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强制性居住护理认证标准是否能为学习型组织树立积极榜样?文本与批判性话语分析。

Do written mandatory accreditation standards for residential care positively model learning organizations? Textual and critical discourse analysis.

机构信息

University Department of Rural Health, University of Tasmania, Private Bag 103, Hobart, Tasmania 7001 Australia.

出版信息

Int J Nurs Stud. 2013 Nov;50(11):1446-58. doi: 10.1016/j.ijnurstu.2013.01.011. Epub 2013 Feb 28.

Abstract

BACKGROUND

Unprecedented global population ageing accompanied by increasing complexity of aged care present major challenges of quality in aged care. In the business literature, Senge's theory of adaptive learning organisations offers a model of organisational quality. However, while accreditation of national standards is an increasing mechanism for achieving quality in aged care, there are anecdotal concerns it creates a 'minimum standards compliance mentality' and no evidence about whether it reinforces learning organisations.

OBJECTIVE

The research question was 'Do mandatory national accreditation standards for residential aged care, as they are written, positively model learning organisations?'.

METHOD

Automatic text analysis was combined with critical discourse analysis to analyse the presence of learning concepts from Senge's learning organisation theory in an exhaustive sample of national accreditation standards from 7 countries. The two stages of analysis were: (1) quantitative mapping of the presence of learning organisation concepts in standards using Bayesian-based textual analytics software and (2) qualitative critical discourse analysis to further examine how the language of standards so identified may be modelling learning organisation concepts.

RESULTS

The learning concepts 'training', 'development', 'knowledge', and 'systems' are present with relative frequencies of 19%, 11%, 10%, and 10% respectively in the 1944 instances, in paragraph-sized text blocks, considered. Concepts such as 'team', 'integration', 'learning', 'change' and 'innovation' occur with 7%, 6%, 5%, 5%, and 1% relative frequencies respectively. Learning concepts tend to co-occur with negative rather than positive sentiment language in the 3176 instances in text blocks containing sentiment language. Critical discourse analysis suggested that standards generally use the language of organisational change and learning in limited ways that appear to model 'learning averse' communities of practice and organisational cultures.

CONCLUSION

The aged care quality challenge and the role of standards need rethinking. All standards implicitly or explicitly model an organisation of some type. If standards can model a limited and negative learning organisation language, they could model a well-developed and positive learning organisation language. In the context of the global aged care crisis, the modelling of learning organisations is probably critical for minimal competence in residential aged care and certainly achievable in the language of standards.

摘要

背景

前所未有的全球人口老龄化,加上老年护理日益复杂,给老年护理质量带来了重大挑战。在商业文献中,圣吉的适应性学习组织理论为组织质量提供了一个模型。然而,尽管国家标准认证是实现老年护理质量的一种越来越重要的机制,但有传闻称,这会造成“仅仅满足最低标准”的心态,而且没有证据表明这是否会加强学习型组织。

目的

研究问题是“强制性国家老年护理住宿认证标准(按原样编写)是否积极地为学习型组织建模?”。

方法

自动文本分析与批判性话语分析相结合,对来自 7 个国家的详尽的国家认证标准样本中圣吉学习型组织理论的学习概念进行了分析。分析分为两个阶段:(1)使用基于贝叶斯的文本分析软件对标准中学习型组织概念的存在进行定量映射;(2)对如此确定的标准语言进行定性的批判性话语分析,以进一步研究这些语言如何为学习型组织概念建模。

结果

在所考虑的 1944 个实例中,标准中“培训”、“发展”、“知识”和“系统”这四个学习概念的相对频率分别为 19%、11%、10%和 10%。“团队”、“整合”、“学习”、“变革”和“创新”等概念的相对频率分别为 7%、6%、5%、5%和 1%。在包含情感语言的文本块中,学习概念往往与负面情绪语言而不是积极情绪语言共同出现,在包含情感语言的 3176 个实例中。批判性话语分析表明,标准通常以有限的方式使用组织变革和学习的语言,这似乎为“厌恶学习”的实践社区和组织文化建模。

结论

老年护理质量挑战和标准的作用需要重新思考。所有标准都隐含或明确地为某种类型的组织建模。如果标准可以为有限的和消极的学习组织语言建模,那么它们也可以为更发达和积极的学习组织语言建模。在全球老年护理危机的背景下,为了在老年护理住宿方面实现最低能力,为学习型组织建模可能至关重要,而在标准语言中,这肯定是可以实现的。

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