未观察到的观察者：护士对分享住院医师绩效反馈的看法。
Unobserved Observers: Nurses' Perspectives About Sharing Feedback on the Performance of Resident Physicians.
机构信息
C. Bhat is a resident physician, Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: https://orcid.org/0000-0003-3198-6450 .
K.A. LaDonna is assistant professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada.
出版信息
Acad Med. 2022 Feb 1;97(2):271-277. doi: 10.1097/ACM.0000000000004450.
PURPOSE
Postgraduate training programs are incorporating feedback from registered nurses (RNs) to facilitate holistic assessments of resident performance. RNs are a potentially rich source of feedback because they often observe trainees during clinical encounters when physician supervisors are not present. However, RN perspectives about sharing feedback have not been deeply explored. This study investigated RN perspectives about providing feedback and explored the facilitators and barriers influencing their engagement.
METHOD
Constructivist grounded theory methodology was used in interviewing 11 emergency medicine and 8 internal medicine RNs at 2 campuses of a tertiary care academic medical center in Ontario, Canada, between July 2019 and March 2020. Interviews explored RN experiences working with and observing residents in clinical practice. Data collection and analysis were conducted iteratively. Themes were identified using constant comparative analysis.
RESULTS
RNs felt they could observe authentic day-to-day behaviors of residents often unwitnessed by supervising physicians and offer unique feedback related to patient advocacy, communication, leadership, collaboration, and professionalism. Despite a strong desire to contribute to resident education, RNs were apprehensive about sharing feedback and reported barriers related to hierarchy, power differentials, and a fear of overstepping professional boundaries. Although infrequent, a key stimulus that enabled RNs to feel safe in sharing feedback was an invitation from the supervising physician to provide input.
CONCLUSIONS
Perceived hierarchy in academic medicine is a critical barrier to engaging RNs in feedback for residents. Accessing RN feedback on authentic resident behaviors requires dismantling the negative effects of hierarchy and fostering a collaborative interprofessional working environment. A critical step toward this goal may require supervising physicians to model feedback-seeking behavior by inviting RNs to share feedback. Until a workplace culture is established that validates nurses' input and creates safe opportunities for them to contribute to resident education, the voices of nurses will remain unheard.
目的
研究生培训计划正在纳入注册护士（RN）的反馈，以促进对住院医师绩效的全面评估。RN 是反馈的潜在丰富来源，因为他们经常在没有医生主管在场的情况下观察受训者的临床情况。然而，RN 对分享反馈的看法并没有得到深入探讨。本研究调查了 RN 提供反馈的看法，并探讨了影响他们参与的促进因素和障碍。
方法
采用建构主义扎根理论方法，在加拿大安大略省的一个三级保健学术医疗中心的 2 个校区对 11 名急诊医学和 8 名内科 RN 进行了访谈，时间为 2019 年 7 月至 2020 年 3 月。访谈探讨了 RN 在临床实践中与住院医师合作和观察的经验。数据收集和分析是迭代进行的。使用恒定性比较分析确定主题。
结果
RN 认为他们可以观察到住院医师日常行为的真实性，这些行为往往是监督医生看不到的，并提供与患者倡导、沟通、领导、合作和专业精神相关的独特反馈。尽管强烈希望为住院医师教育做出贡献，但 RN 对分享反馈感到担忧，并报告了与等级制度、权力差异和害怕越界有关的障碍。尽管很少见，但使 RN 感到安全地分享反馈的一个关键刺激因素是监督医生邀请他们提供意见。
结论
学术医学中的等级观念是让 RN 参与对住院医师的反馈的一个关键障碍。要获取 RN 对住院医师真实行为的反馈，需要消除等级制度的负面影响，并培养一种协作的跨专业工作环境。实现这一目标的关键步骤可能需要监督医生通过邀请 RN 分享反馈来树立寻求反馈的行为模式。在建立一种认可护士的投入并为他们提供参与住院医师教育的安全机会的工作文化之前，护士的声音将继续被忽视。
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