Managing Patient-centered Communication across the Type 2 Diabetes Illness Trajectory: A Grounded Practical Theory of Interactional Sensitivity

This article uses the theoretical and methodological framework of Grounded Practical Theory (GPT) to provide a lens for analyzing and interpreting discourse as a situated form of social action in routine Type 2 diabetes visits. Drawing on a total data-set of 400 audio-recorded routine visits, we randomly selected 55 visits for qualitative analysis. In this article, we use Conversation Analysis to document communication techniques, which we in turn use as evidence to ground our claims within the GPT framework. We use two single cases of interaction to analyze communication techniques physicians use when recommending a change from oral medication to insulin. We argue treatment intensification is a key moment in health communication to reflect about patient centeredness because physicians can find themselves in an interactional dilemma: while insulin may effectively help control unstable disease, an insulin recommendation may simultaneously counter patient values and treatment preferences. Our analysis suggests that physicians use what we call interactional sensitivity to balance medical need and patient preferences when making medical decisions by tailoring their communication according to the local situation and the patient's larger illness trajectory. We propose that interactional sensitivity is a type of communication work and a quality of patient-centered communication characterized by the theoretical relationship between tailoring communication to the contingencies of the local interaction and the global illness trajectory. Overall, this article contributes to health communication scholarship by proposing a normative model for reflecting on how physicians negotiate challenging interactions with patients during routine chronic illness visits.     

A Call to Educate,Participate, Invoke and Indict: Understanding the Communication of Online Hate Groups

This study analyzes the messages in hate group websites using a grounded theory approach. Through this process of interpretive inquiry we propose four prominent themes—educate, participate, invoke, and indict—that characterize the messages examined in 21 hate groups. These message themes speak to the: (a) education of members and external publics; (b) participation within the group and in the public realm; (c) invocation of divine calling and privilege; and (d) indictment of external groups including the government, media, and entertainment industries, and other extremist sects. In advancing a substantive grounded theory of online hate group communication, we also explore the potential of these themes to ostensibly reinforce the hate group's identity, reduce external threats, and recruit new members.     

A Grounded Practical Theory Reconstruction of the Communication Practice of Instructor-facilitated Collegiate Classroom Discussion

Instructor-facilitated collegiate classroom discussion (IFCCD) is a highly valued yet undertheorized instructional practice. Research examining the structure of classroom interaction, scholarship advocating rationales for discussion-based pedagogy, and an investigation of a related interactive classroom communication practice provide an informative backdrop for this study. The data in the study were collected using action-implicative discourse analytic techniques throughout a semester in three classrooms at the same university. Reconstructing the three levels of the practice through grounded practical theory—the problem/dilemma level, the normative situated ideals level, and the talk/discourse techniques level—provides some insight into why in two of these cases of IFCCD, engaged and participatory discussion was accomplished. The shared dilemma of the practice is reconstructed as the problem of engagement in which both individual engagement with curricular content and shared engagement in co-creation of the discussion are valued. The dilemmatic nature of the practice is explored specifically in terms of traditional and nontraditional teacher talk and associated participation structures. Significant similarities and differences across the three cases are found and examined in the reconstructions of instructor situated ideals and third-turn facilitation techniques. Initial conclusions are incorporated in the discussion of discourse-based applications for practitioners interested in facilitating discussion in college classrooms.     

Designing Communication Process for the Design of an Idea Zone at a Science Center

In this paper, we use the occasion of the design of a learning space (The Idea Zone) in a science center setting, the Museum of Science and Industry, to illustrate the importance of attending to communication issues in the design of a process to design the space. We explore communication processes in the conceptual design phase, with specific attention to bringing Needfinding to a participatory design framework. Use of the World Café is made to create a conversational space for the participatory design process. We reflect on the recursive nature of designing communication process for participatory design of the Idea Zone and offer seven principles that integrate the theories and practices of both communication and design, bringing particular attention to generative metaphors, reflective practice, and emergence of a “third language” for designing together with others.     

Communication in Emergency Medicine: Implications for Patient Safety1 This study was funded by a generous grant from the National Patient Safety Foundation.

Emergency medicine is largely a communicative activity, and medical mishaps that occur in this context are too often the result of vulnerable communication processes. In this year-long qualitative study of two academic emergency departments, an interdisciplinary research team identified four such processes: triage, testing and evaluation, handoffs, and admitting. In each case, we found that narrative rationality (the patient's story) was consistently subjugated to technical rationality (actionable lists). Process changes are proposed to encourage caregivers to either reconsider their course of action or request additional contextual information. A heightened awareness of the bias for technical over narrative rationality and a better recognition of uncertainty in emergency medicine communication are important first steps toward anticipating potential failures and ensuring patient safety.     

EPR核电工程文档管理系统设计的挑战、应对及实践

作为国内首个EPR核电站,台山核电站以建设"国际一流三代核电标杆工程"为目标。本文以此为楔入点,以EPR核电工程文档1管理系统的相关设计问题为研究对象,分析了其面临的管理要求与业务挑战,提出了项目视角、内容管理和全电子化等主要应对策略,并对系统设计初步实践的成效进行了客观阐述。