, nurses, and surgeons) at four urban Canadian hospitals in the context of two research studies conducted between August 2004 and December 2007. We ask the questions: how and why did briefings succeed, how and why did they fail, and what did they mean for different participants? Ethnographic fieldnotes documenting the coordination and performance of team briefings were analyzed …

Current Practice In Physical Child Abuse Forensic Reports: A Preliminary Exploration, Marcellina Mian, Catherine Schryer, Marlee Spafford, Jan Joosten, Lorelei Lingard

Lorelei Lingard

No abstract provided.

The Sum Of The Parts Detracts From The Intended Whole: Competencies And In-Training Assessments, Elaine Zibrowski, S. Singh, Mark Goldszmidt, Christopher Watling, Cynthia Kenyon, Valerie Schulz, Heather Maddocks, Lorelei Lingard

Lorelei Lingard

OBJECTIVES: Despite the fact that Canadian residency programmes are required to assess trainees' performance within the context of the CanMEDS Roles Framework, there has been no inquiry into the potential relationship between residents' perceptions of the framework and their in-training assessments (ITA). Using data collected during the study of ITA, we explored residents' perceptions of these competencies.

METHODS: From May 2006-07, a purposive sample of 20 resident doctors from internal medicine, paediatrics, and surgery were interviewed about their ITA experiences. Data collection and analysis proceeded in an iterative fashion consistent with grounded theory. In April 2008, a summary of recurrent …

Silence, Power And Communication In The Operating Room, Fauzia Gardezi, Lorelei Lingard, Sherry Espin, Sarah Whyte, Beverley Orser, G. Baker

Lorelei Lingard

Aim.  This paper is a report of a study conducted to explore whether a 1- to 3-minute preoperative interprofessional team briefing with a structured checklist was an effective way to support communication in the operating room.

Background.  Previous research suggests that nurses often feel constrained in their ability to communicate with physicians. Previous research on silence and power suggests that silence is not only a reflection of powerlessness or passivity, and that silence and speech are not opposites, but closely interrelated.

Methods.  We conducted a retrospective study of silences observed in communication between nurses and surgeons in a multi-site observational …

'It's A Cultural Expectation...' The Pressure On Medical Trainees To Work Independently In Clinical Practice, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

CONTEXT: Medical trainees demonstrate a reluctance to ask for help unless they believe it is absolutely necessary, a situation which could impact on the safety of patients. This study aimed to develop a theoretical exploration of the pressure on medical trainees to be independent and to generate theory-based approaches to the implications for patient safety of this pressure towards independent working.

METHODS: In Phase 1, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants completed brief interviews. In Phase 2, 36 in-depth interviews were conducted using video vignettes. Data collection …

Routine And Adaptive Expert Strategies For Resolving Ict Mediated Communication Problems In The Team Setting, Lara Varpio, Catherine F Schryer, Lorelei Lingard

Lorelei Lingard

CONTEXT: The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR).

METHODS: A total of 72 doctors and nurses participated in this 8-month study on a paediatric in-patient ward. Eighty hours of non-participant observations and 20 semi-structured interviews were conducted. All data …

What's So Great About Rehabilitation Teams? An Ethnographic Study Of Interprofessional Collaboration In A Rehabilitation Unit, Lynne Sinclair, Lorelei Lingard, Ravindra Mohabeer

Lorelei Lingard

OBJECTIVE: To explore team structures, team relationships, and organizational culture constituting interprofessional collaboration (IPC) in a particular rehabilitation setting; to develop a description of IPC practice that may be translated, adapted, and operationalized in other clinical environments.

DESIGN: An ethnographic study involving: Field observations: 40 hours, over 4 weeks, daily activities, 7 interprofessional meetings, 3 care planning meetings, 1 business meeting, and 3 family meetings; Individual observations: a physiotherapist, an occupational therapist, and a social worker individually observed for 45 minutes to an hour; and Interviews: 19 participants, 11 professions, 27 informal, 5 formal interviews. Data analysis consisted of an …

Communication Channels In General Internal Medicine: A Description Of Baseline Patterns For Improved Interprofessional Collaboration, Lesley Gotlib Conn, Lorelei Lingard, Scott Reeves, Karen-Lee Miller, Ann Russell, Merrick Zwarenstein

Lorelei Lingard

General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets-synchronous …

The Trial Of The Expert Witness: Negotiating Credibility In Child Abuse Correspondence, Catherine Schryer, Elena Afros, Marcellina Mian, Marlee Spafford, Lorelei Lingard

Lorelei Lingard

This article reports on forensic letters written by physicians specializing in identifying children who have experienced maltreatment. These writers face an extraordinary exigence in that they must provide an opinion as to whether a child has experienced abuse without specifically diagnosing abuse and thus crossing into a legal domain. Their credibility was also at issue because, in this jurisdiction, child abuse identification was not recognized as a medical subspecialty and because the status of expert witnesses is currently being challenged. Through an analysis of 72 forensic letters combined with interview data from six letter writers and five letter readers, we …

Timing Of Surgical Antibiotic Prophylaxis Administration: Complexities Of Analysis, Carrie Cartmill, Lorelei Lingard, Glenn Regehr, Sherry Espin, John Bohnen, Ross Baker, Lorne Rotstein

Lorelei Lingard

BACKGROUND: The timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges. CHALLENGES: Two clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different …

Preserving Professional Credibility: Grounded Theory Study Of Medical Trainees' Requests For Clinical Support, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor.

DESIGN: Phase 1: members of teaching teams in internal and emergency medicine were observed during regular clinical activities (216 hours) and subsequently completed brief interviews. Phase 2: 36 in depth interviews were conducted using videotaped vignettes to probe tacit influences on decisions to request support. Data collection and analysis used grounded theory methods.

SETTING: Three teaching hospitals in an urban setting in Canada.

PARTICIPANTS: 124 members of teaching teams on general internal medicine wards and in the emergency department, …

Perceptions Of The Role Of The Registered Nurse In An Urban Interprofessional Academic Family Practice Setting, Jennifer Akeroyd, Ivy Oandasan, Ann Alsaffar, Cynthia Whitehead, Lorelei Lingard

Lorelei Lingard

Registered nurses (RNs) in Ontario have been asked to work collaboratively with family physicians (FPs) and other healthcare professionals in the family practice setting to improve the efficiency and effectiveness of healthcare delivery (OFPN 2005). Yet, little is known about the optimal utilization of the RN's role in family practice. This study builds on recent conversations regarding utilization of the nursing workforce (Oelke et al. 2008) and the nursing role (White et al. 2008) in the acute care setting by presenting perceptions of the role of the RN in an urban academic family practice setting. Interviews were conducted with 23 …

The Impact Of Space And Time On Interprofessional Teamwork In Canadian Primary Health Care Settings: Implications For Health Care Reform, Ivy Oandasan, Lesley Gotlib Conn, Lorelei Lingard, Allia Karim, Difat Jakubovicz, Cynthia Whitehead, Karen-Lee Miller, Natalie Kennie, Scott Reeves

Lorelei Lingard

Aim: This paper explores the impact of space and time on interprofessional teamwork in three primary health care centres and the implications for Canadian and other primary health care reform.

Background: Primary health care reform in Canada has emphasized the creation of interprofessional teams for the delivery of collaborative patient-centred care. This involves the expansion and transformation of existing primary health care centres into interprofessional family health teams (FHT) promising to provide patients better access, more comprehensive care, and improved utilization of individual health professionals. Benefits for providers include improved workplace satisfaction and organizational efficiencies. Currently, there is little evidence …