Professionals’ embodied orientations towards patients in discharge-planning meetings and their impact on patient participation
DOI:
https://doi.org/10.1558/cam.21624Keywords:
conversation analysis, discharge planning, interdisciplinary meetings, rehabilitation, patient participation, professionals’ embodied orientationAbstract
To enhance the patient’s involvement, clinical guidelines on rehabilitation require the patient’s participation in the entire rehabilitation process, including discharge planning (DP). However, very little is known about how this institutional demand is actually dealt with in everyday clinical practice. Adopting a conversation analytic (CA) approach, our paper tackles the matter by looking at interdisciplinary entry meetings (IEMs) at a rehabilitation clinic in German-speaking Switzerland. Our study is based on audio-visual recordings of 11 IEMs, whose central aim is to formulate patients’ rehabilitation goals and to plan their discharge. The paper offers a detailed analysis of the embodied practices through which healthcare professionals seek to involve patients in the IEMs, and also investigates patients’ responses. Our analysis shows that, although carefully elaborated, the professionals’ practices do not elicit more than reactive patient participation. The paper argues that this is due to (1) the practices’ temporal positioning within the overall activity structure of the meeting – they are deployed when no important decision is at stake, projecting minimal patient participation on the phases in which decisions are taken – and (2) the actions the practices project on the next turn: confirmation, acknowledgement or ratification of what has previously been proposed by professionals.References
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Barnes, R. K. (2007) Formulations and the facilitation of common agreement in meetings talk. Text and Talk 27 (3): 273–296. http://dx.doi.org/10.1515/TEXT.2007.011
Beck Nielsen, S. (2009) Accounts on the behalf of patients during Geriatric Case Conferences. Research on Language and Social Interaction 42 (3): 231–248. http://dx.doi.org/10.1080/08351810903089167
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Collins, S., Drew, P., Watt, I. and Entwistle, V. (2005) ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine 61 (12): 2611–2627. http://dx.doi.org/10.1016/j.socscimed.2005.04.047
Department of Health UK (2010) Equity and Excellence: Liberating the NHS. Retrieved from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
Efraimsson, E., Rasmussen, B., Gilje, F. and Sandman, P. (2003) Expressions of power and powerlessness in discharge planning: A case study of an older woman on her way home. Journal of Clinical Nursing 12 (5): 707–716. http://dx.doi.org/10.1046/j.1365-2702.2003.00718.x
Ford, C. E. (2010) Questioning in meetings. In A. F. Freed and S. Ehrlich (eds) ‘Why Do You Ask?’ The Function of Questions in Institutional Discourse, 211–234. Oxford: Oxford University Press.
Golato, A. and Fagyal, Z. (2008) Comparing single and double sayings of the German response token ja and the role of prosody: A conversation analytic perspective. Research on Language and Social Interaction 41 (3): 241–270. http://dx.doi.org/10.1080/08351810802237834
Halvorsen, K. (2010) Team decision making in the workplace: A systematic review of discourse analytic studies. Journal of Applied Linguistics and Professional Practice 7 (3): 273–296. http://dx.doi.org/10.1558/japl.v7i3.273
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Heath, C. (2006) Body work: The collaborative production of the clinical object. In J. Heritage and D. Maynard (eds) Communication in Medical Care, 185–213. Cambridge: Cambridge University Press.
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Huby, G., Holt Brook, J., Thompson, A. and Tierney, A. (2007) Capturing the concealed: Interprofessional practice and older patients’ participation in decision-making about discharge after acute hospitalization. Journal of Interprofessional Care 21 (1): 55–67. http://dx.doi.org/10.1080/13561820601035020
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Jefferson, G. (2004) Glossary of transcript symbols with an introduction. In G. H. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 13–31. Amsterdam: Benjamins. http://dx.doi.org/10.1075/pbns.125.02jef
Jones, A. (2009) Creating history: Documents and patient participation in nurse-patient interviews. Sociology of Health and Illness 31 (6): 907–923. http://dx.doi.org/10.1111/j.1467-9566.2009.01190.x
Lerner, G. (2002) Turn-sharing: The choral co-production of talk-in-interaction. In C. Ford, B. Fox and S. Thompson (eds) The Language of Turn and Sequence, 225–256. New York: Oxford University Press.
