Interprofessional bedside rounds: Nurse-physician collaboration and perceived barriers in an Asian hospital

The association between proactive personality and interprofessional learning readiness in nursing students: The chain medication effects of perceived social support and professional identity

BACKGROUND

Interprofessional education (IPE) has been advocated for all healthcare students, and readiness for interprofessional learning significantly influences its effectiveness. It is essential to explore the antecedent factors of readiness for interprofessional learning among nursing students to promote IPE. While a proactive personality might impact readiness for interprofessional learning, its specific role has remained unspecified.

OBJECTIVE

To examine the mediation effects of perceived social support and professional identity on the association between proactive personality and readiness for interprofessional learning among nursing students.

DESIGN

The study utilised a cross-sectional design.

SETTINGS

Research was conducted at two universities and two vocational schools in Hainan Province, China.

PARTICIPANTS

On-campus nursing students were invited to participate between March and May 2023.

METHODS

A flyer was distributed to the participants with a QR code to scan to voluntarily complete the online survey, including the Readiness for Interprofessional Learning Scale (RIPLS), Proactive Personality Scale, Perceived Social Support Scale and Professional Identity Status Questionnaire Scale 5d. Descriptive analysis, Pearson associations and mediation analysis were conducted using SPSS software version 26.0 and PROCESS version 4.2 for SPSS.

RESULTS

The participants' average RIPLS score was 66.93 ± 9.28. Proactive personality (r = 0.633, p < 0.01), perceived social support (r = 0.605, p < 0.01) and professional identity (r = 0.549, p < 0.01) were all positively related to readiness for interprofessional learning. Meanwhile, the relationship between proactive personality and readiness for interprofessional learning was partly mediated by perceived social support (25.15 %), professional identity (13.35 %) and the chain effects (9.48 %) of perceived social support and professional identity.

CONCLUSIONS

The nursing students in Hainan, China demonstrated a medium level of readiness for interprofessional learning. Compound strategies that foster proactive personality, provide social support and boost positive professional identity are warranted to improve nursing students' readiness for interprofessional learning.

Collaborative practice in type 2 diabetes management in a developing country: A qualitative study of perceptions and attitudes of key stakeholders

AIMS AND OBJECTIVES

To explore collaborative practice and perceptions and attitudes of key stakeholders on collaboration in type 2 diabetes management in a tertiary care setting.

BACKGROUND

Understanding collaborative practice in diabetes care in developing countries helps to design and provide patient-centred and cost-effective care.

DESIGN

An exploratory qualitative study.

METHODS

Interviews were undertaken with 30 patients and 18 health professionals and policymakers. Thematic data analysis was undertaken to explore collaborative practice and examine participant perspectives on collaboration in diabetes management. We compared the findings with D'Amour's Collaboration Framework to determine the level of collaboration.

RESULTS

Most participants reported a lack of collaborative practice in diabetes management, while they appreciated its importance in improving care. Perceptions varied with respect to what constituted collaborative practice. Three themes were identified: (1) perspectives of key stakeholders on current practice of collaboration; (2) impediments to collaborative practice; (3) strategies to improve collaborative practice. Analyses of the themes using D'Amour's Collaboration Framework indicated a low level of collaboration among physicians, nurses, pharmacists and policymakers, which was attributed to workload and time pressures on health professionals, power dynamics and lack of role clarity of all actors in collaborative action. Participants commented on the need to improve collaboration by establishing strong leadership and governance at different healthcare structure levels, which is committed to coordinating collaboration and developing collaborative frameworks and policies that guide collaborative undertaking.

CONCLUSIONS

Perceived shortcomings of collaboration were attributed to inadequate resources, power dynamics, a lack of strong team functioning and policies. Participants' positive perceptions provide an opportunity to improve collaborative practice through incorporation of collaborative frameworks and policies.

RELEVANCE TO CLINICAL PRACTICE

The findings in this study inform development of tailored and patient-centred diabetes care in tertiary care settings in sub-Saharan Africa.

