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“这是我应该担心的事情吗?”:一项基于患者报告的结果数据做出临床决策时护士重新语境化工作的研究。

'Is this something I should be worried about?': A study of nurses' recontextualisation work when making clinical decisions based on patient reported outcome data.

机构信息

Department of Public Health, Section for Health Services Research, Øster Farimagsgade 5, DK-1014, København K, Denmark.

Department of Health and Social Context, National Institute of Public Health, Studiestræde 6, DK-1455, København K, Denmark.

出版信息

Soc Sci Med. 2022 Feb;294:114645. doi: 10.1016/j.socscimed.2021.114645. Epub 2021 Dec 8.

Abstract

As clinical care practices are becoming more digitalised, information about patients is increasingly being encoded as quantified data, and the processes of sorting data are often supported by algorithmic computations. One such practice becoming more prevalent across Western countries is the clinical use of Patient Reported Outcome (PRO) data. Drawing on ethnographic fieldwork carried out in a Danish setting among nurses managing PRO-based breast cancer follow-up, we examine how clinical decisions are made on the basis of PRO-data and what this requires from the nurses. By applying the concept of recontextualisation work as an analytical perspective, we shed light on the efforts of nurses when mobilising complementary information about patients in order to recontextualise the otherwise decontextualised data, thereby giving data practical value in clinical decision-making. Recontextualisation work, we show, is shaped by organisational structure, available resources, and nurses' professional capacity. Drawing analytical attention to the work of recontextualisation allows for a nuanced understanding of the efforts required to make data workable and hence what it takes to carry out clinical decisions in today's datafied healthcare system.

摘要

随着临床护理实践变得更加数字化,有关患者的信息越来越多地被编码为量化数据,并且数据排序过程通常由算法计算支持。在西方国家,一种越来越流行的做法是在临床中使用患者报告的结果(PRO)数据。本研究通过在丹麦进行的一项针对管理基于 PRO 的乳腺癌随访的护士的民族志实地工作,考察了如何根据 PRO 数据做出临床决策,以及这对护士有何要求。通过将重新语境化工作的概念作为一种分析视角,我们揭示了护士在调动有关患者的补充信息以重新语境化原本非语境化的数据时所付出的努力,从而使数据在临床决策中具有实际价值。我们表明,重新语境化工作受到组织结构、可用资源和护士的专业能力的影响。通过分析关注重新语境化工作,可以更细致地了解使数据可行所需的努力,以及在当今数据化的医疗保健系统中进行临床决策所需的条件。

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