Title: Assistant Professor of English
University: Marquette University
Email: lillian.campbell@mu.edu
Twitter: N/A
Website: https://marquette.academia.edu/LillianCampbell
Description of Work:
Within rhetorics of health and medicine, I’m interested in theories of materiality and embodiment, feminist rhetoric, genre theory, and technical and professional writing pedagogy. My current research focuses on how individuals learn to communicate in the health professions and explores innovative educational methods for fostering ethical and empathetic communication between patient and provider. My dissertation project, which I continue to develop, examined how clinical nursing simulations initiate students into the writing, talk, and action of the nursing field.
Clinical simulations offer students hands-on practice with robotic patients in structured scenarios. In my analysis, I draw on a year of qualitative research on junior year nursing students, including fieldwork observations, interviews, and video recordings of their simulations, to examine relationships between students’ discursive, embodied, and ethical professional learning. I consider how students interact with the physician and the patient (played by their instructor), negotiate their priorities for care in response to the robotic simulator and classroom space, and repurpose classroom and professional genres to meet their needs. I also examine debrief conversations between students and instructors after the simulation about race, gender, or disability as rich sites for transformation of professional discourse.
Aims include theorizing a rhetoric of patient simulation, modeling a multi-modal methodology for coding video data, and considering the implications of these findings for technical and professional communication pedagogy. As I expand on this project, I am interested in further considering the role of experiential learning in helping health science students learn to negotiate barriers in patient-provider communication, especially gender and ethnicity-based barriers. I am also interested in the increasing use of simulations to teach inter-professional communication and in exploring the potential to expand inter-professional training beyond the health professions to include students studying technical writing or communication.
My work is published or forthcoming in Women’s Studies in Communication, Composition Forum, Written Communication, and the collection Interrogating Gendered Pathologies.
Symposium Submission:
Documenting Embodied Medical Intuition
This article-in-progress investigates intuition’s role in patient assessment and medical documentation, drawing on scholarship of embodiment (Hayles, 1999; Rice, 2015; Sauer, 2003) and RHM (Emmons, 2010; Fountain, 2014; Scott, 2014) to inform a grounded theory analysis of intuitive moments in healthcare providers’ communication practices. We argue that intuition influences stages of care and provider communication, shifting attention away from the product—patient records—and towards the process of medical communication.
To support our claims, we present preliminary findings from qualitative analysis of two individual ethnographic research projects with live-action nursing clinical simulations and emergency medical services (EMS). The simulation project drew on a year of qualitative research on junior-year nursing students including field observations and video recordings of simulations, focal student interviews, and collection of student texts including patient charts. The EMS project included 16 months of participant observation, interviews, and surveys to better understand how EMS professionals communicate. Data included field notes, surveys, interview transcripts, and patient care report templates.
Intuition refers to using “experience to recognize key patterns that indicate the dynamics of the situation” (Klein, 1999, p. 29). In our research sites, participants referenced “gut feeling” or “experience,” mentioning that these moments influenced patient care and documentation. Legally binding documents, like the patient record, prompted participants to support decision-making processes with detailed evidence. This evidence, though, was not always tangible but manifested as an intuitive moment—a gut feeling or a memory from an experience. Thus, this project considers how providers document intuitive information in forms designed to de-emphasize non-scientific information.
Theoretical frameworks
Rhetoric scholars have examined how unnamable bodily forces impact persuasive action (Emmons, 2010; LeMesurier, 2014; Rai, 2016). Fountain’s (2014) notion of “trained vision” through embodied practice informs this study, but we aim to move this notion from the classroom to the workplace. To do so, we argue that medical professionals’ knowledge parallels what Sauer calls “pit sense … direct physical sensations felt or perceived in highly specific local environments” (2003, p. 134). We use “patient sense” to describe embodied sensory knowledge that providers acquire from physical presence with patients. Patient sense includes a range of intuitive experiences such as a physical feature that does not feel quite right or an off-hand comment that indicates a larger problem.
