1 University of Otago, Dunedin, New Zealand.
Qual Health Res. 2018 Mar;28(4):523-533. doi: 10.1177/1049732317740347. Epub 2017 Nov 7.
This New Zealand study used focused ethnography to explore the activities of communities of clinical practice (CoCP) in a community-based long-term conditions management program within a large primary health care clinic. CoCP are the informal vehicles by which patient care was delivered within the program. Here, we describe the CoCP as a micro-level moral economy within which values such as trust, respect, authenticity, reciprocity, and obligation circulate as a kind of moral capital. As taxpayers, citizens who become patients are credited with moral capital because the public health system is funded by taxes. This moral capital can be paid forward, accrued, banked, redeemed, exchanged, and forfeited by patients and their health care professionals during the course of a patient's journey. The concept of moral capital offers another route into the "black box" of clinical work by providing an alternative theoretic for explaining the relational aspects of patient care.
这项新西兰研究采用聚焦民族志方法，探索了一个大型基层医疗诊所中基于社区的慢性病管理项目中临床实践共同体（CoCP）的活动。CoCP 是该项目中提供患者护理的非正式载体。在这里，我们将 CoCP 描述为一个微观层面的道德经济体系，其中信任、尊重、真实、互惠和义务等价值观作为一种道德资本循环流动。作为纳税人，成为患者的公民因公共卫生系统由税收资助而获得道德资本。在患者的就诊过程中，患者及其医疗保健专业人员可以向前支付、积累、存入、赎回、交换和放弃这种道德资本。道德资本的概念通过提供另一种理论解释患者护理的关系方面，为进入临床工作的“黑箱”提供了另一种途径。
