Team talk and team decision processes: a qualitative discourse analytical approach to 10 real-life medical emergency team encounters

ObjectivesExplore the function of three specific modes of talk (discourse types) in decision-making processes.DesignTen real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.Set...

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Published in:BMJ open 2018-11, Vol.8 (11), p.e023749-e023749
Main Authors: Gundrosen, Stine, Thomassen, Gøril, Wisborg, Torben, Aadahl, Petter
Format: Article
Language:English
Subjects:
Anesthesiology
Clinical decision making
Communication
Critical care
Decision making
Discourse analysis
Emergency medical care
Health sciences: 800
Helsefag: 800
Interdisciplinary aspects
Internal medicine
Linguistics
Medical disciplines: 700
Medical personnel
Medisinske Fag: 700
Patient safety
Qualitative research
Teams
Teamwork
Thoracic surgery
VDP
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creator Gundrosen, Stine
Thomassen, Gøril
Wisborg, Torben
Aadahl, Petter
description ObjectivesExplore the function of three specific modes of talk (discourse types) in decision-making processes.DesignTen real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.SettingInterdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).ParticipantsAll emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.ResultsThe three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.ConclusionA discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.
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Activity-type analysis (a qualitative discourse analytical method) was applied.SettingInterdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).ParticipantsAll emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.ResultsThe three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.ConclusionA discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2018-023749</identifier><identifier>PMID: 30391920</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Anesthesiology ; Clinical decision making ; Communication ; Critical care ; Decision making ; Discourse analysis ; Emergency medical care ; Health sciences: 800 ; Helsefag: 800 ; Interdisciplinary aspects ; Internal medicine ; Linguistics ; Medical disciplines: 700 ; Medical personnel ; Medisinske Fag: 700 ; Patient safety ; Qualitative research ; Teams ; Teamwork ; Thoracic surgery ; VDP</subject><ispartof>BMJ open, 2018-11, Vol.8 (11), p.e023749-e023749</ispartof><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2018 Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b496t-5b00497c89567ce5863f8260fa4567155dfeea9871d11f78750dfc84cbbf7f33</citedby><cites>FETCH-LOGICAL-b496t-5b00497c89567ce5863f8260fa4567155dfeea9871d11f78750dfc84cbbf7f33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2129370874/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2129370874?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,315,733,786,790,891,3213,25783,26600,27582,27583,27957,27958,37047,37048,44625,53827,53829,75483</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30391920$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gundrosen, Stine</creatorcontrib><creatorcontrib>Thomassen, Gøril</creatorcontrib><creatorcontrib>Wisborg, Torben</creatorcontrib><creatorcontrib>Aadahl, Petter</creatorcontrib><title>Team talk and team decision processes: a qualitative discourse analytical approach to 10 real-life medical emergency team encounters</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectivesExplore the function of three specific modes of talk (discourse types) in decision-making processes.DesignTen real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.SettingInterdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).ParticipantsAll emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.ResultsThe three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.ConclusionA discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. 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subjects Anesthesiology
Clinical decision making
Communication
Critical care
Decision making
Discourse analysis
Emergency medical care
Health sciences: 800
Helsefag: 800
Interdisciplinary aspects
Internal medicine
Linguistics
Medical disciplines: 700
Medical personnel
Medisinske Fag: 700
Patient safety
Qualitative research
Teams
Teamwork
Thoracic surgery
VDP
title Team talk and team decision processes: a qualitative discourse analytical approach to 10 real-life medical emergency team encounters
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