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Hoeft M, Van Hooser J, Rupnow N, Clarkson C. Merging the Worlds of Pets and Pills: Development and Evaluation of an Interprofessional Activity Linking Pharmacy and Veterinary Medicine. MEDICAL SCIENCE EDUCATOR 2024; 34:765-770. [PMID: 39099878 PMCID: PMC11297220 DOI: 10.1007/s40670-024-02060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 08/06/2024]
Abstract
Interprofessional education (IPE) is noticeably lacking between pharmacy and veterinary medicine students despite the two health professions overlapping in practice. To address this, an asynchronous IPE activity was developed together with practicing pharmacists and veterinarians. Students worked in groups across two campuses to discuss clinical cases, specifically requiring input from both professions. Students reported they learned more about the two professions' interconnection, felt prepared to interact with the other professionals in the future, and found value in learning from each other. Overall, the results of this study outline a successful pilot IPE activity between veterinary medicine and pharmacy students.
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Affiliation(s)
- Morgan Hoeft
- Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, 3-150C Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455 USA
| | - Jared Van Hooser
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, 217 Life Science, 1110 Kirby Drive, Duluth, MN 55812 USA
| | - Nichole Rupnow
- Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, 3-150D Weaver Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455 USA
| | - Christina Clarkson
- Department of Veterinary and Biological Sciences, University of Minnesota College of Veterinary Medicine, 235D AS/VM Building, 1988 Fitch Avenue, Saint Paul, MN 55108 USA
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Ranta M, Lönnroos E, Miettinen M, Kouvo A, Lammintakanen J. Emergency nurses' and physicians' perceptions and self-assessed competence in providing care to older patients. Int Emerg Nurs 2024; 74:101443. [PMID: 38677059 DOI: 10.1016/j.ienj.2024.101443] [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: 05/02/2023] [Revised: 01/26/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Abstract
AIM This study examined emergency nurses' and physicians' perceptions and self-assessed competence in caring for older patients. METHODS Data were analyzed using a mixed methods approach and quantitative data were supplemented with qualitative responses. There were 451 nurses and physicians working at the two examined emergency departments, with 125 of them responding to the survey; the response rate was 27.7 %. RESULTS Physicians and nurses felt that acutely ill older patients are a responsibility of emergency services. Nurses were more critical than physicians (p = 0.000) of the failure to recognize older patients as a special group at the emergency department. Over half (51.8 %) of the physicians and 29.0 % of the nurses (p = 0.027) felt that older patients' special needs had been considered during facility planning. Nurses and physicians described the problems related to multimorbidity and aging relatively similarly. Both expressed a need for more knowledge in geriatrics and gerontology. CONCLUSION Future facility planning and care processes at the emergency department should better consider the specific needs of older patients. The results also emphasize a need to more effectively prioritize competence and educational needs of emergency staff and recognize caring for older patients as a specific competence area in the emergency department.
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Affiliation(s)
- Milja Ranta
- University of Eastern Finland, Yliopistonranta 1, Department of Health and Social Management, 70210 Kuopio, Finland.
| | - Eija Lönnroos
- University of Eastern Finland, Yliopistonranta 1, Department of Medicine, Public Health and Clinical Nutrition, 70210 Kuopio, Finland.
| | | | - Antti Kouvo
- University of Eastern Finland, Yliopistonranta 1, Faculty of Social Sciences and Business Studies, Department of Sociology, 70210 Kuopio, Finland.
| | - Johanna Lammintakanen
- University of Eastern Finland, Yliopistonranta 1, Faculty of Social Sciences and Business Studies, Department of Health and Social Management, 70210 Kuopio, Finland.
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Levoy E, Sperber A, Poon D, Casazza M, Vargas J, Yang S, Grant G, Singer S, Srinivas N. A Multifaceted Intervention to Improve Teamwork on an Inpatient Pediatric Neurosurgery Service. Jt Comm J Qual Patient Saf 2024; 50:104-115. [PMID: 37806797 DOI: 10.1016/j.jcjq.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Increased safety reports related to interprofessional teamwork on an acute care unit at a quaternary children's hospital prompted a teamwork-focused improvement effort on the pediatric neurosurgery service. METHODS An interprofessional workgroup was formed and met twice monthly throughout the project. A survey using modified validated items was disseminated to pediatric neurosurgery nurses, advanced practice providers (APPs), and physicians in March 2021 to identify opportunities for improvement. Structured debriefs on survey results promoted discourse on teamwork. The researchers implemented two interventions: (1) nursing-centered interprofessional education and (2) a rounding checklist before redistributing the survey in December 2021. RESULTS Baseline and follow-up survey response rates were 84.1% (58/69) and 71.4% (50/70), respectively. Nurses at baseline perceived lower teamwork scores for 12 items compared to physicians and APPs (p < 0.05). Nurse perceptions improved after interventions in: "using 'we' rather than 'they'" (21.3% vs. 51.2% agree, p = 0.003), "I am confident that this team works effectively" (46.8% vs. 80.5%, p = 0.001), "shared understanding of each other's role on the team" (48.9% vs. 73.2% agree, p = 0.02), and "getting others on the team to listen" (46.8% vs. 75.6%, p = 0.004). Mean teamwork effectiveness improved from 4.12 to 5.25 (out of 7; p < 0.0001). Nurses ranked three interventions as most effective: interprofessional training (35/41, 85.4%), educational clinical pearls (14/41, 34.1%), and structured opportunities to discuss teamwork (10/41, 24.4%). CONCLUSION Interprofessional training, a teamwork survey, and structured debriefing improved nurse perceptions of teamwork. Interventions targeting social components of change can improve teamwork even without process changes.
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Rogers L, De Brún A, McAuliffe E. Exploring healthcare staff narratives to gain an in-depth understanding of changing multidisciplinary team power dynamics during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:419. [PMID: 37127626 PMCID: PMC10150666 DOI: 10.1186/s12913-023-09406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Multidisciplinary teams (MDTs) are integral to healthcare provision. However, healthcare has historically adopted a hierarchical power structure meaning some voices within the MDT have more influence than others. While power dynamics can influence interprofessional communication and care coordination, the field's understanding of these power structures during the COVID-19 pandemic is limited. METHODS Adopting a narrative inquiry methodology, this research addresses this knowledge gap and provides an in-depth understanding of MDT power dynamics during COVID-19. Using semi-structured interviews (n = 35) and inductive thematic analysis, this research explores staff perspectives of changing power dynamics in MDTs during the pandemic response. RESULTS An in-depth analysis generated three overarching themes: (1) Healthcare: a deeply embedded hierarchy reveals that while a hierarchical culture prevails within the Irish health system, staff perceptions of influence in MDTs and 'real' experiences of autonomy differ significantly. (2) Team characteristics: the influence of team structure on MDT power dynamics highlights the impact of organisational structures (e.g., staff rotations) and local processes (e.g., MDT meeting structure) on collaborative practice. (3) Ongoing effort to stimulate true collaboration underscores the importance of ongoing interprofessional education to support collaborative care. CONCLUSION By offering a greater understanding of MDT power dynamics throughout the COVID-19 pandemic, this research supports the development of more appropriate strategies to promote the provision of interprofessional care in practice.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland.
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, Dublin, Ireland
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Christensen I, Power E, Togher L, Norup A. "Communication Is Not Exactly My Field, but It Is Still My Area of Work": Staff and Managers' Experiences of Communication With People With Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:827-847. [PMID: 36455235 DOI: 10.1044/2022_ajslp-22-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Communication between people with traumatic brain injury (TBI) and rehabilitation staff can be impacted by cognitive-communication disorders. Communication partner training (CPT) programs hold potential to improve communication between people with TBI and their communication partners. To tailor CPT programs to the rehabilitation environment, it is critical to understand the nature of communicative interactions for staff members. This study explores staff and managers' experiences of communication with people with TBI in the rehabilitation setting. METHOD Individual semistructured videoconference interviews were carried out with staff members (n = 22) and managers (n = 4) varying in terms of professions and length of work experience. Interviews were guided by a phenomenological approach to gain comprehensive knowledge of staff and managers' lived experiences of communication with people with TBI. RESULTS Four themes with nine subthemes were generated: (a) cognitive-communication disorders challenge interaction (communication is socially inappropriate, the diversity of presenting symptoms associated with TBI is demanding), (b) staff struggle in communication (there is a breakdown of communicative collaboration, communication increases staff's workload, emotional well-being of staff is at risk), (c) communication context is crucial (tasks affect communication, extending the professional roles), and (d) staff want communication knowledge and skills (needs vary according to work experience, access to tailored strategies, and feedback). CONCLUSIONS Staff and managers experienced communication with people with TBI as highly demanding. The socially inappropriate communication in people with TBI was perceived to disturb the collaborative aspects of communication and create negative emotional impacts for staff. Staff experiences varied according to discipline, work experience, rehabilitation tasks, and facility. Consequently, staff and managers expressed a need for specific communication strategies to help them overcome the communicative challenges. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21579159.
