与患有慢性病的患者合作对于医疗保健专业人员来说可能是一种平衡行为 - 定性研究的综合分析。
Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies.
机构信息
Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.
出版信息
BMC Health Serv Res. 2020 Feb 10;20(1):98. doi: 10.1186/s12913-019-4826-2.
BACKGROUND
The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs' experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD).
METHOD
A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs' experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes.
RESULTS
Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs' experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 sub-categories that formed three overarching main themes of work experiences: 1) individualizing one's professional approach within the clinical encounter; 2) managing one's emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs' work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one's own emotions.
CONCLUSION
Few qualitative studies highlighted HCPs' general working experiences, as they mainly focused on the patients' experiences or HCPs' experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs' work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support.
TRIAL REGISTRATION
PROSPERO number: CRD42019119052.
背景
患有长期慢性病的患者人数正在增加。这些患者给医疗保健系统和医疗保健专业人员（HCP）带来了压力。目前，我们旨在系统地回顾文献，了解 HCP 与患有 2 型糖尿病、慢性阻塞性肺疾病（COPD）和慢性肾脏病（CKD）等长期慢性病患者合作的经验。
方法
在 Embase、AMED、PsycINFO、MEDLINE、CINAHL 和 COCHRANE 数据库中进行了 2002 年至 2019 年 7 月期间发表的论文的系统检索，以确定报告定性访谈的研究，这些研究涉及 HCP 与 COPD、CKD 或 2 型糖尿病成人合作的经验。一个跨学科的研究小组参与了研究的所有阶段。在 NVivo 的帮助下，对每篇论文的摘录进行了编码，并在论文之间比较了代码，并使用翻译分析进行了精炼。进一步的代码被聚类在类别中，这些类别又形成了总体主题。
结果
我们全面的搜索确定了 4170 个引用。其中，20 篇论文符合我们的纳入标准。关于 HCP 与 COPD、CKD 或 2 型糖尿病患者合作的经验，我们制定了 10 个子类别，形成了三个主要工作经验主题：1）在临床接触中个性化专业方法；2）随着时间的推移管理自己的情绪；3）努力保持专业性。总的来说，这三个主题表明，HCP 的工作是一种复杂的平衡行为，取决于患者和专业人员之间的互动、现实和专业理想之间的互动，以及背景支持和管理自己情绪之间的互动。
结论
很少有定性研究强调 HCP 的一般工作经验，因为它们主要关注患者的经验或 HCP 使用特定临床程序的经验。这项研究从 HCP 工作的复杂性方面带来了新的见解，即权衡不同的、往往相互矛盾的方面，以提供适当的实践。承认、讨论和支持这种复杂性可以使 HCP 避免精疲力竭。领导者、卫生组织和教育机构有责任为 HCP 提供全面的专业知识和系统的支持。
试验注册
PROSPERO 编号：CRD42019119052。
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