University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMC Med Educ. 2024 Aug 13;24(1):873. doi: 10.1186/s12909-024-05885-2.
As person centred care (PCC) is being implemented globally, higher educational institutions (HEI) have begun to play a crucial part in enabling this transition. In Sweden, however, the delivery of PCC is inconsistently implemented in medicine, nursing, occupational therapy, and physiotherapy study programmes. This inconsistency is partly the result of a lack of a national strategy across HEI. Program directors are responsible for the PCC content of their programs, so their views influence how PCC is taught. Using interviews with programme directors in higher education, we aim to deepen the understanding of the preconditions needed to implement PCC by exploring discourses and identifying subject positions of how PCC is taught and learned.
We performed a discourse analysis based on interviews with program directors in the above-mentioned national study programmes. A discourse can be seen as a struggle over identity. The subject position - i.e., discourses designate positions for persons to occupy as subjects - guided our analysis and identification of the subject positions of the teacher and the student in teaching and learning PCC.
This study unfolded in two main antagonistic aspects with respect to teaching and learning PCC, resulting in four subject positions for the teacher and four corresponding subject positions for the students. First, the teacher and student were given a subject position as change agents towards a more egalitarian healthcare and were assigned a subject position to cope with a practical reality they could not change. Second, the teacher and student were assigned a subject position that embodied profession-specific identities, navigating and valuing these boundaries. Simultaneously, both teachers and students assumed a subject position that required interprofessional interaction and co-creation for teaching and learning PCC.
This study demonstrates the discursive tension surrounding the implementation of PCC in HEI, and the findings can serve as a basis for creating future relevant and high-quality learning activities. The process of negotiating diverse and co-existing perspectives as well as building interprofessional trust when incorporating PCC into higher education is essential and requires further exploration.
随着以患者为中心的护理（PCC）在全球范围内的实施，高等教育机构（HEI）已开始在实现这一转变中发挥关键作用。然而，在瑞典，PCC 的实施在医学、护理、职业治疗和物理治疗的学习计划中并不一致。这种不一致部分是由于缺乏整个 HEI 的国家战略所致。项目主任负责其项目的 PCC 内容，因此他们的观点会影响 PCC 的教学方式。我们通过对高等教育中的项目主任进行访谈，旨在通过探讨话语和确定 PCC 的教学和学习方式的主体地位，深入了解实施 PCC 所需的前提条件。
我们对上述国家研究计划中的项目主任进行了访谈，并基于访谈进行了话语分析。话语可以被视为一场关于身份的斗争。主体地位——即话语为人们在教学和学习 PCC 中占据的主体地位——指导了我们的分析和对教师和学生的主体地位的识别。
这项研究在教学和学习 PCC 方面展开了两个主要的对立方面，导致教师有四个主体地位，学生也有四个相应的主体地位。首先，教师和学生被赋予了一个向更平等的医疗保健转变的主体地位，并被赋予了一个应对他们无法改变的现实的主体地位。其次，教师和学生被赋予了体现专业身份的主体地位，同时也在导航和重视这些边界。同时，教师和学生都承担了一个需要跨专业互动和共同创造才能进行 PCC 教学和学习的主体地位。
本研究展示了 PCC 在 HEI 中的实施所面临的话语张力，研究结果可以为创造未来相关的高质量学习活动提供基础。在将 PCC 纳入高等教育时，协商多样化和共存的观点以及建立跨专业信任的过程至关重要，需要进一步探讨。
