Risk Of Misunderstanding Research Articles

Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study

Pictograms for assessing pain quality in foreign language-speaking patients: a quality improvement study Abstract. Background: Numerical assessment instruments allow foreign language patients to quantify their pain. However, for a complete assessment of the pain situation, the description of pain quality is also important. Problem: To assess pain quality completely, the treatment team lacked a tool. Objective: Foreign language-speaking patients can communicate their pain to the treatment team and are actively involved in the treatment process. The treatment team develops tools for recording the quality of pain and reflects on their experiences. Method: In a practice development project, pictograms of the Iconic Pain Assessment Tool 2 (IPAT2) where chosen to assess pain quality. The pictograms were prepared for everyday use, tested, and evaluated. Results: With the help of pictograms, quality of pain of 72 patients was documented almost 50% more frequently than before the study. The nursing team experienced IPAT2 as helpful in obtaining information and deepening the quality of the relationship. A feeling of being seen and understood emerged. Discussion: Pictograms are a valid method for nonverbal pain assessment. However, there is a risk of misunderstanding. The study only allowed an external assessment of patient's perceptions. An empirical investigation of the patient's view would be desirable. Conclusions: Further use and development of pictograms for communicating with foreign language-speaking patients are recommended.

Identifying and Managing Risks Inherent to Cultural Differences in the Case of Production Internationalization

Abstract Ignoring cultural differences can cause unfavourable situations and negatively influence the success of production internationalization projects. A decision to subcontract part of the production or to produce in a foreign country, requires identifying and controlling the risks related to cultural differences. Our research objective was to study these risks and the business practices used to face them. In order to reach this objective, we studied eight (8) Canadian manufacturing companies, that outsourced part of their production to China. Results show that the risks related to cultural differences, can provoke an important divergence between requirements of the Canadian company and the resulting products manufactured by the Chinese subcontractor and cause an additional unexpected manufacturing cost. The risk of misunderstanding and difficulty communicating in addition to difficulty applying quality control practices were critical for most of the studied companies’ managers. However, the identified risks could be controlled with different business practices, which we classified according to their role of mitigation or contingency. Frequent interaction with Chinese partners, developing a good trust-based relationship with them and finding ways of encouraging them to get more involved in the partnership and to suggest solutions and innovations represent some of the important practices to adopt. JEL classification numbers: M1. Keywords: Cultural differences, Production internationalization, International outsourcing, Outsourcing in China, Risk management, Cross-cultural management.

Constitutional Courts Speak Their Voice

Abstract The rise of the Internet and associated technologies and the widespread use of social media have deeply affected the relationship between constitutional courts, the media and public opinion. Increased public exposure increases the risks of misunderstandings of courts’ judgments and attacks on courts’ legitimacy. The article aims at addressing the challenges that changes in institutional communication are now posing for constitutional courts. It focuses on the courts’ concern that their decisions are faithfully reported by the media and understood by a specialized audience and the general public. It analyzes the different tools courts have adopted to counteract misinformation and addresses the reasons why constitutional courts have been engaging in a more proactive communication in order to prevent misreading or even exploitation of the contents of their decisions.

Messen von Kooperation – Der KOOP‐Quickcheck der Österreichischen Bautechnikvereinigung

AbstractCooperation on the construction site means less stress, a better atmosphere, working together to find solutions and fun at work. This gives the opportunity to focus more on the technical challenges, because much less time is needed to settle disputes. This also requires significantly less administrative cost and thus ensures greater efficiency, because any improvement in communication creates trust and openness, reduces controversial correspondence and the risk of misunderstandings. The working group ”Cooperative Project Management“ of the ÖBV, launched a pilot project in 2016 to measure the cooperation on construction sites. Ongoing anonymous surveys of key people in a construction project were intended to establish mutual cooperation and, in particular, to monitor its development over time. On the basis of these findings, it should be possible to detect and counteract any undesirable developments in cooperation on construction projects at an early stage.

Ethical issues after pre-natal diagnosis.

