University of Waterloo, Department of English Language and Literature, Waterloo, Ontario, Canada N2L 3G1.
Soc Sci Med. 2009 Dec;69(12):1757-66. doi: 10.1016/j.socscimed.2009.09.054. Epub 2009 Oct 23.
Communication among healthcare professionals is a focus for research and policy interventions designed to improve patient safety, but the challenges of changing interprofessional communication patterns are rarely described. We present an analysis of 756 preoperative briefings conducted by general surgery teams (anesthesiologists, nurses, and surgeons) at four urban Canadian hospitals in the context of two research studies conducted between August 2004 and December 2007. We ask the questions: how and why did briefings succeed, how and why did they fail, and what did they mean for different participants? Ethnographic fieldnotes documenting the coordination and performance of team briefings were analyzed using Kenneth Burke's concepts of motive and attitude. The language and behaviour of participants were interpreted as purposive and situated actions which reveal perceptions, beliefs and values. Motives and attitudes varied both within and across sites, professions, individuals, and briefings. They were contingent on the organizational, medical and social scenes in which the briefings took place and on participants' multiple perceived purposes for participating (protecting patient safety, exchanging information, engaging with the team, fulfilling professional commitments, participating in research, and meeting social expectations). Participants' attitudes reflected their recognition (or rejection) of specific purposes, the briefings' perceived effectiveness in serving these purposes, and the briefings' perceived alignment (or conflict) with other priorities. Our findings illustrate the intrinsically rhetorical and variable nature of change.
医护人员之间的沟通是研究和政策干预的重点，旨在提高患者安全，但很少有人描述改变跨专业沟通模式的挑战。我们在 2004 年 8 月至 2007 年 12 月期间进行的两项研究背景下，对四家加拿大城市医院的普通外科团队（麻醉师、护士和外科医生）进行的 756 次术前简报进行了分析。我们提出了以下问题：简报是如何以及为何成功的，它们是如何以及为何失败的，以及它们对不同的参与者意味着什么？记录团队简报协调和表现的民族志实地记录使用肯尼斯·伯克的动机和态度概念进行了分析。参与者的语言和行为被解释为揭示感知、信仰和价值观的有目的和特定情境的行动。动机和态度在不同的地点、专业、个人和简报中都有所不同。它们取决于简报发生的组织、医疗和社会背景，以及参与者参与的多种目的（保护患者安全、交换信息、与团队合作、履行专业承诺、参与研究和满足社会期望）。参与者的态度反映了他们对特定目的的认可（或拒绝）、简报在实现这些目的方面的有效性，以及简报与其他优先事项的一致性（或冲突）。我们的研究结果说明了变化的内在修辞和多变性质。
