D'Lima Danielle M, Murray Eleanor J, Brett Stephen J
Department of Applied Health Research, University College London, London, United Kingdom.
Saïd Business School, University of Oxford, Oxford, United Kingdom.
Crit Care Med. 2018 Jan;46(1):60-70. doi: 10.1097/CCM.0000000000002773.
The aims of this study were to 1) examine individual professionals' perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions.
Qualitative case study methodology with nurses, doctors, and physiotherapists.
Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group.
Forty-four ICU team members of diverse professional backgrounds and seniority.
None.
Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an "A" team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a "dynamic balance" influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals' risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit.
This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals' cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals' perfectionist or pragmatic approach. Perfectionists' team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived "A" team but diminished by interdisciplinary tensions. Third, counter intuitively, higher "situational" awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize risk begins and ends, which we have termed "risk horizons" and that these horizons may affect their behavior both within and beyond the unit.
本研究的目的是：1）调查个体专业人员对重症监护中人员配置风险和安全人员配置的看法；2）识别并研究这些看法背后的认知过程。
对护士、医生和物理治疗师采用定性案例研究方法。
三个成人内科和外科混合重症监护病房，分别位于伦敦一家拥有1200张床位的学术型三级医院集团内的不同医院地点。
44名具有不同专业背景和资历的重症监护病房团队成员。
无。
确定了四个主题（个人、团队、科室和组织）。个人护理的提供受到个人实用主义与完美主义立场的影响，团队动态受到“A级”团队概念和跨学科紧张关系的影响。对安全性的看法取决于实现“动态平衡”的重要性，这受到当前情况的负担和患者临床状况的影响。在组织层面，专业人员的风险认知影响了他们对科室以外互动承担个人责任的意愿。
本研究借鉴了认知研究，特别是认知失调、心理安全和情境意识理论，来解释专业人员的认知过程如何影响重症监护病房中的行为。我们的结果可能对重症监护病房中的人际关系、管理和领导力产生影响。首先，患者护理的提供可能受到专业人员完美主义或实用主义方法的影响。完美主义者在团队中的角色可能会受到损害，他们可能会经历认知失调以及随后的孤立/压力。其次，在一个被认为是“A级”团队的范围内，团队中的心理安全可能会得到改善，但跨学科紧张关系会使其降低。第三，与直觉相反，一些人较高的“情境”意识增加了他们的压力和焦虑。最后，我们的结果表明，专业人员对于将风险降至最低的个人责任从何处开始和结束有不同的概念，我们将其称为“风险范围”，并且这些范围可能会影响他们在科室内外的行为。
