Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.

AIMS AND OBJECTIVES: This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. BACKGROUND: Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. DESIGN: A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. METHODS: A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. FINDINGS: Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. CONCLUSIONS: The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. RELEVANCE TO CLINICAL PRACTICE: Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed.

Family centred care before and during life-sustaining treatment withdrawal in intensive care: a survey of information provided to families by Australasian critical care nurses

BACKGROUND: A core component of family-centred nursing care during the provision of end-of-life care in intensive care settings is information sharing with families. Yet little is known about information provided in these circumstances.

OBJECTIVE: To identify information most frequently given by critical care nurses to families in preparation for and during withdrawal of life-sustaining treatment.

DESIGN: An online cross-sectional survey.

METHODS: During May 2015, critical care nurses in Australia and New Zealand were invited to complete the Preparing Families for Treatment Withdrawal questionnaire. Data analysis included descriptive statistics to identify areas of information most and least frequently shared with families. Cross tabulations with demographic data were used to explore any associations in the data.

RESULTS: From the responses of 159 critical care nurses, information related to the emotional care and support of the family was most frequently provided to families in preparation for and during withdrawal of life-sustaining treatment. Variation was noted in the frequency of provision of information across body systems and their associated physical changes during the dying process. Significant associations (p<0.05) were identified between the variables gender, nursing experience and critical care experiences and some of the information items most and least frequently provided.

CONCLUSIONS: The provision of information during end-of-life care reflects a family-centred care approach by critical care nurses with information pertaining to emotional care and support of the family paramount. The findings of this study provide a useful framework for the development of interventions to improve practice and support nurses in communicating with families at this time.

Existentialist methodology and perspective: writing the first-person

Without proposing anything quite so grandiose as a return to existentialism, in this paper we aim to articulate and minimally defend certain core existentialist insights concerning the first-person perspective, the relationship between theory and practice, and the mode of philosophical presentation conducive to best making those points. We will do this by considering some of the central methodological objections that have been posed around the role of the first-person perspective and “lived experience” in the contemporary literature, before providing some neo-existentialist rejoinders. We will suggest that the dilemma that contemporary philosophy poses to existentialism, vis-à-vis methodology, is that it is: a) committed to lived experience as some sort of given that might be accessed either introspectively or retrospectively (with empirical science posing prima facie obstacles to the veridicality of each); and/or b) it advocates transformative experiences, and the power of philosophy in connection with such experiences, to radically revise our doxastic and inter-connected web of beliefs. In short, the charge is conservatism on the one hand, radicalism on the other. Each of these concerns will be addressed in turn, utilizing ideas from Kierkegaard (as the source for many existentialist themes, methodological concerns, and formal practices) and from the German and French twentieth century versions of existentialism

Temporal asymmetry and the self/person split

Derek Parfit’s discussion of our bias towards the future has sparked considerable discussion of our pervasively asymmetrical attitudes towards past and future goods. Much of this discussion has centred on whether we can rationally justify such attitudes or whether they are intrinsically irrational. This paper seeks neither to justify nor to reject temporally asymmetrical attitudes, but to explicate the way perspective, and particularly temporal perspective, operates in such biases, in order to show how our temporal biases point to something important about the structure of selfhood. By employing an emerging distinction in the personal identity literature between the ‘self’ as an intrinsically first personal and temporally indexical locus of consciousness, and the ‘person’ as a diachronic bearer of various forms of physical and psychological predicates, we can see that the clash between temporally asymmetrical attitudes and symmetrical welfare judgments is in fact a result of the ways in which selves and persons interact.