Developing skilled doctor–patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors

To inform the development of recommendations to facilitate learning of skilled doctor–patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees’ learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors’ experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.     

Clinicians’ evaluation of clinical ethics consultations in Norway: a qualitative study

Clinical ethics committees have existed in Norway since 1996. By now all hospital trusts have one. An evaluation of these committees’ work was started in 2004. This paper presents results from an interview study of eight clinicians who evaluated six committees’ deliberations on 10 clinical cases. The study indicates that the clinicians found the clinical ethics consultations useful and worth while doing. However, a systematic approach to case consultations is vital. Procedures and mandate of the committees should be known to clinicians in advance to ensure that they know what to expect. Equally important is bringing all relevant facts, medical as well as psychosocial, into the discussion. A written report from the deliberation is also important for the committees to be taken seriously by the clinicians. This study indicates that the clinicians want to be included in the deliberation, and not only in the preparation or follow-up. Obstacles for referring a case to the committee are the medical culture’s conflict aversion and its anxiety of being judged by outsiders. The committees were described as a court by some of the clinicians. This is a challenge for the committees in their attempt to balance support and critique in their consultation services.     

Guys and dolls: a qualitative study of teachers’ views of gendered play in kindergarten

Drawing on data collected for a larger study investigating kindergarten teachers’ online discussions of play, the present qualitative study examines teachers’ discussions of gender. Findings suggest that teachers’ project onto their kindergarten students many of their own gender prejudices about play. These teachers reinforced gendered attitudes by encouraging the children, especially the boys, to play only with toys and in activities traditionally associated with their gender. Email interviews were then conducted with seven kindergarten teachers to further explore the main theme from the netnographic research. Findings support the contention that further research is needed to examine gendered play in kindergartens, and that kindergarten teachers could benefit from becoming aware of their unintentional teachings and in learning how better to encourage gender equity in play-based class activities.     

Educators’ experiences with governance in curriculum change processes; a qualitative study using rich pictures

Advances in Health Sciences Education - In the midst of continuous health professions curriculum reforms, critical questions arise about the extent to which conceptual ideas are actually put into...     

Medical educators’ social acts of explaining passing underperformance in students: a qualitative study

Passing underperformance in students is ubiquitous across health and social care educators and is intimately related to the subsequent welfare of patients: underperforming students may become underperforming practitioners. This paper aims to examine how medical educators construct passing underperformance through an analysis of their social act of explaining such behaviours in peer-group settings. Ten focus groups were conducted with 70 medical educators across two UK schools with different curricular/assessment styles (England, Scotland). A qualitative content analysis of how educators explained their behaviours of passing underperformance was undertaken using the psychological concepts of proximality and distalness according to: (1) Malle’s F.Ex. coding framework for behavioural explanations, and (2) participants’ use of pronouns. 149 explanations of passing underperformance were identified: 72 for participants’ own behaviour, 77 for others’ behaviour. When explaining their own behaviour, participants used the proximal pronoun I 37% (n = 27) of the time and the distancing pronouns we/you 51% (n = 37) of the time. More Causal History of Reasons (38%; n = 27) and Enabling Factors (29%; n = 21) than Reasons (33%; n = 24) were cited. A similar pattern was found for explaining others’ behaviour. Thus, medical educators used linguistic form, explanation mode and informational content within peer-group discussions to distance themselves from intentionality for their action of passing underperformance and highlighted desirable characteristics of themselves and medical educators in general. Faculty development programmes should develop assessors’ awareness of how implicit factors within their talk can legitimise a culture of passing underperformance and explore the steps for cultural change.     

Nurses’ ethical reasoning in cases of physical restraint in acute elderly care: a qualitative study

In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses’ decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses’ reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009–April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses’ decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly.     

Recognition as care: a longitudinal study of Arabic immigrants’ experiences of diabetes training in Denmark

This longitudinal study provides critical insight into the social processes of municipal diabetes training for Arabic-speaking immigrants in Denmark focusing on participants’ experiences. Our study builds on observations of three diabetes courses and 36 interviews with participants at the start of, immediately following or 30–36 months after the courses. Lifestyle change and responsibility were dominant messages in the courses; over time and depending on their daily social context, participants selectively accepted and incorporated these messages. However, in retrospect, participants highlighted other meaningful benefits; these centred on reducing isolation and being met on their own terms regarding language and logistics. Most importantly, they remembered when treated with attention and respect by professionals and the mutual acknowledgement between participants. We use Axel Honneth’s notions of rights-based and solidarity-based recognition to analyse what was at stake in these experiences, and we engage Annemarie Mol’s concept of a logic of care to show how recognition unfolded practically during the training. We propose that participants’ wider social context and experiences of misrecognition situated the training experiences concerned with recognition. We also show exceptions. The sociality, which for some generated solidarity-based recognition, felt intimidating for others. We argue that the silent processes of recognition in the diabetes training carried significant meaning for participants, and that over time, many highlighted these as benefits rather than lifestyle change and responsibility.     

Parents’ experiences of conducting a goal-directed intervention based on children’s self-identified goals,a qualitative study

Aim/objective: To explore and describe parents’ perceptions and experiences of conducting a goal-directed intervention focused on children’s self-identified goals.

Material and methods: Individual semi-structured interviews were performed with nine parents (8 mothers, 1 father). All the parents had participated actively in conducting a goal-directed intervention addressing their children’s self-identified goals. The interviews were analyzed using qualitative content analysis.

