| 1. |
- Seing, Ida, 1982-
(författare)
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Activating the Sick-Listed : Policy and Practice of Return to Work in Swedish Sickness Insurance and Working Life
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A critical task of social policy in most Western welfare states during recent decades has consisted of reducing the economic burden on society due to sick leave, by stimulating participation in the labour market. Many jurisdictions have introduced activation policies, based on the premise that work “per se” has a therapeutic effect on sick-listed workers. People are expected to be “active”, rather than “passive”, recipients of financial benefits. However, there is limited knowledge of how activation policies focusing on return to work (RTW) are carried out in local practice. Against this background, the overall aim of this thesis is to study the local practice of activation policies by analysing how they are received, implemented and experienced by welfare state organizations, employers and sick-listed workers. The analysis has been influenced by theories concerning organization fields, individualization, street-level bureaucracy and organizational governance.In this thesis, the overall aim is investigated in four interrelated papers. In Paper I, the aim is to analyse the perspectives of stakeholders (i.e. welfare state actors and employers) on work ability by studying multistakeholder meetings. Paper II sheds light on activation policy, focusing on early RTW in the context of modern working conditions; the aim is to analyse RTW practice in local workplace contexts, in relation to Swedish early-RTW policy. The third paper focuses on employers, with the aim of analysing their role and activities regarding RTW, in local workplace practice. In Paper IV, the aim is to analyse sick-listed workers’ experiences of the sickness insurance system in their contact with the Swedish Social Insurance Agency (SSIA) and their front-line staff.The empirical material comprises two empirical studies: 1) audio-recorded multi-stakeholder meetings from regular practice (n=9) and 2) semi-structured interviews with sick-listed workers and their supervisors in 18 workplaces (n=36). The analyses of the material have been performed in accordance with the principles of qualitative content analysis.Main findings of the papers reflect strong organizational boundaries in the implementation process of activation policies. Welfare state actors and employers appear to be governed by their own organizational logics and interests, so the actors involved fail to take a holistic view of sick-listed workers and do not share a common social responsibility for individuals’ RTW. This thesis illustrates how current activation policies focusing on RTW are based on a rather idealized image of the standard workplace. There is an explicit or implicit assumption that employers and work organizations are able to welcome sick-listed workers back to work in a healthy way. However, the intensity of modern working life leaves limited room for accommodating people with reduced work ability, who are not considered to have a business value to the workplace. In several cases, findings indicate that the SSIA’s focus on activation and early RTW clashes with the financially oriented perspective of employers. Economic considerations regarding their business take precedence over legal and ethical considerations, and employers have difficulty taking social responsibility for RTW. Sick-listed workers are encouraged to adjust to new workplace settings and environments to meet the demands of the workplace, and, if RTW is not possible, to the demands of the labour market. The findings also show that sick-listed workers experience that contacts with the SSIA are ‘standardized’; i.e., they perceive that the officials are loyal to demands in their organizations rather than being involved actors who support workers’ individual needs. Sick-listed workers clearly experience that measures in Swedish activation policies have a strong focus on demanding aspects (financial work incentives) and less on enabling aspects (investments in skills).Overall, this thesis illustrates an emerging social climate where sick-listed workers are positioned as active agents who must take responsibility for their sick leave and their RTW process. In a Swedish context, RTW is a matter of activating the sick-listed rather than activating the workplace.
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| 2. |
- Ziegert, Kristina
(författare)
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Everyday Life among Next of Kin of Haemodialysis Patients
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Everyday life can be complex when next of kin of haemodialysis patients are preoccupied with taking care of the patient and his/her health, which implies the difficulties and requirements needed. The general aim of this thesis was to explore and describe everyday life among next of kin of haemodialysis patients with focus on the life situation, health, time and professional support. Two perspectives of the thesis was applied: a holistic perspective on the everyday life of next of haemodialysis patient and a social perspective with focus on human communication and understanding of next of kin’s experience of everyday life. A qualitative descriptive and explorative design, comprising a phenomenographic and content analysis was used in Studies I-IV. The data collected in the studies consisted of interviews with next of kin to haemodialysis patient and analysis of professional support for next of kin to chronic haemodialysis patients in nursing documentation from two hospitals in Sweden. The experience of time in everyday life among next of kin of haemodialysis patients demonstrated that time for them is minimised and life space contracted. Next of kin experienced ambivalence towards their own health, especially in cases of patients’ spouses When next of kin of haemodialysis patient’s became involved in the patients’ care, they experienced arduousness in relation to their own health as well as less uninterrupted time for themselves in everyday life, and their life situation was characterised by confinement and social isolation. They were aware of the prognosis of renal disease and the fact that haemodialysis is a life-sustaining treatment, which forced them to live for the moment. The everyday life among the next of kin changed when the family became involved in the care, which in turn lead to a changed life situation and restrictions in everyday life. Lack of knowledge in nursing documentation of professional support revealed necessity of the readiness of next of kin. It is therefore important to be familiar with this in the nursing process, especially when the patient and their next of kin need support and attention in everyday life.Original papers not included.
