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Zhang J, Zheng J, Cai Y, Zheng K, Liu X. Nurses' experiences and support needs following workplace violence: A qualitative systematic review. J Clin Nurs 2020; 30:28-43. [PMID: 32936970 DOI: 10.1111/jocn.15492] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 02/03/2023]
Abstract
AIMS AND OBJECTIVES To systematically identify, appraise and synthesise existing qualitative studies exploring nurses' lived experiences of workplace violence by patients, families and hospital visitors, identifying their support needs following workplace violence. BACKGROUND Workplace violence against nurses is a significant concern globally, as it leads to serious negative consequences for nurses, patients and organisations as a whole. Having adequate support is considered significant. While numerous studies have been conducted on workplace violence, few qualitative reviews have focused on identifying nurses' support needs following episodes of workplace violence. METHODS Four databases (MEDLINE, CINAHL, PsychINFO and Scopus) were systematically searched. Additionally, hand searching of prominent journals, grey literature and reference lists of included studies was also performed to identify additional research. The Critical Appraisal Skills Programme checklist for qualitative studies was used to assess all included articles. Thomas and Harden's three-stage approach to thematic analysis was followed, using the ENTREQ statement for reporting. RESULTS Ten studies published in English, conducted across eight countries, met the inclusion criteria. Four analytical themes relating to nurses' experiences were identified: "inevitable and unpredictable trauma in the career" "higher tolerance and understanding of unintentional violence," "positive learning or passive adjustment" and "struggle with the role and behaviour conflict." In terms of nurses' support needs, the analysis yielded two themes: "informal support needs" and "formal support needs." CONCLUSION Nurses experience significant and lasting psychological trauma due to workplace violence; however, the support for nurses remains seriously inadequate. Establishing an effective and robust support system based on nurses' needs must be viewed as a priority for organisations, as well as researchers. RELEVANCE TO CLINICAL PRACTICE Institutions and managers have a duty to maintain an awareness of nurses' experiences and support needs regarding workplace violence. There is a need for further policymaking and research, based on clinical practice, in order to develop effective preventive and interventive strategies regarding workplace violence.
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Affiliation(s)
- Junfeng Zhang
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, China
| | - Jing Zheng
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yingying Cai
- Department of Chemotherapy, Jieyang People's Hospital, Jieyang, China
| | - Kexin Zheng
- Department of Psychiatry, Zhuhai Center for Chronic Disease Control, Zhuhai, China
| | - Xingling Liu
- Department of Nursing, SSL Central Hospital of Dongguan City, Dongguan, China
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Buckland R. Medical student volunteering during COVID-19: lessons for future interprofessional practice. J Interprof Care 2020; 34:679-681. [PMID: 32962471 DOI: 10.1080/13561820.2020.1822790] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Rosalyn Buckland
- Barts and the London School of Medicine and Dentistry, Queen Mary University , London, UK
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Jiang Z, Wang A, Wang C, Kong W. Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation. J Orthop Surg Res 2020; 15:381. [PMID: 32887632 PMCID: PMC7650293 DOI: 10.1186/s13018-020-01920-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Percutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients’ awareness of spinal endoscopy and their election of endoscopic techniques? Objective To analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation. Methods Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Results The postoperative feeding time in the experimental group was 8.319 ± 1.374 h, the postoperative time to get out of bed was 16.64 ± 3.728 h, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 h, the postoperative time to get out of bed was 45.06 ± 9.027 h, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p > 0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p < 0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p < 0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p < 0.05; there was no significant difference between the two groups, p > 0.05. Conclusion The integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.
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Affiliation(s)
- Zhongyan Jiang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Ansu Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Chong Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Weijun Kong
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China. .,Department of Orthopedics Surgery, The Second Affiliated Hospital of Zunyi Medical University, No.1 Xinpu Road, Zunyi, 563000, Guizhou, China.
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Landis TT, Severtsen BM, Shaw MR, Holliday CE. Professional identity and hospital-based registered nurses: A phenomenological study. Nurs Forum 2020; 55:389-394. [PMID: 32096218 DOI: 10.1111/nuf.12440] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Nurses continue to struggle to define their role as professionals in the hospital-setting often being represented in media as less competent than other health care providers. Paradoxically, an annual poll of the public consistently identifies nursing as the most trusted profession. This dichotomy of simultaneously being considered incompetent yet holding a high level of trust leads nurses to question their own professional identity. A gap exists in the literature about the professional identity of nurses who work directly with patients in the hospital environment. METHODOLOGY Therefore, the aim of this interpretive phenomenology study was to describe the lived experience of nurses working with patients in the hospital environment and the meaning of this phenomenon as it relates to their professional identity. RESULTS Four themes were identified: (a) being validated as an expert by providers within the healthcare system; (b) working well as a valued member of a team; (c) advocating for the patient's needs despite opposition; and (d) Valuing human-ness in the patient. IMPLICATIONS The findings provide a deeper representation of the practice of hospital-based nurses and implications for Anchornurses to be empowered in their workplace.
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Mischo-Kelling M, Wieser H, Vittadello F, Cavada L, Lochner L, Fink V, Naletto C, Kitto S, Reeves S. Application of an adapted relationship scale for assessing the occurrence of six different relationships as perceived by seven health care professions in Northern Italy. J Interprof Care 2020; 35:419-429. [PMID: 32552118 DOI: 10.1080/13561820.2020.1757629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Interprofessional working relationships can influence the quality of collaborative practices, with consequences for patient safety outcomes. This article reports findings of an adapted relationship scale comprising six different relationship types, ranging from hostile to collegial, between seven health-care professions: physicians, nurses, dieticians, occupational therapists, physiotherapists, speech therapists, and psychologists. Survey data were gathered within amixed-method study aiming to explore the current status quo of interprofessional collaboration in aHealth Trust, located in Northern Italy. An online questionnaire was completed by 2,238 health professionals achieving aresponse rate of 44%. The working relationship element was answered by 1,897 respondents. The results of the survey are used as abasis for recommending strategies for advancing interprofessional collaboration in the Trust. Descriptive statistics were used to examine relationship-types, with frequency of occurrence considered. The non-parametric Mann Whitney and Kruskal Wallis tests were used to explore relationship differences among groups defined by sociodemographic variables. Participants reported overall positive relationships with other health professions. We noted variability in the occurrence of different relationship-types amongst the health professions. In particular, the six professions viewed their relationships with doctors more negatively than physicians who reported amore positive perception of their relationships with the six professions.
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Affiliation(s)
- Maria Mischo-Kelling
- Faculty of Social Work, Health and Nursing, University of Applied Sciences Ravensburg-Weingarten, Weingarten, Germany.,College of Health-Care Professions - Claudiana, Research Unit, Bolzano/Bozen, Italy
| | - Heike Wieser
- College of Health-Care Professions - Claudiana, Research Unit, Bolzano/Bozen, Italy
| | | | - Luisa Cavada
- Department of Nursing, College of Health-Care Professions - Claudiana, Bolzano/Bozen, Italy
| | - Lukas Lochner
- College of Health-Care Professions - Claudiana, Teaching Support Office, Bolzano/Bozen, Italy
| | - Verena Fink
- Department of Physiotherapy, Hospital of Bolzano, Bolzano/Bozen, Italy
| | - Carla Naletto
- Department of Physiotherapy, College of Health-Care Professions - Claudiana, Bolzano/Bozen, Italy
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada.,Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Scott Reeves
- Centre for Health and Social Care Research, Kingston University and St George's University of London, London, UK
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Molina MF, Landry AI, Chary AN, Burnett-Bowie SAM. Addressing the Elephant in the Room: Microaggressions in Medicine. Ann Emerg Med 2020; 76:387-391. [PMID: 32456801 DOI: 10.1016/j.annemergmed.2020.04.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Melanie F Molina
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
| | - Adaira I Landry
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Anita N Chary
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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Mattar E Silva TW, Velloso ISC, Araújo MT, Fernandes ADRK. Configuration of power relations in physicians and nurses' professional practices. Rev Bras Enferm 2020; 73 Suppl 1:e20180629. [PMID: 32428173 DOI: 10.1590/0034-7167-2018-0629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/12/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the configuration of power relations constituted in and by the knowledge and daily practices of physicians and nurses in an Intensive Care Unit (ICU). METHOD qualitative study in which data were collected through interviews with physicians and nurses from an ICU of a hospital in Belo Horizonte, Minas Gerais. A semi-structured script was used. Data were analyzed through discourse analysis in a Foucaultian perspective. RESULTS three categories were developed - Professional Identity: self-recognition in the profession; Discipline: individualizing attitudes or collective need?; and Circularity of knowledge and power in the constitution of daily practices. Final considerations: the identity, discipline and circulation of power are connected in a continuous movement of subjectivation of the subject, which, in turn, uses discourse as a persuasion strategy to modify the position taken over in different situations thereby causing the circulation of power.
