瑞典初级保健中全科医生和社区护士对整体观的认知意义：一项定性研究。
The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study.
作者信息
Strandberg Eva Lena, Ovhed Ingvar, Borgquist Lars, Wilhelmsson Susan
机构信息
Lund University, Department of Clinical Sciences, Malmö, Family Medicine, Malmö University Hospital, SE-205 02, Malmö, Sweden.
出版信息
BMC Fam Pract. 2007 Mar 8;8:8. doi: 10.1186/1471-2296-8-8.
BACKGROUND
The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs).
METHODS
Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis.
RESULTS
The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools.
CONCLUSION
'Holistic view' is multidimensional, well implemented and very much alive among both GPs and DNs. The word holistic should really be spelled 'wholistic' to avoid confusion with complementary and alternative medicine. It was obvious that our participants were able to verbalize the meaning of a 'wholistic' view through narratives about their clinical, every day work. The possibility to implement a 'wholistic' perspective in their work with patients offers a strong motivation for GPs and DNs.
背景
各国对初级保健的定义不尽相同。瑞典的初级保健是基于质量、可及性、连续性、合作及整体观的哲学观点发展而来的。国际文献中整体观在医学和护理领域的含义有所不同。问题在于，这种差异是否源于不同的教育传统。由于在定义整体观和整体视角方面存在不确定性，我们希望深入研究医生和护士在临床工作中如何理解整体观。因此，本研究旨在探讨全科医生（GPs）和社区护士（DNs）对整体视角的理解含义。
方法
对瑞典两个郡议会从事初级保健工作的22名全科医生和20名护士进行了有目的抽样的七次焦点小组访谈。访谈内容逐字记录，并采用定性内容分析法进行分析。
结果
分析得出三个类别，即态度、知识和环境，分别包含两个、两个和四个子类别。专业态度包括认识到完整的人，而不仅仅是患有疾病的人的各个部分。事实性知识通过专门培训和长期专业经验获得。隐性知识涉及情感和社交能力。环境既可能是障碍，也可能是促进因素。整体观是一种强大的动力，因此是一种促进因素。初级保健的组织方式既可能是障碍，也可能是促进因素，并且可能影响整体方法的使用。明确的地理区域和护理团队有助于形成整体观，上门服务至关重要，尤其是对护士而言。在预防工作和姑息治疗中，整体观被认为特别重要。与患者的咨询和沟通被视为重要工具。
结论
“整体观”是多维度的，在全科医生和社区护士中得到了很好的贯彻且非常活跃。“holistic”这个词实际上应该拼写为“wholistic”，以避免与补充和替代医学混淆。很明显，我们的参与者能够通过讲述他们日常临床工作中的故事来阐述“wholistic”观点的含义。在与患者的工作中实施“wholistic”视角的可能性为全科医生和社区护士提供了强大的动力。
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