"病人醒了,我们需要保持冷静":面对医疗失误和专业失误,重新考虑间接沟通。

IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Advances in simulation (London, England) Pub Date : 2024-05-10 DOI:10.1186/s41077-024-00293-4
Taryn Taylor, Lauren Columbus, Harrison Banner, Natashia Seemann, Trevor Hines Duncliffe, Rachael Pack
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引用次数: 0

摘要

背景:尽管 "大声说出来 "作为一项重要的患者安全策略备受赞誉,但对于团队成员来说,要做到这一点仍然极具挑战性。为解决跨专业团队中的沉默问题,现有的工作包括培训低权威成员使用直接语言和明确的质疑脚本。尽管间接沟通在跨专业团队中普遍存在,但其在预防医疗差错方面的作用或价值在很大程度上仍未得到探讨。本研究探讨了间接质疑在面对医疗失误和专业失误时的作用:一个学术中心的产科医生作为部分演员参与了跨专业模拟。39 名参与者(13 名产科顾问、11 名产科住院医师、2 名家庭医学顾问、5 名助产士和 8 名产科护士)完成了 13 次迭代。30 名参与者完成了随后的半结构化访谈。为产科医生编写了五个挑战时刻的脚本,涉及故意的临床判断错误或违反职业道德的行为。其他参与者不知道产科医生的部分角色。对情景进行了录像;对汇报和访谈进行了录音和逐字记录,并采用建构主义定性方法进行了分析:结果:在模拟过程中,低权威团队成员主要依靠间接挑战脚本来促进患者安全。教员参与者非常乐于接受低权威团队成员的间接挑战,尤其是在清醒患者面前。在产科护理的背景下,参与者认为直接挑战实际上威胁到了患者的信任,并破坏了跨专业团队。与其把精力完全放在通过直接挑战来鼓励低权威团队成员畅所欲言上,不如把我们的注意力扩大到教会教师识别、倾听和应对已经在跨专业团队中大量存在的间接、微妙挑战上。
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"The patient is awake and we need to stay calm": reconsidering indirect communication in the face of medical error and professionalism lapses.

Background: Although speaking up is lauded as a critical patient safety strategy, it remains exceptionally challenging for team members to enact. Existing efforts to address the problem of silence among interprofessional teams involve training low-authority members to use direct language and unambiguous challenge scripts. The role or value of indirect communication in preventing medical error remains largely unexplored despite its pervasiveness among interprofessional teams. This study explores the role of indirect challenges in the face of medical error and professionalism lapses.

Methods: Obstetricians at one academic center participated in an interprofessional simulation as a partial actor. Thirteen iterations were completed with 39 participants (13 obstetrician consultants, 11 obstetric residents, 2 family medicine consultants, 5 midwives, and 8 obstetrical nurses). Thirty participants completed a subsequent semi-structured interview. Five challenge moments were scripted for the obstetrician involving deliberate clinical judgment errors or professionalism infractions. Other participants were unaware of the obstetrician's partial actor role. Scenarios were videotaped; debriefs and interviews were audio-recorded and transcribed verbatim and analyzed using a constructivist qualitative approach.

Results: Low-authority team members primarily relied on indirect challenge scripts to promote patient safety during simulation. Faculty participants were highly receptive to indirect challenges from low-authority team members, particularly in front of awake patients. In the context of obstetric care, direct challenges were actually viewed by participants as threatening to patient trust and disruptive to the interprofessional team. Instead of exclusively focusing our efforts on encouraging low-authority team members to speak up through direct challenges, it may be fruitful to expand our attention toward teaching faculty to identify, listen for, and respond to the indirect, subtle challenges that are already prolific among interprofessional teams.

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来源期刊
CiteScore
5.70
自引率
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审稿时长
12 weeks
期刊最新文献
Massive open online course: a new strategy for faculty development needs in healthcare simulation. Changing the conversation: impact of guidelines designed to optimize interprofessional facilitation of simulation-based team training. Speech recognition technology for assessing team debriefing communication and interaction patterns: An algorithmic toolkit for healthcare simulation educators. Effectiveness of hybrid simulation training on medical student performance in whole-task consultation of cardiac patients: The ASSIMILATE EXCELLENCE randomized waitlist-controlled trial. Using simulation scenarios and a debriefing structure to promote feedback skills among interprofessional team members in clinical practice.
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