基于共享心智模型的脑卒中康复病房护士多学科团队沟通合作能力提升干预方案构建

doi:10.3969/j.issn.1006-9771.2026.01.011

摘要/Abstract

摘要：

目的构建基于共享心智模型的脑卒中康复病房护士多学科团队沟通合作能力提升干预方案。

方法以共享心智模型为理论框架，通过文献研究奠定理论基础、质性研究锚定临床需求，初步拟定干预方案，再采用德尔菲法对方案进行修订完善。

结果经文献研究与质性研究，提炼出设备、任务、团队交互和团队成员4个维度的干预要素，据此形成干预方案初稿。对18名专家开展两轮函询，问卷有效回收率均100%。专家权威系数分别为0.87和0.90。第2轮函询中，各条目重要性评分变异系数为0~0.20 (总体Kendall's W = 0.272，P < 0.001)，可行性评分的变异系数为0~0.21 (总体Kendall's W = 0.275，P < 0.001)；最终形成含一级指标5项，二级指标8项，三级指标29项，且与共享心智模型四维度呼应的干预方案。

结论基于共享心智模型构建脑卒中康复病房护士多学科团队沟通合作能力提升干预方案。

关键词: 沟通, 合作, 干预方案, 共享心智模型, 多学科团队, 护士

Abstract:

Objective To develop an intervention program based on a shared mental model to enhance the communication and collaboration skills of nurses in multidisciplinary teams in stroke rehabilitation wards.

Methods Using the shared mental model as the theoretical framework, the intervention program was preliminarily drafted through literature review to establish a theoretical foundation and qualitative research to identify clinical needs. The Delphi method was then used to revise and refine the program.

Results Based on literature review and qualitative research, intervention elements were extracted across four dimensions: equipment, tasks, team interaction and team members, forming the initial draft of the intervention program. Two rounds of consultations were conducted with 18 experts, achieving a 100% valid response rate in both rounds. The expert authority coefficients were 0.87 and 0.90, respectively. In the second round of consultation, the variation coefficients for the importance scores of each item ranged from 0 to 0.20 (overall Kendall's W = 0.272, P< 0.001), and the variation coefficients for feasibility scores ranged from 0 to 0.21 (overall Kendall's W = 0.275, P < 0.001). The final intervention program included five first-level indicators, eight second-level indicators, and 29 third-level indicators, aligning with the four dimensions of the shared mental model.

Conclusion The intervention program was developed to enhance the communication and collaboration skills of nurses in multidisciplinary teams in stroke rehabilitation wards based on the shared mental model.

Key words: communication, collaboration, intervention program, shared mental models, multidisciplinary teams, nurses

中图分类号:

R743.3

王啸鹤, 张璐, 肖树芹. 基于共享心智模型的脑卒中康复病房护士多学科团队沟通合作能力提升干预方案构建[J]. 《中国康复理论与实践》, 2026, 32(1): 101-109.

WANG Xiaohe, ZHANG Lu, XIAO Shuqin. Development of an intervention program to enhance communication and collaboration in multidisciplinary teams of nurses in stroke rehabilitation wards based on a shared mental model[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(1): 101-109.

图/表 3

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表3

基于共享心智模型的脑卒中康复病房护士多学科团队沟通合作能力提升干预方案函询结果"

