Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Nurs Crit Care. 2011 Jan-Feb;16(1):5-10. doi: 10.1111/j.1478-5153.2010.00398.x.
The intensive care unit (ICU) is a dynamic, complex and, at times, highly stressful work environment that involves ongoing exposure to the complexities of interprofessional team functioning. Failures of communication, considered examples of poor collaboration among health care professionals, are the leading cause of inadvertent harm across all health care settings. Evidence suggests effective interprofessional collaboration results in improved outcomes for critically ill patients. One recent study demonstrated a link between low standardized mortality ratios and self-identified levels of collaboration. The aim of this paper is to discuss determinants and complexities of interprofessional collaboration, the evidence supporting its impact on outcomes in the ICU, and interventions designed to foster better interprofessional team functioning. Elements of effective interprofessional collaboration include shared goals and partnerships including explicit, complementary and interdependent roles; mutual respect; and power sharing. In the ICU setting, teams continually alter due to large staff numbers, shift work and staff rotations through the institution. Therefore, the ideal 'unified' team working together to provide better care and improve patient outcomes may be difficult to sustain. Power sharing is one of the most complex aspects of interprofessional collaboration. Ownership of specialized knowledge, technical skills, clinical territory, or even the patient, may produce interprofessional conflict when ownership is not acknowledged. Collaboration by definition implies interdependency as opposed to autonomy. Yet, much nursing literature focuses on achievement of autonomy in clinical decision-making, cited to improve job satisfaction, retention and patient outcomes. Autonomy of health care professionals may be an inappropriate goal when striving to foster interprofessional collaboration. Tools such as checklists, guidelines and protocols are advocated, by some, as ways for nurses to gain influence and autonomy in clinical decision-making. Protocols to guide ICU practices such as sedation and weaning reduce the duration of mechanical ventilation in some studies, while others have failed to demonstrate this advantage. Existing organizational strategies that facilitate effective collaboration between health care professionals may contribute to this lack of effect.
重症监护病房（ICU）是一个充满活力、复杂且有时压力极大的工作环境，其中涉及到不断应对跨专业团队功能的复杂性。沟通失败被认为是医疗保健专业人员之间协作不善的例子，是所有医疗保健环境中无意伤害的主要原因。有证据表明，有效的跨专业协作可改善重症患者的预后。最近的一项研究表明，低标准化死亡率比与自我认同的协作水平之间存在关联。本文旨在讨论跨专业协作的决定因素和复杂性，支持其对 ICU 结果产生影响的证据，以及旨在促进更好的跨专业团队功能的干预措施。有效的跨专业协作的要素包括共同的目标和伙伴关系，包括明确、互补和相互依存的角色；相互尊重；和权力分享。在 ICU 环境中，由于工作人员人数众多、轮班工作和工作人员在机构内的轮换，团队不断变化。因此，理想的“统一”团队共同努力提供更好的护理和改善患者预后可能难以维持。权力分享是跨专业协作中最复杂的方面之一。当所有权未得到承认时，对专业知识、技术技能、临床领域甚至患者的所有权可能会导致跨专业冲突。协作根据定义意味着相互依存而不是自主。然而，许多护理文献都侧重于在临床决策中实现自主性，这被认为可以提高工作满意度、保留率和患者预后。在努力促进跨专业协作时，医护人员的自主性可能不是一个合适的目标。一些人提倡使用清单、指南和方案等工具，让护士在临床决策中获得影响力和自主性。指导 ICU 实践（如镇静和脱机）的方案在一些研究中减少了机械通气的持续时间，而其他研究则未能证明这一优势。现有的组织策略可以促进医护人员之间的有效协作，可能有助于避免这种影响。
