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Psychologists in italian hospital settings: an exploratory analysis of hospital physicians: representations and demands of psychological Intervention
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Advisor(s)
Abstract(s)
Aunque la Organización Mundial de la Salud
ha evidenciado la importancia de adoptar modelos
integrados de asistencia basados en el enfoque
bio-psico-social, en los servicios de salud, como
los hospitales, existe todavía mucha resistencia
para su implementación. Se presenta un estudio
exploratorio cualitativo dirigido a comprender las
representaciones y las demandas de los médicos
hospitalarios con respecto a la intervención psicológica
en los contextos hospitalarios italianos.
Conforme a este objetivo se desarrolló un guión de
entrevista semi-estructurada y se entrevistaron 15
médicos italianos divididos por género, edad y especialidad
médica. Fueron investigados las representaciones
de la enfermedad, el acercamiento a
los pacientes y los modelos de intervención, la experiencia
de colaboración con psicólogos, las representaciones
de dónde, cuándo y cómo los psicólogos
podrían ser útiles en el contexto hos pitalario,
las visiones generales del hospital y de su
futuro, los puntos de fuerza y de debilidad de su
trabajo, las estrategias utilizadas para superar las
dificultades diarias y las estrategias propuestas
pa ra mejorar el sistema hospitalario. El análisis de
contenido de las entrevistas ha revelado que la intervención
psicológica está representada predominantemente
como una intervención a nivel individual
dirigida a contener el distrés emocional en
relación con la enfermedad. Además se ha evidenciado
la falta de consideración de la competencia
psicológica como útil para promocionar el
funcionamiento organizativo de los servicios hospitalarios.
Estos resultados pueden apoyar la investigación
futura en esta área y son utilizados pa -
ra discutir las oportunidades de un diálogo constructivo
entre ciencias médica y psicológica en los
contextos hospitalarios.
ABSTRACT: During the years, the World Health Organiza - tion has been emphasising the importance of promoting integrated models of care consistent with a bio-psycho-social approach to health-illness. Nonetheless, healthcare services still show much resistance to the implementation of such models and the use of multidisciplinary teams. As a con - sequence, and despite the efforts made over the years by psychologists, the role and specificity of psychological competence in healthcare settings continues to remain unclear. This is particularly true as regards hospital settings. Based on these considerations, this article presents an exploratory qualitative study aimed at understanding hospital physicians’ representations of, and demands for, psychological intervention in Italian hospital set - tings. The main argument on which the study was based is that the integration of psychological competence into hospital settings very much depends on other professionals’ representation of the psychological profession, as well as on the emotional symbolization of their work context and professional practice. A key role is played by physicians, whose representations of the psychol - ogical intervention in hospital settings have been under studied at the international level, and almost not studied with regard to the Italian context. The purpose of this study was to respond to this gap in the literature. In this regard, a semi-structured interview script was developed and used to inter - view 15 Italian hospital physicians varying in gender, age, and medical speciality. Participants were selected by convenience and interviews were carried out individually in the hospital settings. Representations of disease; approach to patients and models of intervention; experiences of collab - oration with psychologists; representations of where, when and how psychologists could be use - ful in the hospital context; overall visions of one’s hospital and its future; strengths and weaknesses of one’s own work; strategies used to overcome every day difficulties and strategies advocated to improve the hospital were focus of analysis. The interviews, administered by two researchers, were audio-recorded and transcribed. Then a content analysis was developed by three analysts that cod - ed the units of the text (sequences) according to the ca tegories and subcategories identified. The cate - gories were: (a) perspective on medical inter vention; (b) problems and weak nesses; (c) strengths; (d) current and future strategies; (e) psychosocial component of disease, and (f) relation ship between Medicine and Psychology. Transcripts were ana - lyzed independently by the analysts, and the interrater agreement was 83%. Results revealed a widespread view that psychol ogical science is of limited relevance in the hospital context. The difficulty in perceiving psychologists as a medical resource appeared to be largely related to phys - icians’ endorsement of a bio-medical ap proach, as well as to their lack of opportunities for formal and/or informal collaboration with psy chologists. Psychologists were thought of primarily as diag - nosticians or therapists, and psychological interven tion was mainly characterized as an individuallevel intervention whose main objective is to support the patient and manage his / her emotional response to the disease (and the response of his / her family). Despite physicians felt the hospital system plagued by problems, especially at the structural and functional levels, they did not envisage psychological competence as useful for fostering hospital organisational functioning. On the contrary, they advocated a top-down change in the hospital system, delegating responsibility for change to hospital management or policy makers. As a consequence, an urgent demand for Psychol - ogy remains unexpressed. Although based on a small sample, the present study provides useful insights which may prompt further research in this area. Furthermore, it provides information about the demand for psychological intervention in the hospital context which can be used to develop strategies to promote multidisciplinary care and integrated mind-body interventions. Results sug gest the necessity to rethink professional roles and to promote a constructive dialogue between medical and psychological science in Italian hospital set - tings.
