Workshop program booklet

 Program  Abstracts  Suggested readings


Agency in Health Care
Phenomenology and Experience
Date: April 15th 2013 Room: KA-052   The workshop is part of the doctoral seminar at Department of Health Studies, but open to everyone with an interest in the subject. REGISTRATION: Write to By Kari Vevatne, Head of Department at University of Stavanger’s Department of Health Studies Language in Human Life and Health: Languaging, personhood, and agency (Paul Thibault) Presentation of data from Clinical Simulation Centre (University of Hertfordshire) (Stephen Cowley & Paul Thibault) Discussion* Lunch From Phenomenology to Ethnomethodology – with examples from Interaction Analysis (Febe Friberg); Educating for teamwork: Nursing students’ coordination in simulated cardiac arrest situations (Sissel Eikeland Husebø) How Simulation Prefigures Actuality: Relying on interactivity (Stephen Cowley) Discussion*

Welcome 09.00-09.45 10.00-10.45 11.00-11.45 11.45-12.30 12.30-13.30

13.45-14.30 14.45-15.30

* Chaired by Morten Tønnessen

Open lecture by STEPHEN COWLEY:

Implications for language and cognition
Date: April 16th 2013 Time: 10.15-12.00 Room: KA-052 1

Open lecture (April 16th): Interactivity
implications for language and cognition
by STEPHEN COWLEY, University of Hertfordshire & University of Southern Denmark For many in the human sciences, one is faced with a choice between privileging a 3rd person perspective or beginning what can be learned about individual 1st person experience. The main aim of the presentation is to argue that this dichotomy can be transcended by developing a view that builds on findings about human interactivity.

Workshop abstracts (April 15th):
Language in Human Life and Health
Languaging, personhood, and agency
by PAUL J. THIBAULT, University of Agder, Faculty of Humanities and Education In this lecture, I will focus on the question of agents and agency in relation to languaging behaviour. The term ‘languaging’ rather than the more usual ‘language’ is used here to highlight the various ways in which agents enact and create dually situated and situation-transcending languaging events rather than use a pre-existing language system or symbolic code. Instead, they draw upon the individual and collective dimensions of human experience and its history in order to individuate languaging events against a backdrop of cultural norms and conventions. Languaging is about the whole person in his or her world. We therefore need a theory of language that can explain the fundamental relationship between languaging and the functioning and ontology of persons in the extended human ecology. In this lecture, I shall discuss recent re-thinking of the nature of language – the distributed view (e.g., Cowley, 2006, 2007, 2008, 2012; Hodges 2007, 2009, Kravchenko, 2003; Linell, 2008; Ross, 2007; Steffensen, 2008; Steffensen et al 2010; Stuart, 2010; Thibault, 2004, 2008, 2011a, 2011b, 2011c, 2012) – that seeks to understand how ‘language’ and the practices in which ‘language’ is embedded contribute to and promote human cognitive activity. The Distributed Language View has affinities with some aspects of the theories of distributed cognition developed by Clark (1997), Hutchins (1995), Wheeler (2005), and others. Specifically, both views agree that human cognition crucially depends on and exploits resources beyond the brain and body of the individual. However, theories of distributed cognition have provided no new insights into language and the role of language in human cognition (Steffensen, 2012). How does human agency work through both human biology and human culture? On the distributed view of language, human agents do not make use of a pre-existing language code. 2

