Describing a Clinical Group Coding Method for Identifying Competencies in an Allied Health Single Session

Figures & data

Figure 1 Clinician group coding method.

Table 1 Thematic Framework of Competencies in Single-Session Healthcare

Phases	Competency	Codes (Skills and Tasks)	Sample Quotes from Group Coding Sessions
Joining	Preparation, introduction, and purpose of meeting	Know the case and details before meeting; physical set-up of room; health literacy; inclusion and language use; proximity and body language of individuals involved; observe family dynamics; acknowledge new situation, potential challenges; start with patient (engage youth; establish relationship; build rapport); encourage coming together for common goal	In terms of body language … we always talk about bringing in a chair and make sure you are at the patient’s level rather than standing over and talking over because it implies power over … in an ambulatory setting it’s very different [patients] want to know why you are there and what your role is specifically. The clinician [should] start from the general to move down to the specific, like [start with] a general statement around the diagnosis.
	Setting the agenda	Explore understanding issues and purpose of meeting; clarify clinician’s role; explore patient(s) goals and reasons for being there; balance between agenda setting and observation; be aware of and address underlying tension	If we think methodically around the process, if there was some introduction describing [the clinician’s] role and then saying, “I want to set the agenda together to see what we are going to talk about today and I want to know what’s important to you so we can talk together.” That delicate balance that you are talking about is hard for students, and for a lot of clinicians, about where [the patient] is setting the agenda where I am supposed to set the agenda. It’s speaking to the conflict and speaking to what you are seeing; [not] allowing that to continue to overwhelm a meeting where the goal and objective is … about health and instruction and new diagnosis – I just speak to the tension.
Working	Refining and carrying out the agenda	Setting ground rules; keep focus on patient (in context); bridge expectation gap (patient expectations vs situational realities); conversation with a purpose (stay on track); help identify and redirect to common goal; time management vs ensuring patients return; rephrase/reframe; probe into underlying tensions and emotions	I say that all the time with families who present already to staff with a little tension and conflict. “We are not going to be speaking over each other. One person speaks at a time.” There is formalization of how the communication is going to occur, which you recognize based on some small details. There has been no direct discussion with the youth around how she feels … her body language seems disconnected from everything going on. Perhaps bringing that up and acknowledging … [giving her] a chance to discuss how she’s feeling around being there today and engaging in this process. The bridging/balancing patient versus clinician needs, expectations and goals is part of moving through the agenda as the exploration of what are we here to achieve today and what am I hoping to support you with. A lot of students thinking about their own goals that they miss a whole big part of it … if we position it with a patient and their family that you are a partner in this process and how can we activate [the patient]to be a partner for her health management? A lot of professionals have difficultly in engaging in conversations with a purpose with patients and that’s often the challenge is how do you bring people back. How do you navigate this conflict that’s happening to this multigenerational health issue? How do you bridge that? We are here for [the patient], but look … We have these two key people in her life here as well.
	Addressing the context and dynamics	Appropriate approach for context; acknowledge power dynamics; cultural awareness; tune in to patient/family; acknowledge concerns; validate diagnosis as a family issue; recognize impact of diagnosis; focus on and reinforce strengths; identify expectations in healthcare; acknowledge clinician role in larger team	It’s important for the mother to know that … [the teen patient’s experience of] diabetes does not have to replicate … the grandmother’s diabetes. It is important to ask what does the disease mean to you? Allowing the process to unfold, initially observing some of the dynamics [means] you have a lot of good information … it’s not a reflection about the clinician [that the family’s arguing], it’s about what the family need to discuss or demonstrate for you to understand the context of their lives better. The clinician is not solely responsible for [the patient’s] care or information and education to the family, and I think telling patients who the team is and is important … She said “the diabetic team” or something about team [that’s important].
	Providing education	Provide relevant information; enhance patient/family understanding; solicit and respond to patient concerns; support autonomy; generate plan	I am hearing about all this food business and diabetes, and there is also a piece around self autonomy and deciding what you want to do with your body and understanding the risks and benefits of whatever is being proposed. When I think of psychosocial education, I think of [talking] about in general terms what the impact of this diagnosis would be on a family, how it might affect relationships, normalization of some of the tensions, normalizations of the grief that might come up, that’s more psychosocial education. Also, related to developmental stage, what you might expect from a 16 year old given this new diagnosis in the context of family relationships being an adolescent, in the context of peers at school. “Let’s talk about diabetes in general. You may have a different understanding.” I think the sequence is important but if you hear one of the family members saying something, that’s when you capitalize on the opportunity to interject, to provide clarity, to provide education.
Ending	Planning and next steps	Summarize plan; provide resources; build towards positive outcome; ensure understanding	Encourage hope because I think they are very sad, grief stricken about this. Very monumental and that’s normal. There is also an opportunity to try and instill and promote some hope that lots of people do live with diabetes and a lot of people do not get complications. That educational piece. There was no what’s the next step and even worse the family said, “I am not clear on the plan.”
	Encouraging success	Provide direction; acknowledge family’s strengths; reinforce common goal (patient’s health); make issue seem manageable	She was acknowledging and validating, especially of the mom and the grandma and some of the stresses. The strengths she talked about what I mentioned before, they are two mothers and they both care for her and they want her to be healthy. The patient, not as much in my opinion. [The clinician] said, “You are lucky to have these lucky ladies with you and supporting you.” She reinforced the strength and maybe support of the family
Ongoing	Use of self	Clinician self-awareness and self-reflexivity; stay present; critical thinking; implicate self; work collaboratively	With a lot of students that they live so much in their head thinking up what they have to accomplish in this situation that they miss what’s happening, the observation piece. There is a preparation skill set that needs to be incorporated into self-reflection. The clinician needs to get into a mindset: “What am I going in to do? What’s going to be my approach? Do I know this family? Do I know this patient? What’s the context? What are the key areas and the key questions that I want to address in this interview?” It’s that self-reflective piece that hopefully they practice in the field.
	Scope of practice	Boundaries; degree (msw, msc); multiple theoretical perspectives; scope of care (role of profession in context); continuum of care	People do need to push themselves in a healthcare environment. It’s not easy. You need to be on the ball. You only have a certain amount of time … just get in there and do what you need to do. We are the specialists in addressing psychosocial stressors around disease.