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临床脱节和未解决的冲突对产时安全失败的影响。

Contributions of clinical disconnections and unresolved conflict to failures in intrapartum safety.

作者信息

Lyndon Audrey, Zlatnik Marya G, Maxfield David G, Lewis Annie, McMillan Chase, Kennedy Holly Powell

出版信息

J Obstet Gynecol Neonatal Nurs. 2014 Jan-Feb;43(1):2-12. doi: 10.1111/1552-6909.12266. Epub 2013 Dec 19.

Abstract

OBJECTIVE

To explore clinician perspectives on whether they experience difficulty resolving patient-related concerns or observe problems with the performance or behavior of colleagues involved in intrapartum care.

DESIGN

Qualitative descriptive study of physician, nursing, and midwifery professional association members.

PARTICIPANTS AND SETTING

Participants (N = 1932) were drawn from the membership lists of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse Midwives (ACNM), and Society for Maternal-Fetal Medicine (SMFM).

METHODS

Email survey with multiple choice and free text responses. Descriptive statistics and inductive thematic analysis were used to characterize the data.

RESULTS

Forty-seven percent of participants reported experiencing situations in which patients were put at risk due to failure of team members to listen or respond to a concern. Thirty-seven percent reported unresolved concerns regarding another clinician's performance. The overarching theme was clinical disconnection, which included disconnections between clinicians about patient needs and plans of care and disconnections between clinicians and administration about the support required to provide safe and appropriate clinical care. Lack of responsiveness to concerns by colleagues and administration contributed to resignation and defeatism among participants who had experienced such situations.

CONCLUSION

Despite encouraging progress in developing cultures of safety in individual centers and systems, significant work is needed to improve collaboration and reverse historic normalization of both systemic disrespect and overt disruptive behaviors in intrapartum care.

摘要

目的

探讨临床医生对于在解决与患者相关问题时是否遇到困难,或观察到参与分娩期护理的同事在工作表现或行为方面存在问题的看法。

设计

对医生、护士和助产专业协会成员进行的定性描述性研究。

参与者和研究背景

参与者(N = 1932)来自妇女健康、产科和新生儿护士协会(AWHONN)、美国妇产科医师学会(ACOG)、美国助产士学院(ACNM)和母胎医学协会(SMFM)的会员名单。

方法

通过电子邮件进行调查,提供多项选择题和自由文本回复。使用描述性统计和归纳主题分析对数据进行特征描述。

结果

47%的参与者报告称,由于团队成员未能倾听或回应问题,导致患者处于危险之中。37%的参与者报告称,对另一位临床医生的表现存在未解决的问题。总体主题是临床脱节,这包括临床医生之间在患者需求和护理计划方面的脱节,以及临床医生与管理层之间在提供安全和适当临床护理所需支持方面的脱节。同事和管理层对问题缺乏回应,导致经历过此类情况的参与者产生辞职和消极情绪。

结论

尽管在个别中心和系统中培养安全文化方面取得了令人鼓舞的进展,但仍需要开展大量工作来改善协作,并扭转分娩期护理中系统性不尊重和明显破坏性行为的历史常态。

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