Use Of Vignettes Research Articles

Medicines management: an interview study of nurses at a secure psychiatric hospital.

To explore mental health nurses' knowledge, attitudes and clinical judgement concerning medicines management in an inpatient setting with a view to enhancing training. Medicines management is a key role of mental health nurses, but little research has been conducted into their training needs. An exploratory mixed-methods design was used involving individual interviews with participants to investigate their responses to hypothetical medicine administration scenarios. Interviews were held with a convenience sample of 50 Registered Nurses working in a specialist mental health hospital between November 2012-February 2013. Participants were presented with clinical vignettes describing eight scenarios they might encounter as part of their medicines management role and asked about how they would respond. Responses were assessed by two independent raters against ten quality standards underpinning the vignettes. The median number of responses that were judged to demonstrate adequate awareness of associated quality standards was 4 (range 1-7), indicating that many participants did not appear to be aware of, or compliant with, current UK medicines management guidance and local policy. Many would not report a 'near miss' or medicines administration error. There was a lack of awareness of guidance on verbal prescribing, consent to treatment rules and the administration of off-label/unlicensed drugs. Past year attendance on a medicines management course, time since registration and self-reported knowledge of national standards for medicines administration did not discriminate between total score on the 10 quality standards. The medicines management training needs of participants appeared not to be fully met by the existing learning sources. The use of vignettes to assess nurses' training needs requires evaluation in other settings.

An exploration of the practice of restricting a child's movement in hospital: a factorial survey.

To identify the reported predictors of the practice of restricting a child for a clinical procedure in hospital. Previous work in this area is dominated by discussion papers and suggestions for addressing the issue of restriction. This is the first study to explore reported predictors of this practice with a view to implementing change based on research findings. A factorial survey was developed, which incorporated the use of vignettes with various scenarios. The factorial design enabled exploration of the interaction of multiple factors on the practice of restriction. One hundred and sixty-six nurses caring for children were each sent 10 vignettes and asked to rate their likelihood to restrict a child based on the vignettes. A total of 105 nurses responded to the survey, representing a response rate of 63%. Hierarchical linear regression was used to identify reported predictors of restriction. Nurses were more likely to restrict a child if they had prior instruction on safe holding, if there was no play therapist available, if the nurse was a registered general nurse with no other registration qualification, if the child required cannulation or if the child was less than five years of age. This study identified predictors of restriction from the perspective of practicing nurses; the evidence needs to be used in developing clinical guidelines and in multidisciplinary education. There is a need to move from any presumption of restriction towards more critical consideration of the individual requirements of the child. There is a need to increase the numbers of nurses receiving specialist training on the care of a child in hospital. The importance of a well-resourced play therapy service is supported, and there is a need for multidisciplinary work to explore alternatives to restriction.

A confiança em situações ambivalentes e incongruentes: a utilização de vinhetas como método exploratório

O objetivo deste trabalho é sugerir a utilização de vinhetas para explorar como os indivíduos interpretam situações em que há ambivalência nas características relacionais com parceiros. Para tanto, investigou-se a forma como indivíduos, em uma organização produtora de software, interpretam situações transacionais concretas e elaboram suas percepções das relações entre confiança e controle. A partir das vinhetas apresentadas aos entrevistados, coletaram-se relatos qualitativos que exibem como seus pressupostos ou indagações conduzem ao "fechamento" das situações. A análise dos dados sugere que esse "fechamento" ocorre por meio de vários mecanismos alternativos: 1. censura seletiva de sinais contraditórios, 2. inclusão de pressupostos inexistentes na narrativa original, 3. busca focada de informações adicionais e 4. reflexão crítica de corresponsabilidades. A adoção de um mecanismo em detrimento de outro pode ter implicações importantes para o desdobramento das relações interorganizacionais estudadas. Neste artigo, buscou-se utilizar a abordagem de Swidler (2001), em que, no uso de vinhetas, procurou-se evidenciar os elementos culturais mobilizados na interpretação, formação de julgamentos e estabelecimento de metáforas e analogias por parte dos indivíduos. Cabe ressaltar que, do ponto de vista metodológico, a abordagem de pesquisa exploratória com a utilização de vinhetas pode ser um mecanismo interessante de abordagem qualitativa, principalmente em contextos em que o pesquisador se interessa por abrir a "caixa-preta" de alguma variável de interesse. Com essa abordagem, é possível obter um acesso privilegiado ao repertório de narrativas dos indivíduos. Cada vinheta reflete uma situação que se coloca ao entrevistado e o leva a evocar valores, crenças, atitudes e narrativas que não seriam de outra forma coletados. Sendo assim, este trabalho postula que a elaboração de vinhetas é um importante instrumento exploratório não apenas para o avanço teórico, mas também para o ensino da administração, conforme o explicado na conclusão deste artigo.