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Standardizing nightly huddles with surgical residents and nurses to improve interdisciplinary communication and teamwork. Am J Surg 2020; 219:769-775. [DOI: 10.1016/j.amjsurg.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 11/20/2022]
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Hitawala A, Flores M, Alomari M, Kumar S, Padbidri V, Muthukuru S, Rahman S, Alomari A, Khazaaleh S, Gopalakrishna KV, Michael M. Improving Physician-patient and Physician-nurse Communication and Overall Satisfaction Rates: A Quality Improvement Project. Cureus 2020; 12:e7776. [PMID: 32461851 PMCID: PMC7243623 DOI: 10.7759/cureus.7776] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Communication between healthcare providers and patients is a key component associated with the quality of healthcare and patient satisfaction. Often, simple communication skills may be insufficient to sustain a successful provider-patient relationship. The aim of this project was to assess and improve patient and nurse satisfaction with physicians via improvement in physician-patient and physician-nurse communication to a level greater than 90%. Methods Initial surveys were given to the patients and nurses on admission to the regular nursing floor to assess current satisfaction rates. Afterward, visual handouts were given that provided details about the current medical team members and the role of each team member. which were updated daily along with the medical plan. Surveys were then handed out to the patients and their nurses at the time of discharge. All surveys were conducted anonymously. Results A total of 26 surveys (n = 13 patients, n = 13 nurses) were collected and analyzed for a preliminary assessment. Surveys concluded that 68.8% of patients were satisfied with the patient-provider communication; similarly, 74.4% of the nurses were satisfied with the nurse-provider communication. In the next six weeks, visual handouts were implemented. During this period, surveys involving a total of 40 patients and 40 nurses were collected. The results after the intervention revealed that 93.3% of patients were satisfied with the patient-provider communication, and 94.7% of nurses were satisfied with the nurse-provider communication. Post-intervention, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) displayed an improvement in physician communication, reaching the expected goal of 84.4%. Conclusion Ineffective communication often goes undetected in many healthcare settings, causing serious effects on the health and safety of patients, and may ultimately jeopardize overall satisfaction. Literature has shown a positive correlation between patient satisfaction and improved clinical outcomes. Using visual aids and updating medical care plans on a daily basis are simple yet effective tools to improve communication. Written materials should be created in a patient-friendly manner to enhance communication, clarity, and understanding.
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Affiliation(s)
- Asif Hitawala
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Monica Flores
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | | | - Sany Kumar
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Vinay Padbidri
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | | | - Shafia Rahman
- Hematology and Medical Oncology, Albert Einstein College of Medicine, New York, USA.,Internal Medicine, Cleveland Clinic Foundation, Cleveland, USA
| | - Ahmed Alomari
- Internal Medicine, The Hashemite University, Zarqa, JOR
| | | | - K V Gopalakrishna
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Madonna Michael
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
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Berduzco-Torres N, Choquenaira-Callañaupa B, Medina P, Chihuantito-Abal LA, Caballero S, Gallegos E, San-Martín M, Delgado Bolton RC, Vivanco L. Factors Related to the Differential Development of Inter-Professional Collaboration Abilities in Medicine and Nursing Students. Front Psychol 2020; 11:432. [PMID: 32292364 PMCID: PMC7135885 DOI: 10.3389/fpsyg.2020.00432] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction For physicians and nurses, teamwork involves a set of communication and social skills, and specific training in interdisciplinary work in order to be able to work together cooperatively, sharing responsibilities, solving problems, and making decisions to carry out actions centered on patients' care. Recent studies demonstrate that in the absence of targeted interdisciplinary educational programs, the development of teamwork abilities is sensitive to the influence of the dominant work environment. The purpose of this study was to characterize the role that environmental and individual factors play in the development of teamwork in environments with a dominant hierarchical work model. Methods Questionnaires were distributed to 1,880 undergraduate students (980 medicine students and 900 nursing students) from three universities of Cusco city (Peru). The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration was used as the main variable. The Jefferson Scales of Empathy and Lifelong Learning, the Social and Emotional Loneliness Scale for Adults, the Scale of Life Satisfaction, sex, discipline, age, and academic semester were used as explanatory variables. After calculating internal reliability and normality of the main measures, descriptive, comparative, and correlation analyses were performed to determine variables influencing the teamwork score. Results A total of 1,518 (81%) surveys were returned fully completed. Adequate reliability was confirmed in all instruments. In the sample, nursing students showed greater inter-professional collaborative abilities than medicine students (p < 0.001). This attitudinal gap was higher in advanced semesters. A three-way ANOVA indicated differences in teamwork were associated with discipline (p < 0.001), sex (p < 0.01), and university (p < 0.001). However, main effects were associated only with discipline (η p2 = 0.14). Teamwork showed an inverse correlation with loneliness (ρ = -0.28; p < 0.001) and a positive correlation with empathy (ρ = + 0.49; p < 0.001) and lifelong learning (ρ = + 0.48; p < 0.001). Teamwork positively correlated with life satisfaction only in the medicine student group (ρ = + 0.15; p < 0.001). Conclusion These findings bring new evidence to support the main effect that social environments, in the absence of targeted interdisciplinary educational programs, play in the development of teamwork.
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Affiliation(s)
- Nancy Berduzco-Torres
- Escuela Profesional de Enfermería, Universidad Nacional San Antonio Abad del Cusco, Cusco, Peru
| | | | - Pamela Medina
- Escuela Profesional de Enfermería, Universidad Nacional San Antonio Abad del Cusco, Cusco, Peru
| | | | - Sdenka Caballero
- Facultad de Ciencias de la Salud, Universidad Andina del Cusco, Cusco, Peru
| | - Edo Gallegos
- Facultad de Ciencias de la Salud, Universidad Andina del Cusco, Cusco, Peru
| | - Montserrat San-Martín
- Departamento de Estadística e Investigación Operativa, Universidad de Granada, Melilla, Spain
| | - Roberto C. Delgado Bolton
- Servicio de Medicina Nuclear, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
- Plataforma de Bioética y Educación Médica, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
- Centro Nacional de Documentación en Bioética, Fundacion Rioja Salud, Logroño, Spain
| | - Luis Vivanco
- Plataforma de Bioética y Educación Médica, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
- Centro Nacional de Documentación en Bioética, Fundacion Rioja Salud, Logroño, Spain
- Area de Salud, Nutrición y Bioética, Fundación Universitaria Iberoamericana (FUNIBER), Barcelona, Spain
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Samuriwo R, Laws E, Webb K, Bullock A. "I didn't realise they had such a key role." Impact of medical education curriculum change on medical student interactions with nurses: a qualitative exploratory study of student perceptions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:75-93. [PMID: 31392511 PMCID: PMC7018789 DOI: 10.1007/s10459-019-09906-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/29/2019] [Indexed: 05/05/2023]
Abstract
Interprofessional teamwork between healthcare professionals is integral to the delivery of safe high-quality patient care in all settings. Recent reforms of medical education curricula incorporate specific educational opportunities that aim to foster successful interprofessional collaboration and teamwork. The aim of this study was to explore the impact of curriculum reform on medical students' perceptions of their interactions and team-working with nurses. We gathered data from 12 semi-structured individual narrative interviews with a purposive sample of male (n = 6) and female (n = 6) medical students from fourth year (n = 6 following an integrated curriculum) and fifth year (n = 6 following a traditional curriculum). Data were subject to narrative analysis which was undertaken using NVivo software. Overall, there was no notable difference in the responses of the participants on the traditional and integrated curricula about their interactions and team work with nurses. However, the introduction of an integrated medical curriculum was viewed positively but a lack of interprofessional education with nursing students, removal of a nursing placement and shorter clinical placements were perceived as lost opportunities for the development of educationally beneficial relationships. The participants reported that nurses play a number of roles in clinical practice which underpin patient safety including being medical educators who provide a valuable source of support for medical students. The participants highlighted different factors that could hinder or foster effective working relationships such as a lack of understanding of nurses' different professional roles and mutual respect. Medical education needs to provide students with more structured opportunities to work with and learn from nurses in clinical practice. Further research could explore how to foster positive relationships between medical students and nurses.
