Shannon Clark

When Surgeons Advise Against Surgery

This article examines the significant interactional work undertaken by orthopedic surgeons in the delivery of recommendations not for surgery—recommendations against surgery or for nonsurgical treatment. Surgeons recurrently use a number of features prior to these recommendations: Projecting turns, parenthetical remarks, brightsides, logical inferences and syllogisms, general case/usual course descriptions, and turns that display the relevance of surgery. Through these features, surgeons manage, and treat as relevant, issues of anticipated patient resistance, legitimacy, and accountability when making recommendations that do not align with their professional identities.

Nurse Practitioners in Aged Care: Documentary Analysis of Successful Project Proposals

Meeting the primary health care needs of an aging population is an increasing challenge for many Western nations. In Australia, the federal government introduced a program to develop, test, and evaluate nurse practitioner models in aged care settings. In this article, we present a documentary analysis of 32 project proposals awarded funding under the Nurse Practitioner–Aged Care Models of Practice Program. Successfully funded models were diverse and were operated by a range of organizations across Australia. We identified three key priorities as underlying the proposed models: “The right care,” “in the right place,” and “at the right time.” In this article, we explore how these priorities were presented by different applicants in different ways. Through the presentation of their models, the program’s applicants identified and proposed to address current gaps in health services. Applicants contrasted their proposed models with available services to create persuasive and competitive applications for funding.

Developing a public health policy-research nexus: An evaluation of Nurse Practitioner models in aged care

A frustration often expressed by researchers and policy-makers in public health is an apparent mismatch between respective priorities and expectations for research. Academics bemoan an oversimplification of their work, a reticence for independent critique and the constant pressure to pursue evaluation funding. Meanwhile, policy-makers look for research reports written in plain language with clear application, which are attuned to current policy settings and produced quickly. In a context where there are calls in western nations for evidence based policy with stronger links to academic research, such a mismatch can present significant challenges to policy program evaluation. The purpose of this paper is to present one attempt to overcome these challenges. Specifically, the paper describes the development of a conceptual framework for a large-scale, multifaceted evaluation of an Australian Government health initiative to expand Nurse Practitioner models of practice in aged care service delivery. In doing so, the paper provides a brief review of key points for the facilitation of a strong research-policy nexus in public health evaluations, as well as describes how this particular evaluation embodies these key points. As such, the paper presents an evaluation approach which may be adopted and adapted by others undertaking public health policy program evaluations.

Contesting facts about wind farms in Australia and the legitimacy of adverse health effects

The development of wind energy in Australia has been subject to ongoing public debate and has been characterised by concerns over the health impacts of wind turbines. Using discursive psychology, we examine ‘wind turbine syndrome’ as a contested illness and analyse how people build and undermine divergent arguments about wind-farm health effects. This article explores two facets of the dispute. First, we consider how participants construct ‘facts’ about the health effects of wind farms. We examine rhetorical resources used to construct wind farms as harmful or benign. Second, we examine the local negotiation of the legitimacy of health complaints. In the research interviews examined, even though interviewees treat those who report experiencing symptoms from wind farms as having primary rights to narrate their own experience, this epistemic primacy does not extend to the ability to ‘correctly’ identify symptoms’ cause. As a result, the legitimacy of health complaints is undermined. Wind turbine syndrome is an example of a contested illness that is politically controversial. We show how stake, interest and legitimacy are particularly relevant for participants’ competing descriptions about the ‘facts’ of wind turbine health effects.

Accomplishing a Continuing Relationship in Psychotherapy: Updates and the Role of Time References

This paper examines how participants in psychotherapy reconnect at the beginning of psychotherapy sessions through ‘updates’, and the role of time references in managing this activity stage. Drawing on 18 sessions from a corpus of 123 audio-recorded sessions between one client and her therapist over the course of two years and utilizing principles of conversation analysis, we show how the client updates the therapist near the beginning of sessions, producing new or newly relevant tellings about aspects of herself and her life, for example, events and happenings, developments in personal relationships, and changes in her feelings and personal state. These aspects are thereby made available for joint therapeutic focus. Time references, for example, ‘10 days’, ‘last week’ and ‘Thursday’, are used by participants to manage coherence and relevance across multiple individual tellings within the update, as well as locating the current session as one-in-a-series of sessions. Through updates, participants orient to and manage their therapeutic relationship as ongoing, incremental and accumulative. Given the central role of the therapeutic relationship to psychotherapy, the analysis shows how time references are employed as a central organizing feature of interactional activities that are constitutive of fundamental psychotherapy work.

Introduction: Language Use in Institutional Settings

The papers in this special issue of the Australian Journal of Linguistics report on current research on institutional talk using Australian data. This volume celebrates and illustrates the use of conversation analysis (CA), ethnomethodology (EM) and membership categorization analysis (MCA) in understanding the accomplishment of work in a variety of settings: in supervision meetings, in the classroom, on the basketball court, on helplines, in psychotherapy consultations, in simulated and actual surgical consultations, and in antenatal consultations. Institutions are a major part of modern society, and talk-in-interaction is central to how the work of most institutions is achieved (Arminen 2005). Research into language use in institutional domains has proliferated in the last few decades, contributing to understanding the tasks and goals of participants in a wide range of workplace settings, including healthcare, helplines, customer service and education. Detailed analysis of actual communication can illuminate the interactional complexities and practical problems that people face as they negotiate institutional goals. Such research is worthwhile and has real value not only in identification of linguistic practices, but providing insight into real-world problems. Increasingly, interactional research is seeking ways to apply its findings to improve practice, address social problems, and even for diagnostic purposes (see Antaki 2011; Reuber 2012; Reuber et al. 2009; Stokoe 2011). The papers in this issue display contributors’ shared interest in understanding how social interaction is accomplished, particularly through the use of language. Contributors draw on CA, EM and MCA as related approaches which share a distinctive approach to the study of social order. They reject ‘top-down’ theories of social life that impose social categories (for example, gender, race, culture, religion, age, etc.) onto the organization of everyday life. Instead, CA, EM and MCA adopt a ‘bottomup’ approach. The methods thus take an inductive approach to data analysis, allowing practices to emerge from participants’ actions. CA and MCA developed from the pioneering ideas of Harvey Sacks. Sacks and his collaborators, Emanuel Schegloff and Gail Jefferson, developed an innovative approach to the study of talk, drawing on Erving Goffman’s observational style of analysing people in face-to-face interaction (e.g. Goffman 1963) and Harold Garfinkel’s ‘ethnomethodology’, which focused on the study of participants’ everyday practices using common-sense reasoning (Garfinkel 1967, 1974; Garfinkel & Sacks 1970). The Australian Journal of Linguistics, 2016 Vol. 36, No. 2, pp. 167–171, http://dx.doi.org/10.1080/07268602.2015.1121528

Affiliating Through Agreements: The Context of Antenatal Consultations

In the field of antenatal care, there is limited research studying communication between midwives and pregnant women in authentic consultations. This paper addresses this research gap. Based on transcripts of 16 antenatal consultations from a private obstetric practice, we examine agreements as examples of affiliation in the consultations. Using conversation analysis, we discuss ways that agreement is accomplished in this institutional setting. We identify clusters of back-to-back agreements between midwives and women and upgraded and high-grade agreements. Through agreements, midwives validate and endorse womens knowledge while also claiming their own knowledge about issues of pregnancy. Through these conversational strategies, the midwives enact institutionally relevant goals of providing support and treating the woman as having knowledge and expertise about her body and pregnancy, goals which are aligned with clinical practice guidelines for antenatal care and the code of ethics for midwives.