Perheen ja sairaalan rajasysteemi potilaan sosiaalisessa verkostossa

Abstract

The study was executed in Tornio in order to develop the family-and network centered treatment system in Keropudas hospital. The system of boundary describes the coevolving collaboration system of the family and the hospital. lt opens in the first treatment meeting, the admission meeting. The admission team aims to create a joined understanding with the family. The team converses openly and seeks with the family the treatment decisions. The admission meeting is the origin of the family-hospital coevolution. The purpose of the study was to (1) describe the admission occurrence, (2) develop the description of the coevolution and (3) clarify the connection between the social network and the treatment incidents. lt used both statistical and qualitative methods. The interaction of the family was evaluated with Olson's Clinical Rating Scale. On the basis of the CRS an evaluation scale for team's interaction was developed. The sample was 70 patients, from which the policlinic group had 28 patients (40%) and the inpatient group 42 patients (60 %). The patients were divided into (1) first time, (2) recurrent and (3) longterm treatment groups on the basis of the earlier hospitalizations. The first group was treated significantly more often at the policlinic than the other groups. The patients in the third group were admitted significantly more often than others. For the recurrent treatment group, the admission situation was most difficult. In the coevolution, the subject and the object became entangled with each other. The admission team had to understand the organizational rule of the family and share this understanding. Both the family's and the team's behavior was determined mostly by their own stucture. The social network collapsed in the recurrent admissions. If there were few mutual relationships, the patient was more often hospitalized. In the difficult treatment problems it was most important to create a polyphonic and dialogical coevolution. The team should act as well with one patient as with a large network. The concern about the purity of the therapeutic methods and the therapeutic neutrality was criticized.