Physicians‟ information practices : a case study of a medical team at a Teaching Hospital

Abstract: This thesis is a user study within library and information science on participatory practices of a professional group in work activity. This has been investigated only to a minor extent in previous library and information science research. The qualitative empirical focus alternates between physicians‟ engagements in work practice and workplace learning within patient care. The overall research problem was to learn how people in workplaces interacted with information that was embedded, intricately intertwined, and tightly bound to the ongoing routines of their everyday work. This thesis aims at understanding information practices of professionals in occupational settings as exemplified by a team of physicians in a Nigerian teaching hospital. In this thesis, the focus was on the collective work activity, and the specific goals identified include how physicians interact and make meaning in the context of the social activities in the workplace, how professionals individually or collectively gather, understand, produce, share and use information, and how workplace learning influences information practices. Information practices are viewed as sociocultural practices that occur inside other practices. The thesis focuses on a nuanced, contextualized understanding of the interplay between the participating actors in activity, the activity per se, and the intermediary role of tools and artefacts. The epistemological point of departure is the sociocultural perspective that emphasizes the dynamic interdependence of the individual with the social and collective development focusing on mediation through tools and artefacts in cultural, institutional, and historical situations. I have chosen cultural-historical activity theory and the practice theories to analyse the dynamic processes in the context of patient care. Their underlying principles guided the empirical study, facilitating extrapolations and illustrations in the analysis. The cultural-historical activity theory was used to understand contextual issues that influence information practices in work activity: the object and subject of activity, division of labour, rules and norms, community, tools and artefacts, as well as the activity system itself and the hierarchical structure of the activity. Theories and concepts employed from a practice perspective on learning were considered useful for understanding the participatory modes in workplace and the influence of social learning communities on diverse information processes. In so doing, the study strives to provide a holistic understanding of information practices, workplace learning, and the relationships between them.The empirical data was gathered through a qualitative case study that lasted over a period of two years. Direct observation was the dominant data collection technique 5 used throughout the preliminary and main empirical studies to capture physicians‟ information practices and experiences. The observation focused on the Clinical Pharmacology and Therapeutics (CPT) team‟s encounters with patients; the interactions they had amongst themselves, and events and situations surrounding patient care. During the main study, other data collection techniques were employed alongside the observation method. In-depth open-ended interviews were conducted with 17 physicians and 9 non-physicians who were selected to provide rich and varied descriptions of the phenomena under study. The interview time totalled at 1,535 minutes. Physical artefacts were another data collection technique employed: 30 patients‟ medical records were assessed during the empirical study. Finally, informal interactions in the research setting were an additional data collection technique used continuously throughout the two empirical periods. The results were analyzed through a combination of inductive and deductive methods of analysis. There are four parts to the empirical results in this thesis. In the first, contextual elements that showed how work environment can be an influencing factor in the information practices of a professional group are described from the perspective of cultural historical activity theory. In the second part, the nature of information access in the real-world information environment was portrayed. It was found that information sources and strategies contributed to the overarching goal of restoring patient health to normalcy. The information sources and strategies were also found useful for mediating the information environment both subjectively and intersubjectively. An equally important result concerns the authority issues related to information sources and strategies. In the third part, available tools and artefacts were presented as useful information aids that also played a mediating role. Tools were categorised into physical tools and language. Language was categorized according to the social situations or classes of speakers. The case notes were seen as useful artefact and occupied a central niche in the studied work activity. These tools and artefacts enabled affordances around which social practices were built on in the work activities. In the last part of the results, various information practices that mirror the participatory practices rather than those of isolated individuals are highlighted. Six dimensions made up and covered the most vital spectrum of the information processing: information gathering, meaning making, information sharing, information use, reading, and documentation. Furthermore, the study revealed that learning took place simultaneously with the work activity and that it influenced information practices at the same time.