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Guest Blog: Doing CA on hospital wards with front-line healthcare professionals

Conversation analysis offers a great deal to those trying to improve how to communicate with people with disorders of language. It’s not always easy, and practical obstacles keep getting in the way: Isabel Windeatt from Nottingham University gives us a lively account of what it’s like to collect and analyse data on a ward for older people .

Isabel Windeatt

I’ve been working closely with front-line healthcare professionals in my role on the VOICE2 study, a conversation analytic study of communication between staff and people living with dementia who are in hospital. I want to share the benefits of collecting data and sharing preliminary CA analyses with healthcare professionals, as well as some of the challenges, in the hope that others will find solutions to collecting data in challenging environments, and be encouraged to involve healthcare staff during the analysis.

The healthcare professionals I refer to are ward-based staff who are unfamiliar with CA and don’t undertake research. I also work with clinical academics who are familiar with CA and recognise its value in healthcare research – they’re the reason I have a job.

Recruiting healthcare professionals on acute hospital wards

The data I’ve been collecting involve naturally occurring interactions on UK acute hospital wards between healthcare professionals and patients living with dementia who were prone to distress, recorded at times when distress was anticipated to occur or had previously occurred.

First, I had to get familiar with the scene. This required a traditional ethnographic immersion in the data collection process. From March to September 2022, myself and 3 other researchers spent 6 months on acute older persons’ hospital wards to collect almost 10 hours of video and audio data.

You have to become familiar with the everyday realities of the scene

Much of that time was spent finding patients for the study and recruiting willing healthcare professionals from amongst the healthcare assistants, doctors, nurses and therapists working on the wards. I had to try to build the trust of staff by talking with them, getting to understand their roles, and generally becoming a bit of a ward fixture so that staff could get to know the person behind the camera. Staff were always busy. I was careful to introduce myself to as many staff as possible and explain what we were doing on the ward – it’s a bit intimidating having someone unfamiliar turning up at your workplace with a large folder and recording equipment, watching and taking notes on what you’re doing!

Start at local manager level. Initially, we presented at a Ward Managers’ team meeting so that those running the wards knew who we were and what we were doing on their ward. We would also approach Ward Managers when first arriving on a ward, recruiting them to take part in the study as this set an example for other ward staff, encouraging them to sign up as well. The Ward Managers recommended staff who might be comfortable in front of the camera. We also presented at Medics’ team meetings and attended board round meetings on the wards. This networking offered our first recruits on each ward and, having broken the ice, recruitment would snowball as talk about the study passed between healthcare professionals.

Recruiting people on the fly

That’s not to say we didn’t have to do our fair share of ‘cold recruitment’. Many healthcare professionals who signed up were those we had to pitch the study to from scratch. For this, having a polished ‘elevator pitch’ was useful, and helped with any nerves about distracting a healthcare professional at work, especially as reading a 10 page long study information sheet didn’t make signing up all that appealing. This pitch would often get interrupted by staff having to dash off to attend to a patient, or a patient might instead stop me – either thinking I was their relative, falling asleep on me, or just wanting to chat. I’d find the healthcare professional later, if possible, to resume our talk when there was a brief moment of calm between patient-focussed tasks, such as when they were watching over their assigned bay.

Not everyone wanted to be part of the study. Many healthcare professionals didn’t feel comfortable being filmed and I even received one unmitigated ‘no’ without any delay or account. Fascinating interactionally, but also mildly disheartening. However, I found many staff were still happy to chat about patients who might be suitable for the study, giving me valuable information on distress patterns of patients I was going to speak to. They would also share their own experiences of dealing with patient distress, and cajole other healthcare professionals to take part.

Blending in

We were careful to emphasise that staff did not have to take part, that they could stop at any time, or say ‘not today’ to us. For those that did take part, our two stage consent process, in which we took consent for future use of video material after they had viewed the recording, meant that they could decide after the recording how they would like it to be used and who would see it. 96 staff allowed us to take up their already limited time by agreeing to take part, a testament to their interest in improving care and demonstrating a selfless nature.

