Professionals’ embodied orientations towards patients in discharge-planning meetings and their impact on patient participation
Keywords:conversation analysis, discharge planning, interdisciplinary meetings, rehabilitation, patient participation, professionals’ embodied orientation
AbstractTo enhance the patient’s involvement, clinical guidelines on rehabilitation require the patient’s participation in the entire rehabilitation process, including discharge planning (DP). However, very little is known about how this institutional demand is actually dealt with in everyday clinical practice. Adopting a conversation analytic (CA) approach, our paper tackles the matter by looking at interdisciplinary entry meetings (IEMs) at a rehabilitation clinic in German-speaking Switzerland. Our study is based on audio-visual recordings of 11 IEMs, whose central aim is to formulate patients’ rehabilitation goals and to plan their discharge. The paper offers a detailed analysis of the embodied practices through which healthcare professionals seek to involve patients in the IEMs, and also investigates patients’ responses. Our analysis shows that, although carefully elaborated, the professionals’ practices do not elicit more than reactive patient participation. The paper argues that this is due to (1) the practices’ temporal positioning within the overall activity structure of the meeting – they are deployed when no important decision is at stake, projecting minimal patient participation on the phases in which decisions are taken – and (2) the actions the practices project on the next turn: confirmation, acknowledgement or ratification of what has previously been proposed by professionals.
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