医疗团队中专业冲突的多层次分析：对未来培训的启示
A Multilevel Analysis of Professional Conflicts in Health Care Teams: Insight for Future Training.
作者信息
Bochatay Naike, Bajwa Nadia M, Cullati Stéphane, Muller-Juge Virginie, Blondon Katherine S, Junod Perron Noëlle, Maître Fabienne, Chopard Pierre, Vu Nu Viet, Kim Sara, Savoldelli Georges L, Hudelson Patricia, Nendaz Mathieu R
机构信息
N. Bochatay is a research assistant, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, and PhD candidate, Institute of Sociological Research, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-6098-4262. N.M. Bajwa is residency program director, Department of General Pediatrics, Children's Hospital, University Hospitals of Geneva, and faculty member, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-1445-4594. S. Cullati is a medical sociologist, Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, and Institute of Sociological Research, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-3881-446X. V. Muller-Juge is a scientific collaborator, Unit of Primary Care (UIGP), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-2346-8904. K.S. Blondon is junior faculty, Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-9407-8516. N. Junod Perron is coordinator, Institute of Primary Care, University Hospitals of Geneva, and faculty member, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-9124-8663. F. Maître is quality officer, Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland. P. Chopard is director, Quality of Care Unit, Medical Directorate, University Hospitals of Geneva, Geneva, Switzerland. N.V. Vu is emeritus professor, Faculty of Medicine, University of Geneva, Geneva, Switzerland. S. Kim is research professor, Department of Surgery, School of Medicine, University of Washington, Seattle, Washington. G.L. Savoldelli is associate professor and attending physician, Division of Anesthesiology, University Hospitals of Geneva, and Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0002-8968-6920. P. Hudelson is a medical anthropologist, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland. M.R. Nendaz is full professor and director, Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, and attending physician, Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland; ORCID: http://orcid.org/0000-0003-3795-3254.
出版信息
Acad Med. 2017 Nov;92(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 56th Annual Research in Medical Education Sessions):S84-S92. doi: 10.1097/ACM.0000000000001912.
PURPOSE
Without a proper understanding of conflict between health care professionals, designing effective conflict management training programs for trainees that reflect the complexity of the clinical working environment is difficult. To better inform the development of conflict management training, this study sought to explore health care professionals' experiences of conflicts and their characteristics.
METHOD
Between 2014 and early 2016, 82 semistructured interviews were conducted with health care professionals directly involved in first-line patient care in four departments of the University Hospitals of Geneva. These professionals included residents, fellows, certified nursing assistants, nurses, and nurse supervisors. All interviews were transcribed verbatim, and conventional content analysis was used to derive conflict characteristics.
RESULTS
Six conflict sources were identified. Among these sources, disagreements on patient care tended to be the primary trigger of conflict, whereas sources related to communication contributed to conflict escalation without directly triggering conflict. A framework of workplace conflict that integrates its multidimensional and cyclical nature was subsequently developed. This framework suggests that conflict consequences and responses are interrelated, and might generate further tensions that could affect health care professionals, teams, and organizations, as well as patient care. Findings also indicated that supervisors' responses to contentious situations often failed to meet health care professionals' expectations.
CONCLUSIONS
Understanding conflicts between health care professionals involves several interrelated dimensions, such as sources, consequences, and responses to conflict. There is a need to strengthen health care professionals' ability to identify and respond to conflict and to further develop conflict management programs for clinical supervisors.
目的
如果不能正确理解医护人员之间的冲突，就难以设计出有效的冲突管理培训项目，以反映临床工作环境的复杂性。为了更好地为冲突管理培训的发展提供信息，本研究旨在探索医护人员的冲突经历及其特点。
方法
2014年至2016年初，对日内瓦大学医院四个科室直接参与一线患者护理的医护人员进行了82次半结构化访谈。这些专业人员包括住院医师、研究员、注册护理助理、护士和护士长。所有访谈均逐字记录，并采用传统内容分析法得出冲突特征。
结果
确定了六个冲突来源。在这些来源中，关于患者护理的分歧往往是冲突的主要触发因素，而与沟通相关的来源则导致冲突升级，但没有直接引发冲突。随后制定了一个整合工作场所冲突的多维性和周期性的框架。该框架表明，冲突的后果和应对措施是相互关联的，可能会产生进一步的紧张关系，从而影响医护人员、团队和组织以及患者护理。研究结果还表明，主管对争议情况的反应往往未能达到医护人员的期望。
结论
理解医护人员之间的冲突涉及几个相互关联的维度，如冲突的来源、后果和应对措施。有必要加强医护人员识别和应对冲突的能力，并进一步为临床主管制定冲突管理项目。
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