{"id":185,"date":"2017-09-04T18:43:57","date_gmt":"2017-09-04T18:43:57","guid":{"rendered":"http:\/\/medicalrhetoric.com\/symposium2017\/?page_id=185"},"modified":"2017-09-26T17:35:12","modified_gmt":"2017-09-26T17:35:12","slug":"elizabeth-angeli","status":"publish","type":"page","link":"https:\/\/medicalrhetoric.com\/symposium2017\/profiles\/elizabeth-angeli\/","title":{"rendered":"Elizabeth Angeli"},"content":{"rendered":"

\"\"<\/p>\n

Title: <\/strong>Assistant Professor of English<\/p>\n

University: <\/strong>Marquette University<\/p>\n

Email:<\/strong>\u00a0Elizabeth.angeli@marquette.edu<\/p>\n

Twitter: <\/strong>lizangeli<\/p>\n

Website: <\/strong>www.elizabethangeli.com<\/p>\n

Description of Work:<\/strong><\/h3>\n

My current work\u202faddresses how healthcare professionals manage changing, urgent medical information in unstable medical contexts. In my single-authored monograph\u202fRhetorical Work in Emergency Medical Services\u202f<\/i>(under contract at Routledge), I investigate how communicators harness\u202frhetoric\u2019s power to stabilize unpredictable medical workplace environments. My two in-progress studies\u202fbuild on this work: First, a collaborative methodological inquiry with\u202fLilly Campbell seeks to understand and define intuitive moments in healthcare writing practices. Second, a multi-cohort longitudinal project investigates how the traditional college-age learner population enrolled in non-academic medical training courses transfers previous knowledge about writing into these courses and, subsequently, into the medical workplace.\u00a0<\/span><\/p>\n

Symposium Submission:<\/strong><\/h3>\n

Documenting Embodied Medical Intuition<\/strong><\/p>\n

This article-in-progress investigates intuition\u2019s 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\u2019 communication practices. We argue that intuition influences stages of care and provider communication, shifting attention away from the product\u2014patient records\u2014and towards the process of medical communication.<\/p>\n

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.<\/p>\n

Intuition refers to using \u201cexperience to recognize key patterns that indicate the dynamics of the situation\u201d (Klein, 1999, p. 29). In our research sites, participants referenced \u201cgut feeling\u201d or \u201cexperience,\u201d 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\u2014a 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.<\/p>\n

Theoretical\u00a0 frameworks\u00a0<\/strong><\/p>\n

Rhetoric scholars have examined how unnamable bodily forces impact persuasive action (Emmons, 2010; LeMesurier, 2014; Rai, 2016). Fountain\u2019s (2014) notion of \u201ctrained vision\u201d 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\u2019 knowledge parallels what Sauer calls \u201cpit sense \u2026 direct physical sensations felt or perceived in highly specific local environments\u201d (2003, p. 134). We use \u201cpatient sense\u201d 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.<\/p>\n

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\u2019s concept of \u201cprofessional vision\u201d by coding, which \u201ctransforms phenomena observed in a specific setting into the objects of knowledge,\u201d and highlighting, which \u201cmakes specific phenomena \u2026 salient by marking them in some fashion\u201d (1994, p. 606). For example, in clinical nursing simulations, a group of students located a warm protrusion on a patient\u2019s 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\u2019s 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.<\/p>\n

Preliminary\u00a0 analysis\u00a0<\/strong><\/p>\n

Despite intuition\u2019s intangible nature, we noted how participants referred to aspects of intuition that guided their actions and communication while completing stages of patient care:<\/p>\n