Defining trauma in complex care management: Safety-net providers' perspectives on structural vulnerability and time.
Defining trauma in complex care management: Safety-net providers' perspectives on structural vulnerability and time.
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定义复杂护理管理中的创伤：安全网提供者对结构脆弱性和时间的看法。
DOI：
10.1016/j.socscimed.2017.06.003
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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
在本文中，我们描述了美国城市安全网医院的两个复杂护理管理（CCM）项目的工作人员如何理解创伤。我们试图(1)描述CCM项目的工作人员如何谈论患者生活中的创伤；(2)讨论创伤概念如何使工作人员了解患者的症状、与健康相关的行为以及由于结构条件而对护理的反应；(3)描述创伤史患者的长期需求与CCM项目提供的短期干预之间的不匹配。2015年2月至2016年8月期间收集的观察和访谈数据表明，CCM提供者广泛地定义了创伤，包括个人暴力经历，如童年虐待和忽视或最近的攻击，在获得医疗保健过程中的创伤和结构性暴力。虽然CCM工作人员实施创伤知情护理的要素，但CCM项目的短期设计给工作人员施加了压力，迫使他们调整努力，将患者推向毕业或出院。创伤概念使临床医生能够以临床合法的语言命名结构性暴力。因此，创伤知情护理和结构能力方法可以相互补充。
In this paper, we delineate how staff of two complex care management (CCM) programs in urban safety net hospitals in the United States understand trauma. We seek to (1) describe how staff in CCM programs talk about trauma in their patients' lives; (2) discuss how trauma concepts allow staff to understand patients’ symptoms, health-related behaviors, and responses to care as results of structural conditions; and (3) delineate the mismatch between long-term needs of patients with histories of trauma and the short-term interventions that CCM programs provide. Observation and interview data gathered between February 2015 and August 2016 indicate that CCM providers define trauma expansively to include individual experiences of violence such as childhood abuse and neglect or recent assault, traumatization in the course of accessing health care and structural violence. Though CCM staff implement elements of trauma-informed care, the short-term design of CCM programs puts pressure on the staff to titrate their efforts, moving patients towards graduation or discharge. Trauma concepts enable clinicians to name structural violence in clinically legitimate language. As such, trauma-informed care and structural competency approaches can complement each other.