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Ethics in the everyday: exploring discursive care practices within households that include children with obesity

日常道德：探索包括肥胖儿童在内的家庭中的话语护理实践

基本信息

批准号：
ES/V011480/1
负责人：
Meredith Hawking
金额：
$ 11.93万
依托单位：
Queen Mary University of London
依托单位国家：
英国
项目类别：
Fellowship
财政年份：
2020
资助国家：
英国
起止时间：
2020 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=ES%2FV011480%2F1
关键词：
Ethics everyday exploring discursive care

项目摘要

In my doctoral project I explored medicine taking amongst patients with atrial fibrillation (AF), focusing on the blood-thinning medications known as direct oral anticoagulants (DOACs) and vitamin K antagonists such as warfarin. I reviewed the available research on how people take their DOACs and found that one third of patients do not possess enough medication to follow their prescription more than 80% of the time, and 1 in 4 patients discontinue within one year. I interviewed 17 patients and analysed patterns in how they described their illness journeys, the types of illness metaphors they used, and the themes that they talked about. I characterised the illness journeys that patients experienced in four ways: the 'big event', the 'long road', the 'chance find', and the 'juggling act'. I went on to show that the decisions people make about medicines emerge from the interaction and negotiation of a collection of actors, bodily sensations, sources of information and objects over time. Finally, I demonstrated how patients undertake work and strategies to create a 'good patient' self when talking about medicines. This effort reflects circulating moral beliefs and understandings about risk, healthy and unhealthy bodies, blame for illness, deservingness for care, and responsible use of scarce healthcare resources.The aims of this one year fellowship include communicating these findings with researchers, clinicians and patients with AF and their carers, through publication in peer reviewed journals, presentations at conferences, and a blog. I will also create an animation aimed at clinicians and patients with AF, and their carers and families.My narrative doctoral work attended to cross cutting themes around the enactment of health practices and decision making, and how beliefs about risk, responsibility and morality are negotiated in cardiovascular illness. With this strong foundation, I will continue my focus on the 'moral', or 'ethical' in everyday health practices. I will extend my methodological expertise to include ethnography, continue my interest in language and metaphor, and bring these together in a linguistic ethnographic approach.Obesity - a complex, stigmatising and contentious condition - is a rich case for continuing my research focus on the negotiation of health practices and decision making. Shifting from the clinic to the household, my planned study will contribute to understanding how ethics and morality play out in everyday conversations and routines in households with childhood obesity, through interviews and observations with families in East London.Focusing on social practices and interaction in these household collectives will illuminate whether, how, and to what extent circulating moral beliefs and social structures shape everyday decision making and actions. It will open up opportunity to consider alternative ways of 'doing' health and happiness that may not focus on weight, but on other ways of doing and being 'good'.My development of two fellowship proposals will include preparatory work such as holding co-production workshops with parents and children from East London, and skills training. I will also undertake a meta-ethnography to inform the proposal and build networks with academics and practitioners from local communities.

在我的博士项目中，我探讨了房颤（AF）患者的药物服用情况，重点是血液稀释药物，即直接口服抗凝剂（DOAC）和维生素K拮抗剂，如华法林。我回顾了关于人们如何服用DOAC的现有研究，发现三分之一的患者在80%以上的时间内没有足够的药物来遵循他们的处方，四分之一的患者在一年内停止服用。我采访了17名患者，并分析了他们如何描述自己的疾病历程，他们使用的疾病隐喻类型以及他们谈论的主题。我以四种方式描述了患者经历的疾病旅程：“大事件”，“漫长的道路”，“偶然发现”和“杂耍表演”。我继续指出，人们对药物的决定是在一系列参与者、身体感觉、信息来源和物体的互动和协商中产生的。最后，我展示了患者如何在谈论药物时进行工作和策略，以创造一个“好患者”的自我。这一努力反映了循环的道德信念和对风险的理解，健康和不健康的身体，疾病的责任，护理的应得性，以及负责任地使用稀缺的医疗资源。这个为期一年的奖学金的目的包括通过在同行评议的期刊上发表文章，会议上的演讲和博客，与研究人员，临床医生和房颤患者及其护理人员交流这些发现。我还将创建一个动画，针对临床医生和房颤患者，以及他们的照顾者和家庭。我的叙事博士工作涉及围绕制定健康实践和决策的交叉主题，以及如何在心血管疾病中协商风险，责任和道德的信念。有了这个坚实的基础，我将继续关注日常健康实践中的“道德”或“伦理”。我将扩展我的方法学专业知识，包括民族志，继续我对语言和隐喻的兴趣，并把这些在语言民族志的方法。肥胖-一个复杂的，污名化和有争议的条件-是一个丰富的情况下，继续我的研究重点对健康的做法和决策的谈判。从诊所转移到家庭，我计划的研究将有助于了解伦理和道德如何发挥在日常对话和家庭与儿童肥胖的惯例，通过采访和观察与家庭在东伦敦。专注于社会实践和互动，在这些家庭集体将阐明是否，如何，以及在多大程度上循环的道德信仰和社会结构塑造日常决策和行动。它将提供一个机会，让我们考虑“做”健康和幸福的替代方法，这些方法可能不关注体重，而是关注其他做和做“好”的方法。我的两个奖学金提案的发展将包括准备工作，例如与来自东伦敦的父母和孩子举办联合制作研讨会，以及技能培训。我还将进行元人种学研究，为提案提供信息，并与当地社区的学者和从业人员建立网络。