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Affiliation(s)
- Iben Christensen
- Department of Nordic Studies and Linguistics, University of Copenhagen, Denmark
| | - Emma Power
- University of Technology Sydney, Department of Speech Pathology, Ultimo, New South Wales, Australia
| | - Leanne Togher
- Department of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anne Norup
- Neurorehabilitation Research and Knowledge Centre, Rigshospitalet, Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Vreugdenhil J, Somra S, Ket H, Custers EJFM, Reinders ME, Dobber J, Kusurkar RA. Reasoning like a doctor or like a nurse? A systematic integrative review. Front Med (Lausanne) 2023; 10:1017783. [PMID: 36936242 PMCID: PMC10020202 DOI: 10.3389/fmed.2023.1017783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.
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Affiliation(s)
- Jettie Vreugdenhil
- Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- VUmc Amstel Academie, Institute for Education and Training, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Hans Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Marcel E. Reinders
- Family Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jos Dobber
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam School of Nursing, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Rashmi A. Kusurkar
- Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
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Penta S. Interdisciplinary Collaboration in International Crisis Medical Relief: A Look at the Nepal Earthquake and Ebola Relief Efforts. Disaster Med Public Health Prep 2023; 17:e305. [PMID: 36789768 DOI: 10.1017/dmp.2022.270] [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] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This study explores interprofessional collaboration among medical and non-medical personnel planning and implementing international crisis health and medical relief efforts, and how disciplinary and professional background influences these activities. METHODS This study analyzes semi-structured interviews with individuals involved in organizations medical or health services to the Ebola epidemic in West Africa (2014-2016) or the 2015 Nepal earthquake. RESULTS Disciplinary background, sometimes coupled with organization role, shaped how relief workers engaged in the process of planning and implementing crisis medical relief. There were 3 thematic areas where these differences emerged: issue focus, problem -solving approaches, and decision-making approaches. Solutions from the field emerged as a fourth theme. CONCLUSIONS The study demonstrates medical relief required collaboration across medical and non-medical professions and highlights the importance of relief workers' disciplinary background in shaping the planning and implementation of crisis medical relief. Successful collaboration requires that people involved in crisis relief communicate the relevance of their own expertise, identify limits of their own and others' disciplinary perspective(s), seek out strengths in others' expertise, and can identify/ respond appropriately to others who do not see their own disciplinary limits, as well as learn these skills before engaging in relief.
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Affiliation(s)
- Samantha Penta
- Department of Emergency Management and Homeland Security, University at Albany, State University of New York, Albany, NY, USA
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Mafinejad MK, Ebrahimpour F, Sayarifard A, Shahbazi F, Gruppen L. Reflection on near-peer shadowing program: impact on operating room student's perception of their future profession. BMC MEDICAL EDUCATION 2022; 22:832. [PMID: 36456954 PMCID: PMC9713979 DOI: 10.1186/s12909-022-03891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Reflection is a key element in learning from observation and experience of future profession's roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students' written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students' written reflections on their first clinical exposure experiences towards their future profession through the shadowing program. METHODS This study was a qualitative analysis on Operating Room freshmen's reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed using the thematic analysis approach. RESULTS Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession's desirability, and (iv) Excellence in professional growth and development. CONCLUSION Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession's realities, as well as initiate realization of professional identity and planning for professional developments.
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Affiliation(s)
- Mahboobeh Khabaz Mafinejad
- Health Professions Education Research Center, Education Development Center, Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ebrahimpour
- Department of Pediatric Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Sayarifard
- Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shahbazi
- Instructor of Medical Education, Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan-Dr. Hesabi Square-Medical Sciences Campus, Zahedan, Iran
- Education Development Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Larry Gruppen
- PhD, Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
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Hanum C, Findyartini A, Soemantri D. Collaborative clinical reasoning learning using an integrated care pathway in undergraduate interprofessional education: An explorative study. J Interprof Care 2022; 37:438-447. [PMID: 35880761 DOI: 10.1080/13561820.2022.2086221] [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: 10/16/2022]
Abstract
Collaborative clinical reasoning (CCR) is part of interprofessional collaborative practice and aims to negotiate and manage patient problems. An integrated care pathway (ICP) can be used as a framework for developing comprehensive patient care, typically in a clinical setting. This study aims to explore the CCR process in undergraduate interprofessional teams and the use of ICP as guidance in discussing a patient's problem and its comprehensive management. This is a qualitative study following phenomenology and was performed in an interprofessional education (IPE) program held by Health Science Cluster Universitas Indonesia. A total of four observations involving 40 students and four focus-group discussions involving 18 students from different health professions backgrounds were conducted to explore the CCR process using the ICP framework. In-depth interviews with four tutors from different health professions backgrounds and document analysis were also conducted as triangulation processes. This study shows that CCR was held in two stages - individual and group. The ICP framework could be used as a guiding tool in the CCR process to discuss the patient's management and discharge plan. This study also demonstrates that there are several challenges in this learning process, including the clinical case used in the discussion, the need for prior knowledge and previous exposure to IPE and the ICP framework, and health professions' dominance during the discussion. This study provides evidence on learning of CCR using the ICP framework as a guiding tool in a pre-licensure IPE program. This approach is useful for preparing students to develop an interprofessional, comprehensive, and holistic health care plan and to help them understand the roles of each profession.
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Affiliation(s)
- Chaina Hanum
- Master Program in Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Faculty of Medicine, Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.,Faculty of Medicine, Medical Education Center, Indonesia Medical Education & Research Institute (IMERI), Universitas Indonesia, Jakarta, Indonesia
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Flenady T, Dwyer T, Kahl J, Sobolewska A, Reid-Searl K, Signal T. Research Ready Grant Program (RRGP) protocol: a model for collaborative multidisciplinary practice-research partnerships. Health Res Policy Syst 2022; 20:62. [PMID: 35698128 PMCID: PMC9195363 DOI: 10.1186/s12961-022-00870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Little attention has been given to the process of implementing or evaluating a structured academic–clinician (university–health service) research capacity-building (RCB) model within healthcare settings. We have developed a model for collaborative multidisciplinary practice–research partnerships called the Research Ready Grant Program (RRGP). The RRGP is informed by Cooke’s (BMC Fam Pract 6:44, 2005) RCB framework and principles. The aim of the study outlined in this protocol is to conduct a process and outcome evaluation of the programme. We will explore how the RRGP's structured mentor model contributes to RCB of clinician-led multidisciplinary research teams. We will identify key factors at the organization, team and individual levels that affect research capacity of health professionals working in one regional health service district. This protocol describes the RRGP design and outlines the methods we will employ to evaluate an RCB programme, the RRGP, delivered in a regional health service in Australia. Methods The study will adopt an exploratory concurrent mixed-methods approach designed to evaluate the process of implementing an RCB model across one regional hospital and health service. Both quantitative and qualitative data collection methods over a 12-month period will be implemented. Data triangulation will be applied to capture the complex issues associated with implementing collaborative multidisciplinary practice–research partnerships. Discussion The RRGP is an innovative RCB model for clinicians in their workplace. It is expected that the programme will facilitate a culture of collaborative multidisciplinary research and strengthen hospital–university partnerships.
