• 【由疾病重新定义:关于类风湿关节炎经验的定性研究的元民族志。】 复制标题 收藏 收藏
    DOI:10.3109/09638288.2013.829531 复制DOI
    作者列表:Daker-White G,Donovan J,Campbell R
    BACKGROUND & AIMS: PURPOSE:To synthesize published qualitative studies concerning the lived experience of rheumatoid arthritis (RA). To compare the conceptual features of qualitative studies covering two different time periods. METHODS:In 2002, 24 items published 1975-2001 were identified in comprehensive literature searches and assessed by multiple reviewers. In 2010, the first author found 28 articles published 2002-2009 in a simple search of the Medline database and synthesized them alone. Articles were synthesized using meta-ethnography. RESULTS:Both syntheses found that the main symptoms of RA are variable and unpredictable. However, in the first synthesis a sociological model dominated where RA was seen as an assault on self-identity with devastating social consequences. The main concepts were biographical disruption, role incompetence and the dread of dependency on others. In the second synthesis, the findings produced a model for health care practitioners tied to perceptions of control and incorporating a career-adaptation model of the experience of RA. CONCLUSIONS:We recommend that future synthesizers and primary qualitative health researchers focus more on non-hospital based populations and non-English language articles or study participants. The implications for rehabilitation follow from reflecting the findings of the synthesis against existing psychological models of coping and adaptation in RA. Implications for Rehabilitation Coping and adaptation are biographical processes, although the relative importance of active "disease mastery" versus more passive "getting used to it" is unclear. The uncertainty and fluctuating nature of symptoms and disease course presents existential challenges for people with RA in relation to maintaining physical functioning and social roles. Within a social model of disability, these findings point to potential intervention sites in society and relationships that would benefit people living with RA.
    背景与目标: 目的:综合有关风湿性关节炎(RA)生活经验的已发表的定性研究。比较涵盖两个不同时间段的定性研究的概念特征。
    方法:在2002年,通过全面的文献检索确定了1975-2001年发表的24项内容,并由多位审阅者进行了评估。在2010年,第一作者在Medline数据库的简单搜索中找到了2002-2009年发表的28篇文章,并单独对其进行了合成。使用元民族志对文章进行了综合。
    结果:两种合成方法均发现RA的主要症状多变且不可预测。但是,在第一个综合中,社会学模型占主导地位,其中RA被视为对自我认同的攻击,具有毁灭性的社会后果。主要概念是个人传记的破坏,角色的无能和对他人依赖的恐惧。在第二个综合报告中,研究结果为卫生保健从业人员提供了一个模型,该模型与对控制的认识联系在一起,并纳入了RA经历的职业适应模型。
    结论:我们建议未来的合成器和主要的定性健康研究人员更多地关注非医院人群和非英语文章或研究参与者。康复的意义是通过反映针对RA中现有的应对和适应心理模型的综合发现得出的。康复应对和适应的含义是传记过程,尽管尚不清楚主动“掌握疾病”相对于更被动“习惯”的相对重要性。症状和疾病进程的不确定性和波动性质为RA患者在维持身体机能和社会角色方面提出了生存挑战。在残疾的社会模型中,这些发现指出了可能有益于RA患者的社会和关系中潜在的干预场所。
  • 【敲钟声:使用人种志技术评估患者对护理质量的满意度。】 复制标题 收藏 收藏
    DOI:10.1097/00001786-200610000-00008 复制DOI
    作者列表:Deitrick L,Bokovoy J,Stern G,Panik A
    BACKGROUND & AIMS: :Ethnographic methods can provide insights into patients' perceptions of quality of care. We used ethnographic methods to examine problems related to answering patient call lights on one inpatient unit in the hospital. Communication through call bells consisted of 3 interrelated components. These included answering the call bell, communicating the patient's request, and following through with the request. Results of this study provided a deeper understanding of the nuances of power and control embedded within the issue of patient-caregiver communication and empowered unit staff to find solutions to the call bell problem.
