Negotiating Quality: Everyday Practice & Self-Regulation

描述（由申请人提供）：临床实践中的质量问题 在医疗保健的讨论中变得越来越突出。虽然 卓越和专业知识已被广泛研究，低劣或不合标准 护理实践受到较少的学术关注。专业 自我监管通常被认为是 保持专业标准。这些的实际机制 过程，然而，也不是它们在实现指定目的方面的功效， 已经被很好地描述或评估。使这个问题更加复杂的是， 标准本身的不确定性：广泛， 一般原则和具体情况，解释的必然性 和翻译，以及临床实践中固有的不确定性。目标 建议的培训计划的目的是加强对日常生活的理解， 护理专业自我调节的实践，以及 实践标准、合议制和问责制。拟建项目 将包括一个民族志调查的象征秩序，惯例， 工作和沟通模式的住院单位，作为护理人员 组织、应对和说明正常变化、挑战和 冲突本研究将探讨（1）如何在工作人员的护士和 一线管理人员协商质量、共事、 （2）正式和非正式之间的动态互动 规则、工作组规范和体制安排 集体护理实践的定义和实施;（3）集体护理实践与护理人员的关系 这些工作人员层面的互动，以机构，社会和专业 结构和文化历史话语。更好地了解这些 互动式社交过程将有助于改善工作人员之间的沟通， 工作人员和管理人员之间的关系，并支持发展更有效的 改进做法和加强保护土著人民的战略 公众

DESCRIPTION (provided by applicant):Concerns about quality in clinical practice have become increasingly prominent in discussions of healthcare. Although excellence and expertise have been extensively studied, inferior or substandard nursing practice has received less scholarly attention. Professional self-regulation is commonly identified as a central strategy for the maintenance of professional standards. Neither the actual mechanisms of these processes, however, nor their efficacy in accomplishing the assigned purposes, have been well described or evaluated. Complicating this topic still further is the indeterminacy of the standards themselves: the tension between broad, general guidelines and specific situations, the inevitability of interpretation and translation, and the uncertainties inherent in clinical practice. The goal of the proposed training program is to enhance understanding of the everyday practices of professional self-regulation in nursing, and the negotiations of standards of practice, collegiality, and accountability. The proposed project will consist of an ethnographic inquiry into the symbolic order, routines of work, and communication patterns on an inpatient unit, as the nursing staff organizes, copes with, and accounts for normal variation, challenges and conflicts. This study will examine (1) the ways in which staff nurses and first-line managers negotiate the practical standards of quality, collegiality, and accountability, (2) the dynamic interactions between formal and informal rules, work-groups norms and institutional arrangements, in the routine definition and performance of collective nursing practice, and (3) the relation of these staff-level interactions to institutional, social, and professional structures, and cultural-historical discourses. Greater understanding of these interactive social processes will help to improve communication among staff and between staff and managers, and support the development of more effective strategies for the improvement of practice and enhanced protection of the public.