Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care
Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care
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DOI：
10.1016/j.socscimed.2015.12.002
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发表时间：
2016-02-01
影响因子：
5.4
通讯作者：
Scaratti, Giuseppe
中科院分区：
文献类型：
--
作者：
Liberati, Elisa Giulia;Gorli, Mara;Scaratti, Giuseppe
提供跨学科综合护理是当代卫生政策的核心。因此，世界各地的医院正试图摆脱围绕学科专业化建立的功能性护理组织，转向通过多学科团队提供护理的方法。然而，这种团队的存在可能并不能保证跨医学学科的综合和协作工作，这可能会受到专业之间和专业内部界限的阻碍。本文分析了影响新创建的多学科团队的合作和护理整合的边界。经验数据来自一项在意大利公立医院亚密集卒中单元进行的人种学研究。数据收集涉及180小时的观察和与42名医疗保健提供者的对话。研究结果表明，学科界限阻碍专业内部和专业间的合作。不同学科的医生采用不同的临床方法，有时甚至相互冲突，医生和护士构建了特定学科的专业身份，不同学科的医生和护士在医疗护理边界的规范上产生了冲突。实现来自不同学科的专业人员之间的合作和整合可能是特别具有挑战性的，当一组较少的机构权力（护士，在这种情况下）已经制定了一个高水平的专业知识的需要，病人的目标团队。因此，有效的跨学科工作不仅需要弥合医疗专业群体内部的界限，而且还需要解决合并具有不同学科背景的医生和护士时的阻力动态。在本文中，我们在一个框架中总结了这些结果，该框架为医疗保健专业边界领域提供了知识，同时提供了实用的见解，以建立新的跨学科关系，这些关系更多地嵌入到护理提供者的日常经验中。(C)2015爱思唯尔有限公司版权所有。
Delivery of interdisciplinary integrated care is central to contemporary health policy. Hospitals worldwide are therefore attempting to move away from a functional organisation of care, built around discipline-based specialisation, towards an approach of delivering care through multidisciplinary teams. However, the mere existence of such teams may not guarantee integrated and collaborative work across medical disciplines, which can be hindered by boundaries between and within professions. This paper analyses the boundaries that affect collaboration and care integration in newly created multidisciplinary teams. Empirical data are drawn from an ethnographic research conducted in the sub-intensive stroke unit of an Italian public hospital. Data collection involved 180 h of observations and conversations with 42 healthcare providers. Findings show that disciplinary boundaries hinder both intra-professional and inter-professional collaboration. Doctors from different disciplines adopt different, and sometimes conflicting, clinical approaches, doctors and nurses construct discipline-specific professional identities, and conflicts emerge between doctors and nurses from different disciplines over the regulation of the medical nursing boundary. Achieving collaboration and integration between professionals from different disciplines may be particularly challenging when the group with less institutional power (nurses, in this case) has developed a high level of expertise on the needs of the patients targeted by the team. Effective interdisciplinary work thus requires not only bridging boundaries within the medical professional group, but also addressing the dynamics of resistance in merging doctors and nurses with different disciplinary backgrounds. In the paper, we summarise these results in a framework that contributes knowledge to the field of professional boundaries in healthcare while offering practical insights to forge new interdisciplinary relationships, which are more embedded in the daily experience of care providers. (C) 2015 Elsevier Ltd. All rights reserved.