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Affiliation(s)
- Tracy Flenady
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia.
| | - Trudy Dwyer
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Julie Kahl
- Central Queensland Hospital and Health Services, Canning Street, Rockhampton, 4701, Australia
| | - Agnieszka Sobolewska
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Kerry Reid-Searl
- School of Nursing and Midwifery, Central Queensland University, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Tania Signal
- School of Health, Medical and Applied Sciences, Central Queensland University, Building 6, Bruce Highway, Rockhampton, 4701, Australia
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Vreugdenhil J, Döpp D, Custers EJFM, Reinders ME, Dobber J, Kusukar RA. Illness scripts in nursing: Directed content analysis. J Adv Nurs 2021; 78:201-210. [PMID: 34378221 PMCID: PMC9290845 DOI: 10.1111/jan.15011] [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: 03/02/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 12/01/2022]
Abstract
Aims To explore the possible extension of the illness script theory used in medicine to the nursing context. Design A qualitative interview study. Methods The study was conducted between September 2019 and March 2020. Expert nurses were asked to think aloud about 20 patient problems in nursing. A directed content analysis approach including quantitative data processing was used to analyse the transcribed data. Results Through the analysis of 3912 statements, scripts were identified and a nursing script model is proposed; the medical illness script, including enabling conditions, fault and consequences, is extended with management, boundary, impact, occurrence and explicative statements. Nurses often used explicative statements when pathophysiological causes are absent or unknown. To explore the applicability of Illness script theory we analysed scripts’ richness and maturity with descriptive statistics. Expert nurses, like medical experts, had rich knowledge of consequences, explicative statements and management of familiar patient problems. Conclusion The knowledge of expert nurses about patient problems can be described in scripts; the components of medical illness scripts are also relevant in nursing. We propose to extend the original illness script concept with management, explicative statements, boundary, impact and occurrence, to enlarge the applicability of illness scripts in the nursing domain. Impact Illness scripts guide clinical reasoning in patient care. Insights into illness scripts of nursing experts is a necessary first step to develop goals or guidelines for student nurses’ development of clinical reasoning. It might lay the groundwork for future educational strategies.
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Affiliation(s)
- Jettie Vreugdenhil
- Amsterdam UMC, LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit, Amsterdam, the Netherlands
| | - Donna Döpp
- Amstel Academie, Amsterdam UMC, Amsterdam, the Netherlands
| | - Eugène J F M Custers
- Centre for Research and Development of Education, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marcel E Reinders
- Department of Family Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos Dobber
- Amsterdam School of Nursing, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Rashmi A Kusukar
- Amsterdam UMC Faculty of Medicine, Faculty of Psychology and Education, LEARN! Research Institute for learning and education, Vrije Universiteit, Amsterdam, the Netherlands
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das Nair R, Hunter R, Garjani A, Middleton RM, Tuite-Dalton KA, Nicholas RS, Evangelou N. Challenges of developing, conducting, analysing and reporting a COVID-19 study as the COVID-19 pandemic unfolds: an online co-autoethnographic study. BMJ Open 2021; 11:e048788. [PMID: 34135052 PMCID: PMC8210677 DOI: 10.1136/bmjopen-2021-048788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To capture the complexities and unique experience of a newly formed multidisciplinary and multicentre research team developing and deploying a COVID-19 study and to identify lessons learnt. DESIGN Co-autoethnographic study. SETTING Staff at two UK academic institutions, a national charity and two major UK hospitals. PARTICIPANTS Researchers, clinicians, academics, statisticians and analysts, patient and public involvement representatives and national charity. METHODS The sampling frame was any content discussed or shared between research team members (emails, meeting minutes, etc), standard observational dimensions and reflective interviews with team members. Data were thematically analysed. RESULTS Data from 34 meetings and >50 emails between 17 March and 5 August 2020 were analysed. The analysis yielded seven themes with 'Managing our stress' as an overarching theme. CONCLUSIONS Mutual respect, flexibility and genuine belief that team members are doing the best they can under the circumstances are essential for completing a time-consuming study, requiring a rapid response during a pandemic. Acknowledging and managing stress and a shared purpose can moderate many barriers, such as the lack of face-to-face interactions, leading to effective team working.
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Affiliation(s)
- Roshan das Nair
- Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham School of Medicine, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Rachael Hunter
- College of Health and Human Science, Swansea University, Swansea, UK
| | - Afagh Garjani
- Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham School of Medicine, Nottingham, UK
- Department of Academic Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rod M Middleton
- Department of Population Data Science, Swansea University, Swansea, UK
| | | | - Richard S Nicholas
- Department of Population Data Science, Swansea University, Swansea, UK
- Department of Cellular and Molecular Neuroscience, Imperial College London, London, UK
| | - Nikos Evangelou
- Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham School of Medicine, Nottingham, UK
- Department of Academic Clinical Neurology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. Context counts: a qualitative study exploring the interplay between context and implementation success. J Health Organ Manag 2021; ahead-of-print. [PMID: 33682395 PMCID: PMC9073593 DOI: 10.1108/jhom-07-2020-0296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice. DESIGN/METHODOLOGY/APPROACH The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success. FINDINGS Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams. ORIGINALITY/VALUE By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.
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Affiliation(s)
- Lisa Rogers
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Sarah A Birken
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. The micropolitics of implementation; a qualitative study exploring the impact of power, authority, and influence when implementing change in healthcare teams. BMC Health Serv Res 2020; 20:1059. [PMID: 33228702 PMCID: PMC7684932 DOI: 10.1186/s12913-020-05905-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022] Open
Abstract
Background Healthcare organisations are complex social entities, comprising of multiple stakeholders with differing priorities, roles, and expectations about how care should be delivered. To reach agreement among these diverse interest groups and achieve safe, cost-effective patient care, healthcare staff must navigate the micropolitical context of the health service. Micropolitics in this study refers to the use of power, authority, and influence to affect team goals, vision, and decision-making processes. Although these concepts are influential when cultivating change, there is a dearth of literature examining the mechanisms through which micropolitics influences implementation processes among teams. This paper addresses this gap by exploring the role of power, authority, and influence when implementing a collective leadership intervention in two multidisciplinary healthcare teams. Methods The multiple case study design adopted employed a triangulation of qualitative research methods. Over thirty hours of observations (Case A = 16, Case B = 15) and twenty-five interviews (Case A = 13, Case B = 12) were completed. An in-depth thematic analysis of the data using an inductive coding approach was completed to understand the mechanisms through which contextual factors influenced implementation success. A context coding framework was also employed throughout implementation to succinctly collate the data into a visual display and to provide a high-level overview of implementation effect (i.e. the positive, neutral, or negative impact of contextual determinants on implementation). Results The findings emphasised that implementing change in healthcare teams is an inherently political process influenced by prevailing power structures. Two key themes were generated which revealed the dynamic role of these concepts throughout implementation: 1) Exerting hierarchical influence for implementation; and 2) Traditional power structures constraining implementation. Gaining support across multiple levels of leadership was influential to implementation success as the influence exercised by these individuals persuaded follower engagement. However, the historical dynamics of each team determined how this influence was exerted and perceived, which negatively impacted some participants’ experiences of the implementation process. Conclusion To date, micropolitics has received scant attention in implementation science literature. This study introduces the micropolitical concepts of power, authority and influence as essential contextual determinants and outlines the mechanisms through which these concepts influence implementation processes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05905-z.
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Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland.
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, Noth Carolina, USA
| | - Carmel Davies
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
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Flenady T, Dwyer T, Sobolewska A, Lagadec DL, Connor J, Kahl J, Signal T, Browne M. Developing a sociocultural framework of compliance: an exploration of factors related to the use of early warning systems among acute care clinicians. BMC Health Serv Res 2020; 20:736. [PMID: 32782002 PMCID: PMC7422559 DOI: 10.1186/s12913-020-05615-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Early warning systems (EWS) are most effective when clinicians monitor patients’ vital signs and comply with the recommended escalation of care protocols once deterioration is recognised. Objectives To explore sociocultural factors influencing acute care clinicians’ compliance with an early warning system commonly used in Queensland public hospitals in Australia. Methods This interpretative qualitative study utilised inductive thematic analysis to analyse data collected from semi-structured interviews conducted with 30 acute care clinicians from Queensland, Australia. Results This study identified that individuals and teams approached compliance with EWS in the context of 1) the use of EWS for patient monitoring; and 2) the use of EWS for the escalation of patient care. Individual and team compliance with monitoring and escalation processes is facilitated by intra and inter-professional factors such as acceptance and support, clear instruction, inter-disciplinary collaboration and good communication. Noncompliance with EWS can be attributed to intra and inter-professional hierarchy and poor communication. Conclusions The overarching organisational context including the hospital’s embedded quality improvement and administrative protocols (training, resources and staffing) impact hospital-wide culture and influence clinicians’ and teams’ compliance or non-compliance with early warning system’s monitoring and escalation processes. Successful adoption of EWS relies on effective and meaningful interactions among multidisciplinary staff.
