{"id":70929,"date":"2021-09-13T14:36:04","date_gmt":"2021-09-13T06:36:04","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=70929"},"modified":"2022-01-04T07:41:19","modified_gmt":"2022-01-03T23:41:19","slug":"a-dramaturgical-analysis-of-a-paediatric-team-handover","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/","title":{"rendered":"A dramaturgical analysis of a paediatric team handover"},"content":{"rendered":"<p>Submitted: 2<span lang=\"EN-GB\"> November 2020<\/span><br \/>\r\nAccepted: 8 February 2021<br \/>\r\nPublished online: <span lang=\"EN-GB\">5 October, TAPS 2021, <\/span><span lang=\"EN-GB\">6(4), 37-48<\/span><br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2425\">https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2425<\/a><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Stephen Bradley<sup>1<\/sup>, Aaron Ooi<sup>2<\/sup>, Kerry Stafford<sup>3<\/sup>, Shuvayon Mukherjee<sup>1<\/sup> &amp; Marcus A. Henning<sup>4<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Paediatrics, Lakes District Health Board, New Zealand; <sup>2<\/sup>Department of Paediatrics, Waikato District Health Board, New Zealand; <sup>3<\/sup><\/span><\/i><i><span lang=\"EN-NZ\">Department of Paediatrics,<\/span><\/i><span lang=\"EN-NZ\"> <\/span><i><span lang=\"EN-GB\">Christchurch Hospital, New Zealand; <sup>4<\/sup>Centre for Medical and Health Sciences Education, University of Auckland, New Zealand<\/span><\/i><i><span lang=\"EN-GB\"><\/span><\/i><\/p>\r\n<p style=\"text-align: center\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-NZ\">Introduction:<\/span><\/b><span lang=\"EN-NZ\"> The paediatric team handover process is a crucial workplace practice and comprises the transfer of patient information from one shift to another involving medical professionals and students.\u00a0 A qualitative study was performed to analyse the feasibility, functionality, benefits and limitations of the dramaturgical approach when applied to examining a handover session.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-NZ\">Methods<\/span><\/b><span lang=\"EN-NZ\">: Data relating to one handover were collected and analysed from video and audio recordings, notes created by two independent observers and a de-identified copy of the handover sheet.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-NZ\">Results:<\/span><\/b><span lang=\"EN-NZ\"> The dramaturgical constructs and subsequent findings allowed us to make informed inferences about the dynamics of the handover procedure. The directors\/lead actors consisted of a consultant and a registrar.\u00a0 One consultant was transitory and the remaining 12 attendees were either major support, support or bit actors.\u00a0 The students (bit actors\/audience) were included when a learning point was emphasised.\u00a0 The script was informal and improvised as the discussion emphasised certain facets of patient care or accentuated learning points.\u00a0 The staging involved the seating arrangement, a whiteboard, computer screen and ongoing data presentation.\u00a0 The performance suggested a handover of two halves: one emphasising learning and the other allocation of patient care responsibility.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-NZ\">Conclusion:<\/span><\/b><span lang=\"EN-NZ\"> We concluded that the real-life drama occurring within a handover was feasibly analysed, with its functionality demonstrated, using the dramaturgical investigative system.\u00a0 The multifaceted recordings enabled researchers to review the \u2018authentic\u2019 handover system without censorship. These findings have implications for educational and organisational research.<\/span><\/p>\r\n<p style=\"text-align: justify\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-NZ\">Dramaturgical, Handover, Paediatric, Methodology<b><\/b><\/span><\/i><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> <\/span><span lang=\"EN-NZ\">Dramaturgical methodology provided a unique, authentic and detailed analysis of the handover.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> <\/span><span lang=\"EN-NZ\">The dramaturgical research methodology used to evaluate the handover was feasible and functional.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> <\/span><span lang=\"EN-NZ\">This research methodology can be used to analyse education within similar team based settings. <\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> <\/span><span lang=\"EN-NZ\">This research methodology can be applied to the team handovers and other complex health meetings.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> <\/span><span lang=\"EN-NZ\">This research methodology identifies important clinical\/educational roles and dynamics within teams.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<ol><\/ol>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Hospital team handovers involve effective transfer of information and responsibility from one health professional to another, ensuring continuity of patient care (Australian Medical Association Limited, 2006; Hilligoss &amp; Cohen, 2011). The level of communication needs to be comprehensive, unambiguous and coherent so that patient information is easily understood, thus optimising patient care through the meaningful and efficient transfer of patient information (Fujikawa et al., 2021). This is crucial given the ramifications for optimising patient care and minimising potential treatment error, including miscued transfer of knowledge, insertion of faulty or misleading information, treatment delay, and poor patient outcomes (Arora et al., 2005; Bomba &amp; Prakash, 2005). To explore the nuances occurring in handover practice from organisational behaviour and educational perspectives, different methodological approaches need to be developed.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">In this paper, we propose that the dramaturgical approach can optimally analyse handover dynamics, as it is an integrated, pragmatic and multidimensional approach. This approach uses multi-source feedback from video and audio recordings, observer records, and transcripts of analysis. The dramaturgical approach argues that the individuals present in the activity assume different roles that influence the way they communicate and behave (Canary et al., 2008; Goffman, 1959; Henderson, 2005). Using this approach, the handover activity can be analysed much like a drama or element of theatre. The dramaturgical approach has the potential to offer insights into the clinical and educational handover components, much like the insights drawn when applying this approach to analysing healthcare simulations (Crea, 2017), decision-making aspects of an emergency department triage (Forde, 2014), and behaviour of radiographers and their patients (Murphy, 2009). This analytical approach enables the researcher to be present at the moment of the occurrence, rather than relying on retrospective data obtained when subsequently interviewing participants. Interviews can be a powerful means of obtaining information, but require participants to accurately retell their experiences of the activity (DiCicco\u2010Bloom &amp; Crabtree, 2006).\u00a0 The dramaturgical approach tells it for what it is, and allows researchers the ability to see and hear the authentic process of communication (Goffman, 1959; Murphy, 2009). We surmised that the dramaturgical approach would be a more comprehensive evaluative system and thus well suited for collecting observational data that could inform training and development initiatives within hospital systems. <\/span><\/p>\r\n<p><span lang=\"EN-NZ\">The research aim of this study was to explore the feasibility and functionality of the dramaturgical methodological system of analysis not yet applied to the handover procedure.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">The research questions driving this study include:<\/span><\/p>\r\n<ol>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> How can the dramaturgical approach feasibly be applied to the handover system?<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> How does the dramaturgical approach describe the functional dynamics of the handover procedure?<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"> What are the benefits and limitations associated with applying this research methodology?<\/span><\/li>\r\n<\/ol>\r\n<p>&nbsp;<\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-NZ\"><\/span><\/i><i><span lang=\"EN-NZ\">A. Phenomenon of Interest<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Feasibility, functionality and quality were informed by examples taken from one handover involving team discussion regarding patients admitted to a general paediatric ward (20 beds) and a Special Care Baby Unit (8 cots) in a New Zealand secondary-level hospital (Hensher et al., 2006). <\/span><\/p>\r\n<p><i><span lang=\"EN-NZ\"><\/span><\/i><i><span lang=\"EN-NZ\">B. Sample\/Participants<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">All the health professionals and medical students involved in one handover were asked to volunteer for the study, with eligibility determined by consent and approval from hospital management. Informed consent was obtained after eligible participants read a detailed information sheet, provided by an administrator, followed by a consent form that they then signed.