Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care

Development and Evaluation of a Nurse Practitioner Huddles Toolkit for Long Term Care Homes

Long-term care homes (LTCHs) were disproportionately affected by the coronavirus disease (COVID-19) pandemic, creating stressful circumstances for LTCH employees, residents, and their care partners. Team huddles may improve staff outcomes and enable a supportive climate. Nurse practitioners (NPs) have a multifaceted role in LTCHs, including facilitating implementation of new practices. Informed by a community-based participatory approach to research, this mixed-methods study aimed to develop and evaluate a toolkit for implementing NP-led huddles in an LTCH. The toolkit consists of two sections. Section one describes the huddles' purpose and implementation strategies. Section two contains six scripts to guide huddle discussions. Acceptability of the intervention was evaluated using a quantitative measure (Treatment Acceptability Questionnaire) and through qualitative interviews with huddle participants. Descriptive statistics and manifest content analysis were used to analyse quantitative and qualitative data. The project team rated the toolkit as acceptable. Qualitative findings provided evidence on design quality, limitations, and recommendations for future huddles.

Outcomes of the Nurse-Led Interdisciplinary-Heart Failure Team Program (NLI-HFTP): A Pilot Study

Information is lacking in long-term care regarding heart failure (HF) management, including in nursing homes. The current pilot project examined the Nurse-Led Interdisciplinary-Heart Failure Team Program (NLI-HFTP) intervention for nursing home residents with HF. This study used a pre-posttest one-group design with 46 nursing home residents who were primarily female, African American, of non-Hispanic ethnicity, and with an average age of 76 years. Post-intervention Nurse-Patient Interaction Scale scores were significantly higher than pre-intervention scores (mean pretest = 124.83, mean posttest score = 103.04; t [45] = 27.78, p < 0.001). Comparison of participants' medical records found a substantial decrease in the number of HF-exacerbated hospitalizations during the 3-month post-implementation period compared with rates during the 3-month pre-implementation period (16 vs. 7). The NLI-HFTP was feasible to implement in a nursing home, reduced referral rates to acute care hospitals, and could thus provide a better resident experience through increasing nurse-patient interactions. [Journal of Gerontological Nursing, 49(12), 18-23.].

The contribution of interprofessional education in developing competent undergraduate nursing students: integrative literature review

BACKGROUND

Effective interprofessional team collaboration is one of the necessary domains for successful interprofessional collaborative practices in healthcare (IPCP), which is crucial for the delivery of safe and quality healthcare services. Therefore, understanding the contribution of interprofessional education in nursing students is vital to improving collaboration practices in nursing students, in preparation for the dynamics that await after registration in practice amongst the interprofessional team. Thus, the aim of the study was to summarise the contribution of interprofessional education in nursing education in developing competent undergraduate nursing students.

DESIGN

The integrative literature review design as described by Whittemore and Knafl was adopted for the review. The review consists of five steps, namely, problem identification, literature search, data analysis, data interpretation, and the last step was data presentation. Three databases were searched for the articles, namely CINHAL, Scopus, and Science Direct. Articles were retrieved using Search terms such as "Competence," "Contribution,", "Development," "Interprofessional education" and "Undergraduate nursing students" retrieved Articles published between 2018 and 2022 were selected.

RESULTS

Three themes emerged from the review, namely the promotion of patient safety in nursing practice, the socialisation of nursing students in interprofessional collaboration, and the promotion of the development of professional identity.

CONCLUSION

This study is the first step in determining the contributions of early interprofessional education to nursing education. It could set the stage for further studies that examine strategies the undergraduate nursing curriculum can adopt and develop sound interprofessional competencies that promote patient safety and quality healthcare by nursing students.

IMPACT

The developers of the nursing curriculum and nursing educators can use the results in developing a curriculum that includes interprofessional education with the aim of improving the quality of teaching and learning that advances competent and safe nursing students.

Impact of Interprofessional Communication on Safety in the Neonatal Intensive Care Unit

BACKGROUND

In light of the complex advances in neonatal intensive care units (NICU), it is essential that healthcare providers (HCPs) are equipped with the appropriate skills to effectively communicate between disciplines to provide safe, quality care. However, many HCPs acknowledge that they are not confident in their ability to communicate effectively with peers.

PURPOSE AND DESIGN

This study aimed to identify perceived barriers and facilitators of communication among HCPs in a NICU setting. This study took place in a 60-bed NICU that utilized multiple disciplines of HCPs. Using a qualitative, cross-sectional design, 2 surveys were administered, namely, a demographic survey with open-ended questions and the Safety Attitudes Questionnaire (SAQ).

RESULTS

Findings indicated inverse relationships in age/experience and perceptions of management. Total SAQ scores ranged from 45 to 77 (N = 28, M = 62.47, SD = 9.40). The SAQ highlight that total scores above 75 correspond with positive perceptions of safety in the NICU.

CONCLUSION

The statistical evidence derived from this study contributes to the evaluation of HCP-perceived communication barriers and facilitators. The identification of perceived barriers and facilitators of communication in an ICU setting may serve as a distinct, evidence-based foundation to develop interventions that emphasize the value of communication.

