In:Errors and Interaction: A cognitive ethnography of emergency medicine
Sarah Bro Trasmundi
[Pragmatics & Beyond New Series 309] 2020
► pp. vii–x
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Published online: 29 May 2020
https://doi.org/10.1075/pbns.309.toc
https://doi.org/10.1075/pbns.309.toc
Table of contents
Preface
xi
Introduction
1
Part I.Investigating errors in healthcare interaction
3
Chapter 1.The ecology of human errors in emergency medicine
7
1.Background: Errare humanum est?
7
1.1Two models of human error
9
1.1.1The person model
10
1.1.2The system model
12
2.Critique: Research incommensurability
16
3.An ecological approach to human error: From errors to error cycles
17
Chapter 2.A cognitive ethnography of emergency medicine
21
1.How errors, interaction and cognition can be studied in the wild
21
2.Cognitive ethnography and its roots in distributed cognition
22
2.1Beyond the representationalist view of distributed cognition: The role of interactivity
28
2.1.1Methodological challenges when studying authentic ecologies of emergency medicine
32
2.2Cognitive Event Analysis (CEA)
34
Part II.Behind the scenes: Welcome to the emergency ward
39
Chapter 3.Presenting the case of the emergency ward
41
1.Stepping into the emergency ward
41
1.2Coding, visualisation and data presentation
42
Chapter 4.Medical errors and visual perception
45
1.The hypothesis of visual perception
45
2.Distributed visual systems: What makes human perception special
46
3.Case 1: Temporal dynamics and visual perception
48
3.1The distributed patient
48
3.2The heterarchical roles of artefacts
53
3.3Semantic memory: Categories as constraints in diagnostic processes
56
4.Case II: Sense-saturated visual systems, intentionality and tendencies in visual perception
62
4.1Moulding the optic array through sense-saturated locomotion
62
4.2The historical body, flow of perception, and timescales
69
5.Case III: Random manipulation: Developing the visual system through probing-activities
70
5.1Moving as seeing: An undeveloped visual system
70
6.Understanding visual systems
75
Chapter 5.The function of procedures in the diagnostic process: Anamnesis and physical examination
81
1.The function of procedures
81
2.Case I: Enacting and discarding procedures
84
2.1Beyond fixed procedures: Meshing anamnesis with physical examination
85
2.2Think-aloud strategies: Verbal utterances as material anchors
95
2.3Embodied procedures
100
3.Case II: Procedure following: Cognitive complexity and simplicity
101
3.1The use of notebooks in anamnesis: Managing the complexity of writing and interacting at the same time
101
4.Understanding the status and function of procedures and expertise
107
Chapter 6.Interruptions and multitask tolerance in emergency medicine
109
1.Interruptions and values realisation in emergency medicine
109
2.Case I: Treating interruptions as what?
113
2.1Low multitask tolerance
114
2.2When caring for more than the patient becomes a constraint for task performance
119
2.3Seeking good prospects
122
3.Case II: Team coordination as values realisation: Managing interruptions so they do not interrupt
123
4.Wayfinding in emergency medicine
130
Chapter 7.Cultural dynamics: Emotions, role hierarchies and touch in emergency medicine
133
1.The biomedical model in emergency medicine: Cultural challenges and values
133
2.Case I: The social touch
137
2.1The soothing effect of touch and emotional alignment: Patient-initiated touch
138
2.2Emotions in a biomedical perspective
145
3.Case II: Re-enacting role hierarchies
146
3.1Phase I: Making medical procedures meaningful
152
3.2Phase II: Embodiment as an affordance for meaning
154
3.3Phase III: Emergent changes in perspectives
157
3.4Phase IV: Cultural dynamics in situated meaning-making
158
3.5Phase V: The doctor and the nurse swop positions
159
3.6Phase VI-VII: Functionality and dysfunctionality in the dialogical system
160
3.7Epilogue: On the poverty of phenomenal reports
161
4.Breaking down traditions
163
Chapter 8.Medical teams of experts and novices: An educational perspective
167
1.Why study teams?
167
1.1Problems and solutions in an ecological perspective
169
2.Case I: The emergence of insight: Linking local perceptions with experience
171
2.1Defining the event and its phases: Reverse problem-solving and learning
172
2.2Explanation and procedural observation as insight: The materiality of thinking and professional vision
175
2.3Contextualisation of learning
179
3.Case II: Team performance, professional evaluation and the patient’s roles
181
3.1A collaborative team: The organising power of gaze
182
3.2Managing boundary constraints in a cognitive system
187
4.The benefits of team performance in an educational perspective
193
Chapter 9.Documentation in the electronic medical record: The function of gesture, voice dynamics and gaze
197
1.Integrating typing and verbal interaction
197
2.Case I: The iPatient is only a model of the patient
199
3.Case II: Voice and body dynamics as event markers
202
4.Case III: Gestures as cognitive resources
207
5.The need for external success criteria in the assessment of task performance
212
Part III.The aftermath: The scientific enterprise
215
Chapter 10.The integration of multiple timescales
217
1.Pursuing careful investigations of natural ecologies
217
2.Practical implications and improvement measures
219
2.1The ‘interactivity turn’ in emergency medicine: Beyond laboratory studies
220
2.2Developing training programmes on the basis of what happens
221
2.3Artefact-rich work environments
222
3.Particularities and generalisability: Why cognitive ethnography studies are crucial in emergency medicine
223
4.Future projects and methodological innovations: Adopting cognitive ethnography, interactivity and cognitive event analysis
226
References
231
Index
257
