"My Mom Is a Fighter": A Qualitative Analysis of the Use of Combat Metaphors in ICU Clinician Notes.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Chest Pub Date : 2024-11-01 Epub Date: 2024-08-26 DOI:10.1016/j.chest.2024.07.178
Shannen Kim, Hunter Mills, Teva Brender, Samuel McGowan, Eric Widera, Allyson C Chapman, Krista L Harrison, Sei Lee, Alex K Smith, David Bamman, Oksana Gologorskaya, Julien Cobert
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引用次数: 0

Abstract

Background: A metaphor conceptualizes one, typically abstract, experience in terms of another, more concrete, experience with the goal of making it easier to understand. Although combat metaphors have been well described in some health contexts, they have not been well characterized in the setting of critical illness.

Research question: How do clinicians use combat metaphors when describing critically ill patients and families in the electronic health record?

Study design and methods: We included notes written about patients aged 18 years or older admitted to ICUs within a large hospital system from 2012 through 2020. We developed a lexicon of combat words and isolated note segments that contained any combat mentions. Combat mentions were defined systematically as a metaphor or not across two coders. Among combat metaphors, we used a grounded theory approach to construct a conceptual framework around their use.

Results: Across 6,404 combat-related mentions, 5,970 were defined as metaphors (Cohen κ, 0.84). The most common metaphors were "bout" (26.2% of isolated segments), "combat" (18.5%), "confront" (17.8%), and "struggle" (17.5%). We present a conceptual framework highlighting how combat metaphors can present as identity ("mom is a fighter") and process constructs ("struggling to breathe"). Identity constructs usually were framed around: (1) hope, (2) internal strength, (3) contextualization of current illness based on prior experiences, or (4) a combination thereof. Process constructs were used to describe: (1) "fighting for" (eg, working toward) a goal, (2) "fighting against" an unwanted force, or (3) experiencing internal turmoil.

Interpretation: We provide a novel conceptual framework around the use of combat metaphors in the ICU. Further studies are needed to understand intentionality behind their use and how they impact clinician behaviors and patient and caregiver emotional responses.

"我妈妈是个斗士":对重症监护室临床医生笔记中使用战斗隐喻的定性分析。
背景:隐喻将一种典型的抽象经验概念化为另一种更具体的经验,目的是使其更容易理解。尽管战斗隐喻在某些健康环境中已经得到了很好的描述,但在危重病环境中还没有得到很好的描述:研究设计和方法:我们纳入了 2012-2020 年间一家大型医院系统内重症监护病房收治的年龄大于等于 18 岁患者的病历。我们开发了战斗词汇词典,并分离出包含任何战斗提及的笔记片段。两名编码员系统地定义了战斗隐喻与否。在战斗隐喻中,我们使用了基础理论方法,围绕其使用构建了一个概念框架:在 6,404 次与战斗有关的提及中,5,970 次被定义为隐喻(科恩卡帕 0.84)。最常见的隐喻是 "bout"(占孤立片段的 26.2%)、"combat"(18.5%)、"confront"(17.8%)和 "struggle"(17.5%)。我们提出了一个概念框架,强调了战斗隐喻如何表现为身份建构("妈妈是个斗士")和过程建构("挣扎着呼吸")。身份建构通常围绕:(1) 希望,(2) 内在力量,和/或 (3) 基于先前经历的当前疾病的背景。过程建构用于描述:(1)"为......而战"(如为实现目标而努力),(2)"对抗 "不想要的力量,或(3)经历内部动荡:我们围绕重症监护室中战斗隐喻的使用提供了一个新颖的概念框架。需要进一步研究,以了解使用这些隐喻背后的意图,以及它们如何影响临床医生的行为和患者/护理人员的情绪反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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