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Affiliation(s)
- Tracy Flenady
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia.
| | - Trudy Dwyer
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Agnieszka Sobolewska
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Danielle Le Lagadec
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Justine Connor
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Julie Kahl
- Central Queensland Hospital and Health Services, Canning Street, Rockhampton, 4701, Australia
| | - Tania Signal
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
| | - Matthew Browne
- Central Queensland University, School of Nursing & Midwifery, Building 18, Bruce Highway, Rockhampton, 4702, Australia
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Brown JB, Mulder C, Clark RE, Belsito L, Thorpe C. It starts with a strong foundation: constructing collaborative interprofessional teams in primary health care. J Interprof Care 2020; 35:514-520. [PMID: 32716727 DOI: 10.1080/13561820.2020.1787360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this qualitative study was to explore how team members experience and enact interprofessional teamwork in primary health care (PHC). Fifty-three participants (from eight teams), members of the Association of Family Health Teams of Ontario (AFHTO), were interviewed; interviews were audiotaped and transcribed verbatim. The data analyses used an iterative process with individual and team analysis. Findings revealed components that comprise the foundation and pillars of collaborative interprofessional teamwork in PHC. First, participants described a shared philosophsy of teamwork with six elements: values, vision, and mission; collaboration; communication; trust; respect and team members that 'fit.' Second, findings revealed three 'pillars.' The first pillar, leadership, included the elements of specific leadership attributes, such as leaders encouraging teamwork, mitigating conflict, and facilitating change. In the second pillar, participants described three elements of team building: formal and informal team building activities plus how these activities benefited both the team and patient care. The last pillar, optimizing scope of practice, included the elements of recognizing, appreciating, utilizing, and expanding team members' scope of practice. While each component and their concomitant elements can be enacted individually, collectively applying all elements produces collaborative interprofessional teamwork in primary health care.
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Affiliation(s)
- Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, the Western Centre for Public Health and Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Carol Mulder
- Centre for Studies in Primary Care, Department of Family Medicine, Queens University, Kingston, Canada
| | - Rebecca E Clark
- Centre for Studies in Family Medicine, Department of Family Medicine, the Western Centre for Public Health and Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Laura Belsito
- Association of Family Health Teams of Ontario (AFHTO), Toronto, Canada
| | - Cathy Thorpe
- Centre for Studies in Family Medicine, Department of Family Medicine, the Western Centre for Public Health and Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
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Glasdam S, Ekstrand F, Rosberg M, van der Schaaf AM. A gap between the philosophy and the practice of palliative healthcare: sociological perspectives on the practice of nurses in specialised palliative homecare. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:141-152. [PMID: 31385188 PMCID: PMC7039838 DOI: 10.1007/s11019-019-09918-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Palliative care philosophy is based on a holistic approach to patients, but research shows that possibilities for living up to this philosophy seem limited by historical and administrative structures. From the nurse perspective, this article aims to explore nursing practice in specialised palliative homecare, and how it is influenced by organisational and cultural structures. Qualitative, semi-structured interviews with nine nurses were conducted, inspired by Bourdieu. The findings showed that nurses consolidate the doxa of medicine, including medical-professional values that configure a control-oriented, positivistic approach, supported by the organising policy for clinical practice. Hierarchically, nurses were positioned under doctors: medical rounds functioned as a structuring structure for their working day. They acted as medical assistants, and the prevailing medical logic seemed to make it difficult for nurses to meet their own humanistic ideals. Only short time slots allowed nurses to prioritise psychosocial needs of patients and relatives. Point-of-actions had high priority, added financial resources and ensured that budgets were allocated. Weekly visits made it possible for nurses to measure, control and govern patients' drugs and symptoms which was a necessity for their function as medical assistants. The findings challenge nurses to take on an ethical point of view, partly to ensure that patients and their families receive good palliative care focusing on more than medical issues and logic, and partly to strengthen the nurses' profession in the palliative field and help them implement palliative care philosophy in practice.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, Baravägen 3, 222 41 Lund, Sweden
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Beech C, Verity F. Health and social work practitioners’ experiences of working with risk and older people. JOURNAL OF INTEGRATED CARE 2019. [DOI: 10.1108/jica-08-2019-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore interprofessional and multidisciplinary working between health and social care practitioners providing services to older people through the prism of how risk is assessed and managed. It proposes that whilst interprofessional and multidisciplinary working is a broad and commonly researched topic, there is a relative paucity of evidence specifically regarding how health and social care practitioners work together across structural, cultural and ideological divides. The study aims to expand the domain of integrated health and social care by including perceptions, understanding and use of the concept of risk by professionals from different disciplines.
Design/methodology/approach
This paper is based upon an exploratory study using an interpretivist phenomenological perspective, including 23 semi-structured individual interviews with health and social care practitioners and 2 non-participant observations of multidisciplinary team meetings.
Findings
The paper provides empirical insights around the complex dynamics of interprofessional and multidisciplinary working between health and social care practitioners, in particular the saliency of the interconnectedness of individual practitioner Personalities with the Process of interprofessional and multidisciplinary working under the auspices of relevant Policy drivers.
Research limitations/implications
The research was conducted in Wales and, due to the increasingly divergent policy context within the UK, the research results may lack generalisability from a wider UK or international perspective. Therefore, researchers are encouraged to test the propositions of this research further.
Practical implications
The paper includes implications for both interprofessional and multidisciplinary policy and practice with older people. With new models of integrated care being sought, the findings of this study may offer a timely and valuable contribution, particularly from the inclusion of a social care perspective and in better understanding the interconnectedness of practitioner personalities with process and policy.
Originality/value
This paper fulfils an identified need to study the complex dynamics and interconnectedness between health and social care practitioners who work together to provide services to older people.
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Sarli L, D'Apice C, Rossi S, Artioli G. Interprofessionalism and interprofessional research: a challenge still to be won in Italy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:5-7. [PMID: 31714495 PMCID: PMC7233633 DOI: 10.23750/abm.v90i11-s.8947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022]
Abstract
Public health and pedagogical institutions have long been calling for collaborative models of assistance and training that provide inter-professional synergy and there is a broad international consensus on the importance of inter-professionalism in the field of assessment and healthcare provision (1-10). [...].
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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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Abstract
Interprofessional collaboration is understood to improve efficiencies and quality of care but is associated with challenges such as professionals' differing routines, knowledge, and identities, as well as professional hierarchies and time constraints. Given these challenges, there is limited understanding of how professionals collaborate effectively in providing patient-centred care. This study, with a convergence triangulation mixed-methods study design, explored interprofessional staffs' perceptions of interprofessional collaboration and patient-centred care when working with hospitalized older adults. Thirty-six staff responded to a survey which included the Patient-Centred Care measure and the Modified Index of Interdisciplinary Collaboration; we also interviewed 14 nursing staff. Although all scores suggested a high value was placed on interprofessional collaboration, scores were low related to activities that facilitated team processes. We identified three themes from the data: knowing the patient/family, functional needs, and communication processes. Staff identified daily rounds with interprofessional teams as supportive of interprofessional collaboration and patient-centred-care.
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McKeown A, Cliffe C, Arora A, Griffin A. Ethical challenges of integration across primary and secondary care: a qualitative and normative analysis. BMC Med Ethics 2019; 20:42. [PMID: 31269930 PMCID: PMC6610833 DOI: 10.1186/s12910-019-0386-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/26/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. METHODS We evaluated an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners (GPs) in co-designing integrated clinical services. RESULTS The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. CONCLUSIONS From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX, England
| | - Charlotte Cliffe
- University College London Medical School, 74 Huntley Street, London, WC1E 6AU, England
| | - Arun Arora
- University of Manchester Medical School, Oxford Road, Manchester, M13 9PL, UK
| | - Ann Griffin
- Research Department for Medical Education, University College London Medical School, 74 Huntley Street, London, WC1E 6AU, England.