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Affiliation(s)
- Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, Heath Park Campus, Cardiff, CF14 4XN UK
- Wales Centre for Evidence Based Care, Cardiff University, Cardiff, UK
| | - Elinor Laws
- School of Medicine, Cardiff University, Cardiff, UK
| | - Katie Webb
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Sciences, Cardiff University, Cardiff, UK
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Nyondo-Mipando AL, Woo Kinshella ML, Bohne C, Suwedi-Kapesa LC, Salimu S, Banda M, Newberry L, Njirammadzi J, Hiwa T, Chiwaya B, Chikoti F, Vidler M, Dube Q, Molyneux E, Mfutso-Bengo J, Goldfarb DM, Kawaza K, Mijovic H. Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi. PLoS One 2020; 15:e0228915. [PMID: 32053649 PMCID: PMC7018070 DOI: 10.1371/journal.pone.0228915] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/27/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Preterm birth complications are the leading cause of neonatal deaths. Malawi has high rates of preterm birth, with 18.1 preterm births per 100 live births. More than 50% of preterm neonates develop respiratory distress which if left untreated, can lead to respiratory failure and death. Term and preterm neonates with respiratory distress can often be effectively managed with Continuous Positive Airway Pressure (CPAP) and this is considered an essential intervention for the management of preterm neonates by the World Health Organization. Bubble CPAP may represent a safe and cost-effective method for delivering CPAP in low-income settings. OBJECTIVE The study explored the factors that influence the implementation of bubble CPAP among health care professionals in secondary and tertiary hospitals in Malawi. METHODS This was a qualitative study conducted in three district hospitals and a tertiary hospital in southern Malawi. We conducted 46 in-depth interviews with nurses, clinicians and clinical supervisors, from June to August 2018. All data were digitally recorded, transcribed verbatim and thematically analyzed. RESULTS Factors that influenced implementation of bubble CPAP occurred in an interconnected manner and included: inadequate healthcare provider training in preparation for use, rigid division of roles and responsibilities among providers, lack of effective communication among providers and between providers and newborn's caregivers, human resource constraints, and inadequate equipment and infrastructure. CONCLUSION There are provider, caregiver and health system level factors that influence the implementation of bubble CPAP among neonates in Malawian health facilities. Ensuring adequate staffing in the nurseries, combined with ongoing training for providers, team cohesion, improved communication with caregivers, and improved hospital infrastructure would ensure optimal utilization of bubble CPAP and avoid inadvertent harm from inappropriate use.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- College of Medicine, IMCHA Project, Blantyre, Malawi
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Christine Bohne
- Institute for Global Health, NEST 360°, Rice University, Houston, Texas, United States of America
| | | | | | - Mwai Banda
- College of Medicine, IMCHA Project, Blantyre, Malawi
| | - Laura Newberry
- College of Medicine, IMCHA Project, Blantyre, Malawi
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jenala Njirammadzi
- College of Medicine, IMCHA Project, Blantyre, Malawi
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tamanda Hiwa
- College of Medicine, IMCHA Project, Blantyre, Malawi
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Felix Chikoti
- College of Medicine, IMCHA Project, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Queen Dube
- College of Medicine, IMCHA Project, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Elizabeth Molyneux
- College of Medicine, IMCHA Project, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- College of Medicine, IMCHA Project, Blantyre, Malawi
- Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi
| | - David M. Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- College of Medicine, IMCHA Project, Blantyre, Malawi
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Hana Mijovic
- Department of Pediatrics, BC Children’s Hospital and University of British Columbia, Vancouver, Canada
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Physician Views on a Computerized Decision Support System for Home Care Information Exchange. J Am Med Dir Assoc 2019; 21:426-428.e1. [PMID: 31780410 DOI: 10.1016/j.jamda.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 11/22/2022]
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Kempner S, Brackmann M, Kobernik E, Skinner B, Bollinger M, Hammoud M, Morgan H. The decline in attitudes toward physician-nurse collaboration from medical school to residency. J Interprof Care 2019; 34:373-379. [PMID: 31752567 DOI: 10.1080/13561820.2019.1681947] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
While interprofessional collaboration is a critical aspect of optimal patient care, practicing physicians often have sub-optimal attitudes regarding the importance of collaboration with their nursing colleagues. The impact of clinical training on medical students' and residents' attitudes toward physician-nurse collaboration has not been investigated. The primary goal of our study was to examine if learners at different stages in their medical training had more or less favorable attitudes regarding interprofessional collaboration (IPC). A secondary goal was to compare residents in procedural versus non-procedural specialties to determine if attitudes toward IPC varied by specialty type. Third-year medical students and residents at a large public university completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. Student (n = 129) and resident (n = 292) scores were compared using Student's t-tests. Resident responses were further analyzed by specialty type. Students' perceptions of the physician-nurse relationship were significantly more favorable than the views of residents, particularly in the "Authority" and "Responsibility" domains. Residents in procedural specialties had less favorable attitudes toward physician-nurse collaboration than those in non-procedural specialties. Our findings highlight the importance of developing effective interventions for improving interprofessional collaboration during medical training.
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Affiliation(s)
- Samantha Kempner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Melissa Brackmann
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Kobernik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Bethany Skinner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Megan Bollinger
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Maya Hammoud
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Helen Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Migotto S, Garlatti Costa G, Ambrosi E, Pittino D, Bortoluzzi G, Palese A. Gender issues in physician-nurse collaboration in healthcare teams: Findings from a cross-sectional study. J Nurs Manag 2019; 27:1773-1783. [PMID: 31529750 DOI: 10.1111/jonm.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/13/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Abstract
AIMS The aims of the study were (a) to assess whether the proportion of female nurses and female physicians in a given unit influences the attitude of collaboration between nurses and physicians as reported by nurses, and (b) to examine how these two dimensions interact to influence attitudes towards cooperation. BACKGROUND Available studies have documented that gender influences the collaboration between physicians and nurses, but no have explored the influence of specific combinations-such as a high proportion of female nurses and a high proportion of female physicians. METHODS A cross-sectional study involving 700 nurses working in 36 hospital units in Italy. The validated Italian version of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration was used. A three stages hierarchical linear regression was performed by entering: (a) the control variables at the individual and at the unit levels, (b) the proportion of female nurses and physicians and (c) the two-way interaction. RESULTS A total of 430 nurses participated; the average Jefferson Scale of Attitudes towards Physician-Nurse Collaboration total score was 48.64 ± 5.27. At the second and third stages of the hierarchical linear regression model (explaining 12.8% and 14.1% of the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration variance, respectively), having more female RNs as staff (model two: ß = 0.61, p =< .1; model three: ß = 0.69, p =< .05) was significantly associated with higher Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores; differently, higher physician-nurse ratios (model two: ß = -4.09, p =< .05; model three: ß = -4.54, p =< .01), and more female physicians (model two: ß = -1.06, p =< .05; model three: ß = -1.29, p =< .01) were associated with lower Jefferson Scale of Attitudes towards Physician-Nurse Collaboration scores. CONCLUSION There is a decreased collaboration as reported by nurses when predominantly male nursing teams interact with teams with more female physicians. However, in units lead by female physicians, having more female members among the nursing team, ensures increased attitudes of collaboration as reported by nurses. IMPLICATIONS FOR NURSING MANAGEMENT With the increasing proportion of female physicians and male nurses, unit mangers should be prepared to manage their influence on interprofessional cooperation.
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Affiliation(s)
- Sandra Migotto
- Hospital Nursing Service, AULSS 2 - Marca Trevigiana, Treviso, Italy
| | | | - Elisa Ambrosi
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | - Daniel Pittino
- Jönköping International Business School, Jönköping, Sweden
| | - Guido Bortoluzzi
- Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy
| | - Alvisa Palese
- Nursing Science, Department of Medical Sciences, University of Udine, Udine, Italy
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Uhm JY, Ko Y, Kim S. Implementation of an SBAR communication program based on experiential learning theory in a pediatric nursing practicum: A quasi-experimental study. NURSE EDUCATION TODAY 2019; 80:78-84. [PMID: 31280009 DOI: 10.1016/j.nedt.2019.05.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/08/2019] [Accepted: 05/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Effective communication by nurses is crucial to ensure patient safety. A structured communication program increases communication clarity, education satisfaction, and positivity during interprofessional collaboration among students. In an effort to facilitate effective communication between nurses and physicians, the well-known structured communication tool SBAR (Situation, Background, Assessment, and Recommendation) has been extensively used in clinical and educational settings. OBJECTIVES The purpose of the study is to investigate the impact of an SBAR communication program on communication performance, perception, and practicum-related outcomes in senior-year nursing students. METHOD The study employed a non-equivalent control group quasi-experimental design and implemented the tool in the pediatric nursing practicum of a nursing school. The experimental group participated in a SBAR program, where role playing using SBAR techniques for different scenarios was used to improve practical communication among nursing students. The SBAR program was developed based on Kolb's Experiential Learning Theory. Communication performance was assessed via the SBAR communication tool and the communication clarity scale. Communication perception was measured by handover confidence level. Practicum-related outcomes of clinical practice self-efficacy, perceived nurse-physician collaboration, and practicum satisfaction, were also evaluated. RESULTS The experimental group demonstrated significantly higher SBAR communication (p < .001), communication clarity (p < .001), and handover confidence (p < .001) than the control group. Clinical practice self-efficacy, perceived nurse-physician collaboration, and practicum satisfaction did not differ. CONCLUSIONS The SBAR program in a pediatric nursing practicum improves SBAR communication, communication clarity, and perceived handover confidence in senior-year nursing students.
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Affiliation(s)
- Ju-Yeon Uhm
- Department of Nursing, Daegu Haany University, 1 Haanydaero, Gyeongsan-si, Gyeongsangbuk-Do, 38610, Republic of Korea
| | - YoungJi Ko
- Department of Nursing, Daegu Haany University, 1 Haanydaero, Gyeongsan-si, Gyeongsangbuk-Do, 38610, Republic of Korea.
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing Science, Hallym University, 1 Hallimdaehak-gil, Chuncheon-si, Gangwon-do 24252, Republic of Korea.
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Rettke H, Lehmann AI, Brauchli R, Bauer GF, Petry H, Spirig R. Capturing interprofessional collaboration between physicians and nurses in an acute care setting. A validation study of the revised German version of the Collaborative Practice Scales. J Interprof Care 2019; 34:211-217. [PMID: 31329001 DOI: 10.1080/13561820.2019.1629399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relevance of interprofessional collaboration (IPC) is widely acknowledged. Given the lack of a fully validated instrument in the German language for measuring the level of IPC, we built upon the current, albeit psychometrically weak, German-language version of the instrument to devise a new version with improved wording and for subsequent psychometric testing. In a tertiary hospital in German-speaking Switzerland, 160 physicians and 374 nurses completed the revised Collaborative Practice Scales in German (CPS-G) and additional scales regarding positive and negative activation at work and regarding job demands and job resources. A confirmatory factor analysis of the CPS-G was performed, and internal consistency estimates were computed. Partial correlations between the CPS-G and the additional scales were examined for criterion validity. The model fit of the CPS-G was good for physicians (χ2/df = 2.38, p < .001; CFI = .923; RMSEA = .051, 90%-CI (0.037-0.065)) and moderate for nurses (χ2/df = 5, p < .001; CFI = .919; RMSEA = .087, 90%-CI (0.072-0.102)) supporting the two-factor structure of the original English version. Reliability was acceptable in all sub-scales for physicians (inclusion, α = 0.79; consensus, α = 0.80) and nurses (assertiveness, α = 0.77; understanding α = 0.82). As expected, the CPS-G physicians' subscales correlated positively with positive activation and job resources and negatively with negative activation and job demands, albeit not always statistically significantly. Similar correlations were found with the CPS-G nurses' subscales other than in one instance. The CPS-G showed good construct and criterion validity and acceptable internal consistency. It consequently represents a valid instrument ready for application to measure the level of interprofessional collaboration between nurses and physicians in acute care settings.