Mistiaen, P., Francke, A. and Poot, E. (2007) Interventions aimed at reducing problems in adult patients discharged from hospital to home: A systematic meta-review. BMC Health Services Research 7 (47): 1–19. http://dx.doi.org/10.1186/1472-6963-7-47
Mondada, L. (2007) Multimodal resources for turn-taking: Pointing and the emergence of possible next speakers. Discourse Studies 9 (2): 194–225. http://dx.doi.org/10.1177/1461445607075346
Nielsen, M. F., Nielsen, S. B., Gravengaard, G. and Due, B. (2012) Interactional functions of invoking procedure in institutional settings. Journal of Pragmatics 44: 1457–1473. http://dx.doi.org/10.1016/j.pragma.2012.06.007
Peräkylä, A., Ruusuvuori, J. and Lindfors, P. (2007) What is patient participation? In S. Collins, N. Britten, J. Ruusvuori and A. Thompson (eds) Patient Participation in Health Care Consultations: Qualitative Perspectives, 121–142. Maidenhead, UK: Open University Press.
Pilnick, A., Hindmarsh, J. and Gill, T. V. (2009) Beyond ‘doctor and patient’: Developments in the study of healthcare interactions. Sociology of Health & Illness 31 (6): 787–802. http://dx.doi.org/10.1111/j.1467-9566.2009.01194.x
Procter, S., Wilcockson, J., Pearson, P. and Allgar, V. (2001) Going home from hospital: The carer/patient dyad. Issues and Innovations in Nursing Practice 35 (2): 206–217. http://dx.doi.org/10.1046/j.1365-2648.2001.01838.x
Robinson, J. D. (2003) An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication 15 (1): 27–59. http://dx.doi.org/10.1207/S15327027HC1501_2
Robinson, J. D. (2013) Overall structural organization. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 257–280. Chichester, UK: Wiley-Blackwell.
Robinson, J. D. and Stivers, T. (2001) Achieving activity transitions in physician-patient encounters: from history taking to physical examination. Human Communication Research 27 (2): 253–298. http://dx.doi.org/10.1111/j.1468-2958.2001.tb00782.x
Schoeb, V. (2014) ‘What Do You Expect From Physiotherapy?’ A Conversation Analytic Approach to Goal Setting Physiotherapy. Unpublished doctoral dissertation, University of Nottingham, Nottingham.
Scottish Intercollegiate Guidelines Network (2010) Management of Patients with Stroke: Rehabilitation, Prevention and Management Of Complications, and Discharge Planning. SIGN 118. Retrieved from http://www.sign.ac.uk/pdf/sign118.pdf
Smith, J., Cheater, F., Bekker, H. and Chatwin, J. (2015) Are parents and professionals making shared decisions about a child’s care on presentation of a suspected shunt malfunction: A mixed method study? Health Expectations 18 (5): 1299–1315. http://dx.doi.org/10.1111/hex.12106
Stewart, M., Brown, J. B., Weston, W. W., McWinney, I. R., McWilliam, C. L. and Freeman, T. R. (1995) Patient?centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage.
Svennevig, J. (2012a) Interaction in workplace meeting. Discourse Studies 14 (3): 3–10. http://dx.doi.org/10.1177/1461445611427203
Svennevig, J. (2012b) The agenda as resource for topic introduction in workplace meetings. Discourse Studies 14 (1): 53–66. http://dx.doi.org/10.1177/1461445611427204
Swiss Medical Association. (1998–) Code de déontologie de la FMH. Retrieved from http://www.fmh.ch/files/pdf16/Standesordnung_20150829_F.pdf
ten Have, P. (2007) Doing Conversation Analysis: A Practical Guide. London: Sage. http://dx.doi.org/10.4135/9781849208895
Thompson A. G. (2007) The meaning of patient involvement and participation in health care consultations: A taxonomy. Social Science & Medicine 64 (6): 1297–1310. http://dx.doi.org/10.1016/j.socscimed.2006.11.002
World Health Organization (2008) The Tallinn Charter: Health Systems for Health and Wealth. Copenhagen: World Health Organization Regional Office. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/88613/E91438.pdf
Barnard, R. A., Cruice, M. N. and Playford, E. D. (2010) Strategies used in the pursuit of achievability during goal setting in rehabilitation. Qualitative Health Research 20 (2): 239–250. http://dx.doi.org/10.1177/1049732309358327
Barnes, R. K. (2007) Formulations and the facilitation of common agreement in meetings talk. Text and Talk 27 (3): 273–296. http://dx.doi.org/10.1515/TEXT.2007.011
Beck Nielsen, S. (2009) Accounts on the behalf of patients during Geriatric Case Conferences. Research on Language and Social Interaction 42 (3): 231–248. http://dx.doi.org/10.1080/08351810903089167
Charles, C., Gafni, A., Whelan, T. and O’Brian, M. A. (2005) Treatment decisions aids: Conceptual issues and future directions. Health Expectations 8 (2): 114–125. http://dx.doi.org/10.1111/j.1369-7625.2005.00325.x
Chartered Society of Physiotherapy (2012) Patient-centred practice. Retrieved from http://www.csp.org.uk/frontline/article/patient-centred-practice
Collins, S., Britten, N., Ruusuvuori, J. and Thompson, A. (2007) Understanding the process of patient participation. In S. Collins, N. Britten, J. Ruusuvuori and A. Thompson (eds) Patient Participation in Health Care Consultations: Qualitative Perspectives, 3–21. Maidenhead, UK: Open University Press.
