Gundrosen Stine, Thomassen Gøril, Wisborg Torben, Aadahl Petter
Department of Circulation and Medical Imaging, The Norwegian University of Science and Technology, Trondheim, Norway.
Department of Anaesthesia and Intensive Care Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
BMJ Open. 2018 Nov 3;8(11):e023749. doi: 10.1136/bmjopen-2018-023749.
Explore the function of three specific modes of talk (discourse types) in decision-making processes.
Ten real-life admissions of patients with critical illness were audio/video recorded and transcribed. Activity-type analysis (a qualitative discourse analytical method) was applied.
Interdisciplinary emergency teams admitting patients with critical illness in a Norwegian university hospital emergency department (ED).
All emergency teams consisted of at least two internal medicine physicians, two ED nurses, one anaesthetist and one nurse anaesthetist. The number of healthcare professionals involved in each emergency team varied between 11 and 20, and some individuals were involved with more than one team.
The three discourse types played significant roles in team decision-making processes when negotiating meaning. Online commentaries (ONC) and metacommentaries (MC) created progression while offline commentaries (OFC) temporarily placed decisions on hold. Both ONC and MC triggered action and distributed tasks, resources and responsibility in the team. OFC sought mutual understanding and created a broader base for decisions.
A discourse analytical perspective on team talk in medical emergencies illuminates both the dynamics and complexity of teamwork. Here, we draw attention to the way specific modes of talk function in negotiating mutual understanding and distributing tasks and responsibilities in non-algorithm-driven activities. The analysis uncovers a need for an enhanced focus on how language can trigger safe team practice and integrate this knowledge in teamwork training to improve communication skills in ad hoc emergency teams.
探讨三种特定谈话模式（话语类型）在决策过程中的作用。
对十例危重症患者的实际入院情况进行音频/视频记录及转录。采用活动类型分析（一种定性话语分析方法）。
挪威一家大学医院急诊科的跨学科急救团队收治危重症患者。
所有急救团队至少由两名内科医生、两名急诊科护士、一名麻醉师和一名麻醉护士组成。每个急救团队涉及的医疗专业人员数量在11至20人之间，有些人员参与了不止一个团队。
在协商意义时，这三种话语类型在团队决策过程中发挥了重要作用。在线评论（ONC）和元评论（MC）推动了进程，而离线评论（OFC）则暂时搁置了决策。ONC和MC都引发了行动，并在团队中分配了任务、资源和责任。OFC寻求相互理解，并为决策奠定了更广泛的基础。
从话语分析角度审视医疗急救中的团队谈话，既能阐明团队合作的动态性，又能揭示其复杂性。在此，我们提请注意特定谈话模式在非算法驱动活动中协商相互理解以及分配任务和责任方面的作用方式。该分析表明，需要更加关注语言如何引发安全的团队实践，并将这一知识纳入团队合作培训，以提高临时急救团队的沟通技能。