Results: From a parental perspective, working on children’s self-identified goals was a positive experience. The findings revealed three categories: Goals challenged the parents describes the parents’ experiences of the complexity of goal setting. The intervention demanded an intensive and flexible parental engagement; here the parents expressed the importance of active parental engagement, which for some parents could be challenging. The child’s personal goals gave more than anticipated describes the parents’ experiences of how the children’s personal goals positively influenced the children’s self-esteem, increased the children’s motivation for practice, and helped the children develop more than the parents had anticipated.

Conclusions and significance: In the parents’ experience, goal-directed intervention comprehensively relies on their engagement. Follow up’s from the occupational therapist motivated the parents and their own child’s personal goals gave them more than they could have expected. This indicates the importance of supporting parents and letting children actively participate in the goal setting process.     

Is peer injecting a form of intimate partner abuse? A qualitative study of the experiences of women drug users

Women are over-represented as the recipients of injections of illicit drugs and are often injected by their intimate partners. This study used qualitative research to explore women drug users' experiences of abuse from intimate partners when being injected with illicit drugs. In-depth interviews were conducted with 45 women drug users in the city of Leeds and the area of North Nottinghamshire, UK. The practice of peer injecting illicit drugs places women recipients at risk of physical, economic and emotional abuse from their male intimate partner injectors. However, this was not a universal feature. In trusting, supportive intimate partner relationships peer injecting took place through reciprocal arrangements. Moving away from peer injecting was technically and emotionally difficult for women and rarely straightforward. The implications of the work are discussed as clinicians and wider drug service staff should be aware of the possibility of abuse and enquire about peer injecting when consulting with women injecting drug users. However, clinicians should avoid working within a simplistic clinical framework that views all peer injecting as intrinsically abusive. More research is needed to provide evidence for best practice. Until then, generic principles of best practice management of intimate partner abuse could apply, including enhancing women's motivation to effect change in an abusive situation.     

Transgender women in Malaysia,in the context of HIV and Islam: a qualitative study of stakeholders’ perceptions

Background

Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia.Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context.

Methods

In-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis.

Results

Five central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; ‘Cure’, ‘Correction’ and finally, Stigma and Discrimination.Discussion: Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations.

Conclusion

The situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in Malaysia.

     

Sooner or later? Issues in the early diagnosis of dementia in general practice: a qualitative study

OBJECTIVE: The aim of this study was to explore the perspectives of primary care practitioners on the early diagnosis of dementia. METHODS: A total of 247 GPs, 146 community nurses, 36 practice nurses, 79 community mental health nurses and others working in a range of hospital, residential and community settings attended 24 one-day workshops in 21 cities and towns in the UK. A nominal group approach was used relating to the early diagnosis of dementia in the community. RESULTS: Groups agreed on the benefits and risks of early diagnosis of dementia; disagreed about screening for dementia, and about professional resistance to making the diagnosis; constructed comprehensive guidelines on diagnosis, but without much reference to resource implications; yet described actual local resource limitations in detail; and avoided dilemmas about dementia care by framing it as a specialist activity. CONCLUSION: Practitioners situate dementia in a family context but do not yet use a disablement model of dementia which might reduce tensions about early diagnosis and the disclosure of the diagnosis. The term diagnosis could usefully be replaced by recognition, to aid this shift in model. Service gaps may emerge or widen if earlier diagnosis of dementia is pursued as a policy objective.     

Farm operators’ experiences of advanced technology and automation in Swedish agriculture: a pilot study

This pilot study investigated how farm operators use and experience working with advanced farm technology and automated systems. The study participants included 10 farm operators at 4 modern and technically well-equipped arable and dairy farms. The informants reported that the technology allowed for more accuracy and efficiency in daily work, made the work less physically strenuous, and gave more time for leisure. The challenges lay in systems and programs not being compatible and difficulties in interpreting generated data. At times, the technology was considered complex or difficult to handle and operate. It was also considered mentally stressful when it did not work as expected. Nightly alarms causing disturbed sleep and work time, and tasks losing some of their clear and natural starts and ends were the most challenging issues on dairy farms. Malfunctions disturbed the daily work, especially when spare parts or service technicians were unavailable. The informants concluded that advanced farm technology and automated systems had both positive and negative sides. They reported no consistent mental strain caused by the technology and considered it a necessity for their future work. However, technology and automated systems must be functional, user-friendly, and reliable to avoid imposing potential mental strain.     

Checklists in the operating room: Help or hurdle? A qualitative study on health workers' experiences

Background  

Checklists have been used extensively as a cognitive aid in aviation; now, they are being introduced in many areas of medicine. Although few would dispute the positive effects of checklists, little is known about the process of introducing this tool into the health care environment. In 2008, a pre-induction checklist was implemented in our anaesthetic department; in this study, we explored the nurses' and physicians' acceptance and experiences with this checklist.     

Communities’ perceptions of factors contributing to child sexual abuse vulnerability in Kenya: a qualitative study

Abstract

Child sexual abuse (CSA) is a major global health concern. Although it is prevalent in Kenya, scant literature on factors contributing to CSA vulnerability exists. Using qualitative data from 28 focus groups and ethnographic field notes, we explored and assessed community perceptions of factors contributing to CSA vulnerability in Homa Bay County, Western Kenya. Findings suggest that people living in these communities perceived CSA as being influenced by multiple factors: developmental stage, peer pressure, huge gender disparities exacerbated by negative social norms and cultural practices, the HIV epidemic and social media platforms that circulate sexualised images. From our findings, it was clear that participants also regarded poverty as exacerbating children’s vulnerability to CSA. Minors from poor families engaged in transactional sex for survival and social status. Some community members perceived girls dressed in short skirts or tight clothing as warranting unwanted sexual advances. Although poverty and gender roles and relations were viewed as increasing vulnerability to CSA, blame was often placed on survivors’ modes of dress or behaviour. There is a need for comprehensive education of the communities on CSA, its consequences and the rights of women and girls.