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Hotta S, Ashida K, Tanaka M. Development of a scale to assess nurses' difficulties in collaborating with physicians in responding to clinical deterioration during night shifts. Jpn J Nurs Sci 2024; 21:e12622. [PMID: 39233516 DOI: 10.1111/jjns.12622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024]
Abstract
AIMS To develop a scale to assess difficulties that nurses experience when collaborating with physicians in responding to clinical deterioration during night shifts and identify factors associated with scoring using the developed scale. METHODS A web-based questionnaire with a draft scale, the Nighttime Collaboration Difficulties between Nurses and Physicians for Nurses (NCDNP-N), was distributed to nurses working night shifts in acute-care hospitals across Japan. Data were collected between July and October 2023. Of 435 responses, 405 were examined for the NCDNP-N's psychometric validation, including structural validity, criterion-related validity, and reliability assessments. Multiple linear regression analysis was performed for 385 responses excluded by listwise methods to identify factors associated with NCDNP-N scores. RESULTS The NCDNP-N has 10 items and three domains: Domain 1, dissatisfaction with physicians' actions; Domain 2, burden of working with night-shift physicians; and Domain 3, barriers to reporting during night shifts. Estimated reliability coefficients exceeded the recommended values. Multiple regression analyses demonstrated that more years of experience in the current ward and frequency of calling the covering physician at night were markedly associated with higher scores, whereas more nursing experience was associated with lower scores. CONCLUSION We developed the NCDNP-N and confirmed its validity and reliability. The study results suggest that the responsibilities and competence of nurses working night shifts and communication with the night-covering physician are associated with difficulties in nighttime collaboration. The NCDNP-N may help identify challenges in clinical settings as well as can be utilized in the evaluation study for improving nighttime collaboration.
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Affiliation(s)
- Soichiro Hotta
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- School of Nursing, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kaoru Ashida
- Department of Nursing, College of Nursing, Kanto Gakuin University, Yokohama, Japan
| | - Makoto Tanaka
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Hotta S, Ashida K, Tanaka M. Night Physician-Nurse Collaboration: Developing the Scale of Physicians' Difficulties and Exploring Related Factors in Acute Care Hospitals. J Multidiscip Healthc 2024; 17:2831-2845. [PMID: 38881754 PMCID: PMC11180433 DOI: 10.2147/jmdh.s454578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 06/18/2024] Open
Abstract
Background Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores. Methods We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics. Results By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach's alpha and McDonald's omega coefficients were 0.81-0.84 and 0.81-0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician's charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores. Conclusion We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians' characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.
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Affiliation(s)
- Soichiro Hotta
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kaoru Ashida
- Department of Nursing, College of Nursing, Kanto Gakuin University, Kanazawa-ku, Yokohama, Japan
| | - Makoto Tanaka
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc 2024:01266021-990000000-00117. [PMID: 38526045 DOI: 10.1097/sih.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
SUMMARY STATEMENT Interprofessional simulation-based team training (ISBTT) is promoted as a strategy to improve collaboration in healthcare, and the literature documents benefits on teamwork and patient safety. Teamwork training in healthcare is traditionally grounded in crisis resource management (CRM), but it is less clear whether ISBTT programs explicitly take the interprofessional context into account, with complex team dynamics related to hierarchy and power. This scoping review examined key aspects of published ISBTT programs including (1) underlying theoretical frameworks, (2) design features that support interprofessional learning, and (3) reported behavioral outcomes. Of 4854 titles identified, 58 articles met inclusion criteria. Most programs were based on CRM and related frameworks and measured CRM outcomes. Only 12 articles framed ISBTT as interprofessional education and none measured all interprofessional competencies. The ISBTT programs may be augmented by integrating theoretical concepts related to power and intergroup relations in their design to empower participants to navigate complex interprofessional dynamics.
