McGrail Kathleen A, Morse Diane S, Glessner Theresa, Gardner Kathryn
Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
J Gen Intern Med. 2009 Feb;24(2):198-204. doi: 10.1007/s11606-008-0869-5. Epub 2008 Dec 17.
Effective physician-nurse collaboration is an important, but incompletely understood determinant of patient and nurse satisfaction, and patient safety. Its impact on physicians has not been described. This study was undertaken to develop a fuller understanding of the collaboration experience and its outcomes.
Twenty-five medical residents, 32 staff nurses, 5 physician and 5 nurse faculty wrote narratives about successful collaboration; the narratives were then qualitatively analyzed. Narrative analysis was the initial qualitative method iteratively employed to identify themes. A phenomenological approach was subsequently used to develop a framework for collaborative competence.
Collaboration triggers, facilitative behaviors, outcomes and collaborative competence were the themes identified. Affect was identified in the triggers leading to collaboration and in its outcomes. Practioners typically entered a care episode feeling worried, uncertain or inadequate and finished the interaction feeling satisfied, understood and grateful to their colleagues. The frequency of affective experience was not altered by gender, profession, or ethnicity. These experiences were particularly powerful for novice practioners of both disciplines and appear to have both formative and transformative potential. Collaborative competence was characterized by a series of graduated skills in clinical and relational domains. Many stories took place in the ICU and afterhours settings.
Despite the prevailing wisdom that nursing and medicine are qualitatively different, the stories from this study illuminate surprising commonalities in the collaboration experience, regardless of gender, age, experience, or profession. Collaborative competence can be defined and its component skills identified. Contexts of care can be identified that offer particularly rich opportunities to foster interprofessional collaboration.
有效的医护协作是患者和护士满意度以及患者安全的重要决定因素，但人们对此并未完全理解。其对医生的影响尚未得到描述。本研究旨在更全面地了解协作体验及其结果。
25名住院医生、32名护士、5名医生教员和5名护士教员撰写了关于成功协作的叙述；然后对这些叙述进行定性分析。叙事分析是最初反复使用的定性方法，用于识别主题。随后采用现象学方法构建协作能力框架。
确定的主题包括协作触发因素、促进行为、结果和协作能力。在导致协作的触发因素及其结果中发现了情感因素。从业者通常在开始护理时感到担忧、不确定或能力不足，而在互动结束时感到满意、被理解并感激同事。情感体验的频率不受性别、职业或种族的影响。这些体验对两个学科的新手从业者尤其强烈，似乎具有形成性和变革性潜力。协作能力的特点是在临床和关系领域有一系列逐步提升的技能。许多故事发生在重症监护病房和非工作时间。
尽管普遍认为护理和医学在本质上有所不同，但本研究中的故事揭示了协作体验中令人惊讶的共性，无论性别、年龄、经验或职业如何。可以定义协作能力并确定其组成技能。可以确定提供特别丰富机会促进跨专业协作的护理环境。
