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Khan NS, Shahnaz SI, Gomathi KG. Currently Available Tools and Teaching Strategies for the Interprofessional Education of Students in Health Professions: Literature review. Sultan Qaboos Univ Med J 2016; 16:e277-85. [PMID: 27606105 PMCID: PMC4996288 DOI: 10.18295/squmj.2016.16.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/12/2016] [Accepted: 06/09/2016] [Indexed: 11/16/2022] Open
Abstract
Interprofessional education (IPE) is designed to provide students from different health sectors with opportunities to work together to enhance future collaboration. The implementation of IPE activities is a current trend in various countries. This review exclusively targets IPE issues involving undergraduate health profession students and highlights various approaches in different regions. A total of 28 articles published in peer-reviewed journals between January 2012 and July 2015 were assessed to determine recent trends in IPE implementation. Nine main strategies were identified: simulation-based education programmes; rotations in rural and community settings; interprofessional training wards; patient-centred case studies; theme-centred workshops; student seminars; student-delivered lectures; health promotion activities; and interactive lectures in a common setting. Many of these institutions had not restricted themselves to a single strategy and supplemented these activities with additional teaching or learning methods. Recommendations gathered from these diverse approaches may assist the development of sustainable strategies for implementing IPE in undergraduate medical curricula.
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Affiliation(s)
- Nelofar S. Khan
- Department of Biochemistry, Gulf Medical University, Ajman, United Arab Emirates
| | - Syed I. Shahnaz
- Department of Pharmacology, Gulf Medical University, Ajman, United Arab Emirates
| | - Kadayam G. Gomathi
- Department of Biochemistry, Gulf Medical University, Ajman, United Arab Emirates
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252
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Braithwaite J, Clay-Williams R, Vecellio E, Marks D, Hooper T, Westbrook M, Westbrook J, Blakely B, Ludlow K. The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment. BMJ Open 2016; 6:e012467. [PMID: 27473955 PMCID: PMC4985874 DOI: 10.1136/bmjopen-2016-012467] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the basis of multidisciplinary teamwork. In real-world healthcare settings, clinicians often cluster in profession-based tribal silos, form hierarchies and exhibit stereotypical behaviours. It is not clear whether these social structures are more a product of inherent characteristics of the individuals or groups comprising the professions, or attributable to a greater extent to workplace factors. SETTING Controlled laboratory environment with well-appointed, quiet rooms and video and audio equipment. PARTICIPANTS Clinical professionals (n=133) divided into 35 groups of doctors, nurses and allied health professions, or mixed professions. INTERVENTIONS Participants engaged in one of three team tasks, and their performance was video-recorded and assessed. PRIMARY AND SECONDARY MEASURES Primary: teamwork performance. Secondary, pre-experimental: a bank of personality questionnaires designed to assess participants' individual differences. Postexperimental: the 16-item Mayo High Performance Teamwork Scale (MHPTS) to measure teamwork skills; this was self-assessed by participants and also by external raters. In addition, external, arm's length blinded observations of the videotapes were conducted. RESULTS At baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43). CONCLUSIONS Once clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals' or professions' characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elia Vecellio
- South Eastern Area Laboratory Services, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Danielle Marks
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tamara Hooper
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mary Westbrook
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Brette Blakely
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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253
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Tomizawa R, Yamano M, Osako M, Hirabayashi N, Oshima N, Sigeta M, Reeves S. Validation of a global scale to assess the quality of interprofessional teamwork in mental health settings. J Ment Health 2016; 26:502-509. [DOI: 10.1080/09638237.2016.1207232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ryoko Tomizawa
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan,
- Graduate School, Tokyo Metropolitan University, Arakawa, Tokyo, Japan,
| | - Mayumi Yamano
- National Hospital Organization, Tokyo Medical Center, Meguro, Tokyo, Japan, and
| | - Mitue Osako
- National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan,
| | | | - Nobuo Oshima
- Graduate School, Tokyo Metropolitan University, Arakawa, Tokyo, Japan,
| | - Masahiro Sigeta
- Graduate School, Tokyo Metropolitan University, Arakawa, Tokyo, Japan,
| | - Scott Reeves
- Kingston University & St George’s, University of London, Kingston upon Thames, UK
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254
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Khan A, Rogers JE, Forster CS, Furtak SL, Schuster MA, Landrigan CP. Communication and Shared Understanding Between Parents and Resident-Physicians at Night. Hosp Pediatr 2016; 6:319-29. [PMID: 27188189 DOI: 10.1542/hpeds.2015-0224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Communication breakdowns between members of the health care team compromise patient safety and experience. Communication breakdowns with parents, an important but often overlooked part of the health care team, are understudied. Parents may play a particularly important role in nighttime care given decreased staffing and inadequate transitions of care at night. We studied communication breakdowns evidenced by lack of shared understanding between parents and night-team residents about the reason for admission and care plan. METHODS We conducted a prospective cohort study of parents (n = 286) and night-team senior residents (n = 34) from May 1, 2013 to October 31, 2013. Parents and residents rated communication and described patients' reason for admission, overall plan, and overnight plan. Two physician investigators independently reviewed (κ = 0.63) resident-parent dyads, assigned subsequently dichotomized 4-point overall agreement scores, and rated plan complexity. Using clustered logistic regression, we evaluated relationships among demographics, plan complexity, and shared understanding. We also examined resident and parent perceptions of shared understanding. RESULTS We analyzed data from 257 parent-resident dyads. Among these, 45.1% were rated as lacking shared understanding (agreement score = 1 or 2). In multivariate analysis, higher plan complexity (P < .001) and length of stay (P = .002) were associated with lack of shared understanding; lower parental education was a borderline predictor (P = .05). When surveyed, parents and residents reported that they shared an understanding with one another about care plans in 86.0% and 73.1% of cases, respectively. CONCLUSIONS Parents and night-team residents frequently lack shared understanding. Family-centered care initiatives to improve parent-provider communication and shared understanding may help empower parents as partners in safe and high-quality nighttime care.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Jayne E Rogers
- Department of Nursing, Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Mark A Schuster
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Christopher P Landrigan
- Division of General Pediatrics, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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255
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Mulvale G, Embrett M, Razavi SD. 'Gearing Up' to improve interprofessional collaboration in primary care: a systematic review and conceptual framework. BMC FAMILY PRACTICE 2016; 17:83. [PMID: 27440181 PMCID: PMC4955241 DOI: 10.1186/s12875-016-0492-1] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/13/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Interprofessional Primary Care Teams (IPCTs) have been shown to benefit health systems and patients, particularly those patients with complex care needs. The literature suggests a wide range of factors that may influence collaboration in IPCTs, however the evidence base is unclear for many of these factors. To target improvement efforts, we identify studies that demonstrate an association between suggested factors and collaborative processes in IPCTs. METHODS A systematic review of 25 years of peer-review literature was conducted to identify studies that test associations between policy, organizational, care team and individual factors, and collaboration in IPCTs. We searched Medline, ProQuest subject, ProQuest abstract, CINAHL, HealthSTAR, and Embase electronic databases between January 1990 to June 2015 and hand-searched reference lists of identified articles. RESULTS The electronic searches identified 1421 articles, nine of which met inclusion criteria. Eighteen factors were significantly associated with collaboration in at least one article. We present the findings within a proposed conceptual model of interrelated 'gears'. The model offers a taxonomy of factors that policy makers (macro gear), organizational managers (meso gear), care teams (micro gear) and health professionals (individual gear) can adjust to improve interprofessional collaboration in IPC teams. Thirteen of the eighteen identified factors were within the micro gear, or team level of decision-making. These pertained to formal processes such as quality audits and group problem-solving; social processes such as open communication and supportive colleagues; team attitudes such as feeling part of the team; and team structure such as team size and having a collaboration champion or facilitator. Fewer policy (eg governance), organizational (eg information systems, organizational culture) or individual (eg belief in interprofessional collaboration care and personal flexibility) level factors were identified. CONCLUSIONS The findings suggest that individual IPCTs have opportunities to improve collaboration regardless of the organizational or policy context within which they operate. Evidence supports the importance of having a team vision and shared goals, formal quality processes, information systems, and professionals feeling part of the team. Few studies assessed associations between collaboration and macro and meso factors, or between factors across levels, which are priorities for future research.
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Affiliation(s)
- Gillian Mulvale
- />DeGroote School of Business, McMaster University, 4350 South Service Road, Rm 421, Burlington, ON Canada L7L 5R8
| | - Mark Embrett
- />Faculty of Health Sciences, McMaster University, CRL Bulding 282, 1280 Main Street West, Hamilton, ON Canada L8S 4K1
| | - Shaghayegh Donya Razavi
- />Faculty of Health Sciences, McMaster University, CRL Bulding 282, 1280 Main Street West, Hamilton, ON Canada L8S 4K1
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256
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The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm. Int J Integr Care 2016; 16:4. [PMID: 28435417 PMCID: PMC5351041 DOI: 10.5334/ijic.2212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn’s theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time. Methods: In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team’s four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn’s theory. Results: The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain. Discussion: This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.
