通过医患沟通引导病人就医行为:美国的做法

病人对病情的理解和对医疗信息的记忆能力是医生影响病人就医的基础。耐心的积极教育是病人自愿同意推荐诊疗计划的必须。在协商时尊重病人和知晓病人的期盼对医生如何影响病人的就医行为是很有帮助的。     

临床决策与卫生政策

从讨论趋利性临床决策与泛企业化卫生政策的共同作用是造成我国医改失败的根本原因入手,在对3个典型案例进行深入剖析的基础上,论证了临床决策和卫生政策相互依存、相互作用的基本关系;研究了临床决策与卫生政策的决策主体、影响因素、决策过程、信息反馈、关系调整的循环路径;认为完善决策机制是保证临床决策和卫生政策正确有效的必要条件,提出了进一步完善临床决策和卫生政策的决策机制的具体意见和建议。     

The words we work with that work on us: clinical paradigm and cumulative relational trauma

This paper addresses a gap between analytic clinical theory and practice which emerges when examining the words we work with via textual and narrative research of case histories. Both subject matter and methodology fit with the remit of conceptual research in psychoanalysis, currently ranging from inductive to nomothetical approaches. Research of clinical language reveals an implicit account of human nature and the world which undergirds clinical practice. Based in the critical philosophy of the previous century, this is termed clinical paradigm. Such implicit views are induced rather than explicitly taught during analytic training, and need to be spelled out in order to become available to discourse and difference of opinion. Textual research shows these implicit pre‐clinical attitudes to be inherently pessimistic and thus too similar to the views of self and others found in cumulative relational trauma. Moreover, clinical accounts tend to normalize subtly antagonistic forms of relating, recently recognised as micro‐trauma. Importantly, this contravenes the agapic orientation of our theories and ethics. Paradigmatic reflection as a form of professional individuation addresses this gap. This includes a more optimistic outlook which can be traced through the philosophical implications of quantum theory.     

Exercise Training for Persons with Alzheimer's Disease and Caregivers: A Review of Dyadic Exercise Interventions

Alzheimer's disease (AD) is the most common form of dementia and the prevalence will increase dramatically in the next decades. Although exercise has shown benefits for people with dementia due to AD as well as their caregivers, the impact of a dyadic exercise intervention including both groups as study participants remains to be determined. The authors review the current clinical evidence for dyadic exercise interventions, which are exercise regimens applied to both the person with dementia and the caregiver. A total of 4 controlled trials were reviewed. This review shows that dyadic exercise interventions are feasible and may produce a positive effect on functional independence and caregiver burden. However, there was insufficient evidence to support a benefit of dyadic exercise intervention on cognitive performance and on behavioral and neuropsychiatric symptoms in participants with dementia due to AD. A dyadic exercise intervention improves functional independence and caregiver burden. However, there is a need for well-designed randomized controlled clinical trials to confirm these benefits and to investigate several important points such as the effects of a dyadic exercise intervention on cognitive and noncognitive outcomes of AD, the optimal intensity of exercise training, and the cost effectiveness of such a program.     

Practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugee clients

The present study is the first study undertaken in Australia that seeks to explore practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugees. We used thematic analysis to analyse extracts of interviews that were conducted with nine professionals who worked therapeutically with asylum seekers and refugees and had experience of participating in individual and peer supervision. The findings of the study suggest that supervision encouraged practitioners to develop multicultural awareness and explore therapeutic ways of working that are compatible with their clients’ frame. In addition, supervision provided the context in which practitioners explored the impact of the asylum legislative framework on their clinical work and reflected upon their feelings of powerlessness and political impotence. Implications for practice that derive from supervisory needs of practitioners who work with asylum seekers and refugees are explored.     

The theory of agency and breastfeeding

Objective: In this paper, we apply psychological agency theory to women’s interviews of their breastfeeding experiences to understand the role of agency in relation to breastfeeding initiation, maintenance and duration.

Design: Qualitative, video interviews were collected from 49 women in the UK from a wide range of ethnic, religious, educational and employment backgrounds about their breastfeeding experiences. We undertook secondary analysis of the data focusing on their accounts of vulnerability and agency.

Findings: Women’s agency was impacted by a variety of factors including their own vulnerability, knowledge, expectations and experience, the feeding environment and the support of health professionals in sharing decision-making and dealing with uncertainty.

Conclusion: Health professionals as co-agents with women are well positioned to maintain, enhance or restore women’s sense of agency. Breastfeeding goals should be included in women’s birth plans. Training related to agency, continuity of care, and staffing and workload management supported by national breastfeeding policies could improve breastfeeding rates and experiences.     

Facilitating supervisees’ developing competence through supervisory conversation

Research on assessing supervisees’ professional development (PD) has been primarily focused on formal end-point, summative evaluations. Little attention has been given to the role that routine supervisory conversations play in formative PD evaluations. This study takes a situated/dialogical approach to explore how PD evaluations are locally proposed, recognized, transacted, and conversationally accomplished in the conversations of actual supervision practice. Informed by ethnomethodology, we discursively analyzed episodes of supervisory sessions selected by supervisory dyads, which they regarded as significant to the supervisee’s PD. We describe and exemplify five conversational Practices by which supervisory dyads brought about shared evaluations vis-à-vis the supervisee’s PD, through supervisory conversations.