Following pre-natal diagnosis of congenital heart defect parents and family face a dramatic psychological crisis because of their state of shock, contradictory information available on potential outcomes, limited availability of time for decisions and for autonomous choices. Counselling the parents can present additional difficulties due to influence of education, cultural and religious background, individual cognitive and emotional processes, and cross-cultural patient care is a challenging issue for the caregivers. Type and quality of messages transmitted by the caregivers determine the counselling process, with the risk of misunderstandings particularly high with reduced available evidence, or with different outcomes accordingly with the various alternatives of treatment. Since the introduction of pre-natal diagnosis for congenital abnormality, interruption of pregnancy became available on these grounds in many Western countries, and the numbers of babies born with congenital heart defects has declined significantly despite concomitant advances in treatment options and outcomes. Detailed and objective information, with all available options, should be provided after pre-natal diagnosis of congenital heart defect. One of the major achievements of pediatric medicine in the last 50 years is the increased understanding of the pathogenetic causal mechanisms of congenital heart defects as well as its treatment. For congenital heart defects the progress of surgical treatments allowed a huge proportion of these children to reach adult life with a decent quality of life and social integration. Therefore, must be a considerable concern that universal pre-natal diagnosis widespread pregnancy interruption may obviate those gains. A reduction in the post-natal population undergoing treatment may have a significantly deleterious effect on the expertise of the caregivers, producing a reduction in outcome quality. With all respect for the parental choices and the obligations to follow the national laws, is necessary to remark that our society is genuinely ambivalent.

Types of Ethical Problems and Expertise in Clinical Ethics Consultation in Psychiatry - Insights From a Qualitative Empirical Ethics Study.

Background: Ethics consultation has been advocated as a valuable tool in ethically challenging clinical situations in healthcare. It is paramount for the development and implementation of clinical ethics support services (CESS) in psychiatry that interventions can address the moral needs of mental health professionals adequately and communicate the nature of the services clearly. This study explores types of ethical problems and concepts of ethical expertise as core elements of CESS in mental healthcare with the aim of contributing to the further development of ethical support in psychiatry.Methods: We conducted 13 semi-structured interviews with mental health professionals and CESS members and triangulated them with four non-participant observations of ethical case consultations in psychiatry. Data were analyzed according to principles of grounded theory and are discussed from a normative perspective.Results: The analysis of the empirical data reveals a typology of three different ethical problems professionals want to refer to CESS: (1) Dyadic problems based on the relationship between patients and professionals, (2) triangular problems, where a third party is involved and affected as a side effect, and (3) problems on a systemic level. However, CESS members focus largely on types (1) and (2), while the third remains unrecognized or members do not feel responsible for these problems. Furthermore, they reflect a strong inner tension connected to their role as ethical experts which can be depicted as a dilemma. On the one hand, as ethically trained people, they reject the idea that their judgments have expert status. On the other hand, they feel that mental health professionals reach out for them to obtain guidance and that it is their responsibility to offer it.Conclusion: CESS members and professionals in mental healthcare have different ideas of the scope of responsibility of CESS. This contains the risk of misunderstandings and misconceptions and may affect the quality of consultations. It is necessary to adapt concepts of problem solving to practitioners' needs to overcome these problems. Secondly, CESS members struggle with their role as ethical experts. CESS members in psychiatry need to develop a stable professional identity. Theoretical clarification and practical training are needed.

The risks of misunderstandings in family discourse

Abstract Based on a large dataset of Russian material, the paper presents these general features of the home: a place to spend leisure time containing a long-established group of different ages and sexes free to move about in their environment These factors lead to tension between communicants and a diversity of topics of conversation. Inadequate recipient design is an overarching trigger for misunderstanding caused by the speaker. It derives from poor concentration on interaction and the common ground fallacy, and leads to the frequent use of indirect and elliptical expressions. Inadequate concentration causes the recipient to non-listen and overguess. Finally, misunderstandings occur because of mishearings, misinterpretations and misreferences. Misinterpretation may concern the content, intention or mode of the message.