Getting immersed in data collection

A lot of the time, the patient being filmed would wander about the ward, or staff would shifting positions to do their work. So I had to navigate around the scene, trying to keep the interaction on screen, but also keeping in mind patient dignity by covering the camera lens if the situation demanded it.

Seeing how staff handle difficult moments

It was very illuminating collecting data in this way. I got to see first-hand what life on the wards was really like for staff. In my first week, a patient I was assessing the capacity of, switched from being quiet and calmly spoken, to yelling at me that he wanted to murder someone. Staff suggested that it was best just to ignore this behaviour and I had many pleasant chats with this patient after this occurrence. In the few months I was there, I’ve witnessed patients throwing walkers and anything else to hand at staff, fighting each other, and trying break the ward doors open to escape. One of my most memorable occurrences of distress, was a patient who, at the time of his distress, believed staff on the ward were a gang who had taken his young children. This gentleman had taken another patient’s shoes thinking they were his, then used them to hit a ward window, resulting in a resounding crack and broken window. Staff were amazing in all of these circumstances, responding calmly, and with understanding, to patients who couldn’t always help their disinhibited behaviour.

The biggest benefit of being so immersed in the data collection, was that I was able to
learn about the context of the interactions that I would otherwise have missed out on. As the focus of our research – distress – could be fleeting, being on the ward for long periods allowed us to collect field notes to be used alongside the recorded data, something not always done with CA (Mondada, 2012:33; ten Have, 2007:88). Much of our data is better understood in the light of the context of the patients’ prior distressed episodes which these field notes provide.

Hit and miss with data collection

Data collection was time consuming: on some days no data collected, and others more time was spent standing around observing, or waiting for a healthcare professional to undertake a task with a recruited patient. On these long days I was very grateful to the wards that had sofas in their bays.

It was a tiring but valuable process, and being on the wards for these extended periods allowed me to learn some of the healthcare jargon and contextual information that I lacked as non-clinical analyst. It’s also given me a better appreciation of healthcare professions’ concerns, an understanding of their roles, and of what our research is being done in support of.

Sharing analyses with other healthcare professionals

I’ve since shared some work-in-progress with other healthcare professionals at monthly project management group meetings and with a community based team in another NHS Trust. Online meetings make doing this sort of dissemination much easier. The analysis I presented wasn’t finished (is it ever?), and I didn’t have any concrete findings to show them. They understood that and didn’t push me for any. What they did do, was offer their own perspective on the data as healthcare professionals. Presenting here offered valuable insights on the analyses and new perspectives into the data that I otherwise may have missed. It reminded me to take a step back from the data and consider why we are doing this research.

Final thoughts (for the moment). A commendable goal of any research is to have the findings from it put into practice and travel beyond academia. The point of research is to learn, not just for the sake of learning (which is still a valuable endeavour), but to also apply that learning to the real world. Working and sharing work at each stage with healthcare professionals is an essential part of the research process to ensure that we have a practical impact with our findings. Building a network of relationships with front-line healthcare professionals and having ongoing discussions with them helps to ensure that our work is relevant and applicable and we should strive to ensure this becomes an essential part of the research process whenever possible. Personally, I’ve found it by turns exciting, frustrating, and occasionally emotionally challenging – and utterly fascinating throughout.

References

Mondada, L. (2012). The Conversation Analytic Approach to Data Collection. In The Handbook of Conversation Analysis (eds J. Sidnell and T. Stivers). https://doi.org/10.1002/9781118325001.ch3 

ten, H. P. (2007). Doing conversation analysis. SAGE Publications, Limited.

Guest blog: Should we share qualitative data?

Conversation analysts soon accumulate many hours of tapes and transcripts; usually these have been collected on the understanding that they are for the researcher’s own use, with permission only to publish extracts anonymously. But should such data be open to other researchers? Jack B. Joyce, Catrin S. Rhys, Bethan Benwell, Adrian Kerrison, Ruth Parry summarise here the arguments examined in a recent paper.

