Supporting children with disabilities at school: implications for the advocate role in professional practice and education.

Purpose: School settings are a common practice context for rehabilitation professionals; health advocacy is a common and challenging practice role for professionals in this context. This study explored how pediatric practitioners advocate for children with disabilities at school. Specifically, we examined everyday advocacy in the context of school-based support for children with disabilities.

An institutional ethnography inquiry of health care work in special education: a research protocol.

Background: Special education for children with chronic health conditions or disabilities requires the integration of health care work with education. This phenomenon occurs in an understudied and challenging context for integrated care despite policies and protocols that outline work processes in this context. We are interested in an approach to inquiry that will allow us to address gaps in current literature and practices in integrated care, and move towards informing policy.

Representing complexity well: a story about teamwork, with implications for how we teach collaboration.

Objectives: In order to be relevant and impactful, our research into health care teamwork needs to better reflect the complexity inherent to this area. This study explored the complexity of collaborative practice on a distributed transplant team. We employed the theoretical lenses of activity theory to better understand the nature of collaborative complexity and its implications for current approaches to interprofessional collaboration (IPC) and interprofessional education (IPE).

Exploring the therapeutic power of narrative at the end of life: a qualitative analysis of narratives emerging in dignity therapy.

Objective: To understand the therapeutic effect of a narrative intervention, specifically dignity therapy, in patients at the end-of-life. To examine the thematic dimensions and shared narrative features of the stories that emerge in dignity therapy and theorise their relationship to the intervention's clinical impact.

Design: Resident physicians, as part of an educational intervention, co-administered the dignity therapy protocol with the principal investigator.

Routine and adaptive expert strategies for resolving ICT mediated communication problems in the team setting.

Context: The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR).

Attending to audience: comparing optometry student talk with and about patients.

We explored mediating concepts that affect clinical novices shifting between their talk with patients in eye examinations and their talk about patients in case presentations (nCPs). In a Canadian optometry teaching clinic, patient 'chief concern or request', 'illness experience', and 'management' utterances were observed in ten eye examinations and nCPs. Twenty-three participants (8 students, 5 instructors, and 10 patients) were observed; 22 were subsequently interviewed.

Interprofessional communication and medical error: a reframing of research questions and approaches.

Progress toward understanding the links between interprofessional communication and issues of medical error has been slow. Recent research proposes that this delay may result from overlooking the complexities involved in interprofessional care. Medical education initiatives in this domain tend to simplify the complexities of team membership fluidity, rotation, and use of communication tools.

Balancing patient care and student education: learning to deliver bad news in an optometry teaching clinic.

Learning to counsel patients in a teaching clinic or hospital occurs in the presence of the competing agendas of patient care and student education. We wondered about the challenges that these tensions create for clinical novices learning to deliver bad news to patients. In this preliminary study, we audio-taped and transcribed the interviews of seven senior optometry students and six optometrist instructors at a Canadian optometry teaching clinic.

The rhetoric of patient voice: reported talk with patients in referral and consultation letters.

Referral and consultation letters are written to enable the exchange of patient information and facilitate the trajectory of patients through the healthcare system. Yet, these letters, written about yet apart from patients, also sustain and constrain professional relationships and influence attitudes towards patients. We analysed 35 optometry referral letters and 35 corresponding ophthalmology consultation letters for reported 'patient voice' coded as 'experience' or 'agenda' and we interviewed 15 letter writers (eight optometry students, six optometrists, and one community ophthalmologist).

Working off the record: physicians' and nurses' transformations of electronic patient record-based patient information.

Background: Electronic patient records (EPRs) are increasingly being used in health care, but little is known about how EPR-based patient information is used in daily care activities, nor about its potential influence on novice training.

Method: Seventy-two physicians and nurses participated in an eight-month study on a single pediatric ward. Eighty hours of nonparticipant observations and 20 interviews were conducted.

What healthcare students do with what they don't know: the socializing power of 'uncertainty' in the case presentation.

Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the 'truth for now' realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students.

Tensions in the field: teaching standards of practice in optometry case presentations.

Purpose: Professional identity formation and its relationship to case presentations were studied in an optometry school's onsite clinic.

Methods: Eight optometry students and six faculty optometrists were audio-recorded during 31 oral case presentations and the teaching exchanges related to them. Using convenience sampling, interviews were audio-recorded of four of the students and four of the optometrists from the field observations.