澳大利亚产科环境中超声检查医师在沟通方面的自主程度：这会影响他们的职业身份认同吗？
Sonographers' level of autonomy in communication in Australian obstetric settings: Does it affect their professional identity?
作者信息
Thomas Samantha, O'Loughlin Kate, Clarke Jill
机构信息
AMS Faculty of Medicine and Health, Sydney University, Sydney, Australia.
Faculty of Medicine and Health, Ageing, Work and Health Research Unit, University of Sydney, Sydney, Australia.
出版信息
Ultrasound. 2020 Aug;28(3):136-144. doi: 10.1177/1742271X20928576. Epub 2020 Jun 9.
INTRODUCTION
Unlike the United Kingdom, policies in Australia prevent sonographers from exercising autonomy in their level of communication with pregnant patients in the event of adverse findings. The organisational structure makes the sonographer dependent on the sonologist because sonographers do not have the authority to provide the official report. The emotional labour on sonographers is increased as they struggle to provide patient-centred care, given the limits put on their communication during the ultrasound examination. The aim of this study was to explore Australian sonographers' views on communicating adverse findings, including their level of autonomy in communicating with patients and how this influences their sense of professional identity.
METHODS
Following a national survey, seven purposively selected participants, who were qualified to perform obstetric ultrasound examinations, completed follow-up interviews. The interviews were thematically analysed with iterative comparison to the survey results. Three case studies show sonographers differed in their 'communicator type' due to geographical location and workplace setting.
RESULTS
The case studies illustrate a sonographer's communication role, and level of autonomy is negotiated/renegotiated depending on the needs and expectations of each workplace. Their communication practices varied due to the sonologist (radiologist/obstetrician) policy on sonographer/patient communication, presence and support in the clinical setting. A strong professional identity and level of autonomy came from the construction of attributes that were built over time based on multiple factors, including previous experience, geographical location, critical incidents, training and supportive work environments.
CONCLUSION
The sonography profession demands autonomy and a strong professional identity free of hierarchical barriers within a collaborative model of care.
引言
与英国不同，澳大利亚的政策规定，在出现不良检查结果时，超声检查技师在与孕妇沟通的程度上没有自主权。组织结构使超声检查技师依赖于超声科医生，因为超声检查技师无权提供官方报告。鉴于超声检查期间其沟通受到限制，超声检查技师在努力提供以患者为中心的护理时，情感劳动增加。本研究的目的是探讨澳大利亚超声检查技师对传达不良检查结果的看法，包括他们在与患者沟通方面的自主程度以及这如何影响他们的职业认同感。
方法
在全国范围内进行调查之后，七名经过有目的挑选、有资格进行产科超声检查的参与者完成了后续访谈。对访谈进行了主题分析，并与调查结果进行了反复比较。三个案例研究表明，由于地理位置和工作场所环境的不同，超声检查技师的“沟通者类型”也有所不同。
结果
案例研究说明了超声检查技师的沟通角色，并且自主程度会根据每个工作场所的需求和期望进行协商/重新协商。由于超声科医生（放射科医生/产科医生）对超声检查技师/患者沟通的政策、在临床环境中的在场情况和支持，他们的沟通方式各不相同。强烈的职业认同感和自主程度来自于基于多种因素（包括以往经验、地理位置、关键事件、培训和支持性工作环境）随着时间推移而形成的特质。
结论
超声检查专业需要自主权和强烈的职业认同感，在协作护理模式中不受等级制度障碍的影响。
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