دانلود رایگان مقاله انگلیسی کار گروهی در مراقبت های اولیه: پرستاران کارآموز و متخصص - NCBI 2018

Abstract

Background: Generalists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care. Methods: A qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically. Results: The ideal cooperation between GPs and ONs was as a “meeting of experts” with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs’ competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly. While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients. Conclusions: The complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.

Conclusions

The complementary competencies and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. GPs could be valid co-workers for ONs by making maximum use of their generalist competencies. By prioritizing palliative care as much as medical emergencies, as suggested by some participants, and by applying their previous knowledge of the patient, GPs could give ONs much of the crucial support they need. If GPs also gave priority to courses in palliative care [43], that would add value to their expertise. A business model where primary health care is mainly funded per capita could lead to more sustainable practices with several professions sharing patient care. Attention to different professional cultures of working and learning [44] has implications for quality improvement efforts. It is worth noting that some GPs’ surgeries act as communities of practice [45, 46] with common goals and standards. This form of collective organization for learning and quality improvement could be a way forward for the GP profession, and a way to overcome undesirable variations [4, 47] in competence and practice.