Influence of interactional structure on patient’s participation during interprofessional discharge planning meetings in rehabilitation centers

Interprofessional meetings, organization, and interactive practices: the reflexive achievement of patient-centeredness

Interprofessional meetings are crucial for achieving patient-centeredness in healthcare. Exactly how patient-centeredness is reached during these meetings remains underexamined. Adopting an Ethnomethodology and Conversation Analysis (hereafter EMCA) perspective, this contribution looks at video-recordings of interprofessional meetings in two distinct healthcare settings: rehabilitation and internal medicine. It aims to provide new insight into how investigations of patient-centeredness as a reflexive achievement allow us to better understand the organizational and relational efforts required to achieve it in practice. This contribution outlines how different healthcare contexts result in variety in the meeting frequency, duration, aims, participants, and agendas, which in turn means that the opportunities for patient-centeredness are not the same. But it also illustrates how patient-centeredness depends on the ways the various opportunities are seized and play out in the interprofessional interactions. It is therefore argued here that research on how patient-centeredness is reached in interprofessional meetings and the development of recommendations for enhancing it both require consideration of context-specific conditions and how participants adapt to and simultaneously modify them to achieve patient-centeredness in practice.

A Rapid Review of the Factors That Influence Service User Involvement in Interprofessional Education, Practice, and Research

Service user involvement in interprofessional education and collaborative practice remains limited despite the increasing push for this by governments and grant funding bodies. This rapid review investigated service user involvement in interprofessional education, practice, and research to determine factors that enable or hinder such involvement. Following the Cochrane and the World Health Organization's rapid review guidelines, a targeted search was undertaken in four databases. Subsequent to the screening processes, included papers were critically appraised, and extracted data were synthesized narratively. Sixteen studies met inclusion criteria. Most studies were related to interprofessional collaborative practice, as opposed to education and research. Service user involvement was more in the form of consultation and collaboration, as opposed to consumer-led partnerships. Enablers and barriers to service user involvement in IPECP were identified. Enablers included structure, the valuing of different perspectives, and relationships. Barriers included time and resources, undesirable characteristics, and relationships. This rapid review has added evidence to a swiftly expanding field, providing timely guidance. Healthcare workers can benefit from targeted training. Policy makers, healthcare organizations, and governments can investigate strategies to mitigate the time and resource challenges that impede service user involvement in IPECP.

Socio-environmental predictive factors for discharge destination after inpatient rehabilitation in patients with stroke: a systematic review and meta-analysis

PURPOSE

To identify which of the socio-environmental factors of patients with stroke are predictive for discharge to their home after inpatient rehabilitation. Because discharge planning is a key component of rehabilitation, it is important to recognize the predictive factors for a discharge home. Other systematic reviews demonstrated the value of functional outcome measures. This review adds to the current literature by assessing the predictive value of socio-environmental factors, which shape the context in which a person lives.

METHODS

We performed a systematic search in seven databases. Two independent reviewers selected studies and assessed them for methodological quality. We extracted data to estimate pooled odds ratio for household situation, social support, ethnicity and socioeconomic status.

RESULTS

Forty studies were included. Significant estimates were found for living with others (OR 2.60; 95%CI 1.84-3.68), having support at home (OR 11.48; 95%CI 6.52-20.21), being married (OR 2.05; 95%CI 1.80-2.33) and living at home before stroke (OR 31.01; 95%CI 7.38-130.18).

CONCLUSION

Living at home and benefiting from social support, including living with others, are important factors to consider during discharge planning after stroke. Further research should consider the impact of socioeconomic status.IMPLICATIONS FOR REHABILITATIONEvaluating the social and environmental factors of patients with stroke plays an important role in discharge planning.Next to functional status, caregiver availability (support at home) is among the strongest predictive factors for discharge home.To assess caregiver availability, the presence of a willing and able caregiver should be surveyed at admission.Further predictive factors for discharge home are cohabitation and marital status.

Correcting medical decisions: a study in nurses' patient advocacy in (Finnish) hospital ward rounds

During daily hospital ward rounds, medical teams, led by doctors, assess the progress of an individual patient's health. It is widely reported in the research literature that nurses play a relatively passive role during these rounds, because although they may have valuable information about the patient's condition and progress, and indeed their role includes advocacy on behalf of their patients, nurses nevertheless can experience difficulties in participating during case constructions. Here we report an instance from a (gastro-surgical) ward round in a Finnish hospital, in which nurses played a key role in reversing a consultant's initial decision to discharge a patient. They did so not by directly challenging the consultant's opinion, but by employing indirect means to introduce their discrepant perspective: they provide descriptions and ask questions that draw attention to information that results in the doctor coming to a different assessment than theirs of the patient's condition, and a different decision about what should be done (the patient was not discharged from hospital). The encounter reported here is taken from a corpus of ward round discussions in a Finnish hospital. The method of our study is Conversation Analysis.