Alexandra G. Murphy

Communication in Emergency Medicine: Implications for Patient Safety1 This study was funded by a generous grant from the National Patient Safety Foundation.

Emergency medicine is largely a communicative activity, and medical mishaps that occur in this context are too often the result of vulnerable communication processes. In this year-long qualitative study of two academic emergency departments, an interdisciplinary research team identified four such processes: triage, testing and evaluation, handoffs, and admitting. In each case, we found that narrative rationality (the patients story) was consistently subjugated to technical rationality (actionable lists). Process changes are proposed to encourage caregivers to either reconsider their course of action or request additional contextual information. A heightened awareness of the bias for technical over narrative rationality and a better recognition of uncertainty in emergency medicine communication are important first steps toward anticipating potential failures and ensuring patient safety.

The Dialectical Gaze: Exploring the Subject-Object Tension in the Performances of Women who Strip

Much of past research on female exotic dance has characterized strippers as deviant workers who are either passive, objectified victims of a sexploitation system that trades on their bodies for financial gain or as active subjects who work the exchange for their own benefit. Drawing on theories of power, performance, and communication, this work complicates the subject-object tension, showing how power circulates through a system of competing discursive relationships forming a dialectic of agency and constraint in which strippers are simultaneously subjects and objects. The author presents ethnographic data of how strippers discursively negotiate the ambivalence and contradictions they experience during their interactions with customers, management, and their families. Finally, this work concludes that given the need for all women to perform their prescribed gender in the course of their everyday lives, the occupation of the exotic dancer may not be as deviant as previously defined.

The flight attendant dilemma: an analysis of communication and sensemaking during in-flight emergencies

Building on past research, this article argues that organizational life can be usefully construed as a series of communicative performances that are embedded and enacted in everyday discursive practices. Specifically, this research explores the sensemaking process individuals undertake when faced with the dilemma of knowing when to invent appropriate ways to respond rather than being automatically constrained by past routines. The research presents case study evidence drawn from participant observation and interviews with flight attendants from a major U.S. airline. Shown to be high in emotional and impression management, flight attendants perform a feminized role that privileges accommodation over authority and reassurance over safety that may influence their performances in emergency situations. The work ends with an evaluation of the dominant air travel performance in relation to safety and offers recommendations for facilitating communication and coordination among flight attendants and pilots.

Discursive Frictions: Power, Identity, and Culture in an International Working Partnership

Abstract This article builds on previous work in power, identity, and culture in organizational communication and transnational feminism. Drawing on a six-year capacity-building partnership between a U.S. and a Kenyan team to promote HIV/AIDS education, it explores the discursive frictions that can arise when universal goals, such as science and health, come into contact with the material, cultural, political, and religious realities of local practitioners. These frictions can reinforce and, at times, shift dominant (post)colonial power relations. It ends with a discussion of the theoretical, practical, and material implications of discursive frictions as they relate to power, voice, and identification.

Discursive negotiations of Kenyan LGBTI identities: Cautions in cultural humility

ABSTRACT This study identifies and analyzes sites of discursive negotiation regarding sexual and gender minority identities in Kenya. A demonizing master narrative of homosexuality is constructed through cultural myths prevalent in Kenyan media yet challenged by claims of innate identity through strategic essentialism and glocalized naming practices. Using participant observation and creative focus group methodologies with lesbian, gay, bisexual, trans*, and intersex community members and journalists in Nairobi, Kenya this research project demonstrates the necessity of cultural humility while addressing contemporary absences in the study of queer identities in intercultural scholarship and communication research within African contexts.

Having Their Say: Sex Workers Discuss Their Needs and Resources

In many countries where HIV/AIDS is prevalent, social, cultural, and economic factors often mitigate the adoption of healthy reproductive behaviors and practices. One group that is particularly susceptible to mitigating influences is women who work in the sex trade. In this article, we utilize a culture-centered approach to determine how a population of sex workers in Nairobi, Kenya, perceives their individual, social, and structural needs and resources in relation to the public, their families, friends, and peers. We conclude the article with next steps regarding collaboration with media representatives and policymakers.

The Development and Evaluation of a National School-based HIV Prevention Intervention for Primary School Children in Kenya

Primary schools in Kenya provide a promising venue for widespread delivery of HIV prevention interventions. This article describes the development and evaluation of Making Lifes Responsible Choices (MLRC), a school-based HIV prevention intervention for primary school children developed through a collaborative global partnership involving multiple community stakeholders. Intervention development was informed by extensive reviews of youth-focused evidence-based HIV prevention interventions, and was rooted in both the Theory of Planned Behavior and Social Cognitive Theory. MLRC includes six modules: 1) self-awareness, 2) human sexuality, 3) healthy relationships, 4) drug/alcohol abuse, 5) HIV/AIDS and other sexually transmitted infections, and 6) behavior change. Class 5 pupils (N=1846; 52.1% girls, 47.9% boys; mean age = 12) attending 46 different Catholic-sponsored public and private primary schools throughout Kenya participated in the evaluation of the intervention program which was delivered in the classroom and occurred over the course of 40 weeks (one academic term). Changes in knowledge and behavioral intentions were assessed using a one-group pre-test post-test experimental design. Pupils completed module-specific assessment measures, and paired samples t-tests were used to compare changes in knowledge and behavioral intentions at the classroom level. Gender-specific analyses were also conducted. All six modules displayed statistically significant positive changes in the mean percentage of knowledge items answered correctly for the full sample, with marginal gender differences revealed. Statistically significant health-promoting changes were seen in 11 of the 18 behavioral intention items (3 per module), with gender differences also revealed. Findings suggest that implementing interventions such as MLRC has the potential to thwart the spread of HIV among youth in Kenya, and equip youth with health-promoting skills. In addition, school-based programs have the potential to become institutionalized in school settings in order to maintain their long-term sustainability.

Narrating sexual identities in Kenya: “Choice,” value, and visibility

ABSTRACT This article examines the discursive construction of female same-sex sexual identities in Nairobi. We identify the discursive forces of “choice,” devaluation, and invisibility as influential within Kenyan media representations of lesbian, gay, bisexual, transgender, and intersex citizens. Using creative focus groups and participant observation, we demonstrate how same-sex attracted women in Nairobi resist and rearticulate these discursive forces to assert their identity and agency as individuals and as a queer community.