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| 3. |
- Broqvist, Mari, 1958-
(författare)
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Asking the public : Citizens´ views on priority setting and resource allocation in democratically governed healthcare
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Resource allocation in publicly funded healthcare systems is inevitably linked with priority setting between different patient groups and between different service areas, so-called meso level priorities. Behind every priority-setting decision (investments, reallocating or rationing), are values affecting both the content of the decisions and how the decisions are made. The importance for priority-setting to reflect social values, has been emphasised for the legitimacy of the healthcare systems and the decision makers. Also important, if supposed to provide enough guidance in practice, is that content values, expressed in ethical principles and criteria, are further operationalised. Few studies exist where Swedish citizens have been asked about priority setting and rationing at meso level, and findings from other countries cannot automatically be transferred to the Swedish context.The overall aim of this thesis is to extend and deepen the knowledge of the Swedish citizens´ views on acceptance of rationing in healthcare, on appropriate decision makers for rationing, and on the severity criterion for priority setting. Two qualitative and one mixmethod study were conducted, where citizens were interviewed. Citizens´ views on severity were also compared, both with a Severity Framework, derived from parliamentary-decided ethical principles and used for resource allocation, and with health professionals´ and politicians´ ranking of different aspects of severity in a quantitative, survey study.Study I shows that citizen participants perceived that acceptance of rationing at meso level is built on the awareness of priority-setting dilemmas between patient groups. No such spontaneous awareness was found. Depending on reactions of self-interest or solidarity, acceptance was also perceived to be built on acceptable principles for rationing and/or access to alternatives to public care. Study II shows that awareness of the meso level forms the basis for awareness of different risks of unfairness, linked with potential decision makers (even health professionals). Collaborative arrangements were promoted in order to control for such risks, especially the risk of self-interest. Politicians, in contrast to previous studies, were favoured as final decision makers for rationing healthcare. In study III, citizen participants identified the same severity aspects as health professionals and experts had done in the Severity Framework. They contributed with some possible refinements, but also promoted aspects not in line with established ethical criteria for priority setting in Sweden. Study IV shows that citizen respondents differ to a larger proportion compared to politicians´ ranking of severity aspects, than with that of health professionals´. The greatest number of significant differences was found between politicians and health professionals.This thesis has several implications. Politicians ought to strive for greater public awareness of the priority-setting dilemma at the meso level in healthcare, both according to the process and the content values behind the decisions. Social values not in accordance to the parliamentary decision indicate a need to facilitate an ongoing dialogue, reason-giving activities and promotion of content values of solidarity. To capture social values on priority setting and rationing, ambitious public deliberation is not the only way. Methodologically stringent research, with a variety of study designs, could contribute in many important ways.
