解决团队中基于 ICT 的沟通问题的常规和自适应专家策略。

Routine and adaptive expert strategies for resolving ICT mediated communication problems in the team setting.

机构信息

Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ontario, Canada.

出版信息

Med Educ. 2009 Jul;43(7):680-7. doi: 10.1111/j.1365-2923.2009.03395.x.

DOI:10.1111/j.1365-2923.2009.03395.x

PMID:19573192

Abstract

CONTEXT

The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR).

METHODS

A total of 72 doctors and nurses participated in this 8-month study on a paediatric in-patient ward. Eighty hours of non-participant observations and 20 semi-structured interviews were conducted. All data were rendered anonymous prior to analysis. Using a constructivist grounded theory approach, one researcher read and analysed all data recursively. As emergent themes were identified, exemplary portions of the data were discussed with three additional researchers to resolve discrepancies and confirm the coding structure. Expertise literatures informed the final analyses.

RESULTS

Three interprofessional communication strategies were identified: (i) all participants routinely formulated 'workarounds' to circumvent problematic EPR-mediated communications; (ii) workarounds were classifiable as instances of Abandoning, Forcing or Submitting to the EPR, and (iii) novices learned workaround strategies through an informal curriculum, but they did not learn to manage the interprofessional effects of these workarounds.

CONCLUSIONS

Trainees relied on workarounds as simplified routines, demonstrating routine expertise. Staff members, demonstrating adaptive expertise, used workarounds as part of a broader network of people and communication tools. Explicit training regarding this network and the ways in which workarounds conceal this network may help trainees develop adaptive expertise.

摘要

背景

在医疗保健中，使用信息和通信技术（ICTs）来支持跨专业交流变得越来越普遍。然而，很少有研究探讨 ICTs 如何影响跨专业交流，或者如何培训新手成为有效的跨专业 ICT 用户。本研究探讨了护士和医生（实习生和专家）在特定 ICT（电子病历）介导其交流时的跨专业交流策略。

方法

共有 72 名医生和护士参与了这项为期 8 个月的儿科住院病房研究。进行了 80 小时的非参与观察和 20 次半结构化访谈。在分析之前，所有数据都被匿名化。使用建构主义扎根理论方法，一名研究人员递归地阅读和分析所有数据。随着出现的主题被确定，数据的示例部分与另外三名研究人员进行了讨论，以解决差异并确认编码结构。专家文献为最终分析提供了信息。