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Affiliation(s)
- Naike Bochatay
- From the University of California San Francisco, San Francisco, CA
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Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
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Amano A, Brown-Johnson CG, Winget M, Sinha A, Shah S, Sinsky CA, Sharp C, Shanafelt T, Skeff K. Perspectives on the Intersection of Electronic Health Records and Health Care Team Communication, Function, and Well-being. JAMA Netw Open 2023; 6:e2313178. [PMID: 37171816 PMCID: PMC10182436 DOI: 10.1001/jamanetworkopen.2023.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Understanding of the interplay between the electronic health record (EHR), health care team relations, and physician well-being is currently lacking. Approaches to cultivate interpersonal interactions may be necessary to complement advancements in health information technology with high-quality team function. Objective To examine ways in which the EHR, health care team functioning, and physician well-being intersect and interact. Design, Setting, and Participants Secondary qualitative analysis of semistructured interview data from 2 studies used keyword-in-context approaches to identify excerpts related to teams. Thematic analysis was conducted using pattern coding, then organized using the relationship-centered organization model. Two health care organizations in California from March 16 to October 13, 2017, and February 28 to April 21, 2022, participated, with respondents including attending and resident physicians. Main Outcome and Measures Across data sets, themes centered around the interactions between the EHR, health care team functioning, and physician well-being. The first study data focused on EHR-related distressing events and their role in attending physician and resident physician emotions and actions. The second study focused on EHR use and daily EHR irritants. Results The 73 respondents included attending physicians (53 [73%]) and resident physicians (20 [27%]). Demographic data were not collected. Participants worked in ambulatory specialties (33 [45%]), hospital medicine (10 [14%]), and surgery (10 [14%]). The EHR was reported to be the dominant communication modality among all teams. Interviewees indicated that the EHR facilitates task-related communication and is well suited to completing simple, uncomplicated tasks. However, EHR-based communication limited the rich communication and social connection required for building relationships and navigating conflict. The EHR was found to negatively impact team function by promoting disagreement and introducing areas of conflict into team relationships related to medical-legal pressures, role confusion, and undefined norms around EHR-related communication. In addition, interviewees expressed that physician EHR-related distress affects interactions within the team, eroding team well-being. Conclusions and Relevance In this study, the EHR supported task-oriented and efficient communication among team members to get work done and care for patients; however, participants felt that the technology shifts attention away from the human needs of the care team that are necessary for developing relationships, building trust, and resolving conflicts. Interventions to cultivate interpersonal interactions and team function are necessary to complement the efficiency benefits of health information technology.
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Affiliation(s)
- Alexis Amano
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
- Department of Health Policy and Management, Fielding School of Public Health, University of California. Los Angeles
| | - Cati G Brown-Johnson
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Marcy Winget
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Amrita Sinha
- Divisions of Medical Critical Care and Clinical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Shreya Shah
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | | | - Christopher Sharp
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Tait Shanafelt
- Division of Hematology and General Internal Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Kelley Skeff
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
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Doig E, Prescott S, Pick V, Turner B, Suleman S, Douglas D, Foster M. Normalising interdisciplinary role-based goal setting in inpatient brain injury rehabilitation: reflections and recommendations of clinicians. Disabil Rehabil 2023; 45:673-683. [PMID: 35282717 DOI: 10.1080/09638288.2022.2040612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Person-centred goal setting with people with brain injury, by interdisciplinary teams has benefits including improved communication between patients, families and clinicians, person-centred care, and improved engagement in rehabilitation. Exploring the experiences of team members who have adopted interdisciplinary, person-centred goal setting may assist in understanding what is needed to implement this complex, core component of rehabilitation practice. This study explored experiences of clinicians working in an extended inpatient brain injury rehabilitation unit about implementing a role-based goal planning approach within an interdisciplinary team. MATERIALS AND METHODS Semi-structured interviews with 13 clinicians working at the rehabilitation unit explored their experiences about the cognitive participation and collective actions required to carry out the practice, with data analysed using inductive content analysis guided by Normalisation Process Theory. RESULTS Three primary themes were identified: putting the person at the centre, accepting the mind-shift to participation focused goals and working collaboratively. CONCLUSIONS This study has elucidated some key processes that occurred and were necessary to carry out goal setting. A mind-shift towards holistic, participation-focussed goal setting was described as "unlearning" discipline-specific goal setting. Development and ownership by the team, acceptance of team members and willingness to share, and structured processes and resources were necessary.IMPLICATIONS FOR REHABILITATIONNormalising interdisciplinary role-based goal setting in multi-professional teams requires a mind-shift away from traditional, discipline-specific goal setting.Implementation of interdisciplinary, collaborative team goal setting within health service settings requires collective actions including collaborative working by team members, structured processes including organised time for collaborative team and family meetings, practical resources and training to support processes.Clinicians perceived the goal setting approach to put the person at the centre resulting in a deep understanding of the person, shared understanding, and motivation for rehabilitation.
