Beyond the unobtrusive observer: reflections on researcher-informant relationships in urban ethnography.

Ethnographic research involves the creation and ongoing renegotiations of relationships between researchers and informants. Prolonged engagement contributes to the complexity as relationships deepen and shift over time and participants accumulate a substantial reservoir of shared experiences. Reflections about the relationships we have co-constructed with informants in several research projects have contributed to our identification of several critical aspects of building and maintaining researcher-informant relationships in cross-cultural research. Aspects of relationship work specifically related to conducting ethnography with children, within the communities in which researchers live, and within the practice of occupational therapy are discussed.

The complexities embedded in family-centered care.

The recent movement toward family-centered care, which has been propelled by the implementation of the Education for All Handicapped Children Amendments of 1986, poses considerable challenges to professionals trained in client-centered models of service delivery. These challenges are compounded by the fact that our understanding of family-centered care lags considerably behind our attempts to implement responsive and efficacious services. When practitioners include family members more integrally as collaborators in pediatric treatment, their perceptions about families and the nature of the therapeutic experience is affected. In this article, we present a number of critical dilemmas that are based on data drawn from ethnographic research, descriptive studies, and training seminars we conducted with pediatric practitioners and parents of children with special health care needs. These dilemmas highlight the complexities involved in building effective partnerships among all the key players, the influence of multiple cultural worlds on everyday practices, and the need to provide supports to practitioners for the emotional and social dimensions of practice. Implications for practice and future research are presented.

A descriptive study of the clinical practice patterns of occupational therapists working with infants and young children.

This investigation was designed to gather descriptive data on the clinical practice patterns of occupational therapists working with infants and young children. One hundred nineteen therapists entered the study, and 118 completed the interview, yielding a response rate of 99.4%. The therapists were highly experienced, with a mean of 9.47 years working in pediatrics. The school setting was the most common type of facility in which therapists served infants and young children and accounted for 37.3% of the sample. The majority of the respondents (67.8%) were members of formally identified teams. Although 80.5% of the therapists served very young children (aged birth to 12 months), no therapists served this population exclusively. Considerable variability in models of service provision, team structures, and assessment and treatment practices were found. Additionally, there was a lack of consensus on the unique contributions of occupational therapy and diverse opinions regarding the importance of selected frames of reference. Implications of the findings on professional initiatives to enhance practice are discussed.

Clinical pharmacist impact on parenteral cephalosporin prescribing.

A study was undertaken to evaluate clinical pharmacist influence on parenteral cephalosporin prescribing patterns. Two intervention methods were evaluated: (1) publication of pharmacy newsletter for physicians containing specific recommendations and emphasizing the primary use of cefazolin, and (2) personal interaction between the clinical pharmacy staff and physicians promoting the recommendations outlined in the newsletter. These two methods were compared with each other as well as with an initial time span during which no influencing efforts were made. The effect of the pharmacy newsletter as a sole means of influencing physician prescribing of parenteral cephalosporins was minimal. The effect of pharmacist-physician interaction, either as a sole means of in conjunction with a pharmacy newsletter, resulted in an increased use of cefazolin. An annual cost savings of up to $11,265.88 was projected. The results indicate that physicians can be influenced in their prescribing of parenteral cephalosporins, leading to significant cost savings.