Jack Pun

The International Charter for Human Values in Healthcare: An interprofessional global collaboration to enhance values and communication in healthcare

OBJECTIVES The human dimensions of healthcare--core values and skilled communication necessary for every healthcare interaction--are fundamental to compassionate, ethical, and safe relationship-centered care. The objectives of this paper are to: describe the development of the International Charter for Human Values in Healthcare which delineates core values, articulate the role of skilled communication in enacting these values, and provide examples showing translation of the Charters values into action. METHODS We describe development of the Charter using combined qualitative research methods and the international, interprofessional collaboration of institutions and individuals worldwide. RESULTS We identified five fundamental categories of human values for every healthcare interaction--Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare--and delineated subvalues within each category. We have disseminated the Charter internationally and incorporated it into education/training. Diverse healthcare partners have joined in this work. CONCLUSION We chronicle the development and dissemination of the International Charter for Human Values in Healthcare, the role of skilled communication in demonstrating values, and provide examples of educational and clinical programs integrating these values. PRACTICE IMPLICATIONS The Charter identifies and promotes core values clinicians and educators can demonstrate through skilled communication and use to advance humanistic educational programs and practice.

A Systematic Review of English Medium Instruction in Higher Education.

After outlining why a systematic review of research in English medium instruction (EMI) in higher education (HE) is urgently required, we briefly situate the rapidly growing EMI phenomenon in the broader field of research in which content and language have been considered and compare HE research outputs with those from other phases of education. An in-depth review of 83 studies in HE documents the growth of EMI in different geographical areas. We describe studies which have investigated university teachers’ beliefs and those of students before attempting to synthesise the evidence on whether teaching academic subjects through the medium of English as a second language (L2) is of benefit to developing English proficiency without a detrimental effect on content learning. We conclude that key stakeholders have serious concerns regarding the introduction and implementation of EMI despite sometimes recognising its inevitability. We also conclude that the research evidence to date is insufficient to assert that EMI benefits language learning nor that it is clearly detrimental to content learning. There are also insufficient studies demonstrating, through the classroom discourse, the kind of practice which may lead to beneficial outcomes. This insufficiency, we argue, is partly due to research methodology problems both at the micro and macro level.

Factors affecting communication in emergency departments: doctors and nurses’ perceptions of communication in a trilingual ED in Hong Kong

BackgroundThis study investigates clinicians’ views of clinician-patient and clinician-clinician communication, including key factors that prevent clinicians from achieving successful communication in a large, high-pressured trilingual Emergency Department (ED) in Hong Kong.MethodsResearchers interviewed 28 doctors and nurses in the ED. The research employed a qualitative ethnographic approach. The interviews were audio-recorded, transcribed, translated into English and coded using the Nvivo software. The researchers examined issues in both clinician-patient and clinician-clinician communication. Through thematic analyses, they identified the factors that impede communication most significantly, as well as the relationship between these factors. This research highlights the significant communication issues and patterns in Hong Kong EDs.ResultsThe clinician interviews revealed that communication in EDs is complex, nuanced and fragile. The data revealed three types of communication issues: (1) the experiential parameter (i.e. processes and procedures), (2) the interpersonal parameter (i.e. clinicians’ engagements with patients and other clinicians) and (3) contextual factors (i.e. time pressures, etc.). Within each of these areas, the specific problems were the following: compromises in knowledge transfer at key points of transition (e.g. triage, handover), inconsistencies in medical record keeping, serious pressures on clinicians (e.g. poor clinician-patient ratio and long working hours for clinicians) and a lack of focus on interpersonal skills.ConclusionsThese communication problems (experiential, interpersonal and contextual) are intertwined, creating a complex yet weak communication structure that compromises patient safety, as well as patient and clinician satisfaction. The researchers argue that hospitals should develop and implement best-practice policies and educational programmes for clinicians that focus on the following: (1) understanding the primary causes of communication problems in EDs, (2) accepting the tenets and practices of patient-centred care, (3) establishing clear and consistent knowledge transfer procedures and (4) lowering the patient-to-clinician ratio in order to create the conditions that foster successful communication. The research provides a model for future research on the relationship between communication and the quality and safety of the patient safety.

Communication in Hong Kong Accident and Emergency Departments The Clinicians’ Perspectives

In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs). In light of the Hong Kong Hospital Authority’s policy emphasis on patient-centered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and time-burdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice.

The effect of first and second language use on question types in English medium instruction science classrooms in Hong Kong

ABSTRACT The role of the first language (L1) in second language (L2) learning has been widely discussed and researched in the second Language Acquisition (SLA) literature. Benefits of L1 use have been found for vocabulary acquisition, and in facilitating comprehension thereby alleviating student anxiety. Many teachers appear to consider L1 use as a necessary option in L2 pedagogy. Disadvantages of L1 use are argued to be that it reduces exposure to the L2 thereby not enabling more implicit forms of L2 acquisition. Considerably less research has been carried out in English medium instruction (EMI) classrooms, surprisingly, as these are predicated on the benefits of massive exposure to the L2. This study investigated the effect of L1 and L2 use on teacher question types and interaction patterns in science lessons in early EMI and late EMI schools in Hong Kong. Our findings show that in late EMI, where there was much greater use of the L1, teachers tended to use higher order questions and were more interactive. In early EMI, despite students having received four more years of greater exposure to English instruction than late EMI students through the use of English as the vehicular language, teachers asked lower order questions and the interaction was more monologic. The implications for policy and pedagogy are discussed.

Expounding knowledge through explanations: Generic types and rhetorical-relational patterns

Abstract In this paper, we focus on contexts where the primary activity is to expound knowledge about general classes of phenomena, either by categorizing and characterizing them or by explaining them based on some theory, ranging from a commonsense folk theory to an uncommonsense scientific theory. Texts produced in such contexts include science lectures, research articles, and entries in encyclopedias. We focus on explanations, considering them across strata in terms of context, semantics, and lexicogrammar, and summarizing contributions from different research strands. Against this background, we report on a study of the registers used in secondary school chemistry textbooks in Hong Kong. We begin by summarizing a framework for classifying the contexts in which texts operate – a framework designed to allow us to differentiate different kinds of text according to the contexts they operate in. Then, we focus on one type of context – that of expounding knowledge about general classes of phenomena. Next, we identify different strategies of expounding knowledge, contrasting explanations and categorizations, and then discuss explanations in more detail. Finally, we move to the question of how these contextual types are realized semantically as texts organized as rhetorical complexes, drawing on secondary school textbooks in chemistry in particular.

Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses

Objectives Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up. Design A mixed-methods design with quantitative and sequential qualitative components was used. Setting and participants Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices. Results The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases. Conclusions Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.