Exploring the practice of patient centered care: The role of ethnography and reflexivity
Exploring the practice of patient centered care: The role of ethnography and reflexivity
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DOI：
10.1016/j.socscimed.2015.03.050
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发表时间：
2015-05-01
影响因子：
5.4
通讯作者：
Scaratti, Giuseppe
中科院分区：
文献类型：
--
作者：
Liberati, Elisa Giulia;Gorli, Mara;Scaratti, Giuseppe
以病人为中心的护理（PCC）是全球医疗保健系统使命的一个重要方面，并被认为是确保护理质量的重要条件。尽管如此，人们也承认，不同的护理提供者认为以患者为中心的不同，仍然有几个悬而未决的问题，有关方面的医疗服务，与PCC的实际成就。在本文中，我们将目前对PCC的研究分为两个流（“二元”和“组织”），我们讨论了各自的优势和劣势。尽管他们的重要贡献，医疗保健服务的研究，这些方法PCC不完全捕捉网络的做法和关系，构成患者和提供者的经验，在医疗保健环境。因此，我们提出了另一种解释PCC整合的见解，从“实践理论”，并强调协商和当地的性质，以病人为中心，这是通过参与提供者和病人在日常护理实践。为了发展这样的解释，我们提出了一个研究方法相结合的民族志和反思的方法。民族志可以帮助实现什么PCC真正封装在护理过程中提请注意医疗环境的社会和物质现实更细致入微的描述。反身性可以帮助解开和表面上的隐性知识传播在日常护理实践中，并将其转化为可操作的知识，一种知识，可以支持对PCC的服务改进。我们预计，这种改进远非直截了当：PCC的实际成就可能会挑战不同利益相关者的利益，并动摇统一的习惯，等级制度和权力动态。然而，这种不确定性也可以作为参与内部发展进程的必要条件。我们讨论的结果，限制和好处，我们的方法通过医院的案例研究。(C)2015爱思唯尔有限公司版权所有。
Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams ("dyadic" and "organizational") and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from "practice theories" and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and benefits of our approach through a hospital case study. (C) 2015 Elsevier Ltd. All rights reserved.