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Using self-efficacy and transformative learning theories to examine interprofessional collaborative practice at end of life in the ICU between nurses and physicians.

机译：使用自我效能感和变革性学习理论来检查护士和医生之间ICU生命终结时的跨专业协作实践。

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摘要

This dissertation will follow the manuscript style and is aimed to gain a better understanding of the collaboration process between nurses and physicians when they care for patients at end of life in a practice environment historically viewed as a setting for saving life's, the intensive care. The first manuscript is a qualitative study investigating nurses' ability to recognize dying in the prolonged mechanically ventilated patient. Using Strauss and Corbin (1998) grounded theory approach of a constant comparative method, two themes emerged. The first theme describes how nurses recognized two types of dying in the prolonged mechanically ventilated patient. The second theme describes the process in which the assessment of dying was communicated to the patient, family and other members of the healthcare team and their view of the physician's communication of dying to the patient and family. The findings from this confirmed that the participants can recognize dying following the premise of Porock's theory Recognizing Dying (2007, 2010) of an increased cognizance that patients under their care is near the end of life. The participants routinely expected to care for patients at end of life but felt the overall palliative purpose of the unit and the care to be delivered was not clearly communicated to the patient and family. This discrepancy led to difficulty in making the transition to comfort care. Nurses in the study were invited to attend family-team meetings where the team discussed the patient's prognosis and treatment plan but declined to attend. The nurses lacked the confidence to speak with the medical staff about their diagnosis of dying. They could determine the breakdown of the communication process but did not see their role as an integral component to improve communication and interprofessional collaboration. The second manuscript is an integrated literature review of research studies focused on interprofessional collaborative practice (IPCP) in the intensive care unit (ICU) between nurses and physicians. This review also examined IPCP between nurses and physicians in the ICU in end-of-life situations. Based on the results of the qualitative study of the first manuscript, the purpose of the integrated review was to identify research studies on the factors that impact IPCP in the ICU practice care setting when caring for dying patients. The synthesis of the literature indicated that the perceptions of healthcare professionals are that the ICU practice environment is complex, based on the bio-medical model, and utilizes advanced technology in managing and delivering the treatment plan. This environment focuses on medical knowledge as the foundation and often the subjective, complementary focus of nursing is not accepted as valid by medicine. Communication effects not only how professionals interact but is necessary for teamwork, development and implementation of the treatment plan and patient outcomes. Effective team work requires mutual respect among members, effective communication, and shared participation and responsibility in the decision making process which are the foundations of the core competencies of IPCP. The third manuscript is the final dissertation study which investigated the perceptions of nurses and physicians on the core competencies of IPCP using Self-Efficacy and Transformative Learning Theories as theoretical guides. The premise of this study theorized that ICU nurses have witnessed effective IPCP between their peers, physicians and communication scenarios between other members of the healthcare team. Nurses can reflect on these experiences and draw from their professional education and training to transform their behaviors and develop an outcome expectation that IPCP with physicians is obtainable. Although 75% of the nurses in this study reported having post licensure professional education and training in communication skills and teamwork, theoretically, reflection on this knowledge and skills should give nurses a means to improve how they communicate and work within the team however, the study did not find a correlation between professional education and training and years of intensive care experience to the core competencies of IPCP. The regression analysis showed that perceived authority for decision-making was a statistically significant predictor (? = -.514, p = .000) and professional valuing was marginally significant slightly above the alpha level of .05, p = .068. The regression model was significant F (4, 80) = 21.54, p < .001, and explained about 52% of the variance in IPCP. Findings from this study suggest that professional valuing, communication and most notably, perceived authority for decision-making have a statically significant impact on nurses' ability to engage in interprofessional collaborative behaviors with physicians in the intensive care practice environment when caring for patients who are at end of life.
机译：本论文将遵循手稿的风格，旨在更好地了解护士和医生在临终关怀的护理环境中的协作过程，而这种护理环境在历史上被视为拯救生命的重症监护环境。第一份手稿是一项定性研究，旨在调查护士在长时间机械通气患者中识别死亡的能力。使用Strauss和Corbin（1998）的基础的恒定比较方法理论方法，出现了两个主题。第一个主题描述了护士如何识别长时间机械通气患者中的两种死亡。第二个主题描述了将死亡评估传达给患者，家人和医疗团队其他成员的过程，以及他们对医师传达给患者和家人的垂死沟通的看法。由此得出的结果证实，参与者可以按照Porock的“认识死亡”理论（2007年，2010年）的前提认识到死亡，这种认识增加了人们对其所护理患者的生命即将尽头的认识。参加者通常希望在生命终了时照料患者，但感到该病房的总体姑息治疗目的以及所要提供的护理并未明确告知患者和家人。这种差异导致难以过渡到舒适护理。研究中的护士应邀参加了家庭团队会议，团队讨论了患者的预后和治疗计划，但拒绝参加。护士没有信心与医护人员谈论他们的垂死诊断。他们可以确定沟通过程的细目，但没有将其视为改善沟通和专业间协作的组成部分。第二份手稿是对护士和医生之间的重症监护病房（ICU）中跨专业协作实践（IPCP）的研究的综合文献综述。这项审查还检查了临终情况下ICU中护士和医生之间的IPCP。根据第一份手稿的定性研究结果，本综合综述的目的是确定有关护理临终患者时在ICU实习护理环境中影响IPCP的因素的研究。文献的综合表明，医疗保健专业人员认为，ICU诊疗环境基于生物医学模型是复杂的，并利用先进技术来管理和提供治疗计划。这种环境注重医学知识作为基础，医学上通常不接受主观的，相辅相成的护理重点。交流不仅影响专业人员之间的互动方式，而且对于团队合作，制定和实施治疗计划以及患者结果也是必不可少的。有效的团队合作需要成员之间的相互尊重，有效的沟通以及在决策过程中的共同参与和责任，这是IPCP核心能力的基础。第三篇论文是最后的论文研究，以自我效能感和变革性学习理论为指导，调查了护士和医生对IPCP核心竞争力的看法。这项研究的前提是，ICU护士已经见证了他们的同龄人，医生之间的有效IPCP以及医疗团队其他成员之间的交流情况。护士可以对这些经历进行反思，并从他们的专业教育和培训中汲取经验，以改变他们的行为，并期望获得与医生的IPCP。尽管本研究中有75％的护士报告对执照持有人进行过沟通技能和团队合作方面的专业教育和培训，但从理论上讲，对这种知识和技能的反思应为护士提供一种改善他们在团队内沟通和工作方式的方法。没有发现专业教育和培训与多年重症监护经验与IPCP核心能力之间存在关联。回归分析表明，决策者的感知权威是统计学上显着的预测指标（？= -.514，p = .000），专业评估的重要性略高于.05的alpha水平（p = .068）。回归模型的显着性F（4，80）= 21.54，p <.001，解释了IPCP的大约52％的方差。这项研究的结果表明，专业价值评估，沟通以及最显着的决策权对护士在护理重症监护实践环境中与医生在重症监护实践环境中从事专业间协作行为的能力具有静态的显着影响。生命的尽头。

著录项

  • 作者

    Ball, Edonn V.;

  • 作者单位

    State University of New York at Buffalo.;

  • 授予单位 State University of New York at Buffalo.;
  • 学科 Nursing.;Health care management.
  • 学位 Ph.D.
  • 年度 2016
  • 页码 178 p.
  • 总页数 178
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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