职业敬畏是 (不) 足够的:从早期采用严重疾病沟通的早期采用者的学习
Patrick Malecha1, Alexis Drutchas2, Jenny Klintman3
1Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, USA.
Journal of pain and symptom management
|May 21, 2025
概括
经常记录严重疾病对话的临床医生受到职业敬畏的激励,并通过积极的框架和最大限度地减少系统障碍来整合护理. 然而,可持续的做法需要系统的支持,包括时间和资源.
科学领域:
- 主要护理是指初级护理.
- 医学教育 医学教育
- 医疗保健管理的管理
背景情况:
- 在一个多站点的学术初级保健实践中实施了一项严重疾病护理计划.
- 在两年后,在少数临床医生中观察到严重疾病对话的例行记录.
研究的目的:
- 了解临床医生的动机和行为,他们经常进行和记录严重疾病对话.
主要方法:
- 确定的初级保健医生记录严重疾病对话 (17/228).
- 与15位早期采用者进行了半结构化采访.
- 使用专题分析分析了采访数据.
主要成果:
- 早期采用者通过放大"职业敬畏" (核心专业价值) 来整合严重疾病对话.
- 策略包括:反思影响,与身份/价值观保持一致,并感知对良好护理的贡献.
- 通过接受时间限制和简化工作流程来实现最大限度地减少系统限制.
结论:
- 职业敬畏推动了严重疾病的沟通,但需要系统支持以实现可持续性.
- 大多数临床医生没有足够的资源,就无法保持持续的动力.
- 常规的严重疾病沟通需要分配时间,补偿和工作流程支持.
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