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Communication between a patient with hearing loss and a health care provider can be challenging and potentially contribute to poor health outcomes. This document describes an audiology doctoral project with clinical innovation emphasis on the development of a guide and interprofessional training for health care providers to communicate effectively with patients with hearing loss. A preliminary assessment of provider needs for training was followed by the development and implementation of an interprofessional training on hearing loss and communication strategies for the University of Arizona-St. Luke's Home Interprofessional Education and Practice Program (Spring, 2015). Additionally, video training segments on effective communication in a health care setting were developed. Evaluation of the interprofessional training included administration of pre- and post-training questionnaires (n = 11). Results indicated a significant change in trainee confidence levels in screening for hearing loss and the use of appropriate communication strategies for communicating with hard of hearing patients. These results support further development and research on hearing loss and communication training for health care curriculums, interprofessional education, and in-service training meetings. Implementation of communication trainings may lead to improved patient-provider communication, with positive impact on health care experiences and outcomes for patients with hearing loss.

There has been a recent increase in the use of graphic symbols in school settings (Abbott and Lucey, 2003). However, the use of graphic symbols in schools remains, to date, an under-researched area. In order to address this and develop understanding of practitioners’ experiences of using graphic symbols in school settings, exploratory research was conducted investigating the experiences of a range of practitioners using symbols in Foundation Stage school settings. A qualitative research design was used drawing upon an interpretive phenomenological philosophical framework. The research sample consisted of three groups of practitioners; teachers, early years practitioners (teaching assistants, learning support assistants and nursery nurses) and speech and language therapists. Data were collected through semi-structured interviews which were conducted face-to-face by the researcher. In the interviews participants were encouraged to explore their experiences of using graphic symbols and their associated beliefs and attitudes about this topic. Interview data was analysed using thematic analysis which was facilitated by the use of qualitative data management software QSR NVivo2. Prolonged engagement with the data led to the development of a theoretical framework based on a set of themes and subthemes. Four major themes were identified: practitioners’ beliefs about which children to use symbols with; practitioners’ thoughts about children’s understanding of symbols; practitioners’ accounts of the ways symbols are used; and, practitioners’ experiences of the implementation of symbols. Interpretations of the data were extended further to develop two original theoretical constructs; ‘models of reasoning’ and ‘perceptions of professional roles’. These constructs were developed to provide an over-arching framework depicting the researcher’s interpretations of the data set as a whole. The findings suggest that practitioners go through a process of reasoning and decision making surrounding the use of symbols. Practitioners in this study also appeared to be influenced by their perceptions of their own professional role and those of others in their decisions surrounding the implementation of symbols. The theoretical model may provide some explanation for the ways in which individual practitioners interact and work alongside practitioners from the same and different professional groups. The findings of the research were related to existing literature in the fields of symbolic development, symbols and literacy, and, collaborative working. The findings led to the development of five suggestions for future research.

The intention of this study was to create an understanding of how multi-professional interaction could convert into inter-professional collaboration, which takes advantage of and acknowledges the individual professional identity. The intention was to understand the meaning of collaboration through the study of meetings between professionals who use different symbol systems. In particular, we wanted to study inter-professional interaction from a symbolic interactional perspective with a focus on Self, Identity, Symbols, Meaning and Professional community. The employed method was semi-structured interviews with ten questions. A convenience sample was used to identify working groups composed of different professions, such as teachers, social workers and therapy assistants. The results suggest that the working group believed that personality precedes the profession one is impending, and that participants preferred stability before communication and reflection. Our study also revealed that inter-professional collaboration cannot be pursued without cultivating awareness, active reflection and communication between the professionals involved. Keywords: Self ∙ Multi-professional ∙ Inter-professional ∙ Identity ∙ Collaboration ∙ Symbols ∙ Qualitative rapport.

Philosophiae Doctor - PhD / The complexity of human health and its determinants has been developing gradually and the means to attend to them has gone beyond the scope of a specific health discipline. Advocacy is underway by health stakeholders such as the World Health Organisation (WHO), higher learning institutions and individual scholars to incorporate interprofessional practice initiatives in health as a means of ensuring that health practitioners share ideas communicate and collaborate in order to put forward a comprehensive management plan for patients. These initiatives seek to ensure that a problem that could hardly be solved uniprofessionally is shed light on. The University of the Western Cape (UWC) is among the universities in the world that have incorporated an Interdisciplinary Core Courses Curriculum to be undertaken by all undergraduate students enrolled in the Faculty of Community and Health Sciences (FCHS) hence aiming at producing graduates who are collaboration conscious in their practice. This effort adds into the UWC’s endeavor of producing socially responsible graduates. This study analysed the UWC curriculum in order to ascertain its cognitive rigor for delivery of the interprofessional competencies. It further sought to identify whether the effort that the FCHS is putting through the Interdisciplinary Core Courses in having an impact on the perceptions of final year students during their field work placements in various health care institutions. The study also sought to find out whether the health care institutions practice policies are interprofessional practice friendly. Finally, the views and perceptions towards interprofessional collaboration (IPC) of institutional manager’s for institutions where UWC places more than one discipline of students for practice were explored.

