Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.
Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.
复制标题
使用定性方法进行多次三角剖分和协作研究，以探索院前急诊室中的决策。
DOI：
10.1186/s12874-017-0290-z
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发表时间：
2017-01-24
影响因子：
4
通讯作者：
Siriwardena AN
中科院分区：
文献类型：
--
作者：
Johnson M;O'Hara R;Hirst E;Weyman A;Turner J;Mason S;Quinn T;Shewan J;Siriwardena AN
护理人员在现场对病人护理做出重要且日益复杂的决定。在院前环境中，患者安全影响对决策的影响先前研究不足。前沿观点主张探索整个系统，而不是个体对患者安全的影响。民族志（对人民和文化的研究）已被认为是确定在自然环境中发生的卫生保健问题的适当方法。在本文中，我们比较了多地点定性研究中使用的多种方法，旨在确定系统对决策的影响。这项研究是在英格兰的三个NHS救护车信托基金进行的，每个信托基金的研究人员都与学术研究人员一起工作。与关键线人（如经理）（n = 16）的探索性访谈和文件审查提供了上下文信息。在2012年10月至2013年7月期间，研究人员观察到34名护理人员轮班，10名护理人员通过录音的“数字日记”提供了额外的记录（155个事件）。三个工作人员焦点小组（共21人）和三个服务用户焦点小组（共23人）探讨了一系列经验和看法。数据收集和分析由学术和救护车服务研究人员以及服务用户进行。在每个地点都举行了讲习班，以征求对调查结果的反馈，并促进确定问题的优先次序。多方法定性方法的使用允许对救护车服务人员和服务用户的重要问题进行交叉验证。成功实施这项研究的一个关键因素是与学术和救护车服务团队建立良好的工作关系。在每个站点招收至少一名研究负责人有助于招募过程和研究进展。积极参与这项研究使救护服务的研究人员和服务使用者能够更好地了解研究过程。反馈研讨会允许利益相关者讨论和确定研究成果的优先顺序，并确定新的研究领域。将多种定性方法与合作研究方法相结合，可以促进在研究不足的情况下探索系统对患者安全的影响。本文强调了这种方法的实证问题、优势和局限性。反馈讲习班对于核实调查结果和确定未来干预和研究的优先领域是有效的。
Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research process. Feedback workshops allowed stakeholders to discuss and prioritise findings as well as identify new research areas. Combining multiple qualitative methods with a collaborative research approach can facilitate exploration of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for future intervention and research.