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.     

Confidentiality and Mental Health/Chaplaincy Collaboration

Confidentiality can both facilitate and inhibit working relationships of chaplains and mental health professionals addressing the needs of service members and veterans in the United States. Researchers conducted this study to examine opportunities for improving integration of care within the Department of Defense (DoD) and Department of Veterans Affairs (VA). Interviews were conducted with 198 chaplains and 201 mental health professionals in 33 DoD and VA facilities. Using a blended qualitative research approach, researchers identified several themes from the interviews, including recognition that integration can improve services; chaplaincy confidentiality can facilitate help seeking behavior; and mental health and chaplain confidentiality can inhibit information sharing and active participation on interdisciplinary teams. Cross-disciplinary training on confidentiality requirements and developing policies for sharing information across disciplines is recommended to address barriers to integrated service delivery.     

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.     

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.     

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.     

L’expertise en responsabilité hospitalière dans le secteur public : l’exemple de l’AP–HP

Public hospitals in France are submitted to special rules different from those in private hospitals. Missions of judicial experts are quite similar but some differences may be found during expertal meetings.     

实施临床路径管理 构建和谐医患关系

医患和谐是医患双方的共同需要,通过时单病种乳腺癌改良根治术等10个单病种临床路径与成本控制绩效分析,评价患者的满意效果。收集整理2006年7月至2007年12月10个单病种的统计信息,以其手术并发症发生率、平均住院天数、平均住院费用、患者满意率等作为评价指标,将实验组（应用临床路径和成本控制组）和对照组（未应用临床路径和成本控制组）进行对比分析。结果显示,应用临床路径和成本控制的患者与未应用这一方式的患者之间在手术并发症发生率、平均住院时间、平均住院费用、患者满意率方面有统计学显著差异。提示单病种临床路径和成本控制模式应用于临床管理,可以明显促进CQI（Continuous Quality Improvement持续性质量改进）,缩短平均住院时间,降低住院费用,提高患者满意率,并从根本上改善医患关系。     

对军队医院合理用药的伦理学思考

本文通过“军卫一号”系统,截取了某军队医院2003年～2006年同一时段军队各类人员门诊及住院药品费用情况,与各统计时段军人疾病谱排序情况以及药品消耗金额排序情况进行了对比分析,并从医学伦理学的角度,阐述了军人用药合理性方面存在的问题及成因,提出了相应的对策。     

上海医院服务信息符号环境需求分析和建议

通过对上海22家不同级别和类型的医院就医标识信息服务环境的调查研究,分析了上海目前主要医院就医信息符号服务环境的现状与特点,提出了改善就医信息服务环境,建设“以人为本”的、符合中国国情的就医信息服务环境的建议。