A culture of caring: the essence of healthcare interprofessional collaboration

A work motivational grounded theory study of workers in caring roles

The aim of this study was to examine and construct a theoretical model of key elements that care workers perceive to have an impact on their autonomy, cohesion, and work motivation. Grounded theory was used for data collection and analysis. There were 20 participants from social welfare service, geriatric care, and women's aid settings (women = 18, men = 2, mean age = 37.6). The analysis resulted in the following categories: (a) Being-a-Cohesive-Team; (b) Agency-Making; (c) Living-Up-to-Expectations; and (d) Developing-Support-and-Feedback. The results identified potential interactions between these factors and suggested how they influenced each other, showing how cohesion, autonomy, and motivation are interdependent and amplified.

A unitary caring science resilience-building model: Unifying the human caring theory and research-informed psychology and neuroscience evidence

Resilience is the psychological capability to recover from difficulties quickly. Healthcare professionals are especially vulnerable to job-related stress and burnout. Unitary Caring Science is the framework for Watson's Human Caring Theory, providing a philosophy of practice in healthcare. With the high rates of clinician burnout and psychological issues, it will be significant to unify the human caring theory with research-informed psychological and neuroscience evidence to develop clinicians' resilience-building strategies. The purpose of this article is to introduce a Unitary Caring Science Resilience Model and explain the science behind the core strategies based on Unitary Caring Science philosophy and the psychological and neuroscience research. This model includes six strategies: Embracing loving-kindness for self and others; Nurturing interpersonal and intersubjective connections/relations; Deepening a creative use of self and sense of belonging; Balancing self-learning, self-awareness, and an evolved self-consciousness; Valuing forgiveness and releasing negativity; Inspiring and maintaining faith-hope. The caring-theory guided resilience-building strategies are proven to alleviate the depletion of clinicians' energy and emotions. Healthcare practices are challenging but rewarding. Clinicians can be emotionally, psychologically, and physically exhausted if they always consider themselves 'giving' and 'doing' institutional tasks without a sense of purpose or fulfillment. The practice can be rewarding if it becomes more aligned with clinicians' value to serve humanity. Through the unitary caring science resilience strategies, clinicians can build resilience as an antidote to clinician burnout and depletion.

An Approach to Improving Clinical Morale: Targeting a Positive Culture

Establishing a positive work environment is critical for successful outcomes and optimized performance. In a high-stakes arena such as healthcare, having all individuals engaged and ready to be part of the team is crucial. In this paper, we highlight a novel strategy for establishing effective communication and breaking down barriers. Through the implementation of a positive culture committee the neurosurgical department will improve relationships and performance. Goals and different strategies are addressed in the discussion. As implementation is underway, we plan to measure improved performance metrics in the coming years.

Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports

BACKGROUND

Nurses are the largest regulated group of healthcare professionals involved in palliative care. In 2004, a taskforce of the European Association for Palliative Care (EAPC) launched the 'Guide for development of palliative nurse education in Europe' (hereinafter, the EAPC 2004 Guide). No systematic evaluation of its impact in the development of palliative care education was undertaken.

AIMS

To describe current undergraduate and postgraduate nursing education across Europe; to identify the roles that nurses with different palliative care educational levels have in palliative care; and to assess the uptake of the EAPC 2004 Guide in the development of palliative care nursing in Europe.

DESIGN

Descriptive research involving an online survey among nursing experts, and the consultation of national representatives.

SETTING/PARTICIPANTS

A total of 135 nurses (52% response rate) from 25 countries completed the online survey; representatives from 16 countries were consulted.

RESULTS

In 14 (56%) countries, palliative care was not identified as a mandatory subject within undergraduate nursing education. The EAPC 2004 Guide is widely known and was/is being used in many countries to promote palliative care nursing education. Large variations were found across and within country responses.

CONCLUSIONS

Palliative care nursing education varies largely in Europe. The wide awareness and use of the EAPC 2004 Guide show how policy measures can influence the development of palliative care education. Recommendations are built and focus on both fostering the use of this guide and implementing policy measures to ensure that palliative care nursing is recognised and certified as a specialty in all European countries.