Teaching Professional Ethics in a Faith-Based Doctoral Program: Pedagogical Strategies

Teaching professional ethics in faith-based doctoral programs is similar to teaching this subject in secular programs, with some exceptions. Defining what is meant by “faith-based program,” this article discusses unique issues relevant to teaching Christian psychologists in training, as well as two specific pedagogical strategies: inviting students to assess their ethical decision-making heritage, and creative use of vignettes.

Effectiveness of peer assessment for implementing a Dutch physical therapy low back pain guideline: cluster randomized controlled trial.

Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting. The aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP). A cluster randomized controlled trial was conducted. Ten communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41). Both groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions. Outcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0-100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20-100). Vignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection. The small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study. Peer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.

Emotional crisis communication

Organizational crises are usually highly emotional experiences for both organizations and stakeholders. Hence, crisis situations often result in emotionally charged communication between the two parties. Despite the attention of organizations and scholars to the emotions of stakeholders during crises, little is known about the effects of the emotions communicated by organizations on corporate reputations. Through the use of vignettes, this experiment reveals that besides crisis-response strategy (diminish vs. rebuild), the communicated emotion (i.e., shame and regret) has a positive effect on corporate reputation. Mediation analyses showed that this effect of communicated emotion could be explained by the public's (negative) affective as well as cognitive responses (i.e., account acceptance). This study confirms that emotional signals embedded in crisis responses may affect corporate reputations by reducing feelings of anger and by increasing the acceptance of the organizational message. In doing so, this study provides a starting point for further exploration of the effectiveness of other emotions in crisis communication.

On Beginning to Become Dietitians

This paper explores beginning dietetic practitioners’ perspectives on the process of becoming dietetics professionals through the use of vignettes to illuminate the complex process of professional socialization. Embedded in these vignettes are three themes related to the socialization process that occurs in the early years of dietetic practice: congruence, resilience, and relationships. Our findings indicate that new dietitians struggle to develop their dietitian identity. They feel unprepared for the relational and practice realities of the workplace and find the transition from dietetic intern to dietitian challenging. They seek many ways to cope including seeking support from others and planning for the future but some consider leaving the profession. It is important to understand the professional socialization and identity formation processes that occur during the early years of practice to ensure that dietitians feel prepared and supported as they begin their careers.

Problematised history pedagogy as narrative research: Self-fashioning, dismantled voices and reimaginings in history education

