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      Distributed expertise: qualitative study of a British network of multidisciplinary teams supporting parents of children with chronic kidney disease

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          Abstract

          Background

          Long-term childhood conditions are often managed by hospital-based multidisciplinary teams (MDTs) of professionals with discipline specific expertise of a condition, in partnership with parents. However, little evidence exists on professional–parent interactions in this context. An exploration of professionals' accounts of the way they individually and collectively teach parents to manage their child's clinical care at home is, therefore, important for meeting parents' needs, informing policy and educating novice professionals. Using chronic kidney disease as an exemplar this paper reports on one aspect of a study of interactions between professionals and parents in a network of 12 children's kidney units in Britain.

          Methods

          We conducted semi-structured, qualitative interviews with a convenience sample of 112 professionals (clinical-psychologists, dietitians, doctors, nurses, pharmacists, play-workers, therapists and social workers), exploring accounts of their parent-educative activity. We analysed data using framework and the concept of distributed expertise.

          Results

          Four themes emerged that related to the way expertise was distributed within and across teams: (i) recognizing each other's' expertise, (ii) sharing expertise within the MDT, (iii) language interpretation, and (iv) acting as brokers. Two different professional identifications were also seen to co-exist within MDTs, with participants using the term ‘we’ both as the intra-professional ‘we’ (relating to the professional identity) when describing expertise within a disciplinary group (for example: ‘As dietitians we aim to give tailored advice to optimize children's growth’), and the inter-professional ‘we’ (a ‘team-identification’), when discussing expertise within the team (for example: ‘We work as a team and make sure we're all happy with every aspect of their training before they go home’).

          Conclusions

          This study highlights the dual identifications implicit in ‘being professional’ in this context (to the team and to one's profession) as well as the unique role that each member of a team contributes to children's care. Our methodology and results have the potential to be transferred to teams managing other conditions.

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          Most cited references28

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          Forming professional identities on the health care team: discursive constructions of the 'other' in the operating room.

          Inter-professional health care teams represent the nucleus of both patient care and the clinical education of novices. Both activities depend upon the'talk' that team members use to interact with one another. This study explored team members' interpretations of tense team communications in the operating room (OR). The study was conducted using 52 team members divided into 14 focus groups. Team members comprised 13 surgeons, 19 nurses, nine anaesthetists and 11 trainees. Both uni-disciplinary (n = 11) and multi-disciplinary (n = 3) formats were employed. All groups discussed three communication scenarios, derived from prior ethnographic research. Discussions were audio-recorded and transcribed. Using a grounded theory approach, three researchers individually analysed sample transcripts, after which group discussions were held to resolve discrepancies and confirm a coding structure. Using the confirmed code, the complete data set was coded using the 'NVivo' qualitative data analysis software program. There were substantial differences in surgeons', nurses', anaesthetists', and trainees' interpretations of the communication scenarios. Interpretations were accompanied by subjects' depictions of disciplinary roles on the team. Subjects' constructions of other professions' roles, values and motivations were often dissonant with those professions' constructions of themselves. Team members, particularly novices, tend to simplify and distort others' roles and motivations as they interpret tense communication. We suggest that such simplifications may be rhetorical, reflecting professional rivalries on the OR team. In addition, we theorise that novices' echoing of role simplification has implications for their professional identity formation.
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            Communities of Practice: Learning Meaning and Identity

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              How to manage and display qualitative data using "Framework" and Microsoft Excel.

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                Author and article information

                Journal
                Child Care Health Dev
                Child Care Health Dev
                cch
                Child
                BlackWell Publishing Ltd (Oxford, UK )
                0305-1862
                1365-2214
                January 2015
                14 May 2014
                : 41
                : 1
                : 67-75
                Affiliations
                [* ]School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of Manchester Manchester, UK
                []Royal Manchester Children's Hospital Manchester, UK
                []Health Psychology (Old Ward 1 Offices), Royal Victoria Infirmary Newcastle, UK
                [§ ]The Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle, UK
                []Great Ormond Street Children's Hospital London, UK
                [** ]Nephrology, Alder Hey Children's NHS Foundation Trust Liverpool, UK
                [†† ]Department of Pediatric Nephrology, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust London, UK
                [‡‡ ]Sydney Children's Hospital Randwick, NSW, Australia
                [§§ ]Children's Kidney Centre, UHW Cardiff, UK
                [¶¶ ]Yorkhill Children's Hospital Glasgow, UK
                [*** ]Birmingham Children's Hospital Birmingham, UK
                [††† ]Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust Manchester, UK
                [‡‡‡ ]University of Bristol Children's Renal Unit, Bristol Royal Hospital for Children Bristol, UK
                [§§§ ]Children's Renal and Urology Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, QMC Campus Nottingham, UK
                [¶¶¶ ]School of Environment, Education and Development, University of Manchester UK
                Author notes
                Correspondence:, Veronica Swallow, School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Oxford Road, Manchester M13 9PT, UK, E-mail: veronica.swallow@ 123456manchester.ac.uk
                Article
                10.1111/cch.12141
                4368419
                24827413
                c50f2603-5324-4e43-8171-7346bbc632f9
                © 2014 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 March 2014
                Categories
                Original Articles

                Pediatrics
                children,ckd,distributed expertise,long-term conditions,multidisciplinary teams,parents
                Pediatrics
                children, ckd, distributed expertise, long-term conditions, multidisciplinary teams, parents

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