Johannessen Lars E F
Centre for the Study of Professions, OsloMet - Oslo Metropolitan University, Norway.
Sociol Health Illn. 2018 Jun;40(5):892-906. doi: 10.1111/1467-9566.12732. Epub 2018 Apr 17.
It is well documented that emergency service staff consider some patients to be 'inappropriate attenders'. A central example is 'trivia', denoting patients with medical problems considered too 'trivial' to warrant attention. Although research has repeatedly shown that frontline staff violate guidelines in turning away 'trivial' patients, existing research has paid insufficient attention to why staff are willing to engage in guideline-violating gatekeeping, which may put both themselves and 'trivial' patients at risk. To address this issue, the present article explores nurses' narratives about 'trivial' patients - referred to in this context as 'GP patients' - drawing on fieldwork data from a Norwegian emergency service. The article reconstructs three narrative clusters, showing that nurses' gatekeeping is motivated by concerns for the patient being turned away, for nurses and more critically ill patients, and for the service they work for. Some of the issues embedded in these narratives have been under-analysed in previous research - most importantly, the role of identity and emotion in nurses' gatekeeping, and how patient narratives can function as 'social prognoses' in nurses' assessments. Analysis of these narratives also reveals an antagonistic relationship between nurses and 'trivial' patients that contradicts nurses' ethical guidelines and indicates a need for healthcare reform.
有充分的文献记载，急救服务人员认为有些患者是“不适当的就诊者”。一个典型的例子是“琐事”，指那些患有被认为过于“琐碎”而不值得关注的医疗问题的患者。尽管研究一再表明一线工作人员在拒绝“琐碎”患者时违反了指导方针，但现有研究对工作人员为何愿意进行违反指导方针的把关关注不足，这可能会使他们自己和“琐碎”患者都面临风险。为了解决这个问题，本文利用挪威急救服务的实地调查数据，探讨护士对“琐碎”患者（在本文中称为“全科医生患者”）的叙述。文章重构了三个叙述集群，表明护士的把关动机是出于对被拒绝患者、对护士和病情更严重患者以及对他们工作的服务机构的担忧。这些叙述中所包含的一些问题在以往的研究中分析不足——最重要的是，身份和情感在护士把关中的作用，以及患者叙述在护士评估中如何作为“社会预后”发挥作用。对这些叙述的分析还揭示了护士与“琐碎”患者之间的对立关系，这与护士的道德准则相矛盾，并表明医疗改革的必要性。