A growing disturbance with history’s identity in the New Zealand schooling curriculum disrupted my educational socialisation (curriculum, professional, academic) and inheritance of educational policy decisions. In turn, this disturbance shaped a critical stance in my research and practitioner work. Accordingly, problematised history pedagogy (PHP) emerged as the phenomenon and method of my doctoral study and was activated as a counterpoint to my experiences of normalised discourses of history curriculum and pedagogy. The PHP as narrative research was situated in my history curriculum programme in a postgraduate year of secondary teacher education. The research aimed to engage my history class (research participants as preservice teachers) in pedagogy that involved critique of and reflection on the things we do as history teachers in the secondary curriculum. The PHP was nested within my historicising and theorising of educational experience. Conceptualised as a reciprocal research process, the PHP involved the participants and me in theorising pedagogies, fashioning pedagogic identities, and engaging critically with curriculum conceptions of history. The PHP sought to reimagine history curriculum and pedagogy and identify pedagogic spaces of possibility. The narrative research was layered as a bricolage of storying that reflected the interdisciplinary nature of my educational socialisation. Experiences as a teacher educator, curriculum and assessment developer and researcher meant many voices, discourses and theories were woven into the narrative. This complex conceptual work focused on understandings of narrative; policy, curriculum and pedagogy; critical pedagogy; history; history education; and notions of space. The narrative research was constructed in three parts. Firstly, my narrative selves and shifts to a critical pedagogy stance were historicised and theorised through an autobiographical approach. An original dimension of this storying has been the use of vignettes that illuminate the convergence of educational experience, theorising and reimaginings as an aesthetic and critical narrative device. The second part of the research narrative arrives at the point of praxis whereby experience and theory came together to activate the PHP. The PHP was placed in the context of the national history curriculum, a review of history education literature, and situated in my teacher education work. The PHP has been represented as a system of meaning through its distinctive research processes of phenomenological inquiry, genealogical disclosure, and discursive self-fashioning. An original form of analysis was conceptualised to deconstruct the participants’ history thinking and their experiences of the cultural politics of the history curriculum. This was conceptualised as a dismantling analysis (DA). The third part of the narrative recounts the history class’s year of reflexive engagement with PHP. Participants’ pedagogic identities, historical thinking and critique of history curriculum and pedagogy as PHP ‘cases’ in secondary classrooms were dismantled and discussed. Emergent PHP findings of the participants’ thinking as beginning history teachers include such features as discourses of embodiment (fears, failure and fraud) prior to practicum; uncertainties about historical knowledge that includes doubt and discomfort about dealing with ‘difficult’ knowledge; disillusionment with familiar historical narratives; scant exposure to Aotearoa New Zealand histories and limited engagement with historical research methods in school and university study; observations of uncritical teacher modelling of history pedagogy; questioning of a strong masculine focus in historical contexts and a recurrent theme of history as violent; history practicum experienced through the dominant orientation of history as inquiry. These findings illustrate the public, accountable and discursive production of the national history curriculum. Reimagined history curricula are glimpsed in the participants’ seeking of counter-orientations of history’s purpose and desired history pedagogy as inclusive and democratic, as social reconstruction, and as an evolving critical project. A reflective critique of the narrative research brings the writing to a close.

Validating a Vignette-Based Instrument to Study Physician Decision Making in Trauma Triage

The evidence supporting the use of vignettes to study physician decision making comes primarily from the study of low-risk decisions and the demonstration of good agreement at the group level between vignettes and actual practice. The validity of using vignettes to predict decision making in more complex, high-risk contexts and at the individual level remains unknown. We had previously developed a vignette-based instrument to study physician decision making in trauma triage. Here, we measured the retest reliability, internal consistency, known-groups performance, and criterion validity of the instrument. Thirty-two emergency physicians, recruited at a national academic meeting, participated in reliability testing. Twenty-eight trauma surgeons, recruited using personal contacts, participated in known-groups testing. Twenty-eight emergency physicians, recruited from physicians working at hospitals for which we had access to medical records, participated in criterion validity testing. We measured rates of undertriage (the proportion of severely injured patients not transferred to trauma centers) and overtriage (the proportion of patients transferred with minor injuries) on the instrument. For physicians participating in criterion validity testing, we compared rates of triage on the instrument with rates in practice, based on chart review. Physicians made similar transfer decisions for cases (κ = 0.42, P < 0.01) on 2 administrations of the instrument. Responses were internally consistent (Kuder-Richardson, 0.71-0.91). Surgeons had lower rates of undertriage than emergency physicians (13% v. 70%, P < 0.01). No correlation existed between individual rates of under- or overtriage on the vignettes and in practice (r = -0.17, P = 0.4; r = -0.03, P = 0.85). The instrument developed to assess trauma triage decision making performed reliably and detected known group differences. However, it did not predict individual physician performance.