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257
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Romijn A, de Bruijne MC, Teunissen PW, de Groot CJM, Wagner C. Complex social intervention for multidisciplinary teams to improve patient referrals in obstetrical care: protocol for a stepped wedge study design. BMJ Open 2016; 6:e011443. [PMID: 27417199 PMCID: PMC4947712 DOI: 10.1136/bmjopen-2016-011443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION In obstetrics, patients often experience referral situations between different care professionals. In these multidisciplinary teams, a focus on communication and interprofessional collaboration is needed to ensure care of high quality. Crew resource management team training is increasingly being applied in healthcare settings to improve team performance and coordination. Efforts to improve communication also include tools for standardisation such as SBAR (situation, background, assessment, recommendation). Despite the growing adoption of these interventions, evidence on their effectiveness is limited, especially on patient outcomes. This article describes a study protocol to examine the effectiveness of a crew resource management team training intervention aimed at implementing the SBAR tool for structured communication during patient referrals in obstetrical care. METHODS AND ANALYSIS The intervention is rolled out sequentially in five hospitals and surrounding primary care midwifery practices in the Netherlands, using a stepped wedge design. The intervention involves three phases over a period of 24 months: (1) preparation, (2) training and (3) follow-up with repeated measurements. The primary outcomes are perinatal and maternal outcomes calculated using the Adverse Outcome Index. The secondary outcomes are the reaction of participating professionals to the training programme, attitudes towards safety and teamwork (Safety Attitudes Questionnaire), cohesion (Interprofessional Collaboration Measurement Scale), use of the tool for structured communication (self-reported questionnaire) and patient experiences. These secondary outcomes from professional and patient level allow triangulation and an increased understanding of the effect of the intervention on patient outcomes. ETHICS AND DISSEMINATION The study was approved by the Medical Ethical Committee of the VU University Medical Centre in the Netherlands and the protocol is in accordance with Dutch privacy regulations. Study findings will be presented in publications in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER NTR4256; Pre-results.
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Affiliation(s)
- Anita Romijn
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim W Teunissen
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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258
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Hastings SE, Suter E, Bloom J, Sharma K. Introduction of a team-based care model in a general medical unit. BMC Health Serv Res 2016; 16:245. [PMID: 27400709 PMCID: PMC4940946 DOI: 10.1186/s12913-016-1507-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban acute care hospital Evidence-based care processes were introduced, including an initial patient assessment and orientation, comfort rounds, bedside shift reports, patient whiteboards, Name Occupation Duty, rapid rounds, and team huddles. Small teams of nurses cared for a portion of patients on the unit. The model was intended to enhance safety and quality of care by allowing providers to work to full scope in a collaborative practice environment. METHODS We evaluated the new model approximately one year after implementation using interviews with staff (n = 15), surveys of staff (n = 25 at baseline and at the final evaluation) and patients (n = 26 at baseline and 37 at the final evaluation), and administrative data pulled from organizational databases. RESULTS Staff interviews revealed that overall, the new care processes and care teams worked quite well. Unit culture and collaboration were improved, as were role clarity, scope of practice, and patient care. Responses from staff surveys were also very positive, showing significant positive changes in most areas. Patient satisfaction surveys showed a few positive changes; scores overall were very high. Administrative data showed slight decreases in overall length of stay, 30-day readmissions, staff absenteeism, staff vacancies, and the overtime rate. We found no changes in unit length of stay, 30-day returns to emergency department, or nursing sensitive adverse events. CONCLUSIONS Conclusions from the evaluation were positive, providing initial support for the idea of the collaborative practice model vision for adult medical units across Alberta. There were also a few positive effects on patient care suggesting that models such as this one could improve the organization's ability to deliver sustainable, high-quality, patient- and family-centred care without compromising quality.
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Affiliation(s)
| | - Esther Suter
- Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada
| | - Judy Bloom
- Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada
| | - Krishna Sharma
- Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada
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259
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Affiliation(s)
| | | | | | | | - Winnie Suen
- Virginia Commonwealth University, Washington, DC
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261
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Quinn EK, Noble J, Seale H, Ward JE. Provision of maternity care for women in remote Far West New South Wales: how far have we come? Aust J Rural Health 2016; 22:114-20. [PMID: 25039845 DOI: 10.1111/ajr.12088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The National Maternity Services Review in 2009 sought to address the ongoing issues of access, workforce capacity and inequalities in health outcomes for women and their babies in rural and remote Australia. The subsequent National Maternity Services Plan describes the type of care that should be offered to all women in Australia. OBJECTIVE The aim of our study was to better understand the local context and progress in delivering recommendations of the National Plan to improve maternity services for women in remote communities of Far West New South Wales. DESIGN Semistructured questionnaires. SETTING Maternity care in Far West New South Wales involves long-standing partnerships between three service providers to provide antenatal and postnatal care to women in remote communities with birthing predominantly occurring at the Broken Hill Health Service. MAIN OUTCOME MEASURES The degree of information sharing and communication, use of guidelines and policies, the effectiveness of workforce retention strategies and the current level of maternity care provided. PARTICIPANTS Fourteen clinicians and policy makers. RESULTS Participants reported clarity in roles and responsibilities of health staff, the appropriateness of antenatal care policies to the context, confidence in practising to their full professional scope and the existence of quality improvement initiatives across all providers. However, participants also reported being constrained by environmental and organisational factors in regards to risk assessment and referral of pregnant women. Key issues for local health service partners include adherence to antenatal care policies and a need to improve local workforce capacity. CONCLUSIONS Local health service partners are demonstrably ready to address the modifiable factors of organisational capacity and interprofessional collaboration in accordance with the recommendations of the National Maternity Services Review.
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Affiliation(s)
- Emma K Quinn
- NSW Public Health Officer Training Program, NSW Ministry of Health, Sydney, NSW, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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262
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Wilson AJ, Palmer L, Levett-Jones T, Gilligan C, Outram S. Interprofessional collaborative practice for medication safety: Nursing, pharmacy, and medical graduates' experiences and perspectives. J Interprof Care 2016; 30:649-54. [PMID: 27351385 DOI: 10.1080/13561820.2016.1191450] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Medication errors are the second most prevalent cause of adverse patient incidents in Australian hospital settings. Although numerous strategies to address this patient safety issue have been implemented, the impact of interprofessional collaborative practice (IPCP) on medication safety has received limited attention. The aim of this article is to report the perspectives and experiences of recently graduated, currently practicing Australian nurses, pharmacists, and doctors in relation to IPCP and medication safety. Sixty-eight graduates from three Australian states participated in focus groups. Thematic analysis of transcripts was conducted using an iterative process. The findings from this study illustrate how knowing about and valuing the skills and responsibilities of other team members and respecting each person's unique contribution to the work of the team can lead to more effective communication and collaboration in the context of medication safety. Although collaborative practice is critical to safe medication prescribing, dispensing, and administration, there are recurring and pervasive challenges to its achievement. This study indicated the need for improved preparation of graduates to equip them with the knowledge and skills needed to participate in an interprofessional team; and we advocate that deliberate, structured, and meaningful interprofessional clinical education initiatives are required.
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Affiliation(s)
- Amanda Jane Wilson
- a School of Nursing and Midwifery , University of Newcastle , Callaghan , New South Wales , Australia
| | - Lorinda Palmer
- a School of Nursing and Midwifery , University of Newcastle , Callaghan , New South Wales , Australia
| | - Tracy Levett-Jones
- a School of Nursing and Midwifery , University of Newcastle , Callaghan , New South Wales , Australia
| | - Conor Gilligan
- b School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia
| | - Sue Outram
- b School of Medicine and Public Health , University of Newcastle , Callaghan , New South Wales , Australia
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263
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Boet S, Pigford AA, Fitzsimmons A, Reeves S, Triby E, Bould MD. Interprofessional team debriefings with or without an instructor after a simulated crisis scenario: An exploratory case study. J Interprof Care 2016; 30:717-725. [DOI: 10.1080/13561820.2016.1181616] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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264
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Makic MBF, Bueno E. Improving Interprofessional Communication Through Structured Rounds. J Perianesth Nurs 2016; 31:340-2. [PMID: 27444766 DOI: 10.1016/j.jopan.2016.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 11/15/2022]
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265
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Hellman T, Jensen I, Orchard C, Bergström G. Preliminary testing of the Swedish version of the Assessment of Interprofessional Team Collaboration Scale (AITCS-S). J Interprof Care 2016; 30:499-504. [PMID: 27268309 PMCID: PMC4926788 DOI: 10.3109/13561820.2016.1159184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interprofessional collaboration might improve healthcare processes and outcomes; however, it has been found that most instruments that aim to measure collaboration have undergone limited testing. The assessment of interprofessional team collaboration scale (AITCS) is one questionnaire that aims to evaluate collaboration, but it has not yet been extensively tested. The aim of this study was to translate and to cross-culturally adapt the AITCS for use in Sweden, to describe floor and ceiling values, and to investigate the AITCS in terms of reliability, face, and content validity. The study included a total of 349 participants working in team-based pain rehabilitation. The participants were asked to fill in the Swedish version of the AITCS (AITCS-S) at baseline. Of these, 73 participants also completed the AITCS-S two weeks later. The results showed that the content and face validity were good. Internal consistency varied from 0.79 to 0.96 and judged to be acceptable to excellent. Test–retest stability showed excellent stability with intraclass correlation values above 0.75 for all subscales. This study concludes that the Swedish version of the AITCS is a reliable and valid questionnaire. Further psychometric investigations might be undertaken in order to attempt to develop shorter versions of the AITCS-S.