\u00a0<\/span><\/p>\r\n<p><i><span lang=\"EN-NZ\"><\/span><\/i><i><span lang=\"EN-NZ\">C. Data Collection<\/span><\/i><\/p>\r\n<p><span lang=\"EN-NZ\">Data were obtained from several sources.<\/span><\/p>\r\n<ol>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"><\/span><span lang=\"EN-NZ\">Five video cameras were situated in the handover room to obtain multiple angles of the handover. Two audio recorders were placed in the room and served as the primary sources of data for transcription. <\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"><\/span><span lang=\"EN-NZ\">The final transcription of events was checked by all authors using data from the cameras. <\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"><\/span><span lang=\"EN-NZ\">Notes on the salient aspects of handover interactions were made by two present \u2018unknown\u2019 observers (i.e., one medical student and one medical educationalist).<\/span><\/li>\r\n<\/ol>\r\n<p><span lang=\"EN-NZ\">A diagram of the seating positions of each participant was constructed (see Figure 1).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1-300x290.png\" alt=\"\" class=\"wp-image-70930 aligncenter\" width=\"496\" height=\"480\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1-300x290.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1.png 702w\" sizes=\"auto, (max-width: 496px) 100vw, 496px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 1: Handover room layout depicting seating arrangements, participants (P1-P15, with original position participants sat in), 2 observers (Ob1 and Ob2) and equipment.<\/span><\/p>\r\n<div>\r\n<p><i><span lang=\"EN-NZ\">D. <\/span><\/i><i><span lang=\"EN-NZ\">Ethical Considerations<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Confidentiality of the key informants was maintained by the following criteria: <\/span><\/p>\r\n<ol>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"><\/span><span lang=\"EN-NZ\">All participants were given an anonymised label (P1 to P15).<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"><\/span><span lang=\"EN-NZ\">All patients discussed within the handover were anonymised (labelled 1 to 36) and identifiable information was deleted from patient reports.<\/span><\/li>\r\n\t<li style=\"text-align: justify\"><span lang=\"EN-NZ\"><\/span><span lang=\"EN-NZ\">Several hospital employees involved in the study were not present at the handover and transcription was conducted by an uninvolved third party. <\/span><\/li>\r\n\t<li style=\"list-style-type: none\">\r\n<ol>\r\n\t<li style=\"list-style-type: none\">\r\n<ol><\/ol>\r\n<\/li>\r\n<\/ol>\r\n<\/li>\r\n<\/ol>\r\n<div>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-NZ\">E. <\/span><\/i><i><span lang=\"EN-NZ\">Data Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">To test the feasibility of the dramaturgical approach, a framework was adapted exploring the perspectives of the actors and audience, the script, the staging and the overall performance (Canary et al., 2008; Crea, 2017; Henderson, 2005).\u00a0 Delineation of roles within the handover (Preves &amp; Stephenson, 2009; Schell, 2016) identified the following \u2018actors\u2019: lead, major support, support, and bit actors. The perceived director was involved in the leading and facilitation of the handover (Goffman, 1959).\u00a0 The audience was defined as observers or those actors minimally involved in the main discussion (Canary et al., 2008; Hays &amp; Weinert, 2006). Other factors considered in the analysis included scripting<b>, <\/b>staging, and performance analysis (Hays &amp; Weinert, 2006). <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">We scrutinised the data using a deductive thematic content analysis based on dramaturgy criteria (Elo &amp; Kyng\u00e4s, 2008).\u00a0 The usefulness of voice-occupied time (VOT) was appraised and VOT was defined as the total time a participant spoke during the entire handover divided by the total duration of the handover, expressed as a percentage. The utility of a timeline considered the dynamics connected to scene development. Lastly, the trustworthiness of the qualitative data analysis protocol was audited (Elo et al., 2014).<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">III. <\/span><span lang=\"EN-GB\">RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The following data were used to assess the feasibility, functionality and quality of the dramaturgical process. For full data details, please refer to Figshare (2020). <\/span><\/p>\r\n<p><i><span lang=\"EN-NZ\">A. Actors<\/span><\/i><span lang=\"EN-NZ\"> <i>and Audience<\/i><\/span><\/p>\r\n<p><span lang=\"EN-NZ\">The handover involved 15 participants (Table 1).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-1-300x83.png\" alt=\"\" class=\" wp-image-70945 aligncenter\" width=\"495\" height=\"137\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-1-300x83.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-1-1024x282.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-1-768x212.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-1-1536x424.png 1536w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-1.png 1759w\" sizes=\"auto, (max-width: 495px) 100vw, 495px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-NZ\">Table 1: Roles and number of participants and observers present in handover.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">The VOT analysis (see Table 2) was useful in quantifying participation as aligned with perceived roles. The participant with the highest VOT was deemed to be the lead actor, while the second highest VOT was classified as the major supporting actor.\u00a0 Participants with VOTs of greater than 5% were defined as supporting actors, and participants who had VOTs of less than 5% were judged to be bit actors and audience. Accordingly, the lead consultant (the initial director) (P13) and the senior registrar (P3), who each had more than 15% of the VOT, were judged to be the lead and major support actors respectively. Eight (53%) of the participants were identified to be present as bit actors or audience.\u00a0 <\/span><\/p>\r\n<\/div>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-1-300x80.png\" alt=\"\" class=\" wp-image-70949 aligncenter\" width=\"496\" height=\"133\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-1-300x80.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-1-1024x274.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-1-768x205.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-1-1536x410.png 1536w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-1.png 1860w\" sizes=\"auto, (max-width: 496px) 100vw, 496px\" \/><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-2-300x85.png\" alt=\"\" class=\" wp-image-70950 aligncenter\" width=\"491\" height=\"139\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-2-300x85.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-2-1024x291.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-2-768x218.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-2-1536x437.png 1536w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-2.png 1846w\" sizes=\"auto, (max-width: 491px) 100vw, 491px\" \/><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-3-300x34.png\" alt=\"\" class=\" wp-image-70951 aligncenter\" width=\"492\" height=\"56\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-3-300x34.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-3-1024x115.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-3-768x87.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-3-1536x173.png 1536w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-part-3.png 1855w\" sizes=\"auto, (max-width: 492px) 100vw, 492px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-NZ\">Table 2: Percentage of voice occupied time (VOT) and number of contributions per participant<\/span><span lang=\"EN-NZ\">.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: left\"><img loading=\"lazy\" decoding=\"async\" width=\"300\" height=\"69\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-Key-1-300x69.png\" alt=\"\" class=\"alignnone size-medium wp-image-71030\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-Key-1-300x69.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-Key-1-1024x236.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-Key-1-768x177.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-Key-1-1536x355.png 1536w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Table-2-Key-1.png 1789w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">A separate analysis was conducted counting the number of contributions (clearly-heard comments) each handover participant made, with a total of 446 contributions quantified during the handover. This was correlated with the VOT and provided a point of comparison to identify crucial facets of the handover drama.