Yes / If global palliative care is to successfully address challenges of unequal access, continuity of care, and health services reductionism, new practice models to address these issues need to be identified, debated and tested. This paper offers one such practice model based on a public health approach to palliative care that has so far shown promising evidence of effectiveness. Methods: We describe how four essential elements within a public health model can work together to address quality and continuity of care as well as addressing the numerous barriers of access. These elements are: (I) specialist, and (II) generalist palliative care services working with (III) communities and neighbourhoods, working in their turn with their (IV) key civic institutions. Results: The positive and negative impact and advantages of each of these elements is described and discussed. Conclusions: A solely clinical model of palliative care is inadequate to addressing the multiple comorbidities and access issues characteristic of modern palliative care. A public health approach based on a close partnership between clinical services and communities/civic institutions is the optimal practice model.

This project examines the medical management of pain and injury in British Olympic sport. By drawing upon the perspectives of health-care providers, it explores key developments such as the professionalisation, formalisation and bureaucratisation of sports medicine and the consequences of such developments on doctors' and physiotherapists' working practices, relationships with each other and on athlete care. A questionnaire about the backgrounds (e.g. the qualifications, experience and methods of recruitment and appointment) was sent to members of the British Olympic Association's Medical Committee and Physiotherapy Forum in November 2007 and in-depth, semi-structured interviews were conducted with 14 doctors and 14 physiotherapists between January and June 2008. Data indicate that attempts to professionalise sports medicine into a medical speciality have created fragmentation and resistance among the various groups involved in athlete care at this level. Whilst clinicians were committed by multi-disciplinary practice overall, data reveal qualitative differences between practitioners who have established themselves within bureaucratic organisations such as the English Institute of Sport (EIS) compared to those who provide largely voluntary medical services via National Governing Bodies of Sport (NGBs). Thus, practitioners in positions of managerial authority were constrained to negotiate the underlying amateur values of numerous sports medicine staff at the same time as striving for a professional ethos. Processes of professionalisation have also impacted upon the inter-professional relations between doctors and physiotherapists and the social organisation of athlete-care. As a consequence of their work setting, clinicians were constrained to adhere to the performance-motivated demands of their athlete and coach clients over longer-term health concerns. Because of their greater orientation towards performance, physiotherapists were able to effectively "compete" with doctors in a number of practice contexts and so claim considerable professional autonomy. This project adds to the existing body of knowledge on the medical practices of sports medicine clinicians in elite level sport and demonstrates the heterogeneity within this area of practice. Furthermore, the thesis highlights the importance of understanding clinicians working practices as a consequence of their particular work setting.

