ABSTRACT

The values of patient autonomy and community participation have become central in health care. However, care practices involve a plurality of possibly conflicting values. These values often transgress the borders of the individual professional–client relationship as they involve family members, other professionals and community organisations. Good care should acknowledge this relational complexity, which requires a collective handling of the tensions between values. To better understand this process, we draw on [Mol, A. 2008. The Logic of Care: Health and the Problem of Patient Choice. Routledge; Mol, A., I. Moser, and J. Pols. 2010a. Care in Practice: On Tinkering in Clinics, Homes and Farms. Transcript Verlag.) by developing the notion of collective tinkering. An ethnographic study was conducted in two teams in community housing services for people with Intellectual Disabilities and Severe Mental Illness. Collective tinkering is analysed (1) within teams; (2) between professionals, family members and professionals from different organisations providing care for the same client; and (3) in organising practices for a collective of clients. Collective tinkering involves assembling goods into a care practice, attentively experimenting with these care practices, and adjusting care accordingly within a collective of those involved in care for a particular client (group). When collective tinkering does not occur, the stakeholders excluded (e.g. clients or family members) may experience poor quality of care.

摘要

患者自主权和社区参与的价值观已成为医疗保健的核心。然而，护理实践涉及多个可能相互冲突的价值观。这些价值观往往超越了个人专业与客户关系的界限，因为它们涉及家庭成员、其他专业人士和社区组织。良好的照顾应该承认这种关系的复杂性，这需要集体处理价值观之间的紧张关系。为了更好地理解这一过程，我们借鉴了 [Mol, A. 2008. The Logic of Care: Health and the Problem of Patient Choice。劳特利奇；Mol, A.、I. Moser 和 J. Pols。2010a。实践中的护理：关于诊所、家庭和农场的修补. Transcript Verlag.) 通过开发集体修补的概念。在为智障和严重精神疾病患者提供社区住房服务的两个团队中进行了民族志研究。(1) 在团队内部分析集体修补；(2) 专业人士、家庭成员和来自不同机构的专业人士为同一客户提供服务；(3) 为一群客户组织实践。集体修补包括将商品组装到护理实践中，仔细试验这些护理实践，并在参与护理特定客户（组）的集体中相应地调整护理。当集体修补不发生时，被排除在外的利益相关者（例如客户或家庭成员）可能会遇到低质量的护理。