Milne Jacqueline, Greenfield David, Braithwaite Jeffrey
Faculty of Medicine, University of New South Wales , Sydney NSW , Australia and.
J Interprof Care. 2015;29(4):347-53. doi: 10.3109/13561820.2015.1004039. Epub 2015 Feb 3.
Collaborative practice among early career staff is at the bedrock of interprofessional care. This study investigated factors influencing the enactment of interprofessional practice by using the day-to-day role of six junior doctors in three teaching hospitals as a gateway to understand the various professions' interactive behaviours. The contextual framework used for the study was Strauss' theory of negotiated order. Ethnographic techniques were applied to observe the actions and interactions of participants on typical working days in their hospital environments. Field notes were created and thematic analysis was applied to the data. Three themes explored were culture, communication, and collaboration. Issues identified highlight the bounded organisational and professional cultures within which junior doctors work, and systemic problems in interprofessional interaction and communication in the wards of hospitals. There are indications that early career doctors are interprofessional isolates. The constraints of short training terms and pressure from multi-faceted demands on junior doctors can interfere with the establishment of meaningful relationships with nurses and other health professionals. The realisation of sustained interprofessional practice is, therefore, practically and structurally difficult. Enabling factors supporting the sharing of expertise are outweighed by barriers associated with professional and hospital organisational cultures, poor interprofessional communication, and the pressure of competing individual task demands in the course of daily practice.
初入职场员工之间的协作实践是跨专业护理的基石。本研究通过以三家教学医院中六名初级医生的日常工作角色为切入点，来调查影响跨专业实践实施的因素，以此了解不同专业的互动行为。该研究使用的情境框架是施特劳斯的协商秩序理论。采用人种学方法观察参与者在医院环境中典型工作日的行为和互动。记录实地笔记，并对数据进行主题分析。探讨的三个主题是文化、沟通和协作。所发现的问题凸显了初级医生工作所处的有限组织文化和专业文化，以及医院病房中跨专业互动和沟通方面的系统性问题。有迹象表明，初入职场的医生处于跨专业孤立状态。短期培训期限的限制以及初级医生面临的多方面需求压力，可能会干扰他们与护士及其他医疗专业人员建立有意义的关系。因此，实现持续的跨专业实践在实际操作和结构层面都存在困难。在日常实践过程中，与专业和医院组织文化、跨专业沟通不畅以及个体任务需求竞争压力相关的障碍，超过了支持专业知识共享的促成因素。