ABSTRACT: During the years, the World Health Organiza - tion has been emphasising the importance of promoting integrated models of care consistent with a bio-psycho-social approach to health-illness. Nonetheless, healthcare services still show much resistance to the implementation of such models and the use of multidisciplinary teams. As a con - sequence, and despite the efforts made over the years by psychologists, the role and specificity of psychological competence in healthcare settings continues to remain unclear. This is particularly true as regards hospital settings. Based on these considerations, this article presents an exploratory qualitative study aimed at understanding hospital physicians’ representations of, and demands for, psychological intervention in Italian hospital set - tings. The main argument on which the study was based is that the integration of psychological competence into hospital settings very much depends on other professionals’ representation of the psychological profession, as well as on the emotional symbolization of their work context and professional practice. A key role is played by physicians, whose representations of the psychol - ogical intervention in hospital settings have been under studied at the international level, and almost not studied with regard to the Italian context. The purpose of this study was to respond to this gap in the literature. In this regard, a semi-structured interview script was developed and used to inter - view 15 Italian hospital physicians varying in gender, age, and medical speciality. Participants were selected by convenience and interviews were carried out individually in the hospital settings. Representations of disease; approach to patients and models of intervention; experiences of collab - oration with psychologists; representations of where, when and how psychologists could be use - ful in the hospital context; overall visions of one’s hospital and its future; strengths and weaknesses of one’s own work; strategies used to overcome every day difficulties and strategies advocated to improve the hospital were focus of analysis. The interviews, administered by two researchers, were audio-recorded and transcribed. Then a content analysis was developed by three analysts that cod - ed the units of the text (sequences) according to the ca tegories and subcategories identified. The cate - gories were: (a) perspective on medical inter vention; (b) problems and weak nesses; (c) strengths; (d) current and future strategies; (e) psychosocial component of disease, and (f) relation ship between Medicine and Psychology. Transcripts were ana - lyzed independently by the analysts, and the interrater agreement was 83%. Results revealed a widespread view that psychol ogical science is of limited relevance in the hospital context. The difficulty in perceiving psychologists as a medical resource appeared to be largely related to phys - icians’ endorsement of a bio-medical ap proach, as well as to their lack of opportunities for formal and/or informal collaboration with psy chologists. Psychologists were thought of primarily as diag - nosticians or therapists, and psychological interven tion was mainly characterized as an individuallevel intervention whose main objective is to support the patient and manage his / her emotional response to the disease (and the response of his / her family). Despite physicians felt the hospital system plagued by problems, especially at the structural and functional levels, they did not envisage psychological competence as useful for fostering hospital organisational functioning. On the contrary, they advocated a top-down change in the hospital system, delegating responsibility for change to hospital management or policy makers. As a consequence, an urgent demand for Psychol - ogy remains unexpressed. Although based on a small sample, the present study provides useful insights which may prompt further research in this area. Furthermore, it provides information about the demand for psychological intervention in the hospital context which can be used to develop strategies to promote multidisciplinary care and integrated mind-body interventions. Results sug gest the necessity to rethink professional roles and to promote a constructive dialogue between medical and psychological science in Italian hospital set - tings.
Description
Keywords
Competencia psicológica Intervención psicológica Contextos hospitalarios Médicos hospitalarios Representaciones Demandas Psychological competence Hospital settings Hospital physicians Representations Demands
Citation
InterdIscIplInarIa, 34(1), 5-23