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应对临床实践中的沟通挑战:团队教育的新方法。

Navigating Communication Challenges in Clinical Practice: A New Approach to Team Education.

作者信息

Rachwal Christine M, Langer Thorsten, Trainor Bethany P, Bell Mary Anne, Browning David M, Meyer Elaine C

机构信息

Christine M. Rachwal is a CICU nurse practice specialist in the cardiovascular and critical care programs, Boston Children's Hospital, Boston, Massachusetts. She is also faculty associate and leadership circle member for the Institute for Professionalism and Ethical Practice, Boston Children's Hospital. Thorsten Langer is an attending physician in the Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, University of Freiburg, Freiburg, Germany, and an international faculty associate for the Institute for Professionalism and Ethical Practice. Bethany P. Trainor is the manager of the clinical research navigation program at the Institutional Centers for Clinical and Translational Research, Boston Children's Hospital. Mary Anne Bell is a clinical staff nurse I in the cardiovascular and critical care programs, Boston Children's Hospital. David M. Browning is senior scholar emeritus for the Institute for Professionalism and Ethical Practice. Elaine C. Meyer is the founding director of the Institute for Professionalism and Ethical Practice and associate professor in psychology, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.

出版信息

Crit Care Nurse. 2018 Dec;38(6):15-22. doi: 10.4037/ccn2018748.

Abstract

BACKGROUND

Cultivating a healthy work environment and upholding patient safety are important priorities in health care. Challenges in workplace communication are common and affect staff well-being and patient outcomes. Previous interventions have focused on organizational issues and work-life balance.

OBJECTIVE

To assess the feasibility of monthly interdisciplinary educational rounds that support clinicians' ability to navigate workplace clinical and communication challenges while promoting interprofessional teamwork and self-care.

METHODS

The Program to Enhance Relational and Communication Skills rounds are an educational initiative within a large pediatric tertiary care hospital. Participation is voluntary and offered to inter-professional clinicians from 4 critical care units, cardiac catheterization unit, and intermediate care unit. Topics of monthly hour-long sessions are developed collaboratively. Feasibility is assessed by ongoing documentation of attendance. Postintervention questionnaires are used to evaluate the program's value.

RESULTS

Between April 2010 and December 2016, a total of 1156 clinicians participated (median, 18 per seminar): 653 nurses (56%), 103 social workers (9%), 102 child life specialists (9%), 32 psychologists (3%), 40 chaplains (3%), 18 physicians (2%), 18 ethicists (2%), and 190 others (16%), including medical interpreters, nursing students, and administrative staff. Ninety-two percent of participants rated their participation as "quite valuable" or "very valuable." Programs of highest interest included child assent, bereavement, social media, and workplace bullying. Evolution into actual clinical practice change remains a challenge for the future.

CONCLUSION

Our approach to communication and workplace challenges is relevant, user-friendly, and feasible. Difficult topics are addressed in real time, with clinicians learning interprofessionally.

摘要

背景

营造健康的工作环境并维护患者安全是医疗保健领域的重要优先事项。职场沟通中的挑战很常见,会影响员工福祉和患者治疗结果。以往的干预措施主要集中在组织问题和工作与生活的平衡上。

目的

评估每月一次的跨学科教育轮训的可行性,该轮训旨在支持临床医生应对职场临床和沟通挑战的能力,同时促进跨专业团队合作和自我保健。

方法

“增强关系与沟通技能轮训计划”是一家大型儿科三级护理医院内的一项教育举措。参与是自愿的,面向来自4个重症监护病房、心导管插入术病房和中级护理病房的跨专业临床医生。每月为时一小时的课程主题是共同制定的。通过持续记录出勤情况来评估可行性。干预后问卷调查用于评估该计划的价值。

结果

在2010年4月至2016年12月期间,共有1156名临床医生参与(每次研讨会的中位数为18人):653名护士(56%)、103名社会工作者(9%)、102名儿童生活专家(9%)、32名心理学家(3%)、40名牧师(3%)、18名医生(2%)、18名伦理学家(2%)以及190名其他人员(16%),包括医学口译员、护理专业学生和行政人员。92%的参与者将他们的参与评价为“非常有价值”或“极有价值”。最受关注的课程主题包括儿童同意、丧亲之痛、社交媒体和职场霸凌。向实际临床实践变革的演变对未来而言仍是一项挑战。

结论

我们应对沟通和职场挑战的方法具有相关性、用户友好性且可行。棘手的主题得到实时处理,临床医生通过跨专业学习。

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