• 【恶棍还是受害者?阿富汗产科人员的民族志和高质量尊敬护理的挑战。】 复制标题 收藏 收藏
    DOI:10.1186/s12884-019-2420-6 复制DOI
    作者列表:Arnold R,van Teijlingen E,Ryan K,Holloway I
    BACKGROUND & AIMS: BACKGROUND:Healthcare providers are the vital link between evidence-based policies and women receiving high quality maternity care. Explanations for suboptimal care often include poor working conditions for staff and a lack of essential supplies. Other explanations suggest that doctors, midwives and care assistants might lack essential skills or be unaware of the rights of the women for whom they care. This ethnography examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan between 2010 and 2012. The aim was to understand their notions of care, varying levels of commitment, and the obstacles and dilemmas that affected standards. METHODS:The culture of care was explored through six weeks of observation, 41 background interviews, 23 semi-structured interviews with doctors, midwives and care assistants. Focus groups were held with two diverse groups of women in community settings to understand their experiences and desires regarding care in maternity hospitals. Data were analysed thematically. RESULTS:Women related many instances of neglect, verbal abuse and demands for bribes from staff. Doctors and midwives concurred that they did not provide care as they had been taught and blamed the workload, lack of a shift system, insufficient supplies and inadequate support from management. Closer inspection revealed a complex reality where care was impeded by low levels of supplies and medicines but theft reduced them further; where staff were unfairly blamed by management but others flouted rules with impunity; and where motivated staff tried hard to work well but, when overwhelmed with the workload, admitted that they lost patience and shouted at women in childbirth. In addition there were extreme examples of both abusive and vulnerable staff. CONCLUSIONS:Providing respectful quality maternity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need enforcing and abusive practices confronting to provide a supportive, facilitating environment for both staff and childbearing women. Polarized perspectives such as 'villain' or 'victim' are unhelpful as they exclude the complex realities of human behaviour and consequently limit the scope of problem solving.
    背景与目标: 背景:医疗保健提供者是循证政策与接受高质量产妇保健的妇女之间的重要纽带。对次优护理的解释通常包括工作人员的工作条件差和缺乏基本用品。其他解释表明,医生,助产士和护理助手可能缺乏基本技能,或者没有意识到她们所照顾的妇女的权利。这项民族志研究了2010年至2012年之间在阿富汗喀布尔的一家三级妇产医院工作的产妇保健提供者的日常生活。目的是了解他们的护理观念,不同的承诺水平以及影响标准的障碍和困境。
    方法:通过六周的观察,41次背景访谈,23次对医生,助产士和护理助手的半结构化访谈,探索了护理文化。在社区环境中与两个不同的妇女小组举行了焦点小组会议,以了解她们在妇产医院护理方面的经验和愿望。对数据进行了专题分析。
    结果:妇女与许多被忽视,口头虐待和要求工作人员贿赂有关。医生和助产士同意,他们没有提供照料,因为他们受到了教导,并且将其归咎于工作量,缺乏轮班制度,物资不足以及管理层的支持不足。仔细检查发现,情况复杂,由于药品和药品供应不足,护理受到阻碍,但盗窃进一步减少了它们的数量。管理层不公正地责怪员工,而其他人则无视规则而不受惩罚;积极进取的工作人员努力地工作良好,但是当工作量不堪重负时,他们承认他们失去了耐心,并对分娩的妇女大喊大​​叫。此外,还存在虐待和脆弱工作人员的极端例子。
    结论:为阿富汗妇女提供尊敬的优质产妇护理需要多方面的举措,因为导致次优护理或虐待的因素是复杂且相互关联的。标准需要面对强制性和滥用行为,以便为工作人员和育龄妇女提供一个支持性的便利环境。诸如“恶棍”或“受害者”之类的极化观点无济于事,因为它们排除了人类行为的复杂现实,因此限制了解决问题的范围。
  • 【参加英国社区学龄前儿童肥胖预防计划的参与者:一项有针对性的民族志研究。】 复制标题 收藏 收藏
    DOI:10.1186/s12889-019-7410-0 复制DOI
    作者列表:Burton W,Twiddy M,Sahota P,Brown J,Bryant M
    BACKGROUND & AIMS: BACKGROUND:Children's centres in the UK provide a setting for public health programmes; offering support to families living in the most disadvantaged areas where obesity prevalence is at its highest. Health, Exercise and Nutrition in the Really Young (HENRY) is an eight-week obesity prevention programme currently delivered in children's centres across the UK. However, low participant engagement in some local authorities threatens its potential reach and impact. This study aimed to explore the factors influencing participant engagement with HENRY to describe where local intervention may support engagement efforts. METHOD:A focused ethnography study was undertaken in five children's centres delivering HENRY across the UK. One hundred and ninety hours of field observations, 22 interviews with staff (commissioners, HENRY co-ordinators, managers and facilitators) and six focus groups (36 parents), took place over five consecutive days in each centre. The Consolidated Framework for Implementation Research (CFIR) was used to guide the observations and analysis of the data. RESULTS:Three overarching themes described the factors influencing participant engagement with HENRY: local authority decision making around children's centre programmes; children's centre implementation of HENRY; and the participant experience of HENRY. The results indicate that factors influencing participant engagement with public health programmes begin at the commissioning body level, influencing children's centre implementation and subsequently the experience of participants. Local authority funding priorities and constraints influence availability of places and who these places are offered to, with funding often targeted towards those deemed most at need. This was perceived to have a detrimental effect on participant experience of the programme. CONCLUSION:In summary, participant engagement is affected by multiple factors, working at different levels of the children's centre and local authority hierarchy, most of which are at play even before participants decide whether or not they choose to enrol and maintain attendance. For programmes to achieve their optimal reach and impact, factors at the commissioning and local implementation level need to be addressed prior to addressing participant facing issues.
