Friberg Febe, Scherman Marianne Hansson
School of Health Sciences, University College of Borås, Borås, Sweden.
Scand J Caring Sci. 2005 Sep;19(3):274-9. doi: 10.1111/j.1471-6712.2005.00341.x.
Patients' noncompliance is regarded as a major problem in health care and efforts have been made to understand the mechanisms behind compliance and noncompliance. The concept of compliance has been analysed and criticized because of the limited way it defines the roles of patients and health professionals and for being supportive of the authority of health professionals. Attempts have been made to change the paternalistic meaning of the concept of compliance and alternative terms have been introduced. However, there is a lack of studies about the teaching and learning component of compliance. The aim of this theoretical article was to examine the meaning of the concept of compliance as is it used in health care, and relate it to a patient-centred, teaching and learning perspective. It is argued that instead of focusing on noncompliant patient behaviour, it would be more powerful to focus on the way the patients experience and understand and on how to create conditions for developing understanding, as this in turn might influence the behaviour or way of acting. It is suggested that the teaching part of compliance could be carried out by 'to follow and let oneself be followed', which means a teaching and learning situation where the health professional follows the patient, guided by patient experiences, and need for understanding. At the same time it means that following the patient's experiences creates possibilities for the health professional to reason and act in a way that the patient can follow. The concept of 'play' is used when putting 'to follow and let oneself be followed' into effect. To this end, the health professional needs to develop a considered pedagogical standpoint.
患者不依从被视为医疗保健中的一个主要问题，人们已努力去理解依从和不依从背后的机制。依从这一概念因其对患者和医护人员角色的定义方式有限以及支持医护人员的权威性而受到分析和批评。人们已尝试改变依从概念的家长式含义，并引入了替代术语。然而，关于依从的教学部分的研究却很缺乏。这篇理论文章的目的是审视依从概念在医疗保健中的含义，并将其与以患者为中心的教学视角联系起来。有人认为，与其关注不依从的患者行为，不如关注患者的体验和理解方式以及如何创造条件来增进理解，因为这反过来可能会影响行为或行动方式。有人建议，依从的教学部分可以通过“跟随并让自己被跟随”来进行，这意味着一种教学情境，即医护人员在患者体验和理解需求的引导下跟随患者。同时，这也意味着跟随患者的体验为医护人员提供了以患者能够理解的方式进行推理和行动的可能性。在实施“跟随并让自己被跟随”时会用到“游戏”这一概念。为此，医护人员需要形成一种经过深思熟虑的教学立场。