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| 4. |
- Fagerlind Ståhl, Anna-Carin, 1982-
(författare)
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Live long and prosper : Health-promoting conditions at work
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to contribute with knowledge concerning health-promoting conditions at work, and to investigate how individual, workplace and organisational conditions are interrelated. In the thesis, work-related flow, i.e. an experience of motivation, absorption and work enjoyment, is used as a holistic notion of occupational health. In Paper I, work-related flow is investigated in relation to decision latitude, social capital and an innovative learning climate at work. Paper II investigates whether the use of tools inspired by lean production, such as standardisation and value stream mapping, is positively associated with conditions for innovative learning in organisations. The aim of Paper III is to identify conditions for health and performance in organisation and at work; further, to investigate the association between work-related flow and performance. Paper IV reports on a longitudinal investigation of workrelated flow in relation to lean tool use and conditions at the workplace. The empirical material is based on data from 10 organisations, including 4442 employees. Papers I-III are cross-sectional, whereas Paper IV is longitudinal. Papers II-IV utilise multilevel analyses.The results show that decision latitude, social capital and an innovative learning climate are associated with an increase in work-related flow (Papers I, III & IV), and with performance (Paper III). Individuals’ decision latitude enables an increased benefit from the social capital and innovative learning climate at work (Paper I). The effect of tools inspired by lean production on work-related flow (Papers III & IV), and on conditions for innovative learning (Paper II) differs, depending on which tools are used, and on workplace conditions. These tools enable innovative learning mainly where decision latitude is low (Paper II), and it is primarily the lean tool value stream mapping which has the potential to create an arena for innovative learning (Paper II) and work-related flow (Paper IV).It is concluded that the individual is embedded in a social work context that has the potential to strengthen the ability to act with motivation, absorption and enjoyment. In order to utilise collective healthpromoting conditions at work, individuals need to have authority to make their own decisions and use their skills. The effect of tools inspired by lean production depends on the specific tools that are used, and on individuals’ decision latitude at work. Their potential to enable innovative learning is most evident for employees who have few opportunities for autonomous decision-making and skill use in their work. For those with a high degree of decision latitude, the use of lean tools has a smaller effect. Work-related flow may in itself serve as a resource that improves performance and increases engagement in health-promoting work conditions. In order to promote health as well as performance, work needsto be organised so that employees have opportunities to decide over their own work, and utilise their skills, individually and collectively within the workgroup.
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| 5. |
- Davidson, Thomas, 1977-
(författare)
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How to include relatives and productivity loss in a cost‐effectiveness analysis
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Health economic evaluations are today commonly used in the decision‐making process in health care. Within the field of cost‐effectiveness analysis (CEA), there are several methodological and empirical issues that cause debate about what is included in the analysis. This thesis covers two such issues; costs and effects for relatives, and the valuation of individuals’ productivity loss due to morbidity. The objective of the thesis is to provide further knowledge about what should be included in CEAs which take a societal approach. The papers that the thesis is based on, four in total, examine the theoretical aspects of the studied issues and test these aspects empirically. Three different data materials were used. The CEA and the estimation of costs and effects are central in all the papers. The outcome measure used is quality‐adjusted life years (QALYs).The relatives of an individual with a disease or disability often provide informal care, and there may also be concomitant effect on their own well‐being. Nevertheless, the costs and effects for the relatives are generally excluded from CEAs, and there are few guidelines for how to include relatives’ effects. This thesis suggests the use of a new measure, R‐QALYs, which can be used both to visualise relatives’ effects and to include them in the analysis. We found that while the EQ‐5D instrument can be used to capture some of the relatives’ effects, it most likely misses a number of important attributes, for example altruistic preferences. Methods of eliciting R‐QALY weights include direct valuation methods and indirect methods, using existing relativerelated instruments. However, none of these methods are without difficulties, and there is a need for more studies on estimating valid relatives’ effects. Another possible approach with high potential is to use monetary measurements for both the costs and effects relevant to relatives.The results also show that income affects the QALY weights if the individuals include the utility generated by consumption within their QALY weights. The empirical tests showed that a majority of individuals do not consider their own income when they value health states. An explicit instruction to take income into account seemed to affect the valuation of those health states that were assumed to have consequences on the ability to perform daily activities. These findings give support for including the productivity costs caused by morbidity in the analysis; as these costs are not, or are only to a minor extent, implicitly incorporated in individuals’ QALY weights. The loss of leisure time, however, is captured in the QALY weight, and care must be taken to avoid double counting this loss in the analysis.The results of CEAs will only be partial if relatives’ costs and effects and the costs of individuals’ productivity loss are excluded for health interventions where they are assumed to be of significant importance.
