Carroll Katherine, Iedema Rick, Kerridge Ross
Faculty of Humanities and Social Services, University of Technology, Sydney, NSW 2007, Australia.
Qual Health Res. 2008 Mar;18(3):380-90. doi: 10.1177/1049732307313430.
In this article, we outline a study method with which structural changes to clinical communication were achieved within a local intensive care unit (ICU). The study method involved in-depth, round-the-clock observation, interviewing, and video filming of how intensivists conducted their practices, as well as showing selected footage to the clinicians for feedback. This feedback component iteratively engaged clinicians in problem-solving their own communication difficulties. The article focuses on one such feedback meeting and describes changes to the morning ward round and planning meeting that this feedback process catalyzed: greater time efficiency, a greater presence of intensivists in the ICU, more satisfied nursing staff, and a handover sheet to improve the structure of clinical information exchanges. We argue that in embodying not a descriptive but an interventionist approach to health service provision, this video-ethnographic method has great significance for enhancing clinicians' and researchers' understanding of the rising complexity of in-hospital practices, and for enabling them to intervene in these practices.
在本文中，我们概述了一种研究方法，通过该方法在当地重症监护病房（ICU）实现了临床沟通的结构变革。该研究方法包括对重症监护医生的执业方式进行深入、全天候的观察、访谈和视频拍摄，并向临床医生展示部分视频片段以获取反馈。这一反馈环节促使临床医生反复参与解决自身的沟通难题。本文聚焦于其中一次反馈会议，并描述了该反馈过程催化的早间病房查房和计划会议的变化：更高的时间效率、重症监护医生在ICU的更多在场时间、更满意的护理人员，以及一份用于改善临床信息交流结构的交接班表。我们认为，这种视频民族志方法体现的不是对医疗服务提供的描述性方法，而是干预性方法，对于增强临床医生和研究人员对医院内医疗实践日益复杂情况的理解，以及使他们能够对这些实践进行干预具有重大意义。
