Formulación mixta y necesidad de control sobre la presión:

The findings of the research have provided an insight into the problem solving used by radiographers in the trauma setting. It is clear that there is still much to learn about how radiographers solve problems in practice. This research has added to the understanding of radiographer problem solving and the presentation of the research findings will raise awareness of this complex topic within the radiography profession. Alongside the findings in relation to problem solving several other matters have been considered. A three stage assessment process has been observed. Further study should be conducted to evaluate and confirm the use of this process in the practice setting. This process could then be used to support the education of students and provide a structured process for radiographers to follow until experience allows the process to become intuitive.

A review of a blank request card has highlighted some limitations in term of the design of the form in use at the research sites. Changes to the form could be made to encourage the inclusion of a more detailed clinical history to support the radiographer’s assessment of the patient with an increase in the size of the field to be completed and removal of erroneous questions from the field. Radiographers assess the patient to evaluate extent of injury but do not use pain scales to inform this process. Many health care professions use pain scales to assess patient injury and mobility. Self-reported pain scales are considered to be the gold standard in assessing patient pain (Campbell, 2006). It is not clear why this information is not provided to the radiographer on the request card or why the radiographer does not use this tool as part of their assessment process. It should be possible for the referrer triaging the patient to include this information with the clinical history for the patient or for radiographers to receive additional training in the use of pain scales to inform their assessment of the patient. It is also clear that radiographers question the patient in order to assess their level of injury and ability to comply with the positioning for the examination. No formal interview teaching is provided at undergraduate level in the training programmes I am associated with. Both research (Lam, Egan & and Baird, 2004) and anecdotal radiographer comments (radiographer 4) suggest that additional interview skills might be beneficial. It can be seen that improving communication skills with the patient will inform the radiographers’ problem- solving process and increase the patients’ participation in the examination moving towards

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patient centred care (Hibbard, 2004) and broadening the “clinical gaze” (Foulcault, 1975) of the radiographer. It is unclear why these skills are developed at post graduate level and not explicitly at undergraduate level and it is recommended that this should be included in the undergraduate curriculum.

In order to understand the data a method of estimating the complexity of the examination was developed. This tool should be evaluated and validated as it could prove useful in both the educational and clinical setting. In the educational setting the tool could be used to provide a structured measure of complexity which the students could apply to help them develop appropriate problem-solving skills for application in practice. The tool could also be used to guide clinical staff about which examinations are appropriate for students to undertake in practice and how much support a student may require when undertaking an examination. At present students are encouraged to conduct examinations of increasing complexity as they progress from year to year in their programme of study. When encountering patients with increasingly complex needs it must be difficult for the radiographer to know what level of complexity the student is capable of managing and what is an appropriate level of examination complexity for that student to undertake. Students’ clinical skills’ are also assessed when they conduct increasingly complex examinations in the academic setting. At present there is no recognised tool for measuring the complexity of the examination and the decision is based on the perspective of the radiographer in practice or the academic setting the examination. Using a recognised tool would add rigor to this process. As mentioned previously the clinician reporting the images reviews them without an understanding of the complexity of the examination. Radiographers can annotate electronic patient notes to add comments about the examination but there is no standardised system for doing so. By applying the complexity rating to the patient records the clinician reporting the image could be provided with information relating to the context of the examination. In their study Lam, Egan and Baird (2004) concluded that the provision of additional information supported those interpreting the image and it seems that it may be beneficial if a complexity assessment was added to the information being reviewed by the reporting clinician.

A theoretical framework has been employed which has applied the work of Newel and Simons’ (1972) and other authors to the practice of radiographers. Application of the other theories utilised in the framework has allowed understanding of radiographer behaviour and cognitive activities in the first steps of problem-solving. The framework has proved adaptable

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allowing accommodation of changes in approach for routine, intermediate and complex examinations and could be utilised for understanding radiographer behaviour in other areas of practice.

4.16. Research recommendations

The following are recommendations for further study based on the outcomes of this research:

Further focused ethnographic studies should be conducted within this area of practice to examine these early findings. These studies might consider gathering additional participant data in relation to personality types in problem solving before conducting the research.

Further work to validate the complexity classification tool.

Further focused ethnographic studies should be conducted in other areas of radiographer practice to develop more general understanding of radiographer problem solving.