1
|
Butler JI, Fox MT. 'Our Voices Aren't Being Heard': A qualitative descriptive study of nurses' perceptions of interprofessional collaboration in care supporting older people's functioning during a hospital stay. Scand J Caring Sci 2024; 38:398-408. [PMID: 38323707 DOI: 10.1111/scs.13243] [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: 11/24/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Older people admitted to hospital are highly susceptible to functional decline and related complications. Care supporting their functioning is complex and requires healthcare professionals working in concert, with nurses playing a central role. Yet, little is known about nurses' perceptions of interprofessional collaboration (IPC) in care supporting functioning in acutely admitted older people. To fill this knowledge gap, we elucidate the perspectives of nurses in Ontario, Canada, on IPC in care supporting older people's functioning during a hospital stay. METHODS We employed a qualitative methodology in conjunction with a qualitative descriptive design. Thirteen focus groups were held with a purposeful, criterion-based sample of 57 acute care nurses practising in a range of acute care settings (e.g. Emergency, General Medicine, General Surgery, Intensive Care, Coronary Care). Data were thematically analysed. RESULTS We identified two overarching themes: (1) IPC is improving, but nurses are excluded from decision-making and (2) nurse advocacy causes friction with other professionals. The first theme captures nurses' perception that IPC in older people's care is improving, but nurses are marginalised in interprofessional decision-making. As a result, nurses perceive that their knowledge is devalued, and their contributions to care supporting older people's functioning are undermined. The second theme underlines a tension between interprofessional team practices and patient- and family-centred care, while also demonstrating nurses' increasing willingness to act as patient and family advocates. CONCLUSIONS Findings can be used to enhance IPC in care supporting the functioning of acutely hospitalised older people. To improve IPC, clinical and administrative leaders should cultivate more egalitarian team relationships that encourage nurses to contribute to decision-making and advocate on behalf of older patients and their families.
Collapse
Affiliation(s)
- Jeffrey I Butler
- Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Mary T Fox
- Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Cucolo DF, de Campos Oliveira JL, Rossit RAS, Mininel VA, Perroca MG, Silva JAMD. Effects of interprofessional practice on nursing workload in hospitals: A systematic review. Int J Health Plann Manage 2024; 39:824-843. [PMID: 38353613 DOI: 10.1002/hpm.3779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE To synthesise scientific evidence on interprofessional practice in hospital care and the effects on nursing workload. METHODS Systematic mixed method review, registered in PROSPERO (CRD42021225627) and conducted in the following databases: CINAHL, Medline, Web of Science and Scopus, with no restrictions on the publication period of the studies. Primary studies were recruited on nurses' interprofessional practice (actions and interactions with other professional categories) in hospitals and the effects on one or more dimensions of nursing workload (quantitative, qualitative, physical, cognitive, emotional, time and variation). Scientific articles available in open access, in English, Spanish or Portuguese, were included. The searches were carried out in January 2021. The studies were evaluated by pairs of independent researchers to verify methodological quality, through the Mixed Method Appraisal Tool, and data extraction. To summarise the studies, thematic analysis was adopted. RESULTS A total of 1774 publications were assessed for eligibility and 17 studies were included. Of these, two were mixed methods, four were qualitative, and 11 were quantitative, published between 2011 and 2020. The main scenarios investigated were Intensive Care Units and/or Inpatient Units. During data analysis, three thematic categories emerged: Interprofessional practice in coping with emotional overload; Time dedicated by nurses to professional communication; and Working conditions and patient care. The third category consisted of three subthemes: Conflict and flexibility in the context of practice; Working conditions and interprofessional practice; and Effects on patient care. CONCLUSIONS The evidence points to the emotional overload of nurses in the face of uncooperative practices. Interprofessional actions, especially communicative ones, demand nurses' time and impact the care provided. The results contribute to political decisions and health work management.
Collapse
Affiliation(s)
- Danielle Fabiana Cucolo
- Postgraduate Program, Multiprofessional Residency in Health at the Pontifícia Universidade Católica de Campinas, Campinas, Brazil
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
| | - João Lucas de Campos Oliveira
- Nursing School of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Postgraduate Program in Nursing at the UFRGS and Clinical Nursing Service at Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Vivian Aline Mininel
- Postgraduate Nursing Program at the Federal University of São Carlos (UFSCar), Sao Carlos, Brazil
- Nursing Department at the UFSCar, Sao Carlos, Brazil
- Center de Recherche sur le Travail et le Développement, Conservatoire National des Arts et Métiers (CRDT-Cnam), Paris, France
| | - Marcia Galan Perroca
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
| | | |
Collapse
|
3
|
Rudberg I, Olsson A, Thunborg C, Salzmann-Erikson M. Adjustments in Interprofessional Communication: A Focus Group Study in Psychiatric Outpatient Units. Issues Ment Health Nurs 2024; 45:417-428. [PMID: 38564368 DOI: 10.1080/01612840.2024.2308556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Communication in healthcare extends beyond patient care, impacting the work environment and job satisfaction. Interprofessional communication is essential for fostering collaboration, but challenges arise from differences in training, roles, and hierarchies. The study aimed to explore psychiatric outpatient clinicians' experiences of interprofessional communication and their perceptions of how the communication intersects the organizational and social work environment of healthcare. Qualitative research involved focus group interviews with clinicians from five psychiatric outpatient units in Central Sweden, representing diverse professions. The authors analyzed semi-structured interview data thematically to uncover clinicians' perspectives on interprofessional communication. An overarching theme, "Adjustment of communication," with subthemes "Synchronized communication" and "Dislocated communication," emerged. Clinicians adapted communication strategies based on situations and needs, with synchronized communication promoting collaboration and dislocated communication hindering it. Communicating with each other was highly valued, as it contributed to a positive work environment. The study underscores the importance of an open, supportive environment that fosters trust, and respect among healthcare clinicians. Consistent with prior research, collaboration gaps underscore the urgent need to improve interprofessional communication.
