Medicine and Health Sciences Commons^™

Patient Education About Anticoagulant Medication: Is Narrative Evidence Or Statistical Evidence More Effective?, Kathleen Mazor, Joann Baril, Elizabeth Dugan, Frederick Spencer, Pamela Burgwinkle, Jerry Gurwitz

Elizabeth Dugan

OBJECTIVE: To determine the relative impact of incorporating narrative evidence, statistical evidence or both into patient education about warfarin, a widely used oral anticoagulant medication.

METHODS: 600 patients receiving anticoagulant therapy were randomly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed, or usual care (no video). The videos differed in whether the physician used narrative evidence (patient anecdotes), statistical evidence, or both to highlight key information. 317 patients completed both the baseline and post-test questionnaires. Questions assessed knowledge, beliefs and adherence to medication and laboratory monitoring regimens.

RESULTS: All …

Sexuality Education, Eva Goldfarb, Norman A. Constantine

Department of Public Health Scholarship and Creative Works

Sexuality education comprises the lifelong intentional processes by which people learn about themselves and others as sexual, gendered beings from biological, psychological, and sociocultural perspectives. It takes place through a potentially wide range of programs and activities in schools, community settings, religious centers, as well as informally within families, among peers, and through electronic and other media. Sexuality education for adolescents occurs in the context of the biological, cognitive, and social-emotional developmental progressions and issues of adolescence. Formal sexuality education falls into two main categories: behavior change approaches, which are represented by abstinence-only and abstinence-plus models, and healthy sexual development …

The Diversity Of Case Management Models, Diane Huber

Diane Huber

Case management is experiencing rapid growth and evolutionary transition. This article explores the diversity and richness of case management models found in practice. Interdisciplinary communication in case management programs can be facilitated by an awareness of discipline-specific definitions and models. A categorization of models is described as a device to stimulate multidisciplinary case management collaboration.

Effective Communication Saves Lives, Victoria Steelman

Victoria J. Steelman

No abstract provided.

Exploring Nursing Home Staff's Perceptions Of Communication And Leadership To Facilitate Quality Improvement, Jill Scott-Cawiezell, M. Schenkman, L. Moore, C. Vojir, R. Connoly, M. Pratt, L. Palmer

Jill Scott-Cawiezell

Leadership and clinical staff were surveyed to explore communication and leadership in nursing homes. Registered nurses and other professionals perceived communication as better than their nursing colleagues did. Overall, results suggest all factors of communication could improve. In terms of leadership, licensed practical nurses perceived less clarity of expectations, encouragement of initiative, and support than other groups. The study provides insight into what is organizationally necessary to improve quality of care in nursing homes.

Are Nursing Homes Ready To Create Sustainable Improvement?, Jill Scott-Cawiezell

Jill Scott-Cawiezell

No abstract provided.

Measuring Organizational Attributes Of Primary Care Practices: Development Of A New Instrument, P. Ohman-Strickland, A. Orzano, P. Nutting, W. Perry Dickinson, Jill Scott-Cawiezell, K. Hahn, M. Gibel, B. Crabtree

Jill Scott-Cawiezell

OBJECTIVE: To develop an instrument to measure organizational attributes relevant for family practices using the perspectives of clinicians, nurses, and staff. DATA SOURCES/STUDY SETTING: Clinicians, nurses, and office staff (n=640) from 51 community family medicine practices. DESIGN: A survey, designed to measure a practices' internal resources for change, for use in family medicine practices was created by a multidisciplinary panel of experts in primary care research and health care organizational performance. This survey was administered in a cross-sectional study to a sample of diverse practices participating in an intervention trial. A factor analysis identified groups of questions relating to latent …

Moving From A Culture Of Blame To A Culture Of Safety In The Nursing Home Setting, Jill Scott-Cawiezell, A. Vogelsmeier, C. Mckenney, M. Rantz, L. Hicks, D. Zellmer

Jill Scott-Cawiezell

TOPIC: A culture of safety. PURPOSE: To explore the current culture of blame and what organizational elements must be impacted to move toward a culture of safety in the nursing home setting. METHODS: A mixed-method approach incorporating a case study and staff member survey results were used to explicate the organizational elements impacting the current nursing home culture. CONCLUSION: Nurse leaders can create an environment in which every member of the team feels a responsibility and an ability to insure that residents are safe by improving communication and participation in decision making.

