Using Harvey Sacks’s concept of membership categorization devices, this article examines the help-search sequences in which Japanese rehabilitation team members use a set of categories to locate the availability of stroke family caregivers. Specifically, based on an analysis of audiovisual data from rehabilitation team conferences in Japan, the article illustrates the ways in which participants at the meetings: evaluate the expectable behaviors of various category incumbents; classify which category of person is proper to turn to for help; and arrive at (...) the conclusion that no one is available, and so the patient must be institutionalized. Analysis shows that participants routinely choose co-resident family members to fulfill the caregiver position. However, the position is not guaranteed unless the selected incumbent can satisfy additional criteria, especially physical strength and time availability. By exploring the ways in which participants use categories to negotiate discharge destinations, the article adds to Sacks’s analysis by illustrating methodical activities for deciding whether someone is unavailable to help. Moreover, it considers the applicability of Sacks’s notion of MCDs to Japanese data. (shrink)

This study investigates rehabilitation team members’ interactive accomplishments of their domains of work and responsibility in rehabilitation team conferences in Japan. A combination of membership categorization analysis and sequential analysis is adopted to systematically illustrate the situated productions of professional sense-making practices. Analysis focuses on the segment in which a physician asks a series of questions regarding a patient’s functional status and disability coded in the functional assessment record (FAR). A close examination of data shows that a physician does not (...) always choose a respondent with his or her gaze when asking a question because s/he is continuously reading the FAR displayed on a computer screen. Despite this, a physician’s mention of a topic generates a professional’s domain of work and responsibility in a local division of labor which is used by members to assume who the relevant categorial respondent is. Further, members demonstrate these assumptions by shifting their gazes toward the computer screen, back to the document on the desk, and turning toward co-participants, thus embodying professional roles and responsibilities in situ. This study utilizes the analyst’s ethnographic understanding of the routines and division of labor at the rehabilitation ward as a resource to explicate professional sense-making practices, thus utilizing Garfinkel’s ethnomethodological studies of work. Together with sequential and categorial resources offered by Sacks, this study elucidates inferences and normative expectations which rehabilitation team members bring together to reproduce the endogenous logic of rehabilitation culture in actual occasions of the institutional life. (shrink)

The functional independence measure is a clinical scale which is used to evaluate the amount of assistance disabled persons need to conduct their daily living activities. Drawing on 65 video-recorded rehabilitation team meetings and medical records collected from a Japanese hospital, this article utilizes ethnomethodology and conversation analysis to uncover how Japanese rehabilitation team members use the FIM to track changes in the functional status of patients and decide the length of stay in ongoing interactional sequences. Analysis shows that a (...) series of the FIM scores assembled and arranged in situ provide a sequential framework for members to understand the progress of rehabilitation and predict the plateau phase. Moreover, a particular expert is asked about patients’ capacity for further improvements and his or her opinions are treated as a basis for clinical decisions. In this way, diagnostic and clinical decision-making is produced through the ongoing collaborative work of various specialists. (shrink)

Using conversation analysis, this study investigates how Japanese rehabilitation team members use their geographic knowledge to search for long-term care facilities for stroke survivors in multidisciplinary team interactions. The study uncovers the orderly use of decision rules during discharge planning activities by exploring the following two questions: What decision criteria are discursively used? In what order are the criteria handled through sequential operations? The data comprise 65 video-recorded rehabilitation team meetings and ethnographic information regarding local care facilities and patients’ residential (...) addresses. The analysis shows that the participants deal with decision criteria in an orderly manner. They identify the type of facility and location preferred by the patient’s family and search for a facility accordingly. Moreover, they routinely select facilities closer to the patients’ and their families’ homes. However, these rules are modified if the family’s choice is inappropriate, or when a facility in a different location is preferred by the family. The study contributes to the conversation analytic understanding of interprofessional decision making and prioritization through the analysis of orderly methods of search procedures interactively accomplished by participants in ongoing medical team interactions. (shrink)