Consenting and Assenting to Psychoanalytic Work

The moment is opportune for a renewed look at what we understand about patient consent to treatment. Until recently, little reference to informed consent could be found in the literature, as though it has never been a preoccupation for psychoanalytic practitioners. Yet several post-Freudian authors offer reasons to suppose the risk of misunderstandings about consent. In fact, the very discovery of transference, replete with unrequited infantile wishes, implies that at some level, at some moment, in every psychoanalytic treatment there will be moments when "consent" will to some extent vacillate. A distinction, justifiable on etymological and intersubjective grounds, is made between patients' consent as a cognitive, somewhat passive, acceptance and patients' assent as an arduous, conflicted, partial disagreement with the symbolically limiting details of analytic work. It is in the discovery and working through of unexpected unconscious responses to aspects of the analytic setting and to the analyst that patients become "informed" of the unique risks to their psychic equilibrium the process poses, as well as its benefits. Instead of a static and unitary contractual event, informed consent in psychoanalysis is more properly conceived as a multilayered, repetitively posed, and necessarily ambivalent process of good-enough assenting over time.

Sticky care and conference travel: unpacking care as an explanatory factor for gendered academic immobility

While there is increasing awareness of the contributing effect of the academic mobility imperative on gendered inequalities in the academic profession at large, there is a missing link in current research on this topic. Namely, while ‘care’ is often named as the explanatory factor for why women, and to an extent professionals of any gender at peak childrearing age, are less mobile, this article argues that care is insufficient as an explanatory factor for immobility. Care and other terms such as ‘family responsibilities’ and ‘domestic obligations’ come to serve as a shorthand or explanatory factor for gendered immobility, but these terms elide the complexity of the relationship between care and mobility. This article argues that, without a fuller understanding of how care and mobility intersect, inclusivity drives run the risk of misunderstanding or even reproducing the problem. The specific mobility addressed here is international conference travel as a form of short-term academic mobility which contributes to academic career success and the perpetuation of a mobile academic ideal. The article elaborates a novel conceptual construct, ‘sticky care’, which is applied to empirical data from a diary-interview study of the impact of caring responsibilities on academics’ conference participation. Two dominant mobility-related strategies are elaborated: ‘night/s away’ and ‘get back’. The overarching ambition of this article is at a conceptual level: to bring more complexity and nuance to the concept of care when it is mobilized as an explanatory factor for (gendered) immobility and indeed for inequalities in the academic profession at large.

Editor’s Pick: Identifying Shared Features and Addressing Common Challenges in Clinical Trials for Chronic Inflammatory Diseases: An Overview

Chronic inflammatory diseases (CID) share many common features, such as debilitating illness, increased mortality, impaired quality of life and productivity, and high economic burden. The approach to treating CID has shifted over the last 20 years from symptom to mechanism of action-targeted therapy following the development of primarily biologic drugs, in which the same therapy can potentially treat multiple diseases. Developing these drugs requires novel strategies and a multidisciplinary approach for implementation. This article provides an overview of shared features for CID clinical trials and addressing common challenges in their planning and execution. Since CID studies often test the same drug for treating different pathologies, knowledge of the drug from previously investigated therapeutic indications can be leveraged when planning clinical trials. Given the variety of CID signs and symptoms, eligibility criteria need to clearly define the target patient population by minimising ambiguity and risk of misunderstanding. Other common challenges include an elevated response in the placebo arm, the subjectivity of investigator assessments, and the use of appropriate patient-reported outcomes. Several measures can help minimise the impact of the aforementioned issues on study outcome, including centralised eligibility review and endpoint adjudication, tight control of background therapy and concomitant medications, and intensive training of assessors. The above common features support an approach to CID as a largely interconnected therapeutic area in which a multidisciplinary approach, application of common strategies, and lessons learnt across different indications represent crucial factors for effectively planning and executing clinical trials.