    背景与目标: 背景:英国的儿童中心为公共卫生计划提供了场所;为生活在肥胖率最高的最贫困地区的家庭提供支持。真正的年轻人中的健康,运动和营养(HENRY)是一项为期八周的预防肥胖计划,目前已在英国各地的儿童中心开展。但是,参与者在某些地方当局的参与度低,威胁了其潜在的影响力和影响力。这项研究旨在探讨影响与HENRY参与的参与者的因素,以描述当地干预可以在哪些方面支持参与工作。
    方法:在五个在英国各地分发HENRY的儿童中心进行了民族志研究。在每个中心连续五天进行了一百零九十小时的实地观察,对工作人员(专员,HENRY协调员,经理和协调人)和六个焦点小组(36名父母)进行了22次访谈。实施研究综合框架(CFIR)用于指导数据的观察和分析。
    结果:三个主要主题描述了影响参与者参与HENRY的因素:围绕儿童中心计划的地方当局决策;亨利儿童中心的实施;以及HENRY的参与者经验。结果表明,影响参与者参与公共卫生计划的因素始于调试机构级别,影响儿童中心的实施,进而影响参与者的体验。地方当局的资金优先级和限制条件会影响场所的可用性以及向这些场所提供的人,而资金通常是针对那些最需要的人。人们认为这对计划参与者的经验有不利影响。
    结论:总而言之,参与者的参与受到多种因素的影响,这些因素在儿童中心和地方当局等级的不同层次上起作用,甚至在参与者决定是否选择注册并保持出勤率之前,大多数因素都在发挥作用。为了使计划达到最佳效果和影响,在解决参与者面临的问题之前,必须先解决调试和本地实施层面的因素。
  • 【旨在改善长期身体状况的儿童和年轻人的心理健康和福祉的干预措施的经验:系统的回顾和元民族志。】 复制标题 收藏 收藏
    DOI:10.1111/cch.12708 复制DOI
    作者列表:Shaw L,Moore D,Nunns M,Thompson Coon J,Ford T,Berry V,Walker E,Heyman I,Dickens C,Bennett S,Shafran R,Garside R
    BACKGROUND & AIMS: BACKGROUND:Children and young people with long-term physical health conditions are at increased risk of experiencing mental health and well-being difficulties. However, there is a lack of research that explores the experiences of and attitudes towards interventions aiming to improve their mental health and well-being. This systematic review seeks to address this gap in the literature by exploring what children and young people with long-term conditions, their caregivers, and health practitioners perceive to be important aspects of interventions aiming to improve their mental health and well-being. METHODS:An information specialist searched five academic databases using predefined criteria for qualitative evaluations of interventions aiming to improve the mental health or well-being of children with long-term physical conditions. Reviewers also performed supplementary citation and grey literature searches. Two reviewers independently screened titles, abstracts, and full texts that met the inclusion criteria and conducted data extraction and quality assessment. Meta-ethnography was used to synthesize the findings. RESULTS:Screening identified 60 relevant articles. We identified five overarching constructs through the synthesis: (a) Getting In and Staying In, (b) Therapeutic Foundation, (c) Social Support, (d) A Hopeful Alternative, and (e) Empowerment. The line of argument that links these constructs together indicates that when interventions can provide an environment that allows young people to share their experiences and build empathetic relationships, it can enable participants to access social support and increase feelings of hope and empowerment. CONCLUSION:These findings may provide a framework to inform the development of mental health interventions for this population and evaluate existing interventions that already include some of the components or processes identified by this research. Further research is needed to establish which of the constructs identified by the line of argument are most effective in improving the mental well-being of young people living with long-term conditions.