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Affiliation(s)
- Horst Rettke
- Clinical Nurse Researcher, Centre for Clinical Nursing Research, University Hospital Zurich, Zurich, Switzerland
| | - Anja I Lehmann
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Rebecca Brauchli
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Georg F Bauer
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Heidi Petry
- Centre for Clinical Nursing Research, University Hospital Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Department of Nursing and Allied Health Professions, University Hospital Zurich, Zurich, Switzerland.,Institute of Nursing Science, Medical Faculty, University Basel, Basel, Switzerland
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How do hospital-based nurses and physicians identify the palliative phase in their patients and what difficulties exist? A qualitative interview study. BMC Palliat Care 2019; 18:54. [PMID: 31288816 PMCID: PMC6617645 DOI: 10.1186/s12904-019-0439-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 07/01/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Early start of palliative care improves the quality of life of eligible patients and their relatives. However, in hospital, patients who could benefit from palliative care are often not identified timely. The aim of this study is to assess how hospital-based nurses and physicians define the palliative phase, how they identify the palliative phase and what difficulties they face. METHODS Semi-structured interviews were held with ten nurses and 18 physicians working at seven hospitals in the Netherlands. Data was analysed using thematic analysis. RESULTS Nurses and physicians feel insecure about how to define the palliative phase and differentiate between an acute and extended phase. Great variation existed in what life expectancy is attributed to each phase. A variety of ways to identify the palliative phase were described: 1) Prognostication. 2) Treatment trade-off. 3) Assessment of patients' preferences and needs. 4) Interprofessional collaboration. Professionals base prognostication on their experience but also search for clinical indicators. When benefits of treatment no longer outweigh the negatives, this was considered an, albeit late, identification point. To start a conversation on a patients' palliative care needs was found to be difficult. Therefore, some respondents wait for patients to vocalize preferences themselves. Many professionals rely on interprofessional collaboration for identification, however uncertainty exist about responsibilities. Difficulties in identification occurred because of variance in definitions, unpredictability of non-oncological diseases, focus on treatment and difficulties in communication and collaboration. CONCLUSION These results provide insight into the challenges and difficulties hospital-based professionals experience in timely identification of patients with palliative care needs.
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69
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Bollen A, Harrison R, Aslani P, van Haastregt JCM. Factors influencing interprofessional collaboration between community pharmacists and general practitioners-A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e189-e212. [PMID: 30569475 DOI: 10.1111/hsc.12705] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
Effective interprofessional collaboration is critical for sustaining high quality care in the context of the increasing burden on primary healthcare services. Despite this, there is limited understanding of the factors contributing to effective collaboration between general practitioners and community pharmacists. The aim of this systematic review was to identify the factors that impact on interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs). Keywords and synonyms were combined and applied to four databases (EMBASE, CINAHL, SCOPUS, and MEDLINE) to identify articles published between January 2000 to April 2017. Relevant journals and reference lists were also hand-searched. A total of 37 articles met the eligibility criteria. Factors that posed a challenge to effective interprofessional collaboration were the perceived imbalance in hierarchy and power between the professions and a lack of understanding of each other's skills and knowledge. Experience of collaboration with the other party led to greater understanding of each other's capabilities and potential role in co-delivering patient care. The physical environment was also identified as important, with co-location and other resources to facilitate clear and regular communication identified as important facilitators of interprofessional collaboration. The review findings highlight a range of approaches that may positively influence interprofessional collaboration between GPs and CPS such as co-location, co-education to understand the professional capabilities of each group, and utilising compatible technologies to facilitate communication between the two professions.
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Affiliation(s)
- Annelies Bollen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Reema Harrison
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Parisa Aslani
- School of Public Health & Community Medicine, University of New South Wales, Sydney, NSW, Australia
- Faculty of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - Jolanda C M van Haastregt
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands
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Kang J, Lim YM. The Relationship between the Work Environment and Person-centered Critical Care Nursing for Intensive Care Nurses. ACTA ACUST UNITED AC 2019. [DOI: 10.34250/jkccn.2019.12.2.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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71
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Lee SE, MacPhee M, Dahinten VS. Factors related to perioperative nurses' job satisfaction and intention to leave. Jpn J Nurs Sci 2019; 17:e12263. [DOI: 10.1111/jjns.12263] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/30/2018] [Accepted: 02/27/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Seung Eun Lee
- Mo‐Im KIM Nursing Research Institute College of Nursing, Yonsei University Seoul Korea
| | - Maura MacPhee
- School of Nursing University of British Columbia Vancouver British Columbia Canada
| | - V. Susan Dahinten
- School of Nursing University of British Columbia Vancouver British Columbia Canada
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Hendrickson MA, Schempf EN, Furnival RA, Marmet J, Lunos SA, Jacob AK. The Admission Conference Call: A Novel Approach to Optimizing Pediatric Emergency Department to Admitting Floor Communication. Jt Comm J Qual Patient Saf 2019; 45:431-439. [PMID: 31000353 PMCID: PMC6588502 DOI: 10.1016/j.jcjq.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
Optimizing information sharing at transfer of care between teams is an important target for the improvement of patient safety. Traditional emergency department (ED)-to-floor handoffs do not support a shared mental model between physicians, residents, and nurses. This report describes and evaluates acceptance of a novel process for coordinating physician and nursing handoff calls for patients being admitted to an inpatient floor from a children's hospital ED. METHODS The Admission Conference Call (ACC) is a single conference call including attendings, residents, and nurses from the ED and inpatient teams, currently used for 29.8% of admissions from one ED. Physicians and nurses were surveyed to assess perception of its effects on patient care. RESULTS A total of 653 ACCs were conducted during 2017. The survey was completed by 43 nurses and 89 physicians. Mean Likert scale findings were in favor of the process supporting safe patient care (4.5/5; standard deviation [SD], 0.6); none said it increased risk. Ratings favored the process improving interdisciplinary alignment (4.0/5; SD, 0.8) and the benefits outweighing the inconvenience (3.9/5; SD, 0.9). Respondents were neutral on the effect of the ACC on throughput time (3.0/5; SD, 1.0). Logistical concerns were expressed; mean satisfaction was 6.8/10 (SD, 2.1). Free text comments varied widely, from pride to frustration. CONCLUSION The Admission Conference Call is a well-accepted alternative to a traditional multiple call process. Most participants believe it supports safe patient care. Further research is necessary to confirm measurable effects on patient outcomes, but this project provides encouragement to institutions considering innovative approaches.
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Affiliation(s)
- Marissa A. Hendrickson
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Emma N. Schempf
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Ronald A. Furnival
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jordan Marmet
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Scott A. Lunos
- Clinical and Translational Science Institute/Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, United States
| | - Abraham K. Jacob
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
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Pakpour V, Ghafourifard M, Salimi S. Iranian Nurses' Attitudes Toward Nurse-Physician Collaboration and its Relationship with Job Satisfaction. J Caring Sci 2019; 8:111-116. [PMID: 31249821 PMCID: PMC6589484 DOI: 10.15171/jcs.2019.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/18/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Although nurses and physicians are known to share the common goal of improving the quality of health care, there has traditionally been a relational gap between them. The aim of the present study was to investigate the attitude of Iranian nurses about physician-nurse collaboration and its relationship with their job satisfaction. Methods: In this cross-sectional study, a total of 232 nurses were recruited from three educational hospitals of Zanjan University of medical sciences. Three questionnaires were used in this study; (a) Demographic data questionnaire, (2) Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC), and (3) Minnesota Satisfaction Questionnaire. Results: In this study, the mean age of the participants was 33.22(SD= 6.13) years, 83.8% of nurses were female, 90.8% had a baccalaureate degree in nursing, and 82.5 % had rotational work shifts. The mean score of physician-nurse collaboration was found to be 48.07 (SD= 8.95) (ranged from 15 to 60), and the mean score of job satisfaction scale was 57.78 (SD = 14.67) (ranged from 20 to 100). There was a significant positive correlation between the attitudes toward physician-nurse collaboration and job satisfaction among the nurses (r=0.59, P≤0.001). Conclusion: The results indicated that the collaboration between nurses and physicians increases the job satisfaction of nurses working in clinical settings. Therefore, nurses and physicians should develop a new culture of collaboration with each other with the mutual goal of high quality patient care. Moreover, health care administrators should implement the strategies that strengthen the development of physician-nurse collaboration.
