Enhancing the Human Dimensions of Children's Neuromuscular Care: Piloting a Methodology for Fostering Team Reflexivity

Monday, 16 July 2018: 16:00
Oral Presentation
Patricia THILLE, University of Manitoba, Canada
Barbara E. GIBSON, University of Toronto, Canada
Thomas ABRAMS, Dalhousie University, Canada
Laura MCADAM, Holland Bloorview Kids Rehabilitation Hospital, Canada
Bhavnita MISTRY, Holland Bloorview Kids Rehabilitation Hospital, Canada
Jenny SETCHELL, University of Toronto, Canada
For people with chronic, progressive conditions, high quality clinical care attends to the human dimensions of illness - emotional, social, and moral dimensions - which co-exist with biophysical manifestations of disease. We piloted a dialogical methodology with a children’s rehabilitation team to foster reflexivity, aiming to strengthen attention to human dimensions of clinical practice. Reflexivity brings historical, institutional, and socio-cultural influences on clinical activities to the fore, enabling consideration of new care practices.

The participating clinical team works with young people with muscular dystrophy, and their families. The methodology involved three facilitated, interactive, two-hour dialogues with the clinicians. We aimed to make routine practice strange, and thus open to reflexive examination. Each dialogue involved clinicians learning to apply a social theory (Mol’s The Logic of Care) to ethnographic fieldnotes of clinical interactions, with discussion and refinement of recommendations for improving clinical care. Dialogues were audiorecorded and transcribed. We used discourse analysis methods that preserve group dynamics to evaluate the extent to which the methodology spurred reflexive dialogue within the team.

Overall, imagining impacts of clinical care on people’s lives – emphasized in the social theory and aided by the 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, choice-logic practices by co-constructing the metaphor of balancing logics that inform care delivery. When invoked, the balance metaphor deflected attention from emotional, social, and moral impacts of clinical care on the lives of patients and their families. These emergent findings highlight the value of analysing reflexivity-oriented dialogues using discourse analysis methods. Our findings now inform a follow-up study, which will examine emerging impacts on clinical practice using realist evaluation methods.