    背景与目标: 背景:患有长期身体健康状况的儿童和年轻人遭受心理健康和福祉困难的风险增加。但是,缺乏研究来探索旨在改善其心理健康和福祉的干预措施的经验和态度。这项系统的综述旨在通过探讨长期病患的儿童和年轻人,他们的看护者和卫生从业者被认为是旨在改善其心理健康和福祉的干预措施的重要方面,来弥补文献中的空白。
    方法:一名信息专家使用预定的标准搜索了五个学术数据库,以对干预措施进行定性评估,以改善长期身体状况儿童的心理健康或幸福感。审稿人还进行了补充引用和灰色文献搜索。两名审稿人独立筛选了符合纳入标准的标题,摘要和全文,并进行了数据提取和质量评估。元民族志用于综合研究结果。
    结果:筛选确定了60篇相关文章。通过综合,我们确定了五个总体构想:(a)进入并停留在其中;(b)治疗基金会;(c)社会支持;(d)有希望的替代方案;以及(e)赋权。将这些构造联系在一起的论点表明,当干预措施可以提供一个让年轻人分享经验并建立同理心的关系的环境时,它可以使参与者获得社会支持并增加希望和增强能力的感觉。
    结论:这些发现可能提供一个框架,为该人群的精神卫生干预措施的发展提供信息,并评估现有的干预措施,这些干预措施已经包括本研究确定的某些组成部分或过程。需要进一步的研究来确定论点所确定的哪些构架在改善长期居住的年轻人的心理健康方面最有效。
  • 【确定与成功戒烟相关的咨询交流策略,以东伦敦的国家卫生服务社区药房戒烟计划:有针对性的人种志,使用记录的咨询。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2016-015664 复制DOI
    作者列表:Rivas C,Sohanpal R,MacNeill V,Steed L,Edwards E,Antao L,Griffiths C,Eldridge S,Taylor S,Walton R
    BACKGROUND & AIMS: OBJECTIVES:To determine communication strategies associated with smoking cessation in the National Health Service community pharmacy Stop Smoking programme. SETTING:11 community pharmacies in three inner east London boroughs. PARTICIPANTS:9 stop smoking advisers and 16 pairs of smokers who either quit or did not quit at 4 weeks, matched on gender, ethnicity, age and smoking intensity. METHOD:1-3 audio-recorded consultations between an adviser and each pair member over 5-6 weeks were analysed using a mixed-method approach. First a content analysis was based on deductive coding drawn from a theme-oriented discourse analysis approach and the Roter Interaction Analysis System. Core themes were identified through this quantification to explore in detail the qualitative differences and similarities between quitters and non-quitters. RESULTS:Quantitative analysis revealed advisers used a core set of counselling strategies that privileged the 'voice of medicine' and often omitted explicit motivational interviewing. Smokers tended to quit when these core strategies were augmented by supportive talk, clear permission for smokers to seek additional support from the adviser between consultations, encouragement for smokers to use willpower. The thematic analysis highlighted the choices made by advisers as to which strategies to adopt and the impacts on smokers. The first theme 'Negotiating the smoker-adviser relationship' referred to adviser judgements about the likelihood the smoker would quit. The second theme, 'Roles of the adviser and smoker in the quit attempt', focused on advisers' counselling strategies, while the third theme, 'Smoker and adviser misalignment on reasons for smoking, relapsing and quitting', concerned inconsistencies in the implementation of National Centre for Smoking Cessation and Training recommendations. DISCUSSION:Advisers in community pharmacies should use the advantages of their familiarity with smokers to ensure appropriate delivery of patient-centred counselling strategies and reflect on the impact on their counselling of early judgements of smoker success.
    背景与目标: 目的:确定国家卫生局社区药房“戒烟计划”中与戒烟相关的沟通策略。
    地点:伦敦东部三个内部行政区的11家社区药房。
    参与者:9名戒烟顾问和16对在4周内戒烟或未戒烟的吸烟者,其性别,种族,年龄和吸烟强度均相匹配。
    方法:采用混合方法分析顾问和每对成员在5-6周内进行的1-3次录音咨询。首先,内容分析是基于演绎编码的,该演绎编码是从主题主题的话语分析方法和Roter交互分析系统中提取的。通过量化确定了核心主题,以详细探讨退出者与非退出者之间的质性差异和相似性。
    结果:定量分析显示,顾问使用了一套核心的咨询策略,这些策略优先考虑“医学之声”,并且常常省略了明确的动机性面试。当支持性谈话增强了这些核心策略时,吸烟者倾向于戒烟,明确允许吸烟者在两次咨询之间寻求顾问的更多支持,鼓励吸烟者使用意志力。专题分析着重介绍了顾问在采用哪种策略以及对吸烟者的影响方面做出的选择。第一个主题“协商吸烟者与顾问的关系”指的是顾问对吸烟者戒烟可能性的判断。第二个主题是“戒烟过程中的顾问和吸烟者的角色”,其重点是顾问的咨询策略,而第三个主题是“吸烟者和顾问在吸烟,复发和戒烟的原因上的失调”,涉及实施中的不一致之处国家吸烟戒烟和培训中心的建议。
    讨论:社区药房的顾问应利用其熟悉吸烟者的优势,以确保适当提供以患者为中心的咨询策略,并反思对吸烟者成功的早期判断对其咨询的影响。
  • 【跨文化心理治疗和人种志研究中的隐藏观点。】 复制标题 收藏 收藏
    DOI:10.1177/1363461506064848 复制DOI
    作者列表:Krause IB
    BACKGROUND & AIMS: :This article examines the challenges posed by cross-cultural psychotherapy in a creolized world, and the way this intersects with issues faced by the ethnographer. It proposes 'the relational subject,' implicit in systemic psychotherapy and social anthropology, as a framework for an understanding of communication. In cross-cultural psychotherapy, this assumption is central to non-discriminatory and equitable treatment. Drawing on Bateson's ethnographic work, the article connects 'the relational subject' to what Bateson, following Whitehead, called 'the fallacy of misplaced concreteness' and later referred to as 'context.' The article examines the choices of 'context' first in ethnography and systemic psychotherapy and then in Bateson's own analysis of the Naven ritual. It is suggested that cross-cultural psychotherapy is psychotherapy in which the therapist keeps in mind, both her own and her client's contexts. This means an assessment of process (performative aspects) as well as content (semiotic aspects) and attention to 'moments' rather than longer sequences in the therapy.