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Affiliation(s)
- Therese Hellman
- a Institute of Environmental Medicine, Intervention and Implementation Research , Karolinska Institutet , Stockholm , Sweden
| | - Irene Jensen
- a Institute of Environmental Medicine, Intervention and Implementation Research , Karolinska Institutet , Stockholm , Sweden
| | - Carole Orchard
- b Arthur Labatt Family School of Nursing, University of Western Ontario , London , Ontario , Canada
| | - Gunnar Bergström
- a Institute of Environmental Medicine, Intervention and Implementation Research , Karolinska Institutet , Stockholm , Sweden
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Handgraaf M, Dieterich S, Grüneberg C. Interprofessional education – structural and didactical challenges / Interprofessionelles Lehren, Lernen und Handeln – Strukturelle und didaktische Herausforderungen. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2016. [DOI: 10.1515/ijhp-2016-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
After five years of experience in interprofessional education (IPE) in the Bachelor programs occupational therapy, midwifery, nursing, speech therapy, and physiotherapy at the University of Applied Sciences in Bochum (Germany), we have systematically evaluated and substantially revised our IPE concept in 2014/15. The structural and curricular embedding of IPE throughout the course of the five Bachelor programs requires the development and ongoing evolution of a binding concept for the interprofessional competence development. This concept needs to be based on a systematic reflection of current practice and sound scientific knowledge concerning interprofessional topics. Furthermore, it needs to address the promotion of competencies to act inter- and transprofessionally to enable a high quality of care (Wissenschaftsrat, 2012; Walkenhorst, 2012). Results of narrative literature reviews, structured internal discussions, interviews of experts and various internal and external evaluations have been incorporated into a new conceptual framework for IPE. It has been shown that a revision of the structure, the temporal sequences of modules and the framework to facilitate interprofessional practice are essential steps for continuous development of interprofessional education. In addition, barriers and challenges are identified and discussed. Overall, the process of development has been coordinated and accompanied continuously and successfully by an IPE committee involving different groups of representative members from the Department of Applied Health Sciences.
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Affiliation(s)
- Marietta Handgraaf
- Hochschule für Gesundheit Bochum , Gesundheitscampus 6-8, 44801 Bochum , Germany
| | - Sven Dieterich
- Hochschule für Gesundheit Bochum , Gesundheitscampus 6-8, 44801 Bochum , Germany
| | - Christian Grüneberg
- Hochschule für Gesundheit Bochum , Gesundheitscampus 6-8, 44801 Bochum , Germany
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267
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Mapping communication spaces: The development and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice. Int J Med Inform 2016; 93:2-13. [PMID: 27435942 DOI: 10.1016/j.ijmedinf.2016.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations. OBJECTIVE This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations. METHODS The tool's development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2). RESULTS Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient's passage across different units in the hospital, (c) across the duration of the patient's stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR's deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces. CONCLUSIONS If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used "as is" in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions.
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268
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Abstract
Background: Geriatric care increasingly needs more multidisciplinary
health care services to deliver the necessary complex and continuous care. The
aim of this study is to summarize indicators of effective interprofessional
outcomes for this population. Method: A systematic review is performed in the Cochrane Library,
Pubmed (Medline), Embase, Cinahl and Psychinfo with a search until June
2014. Results: Overall, 689 references were identified of which 29 studies
met the inclusion criteria. All outcome indicators were summarized in three
categories: collaboration, patient level outcome and costs. Seventeen out of 24
outcome indicators within the category of ‘collaboration’ reached
significant difference in advantage of the intervention group. On ‘patient
outcome level’ only 15 out of 32 outcome parameters met statistical
significance. In the category of ‘costs’ only one study reached
statistical significance. Discussion and conclusion: The overall effects of interprofessional
interventions for elderly are positive, but based on heterogeneous outcomes.
Outcome indicators of interprofessional collaboration for elderly with a
significant effect can be summarized in three main categories:
‘collaboration’, patient level’ and ‘costs’. For
‘collaboration’ the outcome indicators are key elements of
collaboration, involved disciplines, professional and patient satisfaction and
quality of care. On ‘patient level’ the outcome indicators are pain,
fall incidence, quality of life, independence for daily life activities,
depression and agitated behaviour, transitions, length of stay in hospital,
mortality and period of rehabilitation. ‘Costs’ of interprofessional
interventions on short- and long-term for elderly need further investigation.
When organizing interprofessional collaboration or interprofessional education
these outcome indicators can be considered as important topics to be addressed.
Overall more research is needed to gain insight in the process of
interprofessional collaboration and so to learn to work interprofessionally.
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269
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Sasaki H, Yonemoto N, Mori R, Nishida T, Kusuda S, Nakayama T. Use of the ICU Nurse-Physician Questionnaire (ICU N-P-Q): testing reliability and validity in neonatal intensive care units in Japan. BMJ Open 2016; 6:e010105. [PMID: 27160841 PMCID: PMC4874164 DOI: 10.1136/bmjopen-2015-010105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Although communication among health providers has become a critical part of improving quality of care, few studies on this topic have been conducted in Japan. This study aimed to examine the reliability and validity of the Intensive Care Unit Nurse-Physician Questionnaire (ICU N-P-Q) for use among nurses and physicians in neonatal ICUs (NICUs) in Japan. METHODS A Japanese translation of the ICU N-P-Q was administered to physicians and nurses working at 40 NICUs across Japan, which were participating in the Improvement of NICU Practice and Team Approach Cluster randomized controlled trial (INTACT). We used the principal components analysis to evaluate the factor structure of the instruments. Convergent validity was assessed by examining correlations between the subscales of Communication and Conflict Management of the ICU N-P-Q and the subscales and total score of the Nurse-Physician Collaboration Scale (NPCS). Correlations between the subscales of Communication and Conflict Management by correlation with scales that refer to performance, including Job Satisfaction and Unit Effectiveness, were calculated to test the criterion validity. RESULTS In total, 2006 questionnaires were completed by 316 physicians and 1690 nurses. The exploratory factor analysis revealed 15 factors in the physicians' questionnaire and 12 in the nurses' questionnaire. Convergent validity was confirmed, except for 'Between-group Accuracy' and 'Cooperativeness' in the physicians' scale, and for 'Between-group Accuracy' and 'Sharing of Patient Information' in the nurses' scale. Correlations between the subscales of communication and outcomes were confirmed in the nurses' questionnaire but were not fully supported in the physicians' questionnaire. CONCLUSIONS Although the psychometric property behaved somewhat differently by occupation, the present findings provide preliminary support for the utility of the common item structure with the original scale, to measure the degree and quality of communication and collaboration among staff at NICUs and similar healthcare settings in Japan. TRIAL REGISTRATION NUMBER UMIN000007064; Pre-results.
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Affiliation(s)
- Hatoko Sasaki
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Toshihiko Nishida
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
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270
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Perrier L, Adhihetty C, Soobiah C. Examining semantics in interprofessional research: A bibliometric study. J Interprof Care 2016; 30:269-77. [DOI: 10.3109/13561820.2016.1142430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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271
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Henkin S, Chon TY, Christopherson ML, Halvorsen AJ, Worden LM, Ratelle JT. Improving nurse-physician teamwork through interprofessional bedside rounding. J Multidiscip Healthc 2016; 9:201-5. [PMID: 27194915 PMCID: PMC4859421 DOI: 10.2147/jmdh.s106644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Teamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician–nurse teamwork are often suboptimal. Objective To improve nurse–physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds. Intervention From July 2013 through October 2013, physicians (attendings and residents) and nurses from four general medicine teams in a single nursing unit participated in bedside rounding, which involved the inclusion of nurses in morning rounds with the medicine teams at the patients’ bedside. Based on stakeholder analysis and feedback, a checklist for key patient care issues was created and utilized during bedside rounds. Assessment To assess the effect of bedside rounding on nurse–physician teamwork, a survey of selected items from the Safety Attitudes Questionnaire (SAQ) was administered to participants before and after the implementation of bedside rounds. The number of pages to the general medicine teams was also measured as a marker of physician–nurse communication. Results Participation rate in bedside rounds across the four medicine teams was 58%. SAQ response rates for attendings, residents, and nurses were 36/36 (100%), 73/73 (100%), and 32/73 (44%) prior to implementation of bedside rounding and 36 attendings (100%), 72 residents (100%), and 14 (19%) nurses after the implementation of bedside rounding, respectively. Prior to bedside rounding, nurses provided lower teamwork ratings (percent agree) than residents and attendings on all SAQ items; but after the intervention, the difference remained significant only on SAQ item 2 (“In this clinical area, it is not difficult to speak up if I perceive a problem with patient care”, 64% for nurses vs 79% for residents vs 94% for attendings, P=0.02). Also, resident responses improved on SAQ item 1 (“Nurse input is well received in this area”, 62% vs 82%, P=0.01). Conclusion Increasing face-to-face communication through interprofessional bedside rounding can improve the perceptions of nurse–physician teamwork, particularly among residents and nurses.
