Rationale. The metaphor is defined as «an expression which describes a person or an object, by referring to something that is supposed to have similar characteristics» (Cambridge Academic Content Dictionary, s.v. “Metaphor,” 2017). Since the 90s, metaphors were studied in General Practice (GP), as strategies that impact on the quality of healthcare (Mabeck & Olesen, 1997). In Palliative and Primary Care, metaphors are used to educate students and patients, and to ameliorate clinical and organizational issues (Rodriguez & Bélanger, 2014). Research explored more metaphors expressed by patients, than those of clinicians. There is no research on the reflection and meta-reflection of clinicians about their deliberate use of metaphors in clinical encounters. The state of the art provides a dualism on metaphors, as useful or dangerous tools. Methodology. The research question “what is the representation of metaphor provided by professionals who work in a GP group, on the use of metaphors?” arose from a gap in the literature. The Interpretative Phenomenological Analysis (IPA)(Smith et al., 2009) was selected as methodology, because it suggests a preliminary bibliographic search, differently from the pure phenomenological approach (Giorgi,1985). The design is qualitative, with an idiographic focus (Mantovani, 1998). The research aims to understand the representations of physicians, nurses, and administrative assistants in a GP group, which is a situation where it is possible to share contexts and therapeutic goals. Sample. We hypothesized that a group was more opened to talk about these issues than a context in which a physician works alone. We recruited a group of 15 participants (10 physicians, 3 administrative assistants, 2 nurses) (10 females, 5 males) with a purposeful sampling. Tools. We conducted 15 semistructured interviews on the use of metaphors by participants and patients, and on the use of metaphors in their professional education. After a month, we conducted 15 indepth interviews (Sità, 2012), to saturate data. Analysis. The IPA requires a careful read of the interviews, the selection and the organization of the contents into categories. A set of generalizations is created to saturate data, by respecting the differences among participants. A theoretical construct is formulated according to the literature. The results report follows the case study strategy (Mortari & Zannini, 2017). Results. The representation of metaphors changes, if these expressions are used by clinicians or by patients, in clinical and educative contexts, and differs for each participant. Strengths and limitations are provided on the clinical use of metaphors. Sometimes, metaphors are used unconsciously by participants, to express some concepts, to talk about patient education, the effects of clinical language, or their professional identity. Conclusion. The hypothesis on the sample is verified. To overcome the dualism in the literature, this study suggests that a metaphor is an epistemological, a relational, and an ontological phenomenon. Therefore, specific curricula could be designed to enhance awareness on this issue, to help students/professionals to reflect on metaphoric language as a communicative strategy in clinical encounters, that also impact on patient education.

Rationale. La metafora è definita come «un’espressione che descrive una persona o un oggetto, riferendosi a qualcosa che si presuppone abbia caratteristiche simili» (Cambridge Academic Content Dictionary, s.v. “Metaphor,” 2017). A partire dagli anni ’90, nei contesti di Medicina Generale (MG) le metafore sono state studiate come strategie comunicative capaci di ricadere sulla qualità della cura (Mabeck & Olesen, 1997). Nelle Cure Palliative e Primarie, sono usate per motivi formativi, professionali, clinici, organizzativi (Rodriguez & Bélanger, 2014). Le ricerche hanno esaminato in particolare le metafore dei pazienti, e molto meno quelle dei curanti. Inoltre, non ci sono studi sulla riflessione e meta-riflessione di questi ultimi circa l’uso consapevole delle stesse. L’attuale dibattito scientifico è scisso in un dualismo, che le vede come strumenti utili oppure rischiosi. Metodologia. Il quesito “qual è la rappresentazione che hanno i professionisti di un gruppo di MG sull’uso delle metafore?” è nato da un gap presente in letteratura. Come metodologia è stata scelta l’Interpretative Phenomenological Analysis (IPA) (Smith et al., 2009) che, a differenza del metodo fenomenologico puro (Giorgi, 1985), non esclude una preliminare ricerca bibliografica. Lo studio qualitativo a scopo idiografico (Mantovani, 1998) coglie le rappresentazioni di medici, infermieri e segretarie di un gruppo di MG, una forma di associazionismo in cui condividere luoghi e obiettivi terapeutici. Campione. Ipotizzando che un gruppo di MG fosse più aperto a trattare queste tematiche rispetto ad un setting pensato per lavorare singolarmente, abbiamo reclutato un gruppo di 15 partecipanti con criterio propositivo (10 medici, 3 segretarie, 2 infermieri) (10 donne, 5 uomini). Strumenti. Sono state condotte 15 interviste semi-strutturate sia sull’uso di metafore da parte di pazienti e curanti, sia sulle metafore nella loro formazione. Dopo un mese sono state effettuate 15 interviste libere (Sità, 2012) per approfondire alcuni aspetti delle precedenti. Analisi. L’IPA prevede la lettura approfondita delle interviste, e la selezione e organizzazione dei contenuti raggruppati in categorie. Si elabora un piccolo set di generalizzazioni che saturino i dati, rispettando le differenze di ogni partecipante. Infine, si crea un costrutto teorico sulla base della letteratura. I risultati sono stati riportati seguendo la strategia dello studio di caso (Mortari & Zannini, 2017). Risultati. Dall’esperienza dei partecipanti si evince che la rappresentazione delle metafore cambia, se vengono espresse da medici o da pazienti; il riconoscimento delle metafore varia a seconda dei partecipanti; sono stati indicati dei vantaggi nell’uso clinico di queste espressioni, a cui seguono limiti nell’uso professionale. Talvolta, le metafore sono state usate inconsapevolmente per spiegare alcuni argomenti, come l’educazione del paziente, gli effetti del linguaggio clinico su di essi e l’identità professionale. Conclusione. L’ipotesi circa il campione scelto ha riportato i risultati sperati. Superando il dualismo presente in letteratura, da questo studio si evince che la metafora sia essenzialmente un fenomeno epistemologico, relazionale e ontologico. Pertanto, nella formazione dei futuri curanti,

