Goldman Joanne, MacMillan Kathleen, Kitto Simon, Wu Robert, Silver Ivan, Reeves Scott
Faculty of Medicine, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada.
School of Nursing, Dalhousie University, Halifax, NS, Canada.
Nurs Inq. 2018 Jul;25(3):e12236. doi: 10.1111/nin.12236. Epub 2018 Apr 1.
Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals' roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses' interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in-depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty-five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses' absence from morning rounds, one-way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision-making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse-physician interactions and the current context of nursing care.
有效的医院出院计划需要护士与其他医疗保健专业人员之间的协作。然而，与出院相关的跨专业互动和实践在医院内部和不同医院之间存在差异。这些互动受到医院出院优先事项塑造医疗保健专业人员角色方式的影响。本研究探讨了普通内科病房床边护士在出院方面的跨专业协作经验。采用人种志方法深入了解护士和其他医疗保健专业人员对出院相关协作实践的看法和做法。进行了65小时的观察，并对护士和其他医疗保健专业人员进行了23次访谈。根据我们的结果，床边护士在跨专业协作和出院计划中的参与有限。这在床边护士不参加晨间查房、查房后信息从查房单向床边护士流动以及白天与其他医疗保健专业人员互动和决策的机会有限方面表现明显。床边护士在患者出院计划中的脱节、无权和被贬低对护理质量和护理工作有影响。研究结果基于先前关于护士与医生互动的研究以及当前护理背景。