<\/span><\/p>\r\n<p><em><span lang=\"EN-NZ\">B. <\/span><\/em><em><span lang=\"EN-NZ\">Roles<\/span><\/em><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">The utility of the dramaturgical approach was also demonstrated in identifying the roles of handover members. It was ascertained that the three consultants had distinct roles. The lead actor (P13) was the consultant on the ward that week. She led the beginning of the handover, directed the flow of discussion and took on a major teaching role. The second consultant (P9), who had been on call overnight, contributed important information and was involved in teaching. The third consultant (P8) sought information about suitable patients for teaching, but contributed little to the discussions. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">A further key role identified was the senior registrar (P3), who contributed little to the handover until the dramatic time when a phone call interrupted the handover. After the departure of the lead consultant (P13), she acquired the major support actor role, but did so in a very business-like manner to ensure that all patients were discussed and a safe plan established.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Roles were highlighted participants\u2019 costumes. The doctors and students in the handover wore smart-casual attire.\u00a0 Several clearly had available stethoscopes, whilst the nurse wore a uniform.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-NZ\">C. Script<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">The script was found to be a useful informal source of information. Whilst close attention was given to the handover sheet containing patient details, it was clear that participants improvised. The dramaturgical analysis established that the patients cared for by the paediatric team were the subjects of the performance. Patients were referred to respectfully, and the discussion was focused on their daily requirements. <\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-NZ\">D. Staging<\/span><\/i><\/p>\r\n<p><span lang=\"EN-NZ\">The room (Figure 1) was notable for the horseshoe-shaped arrangement of tables and chairs, which enabled the researchers to evaluate visibility of participants and their access to technological equipment. The notion of staging also enabled researchers to establish the activities that occurred within the room (on-stage) as opposed to those outside the room (off-stage).<\/span><\/p>\r\n<p><i><span lang=\"EN-NZ\">E. Props<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">The most significant prop was the handover sheet (or script) listing the patients\u2019 names, demographic data, their medical issues, and initiated investigations and plan.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-NZ\">F. Performance<\/span><\/i><\/p>\r\n<p><span lang=\"EN-NZ\"><\/span><i><span lang=\"EN-NZ\">1) Scenes:<\/span><\/i><span lang=\"EN-NZ\"> The scenes could be classified as follows. These were the prologue, three acts, and an epilogue represented as 14 distinct scenes (Table 3). We were able to identify each new scene arising at the point of a significant incident in the handover discussion.<\/span><\/p>\r\n<div align=\"center\">\r\n<table>\r\n<tbody>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span style=\"font-size: 10pt\"><b><span lang=\"EN-GB\">Act<\/span><\/b><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span style=\"font-size: 10pt\"><b><span lang=\"EN-GB\">Scene number<\/span><\/b><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span style=\"font-size: 10pt\"><b><span lang=\"EN-GB\">Scene name<\/span><\/b><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span style=\"font-size: 10pt\"><b><span lang=\"EN-GB\">Major theme of scene<\/span><\/b><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span style=\"font-size: 10pt\"><b><span lang=\"EN-GB\">Description of scene<\/span><\/b><\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span style=\"font-size: 10pt\"><b><span lang=\"EN-GB\">Actors with VOT within scene<\/span><\/b><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Prologue.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">1<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cNice to meet you.\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Setting the scene.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">First four handover members arrive (P3, P12, P13, P14).<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">New SHO arrives (P6) and receives brief orientation. <\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Remaining handover members arrive (P1, P2, P4, P5, P7, P9, P10, P11). Meet member of research team (Ob 1).<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P3, P6, P12, P13, P14, Ob 1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"3\" valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Act 1 \u2013 The beginning of handover.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">2<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cCan we just get going?\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Introductions.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Each member of team states their name and role.\u00a0 <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P2, P3, P4, P5, P6, P7, P9, P10, P11, P12, P13, P14<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">3<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cFire away!\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Start of night handover.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Lead consultant (P13) initiates handover. <\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Night SHO (P2) utilises handover sheet as a prompt to discuss cases encountered during the night. P8 enters room. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P2, P8, P13 <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">4<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cPatient 21, a baby.\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Focus on a sick child.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Case of specific child who deteriorated during the night presented, becoming a significant aspect of discussion. <\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Four most senior members of the team (P3, P8, P9, P13) contribute to this discussion. P15 enters room. <\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P2 completes handover of relevant patients, exits thereafter.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P2, P3, P8, P9, P13<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"5\" valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Act 2 \u2013 Educational moments and the climax.<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">5<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cCan I just interrupt?\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Planning for assessment.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Consultant (P8) requests patients for examination purposes (principal reason for P8 attending handover), exits thereafter. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P8, P13<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">6<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cWhat other things would you like to tell us?\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Educational moment arising from handover.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Consultant (P9) presents case of a specific child with alleged non accidental injury, with subsequent educational moment (P13 and P9 acting as prompts for discussion and sources of information respectively).<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P4, P9, P13, P14<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">7<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cIs there any learning for us from that one?\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Further educational moment.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Lengthy discussion focussed around a \u2018difficult\u2019 case.<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Consultant (P13) uses words \u201cAnd herein is the learning\u201d, stands up and uses whiteboard to discuss differentials and poses questions to individual team members.<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P9 serves as a source of clinical information.<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">On-call SHO phone rings and SHO (P5) exits room, followed by senior registrar (P3) from whom help is sought. P9 exits room. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P3, P4, P5, P6, P7, P9, P10, P11, P12, P13, P14, P15<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">8<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cI will need to divide them up.\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Focus on workload for patients on inpatient ward.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Resumption of systematically working through inpatients on the handover sheet to generate management plans, with input obtained from residents and students who had seen children the previous day. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P3, P7, P13<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">9<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cJust been phoned from ED!\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Dramatic intervention \u2013 a sick child in the Emergency Department (ED).<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Interruption of handover to discuss a seriously unwell child who requires specialist attention in ED (climax).<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P13 states: \u201cEmergent patient care always takes priority\u201d.<\/span><\/p>\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Lead consultant (P13) exits with on-call SHO (P5). <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P3, P5, P13, P14<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"3\" valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Act 3 \u2013 The business end of handover.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">10<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cSo, shall we go back up to \u2026?\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Focus on workload for patients on inpatient ward.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Resumption of systematically working through inpatients on the handover sheet to generate management plans, with input obtained from residents and students who had seen children the previous day.\u00a0 Senior registrar (P3) now leads the handover discussion with regular, brief contributions.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P3, P7, P11, P14 <\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">11<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cOK.\u00a0 Umm and SCBU\u2026\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Focus on workload for neonates in the Special Care Baby Unit (SCBU).<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Systematic working through SCBU patients on the handover sheet to generate management plans, with input obtained from residents and students who had seen children the previous day.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P3, P7, P14<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">12<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cAnd then\u2026 chase results.\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Focus on chasing up outstanding laboratory results.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Systematic working through patients on handover sheet who have outstanding laboratory results to be followed up. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P3, P7, P14<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td rowspan=\"2\" valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Epilogue.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">13<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cSo, what are you doing now?\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Discussion about participants\u2019 day plans.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Senior registrar (P3) checks with members of team their understanding of their roles for the day. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P1, P3, P4, P6, P7<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">14<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">\u201cYeah, sweet\u2026 done!\u201d<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Conclusion.<\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">Completion of handover as evidenced by verbal and body language cues as members of team exit the room. <\/span><\/p>\r\n<\/td>\r\n<td valign=\"top\">\r\n<p><span lang=\"EN-GB\" style=\"font-size: 10pt\">P3<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div>\r\n<p align=\"center\"><span lang=\"EN-NZ\">Table 3: Acts and scenes within the handover<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-NZ\">2) Entrances and exits:<b> <\/b><\/span><\/i><span lang=\"EN-NZ\">Easily demarcated entrance and exit points of the handover were identified. P1 arrived 5 minutes before the handover commenced, prepared the computer, and then left and returned with the remainder of the handover team. This initial entrance represented the entire group arriving, with a prologue consisting of set up and early introductions (Scene 1).\u00a0 <b><i><\/i><\/b><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">An example of a dramatic exit and re-entrance of two doctors (P3, P5) was noted during Scenes 7 and 9, which proved to be a major incident, as the phone call off-stage notified them of a critical case. Following this, the lead consultant (P13) exited with a SHO (P5) and the director role was handed to the senior registrar (P3). This altered the handover significantly and came at a time when the handover had moved from a largely educational milieu to a more work-like role.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">See Figure 2 for a time-line regarding the Handover.<\/span><\/p>\r\n<\/div>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-2-300x170.png\" alt=\"\" class=\" wp-image-70952 aligncenter\" width=\"678\" height=\"384\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-2-300x170.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-2-1024x579.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-2-768x434.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-2.png 1401w\" sizes=\"auto, (max-width: 678px) 100vw, 678px\" \/><\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-NZ\">Figure 2: Timeline of acts, scenes and selected events<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-NZ\"><\/span><\/i><i><span lang=\"EN-NZ\">3) Additional observations:<b> <\/b><\/span><\/i><span lang=\"EN-NZ\">Multiple data collection methods enhanced the dramaturgical method, through clarifying inaudible audio data. Entrances and exits did not always prompt comments on the audio recording, but were noted from the video recordings. A critical incident occurred when the lead consultant established an educational role and used the whiteboard for teaching \u2013 the impact of this would not have been so apparent without a video recording.<\/span><b><span lang=\"EN-NZ\">\u00a0<\/span><\/b><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The studied handover was attended by multiple professionals and students, and had several purposes, focussing on the safe exchange of knowledge and responsibility for a group of patients with variable clinical conditions and acuity (Australian Medical Association Limited, 2006; Hilligoss &amp; Cohen, 2011). We argued that the dramaturgical approach would be a valuable method for analysing the dynamics of this handover. To evaluate the effectiveness of this research approach, we focussed on the feasibility, functionality and quality of the dramaturgy approach.<\/span><\/p>\r\n<p style=\"text-align: justify\"><em><span lang=\"EN-GB\">A. Feasibility<\/span><\/em><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The dramaturgical perspective argues that individuals \u201cplay different roles as \u2018actors\u2019 and engage in \u2018performances\u2019 in order to shape their \u2018definition of the situation\u2019\u201d (Canary et al., 2008, p. 155). We applied the metaphor of \u2018life as drama\u2019 to this handover. The findings and information gleaned from this handover demonstrated that a dramaturgy approach embedded within a case study methodology can be applied to a complex team handover. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Obtaining consent from all handover attendees in a manner that did not impact on the handover itself required significant pre-planning by the research team and cooperation from the department. In their systematic review, Flory and Emanuel (2004) examined methods for improving the consent process and for increasing participant understanding. One recommendation centred on employing significant person-to-person contact as an optimal method to improve understanding. To avoid undue power dynamics, a senior consultant at this hospital involved in the study was not involved in the administrative process, and this prevented any direct involvement in the recruitment and data collection processes, thus minimising inducement and conflict of interest.\u00a0\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Patients are often particularly vulnerable in this type of research, as they may not fully understand their legal or ethical rights (Sankar et al., 2003). We were cognisant of this when considering our research design. To maintain confidentiality of patients, we de-identified patient details, using a numbering system and only referred to patients by their number code to minimise release of personal medical information.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">We established that the dramaturgical approach was able to feasibly capture both verbal and non-verbal elements of the discourse. To capture this wide range of information, we used multiple methods of data collection creating greater accuracy of the handover.