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Affiliation(s)
| | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew J Halvorsen
- Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Internal Medicine Residency Office of Educational Innovations, Mayo Clinic, Rochester, MN, USA
| | | | - John T Ratelle
- Division of Hospital Medicine, Mayo Clinic, Rochester, MN, USA
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272
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Systematic Review of Knowledge Translation Strategies to Promote Research Uptake in Child Health Settings. J Pediatr Nurs 2016; 31:235-54. [PMID: 26786910 DOI: 10.1016/j.pedn.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/14/2015] [Accepted: 12/11/2015] [Indexed: 11/21/2022]
Abstract
UNLABELLED Strategies to assist evidence-based decision-making for healthcare professionals are crucial to ensure high quality patient care and outcomes. The goal of this systematic review was to identify and synthesize the evidence on knowledge translation interventions aimed at putting explicit research evidence into child health practice. METHODS A comprehensive search of thirteen electronic databases was conducted, restricted by date (1985-2011) and language (English). Articles were included if: 1) studies were randomized controlled trials (RCT), controlled clinical trials (CCT), or controlled before-and-after (CBA) studies; 2) target population was child health professionals; 3) interventions implemented research in child health practice; and 4) outcomes were measured at the professional/process, patient, or economic level. Two reviewers independently extracted data and assessed methodological quality. Study data were aggregated and analyzed using evidence tables. RESULTS Twenty-one studies (13 RCT, 2 CCT, 6 CBA) were included. The studies employed single (n=9) and multiple interventions (n=12). The methodological quality of the included studies was largely moderate (n=8) or weak (n=11). Of the studies with moderate to strong methodological quality ratings, three demonstrated consistent, positive effect(s) on the primary outcome(s); effective knowledge translation interventions were two single, non-educational interventions and one multiple, educational intervention. CONCLUSIONS This multidisciplinary systematic review in child health setting identified effective knowledge translation strategies assessed by the most rigorous research designs. Given the overall poor quality of the research literature, specific recommendations were made to improve knowledge translation efforts in child health.
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273
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Glaser B, Suter E. Interprofessional collaboration and integration as experienced by social workers in health care. SOCIAL WORK IN HEALTH CARE 2016; 55:395-408. [PMID: 27007283 DOI: 10.1080/00981389.2015.1116483] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Interprofessional collaboration in health care is gaining popularity. This secondary analysis focuses on social workers' experiences on interprofessional teams. The data revealed that social workers perceived overall collaboration as positive. However, concerns were made apparent regarding not having the opportunity to work to full scope and a lack of understanding of social work ideology from other professionals. Both factors seem to impede integration of and collaboration with social workers on health care teams. This study confirms the need to encourage and support health care providers to more fully understand the foundation, role, and efficacy of social work on interprofessional teams.
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Affiliation(s)
- Brooklyn Glaser
- a Faculty of Social Work , University of Calgary , Calgary , Alberta , Canada
| | - Esther Suter
- b Workforce Research & Evaluation , Alberta Health Services , Calgary , Alberta , Canada
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274
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Cooper M, Evans Y, Pybis J. Interagency collaboration in children and young people's mental health: a systematic review of outcomes, facilitating factors and inhibiting factors. Child Care Health Dev 2016; 42:325-42. [PMID: 26860960 DOI: 10.1111/cch.12322] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/23/2015] [Accepted: 12/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the UK and internationally, there have been increasing calls for interagency collaboration across mental health services for children and young people. However, it is not clear whether such practices do, indeed, have a positive impact and, if so, what factors facilitate and inhibit collaboration across agencies. METHODS Electronic searches were carried out on seven key computerized bibliographic databases. For inclusion in the review, studies needed to report on close working by two or more services that provided mental health support for children and/or young people and that had some systematic collection of qualitative and/or quantitative data. Outcomes were analysed narratively, and facilitating and inhibiting factors were examined using thematic analysis. RESULTS A final sample of 33 studies was identified from 4136 initial records. Outcomes were mixed, with some findings indicating that interagency collaboration was associated with greater service use and equity of service provision, but other suggesting negative outcomes on service use and quality. However, interagency collaboration was perceived as helpful and important by both service users and professionals, and collaborative initiatives were evaluated positively. The factors most commonly identified as facilitating interagency collaboration were good interagency communication, joint trainings, good understandings across agencies, mutual valuing across agencies, senior management support, protocols on interagency collaboration and a named link person. The most commonly perceived barriers to interagency collaboration were inadequate resourcing, poor interagency communication, lack of valuing across agencies, differing perspectives, poor understandings across agencies and confidentiality issues. CONCLUSIONS The results are consistent with findings from previous reviews of interagency collaboration across adult and child services: there were some indications of benefit; and facilitating and inhibiting factors involved working relationships and multi-agency processes, resources and management. The identification of these factors has implications for practitioners, service managers, trainers, commissioners and researchers.
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Affiliation(s)
- M Cooper
- Department of Psychology, University of Roehampton, London, UK
| | - Y Evans
- Department of Psychology, University of Roehampton, London, UK
| | - J Pybis
- Research Department, British Association for Counselling and Psychotherapy, Lutterworth, UK
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275
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Berger S, Mahler C, Krug K, Szecsenyi J, Schultz JH. Evaluation of interprofessional education: lessons learned through the development and implementation of an interprofessional seminar on team communication for undergraduate health care students in Heidelberg - a project report. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc22. [PMID: 27280133 PMCID: PMC4895838 DOI: 10.3205/zma001021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/20/2015] [Accepted: 11/30/2015] [Indexed: 05/10/2023]
Abstract
INTRODUCTION This project report describes the development, "piloting" and evaluation of an interprofessional seminar on team communication bringing together medical students and Interprofessional Health Care B.Sc. students at the Medical Faculty of Heidelberg University, Germany. PROJECT DESCRIPTION A five-member interprofessional team collaborated together on this project. Kolb's experiential learning concept formed the theoretical foundation for the seminar, which explored three interprofessional competency areas: team work, communication and values/ethics. Evaluation for the purposes of quality assurance and future curricula development was conducted using two quantitative measures: descriptive analysis of a standardized course evaluation tool (EvaSys) ANOVA analysis of the German translation of the University of the West of England Interprofessional Questionnaire (UWE-IP-D). RESULTS The key finding from the standardized course evaluation was that the interprofessional seminars were rated more positively [M=2.11 (1 most positive and 5 most negative), SD=1, n=27] than the monoprofessional seminars [M=2.55, SD=0.98, n=90]. The key finding from the UWE-IP-D survey, comparing pre and post scores of the interprofessional (IP) (n=40) and monoprofessional (MP) groups (n=34), was that significant positive changes in mean scores for both groups towards communication, teamwork and interprofessional learning occurred. CONCLUSIONS Lessons learnt included: a) recognising the benefit of being pragmatic when introducing interprofessional education initiatives, which enabled various logistical and attitudinal barriers to be overcome; b) quantitative evaluation of learning outcomes alone could not explain positive responses or potential influences of interprofessional aspects, which highlighted the need for a mixed methods approach, including qualitative methods, to enrich judgment formation on interprofessional educational outcomes.
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Affiliation(s)
- Sarah Berger
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Germany
| | - Cornelia Mahler
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Germany
| | - Katja Krug
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Germany
| | - Joachim Szecsenyi
- Universitätsklinikum Heidelberg, Abteilung Allgemeinmedizin und Versorgungsforschung, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Universitätsklinikum Heidelberg, Klinik für Allgemeine Innere Medizin und Psychosomatik,Heidelberg, Germany
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276
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Balancing Patient Access to Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome With Maintaining Procedural Competence: Are Collaborative Services Part of the Solution? Twin Res Hum Genet 2016; 19:276-84. [PMID: 27087260 DOI: 10.1017/thg.2016.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The benefits of fetoscopic laser photocoagulation (FLP) for treatment of twin-to-twin transfusion syndrome (TTTS) have been recognized for over a decade, yet access to FLP remains limited in many settings. This means at a population level, the potential benefits of FLP for TTTS are far from being fully realized. In part, this is because there are many centers where the case volume is relatively low. This creates an inevitable tension; on one hand, wanting FLP to be readily accessible to all women who may need it, yet on the other, needing to ensure that a high degree of procedural competence is maintained. Some of the solutions to these apparently competing priorities may be found in novel training solutions to achieve, and maintain, procedural proficiency, and with the increased utilization of 'competence based' assessment and credentialing frameworks. We suggest an under-utilized approach is the development of collaborative surgical services, where pooling of personnel and resources can improve timely access to surgery, improve standardized assessment and management of TTTS, minimize the impact of the surgical learning curve, and facilitate audit, education, and research. When deciding which centers should offer laser for TTTS and how we decide, we propose some solutions from a collaborative model.
