Accomplishing Intergroup Relations in Group Homes: A Discursive Analysis of Professionals Talking About External and Internal Stakeholders.

Focusing on one of the most studied dimensions of Social Psychology, i.e., intergroup relations, this study analyzes its discursive accomplishment in a specific group-based intervention, i.e., the talk and work of an Italian group home, i.e., a small alternative care facility hosting a group of out-of-home children. Particularly, we focused on the fictionally called "Nuns' Home," a group home previously investigated for its ethnocentric bias, and its intergroup relations with "inside" and "outside" groups, such as schools, biological families, and social services. By combining a qualitative and quantitative approach in analyzing one audio-recorded ethnographic interview with the whole team of professionals, we aimed at accounting for the multitude of internal and external stakeholders that participants refer to, analyzing the discursive accomplishment of ingroup and outgroup in talk-in-interaction and investigating ingroup bias and group qualification. To do so, we detected social categorization markers and qualifying devices that participants rely on when referring to groups. Results show that, among the numerous groups recognized, participants co-construct intergroup relations and ingroup bias implying negative assessment over external groups. Being different from traditional laboratory studies illustrating substantial contraposition between ingroup and outgroup, our qualitative analysis reveals the multitude of groups by which the ingroup is formed and their internal fragmentation. To conclude, we discussed the implications of qualitatively studying intergroup relations in group homes and indicated future lines of research.

Challenging the interprofessional epistemic boundaries: The practices of informing in nurse-physician interaction.

Interprofessional management of knowledge in health care settings appears to be particularly vital for the ways in which information circulates, medical decisions are taken, and nursing practices are implemented. Drawing on an extensive ethnographic fieldwork in an Italian Intensive Care Unit, this article investigates how the nurses orient to and concurrently challenge the nurse-physician epistemic boundaries by the different ways through which they perform "informing", and make it work as a diagnostic-relevant activity. Adopting an ethnographic-nurtured discursive approach to a dataset of video-recorded morning briefings, we analyze the nurses' informing contributions in terms of sequential position, turn-taking and turn design. We identify five practices of informing and show how they display different degrees of agency and differently impact on the team's "infectious diseases diagnostic reasoning". This article contributes to nurse-physician interaction studies by showing how the epistemic imbalance at play is interactionally accomplished by participants one interaction at a time. Particularly, the analysis demonstrates that the nurses actively contribute to the teamwork by a skillful management of knowledge that precedes the exercise of the physicians' epistemic and deontic rights implied in diagnosing and planning. Our findings illustrate how the nurses: a) exert their interactional agency without crossing the institutionally sanctioned epistemic and deontic boundaries to which they are observably oriented to; b) cautiously challenge the epistemic imbalance at play in nurse-physician interaction and c) actively contribute in setting the premises of the team's collective decisions. Conclusion and practical implications are proposed.

Knowledge and agency in interprofessional care: How nurses contribute to the case-construction in an Intensive Care Unit.

This paper focuses on the epistemic and interactional resources displayed by nurses participating in medical case construction and the ways through which they make a difference in the unfolding of this activity. This paper draws on an ethnographic research in an Italian Intensive Care Unit (ICU) selected according to a purposeful sampling approach out of a national sample of 40 ICUs participating in a larger research project. Our dataset, collected over a period of six months of ethnographic observations, consisted of the observers' field notes and log-books, audio and video-recordings of morning briefings, in-depth interviews, informal conversations and shadowing of bedside practices. For the purpose of this article, we analyzed the video-recorded morning briefings, involving nine attending physicians and three specialized nurses. Adopting a conversational analysis approach, this paper identifies the epistemic activities through which the nurses orient the physicians' ongoing reasoning. It illustrates how the nurses' contributions display different degrees of agency depending on the type of activity, the turn taking and the turn design. We contend that the nurses' interactional competence in managing their epistemic resources and rights related to their professional territory of knowledge makes their knowledge relevant and contributes in constituting the case construction as an interprofessional activity. Implications, limitations and suggestions for future research are discussed.

Struggles Over Antibiotics: Physicians' Stance-Taking Toward a Nonconforming Policy in an Intensive Care Unit.

One of the most pressing contemporary health care challenges consists in rethinking antibiotic use to contrast the increase of multidrug resistant bacteria. Drawing on an ethnographic fieldwork in an Intensive Care Unit that adopts a nonconforming policy of antibiotic stewardship, this article analyzes doctor-doctor interaction concerning infectious disease diagnosis and antibiotic treatment. By analyzing examples of medical decision-making from a corpus of video-recorded morning briefings, we focus on physicians' stance-taking toward the ward's nonconforming policy and illustrate how it is contingently situated along a continuum from strong commitment to overt resistance. We suggest that physicians' oscillating stance-taking is favored by the moral load of following an extreme and "off-label" policy and, in turn, impacts on the way this policy is practically accomplished as a highly reflective interactional achievement by the team members.