(2018). L’uso di metafore linguistiche nella Medicina Generale. Aspetti educativi per la formazione dei professionisti della cura. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2018).

L’uso di metafore linguistiche nella Medicina Generale. Aspetti educativi per la formazione dei professionisti della cura

D'ORIA, MARIKA
2018

Abstract

Rationale. The metaphor is defined as «an expression which describes a person or an object, by referring to something that is supposed to have similar characteristics» (Cambridge Academic Content Dictionary, s.v. “Metaphor,” 2017). Since the 90s, metaphors were studied in General Practice (GP), as strategies that impact on the quality of healthcare (Mabeck & Olesen, 1997). In Palliative and Primary Care, metaphors are used to educate students and patients, and to ameliorate clinical and organizational issues (Rodriguez & Bélanger, 2014). Research explored more metaphors expressed by patients, than those of clinicians. There is no research on the reflection and meta-reflection of clinicians about their deliberate use of metaphors in clinical encounters. The state of the art provides a dualism on metaphors, as useful or dangerous tools. Methodology. The research question “what is the representation of metaphor provided by professionals who work in a GP group, on the use of metaphors?” arose from a gap in the literature. The Interpretative Phenomenological Analysis (IPA)(Smith et al., 2009) was selected as methodology, because it suggests a preliminary bibliographic search, differently from the pure phenomenological approach (Giorgi,1985). The design is qualitative, with an idiographic focus (Mantovani, 1998). The research aims to understand the representations of physicians, nurses, and administrative assistants in a GP group, which is a situation where it is possible to share contexts and therapeutic goals. Sample. We hypothesized that a group was more opened to talk about these issues than a context in which a physician works alone. We recruited a group of 15 participants (10 physicians, 3 administrative assistants, 2 nurses) (10 females, 5 males) with a purposeful sampling. Tools. We conducted 15 semistructured interviews on the use of metaphors by participants and patients, and on the use of metaphors in their professional education. After a month, we conducted 15 indepth interviews (Sità, 2012), to saturate data. Analysis. The IPA requires a careful read of the interviews, the selection and the organization of the contents into categories. A set of generalizations is created to saturate data, by respecting the differences among participants. A theoretical construct is formulated according to the literature. The results report follows the case study strategy (Mortari & Zannini, 2017). Results. The representation of metaphors changes, if these expressions are used by clinicians or by patients, in clinical and educative contexts, and differs for each participant. Strengths and limitations are provided on the clinical use of metaphors. Sometimes, metaphors are used unconsciously by participants, to express some concepts, to talk about patient education, the effects of clinical language, or their professional identity. Conclusion. The hypothesis on the sample is verified. To overcome the dualism in the literature, this study suggests that a metaphor is an epistemological, a relational, and an ontological phenomenon. Therefore, specific curricula could be designed to enhance awareness on this issue, to help students/professionals to reflect on metaphoric language as a communicative strategy in clinical encounters, that also impact on patient education.
ZANNINI, LUCIA
metafora;; educazione; degli; adulti;; sanità;
metaphor;; adult; education;; health; sanità;
M-PED/01 - PEDAGOGIA GENERALE E SOCIALE
Italian
7-mar-2018
SCIENZE DELLA FORMAZIONE E DELLA COMUNICAZIONE - 91R
30
2016/2017
open
(2018). L’uso di metafore linguistiche nella Medicina Generale. Aspetti educativi per la formazione dei professionisti della cura. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2018).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/199145
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