Centre for Patient Safety and Service Quality, Imperial College, London, UK.
Emerg Med J. 2012 Dec;29(12):e2. doi: 10.1136/emermed-2011-200084. Epub 2011 Dec 20.
To identify key stressors for emergency department (ED) staff, investigate positive and negative behaviours associated with working under pressure and consider interventions that may improve how the ED team functions.
This was a qualitative study involving semistructured interviews. Data were collected from staff working in the ED of a London teaching hospital. A purposive sampling method was employed to recruit staff from a variety of grades and included both doctors and nurses.
22 staff members took part in the study. The most frequently mentioned stressors included the '4-hour' target, excess workload, staff shortages and lack of teamwork, both within the ED and with inpatient staff. Leadership and teamwork were found to be mediating factors between objective stress (eg, workload and staffing) and the subjective experience. Participants described the impact of high pressure on communication practices, departmental overview and the management of staff and patients. The study also revealed high levels of misunderstanding between senior and junior staff. Suggested interventions related to leadership and teamwork training, advertising staff breaks, efforts to help staff remain calm under pressure and addressing team motivation.
This study highlights the variety of stressors that ED staff are subject to and considers a number of cost-efficient interventions. Medical education needs to expand to include training in leadership and other 'non-technical' skills in addition to traditional clinical skills.
确定急诊科（ED）工作人员的主要压力源，调查与工作压力相关的积极和消极行为，并探讨可能改善 ED 团队功能的干预措施。
这是一项定性研究，涉及半结构化访谈。数据来自伦敦一所教学医院 ED 的工作人员。采用目的抽样法招募来自不同级别、包括医生和护士在内的工作人员。
22 名工作人员参与了这项研究。最常提到的压力源包括“4 小时”目标、工作量过大、人员短缺以及 ED 内部和与住院部人员之间缺乏团队合作。领导力和团队合作被认为是客观压力（例如，工作量和人员配置）与主观体验之间的中介因素。参与者描述了高压对沟通实践、部门概述以及员工和患者管理的影响。该研究还揭示了资深和初级工作人员之间存在高度误解。建议的干预措施包括领导力和团队合作培训、宣传员工休息时间、努力帮助员工在压力下保持冷静以及解决团队激励问题。
本研究强调了 ED 工作人员面临的各种压力源，并考虑了一些具有成本效益的干预措施。医学教育除了传统的临床技能外，还需要扩展到领导力和其他“非技术”技能的培训。
