Résumés
Abstract
Background: Teamwork in healthcare is shaped by reciprocal interactions among individual team members and their clinical context. Cultural Historical Activity Theory (CHAT) provides a framework to study teamwork from a developmental perspective. We observed interactions between members of an Interprofessional Healthcare Team (IHT) to identify practical guidelines for educators.
Method: Three Health Care Providers (HCPs) with more than 22-years’ experience in a semi-urban LTC facility participated. We video-recorded two regular IHT meetings and selected excerpts for subsequent video-recall interviews. The excerpts were shown and discussed first with each team member, then with members in pairs and finally with all members reunited. We prompted participants to explain what was happening on the videos. All interviews were recorded, transcribed, and analyzed using CHAT’s unit of analysis based on Activity Systems.
Findings: We observed contradictions within the Activity Systems involving diverging views on outcomes of enhancing or maintaining quality of life; using non-traditional tools and spaces to sustain resident mobility; safeguarding community and patient safety despite time constraints and job titles, and unease for being paid to perform unconventional interventions. The contradictions have been grouped into three themes reflecting the Activity Systems: 1) enhancing versus maintaining quality of life; 2) improvising to achieve care goals; and 3) role fluidity.
Discussion: Our findings show that practical goal-oriented and contextual adaptations rely heavily on improvisation and dialogue. Educating HCPs for interprofessional teamwork should focus on developing situational awareness to foster continuous adaptation of disciplinary interventions.
Résumé
Contexte : Le travail d’une équipe interdisciplinaire (EID) est façonné par les interactions entre ses membres et l’environnement. La Théorie de l’activité historico-culturelle (TAHC) offre une perspective évolutive sur le travail en équipe. Nous avons observé les interactions au sein d’une EID pour y déceler des orientations pratiques pour la formation des soignants au travail en équipe.
Méthode : Un groupe de trois professionnels de la santé, ayant plus de 22 ans d'expérience dans un petit établissement de soins de longue durée semi-urbain, a participé à l'étude. Nous avons enregistré sur vidéo deux réunions régulières de l’EID et sélectionné 5 extraits. Les participants ont regardé les extraits vidéo et ont été invités à expliquer leurs actions. Ensuite, les participants ont visionné les mêmes extraits par groupes de deux et en ont discuté. Enfin, les participants réunis ont revu les séquences en groupe et en ont discuté. Tous les entretiens ont été enregistrés et transcrits en vue d'une analyse thématique utilisant le cadre de la théorie de l'activité.
Résultats : L'EID se concentre sur le maintien de la santé des résidents en équilibrant les interventions de soins de santé dans un milieu de vie et de soins. L'analyse thématique nous a permis d'identifier trois thèmes : 1) les membres de l'EID se concentrent de manière asymétrique sur le maintien de la santé plutôt que sur le diagnostic et l'intervention ; 2) les interventions spécifiques à la discipline s'adaptent continuellement pour maintenir la santé des résidents, et ; 3) les activités qui ne relèvent pas des rôles professionnels génèrent des tensions et des malaises qui modifie la séparation des rôles.
Discussion : En raison de la nature du travail équipe interdisciplinaire en soins de longue durée, les frontières disciplinaires sont constamment remises en question en raison du chevauchement entre le milieu de soins qui est à la fois un milieu de vie. La théorie de l'activité apporte un éclairage utile sur cette complexité, en fournissant des données empiriques sur la manière dont les professionnels de la santé collaborent pour prodiguer des soins personnalisés dans les établissement de soins de longue durée.
Parties annexes
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