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Affiliation(s)
- Emmah Doig
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Hospital Service, Brisbane, Australia
| | - Sarah Prescott
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Valerie Pick
- Brain Injury Rehabilitation Service, Metro South Health, Brisbane, Australia
| | - Ben Turner
- Acquired Brain Injury Outreach Service, Metro South Health, Brisbane, Australia
| | - Sameera Suleman
- Brain Injury Rehabilitation Service, Metro South Health, Brisbane, Australia
| | - David Douglas
- Brain Injury Rehabilitation Service, Metro South Health, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Michele Foster
- The Hopkins Centre, Griffith University, Brisbane, Australia
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Unintended Consequences of a Transition to Synchronous, Virtual Simulations for Interprofessional Learners. Healthcare (Basel) 2022; 10:healthcare10112184. [DOI: 10.3390/healthcare10112184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
The coronavirus pandemic shifted in-person environments to virtual environments. Little is known about the effectiveness of fully synchronous, virtual interprofessional education (IPE). This study aims to compare two IPE cases that occurred in-person pre-pandemic and virtual during-pandemic. Two cases are analyzed: a medical error care and a charity care case. Participants were students from various health science disciplines. Assessments were captured through The Interprofessional Collaborative Competency Attainment Survey (ICCAS). Effect sizes were calculated for the pre-and post-surveys and analyzed using Cohen’s d for independent samples. From the in-person collection period, a total of 479 students participated in the medical error simulation and 479 in the charity care simulation. During the virtual collection period, a total of 506 students participated in the medical error simulation and 507 participated in the charity care simulation. In the data for the virtual simulations, the medical error case study maintained a large effect size (0.81) while the charity care simulation had a lesser impact (0.64 effect size). Structural details of the patient cases may be a critical variable. Future research is needed to better understand how health science students can obtain more training to notice the subtle cues from patients assessed through telemedicine modalities.
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Abstract
Purpose This study aimed to understand rehabilitation nurses’ perceptions of research information, related barriers, and avenues for future research, specifically in those caring for individuals with burn injury, spinal cord injury, or traumatic brain injury. Design Qualitative semistructured interviews were conducted. Methods Eighteen interviews were conducted. A thematic network approach identified codes and developed basic, organizing, and global themes. Results Researchers identified factors that facilitated research uptake, determined organizational structures that support research culture, and described nurse engagement with literature. Conclusions Although participants desired to engage with the research literature, they identified barriers including time constraints, heavy workloads, and lack of access. To facilitate research uptake, research must be easily accessible, be easily digestible, and include clinical practice recommendations. Research must expand its scope to address issues relevant to the rehabilitation population. Clinical Relevance Our findings may be used to drive improvements in research competence, facilitate knowledge translation, and support evidence-based practice among rehabilitation nurses.
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Konopasky A, Varpio L, Stalmeijer RE. The potential of narrative analysis for HPE research: Highlighting five analytic lenses. MEDICAL EDUCATION 2021; 55:1369-1375. [PMID: 34291492 DOI: 10.1111/medu.14597] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 07/06/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Health professions education (HPE) has increasingly turned to qualitative methodology to address a number of the field's difficult research problems. While several different methodologies have been widely accepted and used in HPE research (e.g., Grounded Theory), others remain largely unknown. In this methodology paper, we discuss the value of narrative analysis (NA) as a set of analytic approaches that offer several lenses that can support HPE scholars' research. METHODS After briefly discussing the 'narrative turn' in research, we highlight five NA lenses: holistic, situated, linguistic, agentive and sequential. We explore what each lens can offer HPE scholars-highlighting certain aspects of the data-and how each lens is limited-obscuring other aspects. To support these observations, we offer an example of each lens from contemporary HPE scholarship. The manuscript also describes methods that can be employed in NA research and offers two different typologies of NA methods that can be used to access these lenses. CONCLUSIONS We conclude with a discussion of how different analytic methods can be used to harness each of the lenses. We urge the deliberate selection and use of NA methods and point to the inherent partiality of any NA approach. Reflecting on our position as narrative scholars, we acknowledge how our own lenses illuminate some areas and conceal others as we tell the story of NA. In conclusion, we invite other researchers to benefit from the potential NA promises.
