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Kompetensutnyttjande i mångprofessionella psykiatriska team
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
2009 (Swedish)Doctoral thesis, monograph (Other academic)Alternative title
The utilization of competence in multi professional psychiatric teams (English)
Abstract [sv]

I vårdverksamhet för patienter med komplexa vårdbehov är teamarbete en vanlig arbetsform. I forskning om mångprofessionellt teamarbete i vården beskrivs fördelar med organisationsformen, samtidigt som svårigheter påtalas somden mångprofessionella sammansättningen kan medföra. Inom forskningen har man dock i liten utsträckning undersökthuruvida de patientinsatser som görs av mångprofessionella vårdteam verkligen präglas av teamens breda kompetens. Manredovisar heller någon övergripande teoretisk modell som beskriver faktorer betydelsefulla för utfallet av vårdteams arbete ibemärkelsen mångdimensionalitet.

Syftet med detta arbete har varit att undersöka i vilken utsträckning patientarbetet i mångprofessionella psykiatriska teampräglas av teamets samlade kompetens, samt på vilket sätt de olika professionerna bidrar till grad av mångdimensionalitet ipatientarbetet. Ett syfte har också varit att undersökta vad som kan vara viktiga påverkansfaktorer för utnyttjandet av densamlade kompetensen i psykiatriska team.

Två empiriska studier har genomförts. Den första studien syftade till att ge en bild av grad av mångdimensionalitet ipatientarbetet, samt av på vilket sätt de olika professionerna bidrar med sin kompetens. I denna studie observeradesvuxenpsykiatriska teams arbete under behandlingskonferens. Resultatet av observationsstudien visade att de studeradeteamen hade svårigheter att under hela diskussionen belysa patienterna på ett mångsidigt sätt – diskussionen dominerades avdet sociala perspektivet. Till denna dominans av det sociala perspektivet bidrog alla professionerna. Resultatet pekade ävenpå ett underutnyttjande främst av omvårdnadspersonalen men även av kuratorerna under behandlingskonferens. Vidarevisade resultatet att en mycket stor del av diskussionsutrymmet ägnades åt att beskriva patienten och en mycket liten del åtanalys- och beslutsprocessen. Till dominansen av det beskrivande momentet bidrog alla professionerna.

Den andra studien syftade till att belysa vad som kan vara viktiga påverkansfaktorer för huruvida patientarbetet ipsykiatriska team får en mångdimensionell prägel. I denna studie intervjuades personal från psykiatrin, och utgångspunkt förintervjuerna var resultatet från observationsstudien. De förklaringar intervjugrupperna lämnade till det sociala perspektivetsdominans och till dominansen av det beskrivande momentet handlade om behov hos medlemmar i psykiatriska team av attkänna sig delaktiga och jämlika, samt av att relationerna i teamet skall vara konfliktfria. Ett underutnyttjande avomvårdnadspersonal samt kuratorer förklarade man med ett hierarkiskt förhållande mellan medlemmar i psykiatriska team.

Sammanfattningsvis kan sägas att resultatet av de två studierna pekar mot att relationella aspekter av teamarbetet samt etthierarkiskt förhållande mellan professionerna kan begränsa psykiatriska teams möjlighet till att under behandlingskonferensbelysa patientärenden på ett mångsidigt sätt, samt till fullo utnyttja teamets samlade kompetens.

Abstract [en]

In the healthcare sector, multi professional teamwork is a common way to organize health care services in areas where thepatients care need is multidimensional. Described in literature are several advantages of the multi professional approach inproducing high quality care. Also shown is that problems might arise from the professional diversity of a team. Research onteamwork in health care settings shows that little is known of whether health care teams make full use of their multiprofessional competence when designing patient care. There is also no overall theoretical framework describing importantfactors influencing the possibilities of a health care teams to make full use of their competence.

The aim of this thesis was to investigate how psychiatric teams make use of their multi professional competence indesigning patient care. To meet the aims of this thesis two empirical studies where conducted.

The aim of the first study was to investigate to what extent patient care was designed in a multi professional way, an inwhat way the different profession contributed to a multi professional designed care. Multi professional psychiatric teamswhere observed during treatment conference. The results indicate that when discussing patient care, the observed teams to alarge extent did not view the patients in a multidimensional way. The main focus was on the social aspect of patients and thiswas something that all the professions contributed to. The result also showed that when the discussions were viewed as awhole, and during the phase of describing the patient, clinical nurses took part in the discussions to a lesser extent than didthe other professions. Results also showed that the observed teams to very a large extent used the discussions for describingthe patients in relation to analyzing causes of symptoms and deciding interventions.

In the second study four group interviews where conducted to investigate what might influence the psychiatric teams'ability to use its multi professional competence when designing patient care. Participating in the interviews where physicians,social workers, clinical nurses and psychologists. To a large extent the explanations suggested for the domination of thesocial perspective concerned relational aspects of team work. The interview groups described team members´ need to feelthat they participate in the discussions and understand what is said, that all team members are considered equal and thatconflicts are avoided. The same kinds of explanations were given for the fact that the observed teams to a large extent usedthe discussions for describing the patients in relation to analyzing causes and deciding interventions. Hierarchy in psychiatricteams was the most frequently used explanation to the fact that clinical nurses took part in the discussions to a lesser extentthan did the other professions.

To summarize — the results indicate that relational aspects of team work and a hierarchic situation in psychiatric teamsmight impede on the psychiatric teams’ ability to draw on its multi professional competence.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 277 + bilagor 1-5 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 491Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 145
Keyword [en]
Multi professional team, utilization of competence, psychiatry, treatment conference
Keyword [sv]
Mångprofessionella team, kompetensutnyttjande, psykiatri, behandlingskonferens
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-50561ISBN: 978-91-7393-553-1 (print)OAI: oai:DiVA.org:liu-50561DiVA: diva2:271574
Public defence
2009-10-09, I:101, Hus I, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-10-12 Created: 2009-10-12 Last updated: 2014-09-26Bibliographically approved

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