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Pedagogia e cuomunicazione interculturale in ambito sanitario.Interazioni fra personale medico e donne migranti in un ambulatorio della gravidanza.
No full textIl lavoro di ricerca unisce il tema del dialogo interculturale e quello della maternità e del periodo di gravidanza che la precede. Gli studi sul dialogo interculturale a cui mi riferisco sono quelli nati dal pensiero di studiosi italiani ed europei soprattutto in ambito pedagogico (nascita e sviluppo della pedagogia interculturale) ma anche nel settore di studi sulla comunicazione interculturale.
L’analisi della letteratura ha messo in evidenza i vissuti di disagio e la vulnerabilità delle donne migranti in relazione all’esperienza di maternità e il malessere comunicativo degli operatori sanitari in relazione ai cambiamenti socio-culturali in atto e alle caratteristiche multiculturali dell’utenza . Parte della letteratura sottolinea l’inadeguatezza della formazione medica e degli operatori sanitari in genere, rispetto alla dimensione culturale della relazione con le pazienti.
Lo scopo ultimo della ricerca è quello di promuovere la riflessione pedagogica sul tema in questione e di mettere a disposizione degli operatori sanitari strumenti formativi utili per far fronte alle criticità della relazione di cura/sostegno alla maternità con donne di origine straniera.
Nel raggiungere tale obiettivo ho ritenuto opportuno concentrarmi su una realtà specifica e adottare una metodologia d’indagine aperta e flessibile, per esplorare il problema senza vincolarlo a ipotesi e a griglie predefinite. Il metodo etnografico mi è parso il più appropriato al fine di: 1) approfondire la conoscenza del contesto in cui la relazione medico-paziente prende forma; 2) analizzare le caratteristiche dell’interazione in relazione all’ambiente e alla situazione specifica in cui si realizza; 3) tener conto dei vissuti dei soggetti coinvolti; 4) implementare interventi ad hoc.
Il lavoro di ricerca si è svolto all’interno dell’Unità Operativa ostetrico-ginecologica del Policlinico G. Rossi di Verona e dell’Ambulatorio della gravidanza ad essa collegato e ha comportato sei mesi di osservazione partecipante, durante i quali ho assistito ai meeting mattutino dei medici, ai “giri” nel reparto di ostetricia e alle visite nell’ambulatorio della gravidanza.
La domanda di ricerca che ha guidato il processo conoscitivo è stata: come comunicano medici e pazienti nel Reparto di ostetricia e nell’Ambulatorio della gravidanza del Policlinico?
Gli strumenti metodologici utilizzati nell’indagine sul campo sono stati: l’osservazione partecipante, l’analisi di fonti scritte, alcune procedure di censimento, i colloqui e le interviste semi-strutturate. Tali strumenti sono stati accompagnati dalla parallela e costante stesura del diario di ricerca, nel quale sono state raccolte le note etnografiche, suddivise in note descrittive, metodologiche, emotive e teoriche. L’analisi delle note etnografiche si è svolta attribuendo alle unità di testo significative delle etichette descrittive e in seguito tematiche, in modo da individuare delle categorie in cui raggruppare i dati. Le interviste sono state analizzate condensando in frasi sintetiche i contenuti e interpretandoli alla luce dei dati fuoriusciti dall’osservazione. L’analisi del corpus di dati ha consentito di individuare delle macro-aree di riferimento, in cui sono raggruppati i diversi aspetti che caratterizzano il fenomeno osservato: proprietà del contesto, caratteristiche dell’interazione, elementi ambientali di disturbo, modalità comunicative, vissuti dei partecipanti.
Le caratteristiche del contesto individuate sono: organizzazione gerarchica; clima conflittuale; cultura medica centrata sulla dimensione organica; cultura organizzativa improntata al principio dell’efficienza. Alla luce delle proprietà del contesto, sono stati analizzati gli episodi di interazione fra medici e pazienti. La visita nell’ambulatorio della gravidanza prevede dei ruoli e un copione ben definito, seguendo il quale si realizza un’interazione direttiva, asimmetrica e unidimensionale. La postura del medico è caratterizzata dall’attenzione a seguire scrupolosamente il “copione” (lo si nota in particolare nei medici inesperti) e a svolgerlo nel minor tempo possibile. Nella prassi quotidiana delle visite intervengono anche dei fattori di disturbo dati dall’ambiente. Ad esempio, l’alternanza frequente del personale medico e le continue interruzioni (telefono, infermiera che entra, ecc.). Per facilitare la comunicazione con le donne di origine straniera, l’Azienda ospedaliera ha predisposto un servizio di mediazione linguistico-culturale a chiamata, di cui può disporre il medico quando ne avverte il bisogno. Tuttavia il ruolo della MLC risulta sminuito, in quanto ridotto all’interpretariato. Nel caso in cui la medicatrice non sia presente, i medici mettono in atto delle strategie comunicative nel tentativo di facilitare la comunicazione, alcune delle quali sono positive ed efficaci (ripetere con parole diverse o utilizzare parole semplici); altre invece sono inefficaci o addirittura controproducenti (aumento della tonalità vocale o insistenza). Riguardo ai vissuti delle partecipanti, in generale è emersa la fatica che la situazione di interazione fra medici, donne di origine straniera e struttura sanitaria comporta (ivi compreso il servizio di mediazione linguistico-culturale). Fatica sia nel garantire un servizio di qualità sia, da parte delle donne, nell’accedervi e nell’ottenere le informazioni e il sostegno desiderato. Da parte delle mediatrici è emerso l’affaticamento nel sostenere un lavoro usurante, poco riconosciuto e valorizzato.