    背景与目标: :本文探讨了在一个狭小的世界里,跨文化心理治疗所带来的挑战,以及与人种学家所面临的问题相交的方式。它提出了系统心理学治疗和社会人类学中所隐含的“关系学科”,作为理解交流的框架。在跨文化心理治疗中,这一假设对于非歧视性和公平的治疗至关重要。这篇文章借鉴了巴特森的民族志研究成果,将“关系主体”与巴特森(在怀特海德之后)称之为“错位的具体性的谬误”(后来被称为“背景”)联系起来。本文首先考察了人种学和系统性心理治疗中“背景”的选择,然后考察了贝特森自己对Naven仪式的分析。建议跨文化心理治疗是指心理治疗师,在心理治疗中,治疗师应牢记自己和服务对象的情况。这意味着要评估过程(执行方面)以及内容(符号学方面)以及对“时刻”的关注,而不是对治疗中较长的顺序进行评估。
  • 【就业与乳腺癌:一项人种志学。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2354.2011.01291.x 复制DOI
    作者列表:Banning M
    BACKGROUND & AIMS: :The purpose of this synthesis is to examine the qualitative evidence on the lived experience of breast cancer survivors in relation to return to work. An in-depth search of the literature was undertaken from 1999 until July 2010. Ten relevant papers emerged that reflected the aims of the synthesis. A meta-ethnographic approach was used to synthesise papers. Four concepts emerged that reflected the return to work, these included influencing factors, sickness absence, work ability and work-related problems and experiences of return to work. Further synthesis of concepts led to the development of four final interpretations. These included breast cancer and employment, treatment-induced physical impairment, employer comprehension of breast cancer and fear of work-related failure. These interpretations indicate that employers need to be educated on the work capabilities of cancer survivors post treatment. Improved support facilities are needed for cancer survivors which are supported by European employment legislation and guidance offered by company occupational health departments. Moreover, health care professionals could become more involved in the education of breast cancer patients with regard to the timing of returning to work.
    背景与目标: :此综合报告的目的是研究关于乳腺癌幸存者与重返工作相关的生活经验的定性证据。从1999年到2010年7月,我们对文献进行了深入研究。发表了10篇相关论文,这些论文反映了合成的目的。元民族志方法用于合成论文。出现了四个反映出重返工作的概念,其中包括影响因素,疾病缺席,工作能力以及与工作有关的问题和重返工作的经历。概念的进一步综合导致了四个最终解释的发展。这些包括乳腺癌和就业,治疗引起的身体障碍,雇主对乳腺癌的理解以及对与工作有关的失败的恐惧。这些解释表明,雇主需要接受有关癌症幸存者治疗后工作能力的教育。对于癌症幸存者,需要改进的支持设施,这些支持设施得到欧洲就业立法和公司职业卫生部门提供的指导的支持。此外,医护专业人员可以在重返工作时间方面更多地参与对乳腺癌患者的教育。
  • 【通过两家教学医院的组织人种志,探索如何在护理中使用证据。】 复制标题 收藏 收藏
    DOI:10.2196/10769 复制DOI
    作者列表:Lander B,Balka E
    BACKGROUND & AIMS: BACKGROUND:Numerous published articles show that clinicians do not follow clinical practice guidelines (CPGs). However, a few studies explore what clinicians consider evidence and how they use different forms of evidence in their care decisions. Many of these existing studies occurred before the advent of smartphones and advanced Web-based information retrieval technologies. It is important to understand how these new technologies influence the ways clinicians use evidence in their clinical practice. Mindlines are a concept that explores how clinicians draw on different sources of information (including context, experience, medical training, and evidence) to develop collectively reinforced, internalized tacit guidelines. OBJECTIVE:The aim of this paper was to explore how evidence is integrated into mindline development and the everyday use of mindlines and evidence in care. METHODS:We draw on ethnographic data collected by shadowing internal medicine teams at 2 teaching hospitals. Fieldnotes were tagged by evidence category, teaching and care, and role of the person referencing evidence. Counts of these tags were integrated with fieldnote vignettes and memos. The findings were verified with an advisory council and through member checks. RESULTS:CPGs represent just one of several sources of evidence used when making care decisions. Some forms of evidence were predominately invoked from mindlines, whereas other forms were read to supplement mindlines. The majority of scientific evidence was accessed on the Web, often through smartphones. How evidence was used varied by role. As team members gained experience, they increasingly incorporated evidence into their mindlines. Evidence was often blended together to arrive at shared understandings and approaches to patient care that included ways to filter evidence. CONCLUSIONS:This paper outlines one way through which the ethos of evidence-based medicine has been incorporated into the daily work of care. Here, multiple Web-based forms of evidence were mixed with other information. This is different from the way that is often articulated by health administrators and policy makers whereby clinical practice guideline adherence is equated with practicing evidence-based medicine.
