Lancaster Gwendolyn, Kolakowsky-Hayner Stephanie, Kovacich Joann, Greer-Williams Nancy
Assistant Nursing Care Coordinator, Omicron Delta, Mount Sinai St. Luke's Hospital, New York, NY.
J Nurs Scholarsh. 2015 May;47(3):275-84. doi: 10.1111/jnu.12130. Epub 2015 Mar 19.
Historically, health care has primarily focused on physician, nurse, and allied healthcare provider triads. Using a phenomenological approach, this study explores the potential for hospital-based interdisciplinary care provided by physicians, nurses, and unlicensed assistive personnel (UAPs).
This phenomenological study used a purposive nonprobability, criterion-based, convenience sample from a metropolitan hospital.
Malhotra's (1981) Schutzian lifeworld phenomenological orchestra study provided the theoretical basis for the conductorless orchestra model, which guided this study. In an orchestra, each member sees and hears the musical score from a different vantage point or perspective and has a different stock of knowledge or talent; however, members work together to produce a cohesive performance. Like the orchestra, individual talents and perspectives of physicians, nurses, and UAPs can be collaboratively blended to create a symphony: enhanced patient-centered care.
Qualitative semistructured face-to-face, individual interviews were carefully transcribed and coded with the aid of NVivo 9, a qualitative data analysis software program, to discover emergent patterns and themes.
The study suggests that most of the time physicians, nurses, and UAPs operate as separate healthcare providers who barely speak to each other. Physicians see themselves as the primary patient care decision makers. Many physicians acknowledge the importance of nurses' knowledge and expertise. On the other hand, the study indicates a hierarchical, subservient relationship among nurses and UAPs. Physicians and nurses tend to work together or consult each other at times, but UAPs are rarely included in any type of meaningful patient discussion.
Since physicians, nurses, and UAPs each provide portions of patient care, coordination of the various treatments and interventions provided is critical to prevent errors and fragmentation of care. Tensions, misunderstandings, and conflicts caused by differences of opinions and interests can interfere with effective interdisciplinary communications and collaboration. Improving patient safety in the hospital requires addressing the current hierarchical professional structure inherent in healthcare delivery. A hospital patient care model based on the conductorless orchestra model would mitigate hierarchy; recognize physician, nurse, and UAP contributions to care; promote improved communication and collaboration; and enhance patient safety.
Study results provide additional information supporting interdisciplinary communication and collaboration education and training among physicians, nurses, and UAPs to support positive patient care outcomes.
从历史上看，医疗保健主要集中在医生、护士和专职医疗保健人员这三者之间。本研究采用现象学方法，探讨医生、护士和无执照辅助人员（UAP）提供的以医院为基础的跨学科护理的潜力。
本现象学研究采用了来自一家大都市医院的有目的的非概率、基于标准的便利样本。
马尔霍特拉（1981年）的舒茨式生活世界现象学管弦乐队研究为无指挥管弦乐队模型提供了理论基础，该模型指导了本研究。在管弦乐队中，每个成员从不同的有利位置或视角看待和聆听乐谱，并且拥有不同的知识储备或才能；然而，成员们共同努力以产生连贯的演奏。与管弦乐队一样，医生、护士和UAP的个人才能和观点可以协同融合，创造出一部交响乐：强化以患者为中心的护理。
定性的半结构化面对面个人访谈被仔细转录，并借助定性数据分析软件程序NVivo 9进行编码，以发现新出现的模式和主题。
该研究表明，大多数时候，医生、护士和UAP作为各自独立的医疗保健提供者开展工作，彼此之间几乎不交流。医生将自己视为患者护理的主要决策者。许多医生承认护士的知识和专业技能的重要性。另一方面，该研究表明护士和UAP之间存在等级森严、从属的关系。医生和护士有时倾向于一起工作或相互咨询，但UAP很少被纳入任何有意义的患者讨论中。
由于医生、护士和UAP各自提供部分患者护理，协调所提供的各种治疗和干预措施对于防止护理失误和碎片化至关重要。由意见和利益差异导致的紧张关系、误解和冲突可能会干扰有效的跨学科沟通与协作。提高医院的患者安全需要解决当前医疗服务中固有的等级森严的专业结构问题。基于无指挥管弦乐队模型的医院患者护理模式将减轻等级制度；认可医生、护士和UAP对护理的贡献；促进改善沟通与协作；并提高患者安全。
研究结果提供了更多信息，支持医生、护士和UAP之间开展跨学科沟通与协作教育及培训，以支持积极的患者护理结果。