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Affiliation(s)
- Vahid Pakpour
- Community Health Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sedigheh Salimi
- Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Asman O, Slutsker E, Melnikov S. Nurses' perceptions of pain management adequacy in mechanically ventilated patients. J Clin Nurs 2019; 28:2946-2952. [PMID: 31013381 DOI: 10.1111/jocn.14896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/24/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. BACKGROUND Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. DESIGN The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. METHODS A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February-May 2015. The "STROBE" EQUATOR checklist was used. RESULTS Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. CONCLUSION Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. RELEVANCE TO CLINICAL PRACTICE Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.
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Affiliation(s)
- Oren Asman
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medical Law, Sechenov First Moscow State Medical University, Moskva, Russia
| | - Elena Slutsker
- Nursing Administration, Wolfson Medical Center, Holon, Israel
| | - Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Paulsen MM, Varsi C, Paur I, Tangvik RJ, Andersen LF. Barriers and Facilitators for Implementing a Decision Support System to Prevent and Treat Disease-Related Malnutrition in a Hospital Setting: Qualitative Study. JMIR Form Res 2019; 3:e11890. [PMID: 31094333 PMCID: PMC6532341 DOI: 10.2196/11890] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 02/18/2019] [Accepted: 03/29/2019] [Indexed: 01/04/2023] Open
Abstract
Background Disease-related malnutrition is a challenge among hospitalized patients. Despite guidelines and recommendations for prevention and treatment, the condition continues to be prevalent. The MyFood system is a recently developed decision support system to prevent and treat disease-related malnutrition. Objective To investigate the possible implementation of the MyFood system in clinical practice, the aims of the study were (1) to identify current practice, routines, barriers, and facilitators of nutritional care; (2) to identify potential barriers and facilitators for the use of MyFood; and (3) to identify the key aspects of an implementation plan. Methods A qualitative study was performed among nurses, physicians, registered dietitians, and middle managers in 2 departments in a university hospital in Norway. Focus group discussions and semistructured interviews were used to collect data. The Consolidated Framework for Implementation Research (CFIR) was used to create the interview guide and analyze the results. The transcripts were analyzed using a thematic analysis. Results A total of 27 health care professionals participated in the interviews and focus groups, including nurses (n=20), physicians (n=2), registered dietitians (n=2), and middle managers (n=3). The data were analyzed within 22 of the 39 CFIR constructs. Using the 5 CFIR domains as themes, we obtained the following results: (1) Intervention characteristics: MyFood was perceived to have a relative advantage of being more trustworthy, systematic, and motivational and providing increased awareness of nutritional treatment compared with the current practice. Its lack of communication with the existing digital systems was perceived as a potential barrier; (2) Outer settings: patients from different cultural backgrounds with language barriers and of older age were potential barriers for the use of the MyFood system; (3) Inner settings: no culture for specific routines or systems related to nutritional care existed in the departments. However, tension for change regarding screening for malnutrition risk, monitoring and nutritional treatment was highlighted in all categories of interviewees; (4) Characteristics of the individuals: positive attitudes toward MyFood were present among the majority of the interviewees, and they expressed self-efficacy toward the perceived use of MyFood; (5) Process: providing sufficient information to everyone in the department was highlighted as key to the success of the implementation. The involvement of opinion leaders, implementation leaders, and champions was also suggested for the implementation plan. Conclusions This study identified several challenges in the nutritional care of hospitalized patients at risk of malnutrition and deviations from recommendations and guidelines. The MyFood system was perceived as being more precise, trustworthy, and motivational than the current practice. However, several potential barriers were identified. The assessment of the current situation and the identification of perceived barriers and facilitators will be used in planning an implementation and effect study, including the creation of an implementation plan.
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Affiliation(s)
- Mari Mohn Paulsen
- National Advisory Unit on Disease-related Malnutrition, Department of Cancer Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
| | - Cecilie Varsi
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingvild Paur
- National Advisory Unit on Disease-related Malnutrition, Department of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Randi Julie Tangvik
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Lene Frost Andersen
- Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
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Sabone M, Mazonde P, Cainelli F, Maitshoko M, Joseph R, Shayo J, Morris B, Muecke M, Wall BM, Hoke L, Peng L, Mooney-Doyle K, Ulrich CM. Everyday ethical challenges of nurse-physician collaboration. Nurs Ethics 2019; 27:206-220. [PMID: 31014168 DOI: 10.1177/0969733019840753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. RESEARCH QUESTION/AIM The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels of hospitals in Botswana (referral, district, and primary). ETHICAL CONSIDERATIONS Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants' written informed consent was obtained. FINDINGS Respondents' ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse-doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants' views about how their work experiences could be improved. DISCUSSION Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom-and not a sufficient number of nursing staff. CONCLUSION Collaboration between physicians and nurses is critical to optimizing patients' health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment.
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Affiliation(s)
| | | | | | | | | | | | - Baraka Morris
- Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania
| | | | | | - Linda Hoke
- Hospital of the University of Pennsylvania, USA
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Tang T, Heidebrecht C, Coburn A, Mansfield E, Roberto E, Lucez E, Lim ME, Reid R, Quan SD. Using an electronic tool to improve teamwork and interprofessional communication to meet the needs of complex hospitalized patients: A mixed methods study. Int J Med Inform 2019; 127:35-42. [PMID: 31128830 DOI: 10.1016/j.ijmedinf.2019.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Teamwork and interprofessional communication are important in addressing the comprehensive care needs of complex hospitalized patients. The objective of this study is to evaluate the impact of an electronic interprofessional communication and collaboration platform on teamwork, communication, and adverse events in the hospital setting. MATERIALS AND METHODS In this mixed methods study, we used a quasi-experimental design in the quantitative component and deployed the electronic tool in a staged fashion to 2 hospital wards 3 months apart. We measured teamwork, communication, and adverse events with Relational Coordination survey, video recordings of team rounds, and retrospective chart review. We conducted qualitative semi-structured interviews with clinicians to understand the perceived impacts of the electronic tool and other contextual factors. RESULTS Teamwork sustainably improved (overall Relational Coordination score improved from 3.68 at baseline to 3.84 at three and six months after intervention, p = 0.03) on ward 1. A small change in face-to-face communication pattern during team rounds was observed (making plans increased from 22% to 24%, p = 0.004) at 3 months on ward 1 but was not sustained at 6 months. Teamwork and communication did not change after the intervention on ward 2. There was no meaningful change to adverse event rates on either ward. Clinicians reported generally positive views about the electronic tool's impact but described non-technology factors on each ward that affected teamwork and communication. CONCLUSION The impact of using an electronic tool to improve teamwork and communication in the hospital setting appears mixed, but can be positive in some settings. Improving teamwork and communication likely require both appropriate technology and addressing non-technology factors.
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Affiliation(s)
- Terence Tang
- Institute for Better Health and Program of Medicine, Trillium Health Partners, 100 Queensway West, Clinical Administrative Building, 6th floor, Mississauga, Ontario, L5B 1B8, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | - Andrea Coburn
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
| | - Ellen Roberto
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Emanuel Lucez
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Morgan E Lim
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Robert Reid
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Sherman D Quan
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Stievano A, Sabatino L, Affonso D, Olsen D, Skinner I, Rocco G. Nursing’s professional dignity in palliative care: Exploration of an Italian context. J Clin Nurs 2019; 28:1633-1642. [DOI: 10.1111/jocn.14753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 10/29/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Laura Sabatino
- Centre of Excellence for Nursing Scholarship Opi Rome Italy Rome Italy
| | - Dyanne Affonso
- Centre of Excellence for Nursing Scholarship Opi Rome Italy Rome Italy
| | - Douglas Olsen
- Michigan State University ‐ College of Nursing East Lansing Michigan
| | | | - Gennaro Rocco
- Centre of Excellence for Nursing Scholarship Opi Rome Italy Rome Italy
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Vetter L, Eissler AB, Konrad C. [Measurement of attitudes toward interprofessional collaboration in an operating theatre - a cross-sectional study]. Pflege 2019; 32:157-164. [PMID: 30657412 DOI: 10.1024/1012-5302/a000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Measurement of attitudes toward interprofessional collaboration in an operating theatre - a cross-sectional study Abstract.Background: Interprofessional cooperation (IC) between healthcare professionals is essential for good treatment outcomes. Surgical departments place special demands on interprofessional cooperation (situational team formation, alterning work environment, coordinative overcrowding of work) within a health organisation. In order to achieve common goals in a team, it is important that those involved have a comparable understanding of and attitude towards interprofessional cooperation, regardless of their profession. Research Question: What is the internal consistency of the German version of the Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC) when applied to personnel in an operating theatre? What is the attitude towards interprofessional cooperation between the various occupational groups in a surgical department of an acute care hospital functioning as a centre and a training establishment? Are there differences between the individual occupational groups and the sexes? Method: The validated JeffSATIC questionnaire was translated back into German and sent to 283 people in a surgical department with eleven operating theatres. The internal consistency of the questionnaire and differences in attitude towards interprofessional cooperation were examined. Findings: The German version of the JeffSATIC questionnaire is a reliable instrument for measuring the attitude of individuals towards interprofessional cooperation. It was used for the first time in the context of a surgical department. In the institution examined, there are no statistically significant differences between the different occupational groups and sexes in relation to the attitude to IC in the dimensions 'work relationship' and 'responsibility' determined by the questionnaire. The medical service anaesthesia shows the greatest divergence in attitude towards interprofessional cooperation within a professional group. Conclusions: In the institution examined, the prerequisites for successful interprofessional cooperation exist. In general, it should be further examined which factors influence the divergence in attitude per occupational group and whether these divergences in attitude are also associated with the quality of the actual cooperation.