Jack B Joyce, Catrin S Hughes, Bethan Benwell, Adrian Kerrison and Ruth Parry
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Guest Blog: Promoting CA in Brazil

As Conversation Analysis is increasingly taken up by researchers across the world, we are seeing efforts to bring the approach to their wider local communities. There are several initiatives in Brazil, and I’m delighted that Fabio Ferraz de Almeida, currently working in Finland, has sent in this report of an inaugural workshop in Sao Paulo.

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Fabio Ferraz de Almeida

The idea of organising an introductory CA workshop in Brazil began to take shape last year, while I was talking to a colleague, Bruna Gisi, professor of Sociology at the University of São Paulo (USP). Bruna was developing a postgraduate course on EM and Goffman and invited me to participate in one of the lectures. According to her, several sociologists in Brazil often talk about ethnomethodology but they rarely show how to put  it to use. Her suggestion was that we  discuss a particular EM concept and show how to ‘apply’ it in empirical research. 

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Guest Blog:  Building an EMCA community at CADSS

Groups of EM/CA analysts have sprung up all over the world to share expertise, pore over data together, bounce ideas off each other and provide a sense of shared community. Here Simon Stewart gives an enthusiastic account of recent developments of the group based on the south coast of England.

Simon Stewart, Southampton

This post is intended to share with the CA community some of the resources and learning that have come from our group, CA Data Sessions South (CADSS), in its first 18 months.

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Guest Blog: In memory of Jack Bilmes

All of us at ROLSI were sorry to hear of the death, in May of this year, of Jack Bilmes, one of ethnomethodology’s most original and independent voices, and a warm, generous and caring man. I’m very grateful to Professor Gabi Kasper, an old friend and teaching colleague of Jack’s, for allowing us to reproduce here the obituary that was read out at this year’s IPrA conference. The paper that Jack was to have presented a paper there will, happily, be published in Discourse Studies (1).

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Guest Blog: EM/CA for Racial Justice

There is an intriguing and welcome movement in EM/CA circles recommending that more be done by scholars to engage with social issues. Prime among these issues is racism, and I’m delighted that three early-career academics, Eleonora Sciubba, Natasha Shrikant and Francesca Williamson have agreed to report on their and their colleagues’ efforts to apply EM/CA perspectives on the issue.

The authors of this post [1] are members of a working group entitled, EMCA4RJ—or EMCA for Racial Justice—that was started in June 2020 [2] The purpose of this group is to foreground race and racism as central issues in the EMCA community. 

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Guest Blog: What it’s like to take up a new job in Finland

CA is in demand in many University departments, but scattered far and wide. Here’s the account of one early career researcher, Fabio Ferraz de Almeida, who has made the huge move from Brazil to Finland. Fabio had done his PhD in the UK with Loughborough’s DARG, so it wasn’t a completely unfamiliar move; but Jyväskylä is not the same as the East Midlands…

Fabio Ferraz de Almeida

What would you do if you noticed the pedestrian traffic lights turning red just before you started crossing a street? In Brazil and the UK, and in many other parts of the world, I assume, people would cross the street as long as they saw none vehicle coming. In Finland, however, this is not the case. I would say that one of the best ways for ‘doing being Finnish’ is to wait patiently for the red lights to turn green before crossing a street, regardless of whether any vehicles were in sight.

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How do I get published in ROLSI?

A couple of years ago we published a blog of a roundtable between the editor and a group of CA scholars at Linköping University, discussing ROLSI’s editorial practices. One of those researchers, Professor Leelo Keevallik, is now the Associate Editor of the journal, and she and I are very pleased to revisit some of those issues. We’re very grateful indeed to Dr Marina Cantarutti, one of global CA’s most active and well-connected early career researchers, for posing us questions which will be of interest to all, but especially those who are submitting for the first time.

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