Item Details

Getting to know a new protocol in hypertension care: Nurses’ use of patients’ self-generated graphical data in follow-up consultations

Issue: Vol 16 No. 1 (2019)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.37345

Abstract:

This study explores the use of a new protocol in hypertension care, in which continuous patient-generated data reported through digital technology are presented in graphical form and discussed in follow-up consultations with nurses. This protocol is part of an infrastructure design project in which patients and medical professionals are co-designers. The approach used for the study was interaction analysis, which rendered possible detailed in situ examination of local variations in how nurses relate to the protocol. The findings show three distinct engagements: (1) teasing out an average blood pressure, (2) working around the protocol and graph data and (3) delivering an analysis. It was discovered that the graphical representations structured the consultations to a great extent, and that nurses mostly referred to graphs that showed blood pressure values, which is a measurement central to the medical discourse of hypertension. However, it was also found that analysis of the data alone was not sufficient to engage patients: nurses' invisible and inclusion work through eliciting patients' narratives played an important role here. A conclusion of the study is that nurses and patients both need to be more thoroughly introduced to using protocols based on graphs for more productive consultations to be established. 

Author: Mona Lundin

View Full Text

References :

Ball, Marion J. and Jennifer Lillis (2001) E-health: Transforming the physician/patient relationship. International Journal of Medical Informatics 61 (1): 1–10. https://doi.org/10.1016/S1386-5056(00)00130-1

Bengtsson, Ulrika, Dick Kasperowski, Lena Ring and Karin Kjellgren (2014) Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives. Blood Pressure 23 (5): 288–295. https://doi.org/10.3109/08037051.2014.883203

Bengtsson, Ulrika, Karin Kjellgren, Inger Hallberg, Mona Lundin and Åsa Mäkitalo (2018) Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system. Scandinavian Journal of Primary Health Care 36 (1): 70–79. https://doi.org/10.1080/02813432.2018.1426144

Beun, Johan G. (2003) Electronic healthcare record; A way to empower the patient. International Journal of Medical Informatics 69 (2): 191–196. https://doi.org/10.1016/S1386-5056(03)00060-1

Derry, Sharron J., Roy D. Pea, Brigid Barron, Randi E. Engle, Frederick Erickson, Ricki Goldman, Rogers Hall et al. (2010) Conducting video research in the learning sciences: Guidance on selection, analysis, technology, and ethics. Journal of the Learning Sciences 19 (1): 3–53. https://doi.org/10.1080/10508400903452884

Drew, Paul and John Heritage (1992) Analyzing talk at work: An introduction. In Paul Drew and John Heritage (eds) Talk at Work, 3–65. Cambridge: Cambridge University Press.

Hallberg, Inger, Charles Taft, Agneta Ranerup, Ulrika Bengtsson, Mikael Hoffmann, Stefan Höfer, Dick Kasperowski et al. (2014). Phases in development of an interactive mobile phone-based system to support self-management of hypertension. Integrated Blood Pressure Control 7: 19-28https://doi.org/10.2147/IBPC.S59030

Heath, Christian, Paul Luff and Marcus S. Svensson (2003) Technology and medical practice. Sociology of Health & Illness 25 (3): 75–96. https://doi.org/10.1111/1467-9566.00341

Hindmarsh, John, K. Neil Jenkings and Tim Rapley (2007) Special Issue: Introduction to healthcare technologies in practice. Health Informatics Journal 13 (1): 5–8. https://doi.org/10.1177/1460458207073642

Goble, Ryan and Caroline H. Vickers (2015) ‘Shift’ ’n ‘control’: The computer as a third interactant in Spanish-language medical consultations. Communication & Medicine 12 (2–3): 171–185. https://doi.org/10.1558/cam.30177

Jordan, Brigitte and Austin Henderson (1995) Interaction analysis: Foundations and practice. Journal of the Learning Sciences 4 (1): 39–103. https://doi.org/10.1207/s15327809jls0401_2

