卫生保健专业人员的社会行为改变干预:影响和效果。

IF 4.9 1区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES Medical Education Pub Date : 2024-08-31 DOI:10.1111/medu.15516
Chinmay Shah, Fouzia Shersad
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引用次数: 0

摘要

在医疗保健领域,尤其是在急诊科内,由于网上流传的错误信息、病人和亲属的痛苦、快速决策的要求以及不合理的高工作量等多种因素,工作人员承受着巨大的压力。政府医护人员还面临着来自公众的额外压力,公众认为自己作为纳税人有权要求提供服务,从而导致急诊科出现混乱。这种长期的压力会导致生理和心理健康问题、工作满意度下降以及人员流失。心理伤害可能表现为同情疲劳,对病人的同情减少,这可能会导致在急诊环境中的不当行为,并加剧紧张局势。当病人和亲属愤怒时,这种情况会进一步升级,导致重大事故。职业倦怠很常见,会增加医疗失误、药物滥用和心理健康危机(包括自残和自杀风险)的易感性。因此,急诊人员亟需掌握必要的技能,以应对他们经常面临的挑战。经伦理委员会批准后,我们使用 Baitha 等人验证过的工具1 寻求对这种社会行为干预的需求,与此同时,其他医学院使用的现有社会行为沟通课程(SBCC)模块也得到了加强,并得到了国家级专家的验证。为教授该课程的教师开展了培训员培训计划。急诊医学科的工作人员应邀对 SBCC 课程表达了兴趣。参加者包括保安、技术和护理人员,以及初级/高级研究生/住院医师和教职员工(最高达主任和教授级别)。其中男性占 74.4%,女性占 35.3%。年龄分布如下24.2%(20-25 岁)、56.8%(26-30 岁)、15.8%(31-35 岁)和 3.2%(35 岁)。根据所确定的需求,组织了为期一天的综合培训课程,其中包括一个前测、后测和反馈机制,以衡量柯克帕特里克一级和二级水平的有效性。工作坊获得了很高的评价,在目标明确性、参与者参与度、主题相关性、内容组织和增强有效医患沟通知识等不同标准上,反馈分数从 3.8 分到 4 分不等(满分 5 分)。学员还对时间分配、场地和视听设施表示满意。据统计,学员在人际沟通、社交礼仪、管理期望值、宽恕、悲伤辅导、人群管理、冲突预防、压力管理和心理健康意识(包括自杀预防)等方面都取得了明显进步。学员们认识到了工作坊在他们的临床实践和住院实习中的实用性。Chinmay Shah:构思;调查;写作--原稿;方法;验证;可视化;正式分析;项目管理;数据整理;监督;资源;资金获取。Fouzia Shersad:构思;调查;撰写--原稿;方法论;验证;可视化;正式分析;监督;数据整理。
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Socio-behaviour change intervention in health care professionals: Impact and effectiveness

In the health care domain, particularly within the emergency department, staff endures significant stress due to several factors, such as misinformation circulating online, patient and relative distress, the requirement of rapid decision-making, and an unreasonably high workload. Government health care workers face additional pressure from the public, who feel entitled to demand services as taxpayers, leading to chaos in the emergency department. This chronic stress can lead to physical and psychological health issues, decreased job satisfaction and attrition from the profession. The psychological toll can manifest as compassion fatigue, diminishing empathy for patients, which may precipitate inappropriate conduct in emergency settings and exacerbate tense situations. This will further escalate when patients and relatives are angry and lead to major mishaps. Burnout is common, increasing susceptibility to medical errors, substance abuse and mental health crises, including self-harm and suicide risks. Therefore, it was identified that there was a crucial need to equip emergency staff with the necessary skills to navigate the frequent challenges they face.

Following ethics committee approval, the felt need for such a socio-behavioural intervention was sought using tool validated by Baitha et al1 Alongside this, the existing Socio-Behavioural Communication Course (SBCC) module, which was being used in other medical schools was enhanced and validated by state level resource persons. A Train-the-Trainer program was conducted for the faculty who will teach this course. Expressions of interest for the SBCC Course were invited from the staff of the emergency medicine department. The participants included security, technical and nursing staff, as well as junior/senior postgraduate students/residents and faculty up to the head and professor levels. Out of the participants, 74.4% were Male and 35.3% were Female. Age distribution was as follows: 24.2% (20–25 years), 56.8% (26–30 years), 15.8% (31–35 years) and 3.2% (>35 years). A comprehensive one-day training session was organised based on the needs identified, incorporating a pre-test, post-test and feedback mechanism to measure effectiveness in reference to Kirkpatrick levels one and two.

The intervention was met with robust support from the administration and active participation by the attendees. The workshop was rated highly, with feedback scores ranging from 3.8 to 4 out of 5 across various criteria, such as clarity of objectives, participant engagement, topic relevance, content organisation and enhancement of knowledge concerning effective patient communication. The participants also expressed satisfaction with the time allocation, venue and audiovisual facilities. Statistically significant improvements were observed in the domains of interpersonal communication, social etiquette, managing expectations, forgiveness, grief counselling, crowd management, conflict prevention, stress management and mental health awareness, including suicide prevention. The participants recognised the workshop's utility in their clinical practice and residency. Further studies can be done to validate the benefits in the clinics.

Chinmay Shah: Conceptualization; investigation; writing – original draft; methodology; validation; visualization; formal analysis; project administration; data curation; supervision; resources; funding acquisition. Fouzia Shersad: Conceptualization; investigation; writing – original draft; methodology; validation; visualization; formal analysis; supervision; data curation.

There is no conflict of interest.

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来源期刊
Medical Education
Medical Education 医学-卫生保健
CiteScore
8.40
自引率
10.00%
发文量
279
审稿时长
4-8 weeks
期刊介绍: Medical Education seeks to be the pre-eminent journal in the field of education for health care professionals, and publishes material of the highest quality, reflecting world wide or provocative issues and perspectives. The journal welcomes high quality papers on all aspects of health professional education including; -undergraduate education -postgraduate training -continuing professional development -interprofessional education
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