Collins, S., Drew, P., Watt, I. and Entwistle, V. (2005) ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine 61 (12): 2611–2627. http://dx.doi.org/10.1016/j.socscimed.2005.04.047
Department of Health UK (2010) Equity and Excellence: Liberating the NHS. Retrieved from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353
Efraimsson, E., Rasmussen, B., Gilje, F. and Sandman, P. (2003) Expressions of power and powerlessness in discharge planning: A case study of an older woman on her way home. Journal of Clinical Nursing 12 (5): 707–716. http://dx.doi.org/10.1046/j.1365-2702.2003.00718.x
Ford, C. E. (2010) Questioning in meetings. In A. F. Freed and S. Ehrlich (eds) ‘Why Do You Ask?’ The Function of Questions in Institutional Discourse, 211–234. Oxford: Oxford University Press.
Golato, A. and Fagyal, Z. (2008) Comparing single and double sayings of the German response token ja and the role of prosody: A conversation analytic perspective. Research on Language and Social Interaction 41 (3): 241–270. http://dx.doi.org/10.1080/08351810802237834
Halvorsen, K. (2010) Team decision making in the workplace: A systematic review of discourse analytic studies. Journal of Applied Linguistics and Professional Practice 7 (3): 273–296. http://dx.doi.org/10.1558/japl.v7i3.273
Halvorsen, K. and Sarangi, S. (2015). Team decision-making in workplace meetings: The interplay of activity roles and discourse roles. Journal of Pragmatics 76: 1–14. http://dx.doi.org/10.1016/j.pragma.2014.11.002
Heath, C. (2006) Body work: The collaborative production of the clinical object. In J. Heritage and D. Maynard (eds) Communication in Medical Care, 185–213. Cambridge: Cambridge University Press.
Heritage, J. and Watson, R. (1979) Formulations as conversational objects. In G. Psathas (ed.) Everyday Language: Studies in Ethnomethodology, 123–162. New York: Irvington.
Huby, G., Holt Brook, J., Thompson, A. and Tierney, A. (2007) Capturing the concealed: Interprofessional practice and older patients’ participation in decision-making about discharge after acute hospitalization. Journal of Interprofessional Care 21 (1): 55–67. http://dx.doi.org/10.1080/13561820601035020
Ijäs-Kallio, T., Ruusuvuori, J. and Peräkylä, A. (2011) ‘Unilateral’ decision making and patient participation in primary care. Communication & Medicine 8 (2): 145–155.
Jefferson, G. (2004) Glossary of transcript symbols with an introduction. In G. H. Lerner (ed.) Conversation Analysis: Studies from the First Generation, 13–31. Amsterdam: Benjamins. http://dx.doi.org/10.1075/pbns.125.02jef
Jones, A. (2009) Creating history: Documents and patient participation in nurse-patient interviews. Sociology of Health and Illness 31 (6): 907–923. http://dx.doi.org/10.1111/j.1467-9566.2009.01190.x
Lerner, G. (2002) Turn-sharing: The choral co-production of talk-in-interaction. In C. Ford, B. Fox and S. Thompson (eds) The Language of Turn and Sequence, 225–256. New York: Oxford University Press.
