Roskilde University, Roskilde, Denmark.
Region Zealand and Roskilde University, Roskilde, Denmark.
Qual Health Res. 2020 Jul;30(9):1419-1430. doi: 10.1177/1049732320913855. Epub 2020 Apr 4.
Several studies identify obstacles to patient-centered care that can be eradicated by bridging the gap between policy goals and practice. In this article, "patient-centeredness" is theorized as an unstable entity riddled with intrinsic, ineradicable tensions. The purpose of the article is to propose a reflexive approach to the tensions as the most appropriate strategy for narrowing the gap between policy and practice. The reflexive approach is illustrated in an account of an action research project on a Danish, patient-centered initiative, "Active Patient Support." The account focuses on the development of a dialogic communication model through collaborative, reflexive analyses of the tensions in the enactment of "patient-centeredness" in dialogue between health care practitioners and citizens-in particular, the tension between empowerment and self-discipline. Finally, the conceptual expansion of one of the dimensions of patient-centeredness, "health-practitioner-as-person," is discussed as a platform for reflexivity, and the limitations of reflexivity are addressed.
许多研究都发现了以患者为中心的护理的障碍，而这些障碍可以通过弥合政策目标与实践之间的差距来消除。在本文中，“以患者为中心”被理论化为一个充满内在、不可消除的紧张关系的不稳定实体。本文的目的是提出一种反思性方法来处理这些紧张关系，这是缩小政策与实践之间差距的最合适策略。反思性方法在对丹麦以患者为中心的倡议“积极患者支持”的一项行动研究项目的说明中得到了体现。该说明重点介绍了通过对医疗保健从业者与公民之间的对话中“以患者为中心”的实施过程中的紧张关系进行协作、反思性分析，如何发展出一种对话式沟通模式，尤其是在赋权和自我约束之间的紧张关系。最后，讨论了“卫生保健从业者作为个体”这一以患者为中心的维度的概念扩展，作为反思的平台，并讨论了反思的局限性。