Instead they engage in various forms of co-action whereby languaging activity is orchestrated in realtime through the integration of a variability of distinctive cultural and biological systems and resources that cannot be reduced to the formal abstracta typically taken to define the properties of ‘language’. On this view, human languaging activity is radically heterogeneous and involves the integration of processes on many different time-scales, including neural, bodily, situational, social, and cultural processes and events. Human agency has evolved to take adaptive advantage of this radical heterogeneity (of language) as a way of potentiating and augmenting human cognitive activity and agency. A crucial theoretical construct is the notion of Cognitive Event. Cognitive events arise through socially coordinated interactivity between persons and between persons and features of their external worlds (e.g., artefacts, tools, texts, technological resources, environmental affordances). Complex, socially coordinated interactivity has an adaptive advantage with respect to the simpler social structures of other species. Language arose on this basis: it upgrades and augments socially coordinated events and the forms of intelligence, interactivity, and agency which these events have made possible. Cognitive Events make use of and coordinate internal and external resources in ways that give rise to social distributed cultural and institutional competencies as well as adaptive, flexible human behaviour. How does language get integrated to cognitive events? How does it contribute to and enhance human agency? On the distributed language view, human agency is not the personal expression of inner attributes and motivations. Instead, persons and the forms of agency they are able to enact are located in, constrained by, and enabled by culturally saturated cognitive events. I will consider how languaging as values-realising activity is ontologically central to the person and to the forms of co-action and co-agency that persons engage in in order to enact and sustain social events in institutional settings – with specific reference to health interaction and medical simulations. With reference to video-recorded examples of health interaction, I will demonstrate the significance of these micro-temporal events and how they are integrated to, and are shaped and guided by second-order cultural patterns emanating from longer, slower cultural-historical timescales that evoke cultural norms and values. I will consider some of the ways in which these conventionalised, second-order patterns, including lexicogrammar and other cultural artefacts, interact with and scaffold first-order interactivity, including pico-scale bodily events, as persons seek to coordinate their actions, perceptions, forms of awareness, self-concepts, and understandings in the service of the larger-scale cognitive events in which these actions, perceptions, etc., are embedded. Workshop (Stephen Cowley and Paul J. Thibault) The lecture will be followed by a practical, hands-on workshop session that will focus on the finegrained analysis of video-recorded data of health interaction as a form of Event Analysis. The aim of the Workshop will be to: 1. show that ‘language’ is not a determinate code or system, but the skilful orchestration in time and across time-scales of diverse skills and capacities – biological, cognitive, social, and cultural; 2. describe key features of languaging as integrated verbal and nonverbal modes of whole-body participatory sense-making rather than as separate communicative or semiotic ‘modalities’ ; 3. help practitioners reflect on and describe the languaging they encounter in professional health interaction settings through the developmental of relevant observational, analytical and 3

technological skills in order to build up a tool-box of useful strategies and resources for understanding the complexities of health interaction; 4. understand and reflect on how second-order cultural constructs such as writing, grammar, and language constrain and enable perception and action in institutional settings with particular reference to health interaction.

How Simulation Prefigures Actuality
Relying on interactivity
by STEPHEN COWLEY, University of Hertfordshire & University of Southern Denmark Simulation was borrowed into Medicine for practical reasons. Hitherto, as Peter Dieckmann complains, there has been little research about simulation. For this reason, performance is often measured against checklists or by turning to participant reports. In developing methods to explore Emergency simulations around events or ‘what happens’, we aim to clarify what simulations offer to health professionals. The method allows one to reach beyond concerns with patient safety by identifying competencies that can be enhanced through experience based facilitation. Using high fidelity simulation in emergency situations readies the team for using coaction to deal with likely events (and problems). In emergency settings, a focus on the fine detail of performance shows that whole-body activity is typically coordinated around the activities of a main cognizer. Without the trainees’ imaginative engagement, this is all too easily lost. Conversely, it is concluded that where authenticity is achieved, high fidelity settings provide as a useful locus for learning to help others to anticipate the likely event trajectory.

From Phenomenology to Ethnomethodology
With examples from Interaction Analysis by FEBE FRIBERG and SISSEL EIKELAND HUSEBØ; Department of Health Studies – University of Stavanger
Theoretical frames During the last decade phenomenology has been one of the most prominent approaches that have informed different disciplines within human sciences and among them health and care sciences. Phenomenology and also hermeneutics are traditions of significance for understanding the world of experience and the complexity in human life and living. Here, the term lifeworld phenomenology is used to point to the connection between life and world. Alfred Schutz was one of the researchers in the phenomenological movement who explicated aspects as action, meaning and intersubjectivety. As mentioned by Natanson (1984) Schutz did something Edmund Husserl took for granted, namely he further developed and explored intersubjectivety. He specifically stressed the pragmatic elements of the everyday social world. Schutz´ principal work, The Phenomenology of the Social World, was published in 1932. We will take the point of departure in Schutz´s phenomenology and describe and problematize some theoretical standpoints (Schutz 1972; Schutz & Luckmann 1973; Schutz & Luckmann 1983). We will further relate to the development of Harold Garfinkel´s ethnomethodology. (Garfinkel 1986). This is followed by an empirical example where interaction analysis is used following the tradition of ethnomethodology (Husebø et al. 2011) 4

