Stuart Ekberg

‘Let's see if you can see me': making connections with Google Earth™ in a preschool classroom

Bringing a social interaction approach to childrens geographies to investigate how children accomplish place in everyday lives, we draw on ethnomethodological and conversation analytic approaches that recognize childrens competence to manipulate their social and digital worlds. An investigation of preschool-aged children engaged with Google Earth™ shows how they both claimed and displayed technological understandings and practices such as manoeuvring the mouse and screen, and referenced place through relationships with local landmarks and familiar settings such as their school. At times, the childrens competing agendas required orientation to each others ideas, and shared negotiation to come to resolution. A focus on childrens use of digital technologies as they make meaning of the world around them makes possible new understandings of place within the geographies of childhood and education.

Retaining Female Postgraduates in Academia: The Role of Gender and Prospective Parenthood.

Women remain under-represented in almost all academic levels at universities internationally, and previous evidence has suggested that women move out of the university system in increasing numbers as they progress from postgraduate study to an academic career. The current study aimed to explore the role of gender in the reports of study experiences and future career plans of Australian postgraduate research students (n = 249). Questionnaire data indicated women were significantly less likely than men to rate an academic career as appealing. In particular, female postgraduate students without dependent children were least likely to want to pursue an academic career. On the basis of qualitative analysis, we attribute this finding, at least in part, to a perceived incompatibility between motherhood and an academic career and discuss the implications for gender equity in higher education.

Delivering healthcare at a distance: Exploring the organisation of calls to a health helpline

BACKGROUND Health helplines are integral to contemporary healthcare, offering fast, low-cost, and geographically unrestricted access to health information and advice. Although some health helplines offer support services (e.g., counselling), many function in ways that are similar to physically co-present (i.e., face-to-face) primary care consultations. However, due to the lack of physical presence, there are differences in the way health consultations are routinely managed on the telephone. This article explores some ways in which healthcare is managed at a distance, on a telephone helpline. METHODS Data are 196 recorded calls from the helpline, Healthdirect Australia. Using conversation analysis, this paper compares the delivery of healthcare over the telephone with what is known about physically co-present primary care consultations. RESULTS Through an exploration of the overall structure of these helpline calls, we show how Healthdirect Australia calls are organised in terms of eight distinct phases: call opening, establishment of reason-for-calling, check of caller safety, creation of a confidential patient file, medical information-gathering, health advice, caller survey questions, and call closing. We demonstrate how interactants organise their talk around these phases, with a particular focus on the shift between mandated administrative tasks and traditional medical tasks. CONCLUSIONS Findings from this study suggest that there are systematic differences between the overall structure of health helplines and physically co-present primary care consultations. We demonstrate that the delivery of health information and advice via helplines can be challenging, but that service can be enhanced through continued efforts to inform understanding about how medical encounters routinely unfold in over-the-phone environments.

Don’t need help, don’t want help and can’t get help: Why primary brain tumour patients don’t utilise supportive care services

Introduction Many haematological malignancy survivors report long-term post-treatment physiological and psychosocial effects. Objectives This study examined cancer nurses’ perception of their role, confidence levels, practices and barriers in relation to survivorship care provision for patients with haematological malignancies. Methods Approximately 1300 cancer nurses were invited to participate in a survey. The survey was distributed to all cancer nurses at a Queensland tertiary cancer centre and via email through two Australian professional cancer nursing bodies. Results In total, 423 cancer nurses (33%) completed the survey. The majority of participants agreed that all survivorship interventions included in the survey should be within their role. Nurses were least confident in discussing fertility (M=5.93, SD=2.66), employment and financial issues with patients (M=6.19, SD=2.66) and discussing information about identifying signs of cancer recurrence (M=6.43, SD=2.69), on a 11-point scale from 0 to 10 with higher scores indicating greater confidence. The least frequently performed interventions included discussing fertility, intimacy and sexuality issues, and communicating survivorship care with the patient’s primary care providers, with over 60% of participants reporting not performing these interventions often. The most significant barriers perceived by participants were lack of dedicated end-of-treatment consultation (M=2.62, SD=1.13), time (M=2.58, SD=0.94), and an appropriate physical location(M=2.21, SD=1.01), on a 5-point scale (0=not at all; 4=a great deal). Conclusions The strong support from nurses for their role in survivorship care highlights opportunities that have not yet been adequately developed. Barriers identified in this survey should be considered in the design of future survivorship care models.

Soliciting additional concerns in the primary care consultation and the utility of a brief communication intervention to aid solicitation: a qualitative study

OBJECTIVE To investigate the perspectives of general practitioners (GPs) on the practice of soliciting additional concerns (ACs) and the acceptability and utility of two brief interventions (prompts) designed to aid the solicitation. METHODS Eighteen GPs participating in a feasibility randomised controlled trial were interviewed. Interviews were semi-structured and audio-recorded. Data were analysed using a Framework Approach. RESULTS Participants perceived eliciting ACs as important for: reducing the need for multiple visits, identifying serious illness early, and increasing patient and GP satisfaction. GPs found the prompts easy to use and some continued their use after the study had ended to aid time management. Others noted similarities between the intervention and their usual practice. Nevertheless, soliciting ACs in every consultation was not unanimously supported. CONCLUSION The prompts were acceptable to GPs within a trial context, but there was disagreement as to whether ACs should be solicited routinely. Some GPs considered the intervention to aid their prioritisation efficiency within consultations. PRACTICE IMPLICATIONS Some GPs will find prompts which encourage ACs to be solicited early in the consultation enable them to better organise priorities and manage time-limited consultations more effectively.

What are the barriers of quality survivorship care for haematology cancer patients? Qualitative insights from cancer nurses.

