Understanding Collaboration Between Nurses and Physicians as Knowledge at Work

2012-07-08T18:31:00.004-07:00

This is the concluding portion of Dr. Jane Stein-Parbury's article titled above. If you want to know the entire article, kindly click details above.

Conclusion

Collaboration requires recognition that knowledge and work are intimately related. A smooth, effortless flow of work gives the impression that knowledge bases are shared between nurses and physicians and that the work is mutually understood and supported. The clinical situation of ICU patients with confusion is a good illustration of how knowledge and work are not exchanged or mutually understood. The model of case, patient, and person knowledge illuminates how physicians and nurses operate by using different types of knowledge, partly because the 2 groups are engaged in different kinds of work. When knowledge bases are not understood, are dismissed, or cannot be communicated, professional boundaries are reinforced and management of a patient is relegated solely to nurses.

A problem that initially appeared as a problem in patients that called for interdisciplinary collaboration became solely the nurses’ problem. In the absence of a way to communicate knowledge other than case knowledge, the nurses and physicians’ mutually shared ground from which to work disintegrated. When the physicians exhausted their case knowledge about how to solve the problem, they felt they had nothing else to offer and left the management to the nurses. Sadly, the walking away was often accompanied by a devaluation of nurses’ work. Relational work is often confused with sentimentality and attributed to nurses’ meeting their own needs rather than the needs of a patient.

Collaboration between nurses and physicians involves the seamless flow of work when the collaboration is based on case knowledge or when patient knowledge is not contested. Case knowledge provides a false sense of certainty or, at least, minimal ambiguity. We have proposed a way of conceptualizing collaboration that includes the kinds of knowledge used in the care of patients and the factors that influence the kind of knowledge brought to bear. Circumstance shapes the use of knowledge and location binds knowledge in particular ways, thus relegating some knowledge to the foreground and some to the background, while other knowledge is rendered invisible.

In the circumstances of ICU patients with confusion, collaboration became problematic because case knowledge was not sufficient in doing the work of diagnosing the condition and managing the patients. When nurses explicitly sought help from their medical colleagues in these less-than-ideal circumstances, the nurses often felt abandoned, rejected, or ignored.

Employing a model of the different types of knowledge used in different kinds of work provides a valuable schema for extending the view of nurse-physician collaboration. The lack of valuing patient knowledge, and an unwillingness to understand this type of knowledge, is historically rooted in hierarchies of knowledge, gendered work, and protocols of behavior between nurses and physicians that remain relevant today. Collaboration remains a problematic and serious issue because the stakes are high not only for patients’ outcomes but also for professional identity. Collaboration is a matter of knowledge and a matter of morality.⁵⁴

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ACKNOWLEDGMENTS

We thank Dr Kim Walker, who provided useful comments on an earlier draft of this article. Also, we thank the journal reviewers whose constructive comments were valuable in the preparation of an improved manuscript. The research described was undertaken while Dr Stein-Parbury was a PhD student at the University of Adelaide. The location of the site where the research was done remains confidential because of research ethics.

2012-03-21T17:48:00.010-07:00

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Omron HJ-112 Digital Pocket Pedometer
From Omron

List Price:	$34.99
Price:	$22.49 & eligible for FREE Super Saver Shipping on orders over $25. Details

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Average customer review:
(3525 customer reviews)

Product Description

The Omron Pocket Pedometer HJ-112 features advanced technology, which provides added durability and flexibility to count steps at all positions perpendicular to the ground. This feature allows the user to place the pedometer in a pocket, bag or clip it to a belt.

Product Details

Amazon Sales Rank: #51 in Health and Beauty
Size: HJ-112
Brand: Omron
Model: HJ 112
Released on: 2005-06-15
Number of items: 1
Dimensions: 1.40" h x 2.13" w x .63" l,

Features

Omron dual axis technology; counts steps accurately and quietly whether positioned vertically or horizontally
Automatically resets daily to accurately track steps
Stores up to 7 days of information in memory; Resets to zero at midnight
Six tracking modes, track steps, aerobic steps, time, distance, calories and fat grams burned
Tracks two kinds of steps; Tracks both regular and brisk steps separately

Editorial Reviews

Amazon.com Product Description

Product Description: Omron® HJ-112 Pedometer

No matter where you're going, make every step count with the HJ-112 Pedometer. Using Omron 2D smart sensor technology, this dual-axis pedometer tracks steps accurately whether it's in your pocket, on your belt or clipped to your bag.

When You Know Your Numbers, You'll Grow Your Numbers.

