Johannessen Anne-Kari, Tveiten Sidsel, Werner Anne
Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway.
Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.
Scand J Caring Sci. 2018 Jun;32(2):815-823. doi: 10.1111/scs.12512. Epub 2017 Aug 23.
User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short-time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street-level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision-makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged.
在过去几十年里，患者参与已成为医疗保健领域日益重要的原则。医疗保健专业人员应让患者参与治疗决策。然而，立法中并未对临床工作中专业人员具体应如何做给出明确指导。在本研究中，我们探讨了市政急性病房的医疗保健专业人员如何看待、体验和开展患者参与。该病房代表了挪威一种新的紧急援助短期服务模式。我们关注专业人员在临床工作中面临的挑战以及他们如何应对这些挑战。数据来源于对11名医疗保健专业人员的定性访谈以及对病房预诊和医生查房的10次观察。访谈和观察的文字记录采用系统文本浓缩法进行分析。在分析过程中，我们运用了利普斯基关于基层官僚困境的观点。结果表明，专业人员将患者参与视为其工作中重要且自然的一部分。他们在与患者、护理人员以及其他服务领域的专业人员合作时遇到困难，同时也面临导致期望、责任和优先级相互冲突的框架条件。专业人员似乎对患者参与采取务实的方法，在狭隘的视角内进行管理。我们的研究表明，参与者以牺牲患者参与为代价来应对这些困境。结果表明，在患者参与方面，既定的卫生政策与专业人员在临床工作中落实该政策的机会之间存在差距。政策制定者应认识到医疗保健专业人员在应对临床工作困难时所需的平衡工作。应承认专业人员作为服务提供者所具备的知识以及政策制定过程中对其进行重视的必要性。
