Le travail collectif à l’épreuve des restructurations organisationnelles

The ergonomic analysis of work (Daniellou, 1996; Wisner, 1996) and especially the psychological analysis of real working activity (Leplat, 2000) allow investigating the main factors of work situations. The objective is to show the influence on the nursing representations of psychiatric services that are restructured, of the initial working situations, the projects, the restructuring models. The analyses assess the nursing representations of psychiatric services that are restructured, the projects, the restructuring models, the real working activity. The data show impacts of collective work and restructuring models, especially the damaging consequences of fusions. The results enable the authors to discuss from the points of views of theory, methodology and interventions.     

Other than obedient: Girls' constructions of doctors and treatment regimes for anorexia nervosa

This paper examines how teenage girls diagnosed with and being treated for anorexia nervosa in hospital construct their anorexia, their identity as patients, medical authority and their doctors. In‐depth interviews were conducted with 25 adolescent girls in two large, metropolitan hospitals in Australia. Using a discourse analytic approach informed by poststructural theory, we elucidate how girls perform as patients, contest the authoritative position of doctors and deploy popular, taken‐for‐granted discourses of femininity to resist treatment regimes and the construction of themselves by others as ‘anorexic’ and ‘sick’. Our analysis indicates that medical discourses in the hospital do not necessarily define or delimit girls' constructions of themselves, of anorexia, treatment or their relationships with doctors. The paper argues that understanding and validating girls' perspectives is essential in building and maintaining a therapeutic alliance in hospitals. We conclude by discussing how insights from poststructural analysis can assist in improving hospital practice. Copyright © 2009 John Wiley & Sons, Ltd.     

医药收费政策调整对医院经济的影响及对策

通过分析医疗服务项目价格调整和药品价格调整对医院经济的影响,指出了新医疗收费政策在降低患者看病费用负担方面起到了一定作用,是值得肯定的。并探讨了在新收费政策下,医院该如何通过对医院管理和经营策略的调整来应对调价带来的不利影响,提高医院的经济效益。     

Ethics Consultation in Pediatrics: Long-Term Experience From a Pediatric Oncology Center

There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000–2011) at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is needed on the role of ethics consultation in pediatrics.     

The effectiveness of intergroup contact at work: Mediators and moderators of hospital workers' prejudice towards immigrants

The present research examines the effectiveness of intergroup contact between 167 Italian hospital workers and foreign patients in reducing prejudice towards immigrants in general. The outcomes of contact at work were analysed controlling for the influence of contact outside the workplace and through mass media, and taking into account the role of empathy, anxiety and group membership salience. Results indicate that the beneficial effects of contact at work were partially mediated by increased empathy and reduced anxiety, experienced both in the work environment and towards immigrants in general. Finally, high levels of group membership salience facilitated the influence of contact on intergroup emotions. These findings show that contact at work can be a powerful means to reduce prejudice, thanks to its capacity to evoke changes in affective responses. Copyright © 2010 John Wiley & Sons, Ltd.     

上海社区医院安宁疗护团队的工作困境质性研究

基于角色理论,通过访谈四家上海社区卫生服务中心的安宁疗护团队,研究探索安宁疗护医生、护士、社工及护工的工作困境。经访谈发现,团队面临的工作困境主要来自于死亡与病痛的压力(角色超荷)、专业技能无法满足实际需求(角色模糊)、医患双方对安宁疗护的预期差异(角色冲突)。上述结果拓展了角色理论在安宁疗护领域的应用,显示了其局限性。研究呼吁尽快完善安宁疗护相关法律保障,以保护患者知情权与安宁疗护团队成员的基本权益。

     

叙事医学赋能医院管理与高质量发展

叙事医院管理强调在医院管理中融入叙事管理理念,是一种与循证管理互补的新兴管理模式。以广东省医院协会的叙事医学专业委员会平台和南方医科大学指导的叙事中心作为实践起点,在构建中国叙事医学体系的基础上,创新性地提出叙事医院管理框架下的医院叙事生态、管理者叙事商数、职业叙事闭锁、组织核心叙事、叙事调解等核心关键词,旨在激发国内医院管理者聚焦叙事理念,推动医院实现各维度的价值共生。

     

地市级医院医学人文继续教育现状分析——以湖南省6所医院为例

为了解地市级医院医学人文继续教育现状,对湖南省6所地市级医院的医护人员采用问卷调查的方法收集信息,共回收672份有效问卷。数据分析显示,湖南省地市级医院对医学人文继续教育重视程度还有待进一步加强;医院开展医学人文继续教育活动的频率较低,教育方法和手段比较单一,不能因地制宜地与医护人员实际工作有机结合;开展医学人文继续教育的内容和形式没有做到与时俱进。建议地市级医院要高度重视医学人文继续教育工作,积极探索医学人文继续教育新模式,创新医学人文继续教育方式方法,合理凝练医学人文继续教育内容,建立医学人文继续教育激励机制,进一步提升医护人员医学人文素养。