Clinical Commentary on Collinge et al.

Clinical Commentary on Collinge et al.

Assessment of psychology competencies in field placements: Standardized vignettes reduce rater bias.

Supervisors' ratings of psychology trainees' competence in field settings are a critical component of training assessment. There has been little systematic research regarding the validity of these assessments, but the available evidence suggests we have a problem! Supervisors' judgments may be affected by systemic biases that pose a serious threat to assessment credibility. The current study is part of a research collaboration among six universities that endeavors to develop and evaluate a new method the use of vignettes against outcomes derived from a conventional rating scale. Individual vignettes were designed and subjected to a rigorous process of peer-review and revisions, before final vignettes were assigned calibration scores by a group of experts. A catalogue of vignettes (n = 41) that represent various domains of competence across several developmental stages was compiled. University and field supervisors used the conventional rating scale and the vignette-matching procedure (VMP) to evaluate competencies at end-placement. Data from a pilot (n = 20) and a follow-up study (n = 57) suggest that compared with a conventional rating scale, the VMP reduced leniency and halo biases. The VMP has the potential to improve outcomes of competency assessments in field placements and merits further research and development.

Overcome Resistance To Critical Thinking Through Writing

There is considerable evidence that many undergraduates show little improvement in critical thinking, complex reasoning, and written communication after four years of college. The findings are especially unfavorable for business majors. Calls for more rigor seldom address student and faculty resistance. After an overview of factors that may contribute to declining student performance, I discuss the literature related to student and faculty resistance and propose strategies to overcome resistance through the use of vignettes in a critical thinking through writing course designed for management majors.

Migration, Risk Attitudes, and Entrepreneurship: Evidence from a Representative Immigrant Survey

Do more risk loving migrants opt for self-employment? This is a question especially relevant for policy makers designing selective immigration policies in countries of destination. In order to provide a rigorous answer to it, we use a novel vignette-adjusted measure of risk preferences in the domain of work to investigate the link between risk aversion and entrepreneurship in migrant communities. Using a representative household survey of the migrant population in the Greater Dublin Area, we find a significant negative relationship between risk aversion and entrepreneurship. In addition, our results show that the use of vignettes improves the significance of the results, as they correct for differential item functioning (where respondents interpret the self-evaluation scale in different ways) between entrepreneurs and non-entrepreneurs, and corrects for variation in the use of self-evaluation scales between migrants from different countries of origin.

The construction and interpretation of vignettes in social research

Vignettes refer to stimuli, including text and images, which research participants are invited to respond. Drawing on a range of social science sources, this paper focuses on two substantive areas concerning the use of vignettes in research. Considered first is the development and construction of vignettes. This section is concerned with internal reliability; research topics; participants; and interest, relevance, realism and timing. Considered second are vignette interpretations and responses, in particular open and closed questioning; vignette perspectives; and difficulties with interpreting and responding to vignettes. Together these explorations contribute to the wider appreciation of vignette methodologies used within the social sciences. The paper concludes by outlining the limitations of using vignettes in social research.

Tailored DVDs: A novel strategy for educating racially and ethnically diverse older adults about their medicines

