儿科住院医师和护士之间的心理安全感和跨学科模拟课程的影响。
Psychological safety between pediatric residents and nurses and the impact of an interdisciplinary simulation curriculum.
机构信息
Department of Pediatric Emergency Medicine, Hasbro Children's Hospital, 593 Eddy St., Providence, RI, 02903, USA.
Department of Nursing, Mass General for Children, 55 Fruit St., Ellison 17, Boston, MA, 02114, USA.
出版信息
BMC Med Educ. 2022 Aug 29;22(1):649. doi: 10.1186/s12909-022-03709-9.
BACKGROUND
Effective teamwork in interdisciplinary healthcare teams is necessary for patient safety. Psychological safety is a key component of effective teamwork. The baseline psychological safety on pediatric inpatient healthcare teams is unknown. The purpose of this study is to determine the baseline psychological safety between pediatric nurses and residents and examine the impact of an interdisciplinary nighttime simulation curriculum.
METHODS
A convergent, multistage mixed methods approach was used. An interprofessional simulation curriculum was implemented fall 2020 to spring 2021. Qualitative focus group data and quantitative survey data on team psychological safety were collected and compared, both pre- and post-intervention and across nurses and residents. Thematic analysis of the qualitative data was conducted, and themes integrated with survey findings.
RESULTS
Data were collected from 30 nurses and 37 residents pre-intervention and 32 and 38 post-intervention, respectively. Residents and nurses negatively rated psychological safety (pre-intervention mean = 3.40 [SD = 0.72]; post-intervention mean = 3.35 [SD = 0.81]). At both times psychological safety was rated significantly lower for residents (pre-intervention mean = 3.11 [SD = 0.76], post-intervention mean = 2.98 [SD = 0.84]) than nurses (pre-intervention mean = 3.76 [SD = 0.45], post-intervention mean = 3.79 [SD = 0.50]), all P < .001. Qualitative analysis identified six integrated themes: (1) influence of existing relationships on future interactions, (2) unsatisfactory manner and frequency of communication, (3) unsatisfactory resolution of disagreements (4) overwhelming resident workload impairs collaboration, (5) interpersonal disrespect disrupts teamwork, and (6) interprofessional simulation was useful but not sufficient for culture improvement.
CONCLUSION
Resident-nurse team psychological safety ratings were not positive. While interprofessional simulation curriculum shows promise, additional efforts are needed to improve psychological safety among residents and nurses.
背景
有效的跨学科医疗团队合作对于患者安全至关重要。心理安全感是有效团队合作的关键组成部分。儿科住院医疗团队的基本心理安全感尚不清楚。本研究的目的是确定儿科护士和住院医师之间的基本心理安全感，并研究跨学科夜间模拟课程的影响。
方法
采用集中式、多阶段混合方法。2020 年秋季至 2021 年春季实施了一项跨专业模拟课程。在干预前后以及护士和住院医师之间，分别收集了关于团队心理安全感的定性焦点小组数据和定量调查数据。对定性数据进行了主题分析，并将主题与调查结果相结合。
结果
分别在干预前收集了 30 名护士和 37 名住院医师的数据，在干预后收集了 32 名和 38 名的数据。住院医师和护士对心理安全感的评价均为负面（干预前的平均得分为 3.40 [SD=0.72]；干预后的平均得分为 3.35 [SD=0.81]）。在这两个时间点，住院医师的心理安全感评分均显著低于护士（干预前的平均得分为 3.11 [SD=0.76]，干预后的平均得分为 2.98 [SD=0.84]），均 P<0.001。定性分析确定了六个综合主题：（1）现有关系对未来互动的影响，（2）沟通方式和频率不满意，（3）不满意的分歧解决方式，（4）住院医师工作量过大影响协作，（5）人际不尊重破坏团队合作，（6）跨专业模拟虽然有用，但不足以改善文化。
结论
住院医师与护士的团队心理安全感评分均不高。虽然跨专业模拟课程显示出前景，但还需要进一步努力来提高住院医师和护士的心理安全感。
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