Collapse
Affiliation(s)
- Ingela Rudberg
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Annakarin Olsson
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Charlotta Thunborg
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Mälardalen University Department of Health and Welfare, Västerås, Sweden
| | - Martin Salzmann-Erikson
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| |
Collapse
|
4
|
Algunmeeyn A, Mrayyan MT, Suliman WA, Abunab HY, Al-Rjoub S. Effective clinical nursing leadership in hospitals: barriers from the perspectives of nurse managers. BMJ LEADER 2024; 8:20-24. [PMID: 37248037 DOI: 10.1136/leader-2022-000681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023]
Abstract
AIM The purpose of this study was to identify barriers to effective clinical nursing leadership in Jordanian hospitals from the perspectives of nurse managers (NMs). BACKGROUND Clinical leadership is about expertise in specialised fields and involving professionals in clinical care. Even though leadership terminology has been used in nursing and healthcare business literature, clinical leadership is still misunderstood, including its barriers. METHOD This study adopted a qualitative narrative approach and recruited a purposive sample of 19 NMs and two associate executive directors of nursing from two hospitals. Data were collected through two focus group discussions and in-depth interviews and were analysed using content analysis. The study was guided by the 'Consolidated Criteria for Reporting Qualitative Research'. RESULT Four themes emerged regarding barriers to effective clinical nursing leadership: (1) power differential, (2) inconsistent connectedness with physicians, (3) lack of early socialisation experiences and (4) clinical practice reform is a mutual responsibility. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Barriers are detrimental to effective clinical leadership; they are associated with interdisciplinary and professional socialisation factors. Managers and academicians at all levels should immediately consider these barriers as a priority. Innovative clinical leaders should identify barriers to effective clinical leadership at the early stages. Thus, innovative clinical leadership programmes are warranted.
Collapse
Affiliation(s)
- Abdullah Algunmeeyn
- Faculty of Nursing, Advanced Nursing Department, Isra University, Amman, Jordan
| | - Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Wafika A Suliman
- Faculty of Nursing, Advanced Nursing Department, Isra University, Amman, Jordan
| | - Hamzeh Y Abunab
- Faculty of Nursing, Basic Nursing Department, Isra University, Amman, Jordan
| | - Saleem Al-Rjoub
- Faculty of Nursing, Department of Community and Mental Health Nursing, Hashemite University, Amman, Jordan
| |
Collapse
|
5
|
Shams-Vahdati N, Shams Vahdati S, Samad-Soltani T. Design and evaluation of collaborative decision-making application for patient care in the emergency department. Health Sci Rep 2024; 7:e1931. [PMID: 38410500 PMCID: PMC10895157 DOI: 10.1002/hsr2.1931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/05/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
Background and Aims Collaboration has become a crucial element of effective healthcare delivery in the emergency department (ED). In high-pressure environments, healthcare providers can prioritize patients by consulting with other specialists to gain diverse perspectives and arrive at a shared understanding of the best course of action. It was conducted for the purpose of designing and evaluating the collaborative decision-making application for patient care in the ED. Methods The present applied research study was conducted between April 1, 2021 and May 31, 2023 at Imam Reza Hospital of Tabriz University of Medical Sciences. The study was conducted in three phases: exploration, development, and evaluation, utilizing modern technologies such as Flutter and Node.js to design and program the application. The effectiveness of the system was evaluated using established measures, including the think-aloud protocol, user experience questionnaire, and Likert-scale questionnaires developed by Ghadri et al. Results The average scale for attractiveness was 2.03, perspicuity was 2.90, efficiency was 2.40, dependability was 1.93, stimulation was 2.48, and novelty was 2.78. Additionally, 71% of physicians gave a very good rating to the accessibility of necessary information at any time, motivation to use the system for accessing information, usefulness of the system compared to the time spent using it throughout the day. Furthermore, 57% of physicians gave a very positive rating to sharing information and knowledge, ease of using the search function and accessing the system, user control and monitoring, free access to the system, and support from colleagues and system users. Conclusion The study suggests that introducing Information and Communication Technology such as medical apps can improve healthcare delivery by streamlining patient care, promoting effective teamwork, and reducing medical errors and treatment delays.
Collapse
Affiliation(s)
- Neda Shams-Vahdati
- Department of Health Information Technology, School of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | - Samad Shams Vahdati
- Emergency and Trauma Care Research Center Tabriz University of Medical Sciences Tabriz Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| |
Collapse
|
6
|
Yilmaz K, Taşçi-Duran E. Examining the views of nurses working in gynecology and obstetrics clinics on collaborative practice. Health Care Women Int 2022:1-21. [PMID: 36409711 DOI: 10.1080/07399332.2022.2144861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
We aimed to reveal the attitudes and perceptions of a group of nurses toward collaborative work and the barriers to collaborative practice. At the end of the study, we obtained four main themes: leadership in health services, interpersonal interaction factors, cooperation in patient care, standardization. The nurses emphasized the critical elements of respect, relationships and communication as components of effective collaborative practice. As a result, it was stated that the practice of cooperation between doctors and nurses is weak and there are some difficulties and obstacles.
Collapse
Affiliation(s)
- Kubra Yilmaz
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
| | - Emel Taşçi-Duran
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
| |
Collapse
|
7
|
Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia. Antibiotics (Basel) 2022; 11:antibiotics11030399. [PMID: 35326862 PMCID: PMC8944506 DOI: 10.3390/antibiotics11030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023] Open
Abstract
Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria.
Collapse
|