Background: Studies show that healthcare professionals often experience ethical difficulties in their relations with patients, relatives, and other professionals and in relation to organisational issues, and these can sometimes be difficult to handle. Failing to act or to relate in accordance with one’s values for what is good and right might cause a troubled conscience that is connected to feelings of guilt and ill-being. Ethical issues related to the care of patients with end-stage renal disease have been described, but no studies in this context have been found that explore registered nurses’ (RNs’) and physicians’ experiences of being in ethically difficult situations that give rise to a troubled conscience. The importance of communicating ethical issues in order to understand and handle ethically difficult care situations has been emphasized. Various forms of clinical ethics support (CES) have been described and evaluated, but studies on the communication processes and the organisation of CES interventions are sparse and no study describing a CES intervention based on Habermas’ theory of communicative action has been found. Aim: The overall aim was to increase our understanding about being in ethically difficult care situations and about how communication concerning ethical issues in healthcare can be promoted. More specifically, the aim of studies I and II was to illuminate experiences of being in ethically difficult situations giving rise to a troubled conscience among RNs and physicians, while studies III and IV aimed to describe the communication of value conflicts (III) and the organisation and performance of a CES intervention (IV). Methods: In studies I and II narrative interviews with ten RNs (I) and five physicians (II), were performed in a dialysis care context. The interviews were analysed using a phenomenological hermeneutic approach. In studies III and IV, eight audio- and video-recorded and two audio-recorded sessions of the CES intervention, were conducted and sorted by the data tool Transana and analysed in accordance with a qualitative content analysis (III) and a qualitative concept- and data-driven content analysis (IV). Results: The RNs’ narratives (I) resulted in the theme ‘Calling for a deliberative dialogue’. Their narratives expressed feelings of uncertainty, solitude, abandonment, and guilt in complex and ambiguous ethically difficult situations. The narratives concerned the value conflict between preserving life by all means and preserving life with dignity. The physicians’ narratives (II) resulted in the themes ‘Feeling trapped in irresolution’ and ‘Being torn by conflicting demands’. Their narratives expressed feelings of uncertainty, solitude, abandonment and guilt related to the obligation to make crucial decisions and in situations when their ideals and the reality iii clashed. The analysis of the communication of value conflicts during the CES intervention inspired by Habermas’ theory of communicative action (study III) revealed a process of five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, revelation of the value conflict, enhancing realistic expectations of the patients and relatives, and seeing opportunities to change the situation instead of obstacles. The CES intervention (study IV) was organised as a framework with a given structure and an openness for variations to facilitate communicative action. Three courses of actions to reach a communicative agreement were identified and concerned the approach to achieve a permissive communication, opening up for extended views, and enhancing mutual understanding (IV). Conclusion: The results show that both RNs and physicians expressed feelings of uncertainty abandonment and loneliness in similar ethically difficult situations but from different points of view. They struggled with the same value conflicts and feelings, but they did not share their struggles with each other. The lack of communication and confirmation led to distrust and increased feelings of uncertainty. The CES intervention, inspired by Habermas’ theory of communicative action, offered the possibility of dealing with experiences of ethically difficult care situations. In the permissive atmosphere, the professionals helped each other to balance their ambiguity, frustrations, and powerlessness and came to an agreement about how to handle the value conflicts and how to act. The findings from this CES intervention constitute a step towards a CES method that is clearly described so that leaders can be educated and extended intervention studies with different kinds of data can be conducted in order to further develop knowledge about how to promote an inter-professional dialogue about ethical difficulties.

Working on teams with professionals from other fields is often challenging. Researchers from the fields of Management and Writing Studies have frequently emphasized the tension and conflict experienced in such inter-professional, or cross-functional, teams. Whether studying engineering project teams, groups of medical professionals, or business teams, researchers have found that inter-professional work is often complicated by misunderstanding and miscommunication due to problems associated with inter-group professional identity. This interdisciplinary research draws from the fields of Management and Writing Studies in the exploration of a modern, inter-professional proposal writing team working at a commercial enterprise. A modified version of Grounded Theory, coupled with Rhetorical Genre Studies analysis, serves as a methodological framework for the study. The analytical framework is provided by the combination of Rhetorical Genre Studies, a model of successful team interactions, borrowed from Management Studies, and an expanded version of Wenger’s conceptualization of multiple communities of practice (CoPs). The research reveals the complexity of inter-professional team work. Professional identity of the team’s member is also presented as more complicated than previously anticipated. The study indicates that the team has been heavily influenced by a former, or an antecedent, CoP to which some of the team members belong. The genre and leadership preferences of the antecedent CoP are shown to moderate much of the predicted tension and conflict in the work of the team. The interdisciplinary study reveals the effects of antecedent CoPs and professional identity of the team members on the inter-professional team dynamics. Both researchers and practitioners may benefit from the findings of the study and a broader interdisciplinary approach used to investigate and interpret the dynamics of inter-professional teams.

The study of communication was born with the study of rhetoric, and scholars have been examining the creation and reception of messages for thousands of years. However, the term rhetoric often has negative connotations, as we hear people label some statement as “just rhetoric” or we hear them say, “The action doesn't match the rhetoric.” However, rhetoric is a style of communication that takes into account the effective use of both verbal and non-verbal languages, and it is one of the main ingredients in the day to day communication in organizations, healthcare organizations being no exception. It is virtually impossible to communicate without the use of rhetoric. This study focused on healthcare organizations because the delivery of healthcare is built on communication, and there is more to understand about the usage of language and organizational rhetoric in healthcare organizations. To these effects, the study examined communication in healthcare organizations and the perceived use of rhetoric among healthcare professionals; it explored how healthcare professionals perceive communication with their audiences, how the use of rhetoric, as perceived by healthcare professionals, affects communication in healthcare organizations and the contribution of rhetoric, as perceived by healthcare professionals, in motivating healthcare audience in healthcare organizations. The five canons of rhetoric were employed as a theoretical framework, and semi-structured interviews were used as tools for data collection. While contributing to existing literature on health and organizational communication, this study will also contribute in providing both government and private organizations insights into the use of rhetoric in professional communication with the hope of enhancing the quality of communication in the workplace.