Rhodes Penny, McDonald Ruth, Campbell Stephen, Daker-White Gavin, Sanders Caroline
NIHR School for Primary Care Research, University of Manchester.
Manchester Business School and NIHR School for Primary Care Research, University of Manchester.
Sociol Health Illn. 2016 Feb;38(2):270-85. doi: 10.1111/1467-9566.12368. Epub 2015 Nov 6.
This study explores the ways in which patients make sense of 'safety' in the context of primary medical care. Drawing on qualitative interviews with primary care patients, we reveal patients' conceptualisation of safety as fluid, contingent, multi-dimensional, and negotiated. Participant accounts drew attention to a largely invisible and inaccessible (but taken for granted) architecture of safety, the importance of psycho-social as well as physical dimensions and the interactions between them, informal strategies for negotiating safety, and the moral dimension of safety. Participants reported being proactive in taking action to protect themselves from potential harm. The somewhat routinised and predictable nature of the primary medical care consultation, which is very different from 'one off' inpatient spells, meant that patients were not passive recipients of care. Instead they had a stock of accumulated knowledge and experience to inform their actions. In addition to highlighting the differences and similarities between hospital and primary care settings, the study suggests that a broad conceptualisation of patient safety is required, which encompasses the safety concerns of patients in primary care settings.
本研究探讨了患者在初级医疗保健背景下理解“安全”的方式。通过对初级保健患者的定性访谈，我们揭示了患者将安全概念化为流动的、偶然的、多维度的且需协商的。参与者的叙述提请人们注意一个很大程度上无形且难以触及（但被视为理所当然）的安全架构、心理社会维度以及身体维度的重要性及其之间的相互作用、协商安全的非正式策略以及安全的道德维度。参与者报告称他们积极采取行动保护自己免受潜在伤害。初级医疗保健咨询具有一定的常规性和可预测性，这与“一次性”住院治疗截然不同，这意味着患者并非被动的护理接受者。相反，他们拥有积累的知识和经验储备来指导自己的行动。除了强调医院和初级保健环境之间的差异和相似之处外，该研究还表明需要对患者安全进行广泛的概念化，其中应涵盖初级保健环境中患者的安全问题。