A Systematic Review of the Outcome Measures Used to Evaluate Interprofessional Learning by Health Care Professional Students During Clinical Experiences

Interprofessional education (IPE) occurs when members of more than one health or social care profession learn interactively together to improve interprofessional collaboration and health care delivery. Interprofessional experiences provide students with the skills and knowledge needed to work in a collaborative manner; however, there is no review on the outcome measures used to assess the effectiveness of IPE learning. The current systematic review examined the outcome measures used to assess interprofessional learning during student clinical experiences. An electronic search of databases retrieved trials of health professional students who completed an IPE intervention during a student clinical experience. Methodological quality of twenty-five studies meeting the inclusion criteria published between 1997 and 2018 was scored independently by two raters using the Physiotherapy Evidence Database and the Confidence in the Evidence from Reviews of Qualitative Research tool. The Interdisciplinary Education Perception Scale was used most frequently to assess interprofessional learning during a student clinical experience. This review provides a summary of outcome measures for educators to consider for evaluation of interprofessional activities during student clinical placements and serves to inform future conversations regarding the use and development of outcome measures to provide evidence for student achievement of IPE objectives and competencies.

Health and social care professionals' experiences of collaborative planning-Applying the person-centred practice framework

Aim

To explore how person‐centred practice framework can be applied to professionals participating in collaborative planning.

Design

An explorative, deductive approach.

Method

Eleven professionals from health care and social care participated in the study. A deductive content analysis was performed using a framework for person‐centred practice for the analysis.

Results

Practicing person‐centred care and collaborative planning is a complex process that needs to take into account system factors on both the macro‐ and the microlevel. Everyone working within the system needs to apply the same approach. Using a framework analysis offered new insights into how person‐centred care is expressed in practice during collaborative planning between the patient, and healthcare and social care professionals.

Medical student volunteering during COVID-19: lessons for future interprofessional practice

Due to the unprecedented pressures on healthcare systems during the COVID-19 pandemic, many medical students internationally volunteered to assist in hospitals. In the United Kingdom, most students worked in roles similar to Healthcare Assistants: helping to support nurses in providing patient care. Although the current situation is exceptional, with medical students eager to contribute to the COVID-19 response, they have also gained valuable experience in interprofessional collaboration. By working closely with nurses, medical students have gained practical understanding of the different roles within the hospital environment and been involved in providing hands-on care to patients. The experience of the current pandemic has shown the willingness of medical students to volunteer in Healthcare Assistant roles and demonstrated the ability of hospitals to successfully integrate students into established nursing teams. This short report provides a reflection on the advantages of these placements and argues for their continuation in future practice.

Connecting Patients' Perceptions of Nurses' Daily Care Actions, Organizational Human Caring Culture, and Overall Hospital Rating in Hospital Consumer Assessment of Healthcare Providers and Systems Surveys

OBJECTIVE

The aim of this study was to connect patients' perceptions of nurses' daily care actions with patients' overall ratings of their hospital experience and hospitals' human caring culture.

BACKGROUND

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey measuring patients' hospital experience. Current literature lacks the connections between patients' perceptions of nurses' daily care actions and their overall hospital experience measured by the HCAHPS survey.

METHODS

This is a correlational study based on the HCAHPS surveys from patients discharged from a hospital in the United States. Correlations were conducted between patients' perceptions of nurses' daily care actions and overall hospital experience.

RESULTS

A total of 3,258 (16.6%) patients returned the HCAHPS survey between January and May 2019. Significant relationships were found among patients' perceptions of nurses' daily care actions, hospitals' caring culture, and overall experience.

CONCLUSION

Nurses' daily care actions significantly contribute to favorable patients' overall hospital ratings on HCAHPS.

Promoting civility in nursing practice using systems thinking: Evidence-based teaching strategies for nurse educators

There is a critical need for nurse educators to promote civility in nursing practice using systems thinking to promote quality and safety and improve patient outcomes by preventing undue patient harm. In this article, evidence is synthesized in order that readers can recognize, respond and manage workplace incivility. Systems thinking is introduced as a best practice solution for advancing a civil workplace culture. The author-created Systems Awareness Model, adapted for civility awareness, guides nurse educators with evidence-based strategies for teaching nurses the essential skills to promoting a civility culture within health systems. The strategies can be used by nurse educators in practice to interface workplace application. Proposed examples of evaluation methods are aligned with the teaching strategies. The purpose of this article is to provide nurse educators in practice with evidence-based teaching strategies and evaluation methods to address incivility in health care using a systems thinking perspective.

Mental distress and influencing factors in nurses caring for patients with COVID-19

BACKGROUND

Nurses are experiencing tremendous stress during the new coronavirus disease 2019 (COVID-19) pandemic, especially intensive care nurses. The pandemic of the disease is a tragedy, which may leave a catastrophic psychological imprint on nurses. Understanding nurses' mental distress can help when implementing interventions to mitigate psychological injuries to nurses.