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| 6. |
- Samelius, Charlotta, 1964-
(författare)
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Abused Women : Health, Somatization, and Posttraumatic Stress
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to estimate the lifetime prevalence of physical, sexual, and psychological abuse in a random population-based sample of women aged 18-60 years; to estimate current suffering thereof; and to investigate associations between abuse and health problems, more specifically to study abuse related variables associated with somatization and PTSD, respectively.The studies had a cross-sectional design. Studies I and II comprised 4150 women 18-60 years. Study III included 547 women, and study IV consisted of 213 women, randomly selected from the population-based sample of the first two studies.The first study found lifetime prevalence rates of 19.4% for physical abuse, 9.2% for sexual abuse, and 18.2% for psychological abuse. Abused women reported more ill-health and a less advantageous social situation than non-abused women. There was an association between magnitude of abuse and health problems. Even a low magnitude of abuse was substantially associated with ill-health. In the second study we found that of the 27.5% of women who had reported any kind of abuse in the first study, 69.5 % reported current suffering thereof. Abused suffering women reported more health problems than abused non-suffering women and non-abused women, and abused non-suffering women reported more health problems than non-abused women. In study three, psychological abuse and sexual abuse without penetration were found to be associated with somatization. Physical abuse and sexual abuse with penetration were not associated with somatization, when adjustments for other kinds of abuse were made. In study four, PTSD and somatization were found to be separately reported phenomena in abused women, although PTSD was positively associated with having somatic symptoms. Women with PTSD reported higher total magnitude of abuse and a higher number of perpetrators than women with somatization. Sexually abused women with PTSD more often described their experience as an act of abuse compared with sexually abused women with somatization.The present thesis demonstrates that even a low magnitude of abuse is associated with health problems. It also shows that a majority of the abused women, when investigating lifetime history of abuse, reported current suffering thereof, which warrants considering abuse an important societal problem. The relationship between somatization and posttraumatic stress in abused women is discussed in relation to abuse variables. Other factors than severity of abuse, such as whether the abused woman herself perceives her experience as abuse, seem to be more decisive for development of somatization in abused women. The findings suggest that PTSD is not a necessary mediator between abuse and somatization.
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| 7. |
- Zarenoe, Reza, 1969-
(författare)
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Tinnitus in Patients with Sensorineural Hearing Loss : Management, Quality of Life and Treatment Strategies
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Approximately 15% of Swedish people experience tinnitus, but only 2.4% experience severe problems. Treatment modalities for tinnitus vary, but the most common treatment is counseling. The majority of patients with tinnitus report some degree of hearing loss, and hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment. The aim of the present thesis was to investigate disease management, determine quality of life and identify treatment strategies for patients with tinnitus and sensorineural hearing loss.The first two studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at two Ear-Nose-Throat (ENT) clinics in Östergötland County, Sweden, during the years 2004 - 2007. Study I showed that 70% of the cohort had tinnitus; however, many did not initially receive a diagnosis of tinnitus. Information about vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to health was often missing from the patients’ medical records. The results could show that the overall scores using the Tinnitus Handicap Inventory (THI) were higher in female patients than in male patients. Although it is likely that hearing aids would be beneficial for the majority of these patients, 314 (44%) of the 714 total patients had hearing aids. Furthermore, the outcomes from study II demonstrated that a majority of the patients (61%) who were dissatisfied with the care they had obtained had no hearing aids. This finding may indicate that the fitting of hearing aids is an important treatment for patients with both tinnitus and hearing loss.Studies III and IV were prospective studies. Data collection was based on patients who sought care for tinnitus and/or hearing loss at the ENT clinic in Linköping during 2012-2013. In study III, 92 patients were divided into two groups: one group contained individuals with both tinnitus and hearing loss, and the other group contained patients with only hearing loss. The patients were assessed using the Reading Span test, the Hearing in Noise Test (HINT) and three questionnaires (the THI, the Hearing Handicap Inventory for Elderly and the Pittsburg Sleep Quality Index) at baseline and follow-up. The results from the age-matched subgroups (n=30+30) generated from the full clinical groups (46+46) showed significantly improved Reading Span test performance and sleep quality in patients with both tinnitus and hearing loss. Similar results were observed in our full clinical population (n=46+46). However, the interpretation of this finding is difficult due to age differences between the groups. In conclusion, hearing aid fitting had a significantly positive impact on working memory capacity and sleep quality in patients with both tinnitus and hearing loss compared with patients with only hearing loss.In study IV, a brief Motivational Interviewing (MI) guide was integrated into the hearing rehabilitation process for 23 patients with both tinnitus and hearing loss, and they were compared against a control group (n=23) of patients with both tinnitus and hearing loss who underwent traditional hearing rehabilitation. The results showed that the patients who received the brief MI guide required fewer visits to complete their hearing rehabilitation compared with the patients in the control group. In addition, there was a significant difference in THI scores between the groups, which indicated that the intervention reduced tinnitus annoyance more in the MI group. Furthermore, both groups showed higher scores at follow-up compared with baseline on the International Outcome Inventory for Hearing Aids (IOI-HA) scale, which indicated that both approaches showed a positive effect on hearing aid satisfaction.Study V was a retrospective, descriptive study that focused on a part of a Stepped Care model and included patients who participated in half-day tinnitus information meetings from 2004 to 2011 in the audiology clinic at Linköping University Hospital. A total of 426 tinnitus patients with complete questionnaires (the THI and the Hospital Anxiety and Depression Scale, HADS) were included in the study. The results showed significant decreases in scores on the THI and the anxiety module of the HADS before and after the information session. However, there were no statistically significant changes in the depression module of the HADS.In conclusion, this thesis underscores the importance of hearing impairment, cognitive variables and motivational procedures in the management of tinnitus. Multidisciplinary group information needs to be further validated.
