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综合健康指导中患者赋权的过程:它是如何发生的?

The Process of Patient Empowerment in Integrative Health Coaching: How Does it Happen?

作者信息

Caldwell Karen L, Gray Jennifer, Wolever Ruth Q

机构信息

Department of Human Development and Psychological Counseling, Appalachian State University, Boone, North Carolina, United States.

Department of Communication, Appalachian State University, Boone, North Carolina, United States.

出版信息

Glob Adv Health Med. 2013 May;2(3):48-57. doi: 10.7453/gahmj.2013.026.

Abstract

Emerging healthcare delivery models suggest that patients benefit from being engaged in their care. Integrative health coaching (IHC) is designed to be a systematic, collaborative, and solution-focused process that facilitates the enhancement of life experience and goal attainment regarding health, but little research is available to describe the mechanisms through which empowerment occurs in the health coaching process. The purpose of this qualitative study is to describe apparent key components of the empowerment process as it actually occurs in IHC. A sample of 69 recorded health coaching sessions was drawn from 12 participants enrolled in a randomized controlled study comparing two different methods of weight-loss maintenance. Two researchers coded the word-for-word transcripts of sessions focusing on the structure of the sessions and communication strategies used by the coaches. Three basic sections of a coaching session were identified, and two main themes emerged from the communication strategies used: Exploring Participant's Experience and Active Interventions. In IHC, health coaches do not direct with prefabricated education based on the patient's presenting problem; rather, they use a concordant style of communication. The major tenets of the health coaching process are patient-centeredness and patient control focused around patient-originated health goals that guide the work within a supportive coaching partnership. As the field of health coaching continues to define itself, an important ongoing question involves how the structure of the provider-patient interaction is informed by the role of the healthcare provider (eg, nurse, therapist, coach) and in turn shapes the empowerment process.

摘要

新兴的医疗服务模式表明,患者参与自身护理会从中受益。综合健康指导(IHC)旨在成为一个系统、协作且以解决问题为导向的过程,以促进生活体验的提升以及健康目标的达成,但关于健康指导过程中实现赋权的机制,现有研究甚少。这项定性研究的目的是描述赋权过程在综合健康指导实际发生时的明显关键组成部分。从参与一项比较两种不同减肥维持方法的随机对照研究的12名参与者中抽取了69次有记录的健康指导课程作为样本。两名研究人员对课程的逐字记录进行编码,重点关注课程结构和指导者使用的沟通策略。确定了指导课程的三个基本部分,并从所使用的沟通策略中浮现出两个主要主题:探索参与者的体验和积极干预。在综合健康指导中,健康指导者不会根据患者提出的问题提供预先设定好的教育内容来进行指导;相反,他们采用一种协调一致的沟通方式。健康指导过程的主要原则是以患者为中心以及围绕患者提出的健康目标进行患者自主控制,这些目标在支持性的指导伙伴关系中指导工作。随着健康指导领域不断明确自身定位,一个重要的持续性问题涉及医疗服务提供者(如护士、治疗师、指导者)的角色如何影响医患互动的结构,进而塑造赋权过程。

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