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Distributed expertise: qualitative study of a British network of multidisciplinary teams supporting parents of children with chronic kidney disease

Lookup NU author(s): Dr Heather Lambert



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


BackgroundLong-term childhood conditions are often managed by hospital-based multidisciplinary teams (MDTs) of professionals with discipline specific expertise of a condition, in partnership with parents. However, little evidence exists on professional-parent interactions in this context. An exploration of professionals' accounts of the way they individually and collectively teach parents to manage their child's clinical care at home is, therefore, important for meeting parents' needs, informing policy and educating novice professionals. Using chronic kidney disease as an exemplar this paper reports on one aspect of a study of interactions between professionals and parents in a network of 12 children's kidney units in Britain.MethodsWe conducted semi-structured, qualitative interviews with a convenience sample of 112 professionals (clinical-psychologists, dietitians, doctors, nurses, pharmacists, play-workers, therapists and social workers), exploring accounts of their parent-educative activity. We analysed data using framework and the concept of distributed expertise.ResultsFour themes emerged that related to the way expertise was distributed within and across teams: (i) recognizing each other's' expertise, (ii) sharing expertise within the MDT, (iii) language interpretation, and (iv) acting as brokers. Two different professional identifications were also seen to co-exist within MDTs, with participants using the term we' both as the intra-professional we' (relating to the professional identity) when describing expertise within a disciplinary group (for example: As dietitians we aim to give tailored advice to optimize children's growth'), and the inter-professional we' (a team-identification'), when discussing expertise within the team (for example: We work as a team and make sure we're all happy with every aspect of their training before they go home').ConclusionsThis study highlights the dual identifications implicit in being professional' in this context (to the team and to one's profession) as well as the unique role that each member of a team contributes to children's care. Our methodology and results have the potential to be transferred to teams managing other conditions.

Publication metadata

Author(s): Swallow V, Smith T, Webb NJA, Wirz L, Qizalbash L, Brennan E, Birch A, Sinha MD, Krischock L, van der Voort J, King D, Lambert H, Milford DV, Crowther L, Saleem M, Lunn A, Williams J

Publication type: Article

Publication status: Published

Journal: Child: Care, Health and Development

Year: 2015

Volume: 41

Issue: 1

Pages: 67-75

Print publication date: 01/01/2015

Online publication date: 14/05/2014

Acceptance date: 28/03/2014

Date deposited: 27/08/2015

ISSN (print): 0305-1862

ISSN (electronic): 1365-2214

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/cch.12141

PubMed id: 24827413


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Funder referenceFunder name
2009/nonich/006Kids Kidney Research