Deber R B, Leatt P
Health Matrix. 1986 Fall;4(3):3-9.
Members of renal unit teams across Canada and in Michigan were asked to describe the involvement of various occupational groups and of patients in the treatment decision-making process in their actual unit and in an ideal unit. All occupational groups shared a belief in a relatively egalitarian team, in which the nephrologists would have primary responsibility for decision-making and the other groups would be highly involved. Nephrologists perceived reality as largely in accord with this ideology, indicating little difference between their authority in actuality and in an ideal unit, and perceiving other team members as having greater responsibility for decision-making than those groups perceived themselves as having. Ambiguity existed as to the appropriate level of decision-making involvement for the semiprofessional roles, and a substantial minority of nonphysician respondents saw staff nurses in particular (as well as patients) as having too little involvement. The findings suggest that as a technology becomes routinized, the multidisciplinary team approach may become less realistic. The resulting dissonance between ideology and reality may lead to job stress and adverse effects on job functioning.
加拿大和密歇根州肾脏科团队的成员被要求描述不同职业群体以及患者在其实际科室和理想科室的治疗决策过程中的参与情况。所有职业群体都认同一个相对平等主义的团队理念，即肾病专家对决策负有主要责任，其他群体也深度参与其中。肾病专家认为实际情况在很大程度上符合这种理念，表明他们在实际和理想科室中的权威差异不大，并且认为其他团队成员在决策中承担的责任比这些群体自身认为的更大。对于半专业角色在决策参与中的适当程度存在模糊认识，相当一部分非医生受访者尤其认为护士（以及患者）参与度过低。研究结果表明，随着一项技术变得常规化，多学科团队方法可能变得不那么现实。这种理念与现实之间产生的不一致可能导致工作压力以及对工作效能产生不利影响。
