Children's nursing and interprofessional collaboration: challenges and opportunities

Cooperação interprofissional e a Reforma Sanitária no Brasil: implicações para o modelo de atenção à saúde

As transformações sanitárias, sociais e econômicas ocorridas no Brasil recolocaram antigos problemas e introduziram outros novos para a área de recursos humanos em saúde. Entre os desafios inéditos, destacam-se aqueles decorrentes da implementação de estratégias de reorientação do modelo de atenção à saúde que exigem intensificação dos processos de interação profissional. O objetivo deste artigo foi sistematizar os conhecimentos relativos à cooperação interprofissional como um objeto de pesquisa, destacando sua relevância para a compreensão das relações entre os trabalhadores na produção do cuidado no contexto da reforma do sistema de saúde brasileiro. Aspectos históricos que marcaram as reformas do setor saúde no mundo, e no Brasil em particular, foram apresentados. Tomando-se por base os conhecimentos produzidos por estudos de revisão sobre o assunto, foram sistematizados aspectos que conformam a teoria sobre a cooperação interprofissional com foco nas definições, nos modelos teóricos e nos resultados observados. Para superar as dificuldades impostas pela necessidade de tornar a atenção à saúde mais efetiva, eficiente e equitativa, é indicada uma abordagem dirigida à compreensão dos processos e das relações imbricadas no problema que considere os profissionais como agentes atuantes, dotados de uma prática interessada, admitindo-se que tanto os esquemas de percepção como as organizações e a estrutura possuem gênese social. A compreensão das forças que orientam o conflito e a cooperação interprofissional pode subsidiar a formulação de estratégias para melhorar a produção do cuidado no âmbito do sistema de saúde no Brasil.

Collaboration between doctors and nurses in children's cancer care: insights from a European project

PURPOSE

It has long been recognised that effective cancer care is not possible without multi-professional team working. Collaboration and multi-professional working however are known to be less than straightforward. This project aimed to use a collaborative approach to explore and facilitate professional groups to work together more effectively in the field of children's cancer care.

METHOD

Based on an earlier project in Italy, a three-year seminar series was organised involving both a doctor and nurse from 15 paediatric haematology/oncology units across Europe. Participants had to be able to speak English and commit to participate in annual seminars as well as the development and implementation of a local project to enhance doctor-nurse collaboration in their own unit. Appreciative Inquiry was the methodological approach used to address organisational as well as interpersonal change.

RESULTS

Fifteen doctor-nurse teams were initially selected from a range of different countries, and 10 completed the project. Key outcomes reported include implementation and successful completion of projects, publication of the results achieved, participant satisfaction with improvements in collaboration. Feedback from participants would suggest that change had been implemented and possibly sustained.

CONCLUSIONS

Active involvement and group support were required for success. More formal relationships needed to be activated with participating centres to guarantee support for those involved in implementing lasting change. A web-based resource to allow other programmes and centres to use the resources developed has been made available. The same approach, we believe, could be used to improve multi-professional working in the care of other childhood illnesses.

Psychosocial issues and care in pediatric oncology: medical and nursing professionals' perceptions

BACKGROUND

Children with cancer and their families have psychosocial support needs. Medical and nursing professionals in pediatrics and pediatric oncology are in a position to identify and help manage these. However, little is known about their perceptions of psychosocial issues and interventions.

OBJECTIVE

The purpose of this study was to investigate physicians' and nurses' perceptions of psychosocial issues in pediatric oncology including their awareness of the psychosocial impact of childhood cancer on families and their knowledge and views of psychosocial interventions.

METHODS

A phenomenological approach was taken whereby semistructured interviews were conducted with a purposive sample of 10 physicians and nurses.

RESULTS

Findings showed that despite a lack of formal training in psychosocial issues, professionals identified a number of psychosocial issues associated with childhood cancer, including effects for family members. In addition, findings illustrated the psychosocial roles that they frequently adopt in relation to the identification, treatment, and referral of psychosocial issues. Finally, physicians and nurses recognized the value of formal intervention, reporting benefits for children, families, and themselves.

CONCLUSION

These findings give a preliminary insight into physicians' and nurses' perceptions and awareness of the psychosocial issues experienced by children with cancer and their families and their knowledge of psychosocial interventions. They highlight ways to enhance the delivery of care in pediatric oncology.

