Communication & medicine
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Several sources of bias can affect the performance of machine learning systems used in medicine and potentially impact clinical care. Here, we discuss solutions to mitigate bias across the different development steps of machine learning-based systems for medical applications.
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Communication & medicine · Jan 2016
Contrasting discourse styles and barriers to patient participation in bedside nursing handovers.
This paper applies qualitative discourse analysis to 'shift-change handovers', events in which nurses hand over care for their patients to their colleagues. To improve patient safety, satisfaction and inclusion, hospitals increasingly require nursing staff to hand over at the patient's bedside, rather than in staff-only areas. However, bedside handover is for many a new and challenging communicative practice. ⋯ The styles capture interactional/interpersonal meaning choices associated with whether and how nurses include patients during handover, and informational/ideational meaning choices associated with whether or not nurses select and organise clinical information in ways that recognise patients' agency. We argue that the co-occurrence of inclusive with agentive and exclusive with objectifying styles demonstrates that how nurses talk about their patients is powerfully influenced by whether and how they also talk to them. In noting the continued dominance of exclusive objectifying styles in handover interactions, we suggest that institutional change needs to be supported by communication training.
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Communication & medicine · Jan 2013
Pain and nurses' emotion work in a paediatric clinic: treatment procedures and nurse-child alignments.
In the treatment of cancer in children, treatment procedures have been reported to be one of the most feared elements, as more painful than the illness as such. This study draws on a video ethnography of routine needle procedure events, as part of fieldwork at a paediatric oncology clinic documenting everyday treatment negotiations between nurses and young children. On the basis of detailed transcriptions of verbal and nonverbal staff-child interaction, the analyses focus on ways in which pain and anxiety can be seen as phenomena that are partly contingent on nurses' emotion work. ⋯ In the preschool group, though, pain and fear seemed to be phenomena that were greatly reduced through nurses' emotion work. This study focuses on three preschoolers facing potentially painful treatment, showing how the nurses engaged in massive emotion work with the children, through online commentaries, interactive formats (delegation of tasks, consent sequences, collaborative 'we'-formats), as well as solidarity-oriented moves (such as praise and endearment terms). Even a young toddler would handle the distress of needle procedures, when interacting with an inventive nurse who mobilized child participation through skilful emotion work.
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Communication & medicine · Jan 2013
The patient's Lifeworld: building meaningful clinical encounters between patients, physicians and interpreters.
In this paper, our objectives are first to explore the different ways physicians and interpreters interact with patients' Lifeworld, and second, to describe and compare communication patterns in consultations with professional and those with family interpreters. We conducted analyses of transcriptions of 16 family practice consultations in Montreal in the presence of interpreters. Patterns of communication are delineated, grounded in Habermas' Communicative Action Theory and Mishler's operational concepts of Voice of Medicine and Voice of Lifeworld. ⋯ A professional interpreter is likely to transmit the patient's Lifeworld utterances to the physician. A family member, on the other hand, may provide extra biomedical and Lifeworld information, but also prevent the patient's Lifeworld accounts from reaching the physician. Physicians' training should include advice on how to work with all types of interpreters and interpreters' training should include mediation competencies in order to enhance their ability to promote the processes of co-construction of meaning.
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Communication & medicine · Jan 2012
Clinical handover as an interactive event: informational and interactional communication strategies in effective shift-change handovers.
Clinical handover -- the transfer between clinicians of responsibility and accountability for patients and their care (AMA 2006) -- is a pivotal and high-risk communicative event in hospital practice. Studies focusing on critical incidents, mortality, risk and patient harm in hospitals have highlighted ineffective communication -- including incomplete and unstructured clinical handovers -- as a major contributing factor (NSW Health 2005; ACSQHC 2010). ⋯ Based on analysis of audio-recorded shift-change clinical handovers between medical staff we argue that handover communication must be conceptualised as inherently interactive and that attempts to describe, model and teach handover practice must recognise both informational and interactive communication strategies. By comparing the communicative performance of participants in authentic handover events we identify communication strategies that are more and less likely to lead to an effective handover and demonstrate the importance of focusing close up on communication to improve the quality and safety of healthcare interactions.