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277
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Chomienne MH, Vanneste P, Grenier J, Hendrick S. Collaboration médecine-psychologie : évolution des mentalités en Belgique et évolution du système de soins de santé au Canada. SANTE MENTALE AU QUEBEC 2016. [DOI: 10.7202/1036094ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
L’expertise des psychologues dans l’évaluation et la prise en charge des troubles communs de santé mentale comme l’anxiété et la dépression qui sont fréquents en soins primaires et co-morbides avec les maladies chroniques font des psychologues une ressource essentielle pour les médecins. Les psychologues représentent un large bassin de professionnels spécialisés dans le diagnostic et la pratique de la psychothérapie ; la collaboration médecins-psychologues est d’autant plus critique dans le contexte visant à augmenter l’accès des populations aux traitements psychologiques et aux psychothérapies. Cet article se veut un regard sur l’état de la collaboration entre médecins et psychologues en Belgique et au Canada. Il examine l’évolution des mentalités entre ces deux professions dans une perspective européenne belge et la façon dont le contexte et le système de soins de santé publique au Canada influencent le potentiel de collaboration entre ces deux professions. Les études démontrent la volonté et la facilité qu’ont ces deux professions à collaborer. Mais ceci doit être appuyé par des structures systémiques et académiques facilitantes notamment dans l’apprentissage précoce à la collaboration dans le cursus de ces professions.
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Affiliation(s)
- Marie-Hélène Chomienne
- M.D., M. Sc., Institut de recherche de l’Hôpital Montfort, Centre C.T. Lamont de recherche en soins de santé primaires, Département de médecine familiale, Université d’Ottawa
- École d’épidémiologie et santé communautaire, Université d’Ottawa
| | - Patrick Vanneste
- Ph. DS., Psychologue clinicien et psychothérapeute, Service de psychologie clinique systémique et psychodynamique, Faculté de Psychologie et Sciences de l’Éducation, Université de Mons, Belgique
| | - Jean Grenier
- Ph. D., C. Psych., Institut de recherche de l’Hôpital Montfort, Centre C.T. Lamont de recherche en soins de santé primaires, Département de médecine familiale, Université d’Ottawa
- École de psychologie, Université d’Ottawa
| | - Stephan Hendrick
- Professeur-Chef de service, Service de psychologie clinique systémique et psychodynamique, Faculté de Psychologie et Sciences de l’Éducation, Université de Mons, Belgique
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278
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Joyce P, Moore ZEH, Christie J, Dumville JC. Organisation of health services for preventing and treating pressure ulcers. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Pauline Joyce
- Royal College of Surgeons in Ireland; School of Medicine; 121 St. Stephens Green Dublin Ireland 2
| | - Zena EH Moore
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St. Stephen's Green Dublin Ireland D2
| | - Janice Christie
- University of Manchester; School of Nursing, Midwifery and Social Work; Oxford Road Manchester Lancashire UK M13 9PL
| | - Jo C Dumville
- University of Manchester; School of Nursing, Midwifery and Social Work; Oxford Road Manchester Lancashire UK M13 9PL
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279
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Kashner TM, Hettler DL, Zeiss RA, Aron DC, Bernett DS, Brannen JL, Byrne JM, Cannon GW, Chang BK, Dougherty MB, Gilman SC, Holland GJ, Kaminetzky CP, Wicker AB, Keitz SA. Has Interprofessional Education Changed Learning Preferences? A National Perspective. Health Serv Res 2016; 52:268-290. [PMID: 26990439 DOI: 10.1111/1475-6773.12485] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess how changes in curriculum, accreditation standards, and certification and licensure competencies impacted how medical students and physician residents value interprofessional team and patient-centered care. PRIMARY DATA SOURCE The Department of Veterans Affairs Learners' Perceptions Survey (2003-2013). The nationally administered survey asked a representative sample of 56,569 U.S. medical students and physician residents, with a comparison group of 78,038 nonphysician trainees, to rate satisfaction with 28 elements, in two overall domains, describing their clinical learning experiences at VA medical centers. STUDY DESIGN Value preferences were scored as independent adjusted associations between an element (interprofessional team, patient-centered preceptor) and the respective overall domain (clinical learning environment, faculty, and preceptors) relative to a referent element (quality of clinical care, quality of preceptor). PRINCIPAL FINDINGS Physician trainees valued interprofessional (14 percent vs. 37 percent, p < .001) and patient-centered learning (21 percent vs. 36 percent, p < .001) less than their nonphysician counterparts. Physician preferences for interprofessional learning showed modest increases over time (2.5 percent/year, p < .001), driven mostly by internal medicine and surgery residents. Preferences did not increase with trainees' academic progress. CONCLUSIONS Despite changes in medical education, physician trainees continue to lag behind their nonphysician counterparts in valuing experience with interprofessional team and patient-centered care.
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Affiliation(s)
- T Michael Kashner
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC.,Loma Linda University Medical School, Loma Linda, CA
| | - Debbie L Hettler
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC.,Pennsylvania College of Optometry and College of Health Sciences, Salus University, Elkins Park, PA
| | - Robert A Zeiss
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC
| | - David C Aron
- Louis Stokes Cleveland DVA Medical Center, Cleveland, OH.,School of Medicine, Weatherhead School of Management, Case Western Reserve University, Cleveland, OH
| | - David S Bernett
- VA Medical Center, Office of Academic Affiliations, St. Louis, MO
| | - Judy L Brannen
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC.,Virginia Commonwealth University, Richmond, VA
| | - John M Byrne
- Loma Linda University Medical School, Loma Linda, CA.,Jerry L. Pettis Memorial VA Medical Center, Loma Linda, CA
| | - Grant W Cannon
- George E. Wahlen VA Medical Center, Salt Lake City, UT.,School of Medicine, University of Utah, Salt Lake City, UT
| | - Barbara K Chang
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC.,University of New Mexico School of Medicine, Albuquerque, NM
| | - Mary B Dougherty
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC
| | - Stuart C Gilman
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC.,University of California Irvine School of Medicine, Irvine, CA
| | - Gloria J Holland
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC
| | - Catherine P Kaminetzky
- Center for Education and Development, VA Puget Sound Health Care System, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
| | - Annie B Wicker
- Department of Veterans Affairs, Office of Academic Affiliations, Washington, DC
| | - Sheri A Keitz
- Department of Medicine, UMass-Memorial Medical Center at the University of Massachusetts, Worcester, MA
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280
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Bagnasco A, Tolotti A, Pagnucci N, Torre G, Timmins F, Aleo G, Sasso L. How to maintain equity and objectivity in assessing the communication skills in a large group of student nurses during a long examination session, using the Objective Structured Clinical Examination (OSCE). NURSE EDUCATION TODAY 2016; 38:54-60. [PMID: 26803712 DOI: 10.1016/j.nedt.2015.11.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/05/2015] [Accepted: 11/15/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND While development, testing, and innovation of the Objective Structured Clinical Examination (OSCE) are common in the international literature, studies from the United States of America (USA), Australia, and the United Kingdom (UK) predominate. There is little known about OSCE use in European countries, such as Italy, where other than cost analysis, there is little reporting of OSCE use or validation. OBJECTIVES This paper reports on one Italian initiative, which evaluated the equity and objectivity of the OSCE method of assessing communication skills. DESIGN An OSCE method was used to assess the communication skills of first-year students of the Degree Course in Nursing. A method of simulation was implemented through role-playing with standardized patients. An observational method was used to collect data. PARTICIPANTS AND SETTINGS Four hundred and twenty-one first-year undergraduate nursing students at one university site in Italy took part. METHODS Ten examination sessions were carried out. The students' performances were assessed by two examiners who used a structured observation grid and conducted their assessment separately. A situation simulated by four nurses with experience as actors was used as the topic for the students' examination. RESULTS Calculation of the daily rate of students who passed the examination revealed a random distribution over time. The nonparametric correlation indexes referring to the assessments and to the scores assigned by the two examiners proved statistically significant (P≤0.001). CONCLUSIONS The study confirmed the validity of the OSCE method in ensuring equity and objectivity of communication skills assessment in a large population of nursing students for the purpose of certification throughout the duration of the examination. This has important implications for nurse education and practice as the extent to which OSCE approaches, while deemed objective, are culturally sensitive or valid and reliable across cultures is not clear. This is something that requires further research and examination in this field.
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Affiliation(s)
- Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Angela Tolotti
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, I-56100 Pisa, Italy.
| | - Giancarlo Torre
- School of Medical and Pharmaceutical Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Fiona Timmins
- School of Nursing, Trinity College, College Green, Dublin 2, Ireland.
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy.