\u00a0 Other studies have used different research approaches. Using grounded theory and content analysis, Behara et al. (2005) studied five North American Emergency Departments using ethnographic observations, and emphasised the active participation of handover members in co-construction of their understanding about the patients who were considered in the handover. The use of ethnographic observation has some resonance with this study, although, in this study, we created an \u2018a priori\u2019 framework for analysis using the dramaturgical components.\u00a0 The dramaturgical method allowed us to structure our analysis. Several researchers (Donnelly et al., 2019; Ooi et al., 2020) have used inductive techniques to analyse semi-structured interview data, and these studies provided useful perceptions of team handovers in New Zealand hospitals. The advantage of using interviews is that professionals interviewed have time to reflect on the salient aspects of the handover; however, a disadvantage is that the interviewees can censor and forget key elements of the process.<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">B. Functionality<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">In this section, we address the second research question focussed on describing the functional dynamics of the handover.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">We found that dramaturgical methods provided a useful lens to analyse the way the actors and their roles interacted with the staging. For example, the handover was clearly orchestrated by designated and perceived roles of the lead actor (P13) and the major support actor (P3). Our method of utilising VOT allowed us to evaluate the reasons why some actors within the handover participated more or less, with findings clearly showing that the handover was directed by P13, until she left the room and then P3 became the dominant driver of the performance. This finding is consistent with the work of Donnelly, who described the critical nature of the team handover leader\u2019s role in ensuring safe and equitable outcomes for patients by \u201crunning meetings smoothly and respectfully\u201d (Donnelly et al., 2019, p. 611).\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The interruption caused by the critical case in Scene 9 highlighted the importance of patient safety and care in handover function (Australian Medical Association Limited, 2006), which took priority over ensuring equal voice contribution of the handover attendees. The impact of handover members having differing levels of clinical experience within a team has been noted as an important contributor to handover dynamics (Behara et al., 2005; Hilligoss &amp; Cohen, 2011). We documented a degree of audience segregation (Canary et al., 2008; Murphy, 2009) within the handover, in that, within specific scenes, some actors were markedly involved, whilst others, particularly the bit actors, were effectively the audience and were relatively uninvolved unless prompted by the director or major support actor.\u00a0\u00a0 <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The video analysis permitted us to regard this handover as more akin to an unscripted improvisation (Sawyer, 2004; Schryer et al., 2003) based on the handover sheet. Hilligoss and Cohen (2011, p. 95) have described handovers as \u201croutines grounded in human memory for habits\u201d, and the handover sheet provided a routine document to be worked through. The dramaturgical framework allowed us to visually consider the layout of the room (or stage) (Goffman, 1959; Murphy, 2009).\u00a0 Kinahan (2017), in her qualitative analysis of seating positions within an educational context, reported that different seating positions likely yield different outcomes. The horseshoe-formation structure used in this handover likely promoted more participant engagement.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Lastly, the dramaturgical approach allowed us to segment the analysis in terms of acts and scenes (Henderson, 2005). This was useful as it allowed us to determine if there were specific activity patterns or key events arising within this handover.\u00a0 Hilligoss and Cohen (2011, p. 95) stated that research \u201cexamines how micro patterns of activity in [handover] are embedded in, shaped by, and ultimately produce effects on the larger system of hospital activities\u201d. The handover had a prologue in which members had a brief period of social contact, an important element of handover (Hilligoss &amp; Cohen, 2011; Nugus et al., 2017) which initiates formalising the community of practice (Bradley et al., 2018; Egan &amp; Jaye, 2009).<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The functionality of the dramaturgical approach can be easily demonstrated within Acts 2 and 3. Act 2 centred on discussion regarding two patients who presented diagnostic uncertainty, and provided the platform for opportunistic teaching, with significant emphasis and time spent on these patients. However, it was clear from our analysis that these teaching moments resulted in a single focus when all team members were effectively engaged through use of directed questioning.\u00a0 The importance of learning within handover has been described (Hilligoss &amp; Cohen, 2011; Ooi et al., 2020; Paradis &amp; Sutkin, 2017). Specifically, the use of brief opportunistic learning related to appropriate patients has been suggested as a useful strategy within handover (Bradley et al., 2018; Ooi et al., 2020). Nonetheless, it was unclear to the researchers whether the teaching initiatives seen in this handover represent typical behaviour, or whether participant activity may have been influenced by the study itself (Paradis &amp; Sutkin, 2017). Act 2 revealed a subsequent shift from a focus on education to patient care, demonstrating that patients continued to receive emergency treatment when required.\u00a0 This reflected an understanding that the participation of the team at handover did not compromise the ongoing provision of medical care for other patients (Australian Medical Association Limited, 2006). <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">A further change in focus was observed in Act 3, with a focus on the requirement to discuss briefly the remaining 28 patients on the sheet. Our analysis demonstrated a shift to much briefer discussions, reflecting the need to work in a timely manner. This suggested a shift in the handover from a community of practice with at least partly an educational focus to that of a formal work group (Egan &amp; Jaye, 2009; Wenger &amp; Snyder, 1999). The need to pace the handover and to balance the conflicting functions has been noted in other studies (Donnelly et al., 2019; Horsky et al., 2015).<\/span><\/p>\r\n<p style=\"text-align: justify\"><i><span lang=\"EN-GB\">C. Quality Appraisal of the Research Methodology<\/span><\/i><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The dramaturgical approach created a formalised structure from which authentic workplace activity could be identified.\u00a0 In comparison to other qualitative methods, the advantages were the rich, untainted data obtained. The findings of semi structured interviews conducted with the participants involved in this handover are published in a further report (Ooi et al., 2020) and builds on other existing findings published to date within other specialties (Donnelly et al., 2019). The findings of the Ooi et al study were informative as they allowed probing, using semi-structured interviews, into the perceptions of the handover participants after the handover had taken place. These findings are useful in the understanding participants\u2019 views on team dynamics, modes of communication, and the opportunities for learning. Similarly using an interview approach to gathering data, Bradley et al. (2018) was able to develop a set of themes that could be used to describe the handover process, namely informal learning (comprising opportunistic learning, implicit learning, and reflective learning) and formal and deliberative learning. Gathering data using the interview approach enables a deliberative process whereby the participants have time to reflect on their educational and clinical experience associated with the handover. Nevertheless, as aforementioned, it also allows participants to censor their thoughts and memories of the handover (Knox &amp; Burkard, 2009) and may not capture the authoritative complexity of what has occurred in a multifaceted meeting. Therefore, the dramaturgical process could be viewed as authentic \u2018in the moment\u2019 research whilst an interview perspective is memory driven, retrospective and reflective. