Sangaleti Carine, Schveitzer Mariana Cabral, Peduzzi Marina, Zoboli Elma Lourdes Campos Pavone, Soares Cassia Baldini
1Nursing Department, The Midwestern State University (UNICENTRO), Paraná, Brazil 2Paulista Medical School, Universidade Federal de São Paulo, São Paulo, Brazil 3Nursing School, University of São Paulo (EEUSP) and The Brazilian Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence, São Paulo, Brazil.
JBI Database System Rev Implement Rep. 2017 Nov;15(11):2723-2788. doi: 10.11124/JBISRIR-2016-003016.
During the last decade, teamwork has been addressed under the rationale of interprofessional practice or collaboration, highlighted by the attributes of this practice such as: interdependence of professional actions, focus on user needs, negotiation between professionals, shared decision making, mutual respect and trust among professionals, and acknowledgment of the role and work of the different professional groups. Teamwork and interprofessional collaboration have been pointed out as astrategy for effective organization of health care services as the complexity of healthcare requires integration of knowledge and practices from differente professional groups. This integration has a qualitative dimension that can be identified through the experiences of health professionals and to the meaning they give to teamwork.
The objective of this systematic review was to synthesize the best available evidence on the experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings.
The populations included were all officially regulated health professionals that work in primary health settings: dentistry, medicine, midwifery, nursing, nutrition, occupational therapy, pharmacy, physical education, physiotherapy, psychology, social work and speech therapy. In addition to these professionals, community health workers, nursing assistants, licensed practical nurses and other allied health workers were also included.
The phenomena of interest were experiences of health professionals regarding teamwork and interprofessional collaboration in primary health care settings.
The context was primary health care settings that included health care centers, health maintenance organizations, integrative medicine practices, integrative health care, family practices, primary care organizations and family medical clinics. National health surgery as a setting was excluded.
The qualitative component of the review considered studies that focused on qualitative data including designs such as phenomenology, grounded theory, ethnography, action research and feminist research.
A three-step search strategy was utilized. Ten databases were searched for papers published from 1980 to June 2015. Studies published in English, Portuguese and Spanish were considered.
Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. All included studies received a score of at least 70% the questions in the instrument, 11 studies did not address the influence of the researcher on the research or vice-versa, and six studies did not present a statement locating the researcher culturally or theoretically.
Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.
Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software.
This review included 21 research studies, representing various countries and healthcare settings. There were 223 findings, which were aggregated into 15 categories, and three synthesized findings: CONCLUSIONS: This review shows that health professionals experience teamwork and interprofessional collaboration as a process in primary health care settings; its conditions, consequences (benefits and barriers), and finally shows its determinants. Health providers face enormous ideological, organizational, structural and relational challenges while promoting teamwork and interprofessional collaboration in primary health care settings. This review has identified possible actions that could improve implementation of teamwork and interprofessional collaboration in primary health care.
在过去十年中，团队合作一直是在跨专业实践或协作的背景下进行探讨的，这种实践的特点包括：专业行动的相互依存性、关注用户需求、专业人员之间的协商、共同决策、专业人员之间的相互尊重和信任，以及对不同专业群体的角色和工作的认可。团队合作和跨专业协作被视为有效组织医疗服务的一种策略，因为医疗保健的复杂性要求整合来自不同专业群体的知识和实践。这种整合具有质量维度，可以通过卫生专业人员的经验以及他们赋予团队合作的意义来识别。
本系统评价的目的是综合关于卫生专业人员在初级卫生保健环境中团队合作和跨专业协作经验的现有最佳证据。
纳入标准 参与者类型：纳入的人群包括所有在初级卫生保健机构工作的官方注册卫生专业人员：牙科、医学、助产、护理、营养、职业治疗、药学、体育、物理治疗、心理学、社会工作和言语治疗。除了这些专业人员外，社区卫生工作者、护理助理、执业护士和其他辅助卫生工作者也包括在内。
感兴趣的现象是卫生专业人员在初级卫生保健环境中团队合作和跨专业协作的经验。
背景是初级卫生保健机构，包括医疗保健中心、健康维护组织、综合医学实践、综合医疗保健、家庭医疗实践、初级保健组织和家庭医疗诊所。国家卫生外科作为一种环境被排除在外。
评价的定性部分考虑了专注于定性数据的研究，包括现象学、扎根理论、民族志、行动研究和女性主义研究等设计。
采用了三步检索策略。在10个数据库中检索了1980年至2015年6月发表的论文。考虑发表在英语、葡萄牙语和西班牙语的研究。
使用乔安娜·布里格斯研究所开发的定性评估和审查工具评估方法学质量。所有纳入的研究在该工具中的问题得分至少为70%，11项研究未涉及研究人员对研究的影响或反之，6项研究未提出在文化或理论上定位研究人员的声明。
使用乔安娜·布里格斯研究所定性评估和审查工具提取定性研究结果。
使用务实的元聚合方法和乔安娜·布里格斯研究所定性评估和审查工具软件汇总定性研究结果。
本评价包括21项研究，代表了不同国家和医疗保健环境。有223项研究结果，汇总为15个类别，以及3个综合研究结果：结论：本评价表明，卫生专业人员在初级卫生保健环境中将团队合作和跨专业协作视为一个过程；其条件、后果（益处和障碍），并最终展示其决定因素。卫生服务提供者在促进初级卫生保健环境中的团队合作和跨专业协作时面临巨大的意识形态、组织、结构和关系挑战。本评价确定了可能改善初级卫生保健中团队合作和跨专业协作实施的行动。