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Affiliation(s)
- Abigail Konopasky
- Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
- Center for Health Professions Education, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Lara Varpio
- Center for Health Professions Education, Uniformed Services University, Bethesda, Maryland, USA
| | - Renée E Stalmeijer
- School of Health Professions Education, Department for Educational Development & Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Sillero Sillero A, Buil N. Enhancing Interprofessional Collaboration in Perioperative Setting from the Qualitative Perspectives of Physicians and Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010775. [PMID: 34682520 PMCID: PMC8535564 DOI: 10.3390/ijerph182010775] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 12/16/2022]
Abstract
Communication failures were a leading cause of sentinel events in the operation room due to frequently the communication breakdown occurs between physicians and nurses. This study explored the perspectives of surgical teams (nurses, physicians, and anaesthesiologists) on interprofessional collaboration and improvement strategies. A surgical team comprising eight perioperative nurses, four surgeons, and four anaesthesiologists from a university-affiliated hospital participated in this qualitative and phenomenological research from December 2018 to April 2019. Data were collected in in-depth interviews and were used in a thematic analysis according to Colaizzi to extract themes and categorised codes with the ATLAS.ti software. The result is presented in three generic categories: Barrier-like disruptive behaviours and lack of coordination of care; consequences by safety threats to the patient; overcoming barriers by shared decision making among professionals, flattened hierarchies, and teamwork/communication training. The conclusion is that different teams’ perspectives can facilitate genuine reflection, discussion, and implementation of targeted interventions to improve operating room interprofessional collaboration and overcome barriers and their consequences. Currently, there is a need to change towards interprofessional collaboration for optimal patient outcomes and to ensure all professionals’ expectations are met.
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Affiliation(s)
- Amalia Sillero Sillero
- Nursing School of Mar (ESimar), University of Pompeu Fabra, 08003 Barcelona, Spain
- Correspondence:
| | - Neus Buil
- Department of Perioperative Nursing, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
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Moos TAO, Rydahl-Hansen S. 'Everything is as before, but nothing is as it was'-A phenomenological-hermeneutic study of meaningfulness in adult patients with refractory epilepsy after interdisciplinary epilepsy rehabilitation. Epilepsy Behav 2021; 122:108168. [PMID: 34271324 DOI: 10.1016/j.yebeh.2021.108168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interdisciplinary Rehabilitation aimed at adults with refractory epilepsy (RE) establishes scientific evidence of higher health-related QoL, including improved self-worth and increased self-awareness as outcomes. Yet, there is very little research-based knowledge of how life transforms itself after the rehabilitation program from patients' perspectives. AIM The aim of this study was to identify and describe how - from the patient perspectives - life transforms itself after rehabilitation among adults with RE, focusing on the meaningfulness of interdisciplinary rehabilitation. METHOD Nine patients, who all completed an Interdisciplinary Rehabilitation Program in an Adult Epilepsy Clinic, were interviewed between six months and two years after rehabilitation. Nine interviews were recorded, transcribed verbatim, and analyzed as described by the phenomenological method 'Reflective Lifeworld Research' (RLR). FINDINGS The essence of the phenomenon was revealed as life as a struggle for a dignified existence with RE as a navigating life companion. Through the clusters of meaning, four constituents emerged from the phenomenon: 1) to accept the limitations of body and mind; 2) to be on a journey toward your inner self; 3) to be quietly understood; 4) to fight for renewed hope and recognition during transition. CONCLUSION The patients consider it significant to know their own bodies with the constraints that this involves. This knowledge helps them make decisions that not only have a positive effect on their epilepsy, but also raise their self-esteem and give them renewed hope and courage to face life. However, the struggle for a dignified life is continuously hard, and it comes to a head in patients' transition from 'patient to citizen', where asymmetries arise. These asymmetries leave considerable marks on the patients' worlds and challenge their renewed hope for a dignified existence.
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Affiliation(s)
- Trine Arnam Olsen Moos
- Department of Adult Epileptology and PNES, The Danish National Epilepsy Center, Filadelfia, Kolonivej 2 A, 1. Sal, 4293 Dianalund, Denmark.
| | - Susan Rydahl-Hansen
- Research Unit of Nursing and Healthcare, Institute of Public Health Health, Aarhus University, Department of Public Health - Department of Science in Nursing, Campus Emdrup, Tuborgvej 164, bygning B8, 1. sal, 2400 Copenhagen NV, Denmark.