    背景与目标: 背景:大量发表的文章表明,临床医生未遵循临床实践指南(CPG)。但是,一些研究探索了临床医生考虑证据的方式,以及他们在护理决策中如何使用不同形式的证据。这些现有的研究很多发生在智能手机和基于Web的高级信息检索技术问世之前。重要的是要了解这些新技术如何影响临床医生在临床实践中使用证据的方式。 Mindlines是一个概念,旨在探索临床医生如何利用不同的信息来源(包括背景,经验,医学培训和证据)来制定集体加强的,内在的默认指南。
    目的:本文的目的是探讨如何将证据整合到心智发展中以及在护理中日常使用心智和证据。
    方法:我们利用由两家教学医院的内科医师组成的阴影收集的人种学数据。通过证据类别,教学和护理以及引用证据的人的角色来标记现场笔记。这些标签的数量与现场注释小插图和备忘录集成在一起。调查结果已通过咨询委员会和成员检查进行了验证。
    结果:CPG只是做出护理决定时使用的多种证据来源之一。思维方式主要使用某些形式的证据,而阅读其他形式的证据以补充思维方式。大多数科学证据通常是通过智能手机通过Web访问的。证据的使用方式因角色而异。随着团队成员积累经验,他们越来越多地将证据纳入他们的思维定势。通常将证据混合在一起,以达成对患者护理的共同理解和方法,其中包括过滤证据的方法。
    结论:本文概述了将循证医学精神纳入日常护理工作的一种方式。在这里,多种基于Web的证据形式与其他信息混合在一起。这与卫生管理人员和决策者经常阐明的方式不同,后者将临床实践指南的依从性等同于实践循证医学。
  • 【对族裔人种行为的方法学系统综述,以阐明复杂的分析阶段。】 复制标题 收藏 收藏
    DOI:10.1186/s12874-019-0670-7 复制DOI
    作者列表:France EF,Uny I,Ring N,Turley RL,Maxwell M,Duncan EAS,Jepson RG,Roberts RJ,Noyes J
    BACKGROUND & AIMS: BACKGROUND:Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence. METHODS:We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016. RESULTS:Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography - determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs. CONCLUSION:The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography.
    背景与目标: 背景:卫生和社会保健中的决策需要对定量和定性证据进行强有力的综合。元民族志是综合定性研究的七个阶段的方法。元民族志学是由社会学家在教育Noblit和Hare于1988年开发的,自成立以来就已经发展起来。现在它已广泛用于医疗保健研究,并在教育研究中越来越受欢迎。本文的目的是通过对最新方法论证据的分析,为进行元民族志的复杂分析综合阶段4至6提供最新,深入的指导。
    方法:我们报告了从2015年至2016年进行的方法学系统评价的发现。共检索了14个数据库和其他5个在线资源。还进行了广泛的搜索,结果纳入了57种有关元民族志行为的出版物,并报告了1988年至2016年出版的一系列学术学科的报告。
    结果:目前有关应用元民族志的指南源自一小部分研究人员在健康背景下使用该方法的研究。我们确定研究人员已实施了元民族志的分析和综合方法-确定研究之间的相关性(第4阶段),将研究相互转化(第5阶段),合成翻译(第6阶段)和论点综合路线-以适应它们自身的合成导致方法及其应用的变化。需要进行经验研究以比较不同翻译和合成方法的影响。某些方法在保留与基础研究的上下文和意义的联系方面可能会更好,这是元民族志的一项重要原则。元民族志可以并且应该包括对等翻译和推论翻译以及论点综合,而不仅仅是其中之一,以最大程度地发挥其产出的影响。
    结论:当前的工作是第一个阐明和区分方法学变化及其在不同目的中的应用的工作,并且代表了对元民族志方法学应用的理解的重大进步。
  • 【充实的生活:对老年人的体育活动产生积极影响-系统评价和元民族志。】 复制标题 收藏 收藏
    DOI:10.1186/s12889-019-6624-5 复制DOI
    作者列表:Morgan GS,Willmott M,Ben-Shlomo Y,Haase AM,Campbell RM
    BACKGROUND & AIMS: BACKGROUND:Increasing physical activity in older adults remains a key public health priority in countries with a high burden of non-communicable disease, yet current interventions have failed to substantially increase population uptake with UK data suggesting that only half of 65-74 year olds report meeting recommended levels. The aim of this study was to conduct a systematic and inductive qualitative synthesis of the large body of qualitative research describing what influences physical activity at this age, and older adults' experiences of physical activity. METHODS:A qualitative meta-ethnography was chosen as the study design as this inductive approach can provide novel insights and generate new theory about physical activity and ageing. Papers were identified by searching electronic databases and key citations. Peer-reviewed primary qualitative studies and systematic reviews were included if they met the following inclusion criteria: community-dwelling participants aged 60 years or older or in the retirement transition period; reporting on leisure-time physical activity; utilising a rigorous qualitative methodology. A line of argument approach was employed to generate a theory about how older adults think and feel about physical activity. RESULTS:Thirty-nine papers met the inclusion criteria and were synthesised. The emergent theory suggested transition to older age can challenge people's sense of self and their role in life. Physical activity can help in regaining feelings of purpose, of being needed in collective group activity, and by creating habitual routine and structure to the day. In overcoming real and perceived barriers, and by taking up or sustaining physical activities, older adults can further build self-esteem all of which contributes to a fulfilling older age. CONCLUSION:Current failures to increase population levels of physical activity in older adults may be explained by an approach overly focused on the health benefits of activity. Insights from this study suggest we need to reframe our approach to consider the wider set of goals and aspirations which are of greater personal importance to older adults, and future interventions should focus on how physical activity can contribute to life satisfaction, sense of purpose, and sense of role fulfilment in older age. TRIAL REGISTRATION:Registered prospectively on PROSPERO on 29th March 2013: CRD42013003796 .
