Psychologist in Italian hospital settings: An exploratory analysis of hospital physicians' representations and demands of psychological intervention

RESUMEN

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 hospitalario, 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 para 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 para discutir las oportunidades de un diálogo constructivo entre ciencias médica y psicológica en los contextos hospitalarios.

ABSTRACT

During the years, the World Health Organization 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 consequence, 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 settings. 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 psychological 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 interview 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 collaboration with psychologists; representations of where, when and how psychologists could be useful 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 everyday 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 coded the units of the text (sequences) according to the categories and subcategories identified. The categories were (a) perspective on medical intervention; (b) problems and weaknesses; (c) strengths; (d) current and future strategies; (e) psychosocial component of disease, and (f) relationship between Medicine and Psychology. Transcripts were analyzed independently by the analysts, and the interrater agreement was 83%. Results revealed a widespread view that psychological science is of limited relevance in the hospital context. The difficulty in perceiving psychologists as a medical resource appeared to be largely related to physicians' endorsement of a bio-medical approach, as well as to their lack of opportunities for formal and / or informal collaboration with psychologists. Psychologists were thought of primarily as diagnosticians or therapists, and psychological intervention was mainly characterized as an individual- level 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 Psychology 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 suggest the necessity to rethink professional roles and to promote a constructive dialogue between medical and psychological science in Italian hospital settings.