Collaborative group reasoning in ward rounds: A critical realist case study

The thesis explored the group reasoning occurring between practitioners during hospital ward rounds. A model of the reasoning was constructed, focused on information gathering, sense-making and decision making. The model explained the role of group reasoning and generated suggestions for evaluating ward rounds, improving medical education and redesigning rounds

Context-awareness and the smart grid: Requirements and challenges

New intelligent power grids (smart grids) will be an essential way of improving efficiency in power supply and power consumption, facilitating the use of distributed and renewable resources on the supply side and providing consumers with a range of tailored services on the consumption side. The delivery of efficiencies and advanced services in a smart grid will require both a comprehensive overlay communications network and flexible software platforms that can process data from a variety of sources, especially electronic sensor networks. Parallel developments in autonomic systems, pervasive computing and context-awareness (relating in particular to data fusion, context modelling, and semantic data) could provide key elements in the development of scalable smart grid data management systems and applications that utilise a multi-technology communications network. This paper describes: (1) the communications and data management requirements of the emerging smart grid, (2) state-of-the-art techniques and systems for context-awareness and (3) a future direction towards devising a context-aware middleware platform for the smart grid, as well as associated requirements and challenges

Treat him as a normal baby: paediatrician's framing of parental responsibility as advice in the management of a genetic condition

Oral Presentation - Parallel Session 2: 2E Risk and Uncertainty/Ethics: no. 2E.4Parental responsibility in the management of genetic conditions has been the focus of both family-oriented interview-based research (e.g. Arribas-Ayllon et al. 2008; 2011) as well as real-life face-to-face genetic counselling research (Sarangi fc; Thomassen and Sarangi 2012). The current paper is an attempt to contribute to the latter tradition involving paediatricians and parents where parental responsibility is constitutive of professional advice. The genetic condition in question is G6PD deficiency (commonly known as favism), a mild hereditary disorder prevalent in Asia (Zayts and Sarangi 2013). We draw on 18 consultations in a maternal unit in Hong Kong (recruitment ongoing) where paediatricians communicate with mothers of newborns diagnosed with G6PD. We employ theme-oriented discourse analysis – comprising activity analysis and accounts analysis (Sarangi 2010) – to examine how the paediatricians frame their advice-giving trajectories – on to which elements of parental responsibility (in terms of future actions and moral selves) can be mapped. We show how 'causal responsibility' (Sarangi, fc) that concerns potential consequences of the mothers' actions in managing the condition emerges as a dominant thread in our data corpus. 'Causal [parental] responsibility' is embedded in the paediatrician's advice-giving trajectories which include, among other things, how to 'treat' these children, ranging from safeguards against certain medications and food to prevention of negative physiological scenarios (such as an acute hemolytic reaction). We examine closely the attendant discourse devices through which parental responsibility is framed, e.g., modalisation, contrast, character/event work. We conclude that, in terms of temporality, 'causal [parental] responsibility' is 'forward-looking' as the mothers' responsible actions can normalise the child’s immediate and future wellbeing.postprin

Developing a social psychology of poverty: social objects and dialogical representations

This thesis develops a social psychological approach to researching poverty. Critiquing the existing models of poverty research in psychological sciences, it conceptualises poverty as a social object whose meanings are generated socially and dialogically. Using the theory of social representations and a dialogical framework informed by G.H. Mead’s work on the social Self and the thesis of dialogical mind, it examines both content (social representations) and processes (dialogicality) of meaning-making on poverty in the Indian public sphere at two levels. First, in a village in Bihar, India, 41 poor and 25 elite participants were interviewed over a period of six months to understand meaning-making in a local community setting. Second, 424 news stories on poverty in two national newspapers were sampled to explore the broader public sphere of India. The research found that poor participants represented poverty in three domains: their present state of being in poverty, their plans to escape poverty, and the social actors responsible for facilitating their escape. Representations in the first two domains allowed poor people to cope with the harsh realities of poverty whereas representations in the third domain allowed coping with their failure in escaping poverty. Elite representations were also organised in three domains: the descriptions of poverty, the reasons why poverty existed, and the possibility of poverty amelioration through improving healthcare and education provisions for the poor. The primary symbolic coping function of the elites’ representations was of absolving their Selves from any blame for the existence poverty — this was achieved by ascribing the responsibility for poverty on the Government and the poor people themselves. The newspapers represented poverty in four ambivalent domains as: an objective reality, a threat, a barrier, and as a political opportunity. Symbolic coping in the mass-media involved features of both poor and elite groups’ representations. In terms of the ‘processes’ through which these representations are generated, the research synthesises how meanings are developed both in terms of and through the Ego–Alter dialogical interdependence, which is also shown to be the link between the content and the processes of social representations. On the basis of its findings, this thesis demonstrates that the representation of poverty — and by extension, of all social objects — is necessarily contingent on the realisation of the Ego’s relationship with Alters in the social world. In this direction, the role of Social Acts, as conceptualised by Mead, is explored in-depth. Finally, the overall representational field of poverty is presented in terms of its stable thematic core and malleable periphery while demonstrating that the relationship between the core and periphery is dialogically mediated. As a whole, this thesis develops a novel approach to studying social problems like poverty in the discipline. In doing so, it also advances links between the theory of social representations, Mead’s work, and the thesis of dialogical mind

