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High turnover in clinical dietetics: a qualitative analysis.

临床营养学的高周转: 定性分析。

  • 影响因子:2.26
  • DOI:10.1186/s12913-020-06008-5
  • 作者列表:"Hewko S","Oyesegun A","Clow S","VanLeeuwen C
  • 发表时间:2021-01-06
Abstract

BACKGROUND:Relationships between dietitians and other healthcare providers can impact the degree to which patient care is collaborative; inefficient communication can lead to suboptimal care. It takes time for multidisciplinary team members to build collaborative, trusting relationships. For this reason, frequent dietitian turnover is of concern. Consequences include fewer referrals to clinical dietetic services and limited provider continuity. The characteristics of clinical dietetic jobs associated with high turnover have not been identified. We predicted that managers would identify disease prestige as having an impact. In this study, we aimed to explore: 1) characteristics of clinical dietetic jobs associated with the highest turnover, and 2) consequences of high turnover on patients and managers of clinical dietitians. METHODS:Research assistants conducted semi-structured interviews with ten managers of clinical dietitians in the Canadian public healthcare system. We employed a constant comparative approach to thematic analysis. We classified themes related to turnover as either avoidable or unavoidable. RESULTS:Sub-themes under avoidable turnover included lack of manager support, growth opportunities, burnout/workload, tension/conflict and hours of work. Sub-themes under unavoidable turnover included life-stage/life-events and geography. We also identified themes related to consequences of turnover, including: burnout/workload, client/patient impact, tension/conflict, cost and gap-specific. As predicted, prestige was perceived as playing a role in triggering dietitian turnover. Managers observed high turnover resulting in low provider continuity and limiting patient access to dietitians. CONCLUSIONS:Managers of publicly-employed dietitians identified many factors as contributing to high turnover. Future prospective research, incorporating the objective measure of turnover and multi-method analysis of work characteristics and work setting, would be of value in the identification of characteristics of clinical dietetic jobs associated with high turnover and the consequences of high turnover on patients and managers of these staff.

摘要

背景: 营养师和其他医疗保健提供者之间的关系会影响患者护理的协作程度; 低效的沟通会导致次优的护理。多学科团队成员建立协作、信任关系需要时间。出于这个原因,频繁的营养师周转是令人担忧的。后果包括转诊到临床饮食服务的次数较少,提供者连续性有限。与高营业额相关的临床饮食工作的特征尚未确定。我们预测管理者会将疾病声望确定为具有影响。在这项研究中,我们旨在探讨: 1) 与最高营业额相关的临床饮食工作的特征,以及2) 高营业额对临床营养师的患者和经理的影响。 方法: 研究助理对加拿大公共医疗保健系统的10名临床营养师经理进行了半结构式访谈。我们采用恒定的比较方法进行专题分析。我们将与营业额相关的主题分为可避免或不可避免。 结果: 可避免离职的次主题包括缺乏经理支持、成长机会、倦怠/工作量、紧张/冲突和工作时间。不可避免的周转下的子主题包括生活阶段/生活事件和地理。我们还确定了与离职后果相关的主题,包括: 倦怠/工作量、客户/患者影响、紧张/冲突、成本和特定差距。正如预测的那样,声望被认为在引发营养师离职中发挥了作用。管理人员观察到高营业额,导致提供者连续性低,并限制患者接触营养师。 结论: 公共雇佣营养师的管理人员确定了许多因素导致高离职。未来的前瞻性研究,结合了离职的客观测量和工作特征和工作环境的多方法分析,将有助于识别与高离职相关的临床饮食工作的特征以及高离职对患者和这些员工的管理人员的影响。

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DOI:10.1080/14656566.2020.1814255
作者列表:["Sawada H","Oeda T","Kohsaka M","Tomita S","Umemura A","Park K","Yamamoto K","Kiyohara K"]

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DOI:10.1007/s11033-021-06299-9
作者列表:["Louvrier A","Terranova L","Meyer C","Meyer F","Euvrard E","Kroemer M","Rolin G"]

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