Identifying Transfer of Care Gaps: Electronic Health Record Capture of Perioperative Handoff Communications

Transitions in patient care are held together by interdisciplinary handoff communications intended to coordinate the patient\u27s ongoing care requirements. Patients with complexity in care encumber the transfer of care process requiring a higher level of care coordination between the interdisciplinary team (Coleman, 2003; Naylor et al., 2004). While the literature is abundant on the characteristics and quality of handoff communications, it is limited on the requirements of what data is necessary for ongoing care following transfer communications (Galatzan & Carrington, 2018). This dissertation explores the verbal information transferred during Operating Room (OR) to Post Anesthesia Care Unit (PACU) nursing handoff communications and whether the data is captured in the electronic health record (EHR) to represent the information critical to ongoing patient care and care planning. the study builds on the Kennedy Integrated Theoretical Framework (KITF) (Kennedy, 2012) integrating cognition theory, patterns of knowledge theory, and clinical communication space theory to support the human-technology characteristics within perioperative handoffs. Evidence of wisdom was present in the KITF in addition to elements of non-verbal communication patterns emerging from shared common ground contributed to the framework\u27s expansion. to understand the contributions of the perioperative nursing interface terminology, the Perioperative Nursing Data Set (PNDS), makes to postsurgical care transitions, the study examines nursing diagnoses, interventions, interim outcomes and goals relationships to the handoff data communicated between OR and PACU Registered Nurses. Study findings revealed a complex fragmented process of verbal communications and electronic documentation for the handoff process. While the EHR is prominent in data procurement for the handoff process, the design of handoff artifacts (e.g., paper, electronic) significantly impact the value of information received. Incomplete handoff tools or missing EHR data adds to a cycle of information decay while contributing to increase cognitive load and potentiating opportunities for information and knowledge loss. the absence of nursing diagnoses in the automation of the PNDS challenges the integrity of the language within the documentation platform and raises considerations for hierarchical representation within interface terminologies. This study reinforces literature to reconsider user requirements in the design and functionality of healthcare information technology (HIT) to enable data and information flow and preserve knowledge development. the inclusion of mobile technology, cognitive support aids including clinical decision support tools, and other HIT will further enable the effectiveness of transfer communication, knowledge development, and the safety of ongoing patient care

Inequality in digital personas - e-portfolio curricula, cultural repertoires and social media

Digital and electronic learning portfolios (e-portfolios) are playing a growing role in supporting admission to tertiary study and employment by visual creatives. Despite the growing importance of digital portfolios, we know very little about how professionals or students use theirs. This thesis contributes to knowledge by describing how South African high school students curated varied e-portfolio styles while developing disciplinary personas as visual artists. The study documents the technological and material inequalities between these students at two schools in Cape Town. By contrast to many celebratory accounts of contemporary new media literacies, it provides cautionary case studies of how young people’s privileged or marginalized circumstances shape their digital portfolios as well. A four-year longitudinal action research project (2009-2013) enabled the recording and analysis of students’ development as visual artists via e-portfolios at an independent (2009-2012) and a government school (2012-2013). Each school represented one of the two types of secondary schooling recognised by the South African government. All student e-portfolios were analysed along with producers’ dissimilar contexts. Teachers often promoted highbrow cultural norms entrenched by white, English medium schooling. The predominance of such norms could disadvantage socially marginalized youths and those developing repertoires in creative industry, crafts or fan art. Furthermore, major technological inequalities caused further exclusion. Differences in connectivity and infrastructure between the two research sites and individuals’ home environments were apparent. While the project supported the development of new literacies, the intervention nonetheless inadvertently reproduced the symbolic advantages of privileged youths. Important distinctions existed between participants’ use of media technologies. Resourceintensive communications proved gatekeepers to under-resourced students and stopped them fully articulating their abilities in their e-portfolios. Non-connected students had the most limited exposure to developing a digital hexis while remediating artworks, presenting personas and benefiting from online affinity spaces. By contrast, well-connected students created comprehensive showcases curating links to their productions in varied affinity groups. Male teens from affluent homes were better positioned to negotiate their classroom identities, as well as their entrepreneurial and other personas. Cultural capital acquired in their homes, such as media production skills, needed to resonate with the broader ethos of the school in its class and cultural dimensions. By contrast, certain creative industry, fan art and craft productions seemed precluded by assimilationist assumptions. At the same time, young women grappled with the risks and benefits of online visibility. An important side effect of validating media produced outside school is that privileged teens may amplify their symbolic advantages by easily adding distinctive personas. Under-resourced students must contend with the dual challenges of media ecologies as gatekeepers and an exclusionary cultural environment. Black teens from working class homes were faced with many hidden infrastructural and cultural challenges that contributed to their individual achievements falling short of similarly motivated peers. Equitable digital portfolio education must address both infrastructural inequality and decolonisation

