Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMC Health Serv Res. 2012 Jul 2;12:184. doi: 10.1186/1472-6963-12-184.
Modern hospital care should ostensibly be multi-professional and person-centred, yet it still seems to be driven primarily by a hegemonic, positivistic, biomedical agenda. This study aimed to describe the everyday practices of professionals and patients in a coronary care unit, and analyse how the routines, structures and physical design of the care environment influenced their actions and relationships.
Ethnographic fieldwork was conducted over a 16-month period (between 2009 and 2011) by two researchers working in parallel in a Swedish coronary care unit. Observations, informal talks and formal interviews took place with registered nurses, assistant nurses, physicians and patients in the coronary care unit. The formal interviews were conducted with six registered nurses (five female, one male) including the chief nurse manager, three assistant nurses (all female), two cardiologists and three patients (one female, two male).
We identified the structures that either promoted or counteracted the various actions and relationships of patients and healthcare professionals. The care environment, with its minimalistic design, strong focus on routines and modest capacity for dialogue, restricted the choices available to both patients and healthcare professionals. This resulted in feelings of guilt, predominantly on the part of the registered nurses.
The care environment restricted the choices available to both patients and healthcare professionals. This may result in increased moral stress among those in multi-professional teams who work in the grey area between biomedical and person-centred care.
现代医院护理理应是多专业和以患者为中心的，但它似乎仍然主要受主导、实证主义、生物医学议程驱动。本研究旨在描述冠心病监护病房（CCU）中专业人员和患者的日常实践，并分析护理环境的常规、结构和物理设计如何影响他们的行动和关系。
两名研究人员在瑞典冠心病监护病房平行开展了为期 16 个月（2009 年至 2011 年）的民族志实地研究。在冠心病监护病房中，对注册护士、助理护士、医生和患者进行观察、非正式交谈和正式访谈。正式访谈包括对六名注册护士（五名女性，一名男性）进行访谈，其中包括首席护士经理，三名助理护士（均为女性），两名心脏病专家和三名患者（一名女性，两名男性）。
我们确定了促进或阻碍患者和医疗保健专业人员各种行动和关系的结构。以极简主义设计、强烈关注常规和适度对话能力为特色的护理环境限制了患者和医疗保健专业人员的选择。这导致了注册护士的内疚感，主要是注册护士。
护理环境限制了患者和医疗保健专业人员的选择。这可能会增加在生物医学和以患者为中心的护理之间的灰色地带工作的多专业团队中的道德压力。