Nursing Home Safety: A Review Of The Literature, Jill Scott-Cawiezell, A. Vogelsmeier

Jill Scott-Cawiezell

The number of older persons in the United States is rapidly growing and, based on this growth projection, the number of consumers needing nursing home (NH) care will likely triple in the next 10 years. Although NHs have been bombarded and scrutinized about the care that they provide, the concept of safety (specifically, error prevention) remains at the margin of most quality improvement efforts. The purpose of this review is to explore what has recently been written (2000-2005) about the evolution of the NH as an organization focused on safety and the most critical clinical processes that must be closely …

An Examination Of Role Strain For University Nurse Faculty And Its Relation To Socialization Experiences And Personal Characteristics, Paula Mobily

Paula Mobily

The purpose of this study is to describe the degree of perceived role strain and the major sources of role strain in nurse faculty employed in major universities; and to explore the relationship between selected socialization experiences and personal characteristics and the degree of role strain experienced. The sample (N = 102) was comprised of full-time tenure track nurse faculty employed in major universities that offered National League for Nursing-accredited undergraduate and graduate programs in nursing, and were located in institutions classified as Research Universities I by the Carnegie Council on Policy Studies in Higher Education (1987). The majority of …

School Nurses' Experiences With Children With Chronic Conditions, Janet Williams, Ann Mccarthy

Ann Marie McCarthy

No abstract provided.

Communication, Encouragement, And Cancer Screening In Families With And Without Mutations For Hereditary Nonpolyposis Colorectal Cancer: A Pilot Study, Anne Ersig, Janet Williams, D. Hadley, L. Koehly

Anne L. Ersig

PURPOSE: Known and suspected mutation carriers for hereditary nonpolyposis colorectal cancer are advised to have colonoscopies every 1 to 2 years to detect colorectal cancer. Little is known about colonoscopy completion in families suspected of having hereditary nonpolyposis colorectal cancer but without identified mutations. METHODS: This study examined the effect of communication and encouragement on colonoscopy in families with and without known mutations. Twenty-three respondents from 11 families with indeterminate genetic test results were matched with 23 respondents from 11 families with mutation-positive results. Hierarchical modeling examined the effects of relational characteristics on time since last colonoscopy in index cases …

Characteristics Of Health Information Gatherers, Disseminators, And Blockers Within Families At Risk Of Hereditary Cancer: Implications For Family Health Communication Interventions, L. Koehly, J. Peters, R. Kenen, L. Hoskins, Anne Ersig, N. Kuhn, J. Loud, M. Greene

Anne L. Ersig

OBJECTIVES: Given the importance of the dissemination of accurate family history to assess disease risk, we characterized the gatherers, disseminators, and blockers of health information within families at high genetic risk of cancer. METHODS: A total of 5466 personal network members of 183 female participants of the Breast Imaging Study from 124 families with known mutations in the BRCA1/2 genes (associated with high risk of breast, ovarian, and other types of cancer) were identified by using the Colored Eco-Genetic Relationship Map (CEGRM). Hierarchical nonlinear models were fitted to characterize information gatherers, disseminators, and blockers. RESULTS: Gatherers of information were more …

President's Message. Reflections, Patricia Clinton

Patricia K. Clinton

No abstract provided.

Sally J. Rogers And Geraldine Dawson: Review Of Early Start Denver Model For Young Children With Autism: Promoting Language, Learning And Engagement (Book Review), Rhea Paul

Communication Disorders Faculty Publications

Book review by Rhea Paul:

Rogers, Sally R. and Geraldine Dawson. Early Start Denver Model for Young Children with Autism: Promoting Language, Learning and Engagement. New York: Guilford Press, 2010. 9781606236321; 9781606234914 (pbk.)

