Alison Pilnick

THE TACIT ORDER OF TEAMWORK: Collaboration and Embodied Conduct in Anesthesia

This article explores the interactional organization of collaborative work in the field of anesthesia. “Anesthetic teams” provide a distinctive case for the analysis of collaborative work, because their work is undertaken with, around, and on an aware and variously involved coparticipant, namely, the patient. To explore such collaboration, this article draws on ethnomethodology and conversation analysis to examine audiovisual data of naturally occurring preoperative anesthetic work recorded in a British hospital. There are three key consequences of the analysis that we elaborate: first, it points toward the limitations of Erving Goffmans regions metaphor for explicating the organization of collaborative work in settings like anesthesia; second, it reveals key organizing practices and skills associated with in situ teamworking that are distinctly absent from the literature of health-care teams; third, it points toward the critical importance of analyzing embodied conduct, not just language or talk, when examining copresent organizational activities.

'It's something for you both to think about': choice and decision making in nuchal translucency screening for Down's syndrome.

Policies and practices around antenatal screening services have long been the subject of debate in a sociological context. However, existing research has largely overlooked the way in which the policies and practices that underpin antenatal screening services are enacted through talk between pregnant women and their health professionals. This paper focuses on one such policy, that of informed choice. It uses data from 14 tape-recorded pre-screening consultations with community midwives, forming part of a newly introduced nuchal translucency screening programme, to examine how the issue of choice is topicalised and discussed. It concludes that, whilst there is clear evidence that midwives are at pains to explicitly invoke the issue of decision making, there are other more subtle factors in the interactional presentation of screening tests that serve to undermine whether and how a recognition of choice is received by pregnant women.

Analysis of pharmacist–patient communication using the Calgary-Cambridge guide

OBJECTIVE This study explored communication between pharmacists and patients through application of the Calgary-Cambridge guide [1] to appointment-based pharmacist-patient consultations and considers use of the guide in pharmacy education. METHODS Eighteen patients attending appointment-based consultations with five pharmacists were recruited to this qualitative study. Consultations were audio-recorded and observed. Transcripts were coded according to the use of skills within the guide and analysed thematically. RESULTS The results showed good use of many skills by pharmacists, particularly signposting and closing the session. Some skills were poorly represented such as listening effectively, eliciting the patients perspective, effective use of computers and creating patient-centred consultations. A key theme of social conversation was present in the data but this skill was not defined in the guide. CONCLUSIONS The Calgary-Cambridge guide was developed for use in medical consultations but its application to pharmacist-patient consultations showed that the guide could be successfully used in pharmacy with some minor alterations. PRACTICE IMPLICATIONS Pharmacists may need more training to improve the use of specific communication skills including how to conduct a patient-centred consultation. The Calgary-Cambridge guide is well aligned with many aspects of pharmacist-patient consultations and could help pharmacists to improve their consultation skills.

Research directions in genetic counselling: a review of the literature

There is a growing body of literature considering genetic counselling services in a variety of clinical settings. This literature encompasses both predictive and diagnostic testing, from the viewpoints of service providers and recipients. It also embraces a wide range of conceptions of the nature and goals of genetic counselling. However, research in this area has been criticised for a focus on outcome rather than process, and it has been suggested that this focus limits its practical use. The purpose of this review is twofold: (1) to describe the varying concepts of counselling which appear to be utilised in published work and (2) to discuss the possible applications of this work to practice.

‘There are no rights and wrongs in these situations’: identifying interactional difficulties in genetic counselling

Abstract The rapid scientific and technological advances in the field of human genetics have created an ever-widening gap in knowledge and understanding between those specialists who are involved with them and the general public who are the intended beneficiaries. Genetic counselling is seen as an important way of addressing this gap. Whilst there is a growing literature on genetic counselling, this has tended to focus on quantitative measures of outcome. However, there is a growing recognition that genetic counselling is a communicative process, and needs to be studied as such. This paper presents extracts from a body of data collected at a regional genetic counselling centre, and analysed using a conversation analytic approach. A particular emphasis is placed upon the communication of genetic information by counsellors and the ways in which this is received by clients, and how this impacts upon the ways in which topics for discussion are arrived at. Four areas around which interactional difficulties arise are identified: achieving a client-led agenda; knowing what is relevant for a particular client; managing different activities within counselling; and managing the multiple perspectives of clients.

Presenting and discussing nuchal translucency screening for fetal abnormality in the UK.