    背景与目标: 背景:在非传染性疾病负担高的国家,增加老年人的体育锻炼仍然是关键的公共卫生重点,但是目前的干预措施并未显着增加人口的摄入量,英国的数据表明,只有一半的65-74岁人口报告达到建议的水平。这项研究的目的是对大量定性研究进行系统和归纳的定性综合,描述什么因素影响该年龄段的体育锻炼以及老年人的体育锻炼经验。
    方法:选择定性元民族志作为研究设计,因为这种归纳方法可以提供新颖的见解并产生有关体育活动和衰老的新理论。通过搜索电子数据库和关键引文来识别论文。如果符合以下纳入标准,则包括经过同行评审的基本定性研究和系统评价:60岁或以上或退休过渡时期的社区居民参与者;报告休闲时间的体育活动;利用严格的定性方法。人们采用了一种论据线的方法来产生关于老年人如何思考和感受体育活动的理论。
    结果:39篇论文符合入选标准并进行了综合。新兴理论表明,过渡到老年人可以挑战人们的自我意识及其在生活中的作用。体育锻炼可以帮助您恢复目的感,集体活动中需要的感觉,并通过建立日常习惯性的习惯和结构来进行锻炼。在克服现实和感知的障碍以及通过从事或维持体育锻炼中,老年人可以进一步建立自尊心,所有这些都有助于充实的老年人。
    结论:目前无法提高老年人体育锻炼的人口水平的原因可能是过度关注体育锻炼对健康的益处所致。这项研究的见解表明,我们需要重新设计方法,以考虑对老年人而言更重要的更广泛的目标和抱负,未来的干预措施应着重于体育锻炼如何有助于生活满意度,目标感和老年人的角色履行感。
    试用注册:前瞻性注册于PROSPERO,2013年3月29日:CRD42013003796。
  • 【在重症监护中照顾病态肥胖患者时,应对社交尴尬:民族志学。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijnurstu.2016.03.016 复制DOI
    作者列表:Hales C,de Vries K,Coombs M
    BACKGROUND & AIMS: BACKGROUND:Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. AIM:To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. DESIGN AND METHODS:A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. SETTING:An 18 bedded tertiary intensive care unit in New Zealand. PARTICIPANTS:Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). FINDINGS:Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. CONCLUSIONS:This study has brought new understandings about intensive care situations where social awkwardness occurs in the context of obesity and care practices, and of the performances and behaviours of staff in managing the social awkwardness of fat-stigma during care situations.
    背景与目标: 背景:重症病态肥胖患者在重症监护环境中构成了相当大的医疗保健交付和资源利用挑战。这些是由于该人群对危重疾病的特定生理反应以及重症监护环境中使用的介入疗法的性质而导致的。当考虑与肥胖相关的社会耻辱时,该人群面临另一个挑战。因此,重症监护人员不仅要照顾病重的肥胖症患者的身体和护理需求,而且要在提供护理时亲自和专业地了解污名化的社会领域。
    目的:探讨重症病态肥胖患者在重症监护环境中的文化及其对医生和护士的影响。
    设计与方法:采用集中的人种志方法从重症监护人员的角度引发了护理重症病态肥胖患者的“现场”经验。在四个月的时间内对参与者的护理习惯进行观察并与重症监护人员进行了访谈。使用恒定比较技术进行分析,以比较适用于每个主题的事件。
    地点:新西兰一个拥有18张床位的三级重症监护室。
    参与者:67名重症监护护士和13名重症监护医生参与了7例体重指数≥40kg / m的重症患者的护理和管理。
    结果:由于围绕肥胖症的社会污名化,重症监护病房人员和病态肥胖患者之间的相互作用具有挑战性。当照顾病态肥胖的患者时,社交尴尬和应对社交尴尬的时刻很明显。重症监护人员在从事护理和护理工作时,采用了面对面工作和相互装扮的策略,以减轻不适感。这是用于防止患者和医务人员陷入尴尬和困扰的策略。
    结论:本研究对在肥胖和护理实践中发生社交尴尬的重症监护情况,以及在护理情况下员工应对肥胖柱头社会尴尬的表现和行为带来了新的认识。
  • 【加拿大蒙特利尔的有子女的移民家庭和跨国家庭支持:针对民族志的协议。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2019-029074 复制DOI
    作者列表:Merry L,Hanley J,Ruiz-Casares M,Archambault I,Mogere D
    BACKGROUND & AIMS: INTRODUCTION:There is a gap in research regarding transnational family support (emotional, practical, spiritual, informational and financial) as a resource for migrant families with children. From the perspective of migrant families and their family back home, the objectives of this study are to (1) identify the types and ways that transnational family support is provided to migrant families in Canada; (2) assess for patterns in the data that may suggest variations in the nature of this support (eg, by migration status, time in Canada, children's ages, family circumstances) and over time and (3) explore the impact (positive and negative) in receiving and providing transnational support, respectively. METHODS AND ANALYSIS:A focused ethnography is planned. We will recruit 25-35 migrant families with children with different migration histories (eg, economic or forced migration from a mix of countries) and family circumstances (eg, single parenthood, families living with extended family, families with children in the home country) living in Montreal, Canada. Families will be recruited through community organisations. Data will be gathered via semistructured interviews. To capture the perspective of those providing support, family members in the home country for each migrant family will also be recruited and interviewed through communication technology (eg, WhatsApp). Data collection will also involve observation of 'transnational interactions' between family members in Montreal and those back home. Data will be thematically analysed and results reported in a narrative form with an in-depth description of each theme. ETHICS AND DISSEMINATION:Ethical approval was obtained from the sciences and health research ethics committee at the University of Montreal. Study results will be shared through traditional forums (publication, conference presentations) and via other knowledge dissemination/exchange activities (eg, 'lunch and learn conferences' and seminars) through the research team's research centres and networks to reach front-line care-providers who interface directly with migrant families.