You'd be surprised by how many steps you already take each day. A few hundred walking to the bus, a couple thousand going a few blocks down for lunch, and with an Omron Pedometer you'll know just how many steps you're taking and begin looking for ways to see that number get bigger every day.

Every Step Counts

Omron Pedometers use smart sensor technology rather than the standard pendulum system to get a more accurate reading. Many Omron Pedometers, including the HJ-112, can be programmed to your personal stride length to provide you with an even more accurate count.

The Omron HJ-112 Pedometer offers:

Omron Dual-Axis Technology—Counts steps accurately and quietly whether positioned vertically or horizontally
Automatic Reset—Start with a clean slate each day to track your steps more accurately
Weekly Log—Store up to 7 days of information in memory; resets to zero at midnight so you're ready to go every morning
Six Tracking Modes—Track steps, aerobic steps, time, distance, calories and fat grams burned
Tracking for Two Kinds of Steps—The HJ-112 tracks both regular and brisk steps separately

Features

The Omron HJ-112 Pedometer features

Omron HJ-112 Pedometer
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Omron HJ-112 Pedometer Features
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A few steps toward a healthier life

Walking is a great way to stay healthy. In fact, walking 10,000 steps a day is widely recommended by health and fitness professionals. And when you track your steps with a pedometer, like the Omron HJ-112, studies show you're likely to increase your total number of steps a day by about 2,000, or 1 mile.*

Getting Started

Warm Up First-Before your walk, stretch (arm circles, hip circles and leg lifts) to get your blood flowing and reduce the risk of injury.
Use a Pedometer—Omron Pedometers are the partners you can count on when you want to accurately track your daily routine and help you reach your recommended 10,000 daily steps.
Set Goals—Begin slowly and work your way up. By setting goals you'll push yourself farther and achieve more.
Mix It Up—Add variety to your routine by changing pace, walking uphill or just changing your route.
Add Resistance—Include some upper-body exercises as you walk, such as arm reaches or carrying water bottles in each hand to increase your calorie burn.

*JAMA. 2007; 298 190:2296-2304

Calorie Chart
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From the Manufacturer
Whether you're taking a walk or taking steps to meet your fitness goals, you'll love how Omron's HJ-112 Dual-Axis Pocket Pedometer easily and accurately tracks your progress. The pedometer features advanced 2D Smart Sensor Technology, which means you can use it horizontally or vertically. For added convenience, you can carry the HJ-112 in your pocket or secure it to your bag or belt loop with the included clip.

The HJ-112 measures steps, aerobic steps, time, and distance quietly and accurately.
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HJ-112 Pocket Pedometer
At a Glance:

Can be used horizontally or vertically
Quiet and accurate
Measures steps, aerobic steps, time, and distance
Calculates calories and fat grams burned
Stores seven days of information
Resets automatically at midnight
Large display

Pocket Pedometer with Smart Sense Technology
Instead of using a simple pendulum mechanism (the clicking device you hear on most pedometers), this Omron pedometer uses Smart Sense Technology with advanced acceleration sensors. These sensors detect exactly when you are taking a step and filter out non-walking movements, ensuring your count is accurate.
Versatile Attachment Options
The HJ-112 comes with a convenient clip, and it is clinically validated for use in a pocket, purse, bag, or on the hip. For further ease of use, 2D Smart Sensor Technology allows you to position the pedometer horizontally or vertically.

2D Smart Sensor Technology allows you to use the HJ-112 both horizontally and vertically.

Accurate Calculations Displayed on a Large Screen
While you walk, the HJ-112 quietly and accurately measures steps, aerobic steps, time, and

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Product Details

Braun Thermoscan Ear Thermometer with ExacTemp Technology
From Braun

List Price:	$59.99
Price:	$38.00 & eligible for FREE Super Saver Shipping on orders over $25. Details

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Product Description

Braun Thermoscan Ear Thermometer with Exclusive ExacTemp Technology. Pre-Warmed tip ensures temperature accuracy. Guidance System confirms secure position for accurate readings.

Product Details

Amazon Sales Rank: #79 in Health and Beauty
Brand: Braun
Model: IRT4520
Released on: 2008-09-11
Number of items: 1
Dimensions: 9.06" h x 3.54" w x 6.85" l,

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Professional accuracy. Flashing light and beep confirm positioning.
On-Off button for easy control. Memory function stores 8 readings.
Soft, flexible tip with filter detector. Lens Filter ejector for easy removal.
Oral, rectal or underarm use
Includes: 2 AA batteries - 21 lens filters and cap

Editorial Reviews

Amazon.com Product Description
Designed to give you some peace of mind when your child comes down with a fever, the Braun Thermoscan Ear Thermometer with ExacTemp Technology has all the features you could ever want in a thermometer. Used by more doctors' offices than any other infrared thermometer brand, the Thermoscan features a pre-warmed tip that improves accuracy, a unique guidance system that ensures precise results, and infrared technology that takes your child's temperature in seconds.

