Negotiating Quality: Everyday Practice & Self-Regulation

描述(申请人提供)：临床实践中对质量的关注 在有关医疗保健的讨论中变得越来越突出。虽然 人们对卓越和专业知识进行了广泛的研究，无论是次要的还是次要的 护理实践受到的学术关注较少。专业人士 自律通常被认为是 保持专业水准。既不是这些的实际机制 然而，过程也不是它们在实现指定目的方面的有效性， 已经得到了很好的描述或评估。使这个话题更加复杂的是 标准本身的不确定性：广泛的、 一般准则和具体情况，解释的必然性 和翻译，以及临床实践中固有的不确定性。目标是 拟议的培训计划的目的是增进对日常生活的了解 护理专业自律的实践与谈判 实践标准、合议性和问责制。拟议中的项目 将包括对象征秩序的人种学调查， 作为护理人员，在住院病房的工作和沟通模式 组织、应对和说明正常的变化、挑战和 冲突。这项研究将考察(1)工作人员护士和 一线管理人员协商质量、合议性、 和问责，(2)正式和非正式之间的动态互动 例行公事中的规则、工作组规范和体制安排 集体护理实践的定义和实施；(3)集体护理实践的关系 这些员工级别的互动涉及到机构、社会和专业人员 结构和文化历史话语。更好地理解这些 互动社交流程将有助于改善员工之间的沟通， 在员工和管理人员之间，并支持更有效的发展 改进做法和加强保护的战略 公开的。

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.