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Ozeke O, Ozeke V, Coskun O, Budakoglu II. Second victims in health care: current perspectives. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:593-603. [PMID: 31496861 PMCID: PMC6697646 DOI: 10.2147/amep.s185912] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/24/2019] [Indexed: 05/13/2023]
Abstract
Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected patient outcomes. These unexpected complications and unintentional errors will always be a part of the medical system due to the universal nature of human fallibility and technology. While not all errors are life-threatening, they can significantly compromise a patient's quality of life. However, the victims of medical error reach far beyond the patient. The second victim (SV), which defined for the first time by Albert Wu in his description of the impact of errors on HCPs by both personally and professionally, is a medical emergency equivalent to post-traumatic stress disorder. When the errors occur, it causes a domino effect including the four groups: the patient and family (first victim), the HCP [SV], the hospital reputation (third victim), and patients who are harmed subsequently (fourth victims). The rights of our patients to safe, reliable, and patient-centered care are critical and most important as a primary and utmost aim of medicine. However, we also have to take care of our own (SVs), especially when we have good people who mean to do well and then find themselves in an emotionally complex situation. There is a need to articulate to the public, politicians, and media how system failure leads to medical error even in hand of well-educated and competent HCPs are given an increasing clinical workload. Furthermore, despite several leading institutions in western countries have developed formal support programs that allow HCPs to cope with their emotional distress by obtaining timely support in an emphatic, confidential, non-judgmental environment, we need to raise awareness of this phenomenon and appropriate institutional responses both to harmed patients and their families and HCPs.
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Affiliation(s)
- Ozcan Ozeke
- Health Sciences University, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
- Correspondence: Ozcan OzekeSağlık Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Klinigi, Ankara06800, TurkiyeTel +90 505 383 6773Email
| | - Vildan Ozeke
- Gaziosmanpasa University, Department of Computer Education and Instructional Technology, Tokat, Turkey
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
| | - Ozlem Coskun
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
| | - Isil Irem Budakoglu
- Gazi University, Department of Medical Education and Informatics, Ankara, Turkey
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81
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Lee YJ, Hwang JI. Relationships of Nurse-Nurse Collaboration and Nurse-Physician Collaboration with the Occurrence of Medical Errors. ACTA ACUST UNITED AC 2019. [DOI: 10.11111/jkana.2019.25.2.73] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yeong-Ju Lee
- The Inje University Paik Hospital of Korea, Korea
| | - Jee-In Hwang
- College of Nursing Science, Kyung Hee University, Korea
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82
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Bianchi M, Bagnasco A, Ghirotto L, Aleo G, Catania G, Zanini M, Carnevale F, Sasso L. The Point of View of Undergraduate Health Students on Interprofessional Collaboration: A Thematic Analysis. SAGE Open Nurs 2019; 5:2377960819835735. [PMID: 33415229 PMCID: PMC7774347 DOI: 10.1177/2377960819835735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 11/17/2022] Open
Abstract
Interprofessional education (IPE) is essential to prepare future professionals for interprofessional collaboration (IPC). Learning together is essential for students because it is a way to understand the roles of other colleagues, improve their skills, knowledge, competencies, and attitudes to collaborate with the interprofessional teams. To explore how undergraduate students who attend IPE courses define IPC, a qualitative study using semistructured interviews followed by a thematic analysis was performed. Four main themes were identifed: IPC as a resource, requirements for IPC, emotions linked to IPC, and tutor's role to facilitate students' perception of IPC. Students considered IPE important to build IPC, where clinical placement tutors play a key role. The most important findings of the present study include the students' considerations about the importance of IPE when building their IPC definition and the key role played by the tutor during the placement in building IPC in clinical practice.
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Affiliation(s)
- Monica Bianchi
- University of Applied Sciences and Arts
of Southern Switzerland, Manno, Switzerland
| | | | - Luca Ghirotto
- Arcispedale Santa Maria Nuova - IRCCS,
Reggio Emilia, Italy
| | - Giuseppe Aleo
- Department of Health Sciences,
University of Genoa, Italy
| | | | - Milko Zanini
- Department of Health Sciences,
University of Genoa, Italy
| | - Franco Carnevale
- Ingram School of Nursing, McGill
University, Montréal, Québec, Canada
| | - Loredana Sasso
- Department of Health Sciences,
University of Genoa, Italy
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Gleddie M, Stahlke S, Paul P. Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery. J Interprof Care 2018:1-11. [PMID: 30596305 DOI: 10.1080/13561820.2018.1562422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 07/29/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.
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Affiliation(s)
- Megan Gleddie
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
| | - Sarah Stahlke
- b Faculty of Nursing , University of Alberta, Edmonton Clinic Health Academy , Alberta , Canada
| | - Pauline Paul
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
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Burm S, Boese K, Faden L, DeLuca S, Huda N, Hibbert K, Goldszmidt M. Recognising the importance of informal communication events in improving collaborative care. BMJ Qual Saf 2018; 28:289-295. [DOI: 10.1136/bmjqs-2017-007441] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 11/03/2022]
Abstract
BackgroundWhile the concept of collaboration is highly touted in the literature, most descriptions of effective collaboration highlight formal collaborative events; largely ignored are the informal collaborative events and none focusing on the frequent, ‘seemingly’ by chance communication events that arise and their role in supporting patient safety and quality care.ObjectiveTo identify the types of informal communication events that exist in the inpatient setting and better understand the barriers contributing to their necessity.MethodsWe undertook a constructivist grounded theory study in an inpatient internal medicine teaching unit in Ontario, Canada. Interview and observational data were collected across two phases; in total, 56 participants were consented for the study. Data collection and analysis occurred iteratively; themes were identified using constant comparison methods.ResultsSeveral types of informal communication events were identified and appeared valuable in three ways: (1) providing a better sense of a patient’s baseline function in comparison to their current function; (2) gaining a more holistic understanding of the patient’s needs; and (3) generating better insight into a patient’s wishes and goals of care. Participants identified a number of organisational and communication challenges leading to the need for informal communication events. These included: scheduling, competing demands and the spatial and temporal organisation of the ward. As a result, nursing staff, allied health professionals and caregivers had to develop strategies for interacting with the physician team.ConclusionWe highlight the importance of informal communication in supporting patient care and the gaps in the system contributing to their necessity. Changes at the system level are needed to ensure we are not leaving important collaborative opportunities to chance alone.
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85
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Wilson KM, Leeman J, Saunders B, Havens DS. Improving physician engagement in interprofessional collaborative practice in rural emergency departments. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.xjep.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Butterworth K, Rajupadhya R, Gongal R, Manca T, Ross S, Nichols D. A clinical nursing rotation transforms medical students' interprofessional attitudes. PLoS One 2018; 13:e0197161. [PMID: 29795598 PMCID: PMC5967832 DOI: 10.1371/journal.pone.0197161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/27/2018] [Indexed: 11/19/2022] Open
Abstract
This study explores the extent to which a one-week nursing rotation for medical students changed the interprofessional attitudes of the participating nurses and students. Third-year medical students worked with nurses before starting clinical rotations. Pre- and post-experience surveys assessing perceptions of mutual respect, nurse-doctor roles, and interprofessional communication and teamwork were given to 55 nurses and 57 students. The surveys consisted of qualitative questions and a Likert scale questionnaire that was analyzed using qualitative and quantitative content analyses. The response rate was 51/57 (89%) students and 44/55 (80%) nurse preceptors. Nurses reported that students met nurses’ expectations by displaying responsibility, respect, effective communication, and an understanding of nursing roles. Medical students’ narratives demonstrated two significant changes. First, their views of nurses changed from that of physician helpers to that of collaborative patient-centred professionals. Second, they began defining nursing not by its tasks, but as a caring- and communication-centred profession. Responses to Likert-scaled questions showed significant differences corresponding to changes described in the narrative. A one-week immersive clinical nursing rotation for medical students was a transformative way of learning interprofessional competencies. Learning in an authentic workplace during a clinical rotation engendered mutual respect between nurses and future doctors. Students’ view of the role of nurses changed from nurses working for doctors with patients, to working with doctors for patients.
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Affiliation(s)
- Katrina Butterworth
- Department of General Practice, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Rashmi Rajupadhya
- School of Nursing, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Rajesh Gongal
- Department of General Surgery, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Terra Manca
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - Darren Nichols
- Department of Family Medicine, University of Alberta, Edmonton, Canada
- * E-mail:
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Simulation of patient flow in multiple healthcare units using process and data mining techniques for model identification. J Biomed Inform 2018; 82:128-142. [PMID: 29753874 DOI: 10.1016/j.jbi.2018.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/05/2018] [Accepted: 05/09/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION An approach to building a hybrid simulation of patient flow is introduced with a combination of data-driven methods for automation of model identification. The approach is described with a conceptual framework and basic methods for combination of different techniques. The implementation of the proposed approach for simulation of the acute coronary syndrome (ACS) was developed and used in an experimental study. METHODS A combination of data, text, process mining techniques, and machine learning approaches for the analysis of electronic health records (EHRs) with discrete-event simulation (DES) and queueing theory for the simulation of patient flow was proposed. The performed analysis of EHRs for ACS patients enabled identification of several classes of clinical pathways (CPs) which were used to implement a more realistic simulation of the patient flow. The developed solution was implemented using Python libraries (SimPy, SciPy, and others). RESULTS The proposed approach enables more a realistic and detailed simulation of the patient flow within a group of related departments. An experimental study shows an improved simulation of patient length of stay for ACS patient flow obtained from EHRs in Almazov National Medical Research Centre in Saint Petersburg, Russia. CONCLUSION The proposed approach, methods, and solutions provide a conceptual, methodological, and programming framework for the implementation of a simulation of complex and diverse scenarios within a flow of patients for different purposes: decision making, training, management optimization, and others.
