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在老年病房的日常工作中建立叙事关系:一项针对医疗保健专业人员的定性研究。

Engaging in narrative relations in everyday work on a geriatric ward: A qualitative study with healthcare professionals.

机构信息

Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.

R&D Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.

出版信息

J Clin Nurs. 2023 Jul;32(13-14):3954-3966. doi: 10.1111/jocn.16480. Epub 2022 Aug 5.

Abstract

AIMS AND OBJECTIVES

To explore healthcare professionals' experiences and reflections about narration in their everyday work.

BACKGROUND

The need for integrated and people-centred healthcare for older adults has highlighted the relevance of narration in healthcare practice. Although theoretical foundations vary, different frameworks building on narration have been proposed for translating person-centredness philosophies into practice. However, to understand how theoretical knowledge on narration can be adopted into clinical work, we need to learn how healthcare staff understand narration from their experiential knowledge and practice.

DESIGN

The research process followed guidelines from Constructivist Grounded Theory as described by Charmaz. The study adheres to the COREQ guidelines.

METHODS

Data collection entailed interprofessional focus groups discussions with healthcare staff (n = 31). Vignettes depicting realistic scenarios were used to encourage participants to reflect on clinical practice. Data were analysed via a constant comparative method.

RESULTS

One core theme arose from the analysis. The core theme showed how narration was a relational process that people engaged in to pursue and uphold several foundational qualities in healthcare practice presented in the following subthemes: preventing simplistic understandings of people and situations; supporting trustful relations; supporting continuity and coherence; and learning from coworkers. However, a minor theme raised awareness of narrative relations as a double-edged sword.

CONCLUSIONS

By acknowledging the mutual and multifacetted nature of narration in everyday practice, this study shows how healthcare professionals' engagement in narrative relations may contribute to upholding several foundational qualities which resonate with philosophies of person-centredness in everyday healthcare practice.

RELEVANCE TO CLINICAL PRACTICE

Recognition of both the advantages and possible risks embedded in narrative relations in healthcare practice emphasises the obligation to collectively reflect on the repercussions of narrative relations in any local context.

PATIENT OR PUBLIC CONTRIBUTION

Healthcare professionals contributed by sharing their experiential knowledge and reflections on narration in practice.

摘要

目的和目标

探索医疗保健专业人员在日常工作中对叙述的经验和反思。

背景

为老年人提供综合和以人为主导的医疗保健的需求凸显了叙述在医疗保健实践中的相关性。尽管理论基础不同,但不同的框架都基于叙述,为将以人为本的理念转化为实践提出了建议。然而,为了了解如何将叙述的理论知识应用于临床工作,我们需要了解医疗保健人员如何从他们的经验知识和实践中理解叙述。

设计

研究过程遵循 Charmaz 描述的建构主义扎根理论指南。本研究遵循 COREQ 指南。

方法

数据收集包括医疗保健专业人员的跨专业焦点小组讨论(n=31)。使用描述真实场景的情景片段来鼓励参与者反思临床实践。通过恒定性比较方法进行数据分析。

结果

分析产生了一个核心主题。核心主题表明叙述是一种关系过程,人们通过这种过程来追求和维护医疗实践中提出的几个基本质量,这些质量体现在以下子主题中:防止对人和情况的简单理解;支持信任关系;支持连续性和一致性;以及向同事学习。然而,一个次要主题引起了对叙述关系作为双刃剑的认识。

结论

通过承认叙述在日常实践中的相互和多方面的性质,本研究展示了医疗保健专业人员如何参与叙述关系,这可能有助于维护与日常医疗保健实践中的以人为本理念相呼应的几个基本质量。

对临床实践的意义

承认叙述关系在医疗保健实践中所嵌入的优势和可能的风险,强调了在任何特定背景下集体反思叙述关系的影响的义务。

患者或公众贡献

医疗保健专业人员通过分享他们在实践中对叙述的经验知识和反思做出了贡献。

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