Cheater F M, Keane M
Eli Lilly National Clinical Audit Centre, University of Leicester, UK.
Qual Health Care. 1998 Mar;7(1):27-36. doi: 10.1136/qshc.7.1.27.
To find out to what extent nurses were perceived to be participating in audit, to identify factors thought to impede their involvement, and to assess progress towards multidisciplinary audit.
Qualitative.
Focus groups and interviews.
Chairs of audit groups and audit support staff in hospital, community and primary health care and audit leads in health authorities in the North West Region.
In total 99 audit leads/support staff in the region participated representing 89% of the primary health care audit groups, 80% of acute hospitals, 73% of community health services, and 59% of purchasers. Many audit groups remain medically dominated despite recent changes to their structure and organisation. The quality of interprofessional relations, the leadership style of the audit chair, and nurses' level of seniority, audit knowledge, and experience influenced whether groups reflected a multidisciplinary, rather than a doctor centred approach. Nurses were perceived to be enthusiastic supporters of audit, although their active participation in the process was considered substantially less than for doctors in acute and community health services. Practice nurses were increasingly being seen as the local audit enthusiasts in primary health care. Reported obstacles to nurses' participation in audit included hierarchical nurse and doctor relationships, lack of commitment from senior doctors and managers, poor organisational links between departments of quality and audit, work load pressures and lack of protected time, availability of practical support, and lack of knowledge and skills. Progress towards multidisciplinary audit was highly variable. The undisciplinary approach to audit was still common, particularly in acute services. Multidisciplinary audit was more successfully established in areas already predisposed towards teamworking or where nurses had high involvement in decision making. Audit support staff were viewed as having a key role in helping teams to adopt a collaborative approach to audit.
Although nurses were undertaking audit, and some were leading developments in their settings, a range of structural and organisational, interprofessional and intraprofessional factors was still impeding progress. If the ultimate goal of audit is to improve patient care, the obstacles that make it difficult for nurses to contribute actively to the process must be acknowledged and considered.
了解护士参与审计工作的程度，确定被认为阻碍其参与的因素，并评估多学科审计的进展情况。
定性研究。
焦点小组和访谈。
西北地区医院、社区和初级卫生保健机构的审计小组主席及审计支持人员，以及卫生当局的审计负责人。
该地区共有99名审计负责人/支持人员参与，分别代表了89%的初级卫生保健审计小组、80%的急症医院、73%的社区卫生服务机构和59%的采购方。尽管审计小组的结构和组织最近有所变化，但许多审计小组仍然由医学主导。专业间关系的质量、审计主席的领导风格，以及护士的资历水平、审计知识和经验，影响了小组是采用多学科方法还是以医生为中心的方法。护士被视为审计工作的热情支持者，尽管在急症和社区卫生服务中，他们在审计过程中的积极参与程度被认为远低于医生。执业护士越来越被视为初级卫生保健中当地的审计热心人。据报告，护士参与审计的障碍包括护士与医生的层级关系、高级医生和管理人员缺乏投入、质量与审计部门之间的组织联系不佳、工作量压力、缺乏受保护的时间、缺乏实际支持，以及缺乏知识和技能。多学科审计的进展差异很大。非学科性的审计方法仍然很常见，尤其是在急症服务中。在已经倾向于团队合作的领域或护士高度参与决策的地方，多学科审计的建立更为成功。审计支持人员被视为在帮助团队采用协作性审计方法方面发挥关键作用。
尽管护士在进行审计工作，并且一些护士在其工作环境中引领着发展，但一系列结构和组织、专业间和专业内的因素仍然阻碍着进展。如果审计的最终目标是改善患者护理，那么必须认识并考虑那些使护士难以积极参与这一过程的障碍。
