护理观察在临床决策中的作用

在临床护理过程中,护士应充分利用护理工作的独特优势,从护理常规观察入手,使用望闻问切等观察手段,注重多向思维及病人的个性化特征,对病人实施全程观察,适时准确的观察患者细微的重要症状与体征变化,为及时正确的临床诊疗提供充分的、有效的信息,使护理观察能够在临床决策中发挥重要作用。     

EDUCATION SECTION: Infant observation in Britain:The Tavistock approach

The author draws attention to something distinctive in the psychoanalytic 'air' from the early 1960s onwards: the strong emphasis upon the very early psychological, emotional and cognitive view of infants and young children. She focuses on the work of two analysts in particular, Esther Bick and Wilfred Bion, and the comparable, though differently expressed, centrality of the observational method in their work. Each explored not only the pathological picture but also the nature and integrative function of psychic containment in earliest mental life. Each also shared a preoccupation with what constituted a psychoanalytic attitude and with the process of becoming a psychoanalyst and, in Bick's case, a child analyst or psychotherapist. The author provides an historical background to the idea of observation, followed by an account, with detailed examples, of the nature of infant observation and the observational method as taught and practised at the Tavistock Clinic, London since the late 1940s, and subsequently in many other training institutions. Here the themes of Bick and Bion are constantly interrelated such that the prototype or model for the creation of emotional meaning and thought can be appreciated and learning from experience can take place.     

Infant observation: A range of questions and challenges for contemporary psychoanalysis1

The author attempts to integrate several perspectives within the field of infant observation that reflect the analyst's personal experience as a clinician, as a professor at the analytic institute and as a researcher in the field of psychoanalysis. Can infant observation contribute to analytic technique, theory and training? If so, what would be the nature of such contribution? To answer these questions, the author reviews the literature on infant observation from Freud to the present, highlighting Latin American contributions to this subject. She makes reference to the role of technological innovations, which have allowed videotaping, repeated observations, temporal segmentation and computerized programs, thus giving rise to microanalytic research. This discussion prompts the question about the contributions made by systematic research to clinical practice. To tackle this question, the author presents both a clinical vignette taken from her personal experience, and the current debate on this subject as it appears in the work of Daniel Stern and André Green. Finally, she presents some conclusions that are part of an ongoing debate in the psychoanalytic field.     

The performance and observation of action shape future behaviour

The observation of other people’s actions plays an important role in shaping the perceptual, cognitive, and motor processes of the observer. It has been suggested that these social influences occur because the observation of action evokes a representation of that response in the observer and that these codes are subsequently accessed by other cognitive systems to modify future behaviour. In the case of social search and movement tasks, the observation-evoked response code is thought to activate the same mechanisms that are activated following internally-generated response codes. In support of this hypothesis, the present study revealed that the magnitudes of the between-person inhibition of return (IOR) effects were correlated with within-person IOR effects. These findings provide substantial support for the link between observation-evoked response codes and social cognitive effects.     

微观发生法:聚焦认知变化

微观发生法通过在变化发生的整个过程中对行为进行高密度观察和反复试验分析,可以提供关于认知变化的路线、速率、广度、来源以及变化模式的多样性等方面的精细信息,对于理解心理变化的机制有重要意义。该文论述了从发生法到微观发生法的演变过程、微观发生法的研究设计及其合理性与有待解决的问题。     

Pragmatic post‐structuralism (I): participant observation and discourse in evaluating violence intervention

This paper discusses the process and merits of a post‐structuralist approach to participant observation and describes the use of this research strategy in evaluating a community based ‘stopping violence’ programme. While the participant observation research strategy is commonly employed as a ‘process evaluation’ method (Rossi and Freeman, 1993 ) it's role within a distinctly post‐structuralist programme is a novel application of a well‐established research strategy. This has significant implications for how social scientists may approach both participant observation and evaluation in the future. Copyright © 2001 John Wiley & Sons, Ltd.     

The perception of preschool social dominance

Children's and teachers' perception of social dominance was examined using a behavioral criterion for determining accuracy of verbal judgments. Video records of agonistic interactions were obtained during approximately 60 hours of free-play at two preschool centers. Analyses of social conflict episodes ending in submission revealed linear dominance structures for both groups. Dominance perception was assessed in two ways. Both teachers and children were asked to rank-order a subgroup of children according to dominance. They were also asked to select the more dominant children in a number of predetermined pairs. Results indicated that teachers could accurately judge dyadic dominance relations, and that accuracy among children varied as a function of their status within the group hierarchy. Findings have implications for social dominance assessment methodology, and for the issue of consensual versus ecological validity in developmental studies of social perception.     

Some empirical justification for a modest proposal regarding data acquisition via intermittent direct observation

Computer simulations of behavior and event records of a child's visual fixation on an adult person were generated and sampled using a modified time sampling procedure. The modified approach required making two independent scoring judgments per observation interval: if the behavior was initiated within the interval, the interval was scored; if the behavior was ongoing precisely at the end of the interval, the interval was again scored. The results showed that the within-interval and end-of-interval scores yielded, respectively, estimates of behavioral frequency and duration. The accuracy of the estimates was a function of the number of observations. Several field studies demonstrated high agreement among observers who employed the measurement system.     

CONTINGENT OBSERVATION: AN EFFECTIVE AND ACCEPTABLE PROCEDURE FOR REDUCING DISRUPTIVE BEHAVIOR OF YOUNG CHILDREN IN A GROUP SETTING1

Since a major task of childhood is learning to get along in a group without disrupting other children's activities, caregivers need explicit guidelines for gentle but effective procedures for dealing with disruptive behaviors in child-care settings. In a day-care center for normal 1- and 2-yr-old children, an effort was made to develop a procedure that appeared sufficiently humane and educational to be acceptable to parents and daycare workers, and yet effective in reducing disruptive play behaviors. Caregivers used the occasion of disruptive behavior to instruct the child in appropriate alternatives, then had the child sit on the periphery and observe the appropriate social behavior of the other children, “sit and watch”, for a brief period before inviting him or her to rejoin the play activities. The effectiveness of this procedure was compared with a method commonly recommended for use with young children: instructing the child, then distracting or redirecting the child to an alternative toy or activity. Contingent observation, combining instruction with a brief timeout (from being a participant in an activity to becoming an observer of the activity), proved considerably more effective in maintaining low levels of disruptions and was considered by caregivers and parents to be an appropriate and socially acceptable method of dealing with young children's disruptive behaviors. Therefore, contingent observation can be recommended for general use in day-care programs for young children.     

Observational assessment of behavioral changes accompanying clinical improvement in hospitalized psychiatric patients

Naturalistic observational techniques were employed over a four-week period to assess the behavior of clinically improved (n=7) and unimproved (n=12) hospitalized patients suffering from acute psychiatric disorders. The population was selected from four clinical diagnostic groups. Patients were sampled on an individual basis. Categories of recorded behaviors included social behavior as well as spatial proximity measures between individuals. Social behavior was further divided into components of sending and receiving. Results showed that patients who clinically improved had significantly different behavioral profiles and greater degrees of behavioral change for the following categories: send affiliation, receive affiliation, send assertion, and receive assertion. Improved patients also maintained closer distance to other individuals during the latter stages of hospitalization. In most cases, week 2 of hospitalization marked the point at which behavioral divergence between improved and unimproved patients occurred. Clinical and theoretical implications of observational procedures are discussed.