Biomedical subjects

Dawn Goodwin

Publications and source records attributed to Dawn Goodwin.

5 recordsLinked to original sources

PubMed2005

Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence.

PURPOSE: Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia. METHODS: We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts. RESULTS: We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake. CONCLUSION: Communication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.

Anesthesia Recovery Period↗

PubMed2005

Safe asleep? Human-machine relations in medical practice.

In the process of anaesthesia the patient must surrender vital functions to the care of clinicians and machines who will act for, and advocate for the patient during the surgical procedure. In this paper, we discuss the practices and knowledge sources that underpin safety in a risky field in which many boundaries are crossed and dissolved. Anaesthetic practice is at the frontier not only of conscious/unconsciousness but is also at the human/machine frontier, where a range of technologies acts as both delegates and intermediaries between patient and practitioner. We are concerned with how practitioners accommodate and manage these shifting boundaries and what kinds of knowledge sources the 'expert' must employ to make decisions. Such sources include clinical, social and electronic which in their various forms demonstrate the hybrid and collective nature of anaesthetised patients. In managing this collective, the expert is one who is able to judge where the boundary lies between what is routine and what is critical in practice, while the junior must judge the personal limits of expertise in practice. In exploring the working of anaesthetic hybrids, we argue that recognising the changing distribution of agency between humans and machines itself illustrates important features of human authorship and expertise.

Anesthesiology↗

PubMed2005

Access, boundaries and their effects: legitimate participation in anaesthesia.

The distribution of work, knowledge and responsibilities in the delivery of anaesthesia has attained particular significance recently as attempts to meet the demands of the European Working Times Directive intensify existing pressures to reorganise anaesthetic services. Using Lave and Wenger's (1991) notions of 'legitimate peripheral participation' in 'communities of practice' (and Wenger 1998) to analyse ethnographic data of anaesthetic practice we illustrate how work and knowledge are currently configured, and when knowledge may legitimately be taken as the basis for action. The ability to initiate action, to prescribe healthcare interventions, we suggest, is a critical element in the organisation of anaesthetic practices and therefore central to any attempts to reshape the delivery of anaesthetic services.

Anesthesiology↗

PubMed2003

Passing on tacit knowledge in anaesthesia: a qualitative study.

OBJECTIVE: To explore the acquisition of knowledge in anaesthetic practice using qualitative methods. METHODS: An ethnographic study examining the nature of expertise in anaesthesia in one English hospital. The study used qualitative research methods, including observation of anaesthetic practice and interviews with members of the anaesthetic team. An integral part of the study was a process of feedback to the anaesthetic team including presenting observational data and conducting debriefing interviews with individual team members. RESULTS: The study highlights the continued importance of the clinical apprenticeship in passing on knowledge, but also emphasizes the central role of practising independently in the acquisition of skills. Anaesthetists who participated in debriefing interviews or read observational transcripts found the experience valuable for thinking about their own practice. DISCUSSION: One suggestion arising from the use of qualitative methods in this setting is that the type of detailed, systematic observation and data recording used in this study could be beneficial in the training and, possibly, appraisal of anaesthetists. This novel and innovative application of qualitative methods in anaesthesia is described and discussed with a view to broadening the debate about specialist training.

Anesthesia↗

PubMed2003

Ethics and ethnography: an experiential account.

In this article, the authors discuss an ethical dilemma faced by the first author during the fieldwork of an ethnographic study of expertise in anesthesia. The example, written from the perspective of the first author, addresses a number of ethical issues commonly faced, namely, the researcher-researched relationship, anonymity and confidentiality, privacy, and exploitation. She deliberates on the influences that guided her decision and in doing so highlights some of the elements that combine to shape the data. The authors argue that this process of shaping the data is a symbiotic one in which the researcher and the community being studied construct the data together.

Anecdotes as Topic↗