紧急医疗服务人员感知到的临床决策中的主要挑战和障碍：定性内容分析。
Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis.
机构信息
Department of Medical Surgical Nursing, Fasa University of Medical Sciences, Fasa, 81936-13119, Iran.
Community-based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
出版信息
BMC Emerg Med. 2021 Jan 19;21(1):11. doi: 10.1186/s12873-021-00408-4.
BACKGROUND
Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel.
METHODS
The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis.
RESULTS
The results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues.
CONCLUSION
The results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel's professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel's clinical decision-making skill.
背景
由于需要在不可预测和危急的条件下工作，急救服务（EMS）人员在事故现场会遇到复杂的情况，这不可避免地会影响他们的临床决策。目前，针对这些专业人员所面临的挑战的研究还很缺乏。因此，本研究旨在从 EMS 人员的角度探讨影响临床决策的主要挑战和障碍。
方法
本研究是一项定性研究，采用内容分析方法。通过目的性抽样，选取符合纳入标准的 25 名伊朗 EMS 人员作为研究对象。研究时间为 2019 年 12 月至 2020 年 7 月。通过保持采样到数据饱和。使用半结构化、深入的个人访谈收集数据。使用定性内容分析对收集的数据进行分析。
结果
数据分析的结果分为四个主题和八个类别。主要主题包括专业能力、职业和环境因素、组织管理效率低下和道德问题。
结论
本研究结果表明，临床知识、经验和技能有助于急救人员做出临床决策的专业能力。良好的团队合作技能和时间管理可以防止在需要处理的伤员数量较大时感到困惑。有效的临床决策技能不仅可以帮助人员做出正确的决策，还可以增强他们的适应力，使他们能够适应困难和不可预测的情况。专业因素、组织管理和道德问题是影响事故现场急救人员临床决策的其他主要因素，决定了他们临床表现的质量。因此，院前急救管理人员提高 EMS 人员临床决策技能的质量至关重要。
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