PDF(Pubmed)
Abstract：
BACKGROUND: Solo medical practices in primary healthcare delivery have been abandoned in favor of interdisciplinary teamwork in most Western countries. Dynamics in interdisciplinary teams might however be particularly difficult when two or more autonomous health professionals develop similar roles at the practice level. This is the case of family physicians (FPs) and nurse practitioners (NPs), due to the fact that the latter might accomplish not only the traditional role proper to a nurse, but also several medical activities such as requesting diagnostic exams and prescribing medical treatments. The tensions that this overlap might generate and their implications in regard of the development of professional identities, and consequently of the quality of health care delivered, have been suggested, but rarely examined empirically. The goal of this study is to examine identity work, i.e., the processes of (re)construction of professional identities, of NPs and FPs working together in primary care interdisciplinary teams.
METHODS: A longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed.
CONCLUSIONS: For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals\' identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.
METHODS: A longitudinal, interpretive, and comparative multiple (n = 2) case study is proposed. Identity work theory in organizations is adopted as theoretical perspective. Cases are urban primary care multidisciplinary teams from two different Canadian provinces: Quebec and Ontario. Participants are NPs, FPs, managers, and patients. Data gathering involves audio-diaries, individual semi-structured and focus group interviews, observations, and archival material. Narrative and metaphor techniques are adopted for analyzing data collected. Within- and cross-case analysis will be performed.
CONCLUSIONS: For practice, the results of this investigation will: (a) be instrumental for clinicians, primary care managers, and policy decision-makers responsible for the implementation of interdisciplinary teamwork in primary healthcare delivery to improve decision-making processes and primary care team performance over time; (b) inform continuing interdisciplinary professional development educational initiatives that support competency in health professionals\' identity construction in interdisciplinary primary care organizations. For research, the project will contribute to enriching theory about identity construction dynamics in health professions, both in the fields of health services and primary care education research.
摘要：
背景：在大多数西方国家，初级医疗保健服务中的单独医疗实践已被放弃，取而代之的是跨学科团队合作。然而，当两个或多个自主卫生专业人员在实践层面发挥类似作用时，跨学科团队的动态可能特别困难。这是家庭医生(FP)和护士从业人员(NP)的情况，由于后者不仅可以完成护士的传统角色，还有一些医疗活动，如要求诊断检查和处方治疗。这种重叠可能产生的紧张关系及其对职业身份发展的影响，以及因此提供的医疗保健质量，有人建议，但很少进行实证检验。这项研究的目的是检查身份工作，即，职业身份(重新)建构的过程，NP和FP在初级保健跨学科团队中共同努力。
方法：纵向，解释性的,并提出了比较多(n=2)案例研究。组织中的身份工作理论被作为理论视角。病例是来自加拿大两个不同省份的城市初级保健多学科小组：魁北克和安大略省。参与者是NP，FPs,经理,和病人。数据收集涉及音频日记，个人半结构化和焦点小组访谈，观察,和档案材料。采用叙事和隐喻技术对收集的数据进行分析。将进行案例分析和跨案例分析。
结论：对于实践，这项调查的结果将：(a)对临床医生有帮助，初级保健经理，和政策决策者负责在初级卫生保健提供中实施跨学科团队合作，以随着时间的推移改善决策过程和初级保健团队绩效；(b)为持续的跨学科专业发展教育举措提供信息，以支持跨学科初级保健组织中卫生专业人员的能力建设。为了研究，该项目将有助于丰富有关卫生专业身份建构动态的理论，在卫生服务和初级保健教育研究领域。
方法：纵向，解释性的,并提出了比较多(n=2)案例研究。组织中的身份工作理论被作为理论视角。病例是来自加拿大两个不同省份的城市初级保健多学科小组：魁北克和安大略省。参与者是NP，FPs,经理,和病人。数据收集涉及音频日记，个人半结构化和焦点小组访谈，观察,和档案材料。采用叙事和隐喻技术对收集的数据进行分析。将进行案例分析和跨案例分析。
结论：对于实践，这项调查的结果将：(a)对临床医生有帮助，初级保健经理，和政策决策者负责在初级卫生保健提供中实施跨学科团队合作，以随着时间的推移改善决策过程和初级保健团队绩效；(b)为持续的跨学科专业发展教育举措提供信息，以支持跨学科初级保健组织中卫生专业人员的能力建设。为了研究，该项目将有助于丰富有关卫生专业身份建构动态的理论，在卫生服务和初级保健教育研究领域。