Assessing the implementation of nurse practitioner-led huddles in long-term care using the Consolidated Framework for Implementation Research (CFIR)

BACKGROUND

The COVID-19 pandemic created major challenges in long-term care (LTC) homes across Canada and globally. A nurse practitioner-led interdisciplinary huddle intervention was developed to support staff wellbeing in two LTC homes in Ontario, Canada. The objective of this study was to identify the constructs strongly influencing the process of implementation of huddles across both sites, capturing the overall barriers and facilitators and the intervention's intrinsic properties.

METHODS

Nineteen participants were interviewed about their experiences, pre-, post-, and during huddle implementation. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. CFIR rating rules and a cross-comparison analysis was used to identify differentiating factors between sites. A novel extension to the CFIR analysis process was designed to assess commonly influential factors across both sites.

RESULTS

Nineteen of twenty selected CFIR constructs were coded in interviews from both sites. Five constructs were determined to be strongly influential across both implementation sites and a detailed description is provided: evidence strength and quality; needs and resources of those served by the organization; leadership engagement; relative priority; and champions. A summary of ratings and an illustrative quote are provided for each construct.

CONCLUSION

Successful huddles require long-term care leaders to consider their involvement, the inclusion all team members to help build relationships and foster cohesion, and the integration of nurse practitioners as full-time staff members within LTC homes to support staff and facilitate initiatives for wellbeing. This research provides an example of a novel approach using the CFIR methodology, extending its use to identify significant factors for implementation when it is not possible to compare differences in success.

A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models

The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].

Exploring interprofessional communication during nursing home emergencies using the SBAR framework

Communication breakdowns during emergencies threaten patient safety. In nursing homes (NHs) vulnerable residents may experience emergencies at any time. Concerns over clinical complexity and diverse communication styles among interprofessional practitioners heighten the need for standardized methods to improve practitioners' communication skills. This study explores communication structures among 32 practitioners in four NHs using in-depth interviews following a formalized Situation-Background-Assessment-Recommendation (SBAR) framework. Network analysis, a deductive approach to qualitative data analysis, and case analysis were performed for a comprehensive understanding of interprofessional communication in 48 emergency cases identified during interviews. Findings identified the flow of information, messaging, and management strategies that were expected of receivers during interprofessional communication. These results could help develop training regimens or guidelines to improve cooperative interprofessional communication, allowing practitioners to provide appropriate emergency care for NH residents.

Associations between Perception of Help-Seeking Behaviors and Quality of Life among Older People in Rural Communities: A Cross-Sectional Study

Older people's help-seeking behaviors (HSBs) may be limited because of various factors and are essential in improving healthcare in aging societies. This cross-sectional study investigated the association between perception of HSBs, concrete HSBs, quality of life (QOL), and other variables among people over 65 in rural Japan using standardized questionnaires. Participants were divided into high or low health status index score groups based on a median split. Logistic regression was used to assess the association between perception of HSBs and high QOL while controlling for age, sex, living conditions, annual health checks, having chronic diseases, regular clinic visits, smoking, habitual alcohol consumption, education, living conditions, social support, social capital, socioeconomic status (SES), and health literacy. Participants in the high QOL group were younger (p < 0.001), and had fewer chronic diseases and regular clinic visits than those in the low QOL group (p < 0.001). The multivariate logistic regression model revealed that age, chronic diseases, tobacco usage, family consultation, and consulting primary care physicians negatively predicted QOL. High SES, social capital and support, and HSB intention positively predicted QOL. Self-efficacy and intention regarding HSBs should be investigated to improve health among older rural people.

Interprofessional Culinary Medicine Training Enhanced Nutrition Knowledge, Nutrition Counseling Confidence, and Interprofessional Experience

Introduction: Culinary medicine training combining evidence-based nutrition instruction with experiential cooking application has improved nutrition knowledge, skills, and attitudes in the professional and personal lives of medical students. However, interprofessional culinary training remains largely unstudied among professional students who will be involved in collaborative patient care. The goal of this study was to evaluate the feasibility and effectiveness of an elective interprofessional culinary medicine course for students in the medical, pharmacy, social work, nursing, law, and dentistry schools at the University of Maryland, Baltimore. Methods: The interprofessional culinary medicine course was offered in-person at the teaching kitchen of the Nova Institute for Health in 2020 and virtually in 2021 during the COVID pandemic. The training featured five workshops combining instruction in a variety of popular diets, cooking a meal inspired by the diet in focus, and group discussion. Paired t tests were utilized to evaluate changes in pre-/post-training nutrition and interprofessional experience outcomes. Linear regression models were constructed to compare outcomes between in-person and virtual delivery. Results: A total of 62 students participated in the culinary medicine training. Confidence in all nutrition knowledge, skills, and attitudes, as well as interprofessional experience outcomes, improved after the training (p < 0.05). Similar improvements were noted in most outcomes with in-person and virtual delivery in linear regression modeling. Discussion: Interprofessional culinary medicine training is feasible, and virtual delivery may help enhance replicability in other settings.