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The Experience of Family Physicians and Home Health Staff Involved in an Intervention to Increase Patient-Related Collaboration. Can J Aging 2019; 38:493-506. [PMID: 31094303 DOI: 10.1017/s071498081900014x] [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: 11/06/2022] Open
Abstract
Les médecins de famille (MF) et le personnel de soins de santé à domicile (PSD) canadiens rencontrent d'importants obstacles lorsqu'ils doivent collaborer pour la prestation de soins aux patients qu'ils ont en commun. Cette étude à méthodologie mixte visait à évaluer la qualité et la viabilité de l'utilisation de l'audioconférence sécurisée dans une optique d'amélioration de la planification des soins pour ces patients. Les données primaires incluaient les résultats d'un sondage réalisé avant et après l'intervention, ainsi que des entretiens semi-structurés et des groupes de discussion post-intervention. Des méthodes statistiques non paramétriques ont été utilisées pour analyser les résultats du sondage, et les données qualitatives ont fait l'objet d'une analyse thématique de contenu. Les résultats des analyses quantitatives et qualitatives ont ensuite été intégrés afin de faire ressortir les inférences reflétant les approches des MF et du PSD relatives aux obstacles et aux avantages de la planification interdisciplinaire des soins. Les MF et le PSD ont montré que des obstacles structurels limitent leur capacité à collaborer. Le PSD et les MF ont également convenu que les rencontres entre les intervenants des deux services étaient bénéfiques pour les patients et que l'utilisation de l'audioconférence constituait une méthode efficiente de planification collaborative des soins. Les limites comprenaient la petite taille de l'échantillon et la courte période d'intervention, compte tenu de l'ampleur des changements attendus. Canadian family physicians (FPs) and home health staff (HHS) experience significant barriers to patient-related collaboration about patients they share. This mixed-methods study sought to determine the quality and sustainability of secure audio conferencing as a way to increase care planning about shared patients. Primary data sources included pre-and post-study administration of a published survey and post-study semi-structured interviews and focus groups. Non-parametric statistical procedures were used to analyze survey results and thematic content analysis was undertaken for qualitative data. Results from both quantitative and qualitative analysis were integrated into the overall analysis, in order to draw inferences reflecting both approaches to barriers and benefits of collaborative care planning for FPs and HHS. Both FPs and HHS provided evidence that structural barriers impede their ability to collaborate. HHS and FPs also agreed that joint conferences were beneficial for patients, and that the use of audio conferencing provided an efficient method of collaborative care planning. Limitations included a small sample size and short timeline for the intervention period, given the magnitude of the expected change.
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Gleddie M, Stahlke S, Paul P. Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery. J Interprof Care 2018:1-11. [PMID: 30596305 DOI: 10.1080/13561820.2018.1562422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 07/29/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.
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Affiliation(s)
- Megan Gleddie
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
| | - Sarah Stahlke
- b Faculty of Nursing , University of Alberta, Edmonton Clinic Health Academy , Alberta , Canada
| | - Pauline Paul
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
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Hsieh CI, Kuo RNC, Liang CC, Tsai HY, Chung KP. Differences in the outcomes of adjuvant chemotherapy for colon cancer prescribed by physicians in different disciplines: a population-based study in Taiwan. BMJ Open 2018; 8:e021341. [PMID: 30567819 PMCID: PMC6303636 DOI: 10.1136/bmjopen-2017-021341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 10/28/2018] [Accepted: 11/02/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES One feature unique to the Taiwanese healthcare system is the ability of physicians other than oncologists to prescribe systemic chemotherapy. This study investigated whether the care paths implemented by oncologists and non-oncologists differ with regard to patient outcomes. SETTING Data from the Taiwan Cancer Registry and National Health Insurance Database were linked to identify patients with colon cancer who underwent colectomy as first treatment within 3 months of diagnosis and adjuvant chemotherapy between 2005 and 2009. PARTICIPANTS AND METHODS Postoperative patients who underwent adjuvant chemotherapy were included in this study. The exclusion criteria included patients with stage IV disease, a positive surgical margin and early disease recurrence. Among the patients presenting with multiple primary cancers, we also excluded patients who were diagnosed with colon cancer but for whom this was not the first primary cancer. The variables included sex, age, comorbidities, disease stage, chemotherapy cycle and changes in treatment regimen as well as the specialty of treatment providers and their case volume. Cox regression models and Kaplan-Meier analysis were used to examine differences in outcomes in the matched cohorts. RESULTS We examined 3534 patients who were prescribed adjuvant chemotherapy by physicians from different disciplines. In terms of 5-year disease-free survival, no significant difference was observed between the groups of oncologists or surgeons among patients with stage II (90.02%vs88.99%) or stage III (77.64%vs79.99%) diseases. Patients who were subjected to changes in their chemotherapy regimens presented recurrence rates higher than those who were not. CONCLUSIONS The discipline of practitioners is seldom taken into account in most series. This is the first study to provide empirical evidence demonstrating that the outcomes of patients with colon cancer do not depend on the treatment path, as long as the selection criteria for adjuvant chemotherapy is appropriate. Further study will be required before making any further conclusions.
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Affiliation(s)
- Cheng-I Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Raymond Nien-Chen Kuo
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chun-Chieh Liang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yun Tsai
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
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O'Carroll V, McSwiggan L, Campbell M. Practice educators' attitudes and perspectives of interprofessional collaboration and interprofessional practice learning for students: A mixed-methods case study. J Interprof Care 2018; 33:414-423. [PMID: 30486692 DOI: 10.1080/13561820.2018.1551865] [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: 10/27/2022]
Abstract
Interprofessional collaboration (IPC) is important for the delivery of effective integrated health and social care systems. Interprofessional practice learning (IPPL) enables students to learn to work together within a relevant context and prepare for future IPC. While there is some evidence that negative attitudes impact on IPC and interprofessional education, there is a dearth of research on health and social work professionals' attitudes and perspectives of IPC and IPPL opportunities for students. A mixed-methods case study was used to investigate practice educators' attitudes and perspectives of IPC and IPPL for their students. Results showed that attitudes were positive and that mainly meso- and macro-level factors, as opposed to the micro level, impacted on the implementation of IPC and IPPL for students' learning in practice settings. IPC was perceived to be best enabled by effective communication, established teams, IPPL for staff, and shared processes and policies. Close working proximity to other professionals encouraged informal communication and positive interprofessional relationships. Motivation and resources were perceived as enablers of IPPL, but there were often missed opportunities for IPPL. These findings suggest that further work is required to identify systems for improving IPC and to enhance IPPL opportunities for students learning within practice settings.
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Affiliation(s)
| | - Linda McSwiggan
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland
| | - Martin Campbell
- School of Psychology and Neuroscience, University of St Andrews, Fife, Scotland
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Franz S, Muser J, Thielhorn U, Wallesch CW, Behrens J. Inter-professional communication and interaction in the neurological rehabilitation team: a literature review. Disabil Rehabil 2018; 42:1607-1615. [PMID: 30457016 DOI: 10.1080/09638288.2018.1528634] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Neurological early rehabilitation aims at regaining cooperativity and acquiring rehabilitation capability with brain-injured patients, most of whom are transferred from Intensive Care Units, most of whom still require intensive care and suffer from disorders of consciousness. In neurological early rehabilitation, therapeutic nursing is an integral part of the therapeutic team. Other than the specialized therapists, nurses are present on the ward 24/7, which gives them a closer perspective on the patient. The research question was how do nurses, physiotherapists, occupational therapists and speech therapists communicate and interact as teams in neurological rehabilitation wards. A literature review was conducted aiming at inter-professional communication and interaction with special regard to the role of these four professionals being the core team members in these settings.Methods: A literature search was conducted in the period from August to October 2016 within the following electronic Databases: Medline, CINAHL, PSYNDEX, SpeechBITE, PEDro und OTseeker. Further searches were undertaken in the reference lists of obtained studies to locate other relevant material. The aim was to gather and evaluate the evidence about inter-professional teamwork in neurological early rehabilitation. The main inclusion criterion was the presence of the following professionals as participants in the study: Nurses, physiotherapists, occupational therapists and speech therapists. Twenty-seven studies were found relevant, of which 17 (12 qualitative and five quantitative) bore empirical results that related to the research questions. These 17 studies were qualitatively analysed for the grade of evidence, methods and the relevance for the conditions and processes in rehabilitation units. Out of 17 studies, four were performed in neurological rehabilitation settings, five in stroke units, six in general rehabilitation, one in short-term care rehabilitation and one in geriatric rehabilitation. Due to the scarcity of material, all these studies were analysed under the perspective of relevance for neurological early rehabilitation.Results: The results of this exploratory literature review indicate that the efficiency and quality of cooperation in rehabilitation teams could be improved through a better patient-oriented inter-professional communication. This is achieved through cross-professional team organization, team supervision and by including team communication in vocational and on-the-job-training. Profession-specific terminologies and differences in understanding of roles could be barriers for collaboration in teams.Conclusions: According to this literature review, successful inter-professional patient-orientated care is promoted by being informed about the various functions of team members from different disciplines, about the role each member plays within the team and communication styles. Means of improving communication are being outlined.Implications for RehabilitationInter-professional communication is promoted by cross-professional team organization.Inter-professional communication should be included in vocational and on-the-job-training and supervision.Barriers for communication in teams are different terminologies and differences in role perception.