理论框架	指标条目内容	重要性		可行性
理论框架	指标条目内容	赋值	变异系数	赋值	变异系数
设备和任务模型	1变革建议	4.89±0.32	0.07	4.67±0.49	0.10
	1.1完善信息模块设计和功能优化	4.94±0.24	0.05	4.39±0.78	0.18
	1.1.1建议完善信息系统权限	5.00±0.00	0.00	4.33±0.84	0.19
	1.1.2建议优化信息系统功能模块	4.94±0.24	0.05	4.56±0.62	0.14
	1.1.3建议优化或构建集信息发布与提醒、临床工作、患者管理等为一体的信息共享平台	5.00±0.00	0.00	4.50±0.71	0.16
	1.2完善专业间沟通制度	5.00±0.00	0.00	4.72±0.46	0.10
	1.2.1建议明确医生/康复治疗师在多学科团队合作中的工作职责	4.89±0.32	0.07	4.72±0.58	0.12
	1.2.2建议相对固定多学科团队工作模式	4.72±0.58	0.12	4.56±0.51	0.11
	1.2.3建议以科室为主导统筹人员工作，设置机动岗位，结合激励机制，将成员团队会议出席情况、提供的信息质量等纳入绩效考核中	4.89±0.47	0.10	4.17±0.86	0.21
团队交互模型	2 成员交互	4.94±0.24	0.05	4.67±0.69	0.15
	2.1围绕脑卒中多学科团队会议交流互动	5.00±0.00	0.00	4.83±0.51	0.11
	2.1.1护士参加团队会议，认识和理解成员在团队中的作用	4.89±0.47	0.07	5.00±0.00	0.00
	2.1.2医护治成员围绕评价案例彼此交流	5.00±0.00	0.00	4.94±0.24	0.05
	2.1.3成员对多学科团队沟通合作提出意见	4.94±0.24	0.05	4.89±0.32	0.07
	2.2护士参加脑卒中多学科查房	4.94±0.24	0.05	4.94±0.24	0.05
	2.2.1护士参加康复医生、康复治疗师床旁查体(每周1次)	5.00±0.00	0.00	4.67±0.59	0.13
	2.3跨专业学习(其他成员授课)	4.94±0.24	0.05	4.72±0.46	0.10
	2.3.1邀请康复治疗师进行授课	4.94±0.24	0.05	4.78±0.55	0.11
	3 角色认识	5.00±0.00	0.00	4.72±0.58	0.12
	3.1了解医护治在脑卒中多学科团队沟通合作中的角色职责	5.00±0.00	0.00	4.72±0.58	0.12
	3.1.1认识康复医生在团队沟通合作中的角色职责	4.89±0.47	0.10	4.89±0.32	0.07
	3.1.2认识康复治疗师在团队沟通合作中的角色职责	4.83±0.51	0.11	4.78±0.43	0.09
	3.1.3脑卒中康复病房护士多学科团队沟通合作岗位职责和工作内容：	4.78±0.43	0.09	4.56±0.62	0.14
	A.参与组织与协调脑卒中多学科团队工作
	a.与团队成员联络及沟通，获取成员支持，参与协调与组织团队工作