Reducing Hospital Admissions for Patients with Heart Failure by Implementing the Chronic Care Management Framework: A Cost, Quality and Satisfaction Improvement Project

OBJECTIVE

To reduce the rate of hospital admissions, and increase the perception of coordinated care for patients with heart failure and associated co-morbidities through improvement of interdisciplinary communication.

BACKGROUND

Heart failure patients with associated multi-morbidities and multiple provider visits are often left to navigate the health system independently. Limited provider to provider communication contributes to care fragmentation, unnecessary utilization and decreased satisfaction.

METHODS

A nurse led complex care management improvement project imbedded care plans and formal and informal collaborative care conferences to improve interprofessional communication across the care continuum.

RESULTS

Hospital admissions decreased by 62% and length of stay decreased by 73% (n = 47, p < .001). Using paired t-test, satisfaction questions improved post intervention, and one was statistically significant (p < 0.05).

CONCLUSION

Improved communication strategies decreased hospital admissions and length of stay in one large Pacific Northwest health system. Days subject to readmission penalties decreased by 98% with a variance in pre-post charges of $615,000.

IMPLICATION FOR NURSES

Nurses and nurse leaders play a significant role in achieving the Triple Aim and can be instrumental in developing small multidisciplinary teams targeting improved coordination across settings and sectors.

Interprofessional team-based geriatric education and training: A review of interventions in Canada

Given world-wide rises in the number of older adults, interprofessional education and training in geriatrics must be promoted across the learning spectrum, both for students and for health care professionals. This review examined interprofessional team-based education and training interventions in Canada focusing on the team component. A total of 10 studies (1997-2017) were eligible for analyzes. Studies offered health care providers opportunities to enhance their knowledge of geriatric competencies, as well as their ability to work in interprofessional geriatric teams. Although several interventions did not include team-based learning content explicitly, team-building opportunities, as well as assignments related to working on teams yielded positive impacts on learners. Results showed improved geriatric competencies as well as team functioning. Geriatric health care teams add significant value to the Canadian health care system. Consequently, opportunities to improve health care providers' geriatric knowledge and their ability to work in teams should be encouraged.

Social work involvement in palliative care heart failure research: a review of recent literature

PURPOSE OF REVIEW

The aim of the review is to examine the findings of empirical studies of palliative care interventions for patients with heart failure in which a social worker was identified as a key member of the interprofessional clinical team.

RECENT FINDINGS

Our systematic review of the empirical literature from January 2016 to August 2019 found five palliative care interventions with heart failure patients that cited involvement of a social worker as a key team member. The reviewed studies highlighted social workers' roles in the areas of psychosocial assessments and support, advance care planning, and patient-medical team communication.

SUMMARY

Palliative social workers possess the knowledge and skills to provide expertise in psychological, social, and cultural care within palliative care domains of practice. Given this primary and critical role, more studies that include the assessment of outcomes linked to the social worker's role should be pursued. Our review unearthed several important studies that highlight the role of the palliative social workers in heart failure models of care.

Recommendations for integrating physiotherapy into an interprofessional outpatient care setting for people living with HIV: a qualitative study

OBJECTIVES

To identify factors to consider when integrating physiotherapy (PT) into an interprofessional outpatient HIV care setting from the perspective of healthcare professionals and adults living with HIV.

DESIGN

We conducted a qualitative descriptive study using semi-structured interviews (healthcare professionals) and focus groups (adults living with HIV). We asked participants their perspectives on barriers, facilitators and strategies to accessing and participating in outpatient PT, important characteristics physiotherapists should possess working in outpatient HIV care, content and structure of PT delivery, and programme evaluation.

RECRUITMENT AND SETTING

We purposively sampled healthcare professionals based on their experiences working in interprofessional HIV care and recruited adults with HIV via word of mouth and in collaboration with an HIV-specialty hospital in Toronto, Canada. Interviews were conducted via Skype or in-person and focus groups were conducted in-person at the HIV-specialty hospital.

PARTICIPANTS

12 healthcare professionals with a median of 12 years experience in HIV care, and 13 adults living with HIV (11 men and 2 women) with a median age of 50 years and living with a median of 6 concurrent health conditions in addition to HIV.

RESULTS

Overall impressions of PT in outpatient HIV care and factors to consider when implementing PT into an interprofessional care setting include: promoting the role of, and evidence for, PT in outpatient HIV care, structuring PT delivery to accommodate the unique needs and priorities of adults living with HIV, working collaboratively with a physiotherapist on the healthcare team and evaluating rehabilitation as a component of interprofessional care.

CONCLUSIONS

Multiple factors exist for consideration when implementing PT into an interprofessional outpatient HIV care setting. Results provide insight for integrating timely and appropriate access to evidence-informed rehabilitation for people living with chronic and episodic illness, such as HIV.

Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use

OBJECTIVES

This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care.

DESIGN

A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use.

SETTINGS AND PARTICIPANTS

Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use.

MEASURES

Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution.

RESULTS

The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff.

CONCLUSIONS/IMPLICATIONS

Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.