IMPLICATIONS FOR PRACTICE

Specifically, they suggest the need for more formal training on psychosocial issues for medical and nursing professionals, for additional experienced psychosocial professionals to be recruited, and for more access to services for both families and medical and nursing professionals.

Nurse/physician conflict management mode choices: implications for improved collaborative practice

In today's complex healthcare organizations, conflicts between physicians and nurses occur daily. Consequently, organizational conflict has grown into a major subfield of organizational behavior. Researchers have claimed that conflict has a beneficial effect on work group function and identified collaboration as one of the intervening variables that may explain the relationship between magnet hospitals and positive patient outcomes. The purpose of this study was to identify and compare conflict mode choices of physicians and head nurses in acute care hospitals and examine the relationship of conflict mode choices with their background characteristics. In a cross-sectional correlational study, 75 physicians and 54 head nurses in 5 hospitals were surveyed, using the Thomas-Kilmann Conflict Mode Instrument. No difference was found between physicians and nurses in choice of the most frequently used mode in conflict management. The compromising mode was found to be the significantly most commonly chosen mode (P = .00) by both. Collaborating was chosen significantly more frequently among head nurses (P = .001) and least frequently among physicians (P = .00). Most of the respondents' characteristics were not found to be correlated with mode choices. The findings indicate a need to enhance partnerships in the clinical environment to ensure quality patient care and staff satisfaction.

Improving care through collaborative working in tissue viability

Collaboration is necessary in order to achieve the government aim of seamless care, but research has tended to focus on inter-professional, rather than intra-professional collaboration. A group of tissue viability nursesfrom across Manchester formed a collaborative group to strengthen their influence across their trusts and to achieve improvements in care through targeting specific objectives. This article discusses the rationale for collaboration, and reports an evaluation of the tissue viability nurse group's first year.

Negotiating socialisation: the journey of novice nurse academics into higher education

In this paper we seek to explore the socialisation process experienced by novice nurse academics when they make the transition from the health sector into the education sector. We will do this by identifying the theoretical tensions between individual freedom in the context of organisational needs. The ramifications of these tensions will be highlighted and solutions for raising awareness as to how to manage them are discussed. We conclude that a socialisation process that protects individual freedom and promotes self-development is one that carries the greatest benefit for the novice nurse academic and the educational institution.

Value of professional collaboration in the care of children with cancer and their families

The aim of this study is to describe professionals' perception of collaboration and their evaluation of a professional collaborative model for children with cancer in mid-Norway. Health and non-health professionals from the families' home communities were invited to participate in the study. The selection was based upon professionals working with children treated for cancer at the Department of Paediatrics, University Hospital in Trondheim between 1990 and 1996. Ninety-one of 142 eligible professionals (64%) responded to a questionnaire. Both health and non-health professionals agreed that collaboration takes care of the family's situation (76%) as well as broadening their own knowledge (77%). Two-thirds considered they had received enough information necessary for follow-up care, however, only 28% believed that families were confident that professionals had this knowledge. More than 80% of professionals considered collaborative meetings and support groups, essential elements of the model, as being effective methods for follow-up care. However, only 39% of professionals had participated in collaborative meetings and 46% in support groups. In addition, only 26% received systematic supervision. Health and non-health professionals regard collaboration as being valuable in follow-up care for children, their families and professionals themselves. However, our results suggest areas of potential improvement in the existing model.

The origins of current nurse education policy and its implications for nurse educators

The publication of Fitness for Practice [UKCC Commission for Nursing and Midwifery Education, 1999. Fitness for Practice (Chair Sir Leonard Peach). UKCC, London] in the United Kingdom (UK) came at a time when anxiety was being expressed by UK government and the National Health Service (NHS) over the suitability of newly trained nurses to be 'fit for purpose'. There had been growing disquiet that the education reforms of the 1990s, which had seen nurse education move into higher education, had failed to deliver skilled nurses for the modern healthcare system. Fitness for Practice (loc. cit.) became the driving force behind government's attempts to bring about change nurse education policy. In the process of these reforms, nurse educators were marginalised and portrayed a negative light. The implementation time of the report was one to two years. This makes the policy ripe for discussion and analysis to explore the complexity of its recommendations, and its implications for UK nurse educators within a higher education context.