	b.参与召开团队会议及各项活动：包括协助成员安排与会议开展，参加组织团队培训
	c.为团队成员提供咨询工作：包括向成员提供团队其他成员工作内容等
	B.提供护理领导力
	护士长定期参加团队会议，指出在脑卒中多学科团队合作中存在的问题，协商解决措施
	C.参与脑卒中多学科信息沟通与决策
	a.收集、整理及记录与患者相关的信息
	b.定期参与成员交班、查房及会议讨论
	c.向成员提供和反馈信息，参与团队决策
	d.与成员沟通合作，参与制定团队目标
	e.向成员提出建议
团队成员模型	4 成员知识	4.94±0.24	0.05	4.89±0.32	0.07
	4.1开展以“共享、交流、反思”为主题的学习会	4.89±0.32	0.07	4.78±0.43	0.09
	4.1.1案例汇报：康复护士汇报评价会病例	5.00±0.00	0.00	4.94±0.24	0.05
	4.1.2分享重点：围绕病例分享康复治疗内容	5.00±0.00	0.00	5.00±0.00	0.00
	4.1.3交流讨论：康复护士和护士长分享会议中其他成员的观点与建议	5.00±0.00	0.00	5.00±0.00	0.00
	4.1.4发现问题：护士与护士长分享团队沟通合作时存在的不足与问题	4.83±0.51	0.11	4.83±0.51	0.11
	4.1.5以案促学：由护士与护士长向其他护士分享会议中涉及的与多学科相关的新知识	4.72±0.96	0.20	4.72±0.96	0.20
	4.1.6总结回顾：总结参加团队沟通合作的收获及思考	4.89±0.47	0.10	4.89±0.47	0.10
	4.1.7答疑解惑：交流互动，解答疑惑	5.00±0.00	0.00	5.00±0.00	0.00
	4.1.8留存资料：会后制定学习资料(电子/纸质案例集或建立学习库)	5.00±0.00	0.00	4.94±0.24	0.05
	5 成员态度	4.94±0.24	0.05	4.94±0.24	0.05
	5.1了解脑卒中多学科团队合作模式，分享护士在团队沟通合作中的阻碍因素及解决方法	4.94±0.24	0.05	4.72±0.43	0.12
	5.1.1脑卒中多学科团队沟通合作的概念	4.72±0.58	0.12	4.83±0.51	0.11
	5.1.2脑卒中多学科团队沟通合作的目标和重要性	4.72±0.46	0.10	4.83±0.38	0.08
	5.1.3结合研究课题分享护士参与脑卒中多学科团队沟通合作的现状和需求	4.89±0.32	0.07	4.94±0.24	0.05
	5.1.4总结护士在团队沟通合作时遇到的阻碍因素	5.00±0.00	0.00	4.89±0.32	0.07
	5.1.5分析阻碍因素背后的原因	4.94±0.24	0.05	4.94±0.24	0.05
	5.1.6总结团队沟通合作问题的解决方法	5.00±0.00	0.00	4.78±0.55	0.11
	5.1.7分享能够促进护士参与脑卒中多学科团队沟通合作的个人特质	4.83±0.51	0.11	4.61±0.61	0.13