Kurhila, Salla and Inkeri Lehtimaja (2018) Dealing with numbers: Nurses informing doctors and patients about test results. Discourse Studies 21 (2): 180–198. https://doi.org/10.1177/1461445618802662

Koch, Tina (2006) Establishing rigour in qualitative research: The decision trail. Journal of Advanced Nursing 53 (1): 91–100. https://doi.org/10.1111/j.1365-2648.2006.03681.x

Langstrup, Henriette and Anja Elkjær Rahbek (2015) Conceptualizing ‘role’ in patient-engaging e-health: A cross-disciplinary review of the literature. Communication & Medicine 12 (2–3): 129–143. https://doi.org/10.1558/cam.31817

Lundin, Mona and Åsa Mäkitalo (2017) Co-designing technologies in the context of hypertension care: Negotiating participation and technology use in design meetings. Informatics for Health and Social Care 42 (1): 18–31. https://doi.org/10.3109/17538157.2015.1113176

Nicolini, Davide (2006) The work to make telemedic­ine work: A social and articulative view. Social Science & Medicine 62 (11): 2754–2767. https://doi.org/10.1016/j.socscimed.2005.11.001

Noss, Richard, Stefano Pozzi and Celia Hoyles (1999) Touching epistemologies: Meanings of average and variation in nursing practice. Educational Studies in Mathematics 40 (1): 25–51. https://doi.org/10.1023/A:1003763812875

Oudshoorn, Nelly (2008) Diagnosis at a distance: The invisible work of patients and healthcare professionals in cardiac telemonitoring techno­logy. Sociology of Health & Illness 30 (2): 272–288. https://doi.org/10.1111/j.1467-9566.2007.01032.x

Oudshoorn, Nelly (2009) Physical and digital proximity: Emerging ways of healthcare in face‐to‐face and telemonitoring of heart‐failure patients. Sociology of Health & Illness 31 (3): 390–405. https://doi.org/10.1111/j.1467-9566.2008.01141.x

Prestin, Abby and Wen-ying S. Chou (2014) Web 2.0 and the changing health communication environment. In Heidi Hamilton and Wen-ying S. Chou (eds) The Routledge Handbook of Language and Health Communication, 184–197. London: Routledge.

Sanderson, Tessa and Jo Angouri (2013) ‘I’m an expert in me and I know what I can cope with’: Patient expertise in rheumatoid arthritis. Com­munication & Medicine 10 (3): 249–261. https://doi.org/10.1558/cam.v10i3.249

Sarangi, Srikant and Christopher N. Candlin (2011) Professional and organisational practice: A discourse/communication perspective. In Christopher N. Candlin and Srikant Sarangi (eds) Handbook of Communication in Organisations and Professions, 3–58. Berlin: Walter de Gruyter. https://doi.org/10.1515/9783110214222.3

Storni, Cristiano (2014) Diabetes self-care in-the-wild: Design challenges for personal health record systems and self-monitoring technologies. Information Technology & People 27 (4): 397–420. https://doi.org/10.1108/ITP-02-2013-0032

Swinglehurst, Deborah, Trisha Greenhalgh and Celia Roberts (2012) Computer templates in chronic disease management: Ethnographic case study in general practice. BMJ Open 2 (6): Art. e001754. https://doi.org/10.1136/bmjopen-2012-001754

Ueckert, Frank, Michael Goerz, Maximilian Ataian, Sven Tessmann and Hans-Ulrich Prokosch (2003) Empowerment of patients and communication with health care professionals through an electronic health record. International Journal of Medical Informatics 70 (2–3): 99–108. https://doi.org/10.1016/S1386-5056(03)00052-2

Wuyts, Kim, Griet Verhenneman, Riccardo Scandariato, Wouter Joosen and Jos Dumortier (2012) What electronic health records don’t know just yet: A privacy analysis for patient communities and health records interaction. Health and Technology 2 (3): 159–183. https://doi.org/10.1007/s12553-012-0026-3