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281
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Uddin S. Exploring the impact of different multi-level measures of physician communities in patient-centric care networks on healthcare outcomes: A multi-level regression approach. Sci Rep 2016; 6:20222. [PMID: 26842548 PMCID: PMC4740773 DOI: 10.1038/srep20222] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/23/2015] [Indexed: 11/09/2022] Open
Abstract
A patient-centric care network can be defined as a network among a group of healthcare professionals who provide treatments to common patients. Various multi-level attributes of the members of this network have substantial influence to its perceived level of performance. In order to assess the impact different multi-level attributes of patient-centric care networks on healthcare outcomes, this study first captured patient-centric care networks for 85 hospitals using health insurance claim dataset. From these networks, this study then constructed physician collaboration networks based on the concept of patient-sharing network among physicians. A multi-level regression model was then developed to explore the impact of different attributes that are organised at two levels on hospitalisation cost and hospital length of stay. For Level-1 model, the average visit per physician significantly predicted both hospitalisation cost and hospital length of stay. The number of different physicians significantly predicted only the hospitalisation cost, which has significantly been moderated by age, gender and Comorbidity score of patients. All Level-1 findings showed significance variance across physician collaboration networks having different community structure and density. These findings could be utilised as a reflective measure by healthcare decision makers. Moreover, healthcare managers could consider them in developing effective healthcare environments.
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Affiliation(s)
- Shahadat Uddin
- Complex Systems Research Centre, University of Sydney, Darlington, New South Wales, Australia
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282
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Härgestam M, Lindkvist M, Jacobsson M, Brulin C, Hultin M. Trauma teams and time to early management during in situ trauma team training. BMJ Open 2016; 6:e009911. [PMID: 26826152 PMCID: PMC4735161 DOI: 10.1136/bmjopen-2015-009911] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. DESIGN In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. SETTING An emergency room in an urban Scandinavian level one trauma centre. PARTICIPANTS A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. PRIMARY OUTCOME HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. RESULTS Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). CONCLUSIONS Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload.
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Affiliation(s)
- Maria Härgestam
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå International School of Public Health, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | | | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Umeå University, Umeå, Sweden
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283
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Wershofen B, Heitzmann N, Beltermann E, Fischer MR. Fostering interprofessional communication through case discussions and simulated ward rounds in nursing and medical education: A pilot project. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc28. [PMID: 27280139 PMCID: PMC4895862 DOI: 10.3205/zma001027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 01/08/2016] [Accepted: 02/09/2016] [Indexed: 05/13/2023]
Abstract
BACKGROUND Poor communication between physicians and nursing staff could result in inadequate interprofessional collaboration with negative effects on patient health. In order to ensure optimal health care for patients, it is important to strengthen interprofessional communication and collaboration between physicians and nurses during their education. AIM The aim of this project is to foster communication for medical and nursing students through interprofessional case discussions and simulated ward rounds as a form of training. METHOD In 2013-15 a total of 39 nursing students and 22 medical students participated in eight seminars, each covering case discussions and simulated ward rounds. The seminar was evaluated based on student assessment of the educational objectives. RESULTS Students who voluntarily signed up for the seminar profited from the interprofessional interaction and gathered positive experiences working in a team. CONCLUSION Through practicing case discussions and ward rounds as a group, interprofessional communication could be fostered between medical and nursing students. Students took advantage of the opportunity to ask those from other profession questions and realized that interprofessional interaction can lead to improved health care.
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Affiliation(s)
- Birgit Wershofen
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
- *To whom correspondence should be addressed: Birgit Wershofen, Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, Ziemssenstraße 1, D-80336 München, Germany, Phone: +49 (0)89/4400-57207, Fax: +49 (0)89/4400-57202, E-mail:
| | - Nicole Heitzmann
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
| | - Esther Beltermann
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
| | - Martin R. Fischer
- Klinikum der Universität München, Institut für Didaktik und Ausbildungsforschung in der Medizin, München, Germany
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284
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Hermann CP, Head BA, Black K, Singleton K. Preparing Nursing Students for Interprofessional Practice: The Interdisciplinary Curriculum for Oncology Palliative Care Education. J Prof Nurs 2016; 32:62-71. [PMID: 26802593 PMCID: PMC4724378 DOI: 10.1016/j.profnurs.2015.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 11/17/2022]
Abstract
Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication, collaboration, and team work. Nurse educators are ideally positioned to develop and lead such initiatives. The purpose of this article is to describe the development and implementation of an interprofessional education (IPE) project involving students in nursing, medicine, social work, and chaplaincy. The Interdisciplinary Curriculum for Oncology Palliative Care Education project uses team-based palliative oncology education as the framework for teaching students interprofessional practice skills. The need for IPE is apparent, but there are very few comprehensive, successful projects for nurse educators to use as models. This article describes the development of the curriculum by the interprofessional faculty team. Issues encountered by nursing faculty members as they implemented the IPE experience are discussed. Solutions developed to address the issues and ongoing challenges are presented. This project can serve as a model of a successful IPE initiative involving nursing students.
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Affiliation(s)
- Carla P Hermann
- Professor and PhD Program Director (Hermann), Assistant Professor (Black), Assistant Professor (Singleton), University of Louisville School of Nursing, Louisville, KY 40292..
| | - Barbara A Head
- Associate Professor, University of Louisville School of Medicine, Louisville, KY 40292
| | - Karen Black
- Professor and PhD Program Director (Hermann), Assistant Professor (Black), Assistant Professor (Singleton), University of Louisville School of Nursing, Louisville, KY 40292
| | - Karen Singleton
- Professor and PhD Program Director (Hermann), Assistant Professor (Black), Assistant Professor (Singleton), University of Louisville School of Nursing, Louisville, KY 40292
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285
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Croker A, Brown L, Little A, Crowley E. Interprofessional Relationships for Work-Integrated Learning in Healthcare: Identifying Scope for Ongoing Professional Development. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ce.2016.712176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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286
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Körner M, Bütof S, Müller C, Zimmermann L, Becker S, Bengel J. Interprofessional teamwork and team interventions in chronic care: A systematic review. J Interprof Care 2015; 30:15-28. [DOI: 10.3109/13561820.2015.1051616] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mirjam Körner
- Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Sarah Bütof
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Müller
- Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
- Saarland University of Cooperative Education in Health Care and Welfare, Saarbrücken, Germany
| | | | - Sonja Becker
- Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Freiburg, Germany
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287
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Aase I, Hansen BS, Aase K, Reeves S. Interprofessional training for nursing and medical students in Norway: Exploring different professional perspectives. J Interprof Care 2015; 30:109-15. [DOI: 10.3109/13561820.2015.1054478] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ingunn Aase
- Health Department, University of Stavanger, Stavanger, Norway
| | - Britt Sætre Hansen
- Health Department, University of Stavanger, Stavanger, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Karina Aase
- Health Department, University of Stavanger, Stavanger, Norway
| | - Scott Reeves
- Centre for Research in Health & Social Care, Kingston University & St. George’s, University of London, London, UK
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288
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Lim FA, Bernstein I. Civility and workplace bullying: resonance of Nightingale's persona and current best practices. Nurs Forum 2015; 49:124-9. [PMID: 24955475 DOI: 10.1111/nuf.12068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Conflict or aggression occurring between and among healthcare workers is undermining attempts to create a culture of safety in the workplace. Healthcare occupations have higher rates of workplace bullying (WPB), and intimidating behavior across healthcare settings has been shown to foster medical errors, increase the cost of care, and contribute to poor patient satisfaction and preventable adverse outcomes. WBP is also partially responsible for the high attrition among nurses, a particular concern in the current nursing shortage. Through a narrative that explores Florence Nightingale's professional persona and experience, this article outlines various factors that contribute to incivility and WPB, and provides suggestions for curriculum design that may help preempt incivility in tomorrow's nurses.
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289
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Bronston LJ, Austin-McClellan LE, Lisi AJ, Donovan KC, Engle WW. A Survey of American Chiropractic Association Members' Experiences, Attitudes, and Perceptions of Practice in Integrated Health Care Settings. J Chiropr Med 2015; 14:227-39. [PMID: 26793034 DOI: 10.1016/j.jcm.2015.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 06/17/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study is to examine the self-report of experiences, attitudes, and perceived educational needs of American Chiropractic Association members regarding practice in integrated health care settings. METHODS This was a descriptive observational study of the American Chiropractic Association members. Participants completed an electronic survey reporting their current participation and interest in chiropractic integrated practice. RESULTS The survey was completed in 2011 by 1142 respondents, for a response rate of 11.8%. The majority of respondents (82.9%) did not currently practice in an integrated setting, whereas 17.1% did. Those practicing in various integrated medical settings reported delivering a range of diagnostic, therapeutic, and case management services. Participation in administrative and scholarly activities was less common. Respondents not practicing in integrated settings reported being interested in delivering a very similar array of clinical services. Doctors of chiropractic practicing in hospital or outpatient medical facilities reported frequent engagement in interprofessional collaboration. Both nonintegrated and integrated respondents reported very similar educational interests on a range of clinical topics. CONCLUSION The findings of this survey provide insight into the experiences, participation, and interests in integrated clinical practice for members of the American Chiropractic Association.
