Response to commentary, "Trauma and the structuring of complex care: Back to the settlements?" by Elizabeth Bowen.
Response to commentary, "Trauma and the structuring of complex care: Back to the settlements?" by Elizabeth Bowen.
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对评论“创伤和复杂护理的构建：回到定居点？”的回应
DOI：
10.1016/j.socscimed.2017.09.023
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Burke,NancyJ
中科院分区：
文献类型：
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作者：
Thompson-Lastad,Ariana;Yen,IreneH;Fleming,MarkD;VanNatta,Meredith;Rubin,Sara;Shim,JanetK;Burke,NancyJ
在我们的文章中，“在复杂的护理管理中定义创伤：安全网提供者对结构脆弱性和时间的看法”，我们提出了一个人种学的肖像创伤知情的护理可能看起来像在实践中，即使不是在名称中，在两个复杂的护理管理（CCM）程序。虽然我们研究的项目没有明确声称提供创伤知情护理，但对他们日常实践的观察突出了他们的工作与Machtinger及其同事的创伤知情初级护理模型（2015）中概述的领域相吻合的方式。我们还说明了提供者如何以战略方式采用创伤的概念，使他们能够将健康的结构性决定因素纳入临床实践和医疗保健领域。在这样做的过程中，我们的民族志在某种程度上可以作为在复杂的护理环境中实施结构能力的例子（汉森等人，2016）。在她对我们文章的评论中，Bowen建议医疗保健提供者应该倡导解决创伤结构性原因的行动。我们基本上同意她的立场，我们的文章展示了为什么以及如何，鉴于他们在医疗机构中的特殊地位和作用，CCM计划能够解决这些根本原因。我们观察到CCM工作人员不仅考虑了创伤对患者健康和健康相关行为的影响，而且还试图改善患者创伤的一些根本原因，例如，通过建立稳定的住房和获得足够的健康食物。文章中描述的后者的例子包括CCM社会工作者帮助患者申请食品券;在其他情况下，我们观察到工作人员在食品储藏室与患者排队等候，甚至从这些地点拿起食品盒并将其送到患者家中。
In our article,“Defining Trauma in Complex Care Management: Safety-Net Providers’ Perspectives on Structural Vulnerability and Time,” we present an ethnographic portrait of what trauma-informed care may look like in practice—even if not in name—in two complex care management (CCM) programs. Though the programs we study did not explicitly claim to provide trauma-informed care, observations of their daily practice highlighted the ways that their work fit with the domains outlined in Machtinger and colleagues’ trauma-informed primary care model (2015). We also illustrated how providers employed the concept of trauma in strategic ways that enabled them to incorporate structural determinants of health into the realm of clinical practice and medical care. In so doing, our ethnography serves, in some ways, as an example of the implementation of structural competency (Hansen et al. 2016) in a complex care setting.In her commentary on our article, Bowen suggests that health care providers should advocate for action that would address structural causes of trauma. We generally agree with her position, and our article shows why and how, given their particular position and role within healthcare institutions, CCM programs are able to work to address these root causes. We observed that CCM staff not only considered the effects of trauma on patients’ health and health-related behaviors, but attempted to ameliorate some of the underlying causes of patients’ trauma, for instance, by establishing stable housing and accessing adequate, healthy food. Examples of the latter described in the article include a CCM social worker helping a patient apply for food stamps; in other cases, we observed staff waiting in line with patients at food pantries, or even picking up food boxes from such sites and delivering them to patients’ homes.