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">The optimal approach is to use the dramaturgical system to capture the objective evidence of what actually happened in the handover, and then to use interview data to consider how the participants frame their reflections of what happened. Using both systems would be highly informative in terms of illustrating congruity or incongruity between what happened, what participants thought had happened, and participants\u2019 consequential deliberations regarding their educational and clinical experiences. Using both research systems would benefit handovers, as they would complement each other. To gather data from a larger sample source, using a self-report questionnaire may be valuable once the theoretical domains are established. However, it is acknowledged that designing and developing a questionnaire that is fit for purpose takes careful planning and a rigorous research process (Rattray &amp; Jones, 2007).<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">A major limitation of the dramaturgical approach taken was the presence of the observers, cameras and audio recording devices and the knowledge of being observed. The Hawthorne effect has been noted as an important aspect of studies as it infers that the perception of special attention may influence behaviour (Paradis &amp; Sutkin, 2017). The research team was uncertain whether the strong emphasis within this handover on teaching reflected the usual practice of the paediatricians involved, but acknowledged that some of the handover participants were aware that two of the researchers were involved in previous research in this area (Ooi et al., 2020), which could have contributed to conciliatory behaviour. One further area of concern was conflict of interest or undue influence.\u00a0 The handover we studied occurred within a hospital at which one of the researchers is both Clinical Director and a paediatrician, and where two others are previous or current members of the paediatric team. None of these three doctors was present in the room during the study, but we acknowledge a potential conflict of interest, which could have altered participants\u2019 behaviour. However, we felt that we had instigated safeguards to minimise this influence, such as having two independent observers within the handover and asking an administrator to contact handover participants with regards to participation and consent. In addition, we also believe in the professionalism of the participants as their main concern in the handover was the authentic transfer of patient information to ensure optimal patient care. It is likely that a mixed-methods approach would be the optimal method for describing the explicit and implicit nature of the handover process.<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Our system of analysis created a triangulation method drawing information from the video and audio recordings taken from differing angles, the subsequent transcription of the audio recording, and the notes from two independent observers (medical student and medical educationalist). We were also able to collect data on the room layout (Figure 1) and the handover sheet.\u00a0 We found the data from the video source invaluable in identifying which participants were speaking and in detecting dialogue that was not clearly audible from the audio recording. Once the transcript was agreed on, we found analysis of the video sources and the recordings of the two observers critical to understanding the dynamics within the handover. The video allowed us to identify non-verbal behaviours such as the entrances and exits of staff where this was not otherwise referenced in the audio recording. An entire sequence of teaching occurred when one participant used the whiteboard, and this would not have been appreciated from use of the audio source only. Rees et al., 2013) used video and audio recordings to collect data relating to bedside teaching of medical students, but did not use a structured method of analysis; nonetheless, they found the video useful in capturing linguistic and para-linguistic information, although they noted the difficulty in capturing subtle non\u2010verbal communication (e.g. smiles).<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: center\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">This feasibility study has demonstrated that a dramaturgical method had immense utility when analysing the complexity of a paediatric handover meeting. A discussion as to its functionality, benefits and limitations is also provided and we believe that this approach has generated a deep understanding of this handover\u2019s dynamics and highlighted key aspects of the handover\u2019s function, with implications for educational and organisational research.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-GB\">Further studies could be designed relating to the dramaturgical method.\u00a0 These could be directed to other team handovers in either paediatric or other specialties, and in different health systems to broaden the understanding of processes that occur within these complex meetings.\u00a0 Examples of other such meetings are Multi-Disciplinary patient related meetings, ward rounds, radiology meetings and educational meetings such as Grand Rounds and workshops. Further research could be broadened to include semi-structured interviews of handover participants to gain further understanding of handover members\u2019 reactions to the handovers they have participated in.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Stephen Bradly is a consultant paediatrician (MBChB, FRACP, MClinEd), Clinical Lead, Medical Education, Lakes District Health Board, New Zealand. He reviewed the literature, co-designed the study, analysed the transcripts and co-wrote the manuscript.<\/span><span lang=\"EN-NZ\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Aaron Ooi is a registrar and teaching fellow (MBChB, DipPaed, PGDipClinEd), Waikato District Health Board, New Zealand. He reviewed the literature, co-designed the study, analysed the transcripts and co-wrote the manuscript. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Kerry Stafford is a senior house officer (BMBS), Department of Paediatrics, Christchurch Hospital, Canterbury District Health Board, New Zealand. She reviewed the literature, co-designed the study, analysed the transcripts and contributed to the manuscript. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Shuvayon Mukherjee was a fifth year medical student (BSc) at the time of the study, University of Auckland, New Zealand and on clinical attachment at the Department of Paediatrics, Rotorua Hospital, Lakes District Health Board. He reviewed the literature, co-designed the study, conducted the interviews, analysed the transcripts and contributed to the manuscript.\u00a0 <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Marcus A. Henning is an associate professor (BA, MA, MBus, PhD), Centre for Medical and Health Sciences Education, University of Auckland, New Zealand. He reviewed the literature, co-designed the study, conducted the interviews, analysed the transcripts and co-wrote the manuscript. He is the corresponding author for this manuscript*.<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Ethics approval was obtained from the University of Auckland Human Participants Ethics Committee (UAHPEC) on 26 June 2018.\u00a0 The reference protocol number is 121483.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-NZ\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">The anonymised data set is available on <\/span><span lang=\"EN-US\"><a href=\"https:\/\/figshare.com\/s\/2985a2e3047594816d88\"><span lang=\"EN-NZ\">https:\/\/figshare.com\/s\/2985a2e3047594816d88<\/span><\/a><\/span><span><span lang=\"EN-NZ\"> <\/span><\/span><span><span lang=\"EN-NZ\">Figshare<\/span><\/span><span lang=\"EN-NZ\"> (2020), with URL details below.<\/span><span lang=\"EN-NZ\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Due to the nature of the video and audio recording containing identifying information, these have not been made public. Requests for these can be directed to the corresponding author if required. <\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">We wish to thank the participants in the handover that we studied, who graciously allowed our observation of them working hard to provide excellent care for their patients. We are also grateful to Brenda Flood, who efficiently and capably transcribed the handover.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">A grant to meet the cost of transcription was received from the Stolwyk Trust, Lakes District Health Board. <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">The authors declare no conflicts of interest.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\" style=\"text-align: center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Arora, V., Johnson, J., Lovinger, D., Humphrey, H., &amp; Meltzer, D. (2005). Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis. <i>BMJ Quality &amp; Safety<\/i>,<i> 14<\/i>(6), 401-407. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1136\/qshc.2005.015107%20\">https:\/\/doi.org\/10.1136\/qshc.2005.015107<\/a><\/span><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Australian Medical Association Limited. (2006). <i>Safe handover: Safe patients. Guidance on clinical handover for clinicians and managers.