Lecture 7: What does it mean for healthcare systems

Question 1

what does epistemology mean?

Answer 1

The study of how we come to know what we know about the world and the basis we use for determining the validity of that knowledge.

Question 2

What are the three dominant epistemology views on health from Salamonsen (2018)?

Answer 2

biomedical (disease),
phenomenological (illness),
social (sickness)

Argues there is a clash between phenomenological models of ‘unhealth’ (the patient’s experience of illness) and biomedical models of ‘unhealth’ (the biomedical worker’s understandings of disease)

Question 3

How does Salamonsen A & Ahlzén (2018) define sickness?

Answer 3

“negative bodily occurrences as conceived of by the society and/or its institutions” (Hofmann, 2002: 657)

– not ‘disease’ as understood in the biomedical world view.

Question 4

What is Patient centered care?

Answer 4

A collaborative humanistic care style (from 1960’s) that includes the patient’s context and involves the use of narrative, partnership and careful documentation

PCC is based on the understanding that people are “independently capable of reasoning and verbal expression and willing to provide clear and genuine
narratives and cooperate with Healthcare professionals” (Naldemirci et al 2018:54)

Question 5

What does entanglement mean and how can this be related to NZ systems?

Answer 5

Some dictionary definitions of entanglement: “a complicated or compromising relationship or situation”, and, “a situation or relationship that you are involved in and that is difficult to escape from”

To say health is ‘entangled’, recognises it is not a simple status easily ascertained by a laboratory result or quick physical examination Health is tied up with ideas of our cultural identity, our gendered identities, unequal systems of power in society etc (biopower)

Question 6

What are the 5 stages of Clinical Competency drawn from Benner (2000)?

Answer 6

• Stage 1 Novice – limited & inflexible understandings, rule bound, focus on avoiding harm
• Stage 2,3 4 Advanced Beginner, Competent, Proficient
• Stage 5 Expert work through & beyond the rules, draw on gestalt understandings of risks and opportunities, innovative & intuitive, prioritise relevance of problems

Entangled notions of health prepare students to better anticipate the complex demands of an EXPERT practice that requires both hyper-specialization as well as holism