REPORTING METHOD

The study was reported in accordance with the COREQ checklist.

PATIENT OR PUBLIC CONTRIBUTION

Patients or the public were not involved in the design, analysis or interpretation of the data in this study. However, patients and healthcare providers participated in pilot interviews, which helped refine the interview guides. The summary of the findings of the study was also discussed with patients and healthcare providers, where they provided feedback.

Nurse-Led Rounds in the Pediatric Intensive Care Unit

Pediatric intensive care units (PICUs) rely on interprofessional communication and collaboration to mitigate the risk for medical error. To operationalize these tenets, many PICUs use multidisciplinary bedside rounds as the foundation of their workflow. Bedside nurse participation in rounds is inconsistent, diminishing the return on team investment in patient safety. Given this dilemma, some institutions have shifted from provider-led to nurse-led rounds. Here, the authors explore the rationale, experiences, and outcomes of implementation of nurse-led rounds within 4 PICU service lines.

The outcomes of interprofessional education in prelicensure nursing education: An integrative review

OBJECTIVES

Nurses are at the center of patient care, serving as the link between patients and their various healthcare providers. As healthcare complexity grows it is increasingly important for research focused on nursing education. This review synthesizes research on the impact of interprofessional education for prelicensure nursing students with the intent to guide curriculum development.

METHODS

The databases Medline (PubMed), Cochrane Library, CINAHL and EBSCO Qualitative were searched for full text articles in the English language published between January 2016 and July 2021 using MeSH terms "interprofessional education" and "healthcare students" and "multiprofessional" and "impact" and "effectiveness" or "collaborative nursing practice" or "nursing students" or "interprofessional curriculum" or "interdisciplinary education" or "collaboration." A systematic review resulted in 11 selected studies for detailed evaluation.

RESULTS

After evaluation, the following three themes were identified: 1) IPE impact should not only be measured through learners' perceptions; 2) Modifiable and nonmodifiable factors are associated with IPE effectiveness; and 3) Various instruments and methods can be used for measuring outcomes.

CONCLUSION

This review contributes to future development of IPE in prelicensure registered nursing curricula. Educators should incorporate performance changes into evaluation, be aware of both modifiable and non-modifiable factors to increase effectiveness and use appropriate validated instruments to measure desired outcomes. Although literature results regarding IPE are encouraging, more research is needed to identify evidence-based approaches with best practice methods for instruction, content delivery, evaluation, and competency assessment.

Physician-Nurse and Nurse-Nurse Collaboration From the Perspective of Nurses: A Cross-Sectional Study

The study aims to determine the physician-nurse and nurse-nurse collaboration levels of nurses and effective factors. A cross-sectional study was conducted with a sample of 477 nurses from five hospitals using a questionnaire. It was determined that the characteristics of working life explained 10% of the Nurse-Nurse Collaboration Scale and the regression model between variables and the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was not statistically significant. Physician-nurse and nurse-nurse collaboration are affected by a variety of factors.

Viewing interprofessional collaboration through the lens of networked ecological systems theory

Interprofessional collaboration (IPC) is key to ensuring safe quality care for patients. However, IPC intervention outcomes are variable, leading to calls for systems theories to understand complex interactions in healthcare. Using networked ecological systems theory (NEST), we aimed to uncover facilitators and barriers impacting the interactions between nurses and physicians in a specialty healthcare center. A qualitative study involving 55 non-participant observations and 17 individual semi-structured interviews was conducted at the National Neuroscience Institute of Singapore from April 2019 to March 2021. Template analysis was used to analyze the data. The most important IPC facilitators were exosystemic institutional support and physicians' willingness to engage in IPC in the microsystems that together enabled the establishment of disease-based outpatient programs fostering patient-centered interactions among different healthcare professionals (HCP). We also found that patient-, disease-, and systems-related knowledge played an important role in facilitating IPC. Macrosystemic entrenchments such as intraprofessional composition of ward rounds emerged as a significant barrier. However, microsystemic efforts such as chat groups connecting all HCP involved in the care of the patients in the wards have fostered IPC. Although still preliminary, these findings suggest NEST can be useful to inform systematic interventions to improve IPC.

Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study

BACKGROUND

There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice.

METHODS

A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes.

RESULTS

Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions.

CONCLUSION

Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.

Understanding decision-making in interprofessional team meetings through interpretative repertoires and discursive devices

Health practitioners of the geriatrics ward in a teaching hospital participate in interprofessional team meetings to agree on treatment and discharge care plans for their patients suffering from chronic illnesses and co-morbidities and in need of coordinated assessments and care. We turn to the ideas in critical discursive psychology to grow a much-needed research area of examining the language-in-use and its effects in team decision-making. Specifically we explore how healthcare team members use language to perform collaboration or disengagement, creating different subject positionings for themselves and others out of a backcloth of discursive resources and practices. We observed and transcribed 108 case discussions and analyzed them for interpretative repertoires and discursive devices. During the first half of the team discussions, the members of various health professions employed the empiricist and lifeworld interpretative repertoires and the discursive strategy of perspective-taking, articulating these through formulations and questions. We use the notion of argumentative texture to better understand why an administrative structural support like protected turn-taking in team meetings is not enough to promote interprofessional collaboration. We conclude that health practitioners can improve their contributions and subject positionings at team meetings and consequently patient-care, by identifying habitually deployed linguistic resources depicting professional knowledge, and augmenting these with Other-oriented perspectives in their repertoires. By expanding their range of discursive repertoires and recognizing that discursive practices are embedded in the bigger context or argumentative texture of institutional and societal discourses, norms, values, beliefs and practices, interprofessional teams can work to improve communication and knowledge-sharing.

Inter-professional physician-nurse collaboration in Lebanon

Purpose

A physician–nurse relationship is a complex, professional and shared-decision-making process, which is an important predictor of high-quality patient care. The purpose of this paper is to explore the attitude of the physician–nurse relationship in Southern Lebanon hospitals.

Design/methodology/approach

A descriptive institutional cross-sectional study was conducted among different departments of three hospitals in Southern Lebanon using a validated Jefferson Scale of Attitude.

Findings

In sum, 89 physicians and 245 nurses accepted to participate. The nurses’ mean age was 32 and the physicians’ was 44. The mean score was found to be 46 for all participants, with significantly higher scores noted among nurses compared to physicians (48 vs 43, respectively) and higher scores among females compared to males (48 vs 46, respectively). However, the study scored no significant difference in relation to the degrees attained by nurses and the participants’ years of experience. The majority had agreed that the shortage in the nurses’ staff affects proper patient care delivery. One fourth of the physicians disagreed that nurses should be considered as a collaborator and colleague. Therefore, more work is required to improve this collaboration.

Research limitations/implications

There is a complex relationship normally displayed by physicians and nurses, which cannot be easily interpreted and analyzed. Physicians and nurses may have given socially desirable responses while filling the questionnaire. Even more, this study was conducted in Hospitals in Southern Lebanon, and it would be nice to extend this study to include further hospitals in other regions in Lebanon as well.

Practical implications

Nurses had higher scores toward collaboration, with females scoring higher than males. However, overall scores are considered to be lower compared to other countries. Thus, more efforts should be done on improving this communication among nurses and physicians, through promoting inter-professional undergraduate and postgraduate education training toward more effective communication.

Social implications

Quality of patient care would be improved if more work is done on improving the collaboration between physicians and nurses, and this was shown to be required as per study results.

Originality/value

There is a gap in literature assessing this important topic which is the collaboration and attitude of nurses and physicians toward their relationship in Lebanon. It is extremely important that efforts should be taken in order to determine the type of nurse–physician relationship in every local context as this relationship affects quality of patients’ care.