<\/i> <\/span><span lang=\"EN-US\"><a href=\"http:\/\/ama.com.au\/sites\/default\/files\/documents\/Clinical_Handover_0.pdf\">http:\/\/ama.com.au\/sites\/default\/files\/documents\/Clinical_Handover_0.pdf<\/a><\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Behara, R., Wears, R. L., Perry, S. J., Eisenberg, E., Murphy, L., Vanderhoef, M., Shapiro, M., Beach, C., Croskerry, P., &amp; Cosby, K. (2005). A conceptual framework for studying the safety of transitions in emergency care. In K. Henricksen, J. Balttles, &amp; E. Marks (Eds.), <i>Advances in patient safety: From research to implementation<\/i> (Vol. 2, pp. 309-321). Agency for Healthcare Research and Quality. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Bomba, D. T., &amp; Prakash, R. (2005). A description of handover processes in an Australian public hospital. <i>Australian Health Review<\/i>,<i> 29<\/i>(1), 68-79. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1071\/AH050068%20\">https:\/\/doi.org\/10.1071\/AH050068<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Bradley, S. K., Egan, J., &amp; Henning, M. A. (2018). Paediatric team handover: A time to learn? <i>New Zealand Medical Journal<\/i>,<i> 131<\/i>(1476), 70-80. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/assets-global.website-files.com\/5e332a62c703f653182faf47\/5e332a62c703f63e992fd3f5_Bradley-FINAL.pdf\">https:\/\/assets-global.website-files.com\/5e332a62c703f653182faf47\/5e332a62c703f63e992fd3f5_Bradley-FINAL.pdf<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Canary, D. J., Cody, M. J., &amp; Manusov, V. L. (2008). <i>Interpersonal communication: A goals based approach<\/i>. Bedford\/St. Martin&#8217;s. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Crea, T. (2017). Narrative dramaturgy and sense making in healthcare simulation. In D. Nestel, B. Jolly, M. Kelly, &amp; M. Watson (Eds.), <i>Healthcare Simulation Education: Evidence, Theory and Practice<\/i> (pp. 54-59). John Wiley and Sons. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">DiCicco\u2010Bloom, B., &amp; Crabtree, B. F. (2006). The qualitative research interview. <i>Medical Education<\/i>,<i> 40<\/i>(4), 314-321. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2929.2006.02418.x%20\">https:\/\/doi.org\/10.1111\/j.1365-2929.2006.02418.x<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Donnelly, S., Dinesh, D., Dew, K., &amp; Stubbe, M. (2019). The handover room: A qualitative enquiry into the experience of morning clinical handover for acute medical teams. <i>Internal medicine journal<\/i>,<i> 49<\/i>(5), 607-614. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/imj.14142%20\">https:\/\/doi.org\/10.1111\/imj.14142<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Egan, T., &amp; Jaye, C. (2009). Communities of clinical practice: The social organization of clinical learning. <i>Health<\/i>,<i> 13<\/i>(1), 107-125. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1177\/1363459308097363%20\">https:\/\/doi.org\/10.1177\/1363459308097363<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Elo, S., K\u00e4\u00e4ri\u00e4inen, M., Kanste, O., P\u00f6lkki, T., Utriainen, K., &amp; Kyng\u00e4s, H. (2014). Qualitative content analysis: A focus on trustworthiness. <i>SAGE Open<\/i>,<i> 4<\/i>(1), 2158244014522633. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1177\/2158244014522633%20\">https:\/\/doi.org\/10.1177\/2158244014522633<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Elo, S., &amp; Kyng\u00e4s, H. (2008). The qualitative content analysis process. <i>Journal of Advanced Nursing<\/i>,<i> 62<\/i>(1), 107-115. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2648.2007.04569.x\">https:\/\/doi.org\/10.1111\/j.1365-2648.2007.04569.x<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Figshare. (2020). Handover notes &#8211; Observer 1 (Anonymised).docx. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/figshare.com\/s\/2985a2e3047594816d88%20\">https:\/\/figshare.com\/s\/2985a2e3047594816d88<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Flory, J., &amp; Emanuel, E. (2004). Interventions to improve research participants&#8217; understanding in informed consent for research: A systematic review. <i>Journal of the American Medical Association<\/i>,<i> 292<\/i>(13), 1593-1601. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1001\/jama.292.13.1593%20\">https:\/\/doi.org\/10.1001\/jama.292.13.1593<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Forde, C. A. (2014). <i>Emergency medicine triage as the intersection of storytelling, decision-making, and dramaturgy.<\/i> University of South Florida. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/scholarcommons.usf.edu\/etd\/5354\/\">https:\/\/scholarcommons.usf.edu\/etd\/5354\/<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Fujikawa, H., Son, D., &amp; Eto, M. (2021). Are residents learners or workers? A historical perspective in Japan. <i>The Asia Pacific Scholar<\/i>,<i> 6<\/i>(1), 122-124. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.29060\/TAPS.2021-6-1\/PV2339%20\">https:\/\/doi.org\/10.29060\/TAPS.2021-6-1\/PV2339<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Goffman, E. (1959). <i>The Presentation of Self in Everyday Life<\/i>. Anchor Books. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Hays, M. M., &amp; Weinert, C. (2006). A dramaturgical analysis of shift report patterns with cost implications: A case study. <i>Nursing Economics<\/i>,<i> 24<\/i>(5), 253. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Henderson, A. (2005). The value of integrating interpretive research approaches in the exposition of healthcare context.<i> Journal of Advanced Nursing<\/i>,<i> 52<\/i>(5), 554-560. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2648.2005.03622.x\"><span lang=\"EN-NZ\">https:\/\/doi.org\/10.1111\/j.1365-2648.2005.03622.x<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Hensher, M., Price, M., &amp; Adomakoh, S. (2006). Referral hospitals. In D. T. Jamison, J. G. Breman, A. R. Measham, G. Alleyne, M. Claeson, D. B. Evans, P. J. Mills, &amp; P. Musgrove (Eds.), <i>Disease control priorities in developing countries<\/i> (2nd ed., pp. 1229-1243). Oxford University Press. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Hilligoss, B., &amp; Cohen, M. D. (2011). Hospital handoffs as multifunctional situated routines: Implications for researchers and administrators. In L. H. Friedman, J. Goes, &amp; G. T. Savage (Eds.), <i>Biennial review of health care management <\/i>(Vol. 11, pp. 91-132). Emerald Group Publishing Limited. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1108\/S1474-8231(2011)0000011008%20\">https:\/\/doi.org\/\/10.1108\/S1474-8231(2011)0000011008<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Horsky, J., Suh, E. H., Sayan, O., &amp; Patel, V. (2015). Uncertainty, case complexity and the content of verbal handoffs at the emergency department. AMIA Annual Symposium Proceedings. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Kinahan, M. P. (2017). <i>Teachers and seating arrangements and assignments: A qualitative study [Doctoral thesis,<\/i><\/span><span lang=\"EN-US\"> <\/span><i><span lang=\"EN-US\">Northeastern University]<\/span><\/i><span lang=\"EN-US\">. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/repository.library.northeastern.edu\/files\/neu:cj82q019x\/fulltext.pdf\">https:\/\/repository.library.northeastern.edu\/files\/neu:cj82q019x\/fulltext.pdf<\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Knox, S., &amp; Burkard, A. W. (2009). Qualitative research interviews. <i>Psychotherapy research<\/i>,<i> 19<\/i>(4-5), 566-575. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/10503300802702105%20\">https:\/\/doi.org\/10.1080\/10503300802702105<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Murphy, F. (2009). Act, scene, agency: The drama of medical imaging. <i>Radiography<\/i>,<i> 15<\/i>(1), 34-39. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.radi.2007.09.006%20\">https:\/\/doi.org\/10.1016\/j.radi.2007.09.006<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Nugus, P., McCarthy, S., Holdgate, A., Braithwaite, J., Schoenmakers, A., &amp; Wagner, C. (2017). Packaging patients and handing them over: Communication context and persuasion in the emergency department. <i>Annals of Emergency Medicine<\/i>,<i> 69<\/i>(2), 210-217. e212. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1016\/j.annemergmed.2016.08.456%20\">https:\/\/doi.org\/10.1016\/j.annemergmed.2016.08.456<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Ooi, A., Bradley, S., Mukherjee, S., Stafford, K., &amp; Henning, M. A. (2020). Facilitating educational experiences in a paediatric handover: A qualitative case study. <i>Journal of Paediatrics Child Health<\/i>,<i> 56<\/i>(9), 1426-1431. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/jpc.14964%20\">https:\/\/doi.org\/10.1111\/jpc.14964<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Paradis, E., &amp; Sutkin, G. (2017). Beyond a good story: from hawthorne effect to reactivity in health professions education research. <i>Medical Education<\/i>,<i> 51<\/i>(1), 31-39. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/medu.13122%20\">https:\/\/doi.org\/10.1111\/medu.13122<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Preves, S., &amp; Stephenson, D. (2009). The classroom as stage: Impression management in collaborative teaching. <i>Teaching Sociology<\/i>,<i> 37<\/i>(3), 245-256. