Rance Susanna, Westlake Debra, Brant Heather, Holme Ingrid, Endacott Ruth, Pinkney Jonathan, Byng Richard
University of East London, London, United Kingdom.
University of Plymouth, Plymouth, United Kingdom.
Glob Qual Nurs Res. 2020 Jun 18;7:2333393620930024. doi: 10.1177/2333393620930024. eCollection 2020 Jan-Dec.
In resource-stretched emergency departments, people accompanying patients play key roles in patients' care. This article presents analysis of the ways health professionals and accompanying persons talked about admission decisions and caring roles. The authors used an ethnographic case study design involving participant observation and semi-structured interviews with 13 patients, 17 accompanying persons and 26 health care professionals in four National Health Service hospitals in south-west England. Focused analysis of interactional data revealed that professionals' standardization of the patient-carer relationship contrasted with accompanying persons' varied connections with patients. Accompanying persons could directly or obliquely express willingness, ambivalence and resistance to supporting patients' care. The drive to avoid admissions can lead health professionals to deploy conversational skills to enlist accompanying persons for discharge care without exploring the meanings of their particular relationship with the patients. Taking a relationship-centered approach could improve the attention to accompanying persons as co-producers of health care and participants in decision-making.
在资源紧张的急诊科，陪同患者的人在患者护理中发挥着关键作用。本文分析了医疗专业人员和陪同人员谈论入院决策及护理角色的方式。作者采用了人种志案例研究设计，对英格兰西南部四家国民保健服务医院的13名患者、17名陪同人员和26名医护人员进行了参与观察和半结构化访谈。对互动数据的重点分析表明，专业人员对患者-护理者关系的标准化与陪同人员与患者的不同联系形成了对比。陪同人员可以直接或间接地表达支持患者护理的意愿、矛盾心理和抵触情绪。避免入院的压力可能导致医护人员运用沟通技巧，在未探究陪同人员与患者特定关系意义的情况下，争取他们参与出院护理。采取以关系为中心的方法可以提高对陪同人员作为医疗保健共同生产者和决策参与者的关注。