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Affiliation(s)
| | - Lauren E Austin-McClellan
- Adjunct Assistant Professor of Clinical Services, University of Bridgeport College of Chiropractic, Bridgeport, CT; Staff Chiropractor, VA Connecticut Healthcare System, West Haven, CT
| | - Anthony J Lisi
- Chiropractor, Aquidneck Chiropractic, Middletown, RI; Chiropractor, Engle Chiropractic Center, Denver, PA
| | - Kevin C Donovan
- Associate Professor of Clinical Sciences, University of Bridgeport College of Chiropractic, Bridgeport, CT
| | - Walter W Engle
- Chiropractic Section Chief, VA Connecticut Healthcare System, West Haven, CT
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290
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Martin SL, Baker RP, Piper BJ. Evaluation of urban-rural differences in pharmacy practice needs in Maine with the MaPPNA. Pharm Pract (Granada) 2015; 13:669. [PMID: 26759622 PMCID: PMC4696125 DOI: 10.18549/pharmpract.2015.04.669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/02/2015] [Indexed: 11/14/2022] Open
Abstract
Background: Maine is a rural state with an aging population located in the northeastern United States. Pharmacists play an important role in serving the public’s health as they are often the most available point-of-contact within a community. Objective: To assess the current pharmacy practice needs as viewed by licensed pharmacists across our rural state, and to distinguish issues that are unique to rural pharmacy practice. Methods: An online survey was sent to all licensed pharmacists in the state in the fall of 2014 (n=1,262) to assess their pharmacy practice needs, and specify an rural-specific needs, within the categories of (1) opioid misuse, abuse, and diversion, (2) challenges associated with access to healthcare, (3) poly-pharmacy use, (4) meeting the needs of special populations, (5) lack of antibiotic stewardship, and (6) resources, such as staffing. Results: The response rate was 22.1 % (n=279). We found the most agreed upon issue facing pharmacists’ in Maine is opioid use, misuse and diversion, followed closely by shortages in staffing. We also learned that pharmacists’ view pharmaceutical care for older adults, those with low health literacy, and those with mental disabilities more time-consuming. Some urban-rural differences were discovered in with regard to the pharmacists’ views; such as the magnitude of the distance barrier, and limited transportation options available to rural residents. Issues related to polypharmacy were viewed as more problematic by pharmacists practicing in urban versus rural sites. Conclusions: Pharmaceutical care in Maine must focus on meeting the needs of the elderly, those with disabilities, and those with limited health literacy. As with the rest of the nation, opioids challenge pharmacy practice in a variety of ways. These findings clarify areas that present opportunities for pharmacists to focus more specifically on Maine’s largely rural population.
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Affiliation(s)
- Sarah L Martin
- School of Pharmacy, Husson University . Bangor, ME ( United States ).
| | - Robert P Baker
- School of Pharmacy, Husson University. Bangor , ME ( United States ).
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291
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Grudniewicz A, Kealy R, Rodseth RN, Hamid J, Rudoler D, Straus SE. What is the effectiveness of printed educational materials on primary care physician knowledge, behaviour, and patient outcomes: a systematic review and meta-analyses. Implement Sci 2015; 10:164. [PMID: 26626547 PMCID: PMC4666153 DOI: 10.1186/s13012-015-0347-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Printed educational materials (PEMs) are commonly used simple interventions that can be used alone or with other interventions to disseminate clinical evidence. They have been shown to have a small effect on health professional behaviour. However, we do not know whether they are effective in primary care. We investigated whether PEMs improve primary care physician (PCP) knowledge, behaviour, and patient outcomes. METHODS We conducted a systematic review of PEMs developed for PCPs. Electronic databases were searched for randomized controlled trials, quasi randomized controlled trials, controlled before and after studies, and interrupted time series. We combined studies using meta-analyses when possible. Statistical heterogeneity was examined, and meta-analysis was performed using a random effects model when significant statistical heterogeneity was present and a fixed effects model otherwise. The template for intervention description and replication (TIDieR) checklist was used to assess the quality of intervention description. RESULTS Our search identified 12,439 studies and 40 studies met our inclusion criteria. We combined outcomes from 26 studies in eight meta-analyses. No significant effect was found on clinically important patient outcomes, physician behaviour, or physician cognition when PEMs were compared to usual care. In the 14 studies that could not be included in the meta-analyses, 14 of 71 outcomes were significantly improved following receipt of PEMs compared to usual care. Most studies lacked details needed to replicate the intervention. CONCLUSIONS PEMs were not effective at improving patient outcomes, knowledge, or behaviour of PCPs. Further trials should explore ways to optimize the intervention and provide detailed information on the design of the materials. PROTOCOL REGISTRATION PROSPERO, CRD42013004356.
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Affiliation(s)
- Agnes Grudniewicz
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Canada.
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, 7th Floor, East Building, Toronto, Canada.
| | - Ryan Kealy
- Interactive Media Lab, Department of Mechanical and Industrial Engineering, University of Toronto, Bahen Centre for Information Technology, 40 St. George Street, Toronto, Canada.
| | - Reitze N Rodseth
- Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Nata, Pietermaritzburg, South Africa.
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
| | - Jemila Hamid
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, 7th Floor, East Building, Toronto, Canada.
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
| | - David Rudoler
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, 7th Floor, East Building, Toronto, Canada.
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292
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Silva JAMD, Peduzzi M, Orchard C, Leonello VM. Educação interprofissional e prática colaborativa na Atenção Primária à Saúde*. Rev Esc Enferm USP 2015; 49 Spec No:16-24. [DOI: 10.1590/s0080-623420150000800003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/16/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo Compreender as percepções de docentes, trabalhadores e estudantes sobre a articulação da educação interprofissional com as práticas na Atenção Primária à Saúde. Método Qualitativo compreensivo e interpretativo, cuja coleta de dados foi realizada de 2012 a 2013, por meio de 18 entrevistas semiestruturadas com docentes e quatro sessões de grupos focais homogêneos com estudantes, docentes e trabalhadores da Atenção Primária. Resultados A triangulação dos resultados possibilitou a construção de duas categorias: prática colaborativa centrada no usuário e barreiras para educação interprofissional. A primeira indicou a necessidade de mudança do modelo de atenção e de formação dos profissionais de saúde, e a segunda apontou dificuldades percebidas pelos diferentes atores sociais no que se refere à implementação da educação interprofissional. Conclusão A educação interprofissional é incipiente no Brasil e sinaliza possibilidades de mudança em direção à prática colaborativa, mas requer maiores investimentos na articulação ensino-serviço.
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293
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The Application of Informatics in Delineating the Proof of Concept for Creating Knowledge of the Value Added by Interprofessional Practice and Education. Healthcare (Basel) 2015; 3:1158-73. [PMID: 27417818 PMCID: PMC4934637 DOI: 10.3390/healthcare3041158] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/21/2015] [Accepted: 11/10/2015] [Indexed: 01/17/2023] Open
Abstract
The resurgence of interest in the promise of interprofessional education and collaborative practice (IPECP) to positively impact health outcomes, requires the collection of appropriate data that can be analyzed and from which information and knowledge linking IPECP interventions to improved health outcomes might be produced and reported to stakeholders such as health systems, policy makers and regulators, payers, and accreditation agencies. To generate such knowledge the National Center for Interprofessional Practice and Education at the University of Minnesota has developed three strategies, the first two of which are: (1) creating an IPECP research agenda, and (2) a national Nexus Innovation Network (NIN) of intervention projects that are generating data that are being input and housed in a National Center Data Repository (NCDR). In this paper, the informatics platform supporting the work of these first two strategies is presented as the third interconnected strategy for knowledge generation. The proof of concept for the informatics strategy is developed in this paper by describing: data input from the NIN into the NCDR, the linking and merging of those data to produce analyzable data files that incorporate institutional and individual level data, and the production of meaningful analyses to create and provide relevant information and knowledge. This paper is organized around the concepts of data, information and knowledge—the three conceptual foundations of informatics.
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294
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Edwards SE, Platt S, Lenguerrand E, Winter C, Mears J, Davis S, Lucas G, Hotton E, Fox R, Draycott T, Siassakos D. Effective interprofessional simulation training for medical and midwifery students. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2015; 1:87-93. [PMID: 35515198 PMCID: PMC8936651 DOI: 10.1136/bmjstel-2015-000022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/04/2022]
Abstract
Introduction Good interprofessional teamworking is essential for high quality, efficient and safe clinical care. Undergraduate interprofessional training has been advocated for many years to improve interprofessional working. However, few successful initiatives have been reported and even fewer have formally assessed their educational impact. Methods This was a prospective observational study of medical and midwifery students at a tertiary-level maternity unit. An interprofessional training module was developed and delivered by a multiprofessional faculty to medical and midwifery students, including short lectures, team-building exercises and practical simulation-based training for one obstetric (shoulder dystocia) and three generic emergencies (sepsis, haemorrhage, collapse). Outcome measures were interprofessional attitudes, assessed with a validated questionnaire (UWE Interprofessional Questionnaire) and clinical knowledge, measured with validated multiple-choice questions. Results Seventy-two students participated (34 medical, 38 midwifery). Following training median interprofessional attitude scores improved in all domains (p<0.0001), and more students responded in positive categories for communication and teamwork (69-89%, p=0.004), interprofessional interaction (3-16%, p=0.012) and interprofessional relationships (74-89%, p=0.006). Scores for knowledge improved following training for medical students (65.5% (61.8-70%) to 82.3% (79.1-84.5%) (median (IQR)) p<0.0001) and student midwives (70% (64.1-76.4%) to 81.8% (79.1-86.4%) p<0.0001), and in all subject areas (p<0.0001). Conclusions This training was associated with meaningful improvements in students' attitudes to teamwork, and knowledge acquisition. Integrating practical tasks and teamwork training, in authentic clinical settings, with matched numbers of medical and non-medical students can facilitate learning of both why and how to work together. This type of training could be adopted widely in undergraduate healthcare education.
