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    Pluralistic dialogue : a grounded theory of interdisciplinary practice : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, New Zealand
    (Massey University, 1999) McCallin, Antoinette
    This grounded theory study explains how health professionals work in interdisciplinary teams in health services where the call for new collaborations is intensifying. Forty-four participants from four teams in two major acute-care hospitals participated in the study. In total there were eighty hours of interviewing and eighty hours of participant observation. All data were constantly compared and analysed using Glaser's emergent approach to grounded theory. Underpinning the study are the premises of symbolic interactionism that are assumed to shape the focus of this study, team interactions, and collective action within an acute care setting. It is argued that interdisciplinary team members express a concern for meeting service needs, and continually resolve that concern through the process of pluralistic dialogue. This is a means for discussing differences, that supports team members who are thinking through and constructing new ways of working together. It emerges as various health professionals integrate multiple perspectives, which contribute to the clinical and organisational management of the client service. Pluralistic dialogue has two complementary phases. These are rethinking professional responsibilities and reframing team responsibilities. Rethinking and refraining are theoretical processes that are underpinned by team learning, and, by new ways of managing changing service structures. Therefore, it is suggested that, in an interdisciplinary team, health professionals must break stereotypical images in order to meet service needs in a context where teams are constantly grappling with different mind-sets. Team members continually resolve their concern for meeting service needs by negotiating service provision. As a result, the health professionals are free to engage in the dialogic culture. The process of pluralistic dialogue has the potential to challenge, to empower, to transform; or it can perpetuate mediocrity. The decision to dialogue mindfully with others is essentially individual. Any variation in an individual's commitment is covered by disciplinary associates but seldom challenged by colleagues from a different professional group. A person may choose a non-involved response at any time, although someone must fulfil functional responsibilities in the team. Any variation in an individual's commitment is covered by disciplinary associates but seldom challenged by colleagues from a different professional group. This study also highlighted several significant categories impacting on effective interdisciplinary practice. Competency, alternative world views, information exchange, accountability, personality differences, and leadership, all affected team processes and pluralistic dialogue. But, it was quite clear from the data that, interdisciplinary team members can, and do form synergistic relationships that benefit both clients and colleagues. Team success is dependent on the individual's courage to challenge the self and the humility to cooperate in collective learning experiences. This substantive theory presents just a glimpse of the practical life of interprofessional people working in two busy city hospitals. The teams studied were unusual in that they each offered specialist care to a select group of clients. Perhaps they were unique and are non-representative of the average person who is a health professional today. So many of the health professionals were highly educated, well-respected specialist practitioners who stand out for their individual investment and dedication to improving the client's pathway through acute care. The study participants' patterns of behaviour would suggest that, when interdisciplinary practice is well established, an attitude of cooperative inquiry pervades joint actions and interactions that focus on meeting service needs
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    Cultural perceptions of illness in rural northeastern Thailand : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University
    (Massey University, 1994) Nuntaboot, Khanitta; Khanitta Nuntaboot
    In a transitional society like Northeastern Thailand, alternative and often competing therapeutic methods have been widely used by local people. Most illnesses are managed without recourse to the Government health care services. In Thailand there is a paucity of studies which explore and develop an understanding of how rural people regard illness in terms of causes and classification and how this knowledge influences what actions they take to deal with it. The impact of medical pluralism on illness management has rarely been studied in this country. The purpose of this study is to provide an understanding of the cultural meanings of illness for people in rural Northeast Thailand and their behaviour regarding health and illness care. An ethnographic approach, employing participant observation, interviews and ethnographic records, was selected as the research method, with fieldwork carried out in one rural village in Northeast Thailand where the researcher lived for 12 months. The findings suggest that what people do during an illness is guided by their healing knowledge which is experiential in nature. Mutual influences exist between people's beliefs about illness and their experiences of illness and healing methods. The experiential healing knowledge encompasses broad illness categories and beliefs in multiple causes of an illness. Multiple healing methods including both Western medicine and village curing methods are applied in any illness situation. Western medicine is believed to be effective to treat disease which is viewed as one part of illness, while village curing is believed to effectively treat other causes of illness as well as disease. Kin and neighbours actively participate in the articulation of illness situations, being involved in diagnosing the illness and identifying and prioritising multiple therapeutic management options. This description of people's perceptions of illness and its management, generated from the data, is crucial to increasing the knowledge base of members of nursing and other health professions. Such knowledge identifies critical aspects and possibilities for change in the practice of health professionals when working with rural people in Northeast Thailand. The study concludes with a discussion of strategies for practice and education which might be applied by nurses and other health professionals to improve the utilisation of available health care services.