Shah Shamsul, Lambrecht Ingo, O'Callaghan Anne
Palliative Care, Auckland City Hospital, Auckland, New Zealand.
Manawanui Hinengaro Oranga Services, Mental Health Services for Māori, Auckland District Health Board, Auckland, New Zealand.
Intern Med J. 2017 Jun;47(6):674-679. doi: 10.1111/imj.13420.
The reported levels of staff stress and burnout at all levels of training and disciplines is significant and recognised to impact on the care of patients and families. We present an initiative to support staff at Auckland City Hospital based on the Schwartz Center Rounds.
To evaluate the efficacy of monthly case-based, staff support reflective rounds to discuss complex emotional and psychosocial issues that arise in caring for patients and families.
At Auckland City Hospital, a pilot programme called Manaakitia Reflective Rounds was conducted between April 2014 and September 2015. These were facilitated 1-h, monthly, case-based, staff support groups to discuss complex emotional and psychosocial issues in caring for patients. Staff evaluations and feedback were collated.
A total of 12 rounds was conducted exploring a range of challenging issues, from difficulty in achieving a patient's wish to die at home to coping with the 'heart sink' patient. There were 276 attendees in total, with an average attendance of 23 participants per round. A total of 218 evaluations was returned (79%) with rounds being rated as either exceptional or excellent by 87.5% of participants. Attendees reported positive benefits, such as gaining knowledge to help them care for patients (94%), working better with colleagues (87%) and gaining insight into how others think and feel in caring for patients (97%). Attendees reported a sense of having a 'shared experience' with better understanding of each other's professional perspectives and acknowledgement of the limitations (practical and human) in caring for patients and families.
Evaluations of the rounds indicate a need for staff to have a safe and supportive space to explore the emotional aspects of their work. Staff particularly appeared to value having a 'shared understanding' with the recognition that they are 'not alone' when managing challenging situations.
据报道，各级培训人员和各学科工作人员的压力和职业倦怠程度很高，且已认识到这会对患者及其家属的护理产生影响。我们基于施瓦茨中心巡诊会提出一项支持奥克兰市医院工作人员的倡议。
评估以病例为基础的每月一次的工作人员支持反思巡诊会的效果，以讨论在护理患者及其家属过程中出现的复杂情感和社会心理问题。
在奥克兰市医院，于2014年4月至2015年9月开展了一个名为“关爱反思巡诊会”的试点项目。这些巡诊会每月举行一次，为期1小时，以病例为基础，是工作人员支持小组，用于讨论护理患者过程中的复杂情感和社会心理问题。收集了工作人员的评估和反馈意见。
共进行了12次巡诊会，探讨了一系列具有挑战性的问题，从难以实现患者在家中离世的愿望到应对“令人沮丧”的患者。总共有276人参加，平均每次巡诊会有23名参与者。共收回218份评估意见（回收率79%），87.5%的参与者将巡诊会评为优秀或卓越。参与者报告了积极的收获，如获得帮助他们护理患者的知识（94%）、与同事更好地合作（87%）以及深入了解他人在护理患者时的想法和感受（97%）。参与者报告有一种“共同经历”的感觉，能更好地理解彼此的专业观点，并认识到在护理患者及其家属方面存在的局限性（实际的和人为的）。
对巡诊会的评估表明，工作人员需要一个安全且支持性的空间来探讨工作中的情感方面。工作人员似乎特别重视达成“共同理解”，并认识到在应对具有挑战性的情况时“并不孤单”。