表3

参考文献 43

[1]	EID J, BRATTEBØ G, JACOBSEN J K, et al. Distributed team processes in healthcare services: a scoping review[J]. Front Med(Lausanne), 2023, 10: 1291877.
[2]	GUTENBRUNNER C, STIEVANO A, NUGRAHA B, et al. Nursing: a core element of rehabilitation[J]. Int Nurs Rev, 2022, 69(1): 13-19. doi: 10.1111/inr.v69.1
[3]	MILLER C J, KIM B, SILVERMAN A, et al. A systematic review of team-building interventions in non-acute healthcare settings[J]. BMC Health Serv Res, 2018, 18(1): 146. doi: 10.1186/s12913-018-2961-9 pmid: 29490664
[4]	CARBO A R, TESS A V, ROY C, et al. Developing a high-performance team training framework for internal medicine residents: the ABC'S of teamwork[J]. J Patient Saf, 2011, 7(2): 72-76. doi: 10.1097/PTS.0b013e31820dbe02 pmid: 21587118
[5]	袁苑. 多学科综合诊疗模式中护理的定位与思考[J]. 全科护理, 2022, 20(24): 3328-3332.
	YUAN Y. Positioning and thinking of nursing in a multidisciplinary comprehensive diagnosis and treatment model[J]. Chin Gen Pract Nurs, 2022, 20(24): 3328-3332.
[6]	BECK S, DOEHN C, FUNK H, et al. Basic life support training using shared mental models improves team performance of first responders on normal wards: a randomised controlled simulation trial[J]. Resuscitation, 2019, 144: 33-39. doi: S0300-9572(19)30605-7 pmid: 31505232
[7]	VAN DER VEEN R, VAN DER BURGT S, KÖNIGS M, et al. Team functioning in neurorehabilitation: a mixed methods study[J]. J Interprof Care, 2024, 38(4): 621-631. doi: 10.1080/13561820.2024.2325694 pmid: 38470835
[8]	胡艺龄, 陈彦君. 人机协作下的共享心智模型研究[J]. 现代教育技术, 2024, 34(1): 64-72.
	HU Y L, CHEN Y J. Research on shared mental model under Human-machine Collaboration[J]. Modern Educ Technol, 2024, 34(1): 64-72.
[9]	吕倩. TeamSTEPPS对胸外科手术团队合作与效率的影响研究[D]. 长沙: 中南大学, 2023.
	LÜ Q. Effect of TeamSTEPPS on the coordination and efficiency of thoracic surgery team[D]. Changsha: Central South University, 2023.
[10]	孟莉, 王虹丽, 刘毅, 等. 团体沙盘游戏干预对护理团队合作的影响[J]. 解放军医院管理杂志, 2018, 25(7): 696-698.
	MENG L, WANG H L, LIU Y, et al. Effects of group sandplay therapy on nursing team cooperation[J]. Hosp Admin J Chin PLA, 2018, 25(7): 696-698.
[11]	熊锦, 何国龙, 李宝珠. 手术团队不良沟通原因分析及干预[J]. 护理学杂志, 2015, 30(12): 48-50.
	XIONG J, HE G L, LI B Z. Causes of poor communication among surgery team and intervention strategy[J]. J Nurs Sci, 2015, 30(12): 48-50.
[12]	廖容, 向汉周, 高红, 等. 团体沙盘游戏改善护理组的团队合作与压力负荷效果观察[J]. 护理学报, 2017, 24(5): 58-61.
	LIAO R, XIANG H Z, GAO H, et al. Effect of group sandplay therapy on improvement of teamwork and pressure load of nurses[J]. J Nurs China, 2017, 24(5): 58-61.
[13]	饶列, 王靓, 徐姣姣, 等. 沙盘游戏提升手术室护理团队合作能力的应用价值[J]. 中国当代医药, 2022, 29(15): 121-123.
	RAO L, WANG L, XU J J, et al. Application value of sandplay in improving the cooperation ability of nursing team in operating room[J]. Chin Modern Med, 2022, 29(15): 121-123.
[14]	陶秋荣, 吴玉苗, 李颖, 等. 跨学科合作模型在安宁疗护团队中的应用成效研究[J]. 医学与哲学, 2021, 42(4): 15-18.
	TAO Q R, WU Y M, LI Y, et al. Application effectiveness of model for interdisciplinary collaboration in hospice care team[J]. Med Philos, 2021, 42(4): 15-18.
[15]	ASSELIN J, OSUNLANA A M, OGUNLEYE A A, et al. Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study[J]. Clin Obes, 2016, 6(2): 124-132. doi: 10.1111/cob.2016.6.issue-2
[16]	HOBEN M, GINSBURG L R, EASTERBROOK A, et al. Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes: the INFORM cluster-randomized controlled trial[J]. Implement Sci, 2020, 15(1): 75. doi: 10.1186/s13012-020-01038-3