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1177\/0092055X0903700303\"><span lang=\"EN-NZ\">https:\/\/doi.org\/10.1177\/0092055X0903700303<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Rattray, J., &amp; Jones, M. C. (2007). Essential elements of questionnaire design and development. <i>Journal of Clinical Nursing<\/i>,<i> 16<\/i>(2), 234-243. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1365-2702.2006.01573.x%20\">https:\/\/doi.org\/10.1111\/j.1365-2702.2006.01573.x<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Rees, C. E., Ajjawi, R., &amp; Monrouxe, L. V. (2013). The construction of power in family medicine bedside teaching: A video observation study. <i>Medical Education<\/i>,<i> 47<\/i>(2), 154-165. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/medu.12055%20\">https:\/\/doi.org\/10.1111\/medu.12055<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Sankar, P., Mora, S., Merz, J. F., &amp; Jones, N. L. (2003). Patient perspectives of medical confidentiality: A review of the literature. <i>Journal of General Internal Medicine<\/i>,<i> 18<\/i>(8), 659-669. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1046\/j.1525-1497.2003.20823.x%20\">https:\/\/doi.org\/10.1046\/j.1525-1497.2003.20823.x<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Sawyer, R. K. (2004). Creative teaching: Collaborative discussion as disciplined improvisation. <i>Educational Researcher<\/i>,<i> 33<\/i>(2), 12-20. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.3102\/0013189X033002012%20\">https:\/\/doi.org\/10.3102\/0013189X033002012<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-US\">Schell, H. (2016). <i>Casting revealed: A guide for film directors<\/i>. Routledge. <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Schryer, C. F., Lingard, L., Spafford, M., &amp; Garwood, K. (2003). Structure and agency in medical case presentations. In B. C &amp; R. D (Eds.), <i>Writing selves\/writing societies: Research from activity perspectives<\/i> (pp. 62-96). The WAC Clearing House. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/wac.colostate.edu\/books\/selves_societies\/schryer\/schryer.pdf\"><span lang=\"EN-NZ\">https:\/\/wac.colostate.edu\/books\/selves_societies\/schryer\/schryer.pdf<\/span><\/a><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\">Wenger, E. C., &amp; Snyder, W. M. (2000). Communities of practice: The organizational frontier. Retrieved June 22, 2019, from <\/span><span lang=\"EN-US\"><a href=\"https:\/\/hbr.org\/2000\/01\/communities-of-practice-the-organizational-frontier\">https:\/\/hbr.org\/2000\/01\/communities-of-practice-the-organizational-frontier<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: justify\"><span lang=\"EN-NZ\"> <span lang=\"EN-AU\">*<span lang=\"EN-US\">Marcus A. Henning<\/span><br \/>\r\n<span lang=\"EN-US\">The University of Auckland,<\/span><br \/>\r\n<span lang=\"EN-GB\"><span lang=\"EN-US\">Private Bag 92019,<\/span><br \/>\r\n<\/span><\/span><span lang=\"EN-AU\"><span lang=\"EN-US\">Auckland 1142,<\/span><br \/>\r\n<span lang=\"EN-US\">New Zealand,<\/span><br \/>\r\n<span lang=\"EN-GB\"><span lang=\"EN-US\">Contact No: 0064 923 7392<\/span><br \/>\r\n<span lang=\"EN-US\">Email:<\/span><span lang=\"EN-US\"> <\/span><span><span lang=\"EN-US\">m.henning@auckland.ac.nz<\/span><\/span><\/span><\/span><\/span><\/p>\r\n<\/div>\r\n<\/div>","protected":false},"featured_media":0,"parent":0,"menu_order":5,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61868],"class_list":["post-70929","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-6-number-4-october-2021"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>A dramaturgical analysis of a paediatric team handover - The Asia Pacific Scholar<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A dramaturgical analysis of a paediatric team handover - The Asia Pacific Scholar\" \/>\n<meta property=\"og:description\" content=\"Submitted: 2 November 2020 Accepted: 8 February 2021 Published online: 5 October, TAPS 2021, 6(4), 37-48 https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2425 Stephen Bradley1, Aaron Ooi2, Kerry Stafford3, Shuvayon Mukherjee1 &amp; Marcus A. Henning4 1Department of Paediatrics, Lakes District Health Board, New Zealand; 2Department of Paediatrics, Waikato District Health Board, New Zealand; 3Department of Paediatrics, Christchurch Hospital, New Zealand; 4Centre [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/\" \/>\n<meta property=\"og:site_name\" content=\"The Asia Pacific Scholar\" \/>\n<meta property=\"article:modified_time\" content=\"2022-01-03T23:41:19+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1-300x290.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"30 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/\",\"name\":\"A dramaturgical analysis of a paediatric team handover - The Asia Pacific Scholar\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1-300x290.png\",\"datePublished\":\"2021-09-13T06:36:04+00:00\",\"dateModified\":\"2022-01-03T23:41:19+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#primaryimage\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1.png\",\"contentUrl\":\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1.png\",\"width\":702,\"height\":678},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/taps\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"A dramaturgical analysis of a paediatric team handover\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/taps\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/taps\/\",\"name\":\"The Asia Pacific Scholar\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"A dramaturgical analysis of a paediatric team handover - The Asia Pacific Scholar","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/","og_locale":"en_US","og_type":"article","og_title":"A dramaturgical analysis of a paediatric team handover - The Asia Pacific Scholar","og_description":"Submitted: 2 November 2020 Accepted: 8 February 2021 Published online: 5 October, TAPS 2021, 6(4), 37-48 https:\/\/doi.org\/10.29060\/TAPS.2021-6-4\/OA2425 Stephen Bradley1, Aaron Ooi2, Kerry Stafford3, Shuvayon Mukherjee1 &amp; Marcus A. Henning4 1Department of Paediatrics, Lakes District Health Board, New Zealand; 2Department of Paediatrics, Waikato District Health Board, New Zealand; 3Department of Paediatrics, Christchurch Hospital, New Zealand; 4Centre [&hellip;]","og_url":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/","og_site_name":"The Asia Pacific Scholar","article_modified_time":"2022-01-03T23:41:19+00:00","og_image":[{"url":"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1-300x290.png","type":"","width":"","height":""}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"30 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/","url":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/","name":"A dramaturgical analysis of a paediatric team handover - The Asia Pacific Scholar","isPartOf":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/#website"},"primaryImageOfPage":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#primaryimage"},"image":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#primaryimage"},"thumbnailUrl":"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1-300x290.png","datePublished":"2021-09-13T06:36:04+00:00","dateModified":"2022-01-03T23:41:19+00:00","breadcrumb":{"@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#primaryimage","url":"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1.png","contentUrl":"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2021\/09\/OA2425-Figure-1.png","width":702,"height":678},{"@type":"BreadcrumbList","@id":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/a-dramaturgical-analysis-of-a-paediatric-team-handover\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/medicine.nus.edu.sg\/taps\/"},{"@type":"ListItem","position":2,"name":"A dramaturgical analysis of a paediatric team handover"}]},{"@type":"WebSite","@id":"https:\/\/medicine.nus.edu.sg\/taps\/#website","url":"https:\/\/medicine.nus.edu.sg\/taps\/","name":"The Asia Pacific Scholar","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/medicine.nus.edu.sg\/taps\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues\/70929","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues"}],"about":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/types\/issues"}],"wp:attachment":[{"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/media?parent=70929"}],"wp:term":[{"taxonomy":"issues_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issues_category?post=70929"},{"taxonomy":"archive_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/archive_category?post=70929"},{"taxonomy":"issue_type","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/issue_type?post=70929"},{"taxonomy":"volume_category","embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/taps\/wp-json\/wp\/v2\/volume_category?post=70929"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}