Re-presenting gender fluid identity in a contemporary arts practice

This dissertation addresses the paucity of representation of gender fluid identity within contemporary imagery. An examination of historical and socio-political structures inherent in modern Western society serves as a foundational position for a broader exploration of differently gendered communities globally. The case is made for contemporary art to be encouraged as a tool for the emancipation of subjugated gender fluid identities. Examples of contemporary gender fluid visual art and artists are presented to illustrate the ability of art to enable agency within the broader gender fluid community. Finally, a commentary on my own artwork is presented and discussed in relation to the research and conclusions advanced within this dissertation

Exploration, Science, and Society in Venezuela's Cave Landscape.

Geographic knowledge has played a key role in the formation of empires and nations. As maps and monuments, it has helped define imperial and national identities and territories. In the case of the Venezuelan cave landscape, however, it is not the state that performs its exploration or manages its knowledge, but a group of civilians—mostly friends among them, many not even career scientists. For over 40 years, the members of the Sociedad Venezolana de Espeleología (Venezuelan Speleological Society), have practiced speleology, or cave science, as an amateur pursuit. This has involved exploring, mapping, and cataloguing caves all over the country into a national registry that the group publishes. Once mapped, caverns become spaces for and objects of science, whether in geology, biology, or archeology. Based on research carried out in 2007 and 2008, this dissertation examines the activities of the Venezuelan Speleological Society, from ethnographic and historical perspectives. By analyzing the relations between scientific practice, sociality, and landscape, I argue that the production of speleological knowledge must be considered in dialectic with the production of the Society itself. For most of its members, cave science primarily is about experience and relatedness: exploring and mapping caverns as a collective pursuit. It is in this context that the national speleological project is produced, gains meaning, and is maintained over time. This highlights the importance of collective experience and relatedness, along with norms and trust, in scientific practice. Moreover, by going beyond the field and laboratories, this project exposes a broader, more intimate, and also more dynamic geography of science. At the same time, understanding speleological practice begs appreciating caves’ intense symbolic and material qualities that come into being as humans traverse their passages. Representing caverns requires their exploration, since there is no technology that can accurately map them from the surface. This grants an anachronistic second life to exploration often dismissed as a thing of the past. Finally, in the case of Venezuela, speleological practice points to unexplored ways citizens may reconfigure and even challenge state-orchestrated relations between nature, nation, and their histories.Ph.D.AnthropologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/91583/4/Perez_2012_Diss_UM_Vnzla_Caves_REV.pd

Putting animals on display: geographies of taxidermy practice

Taxidermy specimens and displays have become increasingly liminal features in contemporary society. Viewed variously as historical curios, obsolete relics or more malignantly as ‘monstrosities’, they can be a source of discomfort for many. Taxidermy objects have become uncomfortable reminders of past scientific and colonial practices which have sought to capture, order and control animated life and as such have become increasingly problematic items for their owners. As a result many taxidermy displays have been dismantled and mounts relegated to ‘backstores’ to gather dust. The paradox is that taxidermy as a practice is a quest for ‘liveness’, to impute life back into the dead. Much like the taxidermist, my goal in this thesis is to revive and restore: to renew interest in and reassert the value of taxidermy collections by recovering what I shall term as the ‘biogeographies’ of their making and continued maintenance. Considerable academic attention has been paid to the ‘finished’ form and display of taxidermy specimens inside cabinets, behind glass – in other words, to their representation. By way of contrast, this thesis recovers the relationships, practices and geographies that brought specimens to their state of enclosure, inertness and seeming fixity. These efforts are aligned with work in cultural geography seeking to counteract ‘deadening effects’ in an active world through a prioritisation of practice (Dewsbury and Thrift 2000), and elsewhere draw on research arguments and approaches originating in historical geography, and the history of science. The thesis firstly investigates historical developments in the scientific and craft practice of taxidermy through the close study of period manuals, combined with ethnographic observations of a practicing taxidermist. Critical attention to practice then facilitates the recovery of the lifeworlds of past taxidermy workshops and the globally sited biogeographies behind the making of individual specimens and collections. The thesis required the purposeful assemblage and rehabilitation of diffuse zoological and historical remains to form unconventional archives, enabling a series of critical reflections on the scientific, creative and political potentials of taxidermy