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医生,我们能帮你什么?一项定性访谈研究,旨在确定针对医院医生职业倦怠的关键干预措施。

Doctor, how can we help you? Qualitative interview study to identify key interventions to target burnout in hospital doctors.

机构信息

School of Health and Human Performance, Dublin City University, Dublin, Ireland

Research, Royal College of Physicians of Ireland, Dublin, Ireland.

出版信息

BMJ Open. 2019 Sep 5;9(9):e030209. doi: 10.1136/bmjopen-2019-030209.

Abstract

OBJECTIVE

To identify priority interventions for the prevention and reduction of work stress and burnout in hospital doctors through analysis of (1) doctors' experiences of work stress and burnout and (2) their preferences with respect to interventions.

DESIGN

Qualitative design using semistructured interviews analysed with deductive thematic analysis.

SETTING

Hospitals in Ireland.

PARTICIPANTS

32 hospital doctors (16 practising consultants and 16 doctors in training) from a range of specialties, career stages, hospital types and locations.

RESULTS

Practical, system-focused interventions were found to be most needed. Challenges with basic entitlements, that is, accessing statutory leave, knowing in advance when leave can be taken and being adequately covered when on leave were identified as requiring urgent attention. Other priority interventions identified were the integration of psychological support in the everyday working environment, time and training for clinical line managers to perform key management activities such as debriefing and education interventions which highlight work stress risks and care pathways, teach self-care and train doctors in how to support one another.

CONCLUSIONS

Hospital doctors are feeling the effects of greater demand and fewer resources. What they most urgently need is adequate staffing levels, access to statutory leave and adequate cover when on leave. Doctors do not receive the support they need from their clinical line managers, who lack the skills and time to excel as people managers. Organisations should focus on developing clinical management skills across the system. The culture of medicine needs to change from stigmatisation and competitiveness to compassion and collaboration. Organisations, medical schools and professional bodies can steer this change through education.

摘要

目的

通过分析(1)医生的工作压力和倦怠经历,以及(2)他们对干预措施的偏好,确定预防和减少医院医生工作压力和倦怠的优先干预措施。

设计

使用半结构化访谈进行定性设计,并进行演绎主题分析。

地点

爱尔兰的医院。

参与者

来自不同专业、职业阶段、医院类型和地点的 32 名医院医生(16 名执业顾问医生和 16 名培训医生)。

结果

发现最需要实用的、以系统为重点的干预措施。基本权利方面的挑战,即获得法定休假、提前知道何时可以休假以及休假时得到充分保障,被认为需要紧急关注。确定的其他优先干预措施包括将心理支持纳入日常工作环境、为临床一线经理提供时间和培训,以便他们能够履行关键管理活动,如汇报和教育干预,突出工作压力风险和护理途径,教授自我保健,并培训医生如何相互支持。

结论

医院医生感受到了需求增加和资源减少的影响。他们最迫切需要的是足够的人员配备水平、获得法定休假的机会和休假时的充分保障。医生没有从他们的临床一线经理那里得到他们需要的支持,而这些经理缺乏作为人员管理者所需的技能和时间。组织应该专注于在整个系统中培养临床管理技能。医学文化需要从污名化和竞争转变为同情和合作。组织、医学院校和专业机构可以通过教育来推动这种变革。

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