Coding Problematic Understanding in Patient–provider Interactions

ABSTRACT This article proposes a coding scheme for identifying and assessing linguistic evidence of problematic understanding in health-care provider communication with patients affected by type 2 diabetes mellitus. Drawing on the existing literature in pragmatics and linguistics, the scheme is grounded on the distinctions between the different types of linguistic evidence of the occurrence of a misunderstanding or a problematic understanding, divided into three levels (stronger, acceptable and weak) based on their probative force. The application of the scheme is illustrated through a pilot study, conducted on an Italian corpus of 46 transcripts of videotaped consultations between six health-care providers and 13 patients affected by diabetes mellitus type 2. The most frequent types of linguistic evidence of problematic understanding were the categories of “acceptable” (amounting to 58% of the total) and the “strong” evidence (35%). Patients’ problematic understanding was detected to occur significantly more frequently than health-care providers. Providers were also found to be significantly more aware of possible misunderstandings, tending to verify more frequently the correctness of their own interpretations. This pilot study represents a first step in the process of developing a productive evidence-based tool for detecting problematic understanding, which can be used for implementing linguistic strategies for helping prevent the risk of misunderstandings in health-care communication. Our findings show that misunderstandings are widespread between patients and that some linguistic strategies may be more effective than others in preventing the risk of misunderstandings, suggesting possible directions of research for improving health-care providers’ communicative skills.

A Portrait of the Mehmandar: Accompanying Hajji Baba, of Ispahan, to England

Abstract There are few professions and professionals to be constantly perceived as ambivalent. But for interpreting and interpreters, this seems to be the norm, rather than the exception. On the one hand, there has always been a sense of fascination for these extraordinary people who speak so many languages and have such a wide knowledge of the world. On the other, they have inspired reluctance, distrust or even fear. While literary works sometimes reflect one or the other perception, James Justinian Morier’s The Adventures of Hajji Baba, of Ispahan, in England (1828) reflects both and provides us with an insight into the nature and circumstances of the situation. By following the attitude towards the mehmandar throughout the novel, the present paper considers a set of memes that seem to be still valid today. The reasons this is so relate to features inherent in the profession, the privilege of understanding both sides ‘of the coin’, the power tamper with information, the risk of misunderstanding, etc.

Attitudes of postnatal women and maternity staff towards audio recording of consent discussions.

Audio recording consent discussions, and giving a copy of the recording to the patient to keep, might improve the consent process and reduce the risk of misunderstandings, complaints or medicolegal claims. However, there may be concerns over confidentiality and how being recorded could affect the consent discussion. We ascertained the views of 50 postnatal women and 100 maternity staff (25 anaesthetists, 25 obstetricians and 50 midwives) on making audio recordings of consent discussions. There was a wide range of opinions, with women and staff similarly supportive of audio recording overall, but the women were more supportive of recording than the staff when asked if they were against it, or whether they would support recording the discussion if the patient requested it; and less concerned than the staff regarding the potential disadvantages of audio recording. There were no significant differences in the views between anaesthetists, obstetricians and midwives.

The People and the Poster: Theorizing the Soviet Viewer, 1920–1931

The relationship between political posters and their intended viewers was the focus of numerous texts in the 1920s; this article analyzes the ways in which Soviet theorists sought to understand this relationship. They operated in an intellectual context that tried to conceive the modern subject as an active consumer and co-creator, rather than a passive audience. Their study of the contexts of viewing, of display practices and of the role of the viewer as an active participant in the creation of meaning, caused concern about the risk of misunderstandings and led to calls for images to address specific audiences with greater clarity. Many imagined that audiences and producers of images were in dialogue with one another, negotiating over the content, form, and function of political art. The image would thus mediate the relationship between individual and state, integrating political messages into everyday life, and aiming to integrate the individual into the process and practice of propaganda.

Navigating Between Treaties and Tweets:How to Ensure Discourse about Maritime Freedom Is Meaningful

ABSTRACTIn contemporary international discourse about maritime freedom (e.g., “freedom of navigation”), nations often speak in generalities, but rarely clarify what they mean. To reduce the risk of misunderstanding, nations should navigate their use of language between two purposes simultaneously. First, any discussion should be concise, communicable, and comprehendible. Additionally, nations should also be prepared to dialogue on these matters in greater depth and detail, and any substantive discussion should be faithful to the applicable international law that binds nations. A way to ensure such discourse is meaningful is by following a three-step process of labeling, framing, and applying. This article details this approach.

