Discovering Culture in a Japanese Rehabilitation Hospital: Structures of Meaning in Medical Team Talk

Izumi, Hiroaki
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[Honolulu] : [University of Hawaii at Manoa], [December 2016]
Drawing on analytical techniques from ethnomethodology, conversation analysis, and occasioned semantics, this dissertation investigates the situated details of everyday institutional practices used by a community of rehabilitation practitioners in a Japanese rehabilitation hospital. Specifically, using audiovisual recordings from multi-professional team meetings as the primary data source, the dissertation empirically examines how rehabilitation team members deploy a range of professional medical category systems to classify patients’ functional status and disability in the course of ongoing interaction, and the consequences of applying these criteria to generate medical decisions. Particular attention is given to the ways in which the members (comprised of a physician, nurses, therapists, a medical social worker, and a dietician) bring together their shared semantic and cultural backgrounds to collaboratively accomplish their professional medical work in the midst of interaction. Thus, the dissertation integrates ethnographic dimensions of medical diagnostics and scaled criteria into the analysis of situated medical interaction. Analysis reveals that semantic and cultural backgrounds provide the systematic basis for members to deal with professional medical activities at hand, such as scaling the level of patients’ independence in daily living activities and making the outcome of rehabilitation generalizable. Moreover, analysis shows that the use of scaling and taxonomic diagrams is essential in describing category relations created in actual interaction and understanding the mechanism of professional sense making practices. By carefully attending to the interplay between known semantic and cultural systems and the emergent structure of medical team talk, the dissertation utilizes an inclusive, systematic methodology to advance our understanding of the organization of meaning and human actions. In so doing, the dissertation contributes to ethnomethodology, conversation analysis, and occasioned semantics by promoting the usefulness of understanding semantic and cultural backgrounds for the systematic analysis of meaning structures in recorded talk. Moreover, the dissertation makes a methodological contribution to hospital ethnography by retaining an ethnomethodological and conversation analytic sensitivity to actual interaction as an analytic resource and presenting empirical evidence based on the analysis of videotaped medical team interactions.
Ph.D. University of Hawaii at Manoa 2016.
Includes bibliographical references.
ethnomethodology, conversation analysis, occasioned semantics, hospital ethnography, medical team meeting, Japanese
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