Discovering a dialectic of care

Using data from a recent study on the outcomes of child psychiatric hospita lization, the author presents a critique of the intervention-outcome moveme nt that dominates the health care agenda. Employing an exploratory descript ive study design and Denzin's interpretive interactionism method, she prese nts data that illustrate how interventions can become distorted by contextu al factors, conflicting ideologies, agendas, and failure to thoughtfully co nsider patient needs. She posits that research agendas are heavily tilted t oward outcomes research that often discount the nature of structure and pro cess. The marketplace emphasis of health care may result in environments in which a structure and process of caring is replaced by a focus of profits over patients. The value of focusing on interventions and outcomes in resea rch without addressing broader ecosystem variables that influence practice is questioned in view of in-depth data that emerge from practice settings.