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Ma C, Park SH, Shang J. Inter- and intra-disciplinary collaboration and patient safety outcomes in U.S. acute care hospital units: A cross-sectional study. Int J Nurs Stud 2018; 85:1-6. [PMID: 29783090 DOI: 10.1016/j.ijnurstu.2018.05.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Collaboration among healthcare providers has been considered a promising strategy for improving care quality and patient outcomes. Despite mounting evidence demonstrating the impact of collaboration on outcomes of healthcare providers, there is little empirical evidence on the relationship between collaboration and patient safety outcomes, particularly at the patient care unit level. OBJECTIVES The purpose of this study is to identify the extent to which interdisciplinary collaboration between nurses and physicians and intradisciplinary collaboration among nurses on patient care units are associated with patient safety outcomes. METHODS This is a cross-sectional study using nurse survey data and patient safety indicators data from U.S. acute care hospital units. Collaboration at the unit level was measured by two 6-item scales: nurse-nurse interaction scale and nurse-physician interaction scale. Patient outcome measures included hospital-acquired pressure ulcers (HAPUs) and patient falls. The unit of analysis was the patient care unit, and the final sample included 900 units of 5 adult unit types in 160 hospitals in the U.S. Multilevel logistic and Poisson regressions were used to estimate the relationship between collaboration and patient outcomes. All models were controlled for hospital and unit characteristics, and clustering of units within hospitals was considered. RESULTS On average, units had 26 patients with HAPUs per 1000 patients and 3 patient falls per 1000 patient days. Critical care units had the highest HAPU rate (50/1000 patients) and the lowest fall rate (1/1000 patient days). A one-unit increase in the nurse-nurse interaction scale score led to 31% decrease in the odds of having a HAPU (OR, 0.69; 95% CI, 0.56-0.82) and 8% lower patient fall rate (IRR, 0.92; 95% CI, 0.87-0.98) on a nursing unit. A one-unit increase in the nurse-physician interaction scale score was associated with 19% decrease in the odds of having a HAPU (OR, 0.81; 95% CI, 0.68-0.97) and 13% lower fall rates (IRR, 0.87; 95% CI, 0.82-0.93) on a unit. CONCLUSIONS Both nurse-physician collaboration and nurse-nurse collaboration were significantly associated with patient safety outcomes. Findings from this study suggest that improving collaboration among healthcare providers should be considered as an important strategy for promoting patient safety and both interdisciplinary and intradisciplinary collaboration are critical for achieving better patient outcomes.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, United States.
| | - Shin Hye Park
- University of Kansas School of Nursing, United States
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Boyd AD, Dunn Lopez K, Lugaresi C, Macieira T, Sousa V, Acharya S, Balasubramanian A, Roussi K, Keenan GM, Lussier YA, Li J'J, Burton M, Di Eugenio B. Physician nurse care: A new use of UMLS to measure professional contribution: Are we talking about the same patient a new graph matching algorithm? Int J Med Inform 2018; 113:63-71. [PMID: 29602435 PMCID: PMC5909845 DOI: 10.1016/j.ijmedinf.2018.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/22/2017] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. OBJECTIVE The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. METHODS 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted "physician terms" from free-text physician summaries. The nursing plans of care were constructed using the HANDS© nursing documentation software. HANDS© utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create "nursing terms". The physician's and nurse's terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. RESULTS We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions' documentation. On average, physicians' discharge summaries contain 27 terms and nurses' documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between nurse and physician care. CONCLUSION Our hypothesis that physician's and nurse's practice domains are markedly different is supported by the preliminary, quantitative evidence we found. Leveraging the UMLS network and graph traversal algorithms, allows us to compare and contrast nursing and physician care on a single patient, enabling a more complete picture of patient care. We can differentiate professional contributions to patient outcomes and related and divergent concepts by each profession.
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Affiliation(s)
- Andrew D Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, United States.
| | - Karen Dunn Lopez
- Department of Health System Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612, United States
| | - Camillo Lugaresi
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
| | - Tamara Macieira
- Department of Health System Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612, United States
| | - Vanessa Sousa
- Department of Health System Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612, United States
| | - Sabita Acharya
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
| | - Abhinaya Balasubramanian
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
| | - Khawllah Roussi
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, United States
| | - Gail M Keenan
- Department of Health Care Environments and Systems, College of Nursing, University of Florida, PO Box 100187, Gainesville, FL 32610, United States
| | - Yves A Lussier
- Department of Medicine, College of Medicine, University of Arizona, 1501 N. Campbell Dr, Tucson, AZ 85724, United States; The University of Arizona Health Sciences Center, 1295 North Martin Ave, Tucson, AZ 85721, United States
| | - Jianrong 'John' Li
- Department of Medicine, College of Medicine, University of Arizona, 1501 N. Campbell Dr, Tucson, AZ 85724, United States; The University of Arizona Health Sciences Center, 1295 North Martin Ave, Tucson, AZ 85721, United States
| | - Michel Burton
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, United States
| | - Barbara Di Eugenio
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
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Timmins B, Thomas Riché C, Saint-Jean M, Tuck J, Merry L. Nursing wound care practices in Haiti: facilitators and barriers to quality care. Int Nurs Rev 2018; 65:542-549. [DOI: 10.1111/inr.12438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B.A. Timmins
- Ingram School of Nursing; McGill University; Montreal QC Canada
| | - C. Thomas Riché
- Nursing Education Collaborative for Haiti - Coopérative des Infirmières en Éducation pour Haiti (NECH-CIEH); Port-au-Prince Haiti
| | - M.W. Saint-Jean
- Nursing Education Collaborative for Haiti - Coopérative des Infirmières en Éducation pour Haiti (NECH-CIEH); Port-au-Prince Haiti
| | - J. Tuck
- Ingram School of Nursing; McGill University; Montreal QC Canada
| | - L. Merry
- School of Nursing; University of Ottawa; Ottawa ON Canada
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91
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Wang JN, Petrini MA. Impacts of a Simulation-Based Interprofessional Intervention on Chinese Health Students. Clin Simul Nurs 2018. [DOI: 10.1016/j.ecns.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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92
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Martland J, Chamberlain D, Hutton A, Smigielski M. Communication and general concern criterion prior to activation of the rapid response team: a grounded theory. AUST HEALTH REV 2018; 40:477-483. [PMID: 26615586 DOI: 10.1071/ah15123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/12/2015] [Indexed: 11/23/2022]
Abstract
Objective Patients commonly show signs and symptoms of deterioration for hours or days before cardiorespiratory arrest. Rapid response teams (RRT) were created to improve recognition and response to patient deterioration in these situations. Activation criteria include vital signs or 'general concern' by a clinician or family member. The general concern criterion for RRT activation accounts for nearly one-third of all RRT activity, and although it is well established that communication deficits between staff can contribute to poorer outcomes for patients, there is little evidence pertaining to communication and its effects on the general concern RRT activation. Thus, the aim of the present study was to develop a substantive grounded theory related to the communication process between clinicians that preceded the activation of an RRT when general concern criterion was used. Methods Qualitative grounded theory involved collection of three types of data details namely personal notes from participants in focus groups with white board notes from discussions and audio recordings of the focus groups sessions. Focus groups were conducted with participants exploring issues associated with clinician communication and how it related to the activation of an RRT using the general concern criterion. Results The three main phases of coding (i.e. open, axial and selective coding) analysis identified 322 separate open codes. The strongest theme contributed to a theory of ineffective communication and decreased psychological safety, namely that 'In the absence of effective communication there is a subsequent increase in anxiety, fear or concern that can be directly attributed to the activation of an RRT using the 'general concern' criterion'. The RRT filled cultural and process deficiencies in the compliance with an escalation protocol. Issues such as 'not for resuscitation documentation' and 'inability to establish communication with and between medical or nursing personnel' rated highly and contributed to the debate. Conclusions This study highlighted that in the surveillance and management of the deteriorating patient and in the absence of effective communication there is a subsequent increase in anxiety, fear or concern that can be directly attributed to the activation of an RRT for the 'general concern' calling criteria. What is known about the topic? Deficiencies in collaboration and communication between healthcare professionals (HCPs) increase the stress and anxiety of healthcare staff and correspond to poorer outcomes for patients. The RRT can be activated as a 'general concern RRT' without observation of physiological derangements if staff are concerned about a patient's condition, allowing for assistance from a skilled critical care team at the patient's bedside. There are limited data on how poor communication affects the frequency of activation of general concern RRTs. What does this paper add? This study shows that poor communication between health professionals increases staff levels of anxiety and concern. In addition, the RRT system is being used to fill deficiencies in many other hospital processes, including end-of-life discussions. The deficiencies in hospital processes contribute to poor communication and increased levels of concern with this study demonstrating a direct link between a clinician's level of anxiety/concern and the 'general concern' activation category for the RRT system. What are the implications for practitioners? The present study highlights the importance of effective communication strategies between HCPs to improve patient safety and quality of care. The study also highlights the expanding role of the RRT in hospitals, which has implications for hospital policy makers with regard to future funding and resource allocation. Finally, many of the concerns raised in the present study by the focus groups have been addressed by recent measures introduced through the Australian Commission on Safety and Quality in Health Care (e.g. rapid detection and response observation charts and Introduction, Situation, Background, Assessment and Recommendation [ISBAR] style of communication) with these measures supported by the findings of the present study.
