Discovering what is essential for help-seeking practice in the hospital training environment: exploring the experiences of junior doctors' help-seeking and senior nurses and doctors' supporting junior doctors' help-seeking

Abstract

Junior doctors' help-seeking is an important day-to-day occurrence in the hospital training environment, commonly described to involve a simple escalation of the problem to a more senior clinician. This research challenges this assumption by exploring what is essential to junior doctors’ help-seeking and supporting of junior help-seeking, thereby advancing knowledge in this area by viewing these lived experiences as interconnected within the hospital training environment. To achieve this, I explored the lived experiences via long interviews with seven junior doctors who had sought help in relation to concerns about patients, as well as five senior nurses and six senior doctors who had supported junior doctors' help-seeking, recruited from two geographically distant Australian training hospitals. In order to derive what is essential to junior doctors' help-seeking and senior nurses' and senior doctors' support of junior doctors' help-seeking, Giorgi's descriptive phenomenological method (2009a) was employed to guide the transcription, transformation and analysis of the experiences. The result was the identification of a series of key constituents that make up each phenomenon’s general structure. Integration of the studies and the model revealed that the experiences of junior doctors, senior nurses and senior doctors are intimately linked with each other. When junior doctors describe seeking help from senior colleagues for a problem related to the care of their patient, they describe both how they sought help and how their seeking of help (or help-seeking) was supported by the senior colleagues. Similarly, when senior nurses and doctors describe junior doctors seeking their help, they also describe both how the junior doctor sought help, and how they supported this help-seeking. Applying the descriptive phenomenological method once again and re-analysing all three phenomena together contributed to understanding of what is essential to help-seeking practice in the hospital training environment as a whole, namely to: intentionally own the care of the patient with others; build trust between colleagues and be regarded as trustworthy by them; and work proactively in the hospital training environment. This research provides junior doctor, senior nurse and senior doctor readers with an understanding that they are not alone in their experiences and highlights how help-seeking in the hospital training environment is significantly different from that in other contexts because of the central role of patients. My thesis reveals that help-seeking support is vital for junior doctors’ clinical progress into independent practitioners and well-being, as well as recognising the support that senior nurses provide to junior doctors in order to foster effective help-seeking. For senior doctors, this research emphasises how their support role does not start or finish when a junior doctor seeks help and involves far more planned support than 'just telling junior doctors to call if they need help'. This thesis concludes by suggesting future directions to advance help-seeking practice in the hospital training environment and indeed across the health system. Show more