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Karam M, Macq J, Duchesnes C, Crismer A, Belche JL. Interprofessional collaboration between general practitioners and primary care nurses in Belgium: a participatory action research. J Interprof Care 2021; 36:380-389. [PMID: 34382494 DOI: 10.1080/13561820.2021.1929878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given the sociodemographic challenges facing the Belgian primary care system, it is essential to strengthen interprofessional collaboration (IPC) between healthcare providers. Therefore, our aims for this study were to assess IPC between general practitioners (GPs) and nurses; identify target priorities for improving IPC; and facilitate the planning and implementation of the proposed improvement strategies. Based on diversity criteria, six groups of GPs and nurses were chosen for a participatory action research. Participants performed a SWOT analysis of their IPC to identify strengths and weaknesses of their collaboration practice configurations. Main factors limiting IPC were related to the type of financing system which impeded or facilitated multidisciplinary team meetings, a weak functional integration, and a lack of interprofessional education. Overall, communication and task delegation were co-identified as common priorities. Actions prioritized by each group were related to these two priorities and accounted for local, specific needs. Communication could be supported through improved tools and dedicating time for multidisciplinary team meetings. Task delegation was more challenging and raised questions related to nurses' training, legislation, and payment systems. IPC seems to be easier to achieve when healthcare professionals belong to the same organization and consider themselves a team.
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Affiliation(s)
- Marlène Karam
- Université catholique de Louvain, Faculty of Public Health, Institute of Health and society, Brussels, Belgium
| | - Jean Macq
- Université catholique de Louvain, Faculty of Public Health, Institute of Health and society, Brussels, Belgium
| | | | - André Crismer
- Université de Liège, Department of Family Medicine, Liège, Belgium
| | - Jean-Luc Belche
- Université de Liège, Department of Family Medicine, Liège, Belgium
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Kowalek K, Bochatay N, Ju M, Van Schaik S. The impact of interprofessional perspective-taking on moral distress in the pediatric intensive care unit. J Interprof Care 2021:1-8. [PMID: 34030556 DOI: 10.1080/13561820.2021.1892613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 10/21/2022]
Abstract
Moral distress arises when constraints outside of healthcare professionals' control prohibit them from acting according to the ethically sound course of action. It can be triggered by poor communication and different perspectives between professionals. We examined whether and how taking the perspective of the other profession reduces moral distress among pediatric intensive care nurses and physicians. Using elements of a previously published scale, we created a Vignette-based Moral Distress Rating Scale (V-MDRS). Study participants from three sites included 105 nurses and 34 physicians who read a patient vignette with their own profession's perspective, completed the V-MDRS, then received the other profession's perspective and completed the V-MDRS again. We conducted semi-structured interviews with nine nurses and nine physicians who completed the V-MDRS to explore how interprofessional perspective-taking impacts moral distress. Nurses experienced higher baseline moral distress than physicians (mean ± standard deviation 31.1 ± 6.9 vs 26.4 ± 5, P < .001), and at two study sites nurses' moral distress declined after reading the physician's perspective. Findings from interviews suggest that physicians were already sensitized to nurses' perspective and that perspective-taking may be particularly beneficial to cohesive teams with strong relationships. Thus, encouraging interprofessional perspective-taking may mitigate moral distress in healthcare professionals.
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Affiliation(s)
- Katie Kowalek
- Department of Pediatrics, University of Arizona, Tucson, USA
| | - Naike Bochatay
- Department of Pediatrics, University of California, San Francisco, USA
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Mindy Ju
- Department of Pediatrics, University of California, San Francisco, USA
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Tong R, Brewer M, Flavell H, Roberts LD. Facilitating interprofessional identity development in healthcare students through dedicated interprofessional placements. J Interprof Care 2021:1-9. [PMID: 33784926 DOI: 10.1080/13561820.2021.1883564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 10/21/2022]
Abstract
There is a growing body of research evidencing the benefits of dedicated interprofessional placements in preparing healthcare students for interprofessional practice. However, little is known about if and how students develop their interprofessional identity during interprofessional placements. This study addresses this knowledge gap by exploring final-year students' interprofessional identity development during dedicated interprofessional placement(s). Thirty-eight students from five health professions were interviewed and data analyzed inductively to identify themes. Participants also drew images representing their perceptions of interprofessional identity and its relationship to professional identity as part of the data collection. The themes showed participants progressed from conceptualizing interprofessional identity as a requirement of the placement at the start of the placement, toward internalizing an interprofessional identity by the end of their placement. Context influences interprofessional identity salience. A commitment from healthcare professionals to model interprofessional practice, combined with explicitly facilitating interprofessional identity development, is recommended to facilitate continued interprofessional identity development in different contexts post placement.
