Examining the Use of Institutionally Designed Documentation Templates as a Vehicle for Changing Values and Practices in Health Care

Changing values and requirements are common occurrences in today’s health care settings. Institutionally designed documentation templates are often developed to demonstrate that these changes have been incorporated into clinical work. Little research has been completed to examine whether the use of these institutional templates leads to the intended change or whether the changes clash with other influences on clinical work. This paper illustrates how two qualitative methods: think aloud interviews and frame analysis can be combined to examine the use of the templates, the changing values themselves, and the influences on changes in clinical practice. An analysis of local change from expert planning to person centered planning is used to illustrate the value of the approach. The analysis reveals influences that affect the adoption of this particular change, the usability of the template, and points of change that need to be negotiated with the users of those documents

Building an Understanding of the Effects of Power and Privilege on Human Development

Introduction: Human development textbooks and courses traditionally address diversity and sociocultural influences on development but seldom are these points extended to an understanding of the role privilege and power plays in human development. Students (particularly privileged students) do not make this jump by themselves. This project was developed to explicitly extend an understanding of sociocultural influences to the major influence that privilege plays to build a general understanding about how power and privilege function in our society

Voices in the text: The uses of reported speech in a psychotherapist\u27s notes and initial assessments

A psychotherapist\u27s initial written assessment document (based on notes taken during an initial interview as well as material in the client\u27s record) recontextualizes information provided by that client into an institutionally viable account. This assessment, designed to provide readers with a clinical picture of the client\u27s problems, justifies the therapist\u27s particular diagnosis of mental disorder which, in turn, supports the therapist\u27s treatment choice. An analysis of reported speech in a therapist\u27s notes written during a therapy session and the written assessment that followed reveal some devices used by the therapist for reporting client\u27s speech in ways that would: (a) depict the client\u27s experiential meanings, as represented in the therapist\u27s notes, and (b) construct a clinical case to support her diagnosis, as can be seen in the assessment. We suggest that the devices function to recontextualize the client\u27s lifeworld perspective, thereby subsuming this perspective (and implicit structure of meanings) into the therapist\u27s psychiatric perspective. © Walter de Gruyter

Genre as tool in the transmission of practice over time and across professional boundaries

In this article, we are concerned with the processes through which a central activity in the natural sciencesclassificationis instantiated in the writing practices of psychotherapists. We examined several psychotherapists\u27 grammatical, lexical, and rhetorical strategies for writing their initial evaluations of their clients\u27 problems. Using membership categorization device analysis from ethnomethodology, we examined several therapists\u27 written initial evaluations for their use of microlevel categories and categorizations derived both from clients\u27 own (oral) representations and the therapists\u27 professional repertoire. The resulting analysis suggests that clients\u27 emic, contextually grounded expressions are absorbed into a monological account reflecting the therapist\u27 s professional interpretive framework. The therapist thus translates the client\u27 s concerns into a set of meanings compatible with the classifications of psychopathology of the American Psychiatric Association\u27s (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The resulting written account supports a billable diagnosis thereby fulfilling its institutional purpose. It fails, however, to serve another important purpose to many therapists, which is helping the therapist to guide the therapy process by providing a record of the client\u27s perspective of his or her lifeworld. Copyright © 1997, Regents of the University of California on behalf of the Laboratory of Comparative Human Cognition