Berg G V, Hedelin B, Sarvimäki A
Nordic School of Public Health, Gothenburg, Sweden.
Int Nurs Rev. 2005 Mar;52(1):73-80. doi: 10.1111/j.1466-7657.2004.00264.x.
To describe how nurses interpreted health promotion related to older patients in a medical hospital ward and the presuppositions for this work.
The study had a descriptive and explorative design. Data were created through participant observation of five nurses and informal dialogues with four nurses working in an infection unit in a small hospital in Norway. The nurses where followed during a period of 6 months. The observations and dialogues were interpreted and transformed into text. This text was analysed with qualitative content analysis and interpreted hermeneutically on three levels: (1) reading the text to get an overview of the themes; (2) systematically separating central patterns; and (3) highlighting the patterns with examples.
The nurses' interpretation of health promotion was closely connected to their interpretation of health and holistic nursing. Two main aspects were uncovered in the informal dialogues: a biomedically oriented nursing view and a holistically oriented nursing view. The observations showed that presuppositions, such as waiting for something or somebody, constantly changing situations, complexity and diversity in patient cases, influenced the nurses' work in general and also their focus on health promotion. The nurses balanced between the biomedical and the holistic approach. It seemed to be important for the nurses to be the masters of walking on a tightrope and to have professional clinical competence.
It was difficult to find a clear focus on health promotion. The most visible focus was on diagnosis and treatment, while the more complex and comprehensive situations related to health promotion of older patients seemed to be underprioritized. The phenomenon of 'waiting' may be an important issue for further research.
描述护士如何解读与综合医院病房老年患者相关的健康促进内容以及这项工作的预设前提。
本研究采用描述性和探索性设计。通过对五名护士的参与观察以及与挪威一家小型医院感染科的四名护士进行非正式对话来收集数据。对这些护士进行了为期6个月的跟踪观察。对观察结果和对话进行解读并转化为文本。运用定性内容分析法对该文本进行分析，并从三个层面进行诠释性解读：（1）阅读文本以了解主题概况；（2）系统地分离核心模式；（3）举例突出这些模式。
护士对健康促进的解读与他们对健康和整体护理的解读密切相关。在非正式对话中发现了两个主要方面：以生物医学为导向的护理观点和以整体为导向的护理观点。观察结果表明，诸如等待某事或某人、情况不断变化、患者病例的复杂性和多样性等预设前提，不仅影响护士的总体工作，也影响他们对健康促进的关注。护士们在生物医学方法和整体方法之间取得平衡。对护士来说，像走钢丝一样把握好平衡并具备专业临床能力似乎很重要。
很难明确聚焦于健康促进。最明显的重点是诊断和治疗，而与老年患者健康促进相关的更复杂、更全面的情况似乎未得到优先考虑。“等待”现象可能是进一步研究的一个重要问题。
