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Article

Jennifer A. Malkowski, J. Blake Scott, and Lisa Keränen

Rhetoric, commonly understood as the art, practice, and analysis of persuasion, has longstanding connections to medicine and health. Rhetorical scholars, or rhetoricians, have increasingly applied rhetorical theories, concepts, and methods to the texts, contexts, discourses, practices, materials, and digital and visual artifacts related to health and medicine. As an emerging interdisciplinary subfield, the rhetoric of health and medicine seeks to uncover how symbolic patterns shape thought and action in health and medical texts, discourses, settings, and materials. In practice, rhetoricians who study health and medicine draw from the standard modes of rhetorical analysis, such as rhetorical criticism and rhetorical historiography, as well as from social science methods—including participant observation, interviewing, content analysis, and visual mapping—in order to deepen understanding of how language functions across health and medical objects, issues, and discussions. The objects of analysis for rhetorical studies of health and medicine span medical research, education, and clinical practice from laboratory notes to provider–patient interaction; health policymaking and practice from draft policies through standards of care; public health texts and artifacts; consumer health practices and patient advocacy on- and offline; public discourses about disease, death, bodies, illness, wellness, and health; online and digital health information; popular entertainments and medical dramas; and alternative and complementary medicine. Despite its methodological breadth, rhetorical approaches to science and medicine consistently involve the systematic examination and production of symbolic exchanges occurring across interactional, institutional, and public contexts to determine how individuals and groups create knowledge, meanings, identities, understandings, and courses of action about health and illness.

Article

Attention to population health issues is growing, and considering that people spend more time at work than in any other organization outside their home, worksites may offer a solution. For more than 30 years, many worksites have included programs to address employee health, safety, and risk. While some of these initiatives are mandated through legislation, other programs (e.g., workplace health programs (WHPs) or wellness initiatives) are often voluntary in the United States. Programs vary around the globe because some countries merge health, risk, and safety into one overarching regulated category, and there is a growing trend toward expanding these focus areas to include mental health and workplace stress. These programs can be quite innovative. Some interventions use technologies as prompts, such as mobile apps reminding employees to take medication. Other programs incorporate concepts from behavioral psychology and economics such as providing sleep pods at work and pricing healthy food in the cafeteria lower than high fat foods. Governmental incentives are offered in some countries that encourage employers to have WHPs. Yet despite the surface-level advantages of using the reach and access found in employing organizations to impact health, employees do not necessarily participate, and these programs are rarely or poorly evaluated. Furthermore, it is difficult to know how to make WHPs inclusive and how to communicate the availability of these programs. With the dual goals of directly impacting workers’ health and saving employers money, understanding how work can be a site for intervention is a worthwhile challenge to explore. WHPs struggle to achieve documentable objectives for several reasons; theory-driven research is suggesting new ways to understand what might improve the outcomes of WHPs. Privacy and surveillance concerns have dominated the WHP conversation in countries like the United States due to fears that health data might be used to fire employees. Another concern is the need to tailor workplace health messages for diverse cultures, ethnicities, and gender identities. Two other concerns relate the power differentials inherent in workplace hierarchies to overt and covert pressure employees feel to participate and meet what is defined as an ideal level of health. While these major concerns could be difficult to overcome, several theories provide guidance for improving participation and producing positive behavioral outcomes. Employees who feel a part of their organization, or are identified with their group, are more likely to positively view health information originating from their organization. Growing evidence indicates that certain technologies might also tap into feelings of identification and help promote the uptake of workplace health information. In addition, workplaces recognized as having norms for safety and health cultures might be more influential in improving health, safety, and risk behaviors. Recognizing boundaries between employee and workplace can also be fruitful in elucidating the ethics and legality of WHPs. Finally, program evaluation must become an integrated part of these programs to effectively evaluate their impact.

Article

Effective communication in health care teams is central to the delivery of high-quality, safe, dependable, and efficient patient care. Understanding how health care team communication operates within healthcare systems is important. Viewing health care teams in hospital settings as creators and channels for diffusions of health and risk messages is an important contribution to health communication scholarship. Health care teams are essential elements of healthcare systems. In many instances, they are components of multiteam systems embedded within larger network ecosystems. These teams are not identical, thus, considering how team type (e.g., unidisciplinary, multidisciplinary, interdisciplinary) shapes distinct communication processes offers a better understanding of how these teams facilitate health and risk message diffusion. TeamSTEPPS is an important framework for essential teamwork behaviors that facilitate team processes in healthcare systems. Significantly, we develop specific communication competencies drawn from observation work that facilitate health care team effectiveness. Ideas developed by Kurt Lewin are utilized to consider how different types of multiteam systems can be effective as channels and facilitators of health and risk messages. We end the chapter with examples from field research. A set of hospital nursing unidisciplinary teams comprise a network of teams that form a heterarchical structure with important messages flowing between teams. An innovative form of hospital interdisciplinary rounds relies on specific communication practices to create and exchange health and risk messages to patients, families, health care team members, and other healthcare stakeholders.

Article

Death is inevitable: We witness the death of others and eventually face our own. However, people in general view death as taboo and tend to avoid discussing their own or others’ mortality. A cultural shift has been taking place in the developed world so that dying has become an increasingly medicalized process, where death is viewed as something to be stopped or delayed instead of accepted as part of a natural life cycle. As family members are less responsible for the dying process, communication about death and dying becomes a sensitive topic and is often ignored or avoided. Lack of this meaningful communication can lead to stereotypes about the dying person, conflict among family members, and fear of death. Talking about death and dying, if done correctly, can have a positive impact on health-care delivery and the bereavement process. Incorporating knowledge of intergroup communication with a lifespan approach can deepen communication effectiveness about death and dying. People’s group identities can play important roles in the conversation about death and dying. As children and adolescents, people can encounter the death of older family members (e.g., grandparents) and the communication here can be intergenerational. Due to age differences, younger adults may feel uncomfortable to react to older adults’ painful disclosure of death and the bereavement process. During adulthood, people deal with the death uncertainty for themselves and their loved ones. The communication in this period can be intergenerational and inter-occupational, especially when there are third parties involved (e.g., medical providers or legal authorities). Death and dying communication tend to happen mostly, albeit not always, during the later lifespan, as time of death approaches, among older adults, family members, and medical providers. These conversations include advanced care planning (i.e., arrangements and plans about the dying process and after death), medical decision making, palliative care, and final talks. Increasing the awareness of death and dying can help to normalize the dying process.