Designing for interactivity in a tele-guidance setting

Purpose : A pilot study has shown that ”teleguidance” in endoscopic retrograde cholangio-pancreatography (ERCP) is followed by an increased number of successfully completed procedures and can offer an enhanced level of competence at the local hospital [1]. We made three observations regarding the guiding endoscopist (teleguider). The teleguider verbally pointed at different parts of the endoscopy image at the same time as he pointed and drew on the screen. The teleguider gestured in order to explain details of the procedure. The teleguider had difficulties interacting with the video conferencing (VC) equipment. The physical and verbal interactions by the teleguider cannot all be easily transmitted through the VC call to the local hospitals, who, therefore, were not being able to follow the teleguider’s interactions and explanations. We present an explorative study of introducing real time interaction through pointing and drawing on the VC screen with medical images during remote guiding in order to enhance the communication between the two sites. Context : A number of Sweden’s most experienced endoscopists within ERCP work at Karolinska University Hospital (Karolinska), mainly conducting more complicated surgery both within the Stockholm region and on patients referred from other parts of the country. Patients from outside the region need to travel to Karolinska, which is costly for society and an extra burden for the patient and relatives. VC technology is readily available and can offer the endoscopists’ at other hospitals the skills of an expert from Karolinska. The teleguider at Karolinska can guide up to three local hospitals in parallel using three VC systems. Methods : In addition to the original pilot study, extensive fieldwork has been conducted and is still on-going. Observations, in combination with formal and informal interviews with endoscopists, nurses and technical personnel, has been conducted 1-2 times respectively at five local hospitals and a large number of times at Karolinska. Guiding sessions have been video recorded, and parts have been transcribed. This preparatory fieldwork entailed a deep understanding of the different contexts, resulting in preliminary ideas of how the interaction technology could be designed and used, and has subsequently been documented in the form of, e.g., personas and scenarios. Early versions of the system set-up (high-fidelity prototypes) have been iteratively developed in a user-centered design process. Low-fidelity prototypes, which suggest more elaborate interaction and functionality, have been developed in parallel, in order to concretize design ideas based on the teleguider’s needs, and effectively evaluate them. Results and discussion : Interactive pointing and drawing on the VC screen is considered a benefit by both the teleguider and the endoscopist at the remote site. It does not have to be drawings in live video streams, which means the technical solution will be less challenging. However, introduction of pointing and drawing functionality requires yet another screen or several windows on a larger screen , at the teleguider’s site. Pointing and drawing functionality also requires an extra screen or window at the remote site. The large number of devices included when introducing the functionality of pointing and drawing requires a steering system that enables the teleguider to more efficiently manage the devices. Similarly, one steering system controlling the three VC systems provides a more usable interface in general for the teleguider. The pointing and drawing can decrease the risk of misunderstandings . References HI. Pahlsson, K. Groth, J. Permert, F. Swahn, M. Lohr, L. Enochsson, L.Lundell, and U. Arnelo (2013) Telemedicine: an important aid to perform high-quality endoscopic retrograde cholangio-pancreatography in low-volume centers. Endoscopy 45(5):357–361.

Qu’en est-il de l’annonce du diagnostic de schizophrénie aujourd’hui en France ?

