Johnson Maxine, O'Hara Rachel, Hirst Enid, Weyman Andrew, Turner Janette, Mason Suzanne, Quinn Tom, Shewan Jane, Siriwardena A Niroshan
Public Health Section, ScHARR, University of Sheffield, Sheffield, UK.
Sheffield Emergency Care Forum, Sheffield, UK.
BMC Med Res Methodol. 2017 Jan 24;17(1):11. doi: 10.1186/s12874-017-0290-z.
Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making.
The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified.
The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research process. Feedback workshops allowed stakeholders to discuss and prioritise findings as well as identify new research areas.
Combining multiple qualitative methods with a collaborative research approach can facilitate exploration of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for future intervention and research.
护理人员在现场就患者护理做出重要且日益复杂的决策。此前，对于院前环境中影响决策制定的因素对患者安全的影响研究不足。前沿观点主张探索整个系统，而非仅关注对患者安全的个体影响因素。人种学（对人和文化的研究）已被公认为一种在自然环境中识别医疗保健问题的合适方法。在本文中，我们比较了在一项多地点定性研究中使用的多种方法，该研究旨在确定对决策制定的系统影响因素。
该研究在英格兰的三个国民保健服务（NHS）救护信托机构中进行，每个信托机构的研究人员与学术研究人员合作开展研究。对关键信息提供者（如管理人员，n = 16）进行探索性访谈，并进行文件审查以提供背景信息。在2012年10月至2013年7月期间，研究人员观察了34次护理人员轮班，10名护理人员通过音频记录的“数字日记”（155个事件）提供了补充记录。三个员工焦点小组（共n = 21）和三个服务用户焦点小组（共n = 23）探讨了一系列经历和看法。数据收集和分析由学术研究人员、救护服务研究人员以及服务用户共同进行。在每个地点都举办了研讨会，以获取对研究结果的反馈，并促进对已识别问题的优先排序。
采用多方法定性研究方法能够对救护服务人员和服务用户的重要问题进行交叉验证。该研究成功实施的一个关键因素是与学术团队和救护服务团队建立良好的工作关系。在每个地点至少招募一名研究负责人有助于招募过程以及研究进展。救护服务研究人员和服务用户积极参与研究，使其对研究过程有了更好的理解。反馈研讨会使利益相关者能够讨论研究结果并确定其优先级，以及识别新的研究领域。
将多种定性方法与协作研究方法相结合，可以促进在研究不足的环境中探索系统对患者安全的影响因素。本文强调了这种方法的实证问题、优势和局限性。反馈研讨会对于验证研究结果以及确定未来干预和研究的优先领域非常有效。