PurposeMany haematological cancer survivors report long-term physiological and psychosocial effects beyond treatment completion. These survivors continue to experience impaired quality of life (QoL) as a result of their disease and aggressive treatment. As key members of the multidisciplinary team, the purpose of this study is to examine the insights of cancer nurses to inform future developments in survivorship care provision.MethodsOpen text qualitative responses from two prospective Australian cross-sectional surveys of nurses (n = 136) caring for patients with haematological cancer. Data were analysed thematically, using an inductive approach to identify themes.ResultsThis study has identified a number of issues that nurses perceive as barriers to quality survivorship care provision. Two main themes were identified: the first relating to the challenges nurses face in providing care (‘care challenges’) and the second relating to the challenges of providing survivorship care within contemporary health care systems (‘system challenges’).ConclusionsCancer nurses perceive the nature of haematological cancer and its treatment and of the health care system itself, as barriers to the provision of quality survivorship care. Care challenges such as the lack of a standard treatment path and the relapsing or remitting nature of haematological cancers may be somewhat intractable, but system challenges relating to clearly defining and delineating professional responsibilities and exchanging information with other clinicians are not.Implications for cancer survivorsAddressing the issues identified will facilitate cancer nurses’ provision of survivorship care and help address haematological survivors’ needs with regard to the physical and psychosocial consequences of their cancer and treatment.

Orienting to Emotion in Computer-Mediated Cognitive Behavioral Therapy

ABSTRACT Exploring emotions is a defining feature of psychotherapy. This study explores how therapists orient to emotions when they cannot see or hear their clients. In analyzing 1,279 sessions of online text-based Cognitive Behavioral Therapy (CBT), we focused on therapists’ commiserations (e.g., “I’m sorry to hear that”) and their affective inferences (e.g., “that sounds very scary for you”). Both practices routinely prefaced moves to pursue a range of therapeutic activities, many of which did not prioritize sustained focus on the emotion that had just been oriented to. By separating message composition from message transmission, the modality used for these therapy sessions enabled therapists to combine orientations to emotion with attempts to shift the focus of discussion. Our analysis finds that although physically co-present and computer-mediated psychotherapy share a common focus on emotional experience, the modality used for therapy can be relevant in the design and use of these orientations. Data are in British English.

Identifying and addressing equivocal trouble in understanding within classroom interaction

Maintaining intersubjectivity is crucial for accomplishing coordinated social action. Although conversational repair is a recognised defence of intersubjectivity and routinely used to address ostensible sources of trouble in social interaction, it is less clear how people address more equivocal trouble. This study uses conversation analysis to examine preschool classroom interaction, focusing on practices used to identify and address such trouble. Repair is found to be a recurrent frontline practice for addressing equivocal trouble, occasioning space for further information that might enable identifying a specific trouble source. Where further information is forthcoming, a range of strategies are subsequently employed to address the trouble. Where this is not possible or does not succeed, a secondary option is to progress a broader activity-in-progress. This allows for the possibility of another opportunity to identify and address the trouble. Given that misunderstandings can jeopardise interactants’ ability to mutually accomplish courses of action, these practices defend intersubjectivity against the threat of equivocal trouble.

Experiential learning to increase palliative care competence among the Indigenous workforce: an Australian experience

Objectives Improving Indigenous people’s access to palliative care requires a health workforce with appropriate knowledge and skills to respond to end-of-life (EOL) issues. The Indigenous component of the Program of Experience in the Palliative Approach (PEPA) includes opportunities for Indigenous health practitioners to develop skills in the palliative approach by undertaking a supervised clinical placement of up to 5 days within specialist palliative care services. This paper presents the evaluative findings of the components of an experiential learning programme and considers the broader implications for delivery of successful palliative care education programme for Indigenous people. Methods Semistructured interviews were conducted with PEPA staff and Indigenous PEPA participants. Interviews were recorded, transcribed and key themes identified. Results Participants reported that placements increased their confidence about engaging in conversations about EOL care and facilitated relationships and ongoing work collaboration with palliative care services. Management support was critical and placements undertaken in settings which had more experience caring for Indigenous people were preferred. Better engagement occurred where the programme included Indigenous staffing and leadership and where preplacement and postplacement preparation and mentoring were provided. Opportunities for programme improvement included building on existing postplacement and follow-up activities. Conclusions A culturally respectful experiential learning education programme has the potential to upskill Indigenous health practitioners in EOL care.

Affording opportunities to discuss deterioration in paediatric palliative care consultations: a conversation analytic study

Objective Discussing the potential deterioration of a child who has a life-limiting condition has recognised benefits for future care, but can be challenging in a clinical context where uncertain illness trajectories are common. Existing research is restricted to indirect forms of evidence such as self-report data from clinicians and families. This study directly explores how discussions about deterioration are managed within actual paediatric palliative care consultations. Methods 9 consultations were video recorded in an Australian paediatric palliative care service. Each consultation involved the same paediatric palliative care specialist. Conversation analysis was used to identify and explore recurrent ways in which discussions about deterioration came to be realised. Findings The study identified two communicative practices used by a paediatric palliative care specialist that afforded opportunities to discuss deterioration: (1) soliciting the familys agenda for the consultation; (2) initiating and maintaining topics where discussing deterioration is a relevant possibility. Across these different practices, a common feature was indirect initiation of discussions about deterioration. This approach made such discussions possible, but without mandating or even suggesting that such discussion must occur. Conclusions These communicative practices balance the benefit of discussing deterioration against a recognised importance of allowing discussions to be directed by a childs family. This was achieved by creating opportunities for discussing deterioration, without making such discussions necessary.