PubMed · 15453246
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Scott MacStravic. 2004. Make it personal.. https://pubmed.ncbi.nlm.nih.gov/15453246/
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To draw the line between health and disease has considerable consequences for medical action and financing of medical services as well. It will be shown that satisfying scientific reasons cannot be given for a general and practicable definition either of health or of disease. This is possible only for a specific concept of disease that can be assessed by a diagnosis. However, even such a specific term may be ambiguous, particularly in psychiatry, for which it is of central importance how and what the patient communicates of his experiences. The reason lies in different ways of assessing: the physician describes phenomena of the patient that are controllable by standardisation, the patient ascribes his own experience uncontrollably individually. Moreover, the moment of appeal in the ascriptive mode indicates a call from the specific need for the help of others, of the community. The descriptive mode is relevant for the generalisable assessment of a disease, the ascriptive mode for the assessment of the individual illness.
This study focused on patterns of communication between midwives and pregnant women and their implications for information, choice and control as now advocated in UK government policy. An earlier casenote audit evaluation of a new organisation of maternity care where midwives carry a personal caseload indicated no difference in quality standards of midwifery care from conventional care, yet women using the service gave a different view. In order to understand whether this difference might be an artefact of the research, responses to change, or a reflection of the limitations of using casenotes for research, an observation-based study was conducted. Forty interviews were observed in three UK settings: hospital clinic, GP clinic and women's homes. Interviews were tape-recorded and notes and drawings of interaction made. The transcripts were analysed using structured and qualitative approaches. The interactional patterns differed according to model of care i.e. conventional or caseload, and setting of care. Several key 'tasks' in the visits were noted, with risk screening and health education information being dominant in conventional care. A continuum of styles of communication was identified, with the prevalent styles also differing according to location and organisation of care. The hierarchical and formal styles discussed in earlier sociological work were the most common in conventional care, despite the focus of midwifery on being 'with-woman' and the recent policy emphasis on consumer choice. The caseload visits showed a less hierarchical and more conversational form and supported women's reports that this model of care offered them greater information, choice and control. The variation in patterns suggests that context is an important consideration in research of this type, with environment (both micro- and macro-level) and organisation of care influencing the ways in which the concepts of choice or consumerism operate in practice.
OBJECTIVE: To study the implementation of multidisciplinary structured work shift evaluations at a pediatric intensive care unit (PICU) to enhance team communication. DESIGN AND SETTING: Prospective, repeated measurements design, comparison of pre/post measurements and process measures in a Dutch tertiary care, university-affiliated PICU. PARTICIPANTS: All 61 PICU staff members. INTERVENTIONS: Implementing multidisciplinary structured work shift evaluations. Before the implementation phase the PICU team received feedback training and eight participants (four physicians, four nurses) were trained as "work shift evaluation leader." MEASUREMENTS AND RESULTS: Outcome measures covered: (a) quality and process of the implementation through prestructured checklists during the 3 months of implementation, (b) a subjective evaluation of a feedback training on team communication as anticipated action and on the level of communication (about patients and with colleagues), and (c) emotional exhaustion complaints and work-related fatigue. The interdisciplinary structured work shift evaluations were implemented successfully as planned during the work shift; all staff were trained ahead, and the process was followed almost completely. Almost two-thirds (62%) of the staff felt a positive influence on team communication. Almost all staff members (92%) were satisfied regarding communication with their colleagues after the intervention, compared to 76% before. Emotional exhaustion in the PICU team decreased significantly after the implementation, but no differences in work-related fatigue levels were found. CONCLUSIONS: As organizational change the implementation of a multidisciplinary structured work shift evaluation at a PICU was successful and team communication improved. Emotional exhaustion decreased during the study period.