[17]	HUNER B, DERKSEN C, SCHMIEDHOFER M, et al. Reducing preventable adverse events in obstetrics by improving interprofessional communication skills: results of an intervention study[J]. BMC Pregnancy Childbirth, 2023, 23(1): 55. doi: 10.1186/s12884-022-05304-8
[18]	ROMIJN A, DE BRUIJNE M C, TEUNISSEN P W, et al. Complex social intervention for multidisciplinary teams to improve patient referrals in obstetrical care: protocol for a stepped wedge study design[J]. BMJ Open, 2016, 6(7): e11443.
[19]	ZWARENSTEIN M, REEVES S, RUSSELL A, et al. Structuring Communication Relationships for Interprofessional Teamwork (SCRIPT): a cluster randomized controlled trial[J]. Trials, 2007, 8: 23. pmid: 17877830
[20]	BLEAKLEY A, BOYDEN J, HOBBS A, et al. Improving teamwork climate in operating theatres: the shift from multiprofessionalismto interprofessionalism[J]. J Interprof Care, 2006, 20(5): 461-470. doi: 10.1080/13561820600921915 pmid: 17000472
[21]	BLEAKLEY A, ALLARD J, HOBBS A. Towards culture change in the operating theatre: embedding a complex educational intervention to improve teamwork climate[J]. Med Teach, 2012, 34(9): e635-e640. doi: 10.3109/0142159X.2012.687484
[22]	CATCHPOLE K R, DALE T J, HIRST D G, et al. A multicenter trial of aviation-style training for surgical teams[J]. J Patient Saf, 2010, 6(3): 180-186. doi: 10.1097/PTS.0b013e3181f100ea pmid: 20802280
[23]	CHEATER F M, HEARNSHAW H, BAKER R, et al. Can a facilitated programme promote effective multidisciplinary audit in secondary care teams? An exploratory trial[J]. Int J Nurs Stud, 2005, 42(7): 779-791. doi: 10.1016/j.ijnurstu.2004.11.002 pmid: 16084925
[24]	MAYER C M, CLUFF L, LIN W T, et al. Evaluating efforts to optimize TeamSTEPPS implementation in surgical and pediatric intensive care units[J]. Jt Comm J Qual Patient Saf, 2011, 37(8): 365-374.
[25]	MILLER D, CRANDALL C, WASHINGTON C R, et al. Improving teamwork and communication in trauma care through in situ simulations[J]. Acad Emerg Med, 2012, 19(5): 608-612. doi: 10.1111/j.1553-2712.2012.01354.x pmid: 22594369
[26]	MORGAN S E, MOSSER A, AHN S, et al. Developing and evaluating a team development intervention to support interdisciplinary teams[J]. J Clin Transl Sci, 2021, 5(1): e166. doi: 10.1017/cts.2021.831 pmid: 34733543
[27]	NIELSEN P E, GOLDMAN M B, MANN S, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial[J]. Obstet Gynecol, 2007, 109(1): 48-55. doi: 10.1097/01.AOG.0000250900.53126.c2 pmid: 17197587
[28]	STRASSER D C, FALCONER J A, STEVENS A B, et al. Team training and stroke rehabilitation outcomes: a cluster randomized trial[J]. Arch Phys Med Rehabil, 2008, 89(1): 10-15. doi: 10.1016/j.apmr.2007.08.127
[29]	WISBORG T, BRATTEBO G, BRATTEBO J, et al. Training multiprofessional trauma teams in Norwegian hospitals using simple and low cost local simulations[J]. Educ Health (Abingdon), 2006, 19(1): 85-95. doi: 10.1080/13576280500534768
[30]	LIAW S Y, WU L T, WONG L F, et al. "Getting everyone on the same page": interprofessional team training to develop shared mental models on interprofessional rounds[J]. J Gen Intern Med, 2019, 34(12): 2912-2917. doi: 10.1007/s11606-019-05320-z pmid: 31515736