AIMS AND OBJECTIVES

To quantify the severity of nurses' post-traumatic stress disorder (PTSD) symptoms and stress and explore the influencing factors of their psychological health when caring for patients with COVID-19.

DESIGN

A cross-sectional survey.

METHODS

The PTSD Checklist-Civilian and the Perceived Stress Scale were administered from 11 to 18 March 2020, to 90 nurses selected from another city to go and help an intensive care unit (ICU) in Wuhan, China. These nurses were selected because of their high levels of clinical performance and resilience status.

RESULTS

Nurses' average PTSD score was 24.62 ± 6.68, and five (5.6%) of the nurses reported a clinically significant level of PTSD symptoms (>38 points). Nurses' perceived stress averaged 19.33 ± 7, and 20 nurses (22.22%) scored positively >25 points. Nurses' stress and PTSD symptoms were positively correlated (P < .01). Major stress sources included working in an isolated environment, concerns about personal protective equipment shortage and usage, physical and emotional exhaustion, intensive workload, fear of being infected, and insufficient work experiences with COVID-19.

CONCLUSIONS

This study showed that even relatively highly resilient nurses experienced some degree of mental distress, including PTSD symptoms and perceived stress. Our findings highlight the importance of helping nurses cultivate resilience and reduce stress.

RELEVANCE TO CLINICAL PRACTICE

Recommendations for practice include providing adequate training and orientation before assigning nurses to ICU to help, offering disaster-emergency-preparedness training to keep nurses prepared, providing caring and authentic nursing leadership, offering ongoing psychological support to frontline nurses.

Shifting traditional healthcare paradoxes-The case for true system transformation

Although national spending on healthcare has progressed on an upward trend over several decades, issues regarding performance remain. Challenges such as access to specialist care and maternal and infant mortality rates contributed to Canada's recent ranking of ninth among 11 Organisation for Economic Co-operation and Development countries for overall health system performance. Although disruptive transformation is required to resolve our chronic performance issues, effective change cannot be realized without addressing the foundational elements of patient-centred care, interprofessional care, and system integration. Inspired by examples of innovative disruption in other jurisdictions and industries, these three concepts are outlined as the core ingredients for healthcare transformation and describe how they currently function in a paradoxical manner-as self-contradictory statements which in reality are not executed to their true meaning. This article illustrates how improvements in health system performance are hinged to the need to rectify and fuse these three mutually inclusive and inseparable concepts.

An interprofessional perspective on healthcare work: physicians and nurses co-constructing identities and spaces of action

In this article we develop a theoretical perspective of how professional identities in multi-professional organisational settings are co-constructed in daily interactions. The research reported here is located in a healthcare context where overlapping knowledge bases, unclear divisions of responsibilities, and an increased managerialist emphasis on teamwork make interprofessional boundaries in healthcare operations more complex and blurred than ever. We thereby build on a research tradition that recognises the healthcare sector as a negotiated order, specifically studying how professional identities are invoked, constructed, and re-constructed in everyday work interactions. The perspective is employed in an analysis of qualitative data from interviews and participant observation at a large Swedish hospital, in which we find three main processes in the construction of space of action: hierarchical, inclusive, and pseudo-inclusive. In most of the interactions, existing inter-professional divides and power relations are sustained, preventing developments towards integrated interprofessional teamwork.

Parents' and healthcare professionals' perceptions of the quality of care: A PITSTOP model of caring

BACKGROUND

Quality of care is measured by various indicators. Besides objective quantifications, it is necessary to understand the meaning of quality of care from the perspectives of patients, families, and healthcare professionals.

OBJECTIVES

This study aimed to understand parents' and healthcare professionals' perceptions of the quality of care.

METHODS

This was a secondary data analysis of two qualitative studies examining parents' and healthcare professionals' perceptions of caring in 2014 and 2018, respectively. Both studies took place in a children's hospital in the United States. There were 40 participants, 13 parents of children undergoing heart surgery and 27 healthcare professionals. The current study focused on parents' and healthcare professionals' viewpoints about the quality of care.

RESULTS

Seven themes emerged: patient-centered care, interprofessional collaboration, team communication, safety and security, trusting relationships, optimal outcomes, and positive patient experiences. The acronym PITSTOP was developed to enable healthcare professionals to recall the elements deemed as important to the quality of care by parents and professionals.

CONCLUSIONS

This study brought up a novice opinion that healthcare should be like a "pitstop," not just a "repair shop." Healthcare encounters may be brief but invaluable in helping patients and families succeed in their health promotion.