通过跨学科理论视角加强临床实践。

IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Kirsti Malterud, Susanne Reventlow, Ann Dorrit Guassora
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引用次数: 0

摘要

背景:全科实践中以经验为基础的认知包括对社会背景下主观、复杂和特殊现象的高级解释。为反思性提供不同的元假设可能会为这种认知提供所需的责任感,使其被认可为循证实践:展示并讨论实质性理论的潜力,以加强对全科临床认知中复杂挑战的解释:方法:我们通过一个虚构的案例来展示跨学科的实质性理论如何通过与具体问题的相关性和具体匹配性,将临床互动置于一个负责任的平台上。一位患有帕金森病的女性患者向全科医生咨询,抱怨帕金森病束缚了她的生活,威胁着她的未来。全科医生从班杜拉的自我效能理论中获得了一些新思路,并向病人介绍了采取进一步行动的策略:该案例提供了一个实例,说明相关的实质性理论可如何为全科医生提供:1)更明确的成就重点:认识到慢性渐进性疾病中的恐惧和身份问题;2)随后对适当策略的个性化理解立场:在众所周知的背景下鼓励体育和社交活动;以及 3)邀请全科医生考虑更多可能性:找到减轻恐惧和渐进性衰退负担的方法;参与快乐生活:一般实践知识包括不同的证据来源。在相关实质性理论的支持下,以临床实践为中介的透明度可能有助于将以经验为基础的知识视为以证据为基础的实践。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical practice enhanced by interdisciplinary theoretical perspectives.

Background: Experience-based knowing in general practice includes advanced interpretation of subjective, complex and particular phenomena in a social context. Enabling different metapositions for reflexivity may provide the accountability needed for such knowing to be recognized as evidence-based practice.

Objective: To demonstrate and discuss the potential of substantive theories to enhance interpretation of complex challenges in clinical knowing in general practice.

Methods: We present a fictional case to demonstrate how interdisciplinary substantive theories, with a relevant and specific match to concrete questions, can situate the clinical interaction at an accountable platform. A female patient with Parkinson's disease consults her GP complaining that the disease is restraining her life and threatening her future. The GP has some new ideas from Bandura's theory of self-efficacy and introduces the patient to strategies for further action.

Findings: The case presents an example of how a relevant substantive theory may offer the GP: 1) a sharper focus for achievement: recognising the issues of fear and identity in chronic, progressive illness, 2) a subsequent position for individualized understanding of adequate strategies: encouraging physical and social activity in a well-known context, and 3) an invitation to consider further possibilities: finding ways to alleviate the burden of fear and progressive decline; engaging in joyful living.

Implications: General practice knowledge embraces a diversity of sources with different evidence power. The transparency mediated to clinical practice when supported by relevant substantive theories may contribute to recognition of experience-based knowing as evidence-based practice.

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来源期刊
CiteScore
3.20
自引率
19.00%
发文量
47
审稿时长
>12 weeks
期刊介绍: Scandinavian Journal of Primary Health Care is an international online open access journal publishing articles with relevance to general practice and primary health care. Focusing on the continuous professional development in family medicine the journal addresses clinical, epidemiological and humanistic topics in relation to the daily clinical practice. Scandinavian Journal of Primary Health Care is owned by the members of the National Colleges of General Practice in the five Nordic countries through the Nordic Federation of General Practice (NFGP). The journal includes original research on topics related to general practice and family medicine, and publishes both quantitative and qualitative original research, editorials, discussion and analysis papers and reviews to facilitate continuing professional development in family medicine. The journal''s topics range broadly and include: • Clinical family medicine • Epidemiological research • Qualitative research • Health services research.
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