자연주의적 탐구조사(Naturalistic Inquiry)

国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題

Public Management Reform. A Comparative Analysis

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Cognition In The Wild

by J. Biggs and C. Tang, Maidenhead, England,
Open University Press, 2007, 360 pp., £29.99, ISBN-13: 978-0-335-22126-4

Teaching for quality learning at university

Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs. A systematic search of relevant databases, using MeSH descriptors ED/EDs, Emergency room/s, ER/s, or A&E coupled with (and) working environment, working condition/s, staff perception/s, as well as reference chaining was conducted. We identified 31 key studies that were evaluated using the mixed methods assessment tool (MMAT). These comprised 24 quantitative-descriptive studies, four mixed descriptive/comparative (non-randomised controlled trial) studies and three qualitative studies. Studies included varied widely in quality with MMAT scores ranging from 0% to 100%. A key finding was that perceptions of working environment varied across clinical staff and study location, but that high levels of autonomy and teamwork offset stress around high pressure and high volume workloads. The large range of tools used to assess staff perception of working environment limits the comparability of the studies. A dearth of intervention studies around enhancing working environments in EDs limits the capacity to recommend evidence-based interventions to improve staff morale.

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Review article: Staff perception of the emergency department working environment: Integrative review of the literature

– The purpose of this paper is to study why collaboration among police, fire, and ambulance services is minimised at accident scenes., – Observations and semi‐structured interviews were carried out during 2007‐2008. The data material comprises a total of 248 hours of observations on 20 occasions and 57 interviews with 80 people., – The study identifies the difference between rhetoric and practice in connection with accident work. Collaboration is seen as a rhetorical ideal rather than something that is carried out in normal practice. Asymmetry, uncertainty and lack of incentives are important explanations as to why only limited forms of collaboration are actually implemented., – The paper shows a distinction between collaboration as rhetoric and practical collaboration at accident scenes., – The article proposes a multi‐faceted collaboration concept. In this way, collaboration can be developed and refined., – The results of the study show that police, fire, and ambulance services want to develop excellent forms of collaboration at the accident scene, but avoid this as it leads to uncertainty and asymmetries and because of a lack of incentives. However, simpler forms of collaboration may be realistic in the organisation of everyday work at accident scenes.

Why is collaboration minimised at the accident scene?: A critical study of a hidden phenomenon

Purpose – The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had experienced extensive change during a research project implementing person‐centred care (PCC) for patients with chronic heart failure.Design/methodology/approach – Surveys were sent out to 170 nurses. The survey included two instruments – the Organisational Values Questionnaire (OVQ) and the Resistance to Change Scale (RTC).Findings – The results indicate that a culture with a dominating focus on social competence decreases “routine seeking behaviour”, i.e. tendencies to uphold stable routines and a reluctance to give up old habits. The results indicate that a culture of flexibility, cohesion and trust negatively covariate with the overall need for a stable and well‐defined framework.Practical implications – An instrument that pinpoints the conditions of a particular healthcare setting can improve the results of a chang...

Eric Carlström

Papers

Review article: Staff perception of the emergency department working environment: Integrative review of the literature

Why is collaboration minimised at the accident scene?: A critical study of a hidden phenomenon

Organisational culture and change: implementing person-centred care.

Manchester Triage in Sweden – Interrater reliability and accuracy

Organizational culture and the implementation of person centered care: Results from a change process in Swedish hospital care