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Affiliation(s)
- Jarrad Martland
- Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA 5042, Australia
| | - Diane Chamberlain
- Flinders University, School of Nursing and Midwifery, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia.
| | - Alison Hutton
- Flinders University, School of Nursing and Midwifery, Sturt Road, Bedford Park, Adelaide, SA 5042, Australia.
| | - Michael Smigielski
- Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email
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93
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Gawronski O, Parshuram C, Cecchetti C, Tiozzo E, Ciofi Degli Atti ML, Dall'Oglio I, Scarselletta G, Offidani C, Raponi M, Latour JM. Qualitative study exploring factors influencing escalation of care of deteriorating children in a children's hospital. BMJ Paediatr Open 2018; 2:e000241. [PMID: 29862330 PMCID: PMC5976135 DOI: 10.1136/bmjpo-2017-000241] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/20/2018] [Accepted: 04/29/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND System-level interventions including rapid response teams and paediatric early warning scores have been designed to support escalation of care and prevent severe adverse events in hospital wards. Barriers and facilitators to escalation of care have been rarely explored in paediatric settings. AIM This study explores the experiences of parents and healthcare professionals of in-hospital paediatric clinical deterioration events to identify factors associated with escalation of care. METHODS Across 2 hospital sites, 6 focus groups with 32 participants were conducted with parents (n=9) and healthcare professionals (n=23) who had cared for or witnessed a clinical deterioration event of a child. Transcripts of audio recording were analysed for emergent themes using a constant comparative approach. FINDINGS Four themes and 19 subthemes were identified: (1) impact of staff competencies and skills, including personal judgement of clinical efficacy (self-efficacy), differences in staff training and their impact on perceived nursing credibility; (2) impact of relationships in care focusing on communication and teamwork; (3) processes identifying and responding to clinical deterioration, such as patient assessment practices, tools to support the identification of patients at risk and the role of the rapid response team; and (4) influences of organisational factors on escalation of care, such as staffing, patient pathways and continuity of care. CONCLUSIONS Findings emphasise the considerable influence of social processes such as teamwork, communication, models of staff organisation and staff education. Further studies are needed to better understand how modification of these factors can be used to improve patient safety.
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Affiliation(s)
- Orsola Gawronski
- Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Christopher Parshuram
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Corrado Cecchetti
- Department of Critical Care Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emanuela Tiozzo
- Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Immacolata Dall'Oglio
- Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianna Scarselletta
- Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Offidani
- Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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94
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Tang CJ, Zhou WT, Chan SWC, Liaw SY. Interprofessional collaboration between junior doctors and nurses in the general ward setting: A qualitative exploratory study. J Nurs Manag 2017; 26:11-18. [DOI: 10.1111/jonm.12503] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Wen T. Zhou
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Sally W.-C. Chan
- School of Nursing and Midwifery; University of Newcastle; Newcastle NSW Australia
| | - Sok Y. Liaw
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
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95
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Pattni N, Bould M, Hayter M, McLuckie D, Noble L, Malavade A, Friedman Z. Gender, power and leadership: the effect of a superior's gender on respiratory therapists’ ability to challenge leadership during a life-threatening emergency. Br J Anaesth 2017; 119:697-702. [DOI: 10.1093/bja/aex246] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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96
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Morales Asencio JM, Hueso Montoro C, de Pedro-Gómez JE, Bennasar-Veny M. 1977-2017: La investigación enfermera en España tras 40 años en la Universidad. ENFERMERIA CLINICA 2017; 27:314-326. [DOI: 10.1016/j.enfcli.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
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97
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Blondon KS, Chan KCG, Muller-Juge V, Cullati S, Hudelson P, Maître F, Vu NV, Savoldelli GL, Nendaz MR. A concordance-based study to assess doctors' and nurses' mental models in Internal Medicine. PLoS One 2017; 12:e0182608. [PMID: 28792524 PMCID: PMC5549723 DOI: 10.1371/journal.pone.0182608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/21/2017] [Indexed: 11/23/2022] Open
Abstract
Interprofessional collaboration between doctors and nurses is based on team mental models, in particular for each professional’s roles. Our objective was to identify factors influencing concordance on the expectations of doctors’ and nurses’ roles and responsibilities in an Internal Medicine ward. Using a dataset of 196 doctor-nurse pairs (14x14 = 196), we analyzed choices and prioritized management actions of 14 doctors and 14 nurses in six clinical nurse role scenarios, and in five doctor role scenarios (6 options per scenario). In logistic regression models with a non-nested correlation structure, we evaluated concordance among doctors and nurses, and adjusted for potential confounders (including prior experience in Internal Medicine, acuteness of case and gender). Concordance was associated with number of female professionals (adjusted OR 1.32, 95% CI 1.02 to 1.73), for acute situations (adjusted OR 2.02, 95% CI 1.13 to 3.62), and in doctor role scenarios (adjusted OR 2.19, 95% CI 1.32 to 3.65). Prior experience and country of training were not significant predictors of concordance. In conclusion, our concordance-based approach helped us identify areas of lower concordance in expected doctor-nurse roles and responsibilities, particularly in non-acute situations, which can be targeted by future interprofessional, educational interventions.
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Affiliation(s)
- Katherine S. Blondon
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
- * E-mail:
| | - K. C. Gary Chan
- Department of Biostatistics and Department of Health Services, University of Washington, Seattle, United States of America
| | - Virginie Muller-Juge
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
| | - Nu V. Vu
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L. Savoldelli
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R. Nendaz
- Division of General Internal Medicine, Department of General Internal Medicine, Geriatrics and Rehabilitation, University Hospitals of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Esmaeilpour-Bandboni M, Vaismoradi M, Salsali M, Snelgrove S, Sheldon LK. Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses. Res Theory Nurs Pract 2017; 31:202-218. [PMID: 28793945 DOI: 10.1891/1541-6577.31.3.202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. METHODS Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. RESULTS Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." IMPLICATIONS FOR PRACTICE Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.
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Effect of Peer-to-Peer Nurse-Physician Collaboration on Attitudes Toward the Nurse-Physician Relationship. J Nurses Prof Dev 2017; 33:13-18. [PMID: 28059985 DOI: 10.1097/nnd.0000000000000310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this study was to pilot a novel peer-to-peer nurse-physician collaboration program and assess for changes in attitudes toward collaboration among a group of newly licensed nurses and resident physicians (n = 39). The program included large group meetings, with discussion of key concepts related to interprofessional collaboration. In unit-based teams, the registered nurses and physicians developed a quality improvement project to meet a need on their unit. Creating learning activities like this program enable nursing professional development specialists to promote interprofessional collaboration and learning.
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100
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Dias RD, Scalabrini-Neto A. Acute stress in residents playing different roles during emergency simulations: a preliminary study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:239-243. [PMID: 28658657 PMCID: PMC5511741 DOI: 10.5116/ijme.5929.60f1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate acute stress response in residents playing nurse and physician roles during emergency simulations. METHODS Sixteen second-year internal medicine residents participated in teams of four (two playing physician roles and two playing nurse roles). Stress markers were assessed in 24 simulations at baseline (T1) and immediately after the scenario (T2), using heart rate, systolic and diastolic blood pressure, salivary α-amylase, salivary cortisol and salivary interleukin-1β. The State-Trait Anxiety Inventory was applied at T2. Continuous data were summarized for the median (1st-3rd interquartile ranges), and the Mann-Whitney U Test was used to compare the groups. RESULTS The percent variations of the stress markers in the physician and nurse roles, respectively, were the following: heart rate: 70.5% (46.0-136.5) versus 53.0% (29.5-117.0), U=89.00, p=0.35; systolic blood pressure: 3.0% (0.0-10.0) versus 2.0% (-2.0-9.0), U=59.50, p=0.46; diastolic blood pressure: 5.5% (0.0-13.5) versus 0.0% (0.0-11.5), U=91.50, p=0.27; α-amylase: -5.35% (-62.70-73.90) versus 42.3% (12.4-133.8), U=23.00, p=0.08; cortisol: 35.3% (22.2-83.5) versus 42.3% (12.4-133.8), U=64.00, p=0.08); and interleukin-1β: 54.4% (21.9-109.3) versus 112.55% (29.7-263.3), U= 24.00, p=0.277. For the physician and nurse roles, respectively, the average heart rate was 101.5 (92.0-104.0) versus 91.0 (83.0-99.5) beats per minute, U=96.50, p=0.160; and the state anxiety inventory score was 44.0 (40.0-50.0) versus 42.0 (37.50-48.0) points, U= 89.50, p=0.319. CONCLUSIONS Different roles during emergency simulations evoked similar participants' engagement, as indicated by acute stress levels. Role-play strategies can provide high psychological fidelity for simulation-based training, and these results reinforce the potential of role-play methodologies in medical education.
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Affiliation(s)
- Roger Daglius Dias
- Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Augusto Scalabrini-Neto
- Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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