Hignett Sue
Dept. of Human Sciences, Loughborugh University, Loughborough, Leics, LE11 3TU, UK.
Ergonomics. 2003 Jul 15;46(9):882-903. doi: 10.1080/0014013031000090143.
The primary objective was to identify the characteristics of the health care industry with respect to organizational and cultural factors and consider how these might impact on the practice of ergonomics. Qualitative methodology was chosen as a suitable approach. This was supported by a middle ground philosophical position. Twenty-one interviews were carried out with academics and practitioners using a questionnaire proforma which developed iteratively over the 18 months of the project. A progressive four stage sampling strategy was used starting with purposive sampling to spread the net. Suggested contacts were then followed up (snowball sampling), before the third stage of intensity sampling to focus on participants with specific experience in hospital ergonomics. A final strategy of analysis sampling sought extreme and deviant cases to achieve theoretical saturation. The analysis resulted in three categories: organizational, staff and patient issues. The organizational issues included both the size and complexity of the National Health Service. For example, three hierarchical lines were identified in the management structure: an administrative line, a professional line and a patient-focused clinical management line. One of the surprising findings for the staff issues was the perceived lack of ergonomic information about female workers as a population group and traditional female employment sectors. The patient issues incorporated three dimensions associated with the caring role: the type of work; expectations; and possible outcomes. The work tends to be dirty and emotional, with a professional subculture to allow the handling of other peoples' bodies. This subculture was linked to a 'coping' attitude where staff put the patients' needs and well-being before their own. The change in patient expectations (from being apologetic through to demanding their rights) is mirrored in a changing model of care from paternalism to partnership. A lack of ergonomic research was identified for female workers in the health care industry relating to both the type of work and gender issues.
主要目标是确定医疗保健行业在组织和文化因素方面的特征，并考虑这些因素如何可能影响人体工程学的实践。选择定性研究方法作为合适的途径。这得到了一种中间立场哲学观点的支持。在项目的18个月期间，使用一份反复修订的问卷模板，对学者和从业者进行了21次访谈。采用了一种循序渐进的四阶段抽样策略，首先是目的抽样以扩大范围。然后对推荐的联系人进行跟进（滚雪球抽样），在第三阶段进行强度抽样，重点关注在医院人体工程学方面有特定经验的参与者。最后的分析抽样策略寻找极端和异常案例以实现理论饱和。分析结果分为三类：组织问题、员工问题和患者问题。组织问题包括国民医疗服务体系的规模和复杂性。例如，在管理结构中确定了三条层级线：行政线、专业线和以患者为中心的临床管理线。员工问题中一个令人惊讶的发现是，作为一个人群群体以及传统女性就业部门的女性工人，被认为缺乏人体工程学信息。患者问题包含与护理角色相关的三个方面：工作类型；期望；以及可能的结果。工作往往脏且情绪化，存在一种专业亚文化以允许处理他人身体。这种亚文化与一种“应对”态度相关联，即员工将患者的需求和福祉置于自身之前。患者期望的变化（从表示歉意到要求自身权利）反映在从家长式护理模式到伙伴关系护理模式的转变中。在医疗保健行业，针对女性工人在工作类型和性别问题方面的人体工程学研究不足。