IntroductionThe availability of comprehensive and accurate medication history information in electronic medical records and through electronic prescribing provides the opportunity to create tailored interventions based on individuals’ particular medication information needs. To meet the challenges of providing medication information to low-literate English and Spanish speaking older adults, we sought to create individualized, culturally and linguistically inclusive medication education materials for older adults from diverse backgrounds. MethodsWe used a mixed-method design including a systematic review, analysis of existing data, a telephone survey (n=326), and exploratory focus groups stratified by race/ethnicity and language spoken (11 focus groups; n=106) to identify what information about medications older adults need, want to learn, and in what format. We evaluated reactions to three DVDs at low-income senior community centers (2 focus groups; n=16). ResultsExploratory focus groups provided insights on areas for improvement in patient–provider communication, and suggested use of vignettes and testimonials. Upon viewing, participants could relate to the testimonials in which actors portrayed people who have problems with their medications and were interested in the medication advice presented, especially when it was presented by a healthcare professional. DiscussionTailored medication education materials in English and Spanish DVD and print material format are suitable for low-literate audiences, acceptable to older adults, and feasible to implement using health IT. Virtually all households in the United States have a television, with most having a DVD player. DVD segments can be used in Internet links, physician office-based television, and consumer health IT applications.

European model of palliative care for dementia: Study protocol

IntroductionDespite increasing attention in the past decade there is still little published work on palliative care (PC) and dementia. There is consensus that there is a need to improve the...

Using Vignettes as Self-Reflexivity in Narrative Research of Problematised History Pedagogy

This article focuses on the use of vignettes as an emergent dimension of narrative research writing. The author draws on doctoral research that problematised history curriculum and pedagogy with pre-service teachers in the context of secondary teacher education in New Zealand. Pedagogic crossings of history education sites, and negotiation of disciplinary boundaries were storied in the narrative research. A lived experience of curriculum continuity and change had shaped a critical pedagogy orientation in the author's theorising and practice. This featured a self-reflexivity of pedagogic identities including those of student, practitioner, and researcher. The narrative writing was conceptualised as a layered bricolage of academic socialisation, engagement with theory, and practitioner work. Accordingly, it proved unworkable to distance the author's lived experience and pedagogic identities from the narrative, for these lay at the heart of the research. Therefore, the styling of vignettes became a creative way to story self-reflexivity within academic writing. Vignettes were conceived as inside stories that recalled pedagogic voices and evoked themes of curriculum disturbance as transgression, and desire as re-imagined history curriculum.

Lessons from the use of vignettes in the study of mental health service disparities.

To examine the development, feasibility, and use of a vignette approach as an important tool in health services disparities research. Interviews with vignette developers and qualitative data from a novel mental health services disparities study that used vignettes in two samples: (1) predominantly low-income parents of children attending mental health specialty care who were Latino or non-Latino White and (2) Latino and non-Latino mental health clinicians who treat children in their practice. We conduct a content analysis of qualitative data from patients and providers in the Ethnic Differences Study to explore the feasibility of vignette methodology in health services disparities research, and we identify lessons learned that may guide future vignette development. Vignettes provide a valuable approach that is acceptable to participants, elicits important insight on participant experience and services, and sheds light on factors that can help optimize study design for exploring health disparities questions. Researchers, clinicians, and others should consider a set of factors that help determine when a vignette approach is warranted in research, training, or for other uses, including how best to address identified weaknesses.

The Use of Vignettes in Cross-Cultural Cognitive Testing of Survey Instruments

Cognitive interviewing (CI) is a pretesting technique that elicits respondents’ interpretations of survey questions as a means to evaluate and revise them. Vignettes are sometimes used as a part of the cognitive testing method. There has been little research on using vignettes in the testing of survey translations. This article examines the use of vignettes in two Spanish and English pretesting projects at the U.S. Census Bureau. The authors examine findings across English and Spanish cases in the two studies and discuss areas for future research.

Come play with me: designing technologies for intergenerational play

Despite research showing that interaction between the elderly and young people is beneficial to the health and well-being of both, little is known about the grandparent–grandchild relationship. Consequently, it is difficult to make informed design decisions about technologies to support their intergenerational interactions. This paper investigates one particularly important type of intergenerational interaction, namely play. The paper presents research that examines grandparent–grandchildren interactions in preschool playgroups. Through the use of vignettes drawn from observation of playful activity, pertinent features of intergenerational play are identified, focussing on the roles grandparents and grandchildren use when playing together. The results are relevant to researchers wishing to understand intergenerational play and to technology designers wanting to support it.