The empirical study Title Educating for teamwork – nursing students’ coordination in simulated cardiac arrest situations Aim The overarching aim was to explore and describe the communicative modes students employ to coordinate the team in a simulation-based environment designed for resuscitation team training. Background Verbal communication is often considered essential for effective coordination in resuscitation teams and enhancing patient safety. Although simulation is a promising method for improving coordination skills, previous studies have overlooked the necessity of addressing the multifaceted interplay between verbal and nonverbal forms of communication. Method Eighty-one nursing students participated in the study. The data were collected in February and March, 2008. Video-recordings from 28 simulated cardiac arrest situations in a nursing program were analysed. First, all communicative actions were coded and quantified according to content analysis. Secondly, interaction analysis was performed to capture the significance of verbal and nonverbal communication respectively in the moment-to-moment coordination of the team. Findings Three phases of coordination in the resuscitation team were identified: Stating unconsciousness, Preparing for resuscitation, Initiating resuscitation. Coordination of joint assessments and actions in these phases involved a broad range of verbal and nonverbal communication modes that were necessary for achieving mutual understandings of how to continue to the next step in the algorithm. This was accomplished through a complex interplay of taking position, pointing, and through verbal statements and directives. Conclusion Simulation-based environments offer a promising solution in nursing education for training the coordination necessary in resuscitation teams as they provide the opportunity to practice the complex interplay of verbal and nonverbal communication modes that would otherwise not be possible.

References Garfinkel, H. (1986). Ethnomethodological studies of work. London: Routledge & Kegan Paul. Husebø, S.E., Rystedt, H. & Friberg, F. (2011). Educating for teamwork – nursing students’ coordination in simulated cardiac arrest situations. Journal of Advanced Nursing, 67(10), 2239–2255. Natanson, M. (1984). Anonymity. A study in the Philosophy of Alfred Schutz. Bloomington: Indiana University Press. Schütz, A. (1972). The phenomenology of the social world (G. Walsh & F. Lehnert, övers.). Evanston, IL: Northwestern University Press. (Original published 1932) Schutz, A. & Luckmann, T. (1973). The Structures of the Lifeworld. Volyme I. Evanston, Illinois: Northwestern University press. Schutz, A. & Luckmann, T. (1983). The Structures of the Lifeworld. Volyme II. Evanston, Illinois: Northwestern University press.


Optional readings Öhlén, J., Wallengren Gustavsson, M., & Friberg, F. (2012). Making sense of receiving palliative treatment- significance to palliative cancer communication and information provision. Cancer Nursing, DOI: 10.1097/NCC.0b013e31826c96d9 Friberg, F. & Öhlén, J. (2009). Reflective exploration of Beekman’s “participant experience” Qualitative Health Research, 20(2), 273-228. Berndtsson, I., Claesson, S., Friberg, F., & Öhlén, J.(2007). Issues about Thinking Phenomenologically while Doing Phenomenology. Journal of Phenomenological Psychology, 38, 256-277. Friberg, F., & Öhlén, J. (2007). Searching for knowledge and understanding while living with impending death – a phenomenological case study. International Journal of Qualitative Studies on Health and Well-being, 2(4), 217-226.


Suggested Readings
All readings will be available in PDF format in the workshop’s Dropbox-folder (at Participants will get access upon registering for the workshop. Cowley, S.J. (2011). Distributed language. In S.J. Cowley, (ed). Distributed Language, pp. 1-14. John Benjamins: Amsterdam. Cowley, Stephen J. (2012). Distributed language: Cognition beyond the brain. Conference paper. Galosia, M., Cowley, S.J., Alliner, G. & Steffensen, S. (2010). When life hangs on biosemiosis: tracking expertise in a medical simulation centre. In Cowley, S.J., Steffensen, S. & J.C. Major, Signifying Bodies: Biosemiosis, Interaction and Health, pp. 173-200. Braga: Portuguese Catholic University Press. Hodges, Bert H. (2007). Good prospects: ecological and social perspectives on conforming, creating, and caring in conversation. Language Sciences 29: 584–604. Husebø, S.E., Rystedt, H. & Friberg, F. (2011). Educating for teamwork – nursing students’ coordination in simulated cardiac arrest situations. Journal of Advanced Nursing 67(10): 2239–2255. Steffensen, S., Cowley, S.J. and Thibault, P.J. (2010). Living in the social meshwork: the case of health interaction. In Cowley, S.J., Steffensen, S. & J.C. Major, Signifying Bodies: Biosemiosis, Interaction and Health, pp. 201-237. Braga: Portuguese Catholic University Press. Thibault, Paul. J. (2011). First-Order Languaging Dynamics and Second-Order Language: The Distributed Language View. Ecological Psychology 23(3): 210-245. Tønnessen, Morten (2011). Semiotics of Being and Uexküllian Phenomenology. In Anna-Teresa Tymieniecka (ed.), Phenomenology/Ontopoiesis Retrieving Geo-Cosmic Horizons of Antiquity (= Analecta Husserliana CX/110), pp. 327-340.. Dordrecht: Springer.


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