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Affiliation(s)
- Ruyi Tong
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Margo Brewer
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Helen Flavell
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lynne D Roberts
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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15
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Posenau A, Handgraaf M. Framework for interprofessional case conferences - empirically sound and competence-oriented communication concept for interprofessional teaching. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc65. [PMID: 33824901 PMCID: PMC7994863 DOI: 10.3205/zma001461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/24/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
Aims/objectives: Interprofessional case conferences support future team-based approaches to healthcare, and inevitably require targeted communication between the various participants. However, the success of communication during a case conference must be learnt explicitly. The subject of conversation is often the only outcome of the case conference that is discussed in plenary or small groups. Communication processes are hardly taken into account. However, integrating process orientation and making communication relevant to goal achievement is mandatory in order to teach in a competence-oriented fashion in this area. The aim of this article is to present an empirically sound framework for teaching case conferences, with the help of which conversation processes can be practiced, evaluated and analysed in interprofessional case conferences. Methodology: With the aid of literature analysis, insights from empirical conversation research and the International Classification of Functioning and Health (ICF), we have developed an empirically and theoretically sound framework for interprofessional case conferences. This is intended to support the training of communication skills and to serve as a basis for assessing them. Results: In practice, it has been shown that embedding case conferences in higher education curricula is feasible and effective for a group size of 200 students. The framework has proven itself in verbal training while aligning itself with concepts of sharing for the negotiation of leadership, goals and decisions. In addition, it could also be used as a theoretical construct for the "interprofessional objective structured clinical examination" (iOSCE) at graduation from the module "Interprofessional Case Conference" at the Hochschule für Gesundheit. Conclusion: The topics of interprofessional practice (IPP) and communication are now the subject of curricula in the health professions, both nationally and internationally. In addition, various competence settings are available that can support didactic orientation. However, the authors believe that there are no concrete imperatives for competence-oriented implementation in teaching and examination. In the area of communication teaching, one can integrate empirically sound concepts instead of induction into degree course for the health professions, in order to provide a basis for the further development of communicative competence in this field.
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Affiliation(s)
- André Posenau
- Hsg Bochum – Hochschule für Gesundheit, Bochum, Germany
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16
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Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature. J Interprof Care 2020; 34:509-519. [PMID: 31928245 DOI: 10.1080/13561820.2019.1702515] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
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Affiliation(s)
- Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
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17
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Sequential Two-Stage Network and Thematic Analysis for Exploring an Interdisciplinary Care Approach in Nursing Homes. Comput Inform Nurs 2019; 37:473-481. [PMID: 31518340 DOI: 10.1097/cin.0000000000000530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since various groups of older adults with different conditions and levels of function coexist in nursing homes, it is necessary to develop integrated care strategies through collaboration among experts across related fields. The purposes of this study are to identify the regularity of information sharing in managing daily function for older adults, with a special focus on interdisciplinary cooperation, and to explore a practical care strategy for nursing home residents. The collaborative methods of network and thematic analysis were done by conducting in-depth interviews with 33 interdisciplinary experts working at seven nursing homes. This study proposed three relationships and three themes as interrelated key factors for providing interdisciplinary care to the elderly at various levels of function based on the experiences accumulated by the practitioners. First, independent sharing is required to make professional judgments about how daily function in older adults changes from reported baselines. Second, practitioners accurately judge clinical situations and supplement experts' judgments through partial sharing. Finally, all interdisciplinary consensus through complete sharing achieves the ultimate goal of maintaining remaining function in older adults. These findings can be the first step in developing practical care guidelines for interdisciplinary use, and the results can be used to develop integrated assessment and intervention strategies.