Mistiaen, P., Francke, A. and Poot, E. (2007) Interventions aimed at reducing problems in adult patients discharged from hospital to home: A systematic meta-review. BMC Health Services Research 7 (47): 1–19. http://dx.doi.org/10.1186/1472-6963-7-47
Mondada, L. (2007) Multimodal resources for turn-taking: Pointing and the emergence of possible next speakers. Discourse Studies 9 (2): 194–225. http://dx.doi.org/10.1177/1461445607075346
Nielsen, M. F., Nielsen, S. B., Gravengaard, G. and Due, B. (2012) Interactional functions of invoking procedure in institutional settings. Journal of Pragmatics 44: 1457–1473. http://dx.doi.org/10.1016/j.pragma.2012.06.007
Peräkylä, A., Ruusuvuori, J. and Lindfors, P. (2007) What is patient participation? In S. Collins, N. Britten, J. Ruusvuori and A. Thompson (eds) Patient Participation in Health Care Consultations: Qualitative Perspectives, 121–142. Maidenhead, UK: Open University Press.
Pilnick, A., Hindmarsh, J. and Gill, T. V. (2009) Beyond ‘doctor and patient’: Developments in the study of healthcare interactions. Sociology of Health & Illness 31 (6): 787–802. http://dx.doi.org/10.1111/j.1467-9566.2009.01194.x
Procter, S., Wilcockson, J., Pearson, P. and Allgar, V. (2001) Going home from hospital: The carer/patient dyad. Issues and Innovations in Nursing Practice 35 (2): 206–217. http://dx.doi.org/10.1046/j.1365-2648.2001.01838.x
Robinson, J. D. (2003) An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication 15 (1): 27–59. http://dx.doi.org/10.1207/S15327027HC1501_2
Robinson, J. D. (2013) Overall structural organization. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 257–280. Chichester, UK: Wiley-Blackwell.
Robinson, J. D. and Stivers, T. (2001) Achieving activity transitions in physician-patient encounters: from history taking to physical examination. Human Communication Research 27 (2): 253–298. http://dx.doi.org/10.1111/j.1468-2958.2001.tb00782.x
Schoeb, V. (2014) ‘What Do You Expect From Physiotherapy?’ A Conversation Analytic Approach to Goal Setting Physiotherapy. Unpublished doctoral dissertation, University of Nottingham, Nottingham.
Scottish Intercollegiate Guidelines Network (2010) Management of Patients with Stroke: Rehabilitation, Prevention and Management Of Complications, and Discharge Planning. SIGN 118. Retrieved from http://www.sign.ac.uk/pdf/sign118.pdf
Smith, J., Cheater, F., Bekker, H. and Chatwin, J. (2015) Are parents and professionals making shared decisions about a child’s care on presentation of a suspected shunt malfunction: A mixed method study? Health Expectations 18 (5): 1299–1315. http://dx.doi.org/10.1111/hex.12106
Stewart, M., Brown, J. B., Weston, W. W., McWinney, I. R., McWilliam, C. L. and Freeman, T. R. (1995) Patient?centered Medicine: Transforming the Clinical Method. Thousand Oaks, CA: Sage.
Svennevig, J. (2012a) Interaction in workplace meeting. Discourse Studies 14 (3): 3–10. http://dx.doi.org/10.1177/1461445611427203
Svennevig, J. (2012b) The agenda as resource for topic introduction in workplace meetings. Discourse Studies 14 (1): 53–66. http://dx.doi.org/10.1177/1461445611427204
Swiss Medical Association. (1998–) Code de déontologie de la FMH. Retrieved from http://www.fmh.ch/files/pdf16/Standesordnung_20150829_F.pdf
ten Have, P. (2007) Doing Conversation Analysis: A Practical Guide. London: Sage. http://dx.doi.org/10.4135/9781849208895
Thompson A. G. (2007) The meaning of patient involvement and participation in health care consultations: A taxonomy. Social Science & Medicine 64 (6): 1297–1310. http://dx.doi.org/10.1016/j.socscimed.2006.11.002
World Health Organization (2008) The Tallinn Charter: Health Systems for Health and Wealth. Copenhagen: World Health Organization Regional Office. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0008/88613/E91438.pdf
Published
2017-02-08
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How to Cite
Keel, S., & Schoeb, V. (2017). Professionals’ embodied orientations towards patients in discharge-planning meetings and their impact on patient participation. Communication and Medicine, 13(1), 115–134. https://doi.org/10.1558/cam.21624
