Collins Sarah
Department of Health Sciences and Hull/York Medical School, University of York, York, UK.
Med Educ. 2005 Aug;39(8):785-96. doi: 10.1111/j.1365-2929.2005.02222.x.
Multidisciplinary and interprofessional working is currently a priority in health care policy, in caring for patients and in health professional education. Realising multidisciplinary approaches presents challenges in the context of changes in doctors' and nurses' roles and the increased emphasis placed on communication with patients. In communication in consultations, explanations are employed in the service of numerous activities, including decision making, diagnosis and physical examination, but they have been little studied.
This paper presents findings from a comparative study of doctors' and nurses' communication with patients in multidisciplinary health care, focusing on diabetes in primary care.
Video- and audio-recorded consultations were subjected to conversation analysis. Output from discussion groups with patient representatives and health professionals underwent qualitative analysis.
Distinctive features of explanations in nurses' and doctors' consultations with patients were identified. These can be understood by reference to patterns of communication. Nurses' communication was mediated by patients' contributions; doctors' communication gave an overarching direction to the consultation as a whole. While nurses' explanations began from the viewpoint of a patient's responsibility and behaviour, doctors' explanations began from the viewpoint of biomedical intervention. Their consultations lent different opportunities for patients' involvement.
Nurses' and doctors' communications each exhibit their own distinct features. Specification of these features, when considered in the context of a particular consultation activity such as explanations, allows both recognition of the distinct contributions each profession can offer and identification of ways of combining these to maximum effect. This has implications for policy, for practice and for interprofessional education.
多学科和跨专业协作目前是医疗保健政策、患者护理以及卫生专业教育中的优先事项。在医生和护士角色发生变化以及日益强调与患者沟通的背景下，实现多学科方法面临挑战。在会诊沟通中，解释用于多种活动，包括决策、诊断和体格检查，但对其研究甚少。
本文展示了一项关于多学科医疗保健中医生和护士与患者沟通的比较研究结果，重点关注初级保健中的糖尿病。
对视频和音频记录的会诊进行对话分析。对患者代表和卫生专业人员讨论组的产出进行定性分析。
确定了护士和医生与患者会诊中解释的显著特征。这些可以通过沟通模式来理解。护士的沟通由患者的贡献介导；医生的沟通为整个会诊提供总体方向。虽然护士的解释从患者的责任和行为角度出发，但医生的解释从生物医学干预角度出发。他们的会诊为患者参与提供了不同的机会。
护士和医生的沟通各有其独特特征。在诸如解释等特定会诊活动的背景下考虑这些特征，既有助于认识每个专业可以做出的独特贡献，也有助于确定将这些贡献结合起来以达到最大效果的方法。这对政策、实践和跨专业教育都有影响。
