Lalleman Pcb, Smid Gac, Dikken J, Lagerwey M D, Schuurmans M J
HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
Sioo; Interuniversity Center for Organization Studies and Change Managment, Utrecht, The Netherlands.
Nurs Inq. 2017 Oct;24(4). doi: 10.1111/nin.12193. Epub 2017 Mar 21.
Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work.
护士中层管理人员处于促进以患者为中心的护理的理想位置。然而，由于在实践中难以阐明这一点，他们的贡献在文献中未得到充分体现。本文探讨了护士中层管理人员如何在医院中促进以患者为中心的护理。采用时间使用分析和人种志研究相结合的方法，在微观层面揭示他们对以患者为中心的护理的贡献。在四家医院对16名护士管理人员进行了超过560小时的跟踪观察。一些护士中层管理人员很少对以患者为中心的护理做出贡献。其他人参与直接的患者护理，但这并未导致以患者为中心的实践。在一家医院，护士中层管理人员确实对以患者为中心的护理做出了贡献。在这里，在“组织工作”和“关怀工作”之间取得平衡被视为他们以患者为中心的前提条件。其他重要主题包括反馈机制；场所很重要；与谁交谈以及如何阐述利害关系问题；以及行为风格。护士中层管理人员的“亲力亲为”和“深思熟虑”的关怀工作都增强了他们以患者为中心的程度。本研究首次通过将时间使用分析与人种志研究相结合，深入了解了护士中层管理人员在以患者为中心的护理方面常常难以阐明的“行为”。
