Zink Silje, Kjeken Ingvild, Feiring Marte
Diakonhjemmet Hospital, REMEDY Center for Treatment of Rheumatic and Musculoskeletal Diseases, Health Service Research and Innovation Unit, Oslo, Norway.
Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway.
J Multidiscip Healthc. 2024 Aug 15;17:3995-4009. doi: 10.2147/JMDH.S467297. eCollection 2024.
The pressure on professionals within the healthcare workforce is increasing due to staffing shortages, economic demands and changing care models. Through boundary work theories, our study explores how task-shifting in hand osteoarthritis (OA) care impacts the professional boundaries and division of labor between rheumatologists and occupational therapists (OTs) in Norwegian specialist healthcare.
Seventeen semi-structured qualitative interviews were conducted at two hospitals in Norway. Participants included ten rheumatologists and five OTs. Data were analyzed using reflexive thematic analysis.
The analysis resulted in three themes (1) Forms of responsibility and task transfers, (2) Circumventing the rules to ensure efficient practices and appropriate patient care, (3) Broadening and specializing; movement of professional demarcations. Overall, we found that medical tasks in hand OA care are increasingly delegated to, and adopted by, OTs, blurring the rheumatologist-OT boundary. Some of the task delegations skirted Norwegian legal boundaries, in efforts to streamline clinic operations. OTs expanded their scope of practice by adopting new tasks, whereas rheumatologist increased their specialist status by shedding unwanted tasks.
Task shifting between rheumatologists and OTs in hand OA care was characterized by boundary blurring activities. The results support a shift in hand OA management from rheumatologists to OTs.
由于人员短缺、经济需求和护理模式的变化，医疗保健劳动力中的专业人员面临的压力日益增大。通过边界工作理论，我们的研究探讨了手部骨关节炎（OA）护理中的任务转移如何影响挪威专科医疗保健中风湿病学家和职业治疗师（OT）之间的专业界限和分工。
在挪威的两家医院进行了17次半结构化定性访谈。参与者包括10名风湿病学家和5名职业治疗师。使用反思性主题分析对数据进行分析。
分析得出三个主题：（1）责任形式和任务转移；（2）规避规则以确保高效实践和适当的患者护理；（3）拓宽和专业化；专业界限的变动。总体而言，我们发现手部OA护理中的医疗任务越来越多地委托给OT并由其承担，这模糊了风湿病学家与OT之间的界限。一些任务委托规避了挪威的法律界限，以努力简化诊所运营。OT通过承担新任务扩大了其执业范围，而风湿病学家则通过摆脱不必要的任务提高了其专科地位。
手部OA护理中风湿病学家和OT之间的任务转移以边界模糊活动为特征。结果支持手部OA管理从风湿病学家向OT的转变。