In conclusione si auspica una riflessione che investa l’ambito organizzativo, la dimensione culturale-formativa, nonché le prassi lavorative. Le proposte pedagogiche riguardano le competenze comunicative del personale medico e la necessità di sviluppare delle prassi riflessive sul proprio lavoro e sulle modalità di relazionarsi con le pazienti.The theoretic premises of this work lie in the Intercultural Education approach. In the Seventies of the last century in Europe, and later in Italy, the problems faced by the teachers in the schools with the sons of immigrant people gave a start to the reflection on the linguistic and cultural diversity. From the Seventies to the Nineties the reflection on the educational strategies changed its approach from a multicultural one to the intercultural one. As Portera and other scholars state in their works , whereas the multicultural approach gives evidence to the similarities and differences between cultures, which are considered static and definite entities, the intercultural one stresses the importance of the inter-action between people, which is the necessary condition for an equal and constructive dialogue which may enrich each person involved. According to this approach the culture and the personal identity are considered as dynamic processes changing all-time.
The Intercultural Education entails the ability to communicate with persons who don’t share our cultural background and this issue leads us to the other main pillar of the work: the Intercultural Communication studies. According to Giaccardi the intercultural communication is an interaction, a dialogue, a process of negotiation between different frames, where negotiation is intended as a bidirectional process in which different interests face each other and, step by step, increase the mutual comprehension; this process, which is not definitive but continual, may require a partial loss of integrity of the individual points of view in order to give value to all the instances involved and to reach an agreement on some points. In order to become able to communicate interculturally, it is necessary to acquire some knowledge, attitudes and skills. E.g., knowledge of social groups and their products and practices, and of the general processes of societal and individual interaction; curiosity and openness, readiness to suspend disbelief about other cultures and belief about one’s own; skills of interpreting and relating, of discovery and interaction, and critical cultural awareness; listening skills and creative conflicts’ management.
Starting from these premises the research work focuses on the relationship between doctors (in most cases female student doctors) and immigrant patients in a Pregnancy Outpatients’ Clinic, heading to the Obstetrics Department in the G. Rossi Hospital in Verona. In order to analyse the subject from an emic point of view, an ethnographic approach has been adopted: I took a period of participant observation (from January to July, 2009) during which I dressed a doctor coat and I attended the Department’s daily life, especially the doctors’ meetings and the visits to the admitted patients, both in the morning time. After about a month I got the possibility to attend also the Pregnancy Outpatients’ Clinic, a public service of the hospital addressed to the external women in order to keep in check their pregnancy. The largest number of women who enter the Clinic are immigrants (they can’t afford private and expensive check visits as the greater part of Italians do). So, I was in the right place to observe the plans arranged by the hospital to address the needs of such a population and the communication strategies adopted by the doctors to conduct the visits. The questions with which I started the participant observation is the following: what are the features of the doctor-patient interaction in the specific context of the Clinic?
Besides the participant observation, I made 6 semi-structured interviews in order to understand the feelings and the problems faced by the participants:
- 3 group-interviews with women coming from Marocco, Sri Lanka and China;
- 2 individual-interviews with linguistic mediators (two women from Sri Lanka and China);
- 1 individual-interview with a female student doctor.
Data analysis revealed that, from the practitioner point of view, the construction and analysis of case histories is more important than the relationship with the person. Furthermore, the efficiency value, which pervades the hospital setting, often steals time to the interaction with patients.
The hospital has arranged a Cultural-Linguistic Mediation Service which helps doctor to communicate with immigrant women. Anyway the cultural and personal dimensions are not addressed in the relationship with patients and the mediator serves as an interpreter.
Women report a lack of attention to their needs and a lack of information on their pregnancy, their baby, ect.. Doctors find it difficult to give complete information, in understanding problems and facing conflicts. Doctors’ communicative competence is poor and requires more training and self-consciousness.
On the basis of this findings, I suggest a reflection on different levels:
1. Management and organization policies.
2. Culture transmitted by medical training.
3. Working practices.
Specifically about the medical education, more training on the intercultural relational competence is required for practitioners who in everyday working life face cultural diversity and take care of immigrant pregnant women
Verso comunità educanti. Cooperative Learning a scuola e Comunicazione interculturale in sanità.
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Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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