    背景与目标: :人种学方法可以洞悉患者对护理质量的看法。我们使用人种学方法来检查与在医院的一个住院单元中应答患者呼叫灯有关的问题。通过呼叫铃进行的通信包含3个相互联系的组件。这些措施包括接听电话铃,传达患者的请求以及遵循请求。这项研究的结果使患者对医护人员沟通中所蕴含的力量和控制的细微差别有了更深入的了解,并使单位工作人员有权找到呼叫铃问题的解决方案。
  • 【一种视频人种学方法,用于将自然主义行为与精神分裂症的神经认知研究结构联系起来。】 复制标题 收藏 收藏
    DOI:10.1176/appi.neuropsych.11080201 复制DOI
    作者列表:Bromley E,Adams GF,Brekke JS
    BACKGROUND & AIMS: :Few methods are available to explore the impact of neurocognition in schizophrenia on behaviors performed in usual contexts. The authors developed a video ethnography approach to examine the relationship between naturalistic behaviors and research constructs of neurocognition. Video ethnographers accompanied subjects through usual routines gathering continuous video data. Researchers developed codes to measure four behavioral domains observed on video. This paper describes the psychometric characteristics to be considered in the development of observational approaches. It also highlights differences between behaviors performed in usual environments and neuropsychological constructs. The authors demonstrate that everyday behaviors that have been shown to correspond to neurocognitive skills in a pilot feasibility study can be identified and rated. They further suggest that observational methods could provide novel strategies for linking research findings and clinical concerns.
    背景与目标: :很少有方法可以探讨精神分裂症中神经认知对通常情况下行为的影响。作者开发了一种视频人种志方法,以检查自然主义行为与神经认知研究结构之间的关系。视频民族志研究人员通过通常的例行活动陪伴对象,收集连续的视频数据。研究人员开发了用于测量视频中观察到的四个行为域的代码。本文描述了观察方法发展中应考虑的心理计量学特征。它还强调了在通常环境下进行的行为与神经心理学构造之间的差异。作者证明,可以对初步可行性研究中已证明与神经认知技能相对应的日常行为进行识别和评估。他们进一步建议,观察方法可以提供将研究结果与临床关注联系起来的新颖策略。
  • 【基于面试的定性研究的元民族志,涉及医学生的观点和同情经历。】 复制标题 收藏 收藏
    DOI:10.1080/0142159X.2016.1210110 复制DOI
    作者列表:Jeffrey D
    BACKGROUND & AIMS: BACKGROUND:Quantitative research suggests that medical students' empathy declines during their training. This meta-ethnography asks: What new understanding may be gained by a synthesis of interview-based qualitative research on medical students' views and experiences of empathy? How can such a synthesis be undertaken? METHODOLOGY:A meta-ethnography synthesizes individual qualitative studies to generate knowledge increasing understanding and informing debate. A literature search yielded eight qualitative studies which met the inclusion criteria. These were analyzed from a phenomenological and interpretative perspective. RESULTS:The meta-ethnography revealed a conceptual confusion around empathy and a tension in medical education between distancing and connecting with patients. Barriers to empathy included a lack of patient contact and a strong emphasis on the biomedical over the psycho-social aspects of the curriculum. A number of influences discussed in the paper lead students to adopt less overt ways of showing their empathy. CONCLUSION:These insights deepen our understanding of the apparent decline in empathy in medical students. The lessons from these studies suggest that future curriculum development should include earlier patient contact, more emphasis on psycho-social aspects of care and address the barriers to empathy to ensure that tomorrow's doctors are empathetic as well as competent.
    背景与目标: 背景:定量研究表明,医学生的同理心在训练过程中会下降。这种元民族学的问题是:通过对医学生的观点和同情经历进行基于访谈的定性研究的综合,可能会获得什么新的理解?如何进行这样的综合?
    方法:元民族志综合了个人定性研究,以产生知识,增进了解并为辩论提供信息。文献检索产生了八项符合纳入标准的定性研究。从现象学和解释的角度对这些进行了分析。
    结果:元民族志学揭示了在移情和与患者保持联系之间医学观念上围绕移情的概念上的混乱。同理心的障碍包括缺乏患者的接触以及在课程的社会心理方面对生物医学的高度重视。论文中讨论的许多影响力引导学生采取较少公开的方式来表达他们的同理心。
    结论:这些见解加深了我们对医学生共情明显下降的理解。这些研究的教训表明,未来的课程开发应包括更早的患者接触,更多地关注护理的社会心理方面,并解决共情障碍,以确保明天的医生具有同情心和能力。
  • 【“值得冒着生命危险吗?”美国-墨西哥边境上的人种志,危险和死亡。】 复制标题 收藏 收藏
    DOI:10.1016/j.socscimed.2013.05.029 复制DOI
    作者列表:Holmes SM
    BACKGROUND & AIMS: :Every year, several hundred people die attempting to cross the border from Mexico into the United States, most often from dehydration and heat stroke though snake bites and violent assaults are also common. This article utilizes participant observation fieldwork in the borderlands of the US and Mexico to explore the experience of structural vulnerability and bodily health risk along the desert trek into the US. Between 2003 and 2005, the ethnographer recorded interviews and conversations with undocumented immigrants crossing the border, border patrol agents, border activists, borderland residents, and armed civilian vigilantes. In addition, he took part in a border crossing beginning in the Mexican state of Oaxaca and ending in a border patrol jail in Arizona after he and his undocumented Mexican research subjects were apprehended trekking through the borderlands. Field notes and interview transcriptions provide thick ethnographic detail demonstrating the ways in which social, ethnic, and citizenship differences as well as border policies force certain categories of people to put their bodies, health, and lives at risk in order for them and their families to survive. Yet, metaphors of individual choice deflect responsibility from global economic policy and US border policy, subtly blaming migrants for the danger - and sometimes death - they experience. The article concludes with policy changes to make US-Mexico labor migration less deadly.