Pulling Together And Pushing Apart: Tides Of Tension In The Icu Team, Laura Hawryluck, Sherry Espin, Kim Garwood, Cathy Evans, Lorelei Lingard

Lorelei Lingard

No abstract provided.

What Do We Mean By "Relevance"? A Clinical And Rhetorical Definition With Implications For Teaching And Learning The Case-Presentation Format, Lorelei Lingard, R. Haber

Lorelei Lingard

No abstract provided.

Tensions Influencing Operating Room Team Function: Does Institutional Context Make A Difference?, Lorelei Lingard, Stacey Garwood, Dan Poenaru

Lorelei Lingard

BACKGROUND: A recent study of operating room (OR) team communication in a large, urban hospital described recurrent tension catalysts and a preliminary theory of team members' interpretive processes. To determine to what extent these findings were transferable to other institutional contexts, we conducted a validation study in 2 small, academic hospitals in a mid-size city. METHODS: Eight focus groups and 8 interviews were conducted with 6 general surgeons, 22 OR nurses, 5 anaesthesiologists and 10 trainees. Observations of 10 surgeons and their team members were conducted over 4 months. Data were analysed by applying thematic codes derived from previous research …

A Qualitative Study Examining Tensions In Interdoctor Telephone Consultations, Anupma Wadhwa, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. METHODS: Data …

Context, Conflict, And Resolution: A New Conceptual Framework For Evaluating Professionalism, Shiphra Ginsburg, Glenn Regehr, Rose Hatala, Nancy Mcnaughton, Alice Frohna, Brian Hodges, Lorelei Lingard, David Stern

Lorelei Lingard

No abstract provided.

Team Communications In The Operating Room: Talk Patterns, Sites Of Tension, And Implications For Novices, Lorelei Lingard, Richard Reznick, Sherry Espin, Glenn Regehr, Isabella Devito

Lorelei Lingard

PURPOSE: Although the communication that occurs within health care teams is important to both team function and the socialization of novices, the nature of team communication and its educational influence are not well documented. This study explored the nature of communications among operating room (OR) team members from surgery, nursing, and anesthesia to identify common communicative patterns, sites of tension, and their impact on novices.

METHOD: Paired researchers observed 128 hours of OR interactions during 35 procedures from four surgical divisions at one teaching hospital. Brief, unstructured interviews were conducted following each observation. Field notes were independently read by each …

Towards Safer Interprofessional Communication: Constructing A Model Of "Utility" From Preoperative Team Briefings, Lorelei Lingard, Sarah Whyte, Sherry Espin, G. Baker, Beverley Orser, Diane Doran

Lorelei Lingard

"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit …

Learning Oral Presentation Skills A Rhetorical Analysis With Pedagogical And Professional Implications, Richard Haber, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: Oral presentation skills are central to physician-physician communication; however, little is known about how these skills are learned. Rhetoric is a social science which studies communication in terms of context and explores the action of language on knowledge, attitudes, and values. It has not previously been applied to medical discourse. We used rhetorical principles to qualitatively study how students learn oral presentation skills and what professional values are communicated in this process. DESIGN: Descriptive study. SETTING: Inpatient general medicine service in a university-affiliated public hospital. PARTICIPANTS: Twelve third-year medical students during their internal medicine clerkship and 14 teachers. MEASUREMENTS: …

Time As A Catalyst For Tension In Nurse-Surgeon Communication, Sherry Espin, Lorelei Lingard

Lorelei Lingard

Carefully studying communication patterns between nurses and surgeons questions popular stereotypes about OR discourse and expands educators' understanding of the factors that motivate team communication, patterns that are habitual among team members, and issues that act as catalysts for tension. This study examines the nature of communication between perioperative nurses and surgeons and identifies patterns and sites of tension. Researchers observed 128 hours of interaction between nurses and surgeons in four surgical divisions at one teaching hospital in Ontario, Canada. Field notes were read, coded, and analyzed independently. Results showed that higher tension in nurse-surgeon communication clusters around particular themes, …