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| 8. |
- Allemann, Hanna, 1979-
(författare)
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Online support for informal carers of persons with heart failure : Focus on perceptions, development and experiences
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Heart failure (HF) is a common condition, and its prevalence is expected to increase. The illness trajectory is unpredictable, and its effects will include a potential impact on informal carers, i.e., family, friends, and significant others. Sometimes these persons are affected by the help and care they provide in such a way that they might themselves need support. However, they may be unrecognised in their endeavours, and might also experience a lack of support, especially from healthcare. Online solutions are considered to have the potential to provide accessible support to carers that is also anticipated to be cost-effective. Aim: This thesis focuses on support to informal carers to persons living with HF, but also take the viewpoint of the person with HF by exploring social supports associations with their health and well-being. The overall aim was to explore perceptions, development, and experiences of online support for informal carers. Method: This thesis comprises four studies. Study I had a cross-sectional design using self-reported data and data from the Swedish Pace-maker and ICD Registry. Data from 1,550 persons with HF who were living with an ICD and who had complete data on the outcome variable were utilised for both descriptive analysis and logistic regression. The outcome variable, perceived social support, was measured using the questionnaire Multidimensional Scale of Perceived Social Support (MSPSS), which includes measuring support from significant others, family, and friends. The logistic regression was conducted to compare those dichotomised as having low/medium perceived social support to those having high levels of support. Study II had a qualitative design, and data were collected through 8 focus groups with 23 informal carers of persons with HF to explore their perceptions of how online solutions could be of value for support. Data were analysed using qualitative content analysis. Study III had a descriptive design. It describes the co-design process of an online support pro-gramme for carers through three phases. In phase I, topics and content that reflected carers needs and preferences were identified. In phase II, the content for the support programme was developed and through phase III the content was refined and finalised. Informal carers participated in every phase, and the co-design process also involved professionals with expertise in, for example, HF and caregiving, for the development of content. It was an iterative process, moving back and forth between phases, and the re-search group acted as coordinators and ensured that carers’ voices were kept central to the process. Study IV had a qualitative design, and data were collected through individual semi-structured interviews with 15 carers. Interviews were analysed using qualitative content analysis. The study focused on informal carers' experiences of online, co-designed support pro-gramme while being participants in a randomised controlled trial (RCT) that has the aim of studying the effects of engaging with the programme. Results: The findings show that one in five diagnosed with HF and living with an ICD reported low/medium levels of social support and that these persons had higher odds of negative psychosocial outcomes. This un-derscores the value and importance of support from informal carers for the well-being of those with HF. The thesis focused on perceptions, development, and experiences of online support for informal carers. The findings suggest that a co-designed support programme has the potential to be usable and useful for carers considering the online format and its content. It may provide insights, preparedness, and validation in relation to being a carer of a person with HF. However, carers may have an ‘ambiguous stance’ towards the online format and going online for support may not be the preferred form of support for all carers. Conclusion: A co-designed online support programme, when built on a trusted platform within a healthcare context, may be considered both usable and useful for carers. The online format and content also provide the potential to offer timely and adaptable support. The content, developed in a collaboration between carers and professionals, offers evidence-based, relevant information, thereby possibly avoiding seeming impersonal, which can also be beneficial. The programme acknowledges the intertwined lives of carers and those with HF, and its content reflects this, potentially also enhancing its perception as usable and useful for carers. Still, the potential of the support programme depends on carers being aware of its existence, or being made aware, and can further recognise its value. The support programme is considered to have the capacity to be relevant for a broad group of carers, and therefore efforts may be of importance to ensure it is accessed and utilised. However, it is also important to take into account that not everyone may be willing or able to go online for support, or may wish to stay in a caring role. Healthcare also needs to recognise this when offering support to carers and the online support may be regarded an option among several.
