北京家电维修,第16届中韩歌会,青岛电缆
个人管理
如果你能乘时光机来一次时光旅行回到1800年，那么那时候的卫生保健系统是什么样子的呢?首先，我们清楚的是它看起来根本不像一个系统。自1948年以来,我们中的大多数人都非常清楚什么是医院,什么是医生,什么是护士,等等。在我们这一代。我们都对于什么是有效可靠的医学知识有了一定程度的共识，如果你回头看看1800年的医疗保健，你会发现这里面有很多的假设性理论，和没有的得到认证的医学知识，同时也没有竞争对手。那个时候，在法律意义上，没有对医生进行定义，也没有限制治疗手段的实践，皇家大学的内科医生和外科医生，以及药剂师协会中所有拥有医疗执照的人都有权利保护保护那些他们已经承认的特权。然而，他们只会为那些生活在相对富裕的人或接近主要城镇的居民看病。在其他地方,医疗将是由家庭成员,尤其是女性,她们会自己阅读一些书籍然后自学一些医学知识，来帮助当地的居民做一些急救措施。或者有一些社区里的人，她们自称是治疗师，接骨师,草药医生或助产士。
Personal Management
If you could travel backwards in time to 1800, what would the health care system look like? The first thing to grasp is that it would not look like a system at all. Since 1948, most of us have grown up with a pretty clear idea of what a hospital is, what a doctor is, what a nurse is, and so on. In our lifetime there has been a fair degree of consensus about what is and is not valid and reliable medical knowledge. If you looked at health care in 1800, you would find that none of these assumptions hold true. There was no generally accepted body of medical knowledge so that rival theories circulated freely and competitively. There was no legal definition of a doctor and few restrictions on the practice of healing. The Royal Colleges of Physicians and Surgeons and the Society of Apothecaries all competed to licence suppliers of medical treatment and to protect the privileges of those whom they had admitted. However, they would only have served relatively well-off people living in or near major towns. Elsewhere, medical care would be given by family members, especially women, using treatments handed down in the local community or taken from books of home remedies, or by anybody from the neighbourhood who could build up some reputation as a healer, a bonesetter, a herbalist, or a midwife. These might be ordinary villagers or people with some education like a parson or a squire, or their wives. Even among the elite physicians, only the most successful healers could work full-time and make a living at this trade (Waddington 1985:180-90).
Architecturally, the voluntary hospitals might have looked more familiar, but, of course, some of their buildings are still in use. Wards were large, rectangular rooms holding between fifteen and thirty patients in parallel rows of beds on each side. If you were to examine the patients, however, you might wonder how many of them were sufficiently ill to justify their place. People seldom died in the voluntary hospitals—death rates were probably no more than 10 per cent of admissions (Woodward 1974:123-42).
The relationship between work and occupations is a topic which has long been of interest to sociologists. However, the main application of this interest to nursing has previously been confined to the question of whether it is or is not a profession. Although we shall not be pursuing that issue here, its prevalence obliges us to explain our decision.
One way round this problem which was explored by some writers was a proposal to study professionalisation as if it were an evolutionary process by the relationship between work and occupations is a topic which has long been of interest to sociologists. However, the main application of this interest to nursing has previously been confined to the question of whether it is or is not a profession. Although we shall not be pursuing that issue here, its prevalence obliges us to explain our decision.
The question about the status of nursing is particularly associated with what is known as the trait or attribute approach to the study of professions. This involves drawing up a list of criteria against which various occupations can be matched (e.g. Greenwood 1957). Those meeting all or most are accepted as professions, those meeting some criteria are often called semi-professions and those which meet few or none are ruled out of the category. This approach has, however, been effectively discredited by Millerson (1964) and Roth (1974) who have shown how vague and inconsistent these lists are and how they tend to be compiled to yield particular results. Moreover, this kind of classification ends up with very little positive to say about either the organisation of work or the organisation of society. It is largely a matter of ranking occupations on some sort of prestige scale.
Then, as now, the greatest part of the care required by the sick involved some kind of assistance with activities of daily living that they were unable to carry out for themselves. Indeed, before the introduction of modern techniques of diagnosis, this would have been the main way of defining someone as ill, that they were involuntarily unable to look after their own bodily needs. Care at this level involves basic assistance with feeding, toileting or personal hygiene. At its margins this form of care would merge into two other types of involvement. One would be the simple
It would now be impossible to quantify the division of nursing work between informal and official carers in pre-industrial England. On the basis of the surviving diaries and literary sources, however, it seems reasonable to infer that most care would have been given on a relatively informal basis by other members of the sick person's household.
Transformation is occurring everywhere—in organisations and corporations; in economic, political, social, educational, and religious institutions; in health care delivery systems. Transformation is occurring throughout the world. Each day the world becomes smaller and smaller. Individual countries can no longer remain isolated and concerned only with issues that arise within their own boundaries. International travel has become commonplace; this has facilitated a greater awareness of cultural similarities and differences, with the need for greater understanding and communication becoming apparent. Global interaction is progressing at a rapid pace that has been spurred by technological developments, particularly in the area of information systems. It will become even more important to understand and clarify language systems that are essentially developed not only to describe the world but also to define it. Languages represent a unique way of perceiving reality.
The words currently being used to describe health care delivery systems are also being used to describe the world. Conflict, crisis, chaos, deterioration, and disintegration are part of the list that provides a picture of massive change and turmoil that is seemingly out of control and promoting human degradation. Societies are seeking new information, new knowledge, and new paradigms, new ways to help them understand and deal with the forces that are driving important decision making. Even more critical, societies are searching for ways to improve quality of life for present and future generations. Are societies also now in the process of Creating a New Civilisation (1995) as suggested by the Tofflers? Although the United States is often the focus of much of their writings, their messages are applicable worldwide. The Tofflers have been writing about the future since 1970, when their first best seller, Future Shock, was published. This work discussed the impact of accelerated change that was overwhelming and disorienting people and their societies. The Third Wave (1980) was even more startling, since it contained a predictive framework. Here the information revolution was compared with the agricultural and industrial revolutions, two other great transformations in history. The Tofflers believe that the impact of this third historical wave of change is currently being felt and a new civilisation is being created.
Worldwide, people are searching for new directions and alternatives to their current state of life, as numerous other titles of various types of literature attest. New paradigms are being created that seem to be leaning more toward a greater emphasis on human respect and human caring. Authors are proposing that an era of true spiritual awareness or a spiritual renaissance is Health care reform is but one aspect of change; holistic and alternative approaches to care and cure are being investigated and accepted. In a number of instances people are returning to health care practices and systems that were used hundreds of thousands of years ago. An increasing emphasis on preventive medicine and health promotion is taking place.
Every one of us should be so fortunate as to have the prospect to opt between two jobs. But should we find ourselves in this desirable situation, do not act in speed, instead, think cautiously about the pros and cons of each job.
I have discovered that people in this type of circumstances try to decide between a job they want, and a job they think they should take. The job people think they should take generally pays very well or is the then reasonable step on the career ladder. But so time and again, it is not the job they want to get. |