    背景与目标: :每年,数百人企图从墨西哥越境进入美国而死亡,通常是由于脱水和中暑,尽管蛇咬和暴力袭击也很普遍。本文利用在美国和墨西哥边境地区的参与者观察野外工作,探索进入沙漠跋涉的结构脆弱性和身体健康风险。在2003年至2005年之间,人种志记录了与过境的无证移民,边境巡逻人员,边境激进主义者,边境居民和武装民警的访谈和谈话。此外,在他和他的无证墨西哥研究人员被逮捕穿越边境之后,他参加了从墨西哥瓦哈卡州开始的边境过境,并在亚利桑那州的边境巡逻监狱中结束。实地记录和访谈记录提供了丰富的民族志详细信息,表明了社会,族裔和公民身份差异以及边境政策迫使某些类别的人使其身体,健康和生命处于危险之中的方式,以便他们及其家人存活。然而,个人选择的隐喻使责任背离了全球经济政策和美国边境政策,他们巧妙地将移民所遭受的危险-有时甚至是死亡-归咎于移民。本文以政策调整结束,以使美墨劳务移民的致命性降低。
  • 【“锅中的灯”:印度南部传统医治的人种志所产生的动力源和动力源。】 复制标题 收藏 收藏
    DOI:10.1080/17441692.2018.1564349 复制DOI
    作者列表:Nambiar D,Mishra A
    BACKGROUND & AIMS: :Medicine and healing have been critical elements of nation-building and governance in India. There is a clear hierarchy: biomedicine, followed by systems like Ayurveda which are to be 'mainstreamed,' and local health traditions, which are to be 'revitalised'. Mindful that power nonetheless resides in positions of marginality, this analysis drew from a health system ethnography on revitalisation of local health traditions in three southern Indian states. Data from multiple interviews with 51 healers, observations of meetings, healing sessions and events convened by healers, as well as a multi-stakeholder dialogue on local health traditions convened by authors were analysed using a grounded analytical process. The state was a source of power, but in an enmeshed, individualised form. Other sources of power included accomplished others who viewed healers and their practices with respect, healers' collectives that produced and reinforced power through the exercise of certain rituals, and the sacred calling to heal, which assumed stringent criteria for practice and training, while also creating a moral imperative for service orientation. Our study shows how power rests in or is derived from multiple sites and sources that inhere and interact in critical ways with the state and other systems of medicine.