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| 9. |
- Andersson, Sten-Ove, 1953-
(författare)
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Militär akutsjukvård i fält : när den övade verkligheten blir verklig
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: Governing for the Armed Forces health care is respect for human dignity and the view of each individual as irreplaceable. The quality of the military care will be at a level equivalent to that of today's civil peace healthcare, which requires that the training is of high quality. Casualty care in the military environment is a complex, challenging and dangerous task. Today there is a lack of knowledge about how to learn these skills. The purpose of the research was to identify the knowledge area pre-hospital care in the military environment by examining what doctors, nurses, paramedics and officers learn about military health care during preparation and exercise.Method: A phenomenographic approach was used in all sub-studies, and empirical data were collected by means of semi-structured interviews. Study I‐III are cross-sectional studies and study IV is a longitudinal study. Twelve registered nurses who had served in Bosnia were interviewed for study I, and 24 conscript paramedics were interviewed for study II. Study III included 20 officers in their pre-deployment training for service in Afghanistan and Liberia, and Study IV included 7 doctors and twenty nurses who previously had served in Afghanistan, Bosnia, Kosovo and Liberia.Results: Learning military health care by training and gaining experience can be seen as different abilities; interaction, action and reflection. In-depth analysis at a meta--‐level revealed that the integration between the military and military medical fields of knowledge was missing. The results indicate that participants' understanding of their respective fields of knowledge is inadequate and needs to be integrated in education in a clearer way.Implications: To create opportunities for better education and integration in these fields of knowledge are proposed (1) that the findings of the thesis could be utilised to develop the design of the curriculum (2) the inter-professional learning is introduced as a part of creating a safer and more effective pre-hospital care, (3) the clinical competence becomes part of the development of pre-hospital emergency care in the field, and (4) that the training is built according to the principle of "train as you fight" with emphasis on the requirements in the combat zone.
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| 10. |
- Fornander, Liselott, 1981-
(författare)
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How we talk : aspects of communication and team cognition of trauma resuscitation teams
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A trauma team consists of professionals assembling in an ad hoc manner to resuscitate a patient with life-threatening injuries. In such a team, how the team manages to use non-technical skills, such as communication is important to achieve task management and decision making. Communication is practised in simulations, and the simulation environment has also been used in research to understand teamwork processes. This thesis is based on video observations of trauma teams working in real life (IRL) and in situ simulations of trauma resuscitations. The aim was to assess the creation of team cognition IRL and in simulation, to analyse verbal communication in the teams and the effects of real-time communication on team structure. In Study I, a grounded theory analysis was undertaken to understand how verbal and non-verbal interactions create team cognition. The analysis resulted in a theory pointing to “split vision” as a team’s ability to alter process modes between team positioning and sensitivity to the patient that was dependent on patient and situational values absorbed from team members’ implicit actions. In Study II, the verbal response modes taxonomy was applied to analyse both the grammatical and pragmatic meaning of verbal interactions that were compared between team roles. In the six most communicative team roles in the context of IRL trauma teamwork, pure mode communication dominated the way of delivering messages. In Study III, the structures of four IRL and four simulated trauma teams were analysed using a social network analysis of real-time communication. Overall, the teams were highly centralised, with the examining physician functioning as an information hub. In Study IV, communication from the same teams was categorised according to information and task management, as well as different coordination behaviours. We compared the IRL and simulation domains based on the proportions of utterances of each category/code, and found that “Give information after request” and closed-loop communication were more prevalent in simulation. Observing real-time communications using different methodologies gave a perspective on the conditions and possibilities for adaptation in terms of work prescriptions and team training, such as room for more communication and possible congestions of nodes in terms of occupancy and tacit communications and working modes thus far unnoticed by us and unreported. Such understanding complements established knowledge about coordination behaviours and interactive team cognition and should be taken into consideration in the practise and training of trauma teams.
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