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Affiliation(s)
- S E Edwards
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - S Platt
- Department of Obstetrics and Gynaecology, St Michael's Hospital, Bristol, UK
| | - E Lenguerrand
- University of Bristol School of Clinical Sciences, RISQ Research, Southmead Hospital, Bristol, UK
| | - C Winter
- Department of Obstetrics and Gynaecology, RISQ Research, Southmead Hospital, Bristol, UK
| | - J Mears
- Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - S Davis
- University of West of England, Health and Life Sciences, Bristol, UK
| | - G Lucas
- University of West of England, Health and Life Sciences, Bristol, UK
| | - E Hotton
- Department of Obstetrics and Gynaecology, Royal United Hospitals, Bath, UK
| | - R Fox
- Department of Obstetrics and Gynaecology, RISQ Research, Southmead Hospital, Bristol, UK
| | - T Draycott
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | - D Siassakos
- University of Bristol, School of Clinical Sciences, Department of Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
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Lacasta Tintorer D, Flayeh Beneyto S, Manresa JM, Torán-Monserrat P, Jiménez-Zarco A, Torrent-Sellens J, Saigí-Rubió F. Understanding the discriminant factors that influence the adoption and use of clinical communities of practice: the ECOPIH case. BMC Health Serv Res 2015; 15:373. [PMID: 26358037 PMCID: PMC4566431 DOI: 10.1186/s12913-015-1036-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/04/2015] [Indexed: 11/24/2022] Open
Abstract
Background The aim of the study presented in this article is to analyse the discriminant factors that have an influence on the use of communities of practice by primary and specialist healthcare professionals (physicians and nurses) for information sharing. Obtaining evidence from an ex-ante analysis to determine what factors explain healthcare professionals’ clinical community of practice use allows aspects of its use to be identified. Methods A theoretical model based on a modified technology acceptance model was used as the analysis tool, and a discriminant analysis was performed. An ad-hoc questionnaire was designed and sent to a study population of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by the 166 healthcare professionals who responded. Results The results revealed three main drivers for engagement in a CoP: First, for the whole sample, perceived usefulness for reducing costs associated with clinical practice was the factor with the greatest discriminant power that distinguished between users and non-users, followed by perceived usefulness for improving clinical practice quality, and lastly habitual social media website and application use. Turning to the two sub-samples of healthcare professions (physicians and nurses, respectively), we saw that the usefulness stemming from community of practice use changed. There were differences in the levels of motivation of healthcare professionals with regards to their engagement with CoP. While perceived usefulness for reducing costs associated with clinical practice was the main factor for the physicians, perceived usefulness of the Web 2.0 platform use for communication for improving clinical practice quality and perceived ease of use were the main factors for the nurses. Conclusions In the context of communities of practice, the perception of usefulness of Web 2.0 platform use for communication is determined by organisational, technological and social factors. Specifically, the position that professionals have within the healthcare structure and particularly the closer healthcare professionals’ activity is to patients and their professional experience of using social networks and ICTs are crucial to explaining the use of such platforms. Public policies promoting Web 2.0 platform use for communication should therefore go beyond the purely technological dimension and consider other professional and social determinants.
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Affiliation(s)
- David Lacasta Tintorer
- Centre d'Atenció Primària la Salut, Institut Català de la Salut, Badalona, Spain. .,Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
| | | | - Josep Maria Manresa
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Spain. .,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Santa Coloma de Gramenet, Spain. .,Departament de Ciències Mèdiques, Universitat de Girona, Girona, Spain.
| | - Ana Jiménez-Zarco
- Economics and Business Studies and Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Joan Torrent-Sellens
- Economics and Business Studies and Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Francesc Saigí-Rubió
- Department of Health Sciences and Internet Interdisciplinary Institute, Universitat Oberta de Catalunya, Barcelona, Spain.
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296
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Pinelli VA, Papp KK, Gonzalo JD. Interprofessional Communication Patterns During Patient Discharges: A Social Network Analysis. J Gen Intern Med 2015; 30:1299-306. [PMID: 26173532 PMCID: PMC4539328 DOI: 10.1007/s11606-015-3415-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Optimal care delivery requires timely, efficient, and accurate communication among numerous providers and their patients, especially during hospital discharge. Little is known about communication patterns during this process. OBJECTIVE Our aim was to assess the frequency and patterns of communication between patients and providers during patient discharges from a hospital-based medicine unit. DESIGN AND APPROACH On the day of the patient's discharge, the patient and all healthcare providers involved in the discharge were interviewed using structured questions related to information exchange during the discharge process. Each interview identified the frequency and method of communication between participants, including synchronous (e.g., face-to-face) and asynchronous (e.g., through electronic medical record) routes. Communication patterns were visually diagramed using social network analysis. PARTICIPANTS Forty-six patients were screened for inclusion in the network analysis. Of those, seven patients who were fully oriented and able to complete an interview and all providers who participated in their care during the discharge were selected for inclusion in the analysis. In all, 72 healthcare professionals contributing to the discharge process were interviewed, including physicians, nurses, therapists, pharmacists, care coordinators, social workers, and nutritionists. KEY RESULTS Patients' mean age was 63, length-of-stay was 7.8 days, and most (86 %) were discharged to home. On average, 11 roles were involved with each discharge. The majority of communication was synchronous (562 events vs. 469 asynchronous events, p = 0.004). Most communication events occurred between the primary nurse and patient and the care coordinator and primary nurse (mean 3.9 and 2.3 events/discharge, respectively). Participants identified intern physicians as most important in the discharge process, followed by primary nurses and care coordinators. CONCLUSIONS In patients being discharged from the medicine service, communication was more frequently synchronous, and occurred between intern physicians, primary nurses, and patients. Potential improvements in coordinating patients' discharges are possible by reorganizing systems to optimize efficient communication.
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297
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Abstract
As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality are lost), the increased risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults and the dangers and benefits of weight loss in this population and provides an overview of the new Medicare Obesity Benefit. In addition, we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice.
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Affiliation(s)
- Lydia E Gill
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Dartmouth Weight and Wellness Center, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Lebanon, NH, 03766, USA.
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298
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Soones TN, O'Brien BC, Julian KA. Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study. J Gen Intern Med 2015; 30:1279-85. [PMID: 26173512 PMCID: PMC4539326 DOI: 10.1007/s11606-015-3228-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. OBJECTIVE To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. DESIGN This was a qualitative study of focus groups with internal medicine residents. PARTICIPANTS Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. APPROACH Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. KEY RESULTS Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. CONCLUSIONS Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in interprofessional teams in their clinic may not be sufficient to teach residents how team-based care can enhance their overall learning and future practice.
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Affiliation(s)
- Tacara N Soones
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA,
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Towards implementing coordinated healthy lifestyle promotion in primary care: a mixed method study. Int J Integr Care 2015; 15:e030. [PMID: 26312058 PMCID: PMC4548708 DOI: 10.5334/ijic.1741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 07/18/2015] [Accepted: 07/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting. Methods A mixed method, convergent, parallel design was used. Three primary care centres took part in a two-year research project. Data collection methods included individual interviews, document data and questionnaires. The General Theory of Implementation was used as a framework in the analysis to integrate the data sources. Results Multi-disciplinary teams were implemented in the centres although the role of the teams as a resource for coordinated lifestyle promotion was not fully embedded at the centres. Embedding of the teams was challenged by differences among the staff, patients and team members on resources, commitment, social norms and roles. Conclusions The study highlights the importance of identifying and engaging key stakeholders early in an implementation process. The findings showed how the development phase influenced the implementation and embedding processes, which add aspects to the General Theory of Implementation.
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300
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Lutfiyya MN, Brandt B, Delaney C, Pechacek J, Cerra F. Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform. J Interprof Care 2015; 30:7-14. [PMID: 26230379 PMCID: PMC4776700 DOI: 10.3109/13561820.2015.1040875] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 04/01/2015] [Accepted: 04/10/2015] [Indexed: 01/17/2023]
Abstract
Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.
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Affiliation(s)
- May Nawal Lutfiyya
- Academic Health Center—Office of Education, R6685 Children’s Rehab Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Barbara Brandt
- Academic Health Center—Office of Education, R6685 Children’s Rehab Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Connie Delaney
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Judith Pechacek
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Frank Cerra
- Academic Health Center—Office of Education, R6685 Children’s Rehab Center, University of Minnesota, Minneapolis, Minnesota, USA
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