[31]	NJAMBI M, RAWSON H, REDLEY B. A brief intervention to standardize postanesthetic clinical handoff[J]. Nurs Health Sci, 2021, 23(1): 219-226. doi: 10.1111/nhs.12803 pmid: 33368896
[32]	CHIEN L J, SLADE D, GONCHAROV L, et al. Implementing a ward‐level intervention to improve nursing handover communication with a focus on bedside handover: a qualitative study[J]. J Clin Nurs, 2024, 33(7): 2688-2706. doi: 10.1111/jocn.v33.7
[33]	TALLEY D A. Improving postoperative handoff in a surgical intensive care unit[J]. Crit Care Nurse, 2019, 39(5): e13-e21. doi: 10.4037/ccn2019523
[34]	BLEGEN M A, SEHGAL N L, ALLDREDGE B K, et al. Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project[J]. Qual Saf Health Care, 2010, 19(4): 346-350. doi: 10.1136/qshc.2008.031252 pmid: 20693223
[35]	WU G, PODLINSKI L, WANG C, et al. Intraoperative code blue: improving teamwork and code response through interprofessional, in situ simulation[J]. Jt Comm J Qual Patient Saf, 2022, 48(12): 665-673. doi: 10.1016/j.jcjq.2022.08.011 pmid: 36192311
[36]	王啸鹤, 肖树芹, 张璐. 脑卒中康复团队沟通合作的质性研究[J]. 中国康复理论与实践, 2023, 29(12): 1473-1480. doi: 10.3969/j.issn.1006-9771.2023.12.012
	WANG X H, XIAO S Q, ZHANG L. Communication and cooperation within a stroke rehabilitation team: a qualitative research[J]. Chin J Rehabil Theory Pract, 2023, 29(12): 1473-1480.
[37]	孙慧慧, 张丙良, 娄连玉, 等. 肝移植患者术前预康复方案的构建[J]. 中华护理杂志, 2023, 58(18): 2195-2202. doi: 10.3761/j.issn.0254-1769.2023.18.003
	SUN H H, ZHANG B L, LOU L Y, et al. Construction of a preoperative prehabilitation program for liver transplant recipients[J]. Chin J Nurs, 2023, 58(18): 2195-2202. doi: 10.3761/j.issn.0254-1769.2023.18.003
[38]	韦秀霞, 李青荷, 陈萍, 等. 2型糖尿病患者参与健康照护方案的构建[J]. 中华护理杂志, 2022, 57(23): 2884-2890. doi: 10.3761/j.issn.0254-1769.2022.23.010
	WEI X X, LI Q H, CHEN P, et al. Construction of a self-management program for patients with type 2 diabetes mellitus[J]. Chin J Nurs, 2022, 57(23): 2884-2890. doi: 10.3761/j.issn.0254-1769.2022.23.010
[39]	黄家欣. 基于支持性照护理论的胃癌术后患者同伴支持干预方案的构建研究[D]. 南昌: 南昌大学, 2022.
	HUANG J X. Construction of peer support intervention program for postoperative patients with gastric cancer based on supportive care theory[D]. Nanchang: Nanchang University, 2022.
[40]	DE LUCA E, SENA B, CATALDI S, et al. A Delphi survey of health education system and interprofessional nurse' role[J]. Nurse Educ Today, 2021, 99: 104779. doi: 10.1016/j.nedt.2021.104779
[41]	傅文瑶, 庄一渝. ICU护士跨专业合作的影响因素及干预研究进展[J]. 中华急危重症护理杂志, 2022, 3(2): 168-172.
	FU W Y, ZHUANG Y Y. Research on influencing factors and intervention of nurses' interprofessional collaboration in ICU[J]. Chin J Emerg Crit Care Nurs, 2022, 3(2): 168-172.
[42]	HAZZARD E, WALTON K, MCMAHON A, et al. Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study[J]. J Interprof Care, 2021, 35(6): 813-820. doi: 10.1080/13561820.2020.1865290
[43]	ŠIMEC M, KRSNIK S, ERJAVEC K. Quality of health care and interdisciplinary collaboration from the perspective of employees and patients[J]. Nursing in the 21st Century, 2023, 22(4): 221-228.

基本情况	项目	人数/n	百分比/%
年龄	30~< 40岁	5	27.8
年龄	≥ 40岁	13	72.2
工作年限	10~< 20年	10	55.6
工作年限	≥ 20年	8	44.4
学历	博士	5	27.8
	硕士	4	22.2
	本科	9	50.0
职称	高级	9	50.0
职称	中级	9	50.0
职务	有	9	50.0
职务	无	9	50.0
从业领域	护理学	11	61.1
	康复医学/康复治疗学	6	33.3
	教育学	1	5.6

项目	重要性			可行性
项目	Kendall's W	χ²值	P值	Kendall's W	χ²值	P值
第一轮	0.199	121.915	< 0.001	0.362	221.338	< 0.001
第二轮	0.272	200.386	< 0.001	0.275	202.706	< 0.001