Decision support in multi-professional communication

An Exploratory Study of Issues in Training Facilitators for Online Training in Advance Care Planning: Mixed Methods Research

Advance care planning (ACP) has attracted increasing research attention in recent years. In Japan, extensive training has been conducted to improve communication through workshops, such as role-playing. In training, including trainee-centered work, the facilitator who assists trainee learning plays an important role. However, only a few studies have focused on the training of facilitators. Therefore, we exploratorily analyzed by the mixed method the differences in the approaches of experienced and inexperienced facilitators during workshops and conducted a study that could contribute to facilitator training in the future. We recorded the comments and attitudes of 12 facilitators who participated in ACP training conducted in 2022. Based on analysis of the obtained data, a distinct difference was confirmed in the progression of trainee-based learning, encouragement to deepen learning among trainees, and trainees' responses to questions. Thus, this study indicated the importance of having the opportunity for fellow facilitators to learn through facilitation with experienced facilitators and involvement in issue awareness.

District nurses' experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study

AIM

The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres.

BACKGROUND

In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults' medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults' ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients' medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions.

METHODS

Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts.Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults' medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.

Nurse as a facilitator to professional communication: a qualitative study

Nurses need to establish communication with other healthcare professionals to facilitate the process of care. Healthcare professionals have complementary roles in providing care to patients. As the key members of the healthcare team, nurses also have an important role in establishing communication among other healthcare professionals. The final outcome of professional communication is effective care and improved patient outcomes. The aim of this study was to explore nurses’ role in establishing professional communications with other healthcare professionals. This was a descriptive qualitative study. The study was conducted by using the content analysis approach. A purposive sample of sixteen healthcare professionals was recruited from six teaching hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. Study data were gathered by conducting personal face-to-face semi-structured interviews and were analyzed by using the qualitative content analysis approach. The three main themes of the study were ‘Nurse as the mediator of communication’, ‘Nurse as the executor of others’ duties, and ‘Nurse as a scapegoat’. Study findings can be used by nurses, managers, and health policy-makers to develop effective strategies for exactly determining and clarifying nurses and other healthcare professionals’ roles as well as for informing the public and other healthcare professionals about nurses’ roles and importance.

Phase II Practice-based Evidence in Nutrition (PEN) evaluation: interviews with key informants

PURPOSE

Dietitians of Canada has collaborated with experts in knowledge translation and transfer, technology, and dietetic practice to develop and implement an innovative online decision-support system called Practice-based Evidence in Nutrition (PEN). A study was conducted to evaluate the perceived facilitators and barriers that enable dietitians to use or prevent them from using PEN.

METHODS

As part of the overall evaluation framework of PEN, a qualitative descriptive research design was used to address the research purpose. Individual, semi-structured telephone interviews with 17 key informants were completed, and the interview transcripts underwent qualitative content analysis.

RESULTS

Respondents identified several facilitators of and barriers to PEN use. Facilitators included specificity to dietetics, rigorous/expert review, easy accessibility, current content, credible/secure material, well-organized/easy-to-use material, material that is valuable to practice, and good value for money. Barriers included perceived high cost, fee structuring/cost to students, certain organizational aspects, and a perceived lack of training for pathway contributors.

CONCLUSIONS

This formative evaluation has indicated areas in which PEN could be improved and strategies to make PEN the standard for dietetic education and practice. Ensuring that PEN is meeting users' knowledge needs is of the utmost importance if dietitians are to remain on the cutting edge of scientific inquiry.

Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature

The objective of this paper is to analyze the literature concerning nurses' roles and strategies in EOL decision making in acute care environments, synthesize the findings, and identify implications for future research. We conducted searches in CINAHL and PubMed, using a broad range of terms. The 44 articles retained for review had quantitative and qualitative designs and represented ten countries. These articles were entered into a matrix to facilitate examining patterns, themes, and relationships across studies. Three nursing roles emerged from the synthesis of the literature: information broker, supporter, and advocate, each with a set of strategies nurses use to enact the roles. Empirical evidence linking these nursing roles and strategies to patients and family members outcomes is lacking. Understanding how these strategies and activities are effective in helping patients and families make EOL decisions is an area for future research.

Electronic hand-drafting and picture management system

The Department of Health of Executive Yuan in Taiwan (R.O.C.) is implementing a five-stage project entitled Electronic Medical Record (EMR) converting all health records from written to electronic form. Traditionally, physicians record patients' symptoms, related examinations, and suggested treatments on paper medical records. Currently when implementing the EMR, all text files and image files in the Hospital Information System (HIS) and Picture Archiving and Communication Systems (PACS) are kept separate. The current medical system environment is unable to combine text files, hand-drafted files, and photographs in the same system, so it is difficult to support physicians with the recording of medical data. Furthermore, in surgical and other related departments, physicians need immediate access to medical records in order to understand the details of a patient's condition. In order to address these problems, the Department of Health has implemented an EMR project, with the primary goal of building an electronic hand-drafting and picture management system (HDP system) that can be used by medical personnel to record medical information in a convenient way. This system can simultaneously edit text files, hand-drafted files, and image files and then integrate these data into Portable Document Format (PDF) files. In addition, the output is designed to fit a variety of formats in order to meet various laws and regulations. By combining the HDP system with HIS and PACS, the applicability can be enhanced to fit various scenarios and can assist the medical industry in moving into the final phase of EMR.