Kreindler Sara A
Research & Evaluation Unit, Winnipeg Regional Health Authority, University of Manitoba, Winnipeg, MB, Canada.
Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Health Expect. 2015 Oct;18(5):1139-50. doi: 10.1111/hex.12087. Epub 2013 May 22.
Despite widespread belief in the importance of patient-centred care, it remains difficult to create a system in which all groups work together for the good of the patient. Part of the problem may be that the issue of patient-centred care itself can be used to prosecute intergroup conflict.
This qualitative study of texts examined the presence and nature of intergroup language within the discourse on patient-centred care.
A systematic SCOPUS and Google search identified 85 peer-reviewed and grey literature reports that engaged with the concept of patient-centred care. Discourse analysis, informed by the social identity approach, examined how writers defined and portrayed various groups.
Managers, physicians and nurses all used the discourse of patient-centred care to imply that their own group was patient centred while other group(s) were not. Patient organizations tended to downplay or even deny the role of managers and providers in promoting patient centredness, and some used the concept to advocate for controversial health policies. Intergroup themes were even more obvious in the rhetoric of political groups across the ideological spectrum. In contrast to accounts that juxtaposed in-groups and out-groups, those from reportedly patient-centred organizations defined a 'mosaic' in-group that encompassed managers, providers and patients.
The seemingly benign concept of patient-centred care can easily become a weapon on an intergroup battlefield. Understanding this dimension may help organizations resolve the intergroup tensions that prevent collective achievement of a patient-centred system.
尽管人们普遍认为以患者为中心的护理很重要，但要创建一个让所有群体都为患者利益共同努力的系统仍然很困难。部分问题可能在于，以患者为中心的护理这一问题本身可能会被用于引发群体间的冲突。
这项对文本的定性研究考察了以患者为中心的护理话语中群体间语言的存在情况和性质。
通过系统的Scopus和谷歌搜索，确定了85篇同行评审和灰色文献报告，这些报告涉及以患者为中心的护理概念。基于社会认同方法的话语分析，考察了作者如何定义和描绘不同群体。
管理人员、医生和护士都使用以患者为中心的护理话语来暗示他们自己的群体是以患者为中心的，而其他群体则不是。患者组织往往淡化甚至否认管理人员和提供者在促进以患者为中心方面的作用，一些组织还用这个概念来倡导有争议的卫生政策。群体间的主题在各种意识形态的政治团体的言辞中甚至更加明显。与那些将内群体和外群体并列的描述不同，那些来自据说是以患者为中心的组织的描述定义了一个包含管理人员、提供者和患者的“马赛克”内群体。
以患者为中心的护理这一看似良性的概念很容易成为群体间战场上的武器。理解这一方面可能有助于组织解决阻碍以患者为中心的系统集体实现的群体间紧张关系。