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Affiliation(s)
- Shiney Franz
- BDH - Federal Association of Rehabilitation, Bonn, Germany.,Medical Faculty, Institute for Health and Nursing Sciences, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | | | - Ulrike Thielhorn
- Management in Healthcare, Catholic University for Applied Sciences, Freiburg, Germany
| | | | - Johann Behrens
- Medical Faculty, Institute for Health and Nursing Sciences, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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Nieuwboer MS, Perry M, van der Sande R, Maassen ITHM, Olde Rikkert MGM, van der Marck MA. Identification of influencing factors and strategies to improve communication between general practitioners and community nurses: a qualitative focus group study. Fam Pract 2018. [PMID: 29529183 DOI: 10.1093/fampra/cmy009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND As the number of patients with complex healthcare needs grows, inter-professional collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. OBJECTIVE To explore patient-related GP-CN communication and facilitating and hindering factors, and to identify strategies to enhance this communication. METHOD A qualitative focus group design was used to identify the facilitating and hindering factors and strategies for improvement. In a Dutch primary care setting, 6 mono-professional focus group interviews (3 meetings of 13 GPs; 3 meetings of 18 CNs) were organized between June 2015 and April 2016, recorded and transcribed verbatim. Two independent researchers performed the coding of these interviews, identifying their categories and themes. RESULTS Results show that, despite the regular contact between GPs and CNs, communication was generally perceived as poor in effectiveness and efficiency by both professions. Mutual trust was considered the most important facilitating factor for effective communication. Profession-specific factors (e.g. differences in responsibility and profession-specific language) and organizational factors (e.g. lack of shared care plans, no in-person communication, lack of time) may be of influence on communication. Participants' suggestions for improvement included organizing well-structured and reimbursed team meetings and facilitating face-to-face contact. CONCLUSION GP-CN patient-related communication benefits most from trusting inter-personal relationships. Inter-professional training programmes should address both professional and organizational factors and should be evaluated for their effect on quality of care.
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Affiliation(s)
- Minke S Nieuwboer
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Perry
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob van der Sande
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Health, Behaviour and Society, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Irma T H M Maassen
- Radboud Institute for Health Science, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolein A van der Marck
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Dahlke S, Hunter KF, Negrin K, Reshef Kalogirou M, Fox M, Wagg A. The educational needs of nursing staff when working with hospitalised older people. J Clin Nurs 2018; 28:221-234. [PMID: 30039614 DOI: 10.1111/jocn.14631] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/09/2018] [Accepted: 07/15/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine nursing staffs' geriatric knowledge, perceptions about interprofessional collaboration and patient-centred care, and perceived learning needs related to working with hospitalised older people. METHOD A triangulation mixed methods design was used. A survey was administered to nursing staff that contained the Knowledge About Older Patients Quiz, the patient-centered Care measure and the Modified Index of Interdisciplinary Collaboration measure. Interviews were conducted to understand nursing staffs' learning needs. Survey data were analysed using descriptive statistics. Interview data were analysed using content analysis. Survey and interview data were then compared and contrasted. RESULTS Twenty-two nursing staff (response rate 26%) completed surveys and 14 participated in interviews. The mean knowledge about older patients score was 22.95, indicating moderately high gerontological knowledge. The mean scores on the patient-centered Care measure and Modified Index of Interdisciplinary Collaboration were moderately high at 3.75 and 3.86, respectively. Themes developed from analysis of the interview data were as follows: complex vulnerable population, clinical care concerns and working as a team. In spite of scores on knowledge surveys, nursing staff identified learning needs related to managing the responsive behaviours of older patients with cognitive impairment, chemical and physical restraints, mobility and continence. CONCLUSIONS There was an incongruence between survey and interview data as nursing staff reported gaps in their knowledge despite moderately high scores on the Knowledge about Older People Quiz. Further research is needed to understand additional factors that influence nurses' educational needs.
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Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Negrin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Mary Fox
- York University, Toronto, Ontario, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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González-Martínez E, Bulliard C. [Interprofessional collaboration between new nursing graduates and social workers: Hospital discharge planning telephone calls.]. Rech Soins Infirm 2018:15-36. [PMID: 30066504 DOI: 10.3917/rsi.133.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In hospitals, the discharge of patients needing home care or going to a care facility is planned interprofessionally, in particular via telephone calls between nurses and social workers. CONTEXT During discharge planning, the collaboration between a nurse and a social worker is fraught with tension. When this planning is conducted over the phone and the nurse is a new graduate, the tension can be heightened. METHOD Sociological study in an acute-care hospital in French-speaking Switzerland based on analyses of telephone conversations between new nursing graduates and social workers, in addition to observations, interviews and document-gathering. RESULTS Discharge planning is fraught with tension related to the timing of the planning and the care requested. The telephone calls are opportunities for new nurses to learn how to present cases, the procedures to follow for discharge planning, and the work logics of the individuals involved. DISCUSSION The study confirms the need to prepare new nurses to work with social workers on discharge planning and recommends offering training in this, both in nursing school and in the workplace. CONCLUSION Research documenting real work practices provides the keys to perfecting them.
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Lamb D. Factors affecting the delivery of healthcare on a humanitarian operation in West Africa: A qualitative study. Appl Nurs Res 2018; 40:129-136. [DOI: 10.1016/j.apnr.2018.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/03/2017] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
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Scantlebury K, Bixley M, Williamson I. Exploring accounts of collaborative working between speech and language therapists and stroke association communication support coordinators following stroke. J Interprof Care 2018. [PMID: 29521553 DOI: 10.1080/13561820.2018.1446921] [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: 10/17/2022]
Abstract
In the United Kingdom, speech and language therapists (SLTs) and Stroke Association communication support coordinators (CSCs) are both employed to provide services for people with communication difficulties following stroke. There is very little literature of this type of collaborative working. This research is unique because it explores collaborative working between SLTs who are employed by the National Health Service and CSCs who are employed by the Stroke Association. Five CSCs and seven SLTs from the East of England participated in a series of in-depth interviews. Data were analysed using thematic analysis informed by an interpretative phenomenological approach. The analysis suggested complex negotiation processes occur at a number of different levels. These levels include negotiation of individual relationships between SLTs and CSCs, negotiating the particular challenges involved in working across organisations and professions, and the need for both roles to negotiate and promote the value of their services at a societal level. The findings of this research are discussed in relation to existing theories and research within the field of collaborative working. Clinical applications are suggested for collaborative working within communication services. We propose that our findings may have relevance to other individuals and organisations delivering services collaboratively.
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Affiliation(s)
- Katherine Scantlebury
- a Speech and Language Therapy Department , West Suffolk NHS Foundation Trust , Bury St Edmunds , UK
| | - Morag Bixley
- b Speech and Language Therapy Division , De Montfort University , Leicester , UK
| | - Iain Williamson
- c Psychology Division , De Montfort University , Leicester , UK
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Balancing cognitive diversity and mutual understanding in multidisciplinary teams. Health Care Manage Rev 2018; 42:42-52. [PMID: 26317304 DOI: 10.1097/hmr.0000000000000088] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interprofessional health care teams are increasingly utilized in health care organizations. Although there is support for their capacity to solve complex problems, there is also evidence that such teams are not always successful. In an effort to understand the capacity of interprofessional teams to innovate successfully, we investigate the role of cognitive diversity to establish whether and how knowledge differences lead to innovation. PURPOSES The aim of this study was to construct and investigate a model of team innovation predicted by cognitive diversity. In addition to investigating the direct impact of cognitive diversity in interprofessional health care teams, we develop a model incorporating mediated and moderated effects. In this study, we explore the role of debate as a mediating factor capable of explaining the impact of cognitive diversity on innovation. We further propose that the link between cognitive diversity and innovation through debate is contingent upon trans-specialist knowledge, knowledge shared by health care professionals, spanning specialist divides and enabling mutual understanding. METHODOLOGY The hypotheses were investigated using a cross-sectional, correlational design. Survey data received from 75 interprofessional teams employed in an acute care setting, representing a 36% response rate, were used to investigate our model. FINDINGS Analysis supports a significant relationship between cognitive diversity and debate, which is stronger when teams rate highly for trans-specialist knowledge. Results also support a positive relationship between debate and innovation and our full moderated mediated pathway. PRACTICE IMPLICATIONS A range of strategies are indicated by our results to increase innovation in interprofessional teams. In particular, interventions such as interprofessional education and training, which have been shown to facilitate the development of shared language and meaning, are recommended by our findings.