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Product Specifications

Model #	IRT-4520
Category	Infrared
Dimensions	9.06 x 6.85 x 3.54 inches
Color	Blue/White
Warranty	60 days

Customer Reviews

Most helpful customer reviews
261 of 275 people found the following review helpful.
Truly amazing - speed,conv. and accuracy
By Baivab Mitra
Bought this couple of weeks back consequent to my son developing high fever and which fluctuated considerably. This caused the Red Cross $9.00 digital thermometer useless as it takes approx. a minute (under armpits) to record temparature. Our doctor advised us to buy Braun based ear thermometer.
First off - there are quite a models available. After taking to doctor and doing research - the 2 new models are IRT 4520 and IRT 4020. These are EXACT copies (all functionality) like their PRO 4000 versions! The ExacTemp feature has a pre-heated tip which is more comfortable for the ear. The older models (PRO 3000) is about $80, but uses lithium batteries and I don't think has pre-heated tip.
Has a "sort of" battery meter. Starts to show - that battery's low, flashing means - will effect results. (Very good)
Usage: Switch on, place tip (with tip cover, without cover, doesn't work), push START and WITHIN TWO SECONDS you get the temperature. Slightly hold the ear in order to place the tip INTO THE EAR HOLE to get best INTERNAL EAR CANAL reading. The readings are stored for access later - total 8 memory readings. Auto shut-off: 60 sec.
The storage is into a white canister type case, which has HORIZONTAL standing (not good - as VERTICAL standing would have been better or if provided ALSO - good).
The given 21 nos. of lens caps are very little. Thankfully, the whole package of lens caps goes INSIDE the thermometer case, storing them together. I have put a Clorex cloth inside the case and into which I push the thermometer, this disinfects my cap and keeps the thermometer disinfected. (Just remember to change the cloth occasionally)
Size-wise it's a bit thick and thus slightly problematic to carry along but due to it's accuracy/etc. worth the hassle.
The ejector is very useful. Just press it and the lens cap is THROWN forward. Be careful, it's literally EJECTED out. (Point towards garbage can - I hit my wife's nose...;)
Note: If you get covers for the PRO 4xxx series - you can use it with IRT 4520. That's very good. The batteries are regular AA series and last a bit. The IRT 4020 has 1 extra feature - has a protective plastic cap covering the disposable lens caps. That's actually very useful. So, if you get 4520 and 4020 at approx. the same price, I would opt for 4020.
There are some calibrations possible, but advice you NOT to do so. If you keep pressing the I/O button even after OFF, then you can switch between Celcius/Farenheit settings. You can set the optimal temperature of the tip, define ambient room temp, etc - Keep i/o button pressed, after OFF starts to FLASH, there will be loud beep - immediately release the I/O button. Then keep pressing (short presses) of the I/O to switch.
Note: ALTHOUGH NOT STATED, IT'S ADVISABLE to have the thermometer calibrated professionally *KAZ, in US* annually.
Weight - about 8 oz.
Any diff. between ExacTemp and non-Exac?
Yes - the pre-heated tip.
Any diff. btw the Professional (+$200) and this?

Angel's health & personal care products

Understanding Collaboration Between Nurses and Physicians as Knowledge at Work

This is the concluding portion of Dr. Jane Stein-Parbury's article titled above. If you want to know the entire article, kindly click details above.

Conclusion

ACKNOWLEDGMENTS

Omron HJ-112 Digital Pocket Pedometer From Omron

Product Description

Product Details

Features

Editorial Reviews

Product Description: Omron® HJ-112 Pedometer

When You Know Your Numbers, You'll Grow Your Numbers.

Every Step Counts

The Omron HJ-112 Pedometer offers:

Features

A few steps toward a healthier life

Getting Started

Braun Thermoscan Ear Thermometer with ExacTemp Technology From Braun

Product Description

Product Details

Features

Editorial Reviews

Customer Reviews

Omron HJ-112 Digital Pocket Pedometer
From Omron

Braun Thermoscan Ear Thermometer with ExacTemp Technology
From Braun