Nurses' culturally mediated practices influencing pain care provision for older people in acute care: Ethnographic study

Groupthink among health professional teams in patient care: A scoping review

There is emerging interest in understanding group decision making among a team of health professionals. Groupthink, a term coined by Irving Janis to depict premature consensus seeking in highly cohesive groups, is a theory that has been widely discussed in disciplines outside health care. However, it remains unclear how it has been conceptualized, studied, and mitigated in the context of health professionals conducting patient care. This scoping review aimed to examine the conceptualization of groupthink in health care, empirical research conducted in healthcare teams, and recommendations to avoid groupthink. Eight databases were systematically searched for articles focusing on groupthink among health professional teams using a scoping review methodology. A total of 22 articles were included-most were commentaries or narrative reviews with only four empirical research studies. This review found that focus on groupthink and group decision making in medicine is relatively new and growing in interest. Few empirical studies on groupthink in health professional teams have been performed and there is conceptual disagreement on how to interpret groupthink in the context of clinical practice. Future research should develop a theoretical framework that applies groupthink theory to clinical decision making and medical education, validate the groupthink framework in clinical settings, develop measures of groupthink, evaluate interventions that mitigate groupthink in clinical practice, and examine how groupthink may be situated amidst other emerging social cognitive theories of collaborative clinical decision making.

Healthcare professionals' practice and interactions in older peoples' cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study

BACKGROUND

Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals' identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals' practice.

AIM

This study aimed to explore and analyse how healthcare professionals' interactions and practice influence older peoples' clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged.

METHODS

This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals' interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines.

RESULTS

The analysis revealed four themes: 1)"The end justifies the means - 'I know what is best for you'", 2)"Basic needs of care overruled by system effectiveness", 3)"Treatment as a bargain", and 4)"Healthcare professionals as solo detectives".

CONCLUSION

Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.

Disjunction, tension and dissonance within nursing pain care provision for the older hospitalized person: A focused ethnographic insight

AIMS

This study presents an ethnographic insight into the older hospitalized persons' experiences on how nurses provide pain care provision. The older persons' perceptions of culturally mediated barriers and facilitators are presented.

DESIGN

Focused ethnography.

METHODS

Multi-site across eight acute care units within two tertiary referral hospitals on the east coast of Australia collected over a one-year period from 2014 to 2015. Semi-structured interviews (n = 12) of older persons (11 hr). Twenty-three (23) semi-structured interviews with nine (9) registered nurses (12 hr 38 min). Participant observation (1,041 hr) during day, night and evening shifts.

RESULTS

The older person experienced disjunction within pain assessment by the reliance of nurses on objective measurement gained during functional task completion. Tension emerged during pain management when the older person was not included and/or options provided were not deemed effective. For some older persons this meant they undertook a decision to exclude their nurse from involvement in pain management. A thread woven throughout was a lack of communication, continuity of care and input from the older person.

CONCLUSION

This study has implications for the provision of nursing care of the older hospitalized person. Dissonance within pain care provision for the older person occurs during episodes of missed pain care. Understanding and insight is gained into aspects of missed communication opportunities between nurses and the experiences of missed pain care of the older person.

Use of artificial intelligence and virtual reality within clinical simulation for nursing pain education: A scoping review

OBJECTIVES

To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses.

DESIGN

A scoping review of published and unpublished research from 2009 to 2019.

DATA SOURCES

Nine electronic databases and hand-searching of reference lists.

REVIEW METHODS

Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis.

RESULTS

The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement.

CONCLUSION

Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.