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Abuzour AS, Lewis PJ, Tully MP. Factors influencing secondary care pharmacist and nurse independent prescribers’ clinical reasoning: An interprofessional analysis. J Interprof Care 2017; 32:160-168. [DOI: 10.1080/13561820.2017.1394279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aseel S. Abuzour
- Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Penny J. Lewis
- Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Mary P. Tully
- Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
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King M, Chambers A, Miller E, Hook A, Jackson L, Gurbutt R, Woods-Gallagher S. Reimagining Undergraduate Health and Social Care Education: A Workforce Fit for Purpose in a Changing Landscape of Care. A Position Paper. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1054137317727102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
NHS England’s Five Year Forward View outlines new care models and the need for a workforce that has the skills, values, and competencies to deliver this vision. This is a position paper detailing the context, method, and intentions of a Health Education England funded project led by Manchester Metropolitan University in the North West of England, which the authors see as making a key contribution to addressing issues of illness, crisis, and loss in the changing landscape of health and social care provision in England. Using an action research methodology and drawing together key stakeholders from the sector, the project aims to explore the potential for creating a professional health and social care graduate workforce which meets the needs of an integrated service delivery landscape by identifying key issues to be addressed when redeveloping the undergraduate curriculum.
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Affiliation(s)
- Martin King
- Manchester Metropolitan University, Manchester, UK
| | | | - Eula Miller
- Manchester Metropolitan University, Manchester, UK
| | - Angela Hook
- University of Salford, Greater Manchester, UK
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The Care of Older Adults Experiencing Cognitive Challenges: How Interprofessional Teams Collaborate. Can J Aging 2017; 36:485-500. [PMID: 28920561 DOI: 10.1017/s0714980817000368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We conducted a scoping study to examine how interprofessional health care teams improve the outcomes of older adults experiencing cognitive challenges. We searched Ovid, Medline 1946, and MEDLINE In-Process and other non-indexed citations, using the concepts multi or interdisciplinary care teams, confusion or cognitive impairment, and elderly adults. Of 4,554 articles the review yielded, 34 relevant to our inquiry, using Arksey and O'Malley's methodological framework. Twenty-nine per cent of authors reported on the processes interprofessional teams use to achieve positive outcomes for older adults. They highlighted the importance of communication, staff strategies, and education interventions in achieving outcomes with older adults and in supporting interprofessional collaboration. The review revealed knowledge gaps about the processes teams use to collaborate in caring for older adults experiencing cognitive challenges, and how to best incorporate older adults and their families' perspectives in team decisions. More research to understand processes interprofessional teams use is needed.
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Welch Bacon CE, Erickson CD, Kay MC, Weber ML, Valovich McLeod TC. School nurses' perceptions and experiences with an interprofessional concussion management team in the secondary school setting. J Interprof Care 2017; 31:725-733. [PMID: 28876140 DOI: 10.1080/13561820.2017.1345873] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Following a concussion, both cognitive and physical rest are imperative aspects of injury management. The inclusion of academic adjustments and the formation of an interprofessional concussion management team (ICMT) provide a mechanism to manage academic issues following a concussion. As one of the sole healthcare providers presents during school hours, the school nurse may offer unique insight regarding the infrastructure of an ICMT in the secondary school setting. The purpose of this study was to explore school nurses' perceptions of and experiences with an ICMT for adolescents following a concussion in the secondary school setting. The consensual qualitative research approach was used to guide this study. Semi-structured individual telephone interviews were conducted with 15 school nurses employed in the secondary school setting across the United States. During data analysis, themes and categories were established based on a consensus process by the research team. Study findings indicated that school nurses identified several stakeholders regarding the concussion management team that are essential to include in the concussion management process. In addition to the school nurse, participants perceived an ICMT should include a physician, athletic trainer, school counsellor, teachers, and other stakeholders such as the patient and their parents. Additionally, participants discussed their perceptions of their own role as a member of an ICMT in the secondary school setting. The inclusion of an ICMT to aid the recovery following a concussion is vital to ensure proper care for the adolescent patient. Furthermore, the school nurse and athletic trainer must effectively collaborate, when possible, to ensure that concussed adolescents are allowed sufficient cognitive rest via the incorporation of academic adjustments during the recovery process.
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Affiliation(s)
- Cailee E Welch Bacon
- a Athletic Training Programs , A.T. Still University , Mesa , Arizona , USA.,b School of Osteopathic Medicine in Arizona , A.T. Still University , Mesa , Arizona , USA
| | - Casey D Erickson
- a Athletic Training Programs , A.T. Still University , Mesa , Arizona , USA
| | - Melissa C Kay
- c Department of Exercise Science , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Michelle L Weber
- d Department of Kinesiology, University of Georgia , Athens , Georgia , USA
| | - Tamara C Valovich McLeod
- a Athletic Training Programs , A.T. Still University , Mesa , Arizona , USA.,b School of Osteopathic Medicine in Arizona , A.T. Still University , Mesa , Arizona , USA
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Lindh Falk A, Hult H, Hammar M, Hopwood N, Abrandt Dahlgren M. Nursing assistants matters-An ethnographic study of knowledge sharing in interprofessional practice. Nurs Inq 2017; 25:e12216. [DOI: 10.1111/nin.12216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Annika Lindh Falk
- Department of Medicine and Health Sciences; Faculty of Medicine and Health Sciences; Linköping University; Linköping Sweden
| | - Håkan Hult
- Department of Clinical Sciences, Intervention and Technology; Karolinska Institute; Stockholm Sweden
| | - Mats Hammar
- Department of Clinical and Experimental Medicine; University Hospital, Linköping University; Linköping Sweden
| | - Nick Hopwood
- Faculty of Arts and Social Science; University of Technology Sydney; Australia and University of Stellenbosch, South Africa
| | - Madeleine Abrandt Dahlgren
- Department of Medicine and Health Sciences; Faculty of Medicine and Health Sciences; Linköping University; Linköping Sweden
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Baatiema L, de-Graft Aikins A, Sav A, Mnatzaganian G, Chan CKY, Somerset S. Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals. BMJ Open 2017; 7:e015385. [PMID: 28450468 PMCID: PMC5719663 DOI: 10.1136/bmjopen-2016-015385] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals' views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. DESIGN A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. SETTING A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. PARTICIPANTS A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. RESULTS Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. CONCLUSION Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.
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Affiliation(s)
- Leonard Baatiema
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Legon, Ghana
| | - Adem Sav
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Melbourne, Australia
| | - Carina K Y Chan
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Shawn Somerset
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
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Toiviainen H, Kira M. From struggles to resource gains in interprofessional service networks: Key findings from a multiple case study. J Interprof Care 2017; 31:479-486. [DOI: 10.1080/13561820.2017.1301898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Mari Kira
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
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Morgan CJ. Graduates’ development of interprofessional practice capability during their early socialisation into professional roles. J Interprof Care 2017; 31:438-445. [DOI: 10.1080/13561820.2017.1295029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Jane Morgan
- School of Interprofessional Health Studies, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Forsyth C, Mason B. Shared leadership and group identification in healthcare: The leadership beliefs of clinicians working in interprofessional teams. J Interprof Care 2017; 31:291-299. [DOI: 10.1080/13561820.2017.1280005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Craig Forsyth
- Department of Specialist Services, Hounslow Learning Disability Team, Hounslow & Richmond Community Healthcare NHS Trust, Hounslow, UK
| | - Barbara Mason
- Department of Psychology, University of Hertfordshire, Hatfield, UK
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Coyle J, Gill SD. Acceptance of primary practitioner physiotherapists in an emergency department: A qualitative study of interprofessional collaboration within workforce reform. J Interprof Care 2017; 31:226-232. [PMID: 28129006 DOI: 10.1080/13561820.2016.1233394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Primary contact practitioner physiotherapists (PPs) are increasingly common in emergency departments (EDs) and provide targeted care to people with uncomplicated musculoskeletal conditions such as sprains, strains, and simple fractures. Workforce redesign can be challenging and success is influenced by staff attitude and opinion. The current study aimed to explore the experiences and perceptions of ED team members about a recently introduced PP service on existing staff and services in a large regional ED. Forty-two staff from eight professional groups participated in semi-structured interviews or focus groups which were audio recorded and field notes were taken. Data were transcribed verbatim and subsequently underwent thematic analysis. Acceptance emerged as one key theme. Acceptance of the PP service by ED staff was not automatic, unconditional, or implied and represented a continuum from PPs being tolerated as transient visitors to being subsumed as integrated members of the ED team. Acceptance of the service and its members was contingent upon the PPs demonstrating three interdependent qualities: being trustworthy, valuing learning, and complementing (not competing with) ED practices to achieve ED goals. Given that staff acceptance was crucial for the successful integration and performance of the service, understanding and manipulating the factors that influence acceptance might increase the likelihood of successfully implementing PP services in EDs. The results might also be applied to facilitate workforce reform in other settings.
