Department of Family Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Côte-des-Neiges Road, 3rd floor, suite 300, room 328, Montreal, QC, H3S 1Z1, Canada.
Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
BMC Prim Care. 2024 May 21;25(1):178. doi: 10.1186/s12875-024-02415-3.
Solo medical practices in primary healthcare delivery have been abandoned in favor of interdisciplinary teamwork in most Western countries. Dynamics in interdisciplinary teams might however be particularly difficult when two or more autonomous health professionals develop similar roles at the practice level. This is the case of family physicians (FPs) and nurse practitioners (NPs), due to the fact that the latter might accomplish not only the traditional role proper to a nurse, but also several medical activities such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications in regard of the development of professional identities, and consequently of the quality of health care delivered, have been suggested, but rarely examined empirically. The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams.
A longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed.
For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals' identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.
在大多数西方国家，单一的医疗实践已经在初级保健服务中被摒弃，转而采用跨学科团队合作。然而，当两个或更多自主的卫生专业人员在实践层面上发展出相似的角色时，跨学科团队的动态可能会特别困难。这种情况发生在家庭医生（FP）和护士从业者（NP）身上，因为后者不仅可以完成传统的护士角色，还可以执行一些医疗活动，如要求进行诊断检查和开处医疗处方。这种重叠可能产生的紧张关系，以及它们对专业身份发展的影响，进而对提供的医疗保健质量的影响，已经被提出，但很少有实证研究。本研究的目的是考察身份工作，即共同在初级保健跨学科团队中工作的 NP 和 FP 的（重新）构建专业身份的过程。
提出了一个纵向的、解释性的、比较的多案例（n=2）案例研究。采用组织中的身份工作理论作为理论视角。案例来自加拿大两个不同省份的城市初级保健多学科团队：魁北克和安大略。参与者是 NP、FP、经理和患者。数据收集包括音频日记、个人半结构化和焦点小组访谈、观察和档案材料。采用叙事和隐喻技术对收集到的数据进行分析。将进行案例内和案例间分析。
对于实践，这项研究的结果将：（a）为临床医生、初级保健经理和负责实施初级保健服务中跨学科团队合作的政策决策者提供工具，以改善决策过程和初级保健团队的绩效随着时间的推移；（b）为支持跨学科初级保健组织中卫生专业人员身份构建能力的持续跨学科专业发展教育举措提供信息。对于研究，该项目将有助于丰富卫生专业人员身份构建动态的理论，涵盖卫生服务和初级保健教育研究领域。