Perceptions Of Operating Room Tension Across Professions: Building Generalizable Evidence And Educational Resources, Lorelei Lingard, Glenn Regehr, Sherry Espin, Isabella Devito, Sarah Whyte, Douglas Buller, Bohdan Sadovy, David Rogers, Richard Reznick

Lorelei Lingard

BACKGROUND: Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication. Replication of these naturalistic findings in a controlled, video-based format could provide a basis for formal curricula. METHOD: Seventy-two surgeons, nurses, and anesthesiologists independently rated three video-based scenarios for the three professions' level of tension, responsibility for creating tension and responsibility for resolution. Data were analyzed using three-way, mixed-design analyses of variance. RESULTS: The three professions rated tension levels of the various scenarios similarly (F=1.19, ns), but rated …

Teaching And Learning Communication In Medicine: A Rhetorical Approach, Lorelei Lingard, R. Haber

Lorelei Lingard

The language people use both makes possible and constrains the thoughts they can have. More than just a vehicle for ideas, language shapes ideas--and the practices that follow from them. Thus, in medical education, teaching students how to talk about medical cases also teaches them how to think about patients and medical work, and how to define their relationships to both. Without a theoretical model, however, teaching efforts in this domain tend to be implicit and ad hoc, which can lead to serious problems. Rhetoric is one science that can deepen understanding of communication and improve teaching of this clinical …

Getting Teams To Talk: Development And Pilot Implementation Of A Checklist To Promote Interprofessional Communication In The Or, Lorelei Lingard, S. Espin, B. Rubin, S. Whyte, M. Colmenares, G. Baker, D. Doran, E. Grober, B. Orser, J. Bohnen, R. Reznick

Lorelei Lingard

BACKGROUND: Pilot studies of complex interventions such as a team checklist are an essential precursor to evaluating how these interventions affect quality and safety of care. We conducted a pilot implementation of a preoperative team communication checklist. The objectives of the study were to assess the feasibility of the checklist (that is, team members' willingness and ability to incorporate it into their work processes); to describe how the checklist tool was used by operating room (OR) teams; and to describe perceived functions of the checklist discussions.

METHODS: A checklist prototype was developed and OR team members were asked to implement …

The Rhetorical 'Turn' In Medical Education: What Have We Learned And Where Are We Going?, Lorelei Lingard

Lorelei Lingard

This paper presents a critical reflection on the contributions and challenges associated with one rhetorical approach to studying teaching and learning communication in health professions education. A rhetorical approach treats language as a social act, and attends to the role of language in establishing professional identities and relationships. The research has produced insights into the use of standard communication formats to teach novices, the nature of socialization on clinical teams, and the relationship between communication patterns and patient safety. Challenges and emerging questions include the problem of accounting for the material dimensions of communication in a rhetorical model, grappling with …

The Role Of Personality On Persuasion To Exercise: Does Conscientiousness And Extraversion Moderate The Constructs Of The Theory Of Planned Behavior?, Amanda I. Samuels

Honors Theses

The Theory of Planned Behavior (TPB) is a leading theoretical model used to explain the intention-behavior relationship as it relates to exercise. Even though TPB consistently explains some of the variance between intention and behavior, the rest of the variance has yet to be explained. This study investigates whether individual differences in terms of the Big Five personality dimensions, specifically, Conscientiousness and Extraversion, can account for any of the additional variance. The present research extends on past research by examining how personality relates to intention in terms of its relation to the constructs of TPB. 122 students at Union college …

Using The Commons To Facilitate Health Communication, Anna Liebzeit, Karen Adams, Mat Jakobi

Aboriginal Policy Research Consortium International (APRCi)

No abstract provided.