Spartan Daily, February 3, 2005

Volume 124, Issue 5https://scholarworks.sjsu.edu/spartandaily/10077/thumbnail.jp

Spartan Daily, February 3, 2005

Volume 124, Issue 5https://scholarworks.sjsu.edu/spartandaily/10077/thumbnail.jp

Spartan Daily, April 24, 1989

Volume 92, Issue 55https://scholarworks.sjsu.edu/spartandaily/7845/thumbnail.jp

The Advocate, Vol. 23, No. 2, 1993

https://dc.suffolk.edu/ad-mag/1067/thumbnail.jp

Exam Room Computers and Patient-Clinician Communication: A Wicked Problem

The present study is a primarily qualitative case study examining the patient-clinician relationship. Clinicians practicing within an oncology practice with a reputation for patient-centered care responded to questions regarding how the introduction of an electronic medical record (EMR) and an exam room computer had affected their day-to-day clinical practice. Framed as a wicked problem (a problem that could not be solved using a linear methodology), I believed clues to understanding a method for incorporating use of an exam room computer into a clinical visit while maintaining empathic communication with the patient could be found by exploring the experience of clinicians who had faced the dilemma. Only three of the nine clinicians interviewed reported routinely using the computer to document the visit while the patient was in the room. The exam room computer was perceived by the clinicians as a third interaction in addition to the patient-clinician relationship and had changed the dynamics of the clinical visit. Identified disadvantages to using an exam room computer included physical environmental factors and relational problems created by system failures or slowness where the clinician felt obligated to explain the unwelcome interruptions of the clinical visit by acknowledging to the patient the interference of the damn computer. Environmental factors interfered with empathic communication by limiting nonverbal communication, particularly eye contact. Similarly, relational factors made empathic communication more difficult by interrupting the flow of conversation or pulling the clinician\u27s attention away from the patient. The clinicians who used the exam room computer in the presence of the patient were unable to verbalize a specific technique they had discovered to unable them to maintain an empathic connection with their patients. However, in explaining how they had adapted their practice after the introduction of the exam room computer they demonstrated a strong commitment to their patients through mindfulness and reflexivity. The empathic connection between these clinicians and their patients was maintained through an awareness of how their words and behavior might be perceived by the patient, and a conscious effort to keep the patient at the center of the interaction despite distractions introduced by the computer

An Exploration of Experiences of Transdisciplinary Research in Aging and Technology

Transdisciplinary research (TDR) involves academics/scientists collaborating with stakeholders from diverse disciplinary and sectoral backgrounds. While TDR has been recognized as beneficial in generating innovative solutions to complex social problems, knowledge is limited about researchers' perceptions and experiences of TDR in the aging and technology field. We conducted a qualitative study to address this knowledge gap by exploring how members of a pan-Canadian research network on aging and technology perceived and experienced TDR. Thirty members participated in semi-structured interviews. Interview data were analyzed thematically. Participants identified benefits that can be gained from implementing TDR, including mutual learning, improved capacity to understand and solve problems, and community engagement and empowerment. Participants also identified challenges to implementing TDR: communication issues and conflicting priorities among team members; tensions between traditional and TDR approaches; and difficulties identifying partners and developing partnerships. In addition, contradictions between TDR principles and participants' understanding of them became apparent. Nevertheless, some participants described successful strategies for implementing transdisciplinary principles in their projects: stakeholder engagement; language and goal sharing; and open, respectful communication. We offer recommendations to support TDR in aging and technology that focus on education and reform of the culture and values that can constrain efforts to practice TDR.Im Rahmen transdisziplinärer Forschung (TDF) arbeiten Wissenschaftler*innen mit Stakeholdern unterschiedlicher disziplinärer und sektoraler Herkunft zusammen. Während es mittlerweile akzeptiert scheint, dass TDF hilfreich ist, um innovative Lösungen für komplexe soziale Probleme zu generieren, ist das Wissen um Wahrnehmungen und Erfahrungen transdisziplinärer Forscher*innen im Bereich Alter(n) und Technologie vergleichsweise gering. Mittels einer qualitativen Studie mit Mitgliedern eines Pan-Kanadischen Forschungsnetzwerks haben wir versucht, diese Wissenslücke zu schließen. Mit 33 Mitgliedern des Netzwerkes wurden teilstrukturierte Interviews geführt, die thematisch analysiert wurden. Zu den berichteten Benefits von TDF gehörten u.a. wechselseitiges Lernen, verbesserte Möglichkeiten zum Verstehen und Lösen von Problemen  sowie Zugehörigkeit zu und Einbettung in die jeweilige Community. Erlebte Herausforderungen betrafen insbesondere kommunikative Schwierigkeiten und Prioritätskonflikte im Team, Spannungen zwischen Vertreter*innen von traditionellen vs. TDF-Ansätzen sowie Hindernisse beim Identifizieren von potenziellen Partner*innen. Zusätzliche waren Widersprüche zwischen TDF-Prinzipien und deren Verständnis durch die Interviewten offensichtlich. Einige der Gesprächspartner*innen haben gleichwohl Strategien beschrieben, die auf eine erfolgreiche Implementierung transdisziplinärer Prinzipien verweisen, nämlich das Engagement von Stakeholdern, das Teilen von Zielen und Sprachen sowie eine offene, respektvolle Kommunikation. Hiervon ausgehend bieten wir Empfehlungen für TDF zu Alter(n) und Technologie mit einem Fokus auf Bildung und auf eine Reform von Kulturen und Werten, die in der Praxis Bemühungen um TDF entgegenstehen

