安大略省饮食失调治疗的统治关系探讨。

IF 4.5 3区 医学 Q2 NUTRITION & DIETETICS
Sarah Costantini, Carla Rice
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引用次数: 0

摘要

背景:尽管近50年来一直呼吁改变,但饮食失调(ED)治疗的服务使用者往往继续在有时间限制的指令模式下进行控制,要求遵守/坚持维护特定形式的康复规则。最近安大略省政府发布了ED治疗的新质量标准,承诺改变该系统的运作方式。这是在COVID-19大流行爆发后寻求帮助的急诊科患者数量空前激增的背景下发生的,这加剧了本已资源不足的治疗系统的压力。因此,我们认为有必要探索临床医生如何在治疗空间中进行护理工作,以更好地了解组织、程序和话语因素在当前时刻协调/调节他们的护理能力,并探索可能形成的新途径。采用机构人种学(IE)的方法,我们的研究探讨了安大略省住院病人、日间病人和住家急诊科治疗项目中协调临床医生护理工作的主导关系。方法:方法包括对6名临床医生进行深度访谈,并对告知或指导治疗的核心文件进行文本分析。临床医生包括一名精神病学家、两名营养师、一名心理学家、一名社会工作者和一名心理治疗师。我们的分析采用了公认的IE分析程序,包括索引、映射和撰写账目。研究结果:我们的IE确定了临床医生所经历的一种紧张关系,特别是在公共资助的治疗中,他们希望实践合作护理,而在高度标准化、时间限制的治疗指令主导的环境中,他们要求执行严格的指令,以寻求定量护理。我们解释了护理即治疗和黄金标准(循证)治疗的话语是如何在治疗不依从的时刻协调临床医生的护理工作的,因为它们通过非正式强迫的实践和循证研究的更广泛的政治来运作。结论:作为ED领域的第一个IE,我们的工作以一种新颖的方式追溯了实践、文本和制度话语之间的联系,为有限的加拿大ED治疗文献和迫切需要的改变增加了令人信服的发现。我们的IE研究结果强调,需要通过开发可替代的护理途径来解决服务用户需求的多样性,并解决护理方面的差距,从而实现去中心生物识别和新中心关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring the ruling relations of eating disorder treatment in Ontario.

Background: Despite nearly 50 years of calls for change, service users in eating disorder (ED) treatment too often continue to experience care as controlling under time-limited directive models, requiring compliance/adherence to rules that uphold a specific form of recovery. Recently the Government of Ontario released new quality standards for ED treatment, which promise to alter how the system operates. This has occurred against a backdrop of an unprecedented surge in the volume of people with EDs seeking help following the onset of the COVID-19 pandemic which has deepened the strain on an already under-resourced treatment system. As such, we contend there is a need to explore how clinicians do carework in treatment spaces to better understand what organizational, procedural, and discursive factors coordinate/ regulate their capacities to care in the current moment and explore what new pathways might be forged. Taking an Institutional Ethnography (IE) approach, our study explores the ruling relations coordinating clinicians' carework in Ontario inpatient, day-patient, and live-in ED treatment programs.

Methods: Methods included in-depth interviews with six clinicians and textual analysis of core documents informing or directing treatment. Clinicians included one psychiatrist, two dieticians, one psychologist, one social worker, and one psychotherapist. Our analysis drew from accepted IE analytic procedures, and included indexing, mapping, and writing accounts.

Findings: Our IE identifies a tension experienced by clinicians, particularly in publicly-funded treatment between their desire to practice collaborative care and the demand to enforce stringent mandates in an environment dominated by highly standardized, time-limited treatment directives that seek to ration care. We explicate how the discourses of care-as-cure and gold standard (evidence-based) treatment coordinate clinician's carework in moments of treatment non-adherence, as they operate through practices of informal coercion and the broader politics of evidence-based research.

Conclusions: As the first IE in the ED field, our work traces connections between practice, texts, and institutional discourses in a novel way, adding compelling findings to the limited Canadian ED treatment literature and the urgent need for change. Our IE findings underscore the need to de-centre biometrics and recentre relationality by developing alternative care pathways that attend to the diversity of service user needs and address gaps in care.

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来源期刊
Journal of Eating Disorders
Journal of Eating Disorders Neuroscience-Behavioral Neuroscience
CiteScore
5.30
自引率
17.10%
发文量
161
审稿时长
16 weeks
期刊介绍: Journal of Eating Disorders is the first open access, peer-reviewed journal publishing leading research in the science and clinical practice of eating disorders. It disseminates research that provides answers to the important issues and key challenges in the field of eating disorders and to facilitate translation of evidence into practice. The journal publishes research on all aspects of eating disorders namely their epidemiology, nature, determinants, neurobiology, prevention, treatment and outcomes. The scope includes, but is not limited to anorexia nervosa, bulimia nervosa, binge eating disorder and other eating disorders. Related areas such as important co-morbidities, obesity, body image, appetite, food and eating are also included. Articles about research methodology and assessment are welcomed where they advance the field of eating disorders.
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