Resume Le bien-fonde de l’annonce du diagnostic de schizophrenie a longtemps fait debat. Cependant, depuis l’aube des annees 2000, differentes evolutions du contexte social et legislatif, doublees de changements majeurs dans les pratiques d’acces a l’information – notamment grâce au developpement d’Internet – ont semble devoir militer pour une annonce quasi-systematique. Notre recherche tente d’evaluer ou en sont les pratiques en la matiere, a travers une revue de litterature nationale et internationale. Nos resultats montrent qu’il existe de nombreuses informations sur l’annonce du diagnostic au plan international, revelant sur ce point une specificite de la pathologie schizophrenique, qui reste moins souvent annoncee que d’autres maladies, et avec plus de difficulte. La complexite de cette annonce a conduit certaines equipes a s’inspirer de travaux effectues dans le cadre d’autres maladies graves pour etablir des recommandations, des protocoles et meme des programmes de formation, qui sont en cours d’experimentation. Sur le plan national, nous avons note une absence d’informations recentes, les dernieres donnees disponibles ayant etabli une plus grande reticence a informer les patients de leur diagnostic que dans le monde anglo-saxon, malgre des benefices prouves de l’annonce diagnostique, notamment sur le plan de l’observance et de l’alliance therapeutique. Dans ce contexte, il nous semblerait utile de mettre en place une enquete actualisee sur les pratiques d’annonce aupres d’un echantillon representatif, ainsi qu’une conference de consensus a ce sujet pour degager des recommandations et harmoniser les pratiques.

Improving Social Measurement by Understanding Interaction in Survey Interviews

Many of the official statistics and leading indicators that inform policy decisions are created from aggregating data collected in scientific survey interviews. What happens in the back-and-forth of those interviews—whether a sampled member of the public agrees to participate or not, whether a respondent comprehends questions in the way they were intended or not, whether the interview is spoken or texted—can thus have far-reaching consequences. But the landscape for social measurement is rapidly changing: Participation rates are declining, and people’s daily communication patterns are evolving with new technologies (text messaging, video chatting, social media posting, etc.). New analyses of survey interactions are demonstrating aspects of interviewer speech that can substantially affect survey participation, which is vital if social measurement is to be trustworthy. Findings also suggest that, once a survey interview starts, the risks of misunderstanding and miscommunication are greater than one might expect, potentially jeopardizing the accuracy of survey results; different approaches to interviewing that allow clarification dialogue can improve respondents’ comprehension and thus survey data quality. Analyses of text messaging and voice interviews on smartphones demonstrate the importance of adapting scientific social measurement to new patterns of communication, adding ways for people to contribute their data at a time and in a mode that is convenient for them even when they are mobile or multitasking.

Uma análise dos relatórios de sustentabilidade no âmbito ambiental do Brasil: sustentabilidade ou camuflagem?

Corporative sustainability has been one of the most relevant issues at the firms’ agenda and their sustainability reports have been means of evaluating their performance and competitiveness. Global Reporting Initiative (GRI) reports are commonly used by firms in order to inform their environmental, social and economic performances. However, previous evidences of their practices seem to demonstrate that their directions are biases and their reports omit information with social and environmental equity so that there are risks of misunderstandings about their corporative performance and the impacts of their formal programs. This study aims to analyze the environmental key performance indicators of the 2009 Brazilian firms’ GRI reports. It is an archival research method with content analysis. The results indicate that in the one hand firms self-declare sustainable; on the other hand they do not inform it in their visions, there is tentative of camouflage their current indicators and they omit relevant negative information. Indeed, firms do not follow some of the GRI guideline principles. Thus, we conclude that they are still under the initial phase of the sustainable consciousness development.

Observation of Online Communities: A Discussion of Online and Offline Observer Roles in Studying Development, Cooperation and Coordination in an Open Source Software Environment

This paper addresses the application of observation to online settings with a special focus on observer roles. It draws on a study of online observation of a virtual community, i.e. an open source software (OSS) community. The paper examines general and specific advantages and disadvantages of the observer roles in online settings by relating these roles to the same roles assumed in offline settings. The study suggests that under the right circumstances online and offline observation may benefit from being combined as they complement each other well. Quality issues and factors important to elicit trustworthy observational data from online study settings, such as OSS communities, are discussed. A proposition is made concerning how threats to credibility and transferability in relation to online observation (i.e. lack of richness and detail, risk of misunderstandings) can be diminished, while maintaining the level of dependability (which is potentially high due to a greater degree of anonymity and isolation in online settings). The paper thus suggests that the less participative the researcher's online observer role is, the more s/he should consider introducing offline data collection techniques rather than adopting a more participative role in the observed online setting. This methodological discussion forms the basis for making a well-considered choice of online observer role rather than passively sliding into a role assigned by the setting. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs110358