Multidisciplinary team meetings in community mental health care: a mixed-methods investigation of their functions and organisation

Background Community mental health teams are a central means of delivering specialist mental health care in England. Weekly multidisciplinary team (MDT) meetings are assumed to improve the quality of care by incorporating diverse professional perspectives into care planning. However, these meetings are resource-intensive and there has been little investigation of their operational procedures or their impact. Aim The aim of this PhD is to examine the functions and organisation of MDT meetings in community mental health care, and to identify current challenges to effectiveness and opportunities for improvement. Method A mixed-methods investigation was conducted to examine current practice and stakeholder views in six community-based mental health teams: three general community mental health teams, two memory clinics and one early intervention psychosis service. This involved non-participant observation of 109 MDT meetings; quantitative data on 3,213 MDT case discussions from 181 MDT meetings; and semi-structured interviews with 35 practitioners and patients. Results MDT meetings were perceived to serve a wide variety of functions, ranging from care planning to peer support. However, many practitioners believed that their meetings were poorly managed and lacked clarity of purpose. Teams varied in terms of which patients were discussed, the time dedicated to each discussion, multidisciplinary representation, and operational procedures. Several challenges made it difficult for teams to capitalise on their multidisciplinary diversity, including conflicting models of care, ambiguous leadership, and a struggle to balance profession-specific and generic keyworker roles. Practitioners’ ability to implement agreed MDT care plans was limited by a lack of patient involvement, inadequate resources, administrative requirements, and organisational instability. Conclusions A wide range of factors mediate the potential for MDT meetings to benefit patients. The findings highlight the importance of critical reflection on the purpose and organisation of MDT meetings to ensure that they are a valuable use of practitioner time

Framework to enhance the uptake of sustainable telehealth services across the DHBs in New Zealand

Background The healthcare sector today, across many countries, including New Zealand, faces many challenges, including a shortage of, and an uneven distribution of, health workers, an ageing population, and the prevalence of non-communicable diseases. Technological advances in telecommunications offer new applications for telehealth to enable fast, efficient, and effective patient care to address some of these challenges. The New Zealand Telehealth Forum and Resource Centre defined telehealth as an enabling technology to underpin changes to improve healthcare services delivery across New Zealand. The telehealth stocktake in 2014 by District Health Boards (DHBs) reported on telehealth services and affirmed that the uptake of telehealth in ongoing and routine operations of healthcare is slow, uneven, and fragmented. The onset of the COVID-19 pandemic in 2020 highlighted these issues in an already stressed system and providers quickly adopted telehealth services facilitate access to health services and thus prevent the spread of the virus. Despite the positive benefits, the uptake of telehealth services could not be sustained, and many providers reverted to in-person care amid decreasing COVID-19 risk in the community. Existing studies have suggested that telehealth technology’s success increases when a suitable framework supports its implementation. No framework has been designed to implement and uptake telehealth services across the DHBs in New Zealand, and frameworks available elsewhere are country- specific and may not apply in the New Zealand context. Objective This study develops an applicable framework to enhance the uptake of telehealth services across DHBs in New Zealand. The study’s main objective is to describe the status of telehealth services and identify factors at the organisational level that influence the uptake of telehealth services across DHBs in New Zealand and develop a framework. Methods A mixed-method research with concurrent triangulation was conducted to answer the research objectives in three phases. Phase 01 was a literature review identifying the factors at the organisational level that influence the uptake of telehealth services. A qualitative thematic analysis was performed in Phase 01 to develop the initial version of the framework underpinned by the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Phase 02 was a survey to investigate the status of telehealth across DHBs in New Zealand. Phase 03 was a semi-structured interview to identify factors at the organisational level that influence the uptake of telehealth across DHBs in New Zealand. Results In Phase 01 of the study, 51 studies were identified and analysed thematically to develop the initial version of the framework. The developed framework identified factors at the organisational level across five major domains: namely, the extent of technology integration, human resources, technology infrastructure, financial support, and factors in the external environment. Results of Phase 02 confirmed that all 20 DHBs use telehealth services, with variable uptake across regions and clinical specialities. The use of video conferencing, a widely used telehealth technology, differed significantly across DHBs. Results showed an increased demand for video conferencing and reported insufficient infrastructure, with patients not having access to devices as the biggest challenges to uptake telehealth services. Survey findings indicated a shift in telehealth service focus, from clinical- related to patient-related telehealth interactions, which involved ensuring that patients can use telehealth services closer to home. In Phase 03 of the study, factors at the organisational level that influence the uptake of telehealth across DHBs were identified. Phases 02 and 03 were used to refine the framework developed so that it was specific to DHBs in New Zealand. Discussion and conclusion The Framework developed in this study identifies the factors at the organisational level that influence the uptake of telehealth services to support stakeholders across DHBs in the uptake of telehealth services. The data collection reported on the study was completed before the 2020 Covid-19 pandemic in New Zealand. The onset of the pandemic caused a rapidly changing, unpredictable environment that increased the demand for telehealth services across the country. The study recommends a follow-up assessment to indicate any changes in influencing factors that emerged during the pandemic across the DHBs and this could be used to update the developed framework. Moreover, the framework developed from this study can be extended to a national framework to promote telehealth services across primary and non-governmental organisations. The revised, extended framework can inform the Health New Zealand to develop a systematic approach to implement and promote nationwide equitable telehealth services benefiting New Zealanders