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Avgjørelser i klinikken - en praxeologisk studie om myndighet mellom leger og sykepleiere i en ortopedisk klinikk ved et norsk sykehus, og om forholdet mellom evidensbasert og erfaringsbasert kunnskap som forskrift for medisinske avgjørelser

Authors: Hauge, Bente Skogseide;

Avgjørelser i klinikken - en praxeologisk studie om myndighet mellom leger og sykepleiere i en ortopedisk klinikk ved et norsk sykehus, og om forholdet mellom evidensbasert og erfaringsbasert kunnskap som forskrift for medisinske avgjørelser

Abstract

Studien har til hensikt å beskrive, forstå og forklare hva som ligger bak avgjørelser som blir tatt i det medisinske feltet som gjelder pasientbehandling. Temaet er avgrenset til anestesimetode og postoperativ smertelindring for pasienter som har operert i et håndledd. Underspørsmål i studien søker å finne bakgrunnen for påstanden at det finnes ulike myndighet mellom leger og sykepleiere, og om dette har noen påvirkningskraft når avgjørelser rundt pasientbehandling tas. Masteroppgaven utforsker også forholdet mellom evidensbasert kunnskap og erfaringsbasert kunnskap, begge kunnskapsformer integrert i det medisinske arbeid. Den praxeologiske optikk har vært både teori og metode i både innhentingen av mine data samt i analysen av materialet. Studiens empiri er innhentet gjennom historisering av subfeltet ortopedi og intervjuer av ansatte ved et universitetssykehus som har pasientkontakt med de aktuelle pasientene. Historie og intervjudata er analysert ved hjelp av Bourdieus felt- og praktikkteori. Posisjoner (stillingsinnehaver) som handler i subfeltet ortopedi og som posisjonerer seg (meninger i ord og handling) på bakgrunn av deres disposisjoner (økonomisk, kulturell og sosial kapital) er analysert og konstruert fram. Studiens funn viser til at i det medisinske feltet anses den evidensbaserte kunnskapen som å være den mest sanne, og selv om det hevdes at avgjørelser bygger på dette, kan erfaringsbasert kunnskap være med og påvirke avgjørelser som tas i klinikken. Samtidig styres slike avgjørelser av den juridiske makten som i samfunnet (det sosiale rommet) gir den svakeste part, som her er pasienten med smerter, talerett. Gjennom å klage kan pasienten påvirke leger i dominant posisjon i feltet til å endre rutine og metode. Den herskende doxa om saken er at medisinsk praksis utøves på statens (maktfeltet) vegne gjennom evidensbasert kunnskap av profesjoner som gjennom utdannelse har fått monopol på det. Samtidig viser det seg i realiteten at også erfaringsbasert kunnskap er i spill. Studien konkluderer at autonomien og egenlogikken i feltet er delvis, for den juridiske myndigheten virker inn på beslutningsstrategien for ny anestesi- og postoperativ smertebehandlingspraksis. Nøkkelord: Bourdieu, felt, habitus, homologi, symbolsk vold, anestesimetode, postoperativ smertelindring, håndleddsoperert. This study aims to describe, understand and explain what lies behind decision making in the medical field regarding patient care. The topic is limited to anesthetic method and postoperative pain relief for patients who have operated on a wrist. The studys subquestions seek to find the basis for the claim that there is different authority between doctors and nurses, and whether this has any influence when it comes to making decisions about patient care. The thesis also explores the relationship between evidence-based knowledge and experience-based knowledge, both forms of knowledge integrated in medical work. The praxeological optics have been both theory and method in both the collection of my data and in the analysis of the material. The study's empirics have been obtained through the historisation of the subfield orthopedics and interviews of staff at a university hospital that has patient contact with the patients concerned. History and interview data have been analyzed and, using Bourdieu's field and practice theories, position (position holders) positions (opinions in words and actions) based on their dispositions (economic, cultural and social capital) acting in the orthopedic subfield are analyzed and constructed. The study's findings indicate that in the medical field, evidence-based knowledge is considered to be the most true, and although it is argued that decisions are based on this, experience-based knowledge can be involved in and influence decisions made in the clinic. At the same time, such decisions are governed by the legal power that gives the weakest party, which here is the patient with pain, the right to speak in society (the social space). By complaining, the patient can influence doctors in the dominant position in the field to change routine and method. The doxa on the matter is that medical practice is exercised on behalf of the state (the field of power) through evidence-based knowledge of professions that have gained a monopoly of that through education, while in reality it also turns out that experience-based knowledge is at stake. When it comes to decisions, it turns out that autonomy and self-logic in the field are partial, for the legal authority influences the decision-making strategy for new anesthesia and post-operative pain management practices. Keywords: Bourdieu, field, habitus, homology, symbolic violence, anesthetic method, postoperative pain relief, wrist surgery. SYKD395 MAMD-HELSE

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Norway
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Keywords

anestesimetode, wrist surgery, wrist surgery., Bourdieu, 610, homology, anesthetic method, symbolic violence, field, symbolsk vold, 761901, felt, håndleddsoperert. Bourdieu, postoperative pain relief, homologi, postoperativ smertelindring, habitus

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
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