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Hacking teamwork in health care: Addressing adverse effects of ad hoc team composition in critical care medicine. Health Care Manage Rev 2019; 46:341-348. [PMID: 31804232 DOI: 10.1097/hmr.0000000000000265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The continued need for improved teamwork in all areas of health care is widely recognized. The present article reports on the application of a hackathon to the teamwork problems specifically associated with ad hoc team formation in rapid response teams. PURPOSES Hackathons-problem-solving events pioneered in computer science-are on the rise in health care management. The focus of these events tends to be on medical technologies, however, with calls for improvements in management practices as general recommendations. The hackathon reported here contributes to health care management practice by addressing improvements in teamwork as the focal problem. METHODOLOGY The hackathon event took place over 2.5 days in conjunction with an academic conference focused on group research. Three teams comprised of practicing healthcare professionals, academic researchers and students developed solutions to problems of ad hoc team formation in rapid response teams. FINDINGS The event fulfilled several goals. The teams produced three distinct, yet complementary solutions that were backed by both field-based experience and solid research evidence. The event provided the opportunity for two-way translation of research and practice through direct collaboration among key stakeholders. The hackathon produced long term effects through establishing or strengthening collaborations, dissemination of the ideas through presentations, workshops, and publications, and changes in participantsâ work practices. PRACTICE IMPLICATION The event demonstrated that hackathons, classically focused on technology, can also offer a spur to innovation around organizational processes. The article provides advice for organizing other hackathons focused on similar topics. The solutions offered by the participants in the event yields the clear insight that multipronged solutions for emergency-oriented teamwork are needed. The hackathon highlighted the scaled of collaboration and effort needed to tackle the many complexities in health care that impact outcomes for providers, patients, and health organizations.
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Sena B, Liani S. The role of relational routines in hindering transdisciplinary collaboration: the case of the setting up of a team in an Italian Breast Unit. J Interprof Care 2019; 34:251-258. [PMID: 31526194 DOI: 10.1080/13561820.2019.1649643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interprofessional teamwork is one of the main characteristics of centers specialized in the treatment of breast cancer, known as Breast Units, which since 2016 European legislation has made mandatory for Member States. However, interprofessional collaborative practice (ICP) has often been applied in traditional healthcare contexts on the basis of mono-disciplinary approaches. This paper reports the results of a case study of an Italian Breast Unit carried out through a qualitative research strategy. To understand the case being studied in its complexity the data were drawn from multiple sources of evidence: documents, in-depth interviews with Breast Unit members and field notes from the participant observation of team meetings. The case study shows that, despite the healthcare organization promoting interprofessional collaboration through the creation of protocols, organizational environments and structures aimed at encouraging communication and collaboration between the professionals of the team, a series of older routine relational practices remain. These are based on traditional communication models, cultural and professional barriers between members of the team, which hinder the development of innovative ICPs, thus preventing professionals from seeing the need for change in their relational practices towards a trans-disciplinary approach.
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Affiliation(s)
- Barbara Sena
- Department of Law and Economics, Unitelma Sapienza University, Rome, Italy
| | - Serena Liani
- Italian National Institute of Statistics (ISTAT), Rome, Italy
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Flood B, Hocking C, Smythe L, Jones M. Working in a spirit of interprofessional practice: a hermeneutic phenomenological study. J Interprof Care 2019; 33:744-752. [DOI: 10.1080/13561820.2019.1577810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Brenda Flood
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Clare Hocking
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Liz Smythe
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Marion Jones
- Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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21
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Casu G, Gremigni P, Sommaruga M. The Patient-Professional Interaction Questionnaire (PPIQ) to assess patient centered care from the patient's perspective. PATIENT EDUCATION AND COUNSELING 2019; 102:126-133. [PMID: 30098906 DOI: 10.1016/j.pec.2018.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate how patients evaluate the provision of patient-centered care (PCC) by healthcare professionals and psychometrically test a questionnaire to assess it. A tool previously developed for self-assessment of professionals' provision of PCC was adapted into a patient-rated form, named Patient-Professional Interaction Questionnaire (PPIQ). METHODS A sample of 1139 patients from six hospitals completed the 16-item PPIQ and the questionnaire structure, reliability, susceptibility to social desirability, and associations with other variables were tested. RESULTS The PPIQ confirmed the original four-factor structure (effective communication, interest in the patient's agenda, empathy, and patient involvement in care) and showed acceptable reliability and measurement invariance across both in-/out-patients and first/non-first encounter with the evaluated professional. Associations with patients' social desirability were negligible and effective communication was rated the highest among the PPIQ dimensions. PPIQ scores varied according to patients' educational level and type of professional evaluated, while associations between first/non-first encounter and PPIQ scores varied according to in-/out-patient. CONCLUSION The PPIQ is a psychometrically sound patient-rated measure of the provision of PCC by healthcare professionals. PRACTICE IMPLICATIONS The PPIQ has potential value in promoting quality patient-professional interactions in the hospital setting, as patients' reported experience is an important dimension of the clinician's performance.
