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是什么影响了护士在农村和偏远地区工作的决定?一项定性研究的系统评价和元综合。

What influences nurses' decisions to work in rural and remote settings? A systematic review and meta-synthesis of qualitative research.

机构信息

Health Sciences and Sport, University of Stirling, Stornoway, Isle of Lewis, Western Isles, UK

Department of Nursing & Midwifery, University of the Highlands and Islands, Centre for Health Science, Inverness, Scotland, UK

出版信息

Rural Remote Health. 2021 Mar;21(1):6335. doi: 10.22605/RRH6335. Epub 2021 Mar 3.

Abstract

INTRODUCTION

Due to global nursing shortages, recruitment and retention of nurses is a major international concern, exacerbated in rural and remote areas. Existing research reveals that individual factors influence healthcare professionals' decision making to work in rural and remote settings. However, existing evidence does not fully consider the multiple influences that may impact nurses' decisions to remain or leave rural and remote areas. This limits the effectiveness of recruitment and retention strategies. The objectives of this study were to explore the influences on nurses' decisions to work in rural and remote healthcare settings, using a systematic review and thematic meta-synthesis of qualitative studies.

METHODS

Databases Medline, Journals@OVID Full text, PsycInfo and specialist journals were searched from January 1990 to January 2020. Inclusion criteria were applied to all records by two independent reviewers. The Critical Appraisal Skills Programme checklist for qualitative studies was used for independent quality critique by two reviewers. Thematic synthesis was conducted using a three step process: (1) the results sections of each article were extracted and inductively coded line by line; (2) master themes and subthemes were organised into tables; (3) relationships between the themes were identified and examined to develop an overarching analytical framework.

RESULTS

A total of 121 articles were screened and 40 were included for data extraction and thematic synthesis. Thematic analysis identified three interrelated dimensions that influenced nurses' retention and migration decision-making, namely 'person/al', 'profession/al' and 'place' with 18 inter-related domains. The 'person/al' dimension contained five domains: a sense of belonging/connectedness, knowledge of rural culture, blurring of personal and professional lives, anonymity and job satisfaction/stress. The 'profession/al' dimension contained eight domains: expert generalist, advanced nurse practitioner, professional isolation, mentorship, education, autonomy and empowerment, role conflict, and recruitment and retention. The 'place' dimension identified five domains: terrain and weather, fewer resources, geographical isolation, safety and rural culture. The data informed the development of the MacKay's 3P (person/al, profession/al and place) model to capture the complex phenomenon of the influences on nurses' decision making to work in rural and remote settings.

CONCLUSION

Multiple dimensions and domains influence nurses' decision making to work in rural and remote settings. MacKay's 3P model provides a theoretical framework to explore the complex interplay between the person/al, profession/al and place-related dimensions of rural nursing. These findings can inform the development of future recruitment and retention initiatives.

摘要

简介

由于全球护理人员短缺,招聘和留住护士是一个主要的国际关注点,在农村和偏远地区更是如此。现有研究表明,个人因素会影响医疗保健专业人员在农村和偏远地区工作的决策。然而,现有证据并没有充分考虑到可能影响护士留在或离开农村和偏远地区的多种影响。这限制了招聘和保留策略的有效性。本研究的目的是使用系统评价和定性研究的主题综合方法,探讨影响护士在农村和偏远医疗保健环境中工作的因素。

方法

从 1990 年 1 月到 2020 年 1 月,我们在 Medline、Journals@OVID 全文、PsycInfo 和专业期刊等数据库中进行了搜索。两名独立评审员对所有记录应用了纳入标准。使用定性研究的批判性评估技能计划清单对两名评审员进行独立质量评估。使用三步过程进行主题综合:(1)从每篇文章的结果部分逐行提取和归纳编码;(2)将主要主题和子主题组织成表格;(3)确定和检查主题之间的关系,以制定一个总体分析框架。

结果

共筛选出 121 篇文章,其中 40 篇文章用于数据提取和主题综合。主题分析确定了影响护士留任和迁移决策的三个相互关联的维度,即“个人/职业”和“地点”,其中有 18 个相互关联的领域。“个人/职业”维度包含五个领域:归属感/联系感、农村文化知识、个人生活和职业生活的模糊性、匿名性和工作满意度/压力。“职业”维度包含八个领域:专家通才、高级执业护师、职业隔离、导师制、教育、自主权和赋权、角色冲突以及招聘和保留。“地点”维度确定了五个领域:地形和天气、资源较少、地理隔离、安全和农村文化。这些数据为麦凯的 3P(个人/职业和地点)模型的发展提供了信息,该模型用于捕捉影响护士在农村和偏远地区工作决策的复杂现象。

结论

多个维度和领域影响护士在农村和偏远地区工作的决策。麦凯的 3P 模型提供了一个理论框架,用于探索农村护理中人与职业和地点相关维度之间的复杂相互作用。这些发现可以为未来的招聘和保留计划提供信息。

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