Knight Kaye M, Kenny Amanda, Endacott Ruth
La Trobe Rural Health School, Bendigo, VIC, Australia.
Centre for Health and Social Care Innovation, Faculty of Health and Human Sciences, University of Plymouth, Drake Circus, Plymouth UK & Monash University, Melbourne, Australia.
BMC Health Serv Res. 2015 Apr 9;15:145. doi: 10.1186/s12913-015-0827-y.
Due to large geographical distances, the telephone is central to enabling rural Australian communities to access care from their local health service. While there is a history of rural nurses providing care via the telephone, it has been a highly controversial practice that is not routinely documented and little is known about how the practice is governed. The lack of knowledge regarding governance extends to the role of Directors of Nursing as clinical leaders charged with the responsibility of ensuring practice safety, quality, regulation and risk management. The purpose of this study was to identify clinical governance processes related to managing telephone presentations, and to explore Directors of Nursing perceptions of processes and clinical practices related to the management of telephone presentations to health services in rural Victoria, Australia.
Qualitative documentary analysis and semi structured interviews were used in the study to examine the content of health service policies and explore the perceptions of Directors of Nursing in eight rural health services regarding policy content and enactment when people telephone rural health services for care. Participants were purposively selected for their knowledge and leadership role in governance processes and clinical practice. Data from the interviews were analysed using framework analysis. The process of analysis resulted in the identification of five themes.
The majority of policies reviewed provided little guidance for managing telephone presentations. The Directors of Nursing perceived policy content and enactment to be largely inadequate. When organisational structures failed to provide appropriate governance for the context, the Directors of Nursing engaged in protective mechanisms to support rural nurses who manage telephone presentations.
Rural Directors of Nursing employed intuitive behaviours to protect rural nurses practicing within a clinical governance context that is inadequate for the complexities of the environment. Protective mechanisms provided indicators of clinical leadership and governance effectiveness, which may assist rural nurse leaders to strengthen quality and safe care by unlocking the potential of intuitive behaviours. Kanter's theory of structural power provides a way of conceptualising these protective mechanisms, illustrating how rural nurse leaders enact power.
由于地理距离较远，电话成为澳大利亚农村社区获得当地医疗服务的核心途径。虽然农村护士通过电话提供护理服务已有一定历史，但这一做法极具争议，且通常缺乏记录，对于该做法的管理方式也知之甚少。在治理方面的知识欠缺还涉及到护理主任作为临床领导者的角色，他们负责确保实践安全、质量、监管和风险管理。本研究的目的是确定与管理电话问诊相关的临床治理流程，并探讨澳大利亚维多利亚州农村地区护理主任对向医疗服务机构进行电话问诊管理流程及临床实践的看法。
本研究采用定性文献分析和半结构化访谈，以检查医疗服务政策的内容，并探讨八个农村医疗服务机构的护理主任对人们打电话到农村医疗服务机构寻求护理时政策内容及实施情况的看法。参与者因在治理流程和临床实践方面的知识及领导作用而被有目的地挑选出来。访谈数据采用框架分析法进行分析。分析过程确定了五个主题。
所审查的大多数政策在管理电话问诊方面提供的指导很少。护理主任认为政策内容和实施在很大程度上是不充分的。当组织结构未能为实际情况提供适当治理时，护理主任会采取保护机制来支持管理电话问诊的农村护士。
农村护理主任采取直观行为，以保护在临床治理环境中执业的农村护士，而该环境不足以应对环境的复杂性。保护机制提供了临床领导和治理有效性的指标，这可能有助于农村护士领导者通过挖掘直观行为的潜力来加强优质和安全护理。坎特的结构权力理论提供了一种概念化这些保护机制的方法，说明了农村护士领导者如何行使权力。