    背景与目标: :医学和康复一直是印度国家建设和治理的关键要素。有一个清晰的等级体系:生物医学,其次是像“阿育吠陀”这样的系统要被“主流化”,以及地方健康传统应该被“振兴”。考虑到权力仍然处于边缘地位,因此本次分析取材自卫生系统民族志,以振兴印度南部三个州的地方卫生传统。使用扎实的分析过程分析了来自对51位治疗者的多次访谈,对治疗者召集的会议观察,康复会议和事件的数据,以及由作者召集的关于当地健康传统的多方利益相关者对话的数据。国家是权力的源泉,但却是一种相互融合的,个性化的形式。其他权力的来源包括成就卓著的人,他们尊重治疗者及其做法;通过行使某些仪式产生和增强权力的治疗者集体;以及神圣的呼吁治愈,这要求严格的实践和培训标准,同时还创造了服务导向的道德要求。我们的研究表明,权力是如何在多种场所和来源中驻留或源自这些场所和来源的,这些场所和来源以至关重要的方式与国家和其他医学系统互动并相互作用。
  • 【新公共管理时代的护理与病人之间的关系,在公共家庭护理中:民族志学。】 复制标题 收藏 收藏
    DOI:10.1111/jan.13850 复制DOI
    作者列表:Strandås M,Wackerhausen S,Bondas T
    BACKGROUND & AIMS: AIM:The aim of this study was to gain deeper understandings of nurse-patient relationships in the New Public Management era, by exploring beliefs and practices of nurses and patients in Norwegian public home care. BACKGROUND:Organization of Norwegian home care services is based on New Public Management-ideologies, which have led to a rigidly formalized and task-oriented nursing practice that may jeopardize individual nursing care. Nurse-patient relationships have several positive effects on patients' health and well-being, but organizational boundaries and time pressure affect the quality of relationships. DESIGN:Focused ethnography. METHODS:Data were collected between November 2015-July 2016 using participant observation and semi-structured interviews with 10 nurses and eight patients in six different home care areas, in two Norwegian municipalities. Data analysis was based on Roper and Shapiras framework. FINDINGS:Findings demonstrate the continued importance of nurse-patient relationships in contemporary home care, while identifying extensive variations in the degree of closeness and emotional involvement. Organizational boundaries, time constraints, high workload, and disharmony between nurses "competence and patients" complex illnesses, influence practice in ways that reduce the significance of nurse-patient relationships and affect conditions under which they develop and evolve. Facing a system nurses perceive to function suboptimal, they govern practices based on their own professional assessments, and findings indicate cultural patterns in the way both nurses and patients prioritize to safeguard nurse-patient relationships. CONCLUSION:Home care cultures based on traditional nursing values continue, despite New Public Management influences, but a transition into New Public Management culture may, over time, influence the quality of nurse-patient relationships and meanings attributed to them.
    背景与目标: 目的:本研究的目的是通过探索挪威公共家庭护理中护士和患者的信念和实践,对新公共管理时代的护士与患者之间的关系有更深入的了解。
    背景:挪威家庭护理服务的组织基于新的公共管理意识形态,这导致了僵化的正规化和面向任务的护理实践,可能会危害个人护理。护士与病人的关系对病人的健康和福祉有若干积极影响,但是组织界限和时间压力会影响关系的质量。
    设计:重点人种志。
    方法:采用参与者观察和半结构化访谈的方法收集了2015年11月至2016年7月在挪威两个城市的六个不同家庭护理区域中的10名护士和8名患者的数据。数据分析基于Roper和Shapiras框架。
    研究结果表明,在确定亲密程度和情感参与程度的广泛差异的同时,护士与患者之间的关系在当代家庭护理中仍然具有重要意义。组织边界,时间限制,高工作量以及护士“能力与患者”复杂疾病之间的不和谐,以降低护士与患者关系的重要性并影响护士发展和进化的条件的方式影响实践。面对护士认为功能欠佳的系统,他们根据自己的专业评估来管理实践,研究结果表明文化模式以护士和患者优先维护护士与患者之间的关系的方式进行。
    结论:尽管受到新公共管理的影响,基于传统护理价值观的家庭护理文化仍在继续,但随着时间的推移,向新公共管理文化的过渡可能会影响护理人员与病人之间的关系质量和意义。
  • 【了解人种志和医学教育。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2929.2004.02070.x 复制DOI
    作者列表:Atkinson P,Pugsley L
    BACKGROUND & AIMS: OBJECTIVE:This paper aims to locate the ethnographic tradition in a socio-historical context. METHOD:In this paper we chart the history of the ethnographic tradition, explaining its roots and highlighting its value in enabling the ethnographic researcher to explore and make sense of the otherwise invisible aspects of cultural norms and practices. We discuss a number of studies that have provided detailed and context-sensitive accounts of the everyday life of medical schools, medical practitioners and medical students. We demonstrate how the methods of ethnographic fieldwork offer "other ways of knowing" that can have a significant impact on medical education. CONCLUSIONS:The ethnographic research tradition in sociological and anthropological studies of educational settings is a significant one. Ethnographic research in higher education institutions is less common, but is itself a growing research strategy.
    背景与目标: 目的:本文旨在将人种学传统置于社会历史环境中。
    方法:在本文中,我们对民族志传统的历史作了图表,解释了民族志传统的根源并突出了其价值,从而使民族志研究者能够探索并理解文化规范和实践的其他不可见方面。我们讨论了许多研究,这些研究提供了有关医学院,医务人员和医科学生日常生活的详细且上下文相关的描述。我们将展示人种志田野调查的方法如何提供“其他认识方式”,这些方式可能会对医学教育产生重大影响。
    结论:在教育环境的社会学和人类学研究中,人种学研究传统是一项重要的研究。在高等教育机构中,人种学研究并不普遍,但它本身就是一种不断发展的研究策略。
  • 【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。

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