Ceci Christine
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Nurs Philos. 2008 Jan;9(1):19-31. doi: 10.1111/j.1466-769X.2007.00331.x.
The analysis undertaken in this paper explores the significance of a central finding from a recent field study of home care case management practice: a notable feature of case management work is the preparation of an orderly, ordered space where care may be offered. However, out of their encounters with an almost endless variety of situations, out of people's diverse narratives of need, case managers seem able to pick out only limited range of recognized needs to which to respond and demonstrate a series of responses themselves equally limited. Though this observation suggests a kind of efficiency that is currently highly valued within healthcare systems, it also underlines the system's inability to engage difference and variability in a meaningful way. This inability or limitation in effectively engaging difference is conceptualized here as, in some sense, a problem, and the nature of this problem is explored through the rhetorical process of problem setting. The central question becomes how might we develop and deploy an orderly and coherent system of care without essentializing people's experiences, without treating these experiences reductively, without, in a Foucaultian frame of reference, allowing what can be understood as similarity or resemblance among clients and situations to be folded back into sameness? As we encounter complexity, variability and difference in practice, how should we treat it?
个案管理工作的一个显著特征是准备一个有序的空间，以便提供护理。然而，尽管个案管理者接触到几乎无穷无尽的各种情况，尽管人们对需求有着多样的叙述，但他们似乎只能挑选出有限范围的被认可的需求来做出回应，而且他们自己表现出的一系列回应同样有限。虽然这一观察结果表明了一种目前在医疗系统中备受重视的效率，但它也凸显了该系统无法以有意义的方式应对差异和可变性。在某种意义上，这里将有效应对差异方面的这种无能或局限性概念化为一个问题，并通过问题设定的修辞过程来探究这个问题的本质。核心问题变成了：我们如何能够在不将人们的经历本质化、不进行简化处理、不在福柯式的参照框架内让客户和情况之间可被理解为相似或类似之处被归结为相同的情况下，开发并部署一个有序且连贯的护理系统？当我们在实践中遇到复杂性、可变性和差异时，我们应该如何对待它们？