Illuminating the Naturalistic Decision-Making Processes of Anesthesia Providers to Inform Medication Error-Reducing Interventions

Medication errors in anesthesia are prevalent and efforts to address medication errors bring with them new potential avenues of failure, especially when the work system and ‘work as done’ are not considered in the design of the intervention. I employed two methodologies in interviews of anesthesia providers to help further understand the context of anesthesia ‘work as done’ to inform the design of future medication error-reducing interventions. Results of the first interview methodology, the critical decision method, revealed a diverse array of challenging scenarios in which ‘work as done’ often deviates from ‘work as imagined.’ Results of the second interview methodology, vignette-based interviews, revealed how the decision-making processes of anesthesia providers may vary even when managing an identical case. These interviews provide context to the otherwise nebulous ‘variability’ of anesthesia provider ‘work as done.’ This context highlights the potential unforeseen dangers that may occur with the addition of future interventions and suggests avenues in which future interventions may fit better into the workflow of the anesthesia provider with design considerations. Future design efforts should focus on supporting the resilience of anesthesia providers: the information seeking and problem anticipation which are used to safely manage the uncertainty and complexity of their work. Future work should assess how ‘work as done’ may vary in different hospitals, and additionally focus on how ‘work as done’ influences the process of medication administration

The Impact of English Language Proficiency and Workplace Readiness on the Employment Outcomes of Tertiary International Students (Full Report)

This project examines the influence of English language proficiency (ELP) on workplace readiness and employment outcomes for international students and graduates who seek to work in Australia. The study adopts a mixed method approach involving a detailed review of relevant literature, semi-structured individual interviews and focus groups, and quantitative analyses of three statistical data sets — Australian 2006 Census data, Australian Education International (AEI) data from January 2002 to June 2008, and the former Department of Immigration and Multicultural and Indigenous Affairs (DIMIA) Longitudinal Survey of Immigrants to Australia (October 2005 and October 2006). The qualitative data from the interviews enabled the authors to analyse the topic of investigation from several different perspectives including those of: international students and graduates; local (permanent resident or citizen) students and graduates; representatives of tertiary institutions and VET providers; recent offshore graduate job seekers with overseas qualifications; and Australian employers and regulatory bodies in five professional and three trade fields. The findings show that international students employment outcomes are not as good as their Australian domestic counterparts and that they face greater challenges in finding full-time employment after graduation. While ELP is a key factor influencing their employment outcomes — particularly if graduates have low levels of ELP — the findings from this study show that ELP is not the only or principal issue. Employers\u27 first priority is to engage graduates with strong profession-specific skills and then to consider their ‘well-roundedness’. The ‘well-roundedness’ includes graduates’ personal characteristics and attributes, the diversity of their experiences and skills, as well as their ‘cultural fit’ into the workplace. There is potential to respond to this expectation through policies and practices that support integrated approaches for enhancing ELP and workplace readiness within educational institutions, as well as increasing international students’ awareness of the value of the experiences and skills they can develop outside of their studies

Mentally Disordered or Culturally Displaced? How the PTSD Label Transforms Personhood in US Military Veterans

Medical experts claim that Posttraumatic Stress Disorder among United States military service personnel, who served in Iraq and Afghanistan has contributed to an “epidemic of suicide” in the U.S. However, veterans, military commanders, and mental health providers argue that feelings of grief, guilt, mistrust, rage, and alienation are actually normal moral reactions to the abnormal situations that war creates. Furthermore, they argue that these normal reactions are currently transformed into a psychiatric diagnosis that promises clinical solution – a cure. Recent epidemiologic studies suggest that evidence-based clinical treatments are ineffective for a majority of veterans with PTSD and that the main barrier to seeking treatment is self-stigma by veterans. This ethnography interrogates the failure in care and vectors of blame that surround it by documenting veterans’ own critical reactions to being diagnosed and/or labeled with PTSD. These narratives provide a moment to critically examine the medicalization and commodification of trauma, as well as the bureaucratization of care, that continue to negatively impact what I describe as veteranhood – a deep constellation of personal and military values. Everyday life for veterans becomes a clash of cultural models, worldviews and various stakeholders of their care. The lack of common ground or “cultural consonance” (versus PTSD/stigma) lies behind the social processes that contribute to veterans’ uneven reintegration into civilian life. This ethnography provides counter-narratives of emergent veteranhood that challenge the dominant cultural script of “stigma as the main barrier to care.” These narratives dismantle concepts of self-stigma by shifting the focus from the standard trauma model of victimization towards a productive veteranhood, where agency remains essential to identity and everyday life. Veterans that reframe the post-effects of war as an issue of cultural dissonance, as opposed to a mental disorder, are creating new personal scripts for healing that a medical anthropology and caregivers must account for. Veterans desire solutions for their distress within their communities, their culture(s), not within the confines of a medical clinic or within the categorical parameters of PTSD