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比较医疗保健中的跨专业和跨组织合作:定性研究的系统评价。

Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research.

机构信息

Catholic University of Louvain, Faculty of Public Health, Institute of Health and Society, Clos-Chapelle-aux-Champs, 30, PO Box B1.30.01, 1200 Brussels, Belgium.

Université de Montréal, Faculty of Nursing, Canada.

出版信息

Int J Nurs Stud. 2018 Mar;79:70-83. doi: 10.1016/j.ijnurstu.2017.11.002. Epub 2017 Nov 11.


DOI:10.1016/j.ijnurstu.2017.11.002
PMID:29202313
Abstract

BACKGROUND: Interprofessional and interorganizational collaboration have become important components of a well-functioning healthcare system, all the more so given limited financial resources, aging populations, and comorbid chronic diseases. The nursing role in working alongside other healthcare professionals is critical. By their leadership, nurses can create a culture that encourages values and role models that favour collaborative work within a team context. OBJECTIVES: To clarify the specific features of conceptual frameworks of interprofessional and interorganizational collaboration in the healthcare field. This review, accordingly, offers insights into the key challenges facing policymakers, managers, healthcare professionals, and nurse leaders in planning, implementing, or evaluating interprofessional collaboration. DESIGN: This systematic review of qualitative research is based on the Joanna Briggs Institute's methodology for conducting synthesis. DATA SOURCES: Cochrane, JBI, CINAHL, Embase, Medline, Scopus, Academic Search Premier, Sociological Abstract, PsycInfo, and ProQuest were searched, using terms such as professionals, organizations, collaboration, and frameworks. METHODS: Qualitative studies of all research design types describing a conceptual framework of interprofessional or interorganizational collaboration in the healthcare field were included. They had to be written in French or English and published in the ten years between 2004 and 2014. RESULTS: Sixteen qualitative articles were included in the synthesis. Several concepts were found to be common to interprofessional and interorganizational collaboration, such as communication, trust, respect, mutual acquaintanceship, power, patient-centredness, task characteristics, and environment. Other concepts are of particular importance either to interorganizational collaboration, such as the need for formalization and the need for professional role clarification, or to interprofessional collaboration, such as the role of individuals and team identity. Promoting interorganizational collaboration was found to face greater challenges, such as achieving a sense of belonging among professionals when differences exist between corporate cultures, geographical distance, the multitude of processes, and formal paths of communication. CONCLUSIONS: This review sets a direction to follow for implementing changes that meet the challenge of a changing healthcare system and the transition towards non-institutional care. It also shows that collaboration between nurses and healthcare professionals from different healthcare organizations is still poorly explored. This is a major limitation in the existing scientific literature, especially given the potential role that could be played by nurses in enhancing interorganizational collaboration.

摘要

背景: 专业间和组织间的协作已成为运行良好的医疗体系的重要组成部分,尤其是在有限的财政资源、人口老龄化和合并慢性病的情况下。护士在与其他医疗保健专业人员合作中的作用至关重要。通过领导,护士可以创造一种文化,鼓励价值观和角色模型,在团队背景下支持协作工作。

目的: 阐明医疗领域中专业间和组织间协作的概念框架的具体特征。因此,本综述为政策制定者、管理者、医疗保健专业人员和护理领导者在规划、实施或评估专业间协作方面提供了关键挑战的见解。

设计: 这是一项基于乔安娜·布里格斯研究所(Joanna Briggs Institute)综合方法的定性研究系统综述。

资料来源: Cochrane、JBI、CINAHL、Embase、Medline、Scopus、Academic Search Premier、Sociological Abstract、PsycInfo 和 ProQuest 等数据库均使用了专业人员、组织、协作和框架等术语进行检索。

方法: 纳入了描述医疗领域专业间或组织间协作的概念框架的所有研究设计类型的定性研究。它们必须用法语或英语写成,并在 2004 年至 2014 年的十年间发表。

结果: 综合分析纳入了 16 篇定性文章。发现一些概念是专业间和组织间协作的共同特征,例如沟通、信任、尊重、相互了解、权力、以患者为中心、任务特征和环境。其他概念对于组织间协作或专业间协作特别重要,例如正式化的必要性、专业角色澄清的必要性、个体的角色和团队身份的重要性。发现促进组织间协作面临更大的挑战,例如在企业文化、地理距离、众多流程和正式沟通途径存在差异的情况下,在专业人员中建立归属感。

结论: 本综述为实施变革指明了方向,以应对不断变化的医疗体系和向非机构化护理过渡的挑战。它还表明,护士与来自不同医疗机构的医疗保健专业人员之间的协作仍未得到充分探索。这是现有科学文献的一个主要局限性,特别是考虑到护士在增强组织间协作方面可能发挥的作用。

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