Enhancing the human dimensions of children's neuromuscular care: piloting a methodology for fostering team reflexivity.
For those with chronic, progressive conditions, high quality clinical care requires attention to the human dimensions of illness-emotional, social, and moral aspects-which co-exist with biophysical dimensions of disease. Reflexivity brings historical, institutional, and socio-cultural influences on clinical activities to the fore, enabling consideration of new possibilities. Continuing education methodologies that encourage reflexivity may improve clinical practice and trainee learning, but are rare. We piloted a dialogical methodology with a children's rehabilitation team to foster reflexivity (patient population: young people with Duchenne's or Becker's muscular dystrophy). The methodology involved three facilitated, interactive dialogues with the clinical team. Each dialogue involved clinicians learning to apply a social theory (Mol's The Logic of Care) to ethnographic fieldnotes of clinical appointments, to make routine practice less familiar and thus open to examination. Discourse analyses that preserve group dynamics were completed to evaluate the extent to which the dialogues spurred reflexive dialogue within the team. Overall, imagining impacts of clinical care on people's lives-emphasized in the social theory applied to fieldnotes-showed promise, shifting how clinicians interpreted routine practices and spurring many plans for change. However, this reflexive orientation was not sustained throughout, particularly when examining entrenched assumptions regarding 'best practices'. Clinicians defended institutional practices by co-constructing the metaphor of balancing logics in care delivery. When invoked, the balance metaphor deflected attention from emotional, social, and moral impacts of clinical care on patients and their families. Emergent findings highlight the value of analysing reflexivity-oriented dialogues using discourse analysis methods.
['Thille|Patricia|P|http://orcid.org/0000-0003-1961-9818', 'Gibson|Barbara E|BE|', 'Abrams|Thomas|T|', 'McAdam|Laura C|LC|', 'Mistry|Bhavnita|B|', 'Setchell|Jenny|J|']
D000884:Anthropology, Cultural D002648:Child D002908:Chronic Disease D004644:Emotions D006282:Health Personnel D006801:Humans D007858:Learning D008297:Male D020388:Muscular Dystrophy, Duchenne D010348:Patient Care Team D061214:Patient Safety D011787:Quality of Health Care D011788:Quality of Life D066269:Social Theory D013192:Staff Development D035502:Trust
Reflexivity Discourse analysis Chronic disease Continuing professional development Qualitative methodology