OBJECTIVE to investigate the relationship between information giving by midwives and decision-making by women offered nuchal translucency (NT) screening. To establish how risk figures are discussed in practice, with the intention of relating this to the existing, and often critical, literature on womens accounts of antenatal screening. DESIGN a qualitative study following women through the process of being offered and deciding to undergo NT screening. Tape recording of consultations, analysed in their entirety, was combined with post-screening interviews. SETTING a large teaching hospital in the UK. PARTICIPANTS fourteen pregnant women eligible for NT screening at the time of recruitment. DATA COLLECTION (i) tape recordings of consultations between community midwives and pregnant women where nuchal translucency screening was offered; (ii) tape recordings of consultations between hospital midwives and pregnant women immediately post-screening; (iii) individual face-to-face interviews with pregnant women between two and six weeks after the screening, carried out by the first author. FINDINGS NT screening was in general well received, particularly by those women who had undergone serum screening with previous pregnancies. However, communicating the nature of a risk figure is an interactionally complex process. A large amount of interactional work is required by midwives both before and after screening to ensure that women comprehend this information. Despite the emphasis placed in these consultations on understanding the purpose of NT screening and the status of the results, women often framed their decision to undergo NT screening in terms of it being a formality, or of presuming that all was well. This sometimes created practical and personal difficulties in terms of decision-making. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE previous sociological and psychological research has tended to be critical of midwives in terms of ensuring informed choice in screening, but this research is often based on post hoc accounts. Examining actual consultations with these accounts helps to illustrate the other factors that affect womens perceptions of testing, and the way in which risk, choice and decision-making are introduced and discussed in practice. Encouraging women to consider what action they might take on the basis of a personally unfavourable NT result in advance of undergoing the scan may help them to decide whether the information gained will be useful to them. Recognising the complex interactional work required in making sure that women understand the nature of the results that will be obtained is an important issue for the education and training of midwives.

‘It’s Just One of the Best Tests that We’ve Got at the Moment’: the Presentation of Nuchal Translucency Screening for Fetal Abnormality in Pregnancy:

Much of the sociological research that has been carried out into antenatal screening has been highly critical of the practical implementation of these programmes, particularly regarding issues of choice. However, most of this research is based on interviews conducted with participants after screening has taken place. This article presents a preliminary exploration of the interactional presentation of a novel antenatal screening procedure, known as nuchal translucency (NT) screening, for Down’s syndrome. The data are analysed from a conversation analytic perspective, with a focus on the ways in which screening is introduced, explained and discussed by those involved. The issue of choice, and of the need to actively make a decision, are explicitly topicalized by midwives in these consultations. However, it is argued that the choice that is presented in this setting often appears to be between ‘old’ and ‘new’ screening practice, rather than a straightforward choice between screening and not screening.

The interactional organization of pharmacist consultations in a hospital setting: a putative structure

Abstract The long term, complex drug regimes prescribed for oncology patients create specific opportunities for pharmacists to play an advisory role in their care, and this kind of ‘extended’ advisory role is being seized upon by the profession as the way forward. However, there is little published research on the nature of these interactions, or the kinds of communicative competencies that they require of pharmacists. This paper presents transcripts of audio data collected from a hospital outpatient clinic, where patients and/or carers are given an opportunity to discuss with a pharmacist questions or problems arising from their therapy. The data are taken from a wider study of advice-giving by pharmacists in this setting. Taking a single encounter as a ‘typical’ case, the data is analyzed and presented in the light of the Conversation Analysis (CA) literature concerned with interactional organization, and specifically the descriptions of overall structures or sequences which recur in particular kinds of interaction (e.g. Zimmerman, 1992; Jefferson, 1988). Drawing on these sequences, a putative ‘template’ structure for the pharmacist/patient/carer encounter is proposed. It is suggested that this mapping begins to establish the interactional contingencies of encounters in this setting, and hence the kinds of communicative competencies required of the ‘extended role’.

Questioning the answer: questioning style, choice and self‐determination in interactions with young people with intellectual disabilities*

For young people with intellectual disabilities (ID), the transition from childrens to adult services has long been recognised as a challenging move. One of the aims of the White Paper Valuing People (2001) was to address some of the problems associated with this transition. This paper reports on data from a project which examines the impact of these service changes, and the ways in which transition is negotiated by carers, professionals and users. It presents a conversation analysis of eight tape-recorded formal review meetings at which transition to adult services is discussed. It takes as its starting point the existing interactional work on ID and the way in which this demonstrates the effects of the local and contextual specifics of particular kinds of interaction on the eventual outcomes (e.g. Rapley 2004, Antaki 2001, Maynard and Marlaire 1992). We show that an attempt to allow self-determination in the context of transitions can paradoxically result in undermining user choice and control. We also argue that, while a rule-based approach to practice may offer moral clarity for professionals, it can result in interactional and practical difficulties which cannot be easily reconciled.

Questioning the answer: questioning style, choice and self-determination in interactions with young people with intellectual disabilities.

For young people with intellectual disabilities (ID), the transition from childrens to adult services has long been recognised as a challenging move. One of the aims of the White Paper Valuing People (2001) was to address some of the problems associated with this transition. This paper reports on data from a project which examines the impact of these service changes, and the ways in which transition is negotiated by carers, professionals and users. It presents a conversation analysis of eight tape-recorded formal review meetings at which transition to adult services is discussed. It takes as its starting point the existing interactional work on ID and the way in which this demonstrates the effects of the local and contextual specifics of particular kinds of interaction on the eventual outcomes (e.g. Rapley 2004, Antaki 2001, Maynard and Marlaire 1992). We show that an attempt to allow self-determination in the context of transitions can paradoxically result in undermining user choice and control. We also argue that, while a rule-based approach to practice may offer moral clarity for professionals, it can result in interactional and practical difficulties which cannot be easily reconciled.