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“团队中的每个成员都确实需要带来拼图的下一块”:专职医疗人员在医院环境中提供跨专业复杂护理的经验。

"You do need each member of the team to bring that next piece of the puzzle": Allied health professionals' experience of interprofessional complex care in hospital settings.

作者信息

Borghmans Felice, Fernandes Venesser, Laletas Stella, Newnham Harvey

机构信息

Faculty of Education, Monash University, Clayton, Victoria, Australia.

Alfred Health, Melbourne, Victoria, Australia.

出版信息

PLoS One. 2025 Mar 14;20(3):e0317799. doi: 10.1371/journal.pone.0317799. eCollection 2025.

Abstract

This study explores the experiences of allied health professionals who work in interprofessional hospital complex care teams. The aim of the study was to identify factors influential to meaningful clinician experiences in these contexts. Increase in interprofessional complex care in hospital settings reflects rising population health complexity. Furthermore, growth in these models coincides with a heightened focus on health system efficiency due to rising healthcare costs, resource constraints, and health workforce shortfalls. Combined, these issues constitute a 'wicked problem'. However, research exploring the experiences of clinicians working under these conditions is limited, exposing the knowledge gap of interest to this study. Using a qualitative approach, in-depth interviews were conducted with allied health professionals engaged in hospital-based interprofessional complex care, and their narratives were analysed according to the conceptual framework of complex adaptive phenomenology. The study identified four interconnected themes: workplace culture and leadership, interprofessional practice, healthcare ethics, and the ambiguity of complex care. Furthermore, the notion of 'empowerment of self and others' was a continuous thread throughout, which appeared essential to effective interprofessional practice. The study showed how the clinician experience provides a window to the functioning of a healthcare system and the bearing of experience on healthcare efficiency and sustainability. Recommendations include developing a more balanced approach to 'efficiency' in policy settings, implementing structured leadership development programs within the allied health workforce, empowering under-graduate practitioners through education to work effectively with uncertainty, and increasing research into the clinician experience of interdisciplinary complex care practice.

摘要

本研究探讨了在跨专业医院综合护理团队中工作的专职医疗人员的经历。该研究的目的是确定在这些环境中对有意义的临床医生经历有影响的因素。医院环境中跨专业综合护理的增加反映了人群健康复杂性的上升。此外,这些模式的发展与由于医疗成本上升、资源限制和卫生人力短缺而对卫生系统效率的高度关注相吻合。综合起来,这些问题构成了一个“棘手问题”。然而,探索在这些条件下工作的临床医生经历的研究有限,这暴露了本研究感兴趣的知识差距。采用定性方法,对参与医院跨专业综合护理的专职医疗人员进行了深入访谈,并根据复杂适应性现象学的概念框架对他们的叙述进行了分析。该研究确定了四个相互关联的主题:工作场所文化与领导力、跨专业实践、医疗伦理以及综合护理的模糊性。此外,“自我与他人赋权”的概念贯穿始终,这似乎对有效的跨专业实践至关重要。该研究展示了临床医生的经历如何为医疗系统的运作以及经历对医疗效率和可持续性的影响提供了一个窗口。建议包括在政策制定中制定一种更平衡的“效率”方法,在专职医疗人员队伍中实施结构化的领导力发展计划,通过教育使本科实习医生有能力在不确定性下有效工作,以及增加对跨学科综合护理实践中临床医生经历的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b83e/11908697/098e846dc72d/pone.0317799.g001.jpg

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