Chloe Shaw

Managing the Moral Implications of Advice in Informal Interaction

What does advice giving look like among family members? Most conversation analytic research on advice has been in institutional settings, which constrain what speakers can do. Here we analyze advice in the apparently freer environment of telephone calls between mothers and their young adult daughters. We concentrate on how the advice is received. Our analysis shows that the position of “advice recipient” is a potentially unwelcome identity to occupy because it implies one knows less than the advice giver and indeed that one may be somehow at fault. Advice can be resisted, but choosing to do so seems to depend on what the interactional costs would be. We discuss the implications for studying advice and promoting advice acceptance as well as the way relationality more generally can be constituted in talk.

Advice-implicative actions: Using interrogatives and assessments to deliver advice in mundane conversation

Work on advice has concentrated on institutional settings where there are restrictions on roles, actions and their organisation. This article focuses on advice giving in mundane settings: interactions between mothers and their young-adult daughters in a corpus of 51 telephone calls. Analysis reveals a range of designs that can be ‘advice implicative’ including advice-implicative interrogatives and advice-implicative assessments. Recipients orient to the characteristic features these implicit forms share with more explicit advice: normative pressure on the recipient’s conduct and epistemic asymmetry between advisor and advisee. Advice-implicative actions orient to contingencies on the recipient’s ability or willingness to perform the target action. They also display varying degrees of entitlement over the recipient’s performance of the target action. Manipulating contingency and entitlement can soften or heighten both the normative thrust and the knowledge asymmetry of the advice giving. This analysis further discusses the distinction between the practices of advising, directing and requesting, and allows consideration of how action design connects to relationality between parties.

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Objective To determine the short-term outcomes of babies for whom clinicians or parents discussed the limitation of life-sustaining treatment (LST). Design Prospective multicentre observational study. Setting Two level 3, six level 2 and one level 1 neonatal units in the North-East London Neonatal Network. Participants A total of 87 babies including 68 for whom limiting LST was discussed with parents and 19 babies died without discussion of limiting LST in the labour ward or neonatal unit. Outcome measures Final decision reached after discussions about limiting LST and neonatal unit outcomes (death or survived to discharge) for babies. Results Withdrawing LST, withholding LST and do not resuscitate (DNR) order was discussed with 48, 16 and 4 parents, respectively. In 49/68 (72%) cases decisions occurred in level 3 and 19 cases in level 2 units. Following the initial discussions, 34/68 parents made the decision to continue LST. In 33/68 cases, a second opinion was obtained. The parents of 14/48 and 2/16 babies did not agree to withdraw and withhold LST, respectively. Forty-seven out of 87 babies (54%) died following limitation of LST, 28/87 (32%) died receiving full intensive care support, 5/87 (6%) survived following a decision to limit LST and 7/87 (8%) babies survived following decision to continue LST. Conclusions A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated.

Experience of training in communication skills among trainee neonatologists

Communication between medical teams and parents is a critical aspect of day-to-day neonatal care and helps to include parents in decisions made for their child. Nonetheless, parents report that current involvement is less than optimal.1 Communication skills are part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum,2 assessed briefly during professional examinations, and signed off at the end of training. However, most training is delivered locally without formal evaluation. This study aimed to explore the experience of and need for communication training among trainee neonatologists. Using a short open-ended questionnaire, we explored the involvement of trainee neonatologists (ST3-8) in communications skills training. Data were collected during a British Association of Perinatal Medicine national training day during September 2014. Forty nine of 58 trainees attending completed the questionnaire. Of the 49, 51% (n=25) had …

Parental experience of interaction with healthcare professionals during their infant’s stay in the neonatal intensive care unit

Objective To explore the experiences of parents of infants admitted to the neonatal intensive care unit towards interaction with healthcare professionals during their infants critical care. Design Semi-structured interviews were conducted with parents of critically ill infants admitted to neonatal intensive care and prospectively enrolled in a study of communication in critical care decision making. Interviews were transcribed verbatim and uploaded into NVivo V.10 to manage and facilitate data analysis. Thematic analysis identified themes representing the data. Results Nineteen interviews conducted with 14 families identified 4 themes: (1) initial impact of admission affecting transition into the neonatal unit; (2) impact of consistency of care, care givers and information giving; (3) impact of communication in facilitating or hindering parental autonomy, trust, parental expectations and interactions; (4) parental perception of respect and humane touches on the neonatal unit. Conclusion Factors including the context of infant admission, interprofessional consistency, humane touches of staff and the transition into the culture of the neonatal unit are important issues for parents. These issues warrant further investigation to facilitate individualised family needs, attachment between parents and their baby and the professional team.

Mentalization in Calm Psychotherapy Sessions: Helping Patients Engage With Alternative Perspectives at the End of Life

OBJECTIVE To identify how therapists invite patients with advanced cancer to engage with alternative perspectives about their illness trajectory and their end of life. METHODS Sequences of talk in which a therapist introduced a patient to alternative perspectives, were transcribed and analysed using the method of conversation analysis. RESULTS The analysis identifies one subtle way a patient is invited to consider an alternative perspective relating to their disease progression. Meaning expansion enquiries invite the patient to expand on the meaning of an utterance and in doing so, implicitly problematize the singularity of the patients assumptions, without directly challenging them. The questions work as preliminary moves, providing the patient with the opportunity to expand on their assumptions. This enables the therapist to subsequently present an alternative perspective in a way that incorporates the patients expanded perspective. CONCLUSION The analysis reveals a skilful way in which therapists can cautiously and collaboratively introduce a patient to alternative perspectives concerning end-of-life, without invalidating the patients perspective in this particularly delicate context. PRACTICE IMPLICATIONS Whilst mentalization is considered an important therapeutic process, the present study reveals precisely how this phenomenon can be enacted in therapy and within the particularly challenging context of end-of-life.