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Affiliation(s)
- Julia Coyle
- a Office for Students , Charles Sturt University , Wagga Wagga , New South Wales , Australia
| | - Stephen D Gill
- b Physiotherapy Department , Barwon Health , Geelong , Victoria , Australia
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Stow J, Morphet J, Griffiths D, Huggins C, Morgan P. Lessons learned developing and piloting interprofessional handover simulations for paramedic, nursing, and physiotherapy students. J Interprof Care 2016; 31:132-135. [PMID: 27996352 DOI: 10.1080/13561820.2016.1251404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Interprofessional education is an important element in the preparation of healthcare students who can communicate effectively and work collaboratively. A grant from Health Workforce Australia funded a shared nursing, paramedicine, and physiotherapy simulation suite and a staff member dedicated to interprofessional simulation, with the aim of increasing high fidelity simulation within and across the three professions. This article describes the development process and pilot testing of four purpose-designed interprofessional handover scenarios for paramedic, nursing, and physiotherapy students. The scenarios tracked an elderly patient (manikin) with a fractured neck of femur from pre-hospital to postoperative assessment and handover. The National League of Nursing Simulation Design Scale was used to evaluate the scenarios. Students' feedback indicated they considered the simulations to be relevant to their practice, with a high level of fidelity. This study re-emphasises the importance of pilot testing simulations before use in large-scale studies.
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Affiliation(s)
- Jill Stow
- a School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences , Monash University , Frankston , Victoria , Australia
| | - Julia Morphet
- a School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences , Monash University , Frankston , Victoria , Australia
| | - Debra Griffiths
- a School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences , Monash University , Frankston , Victoria , Australia
| | - Chris Huggins
- b Department of Community Emergency Health and Paramedic Practice, Faculty of Medicine, Nursing and Health Sciences , Monash University , Frankston , Victoria , Australia
| | - Prue Morgan
- c Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences , Monash University , Frankston , Victoria , Australia
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Gregory PAM, Austin Z. Conflict in community pharmacy practice: The experience of pharmacists, technicians and assistants. Can Pharm J (Ott) 2016; 150:32-41. [PMID: 28286591 DOI: 10.1177/1715163516679426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraprofessional conflict among pharmacists, regulated technicians and assistants may undermine attempts to advance patient care in community pharmacy. There is no available research examining this issue in light of the evolution of the profession and roles within the profession. METHODS A combination of interviews and focus groups involving pharmacists, technicians and assistants was undertaken. Each participant completed the Conflict Management Scale as a way of identifying conflict management style. Data were analyzed and coded using a constant-comparative, iterative method. RESULTS A total of 41 pharmacy team members participated in this research (14 pharmacists, 14 technicians and 13 assistants). Four key themes were identified that related to conflict within community pharmacy: role misunderstanding, threats to self-identity, differences in conflict management style and workplace demotivation. INTERPRETATION As exploratory research, this study highlighted the need for greater role clarity and additional conflict management skills training as supports for the pharmacy team. The impact of conflict in the workplace was described by participants as significant, adverse and multifactorial. CONCLUSIONS To support practice change, there has been major evolution of roles and responsibilities of pharmacists, technicians and assistants. Conflict among pharmacy team members has the potential to adversely affect the quality of care provided to patients and is an issue for managers, owners, regulators and educators.
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Affiliation(s)
- Paul A M Gregory
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Zubin Austin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Kulnik ST, Pöstges H, Brimicombe L, Hammond J, Jones F. Implementing an interprofessional model of self-management support across a community workforce: A mixed-methods evaluation study. J Interprof Care 2016; 31:75-84. [DOI: 10.1080/13561820.2016.1246432] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
| | - Heide Pöstges
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
| | - Lucinda Brimicombe
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
| | - John Hammond
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK
- Bridges Self-Management Limited, London, UK
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Salter KL, Kothari A. Knowledge 'Translation' as social learning: negotiating the uptake of research-based knowledge in practice. BMC MEDICAL EDUCATION 2016; 16:76. [PMID: 26925578 PMCID: PMC4772655 DOI: 10.1186/s12909-016-0585-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Knowledge translation and evidence-based practice have relied on research derived from clinical trials, which are considered to be methodologically rigorous. The result is practice recommendations based on a narrow view of evidence. We discuss how, within a practice environment, in fact individuals adopt and apply new evidence derived from multiple sources through ongoing, iterative learning cycles. DISCUSSION The discussion is presented in four sections. After elaborating on the multiple forms of evidence used in practice, in section 2 we argue that the practitioner derives contextualized knowledge through reflective practice. Then, in section 3, the focus shifts from the individual to the team with consideration of social learning and theories of practice. In section 4 we discuss the implications of integrative and negotiated knowledge exchange and generation within the practice environment. Namely, how can we promote the use of research within a team-based, contextualized knowledge environment? We suggest support for: 1) collaborative learning environments for active learning and reflection, 2) engaged scholarship approaches so that practice can inform research in a collaborative manner and 3) leveraging authoritative opinion leaders for their clinical expertise during the shared negotiation of knowledge and research. Our approach also points to implications for studying evidence-informed practice: the identification of practice change (as an outcome) ought to be supplemented with understandings of how and when social negotiation processes occur to achieve integrated knowledge. This article discusses practice knowledge as dependent on the practice context and on social learning processes, and suggests how research knowledge uptake might be supported from this vantage point.
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Affiliation(s)
- K. L. Salter
- />Graduate Program, Health and Rehabilitation Sciences, Western University, London, ON Canada
| | - A. Kothari
- />Graduate Program, Health and Rehabilitation Sciences, Western University, London, ON Canada
- />School of Health Studies, Western University, London, Ontario, Canada
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O’Carroll V, McSwiggan L, Campbell M. Health and social care professionals’ attitudes to interprofessional working and interprofessional education: A literature review. J Interprof Care 2015; 30:42-9. [DOI: 10.3109/13561820.2015.1051614] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Veronica O’Carroll
- School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, Fife, Scotland, UK
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Linda McSwiggan
- School of Nursing and Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Martin Campbell
- School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, Fife, Scotland, UK
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Kinnison T, May SA, Guile D. Veterinary team interactions, part one: the practice effect. Vet Rec 2015; 177:419. [PMID: 26446881 DOI: 10.1136/vr.103312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 11/04/2022]
Abstract
Veterinary practices have evolved since the era of solo practitioners working on one site. Today veterinary practices tend to include veterinary surgeons, veterinary nurses, receptionists and business managers, leading to the notion of the veterinary team and the rise of interprofessional working. In addition, practices have grown in size and frequently include several branches, creating a distributed team. Research regarding veterinary teamwork is lacking. This paper uses Social Network Analysis (SNA) to address this issue. SNA measures interactions between members of a network. The types of interactions in practice and the effects of practice size and location (branches) are considered. Information sharing and asking for advice are straightforward, lower order interactions. Problem solving and being influenced by another are complex, higher order interactions. Smaller practices have higher densities of interactions, implying a more cohesive team. However, individuals in smaller practices still do not interact with everyone and therefore actively choose with whom to interact. Practices with little staff rotation across branches experience limited interactions across locations. The results of this study have implications for practices aiming to expand their team, either in a single site or by acquiring more branches. Suggestions for ways to maintain and improve interactions are made.
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Affiliation(s)
- T Kinnison
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - S A May
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, UK
| | - D Guile
- Department of Lifelong and Comparative Education, The Institute of Education, 20 Bedford Way, London WC1H 0AL, UK
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Abstract
Purpose
– The aim of this paper is to confirm whether the factors that act as enablers of team effectiveness in professional context are also relevant for team effectiveness in higher education.
Design/methodology/approach
– From a review of the factors that act as enablers of team effectiveness in professional contexts, this paper explores whether they are also relevant in learning environments, in particular, in higher education. After conducting a literature analysis, a Delphi study was conducted to obtain a consensus proposal of a set of input factors that can act as enablers of team effectiveness; next this paper explored, via questionnaire, in a specific context the perceptions of lecturers and students involved in teamwork.
Findings
– A set of factors reached by consensus that seem to be enablers of team effectiveness in the specific context analyzed is presented. These factors can be the basis of future studies to generalize their validity.
Originality/value
– There are many studies that identify the factors that act as enablers of team effectiveness in professional environments. The set of input factors that emerged in this study would be a useful starting point for making higher education institutions and lecturers aware of the importance of taking these factors into account when using teamwork as an educational methodology. Fostering these factors will help higher education institutions to generate shared team mental models (TMMs); these TMMs, in turn, influence team effectiveness.
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