Although Sauer argues that technical documents cannot account for pit sense, our project investigates how nurses and EMS professionals transcribe their patient sense so that others can act on it. We argue that participants followed Goodwin’s concept of “professional vision” by coding, which “transforms phenomena observed in a specific setting into the objects of knowledge,” and highlighting, which “makes specific phenomena … salient by marking them in some fashion” (1994, p. 606). For example, in clinical nursing simulations, a group of students located a warm protrusion on a patient’s leg and ordered an ultrasound to confirm a blood clot. This group did not receive doctor confirmation before their shift ended, so they documented the leg’s condition without diagnosing a clot. By emphasizing pain, lack of pulse, and swelling in their charting, they coded their patient sense about the leg. During hand-off, the group emphasized the leg again, highlighting their findings as key material for follow-up. Coding and highlighting, then, offer two concepts for understanding how medical professionals communicate their patient sense to other providers, both verbally and textually.
Preliminary analysis
Despite intuition’s intangible nature, we noted how participants referred to aspects of intuition that guided their actions and communication while completing stages of patient care:
- Anticipate – participants relied on previous learning and experience to help them anticipate a patient’s needs and corresponding treatment plans
- Assess – participants drew on intuition as they assessed patients and decided how to move forward with a treatment plan
- Plan – participants combined previously collected information with intuition to form a treatment plan
- Act and re-assess – participant’s patient sense developed as patients spoke, leading providers to treatment plans that were largely based on intuitive knowledge
- Document – participants captured and translated their intuition about a patient’s condition into the standard but limiting patient health record for future providers
Discussion
Although we are in early stages of analysis, we envision three key takeaways: 1. intuitive work supports patient-specific, responsive care; 2. coding and highlighting mediate patient sense; and 3. recognizing and valuing patient sense is a learned skill.
First, no two patients are alike. Providers approach patients with general expectations based on communicated information and their own experience. As providers and patients interact, their intuition about a patient’s specific needs develops. Along the way, providers select treatment plans, provide treatment, and reassess decisions to ensure that intuition-coupled with other types of evidence, like vital signs and observations–guide providers to appropriate treatment decisions.
Second, most of the patient care stages involve coding patient sense, either internally as providers interpret their feelings about a patient through the lens of a defined protocol or collaboratively as they communicate their sense of patient experience to other providers. In the document stage, participants support other healthcare providers by coding and highlighting their patient sense in verbal exchanges lack of official space for this work. Thus, intuition complements the visible, communicated work of healthcare.
Finally, recognition and integration of patient sense into all stages of care is a learned skill. Participants in both contexts emphasized that their ability to leverage intuition to guide care developed over time and through multiple successes and failures. By attuning to their embodied feelings and internalizing previous experience, they learned to trust their patient sense and to value it throughout patient care.
Remaining questions
We submit this article-in-progress to receive feedback on remaining questions:
- How do individuals capture embodied knowledge in genres that are designed to privilege the concrete and scientific?
- How do researchers recognize and account for intuition coded into medical documentation?
- How do researchers identify when and how healthcare providers move from intuiting information to acting on intuition?
- How might our findings inform the healthcare communication pedagogy?
References
Emmons, K. (2010). Black dogs and blue words: Depression and gender in the age of self care. Rutgers University Press.
Fountain, T. K. (2014). Rhetoric in the flesh: Trained vision, technical expertise, and the gross anatomy lab. Routledge.
Goodwin, C. (1994). Professional vision. American anthropologist, 96(3), 606-633. Hayles, N. K. (2008). How we became posthuman: Virtual bodies in cybernetics, literature, and informatics. University of Chicago Press.
Klein, G. (1999). Sources of power: How people make decisions. Cambridge, Mass.: MIT Press.
LeMesurier, J. L. (2014). Somatic Metaphors: Embodied Recognition of Rhetorical Opportunities. Rhetoric Review, 33(4), 362-380.
Rai, C. (2016). Democracy’s lot: Rhetoric, publics, and the places of invention. Tuscaloosa:University of Alabama Press.
Rice, Jenny. (2015). Para-expertise, tacit knowledge, and writing problems. College English, 78(2), 117-138.
Sauer, B. A. (2003). The rhetoric of risk: Technical documentation in hazardous environments. Taylor & Francis.
Scott, J. B. (2014). Afterword: Elaborating health and medicine’s publics. Journal of Medical Humanities, 35(2), 229-235.