    背景与目标: 简介:关于跨国家庭支持(情感,实践,精神,信息和财政)作为有孩子的移民家庭的一种资源的研究存在差距。从移民家庭及其家庭的角度来看,本研究的目的是(1)确定在加拿大向移民家庭提供跨国家庭支持的类型和方式; (2)评估数据模式,这些模式可能表明这种支持的性质有所不同(例如,根据移民状况,在加拿大的时间,儿童的年龄,家庭情况)以及随着时间的推移,并且(3)探索影响(正面和负面) )分别接受和提供跨国支持。
    方法与分析:计划了一个重点突出的人种志研究。我们将招募25-35个有不同移民历史(例如,来自不同国家的经济或强迫移民)和家庭环境(例如,单身父母,大家庭住的家庭,有子女的家庭)的子女的移民家庭居住在加拿大蒙特利尔。家庭将通过社区组织招募。数据将通过半结构化访谈收集。为了抓住提供支持者的观点,还将通过通信技术(例如WhatsApp)招募和采访每个移民家庭的母国家庭成员。数据收集还将涉及观察蒙特利尔家庭成员与家庭成员之间的“跨国互动”。将对数据进行主题分析,并以叙述形式报告结果,并对每个主题进行深入描述。
    道德与传播:道德方面的批准是从蒙特利尔大学的科学与健康研究道德委员会获得的。研究结果将通过研究团队的研究中心和网络,通过传统论坛(出版物,会议演讲)和其他知识传播/交流活动(例如“午餐和学习会议”和研讨会)共享,以达到一线护理提供者他们直接与移民家庭交往。
  • 【以人为中心的急性腹痛患者的疼痛管理:由基础护理框架提供的人种志。】 复制标题 收藏 收藏
    DOI:10.1111/jan.13739 复制DOI
    作者列表:Avallin T,Muntlin Athlin Å,Elgaard Sørensen E,Kitson A,Björck M,Jangland E
    BACKGROUND & AIMS: AIMS:To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway. BACKGROUND:Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance. DESIGN:Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework. METHODS:Participant observation and informal interviews (92 hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged ≥18 years seeking care for AAP at the ED and admitted to a surgical ward (N = 31; aged 20-90 years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N = 198). RESULTS:The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics. CONCLUSIONS:Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.
    背景与目标: 目的:探讨和描述组织文化对行为的影响以及患者-从业者的行为模式,这些行为有助于或破坏急性护理途径中急性腹痛(AAP)患者的成功疼痛管理。
    背景:尽管疼痛管理是公认的人权,但无法控制的疼痛继续造成痛苦并延长医院护理时间。有关如何成功解决疼痛的未解决问题与组织文化和个人从业者的表现有关。
    设计:重点人种志,应用发展研究顺序和基本保健框架。
    方法:2015年4月至11月,在大学医院的一个急诊科(ED)和两个外科病房进行了参与者观察和非正式访谈(92小时)。数据包括≥18岁的寻求AAP护理的患者之间的261互动急诊科,并进入外科病房(N = 31;年龄20-90岁;男14例,女17例;有沟通障碍的9例)和医疗保健从业人员(N = 198)。
    结果:这些观察结果揭示了一种组织文化,对缓解疼痛的方式有相当大的影响。妥善管理疼痛的前提是患者和医生要进行整体疼痛管理,包括建立信任关系,交流知识共享和个性化止痛药。
    结论:以人为中心的疼痛管理需要一个组织,患者和从业人员必须以真正的伙伴身份分享他们的疼痛知识和疼痛管理知识。领导者和从业者应该做出小的行为改变,以实现疼痛管理的关键积极体验。
  • 【人种学在津巴布韦的传统治疗师在性传播感染和艾滋病毒/艾滋病教育和促进中的作用。】 复制标题 收藏 收藏
    DOI:10.1093/heapro/dar004 复制DOI
    作者列表:Simmons D
    BACKGROUND & AIMS: :This article explores the utility of ethnography in accounting for healers' understandings of HIV/AIDS-and more generally sexually transmitted infections-and the planning of HIV/AIDS education interventions targeting healers in urban Zimbabwe. I argue that much of the information utilized for planning and implementing such programs is actually based on rapid research procedures (usually single-method survey-based approaches) that do not fully capture healers' explanatory frameworks. This incomplete information then becomes authoritative knowledge about local 'traditions' and forms the basis for the design and implementation of training programs. Such decontextualization may, in turn, affect program effectiveness.
