Bailey Patricia, Jones Linda, Way Daniel
School of Nursing, Laurentian University, Sudbury, Ontario, Canada.
J Adv Nurs. 2006 Feb;53(4):381-91. doi: 10.1111/j.1365-2648.2006.03734.x.
This paper presents the experiences of nurse practitioners and family physicians working in collaborative practice at four Canadian rural primary care agencies. It focuses on the qualitative segment of a larger study examining the impact of an educational intervention on interprofessional practice.
Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal in Canada. Key to primary healthcare renewal is care delivery through interdisciplinary teams that include nurse practitioners.
Narrative analysis, a form of interpretive analysis that respects the integrity of the stories told by participants, was chosen as the strategy to examine the narrative data gathered in two sets of interviews with the nurse practitioners and family physicians. The study was undertaken during 2000.
Thirteen family physicians and five nurse practitioners with diverse educational backgrounds and varied experience with collaboration participated in the qualitative component of the study. A number of issues related to working in a shared practice were identified in nurse practitioner and family physician interviews across the research sites. The themes identified in participants' stories included issues related to the scope of practice, emphasizing the importance of role clarity and trust, the ideological difference regarding disease prevention and health promotion, differences in perceptions about the operation of collaborative practice, and the understanding that collaborative relationships evolve.
The placement of nurse practitioners and family physicians in a common clinical practice without some form of orientation process does not produce collaborative practice. Educational strategies related to role expectations are necessary to facilitate the development of care delivery partnerships characterized by interdependent practice.
本文介绍了加拿大四个农村初级保健机构中从事协作实践的执业护士和家庭医生的经历。它侧重于一项更大规模研究的定性部分，该研究考察了教育干预对跨专业实践的影响。
人们越来越意识到健康促进和疾病预防的重要性，基于社区的护理复杂性增加，以及需要更高效、更有效地利用稀缺的人力医疗资源，特别是家庭医生，这导致加拿大更加重视初级医疗保健的更新。初级医疗保健更新的关键是通过包括执业护士在内的跨学科团队提供护理。
叙事分析是一种解释性分析形式，尊重参与者讲述的故事的完整性，被选为研究策略，以检查在对执业护士和家庭医生进行的两组访谈中收集的叙事数据。该研究于2000年进行。
13名家庭医生和5名执业护士参与了该研究的定性部分，他们具有不同的教育背景和不同的合作经验。在各个研究地点对执业护士和家庭医生的访谈中，确定了一些与共同实践相关的问题。参与者故事中确定的主题包括与执业范围相关的问题，强调角色明确和信任的重要性、关于疾病预防和健康促进的意识形态差异、对协作实践运作的看法差异，以及对协作关系不断发展的理解。
如果没有某种形式的入职培训流程，将执业护士和家庭医生安排在共同的临床实践中不会产生协作实践。与角色期望相关的教育策略对于促进以相互依存实践为特征的护理提供伙伴关系的发展是必要的。