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Affiliation(s)
- Giulia Casu
- Department of Psychology, University of Bologna, Italy.
| | | | - Marinella Sommaruga
- Clinical Psychology and Social Support Unit, Istituti Clinici Scientifici Maugeri - IRCCS, Milan, Italy.
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Overbeck G, Brostrøm Kousgaard M, Davidsen AS. Enactments and experiences of 'enhanced interprofessional communication' in collaborative care - a qualitative study. J Interprof Care 2018; 33:519-527. [PMID: 30358462 DOI: 10.1080/13561820.2018.1538109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
One of the key components in collaborative care (CC) for anxiety and depression between general practitioners (GPs) and psychiatry is 'enhanced interprofessional communication'. However, the literature contains few detailed descriptions of the interprofessional roles and specific collaborative behaviours that are required to enhance communication. Using semi-structured interviews and observations, this study explores how interprofessional communication was enacted in a CC intervention in Denmark. Analysis was by Interpretative Phenomenological Analysis and interaction analysis. In the intervention the components of the enhanced communication were a) weekly meetings between care managers (CMs) and GPs and b) group supervision of GPs by a psychiatrist. This study showed that the meetings between CMs and GPs were enacted very differently across clinics, with communication ranging from monological 'giving report'-style to more dialogical 'peer-discussion'-style with development of new shared knowledge. The type of communication depended on the GP's professional style. The supervision element was not perceived as being meaningful and GPs reacted by non-attendance and non-response. Engagement of the GPs in a shared process requires a more dialogical model. However, the choice depends on whether a referral or a collaborative model is aimed at. A dialogical model would demand the teaching and guidance of the professionals.
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Affiliation(s)
- Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen , Denmark
| | - Marius Brostrøm Kousgaard
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen , Denmark
| | - Annette Sofie Davidsen
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen , Denmark
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23
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Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D, Pronovost PJ, Weaver SJ. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. AMERICAN PSYCHOLOGIST 2018; 73:433-450. [PMID: 29792459 PMCID: PMC6361117 DOI: 10.1037/amp0000298] [Citation(s) in RCA: 459] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Few industries match the scale of health care. In the United States alone, an estimated 85% of the population has at least 1 health care encounter annually and at least one quarter of these people experience 4 to 9 encounters annually. A single visit requires collaboration among a multidisciplinary group of clinicians, administrative staff, patients, and their loved ones. Multiple visits often occur across different clinicians working in different organizations. Ineffective care coordination and the underlying suboptimal teamwork processes are a public health issue. Health care delivery systems exemplify complex organizations operating under high stakes in dynamic policy and regulatory environments. The coordination and delivery of safe, high-quality care demands reliable teamwork and collaboration within, as well as across, organizational, disciplinary, technical, and cultural boundaries. In this review, we synthesize the evidence examining teams and teamwork in health care delivery settings in order to characterize the current state of the science and to highlight gaps in which studies can further illuminate our evidence-based understanding of teamwork and collaboration. Specifically, we highlight evidence concerning (a) the relationship between teamwork and multilevel outcomes, (b) effective teamwork behaviors, (c) competencies (i.e., knowledge, skills, and attitudes) underlying effective teamwork in the health professions, (d) teamwork interventions, (e) team performance measurement strategies, and (f) the critical role context plays in shaping teamwork and collaboration in practice. We also distill potential avenues for future research and highlight opportunities to understand the translation, dissemination, and implementation of evidence-based teamwork principles into practice. (PsycINFO Database Record
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Affiliation(s)
- Michael A Rosen
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine
| | - Deborah DiazGranados
- Office of Assessment and Evaluation Studies, Virginia Commonwealth University School of Medicine
| | - Aaron S Dietz
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine
| | - Lauren E Benishek
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine
| | - David Thompson
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine
| | - Peter J Pronovost
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine
| | - Sallie J Weaver
- Health Systems and Interventions Research Branch of the Healthcare Delivery Research Program, National Cancer Institute
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