    背景与目标: :本文探讨了民族志方法在解释医务人员对HIV / AIDS以及更普遍的性传播感染的理解以及针对津巴布韦市区医务人员的HIV / AIDS教育干预措施规划中的作用。我认为,用于计划和实施此类计划的许多信息实际上是基于快速研究程序(通常是基于单方法调查的方法),而这些程序并未完全掌握治疗者的解释框架。然后,这些不完整的信息成为有关本地“传统”的权威知识,并构成了设计和实施培训计划的基础。这样的脱上下文可能反过来影响程序的有效性。
  • 【出院后的健康人种志】 复制标题 收藏 收藏
    DOI:10.1590/s1413-81232008000900012 复制DOI
    作者列表:de Castro EA,de Camargo Junior KR
    BACKGROUND & AIMS: :This paper presents an analysis of how Clifford Geertz' anthropological approach contributes to studies and investigations on health care. Geertz' approach relies basically on a semiotic conception of culture adopting thick description as the axis for interpretive elaborations and defending cultural interpretation as a science allowing to understand processes and to construct knowledge. We will present an overview of some constitutive elements of that author's thoughts we consider relevant for understanding the human experience of dealing with the disease/health process. The challenging question is how families deal with the need to provide care to a diseased relative after hospital discharge. We use this issue as an excuse for expounding this theoretical approach, interweaving the two areas. The micro-focus is the kind of healthcare that takes place outside the cultural environment where the technical forms of care based on scientific knowledge occur. We will briefly discuss how this question becomes evident in an object of study, and how it can be investigated according to the ethnography proposed by Geertz (op. cit.), allowing, in the end, for some considerations that further contribute to the construction of knowledge in public health.
    背景与目标: :本文分析了克利福德·盖尔茨(Clifford Geertz)的人类学方法如何有助于医疗保健的研究和调查。盖尔茨的方法基本上依赖于文化的符号学概念,即采用厚实的描述作为解释性阐述的轴心,并捍卫文化解释作为一门允许理解过程和建构知识的科学。我们将概述我们认为与理解人类应对疾病/健康过程的经验有关的该作者思想的一些构成要素。充满挑战的问题是,家庭出院后,家庭如何应对为患病亲属提供护理的需求。我们以这个问题为借口来阐述这种理论方法,将这两个领域交织在一起。微观焦点是一种在基于科学知识的医疗技术形式出现的文化环境之外进行的医疗保健。我们将简要讨论这个问题如何在研究对象中变得明显,以及如何根据Geertz(民族同志)提出的人种志对其进行研究,最后,出于一些考虑因素,这进一步有助于构建该问题。公共卫生方面的知识。
  • 【改进元民族志的报告:eMERGe报告指南。】 复制标题 收藏 收藏
    DOI:10.1186/s12874-018-0600-0 复制DOI
    作者列表:
    BACKGROUND & AIMS: AIMS:The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting. BACKGROUND:Evidence-based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality. DESIGN:The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes. METHODS:The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes. FINDINGS:Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance. CONCLUSION:The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology.
    背景与目标: 目的:本研究的目的是为提高元民族志报告的完整性和清晰度提供指导。
    背景:基于证据的政策和实践需要可靠的证据综合,可以进一步了解人们的经历和相关的社会过程。元民族志学是由Noblit和Hare开发的严格的七阶段定性证据综合方法。元民族志学在健康研究中被广泛使用,但是报告的质量通常很差,这阻碍了人们对其研究结果的信任和使用。需要元民族志报告指南来提高报告质量。
    设计:eMERGe研究使用严格的混合方法设计和基于证据的方法来开发新颖的报告指南和解释性注释。
    方法:该研究于2015年至2017年进行,包括:(1)对元民族志学行为和报告指南的方法学系统回顾; (2)对已出版的元民族志进行审查和审核,以识别良好做法原则; (3)达成指导内容的国际,多学科共识建立过程; (4)创新发展的指导和解释性说明。
    结果:新确定了元民族志行为和报告的所有七个阶段的建议和良好实践,从而形成了19个报告标准并随附了详细的指南。
    结论:定制的《 eMERGe报告指南》结合了新的方法学发展和先进的方法,可以帮助研究人员报告元民族志的重要方面。使用指南应提高报告质量。更好的报告可以使对结果的信心评估更加有力,并可以更多地使用元民族志输出成果,以改善卫生和其他领域的实践,政策和服务使用者的成果。这是针对元民族志的第一个量身定制的报告指南。本文同时在以下期刊上发表:《高级护理杂志》,《心理肿瘤学》,《教育评论》和BMC医学研究方法论。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录