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Verhagen MJ, Frouws MA, Timmer RA, Schepers A, Brunsveld-Reinders AH, de Vos MS, Hamming JF. How to Support Communication Between Nurses and Residents During Shift Work: A Mixed-Methods Study Into Local Practices and Perceptions. JOURNAL OF SURGICAL EDUCATION 2024; 81:1034-1043. [PMID: 38879374 DOI: 10.1016/j.jsurg.2024.05.017] [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: 02/29/2024] [Revised: 04/15/2024] [Accepted: 05/20/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE The aim of this study was to explore local practices and perceptions of effective nurse-resident communication during shifts. Subsequently, effective communication was sought to be reinforced by implementing an initiative for improvement. DESIGN A mixed-methods study was performed, combining a questionnaire with focus groups. Following qualitative analysis, 3 initiatives for improvement of nurse-resident communication were scrutinized, after which 1 initiative was implemented. Overall contentment with the implementation and effectiveness of communication was reassessed through a questionnaire at 3 months postimplementation. SETTING This study took place between 2022 and 2023 at the Department of Surgery of the Leiden University Medical Center, a tertiary center in the Netherlands. PARTICIPANTS All surgical nurses (n = 150) and residents (n = 20) were invited to participate, by responding to the questionnaire and take part in the focus groups. A total of 38 nurses (response rate 25.3%) and 12 residents (60%) completed the questionnaire, and 31 nurses and 13 residents participated in the focus groups. RESULTS The themes "clarity," "mutual respect," "accessibility" and "approach" were critical for effective communication, in which there were interdisciplinary differences in the interpretation and needs regarding "clarity." In response, structured moments for interdisciplinary consultation during shifts were implemented, which were foremostly useful according to nurses (73.9%), compared to residents (40.0%). A majority of the nurses agreed that communication during shifts improved through fixed moments (60.9%). CONCLUSION Differences in the perception of critical elements for efficient nurse-resident communication during shifts can be found, which could possibly be explained by differences in training and culture. Mutual awareness for each other's tasks, responsibilities and background seems vital for the ability to deliver good patient care during shifts. To improve interprofessional practice and overcome concerns of quality of care, attention for local practices is imperative. Practical arrangements, such as fixed moments for peer communication, can strengthen partnership during shift work.
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Affiliation(s)
| | | | | | - Abbey Schepers
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Marit S de Vos
- Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Leiden University Medical Center, Leiden, The Netherlands
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Dai ZH, Xu L, Yang Y, He XN, Chen K. Effects of integrated management on surgical outcomes and mental health of patients following endoscopic submucosal dissection. World J Clin Cases 2024; 12:4034-4040. [PMID: 39015912 PMCID: PMC11235559 DOI: 10.12998/wjcc.v12.i20.4034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a less invasive local treatment for diseases throughout the gastrointestinal tract. AIM To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD. METHODS The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management. RESULTS The management group exhibited shortened fasting time and length of hospital stay compared to the control group (P < 0.05). The management group exhibited a higher incidence rate of postoperative complications than the control group (3 cases vs 11 cases; P = 0.043). The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery (P < 0.05). The management group gave more scores on the domains of patient familiarity to the responsible nurses, professional skills of responsible nurses, and general evaluation compared to the control group. The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group (P < 0.01). The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery (P < 0.01). CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.
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Affiliation(s)
- Zhu-Hua Dai
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Lu Xu
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Yu Yang
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Xu-Ni He
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
| | - Ke Chen
- Department of Gastroenterology, Ningbo Yinzhou No. 2 Hospital, Ningbo 315000, Zhejiang Province, China
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Petruzzi L, Smithwick J, Lee L, Delva J, Fox L, Wilkinson G, Vohra-Gupta S, Aranda M, Valdez C, Jones B. Community Health Work and Social Work Collaboration: Integration in Health Care and Public Health Settings: A Conceptual Framework. J Ambul Care Manage 2024; 47:187-202. [PMID: 38775666 DOI: 10.1097/jac.0000000000000498] [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: 06/01/2024]
Abstract
Community health worker (CHW) and social worker (SW) collaboration is crucial to illness prevention and intervention, yet systems often engage the 2 workforces in silos and miss opportunities for cross-sector alignment. In 2021, a national workgroup of over 2 dozen CHWs, SWs, and public health experts convened to improve CHW/SW collaboration and integration across the United States. The workgroup developed a conceptual framework that describes structural, systemic, and organizational factors that influence CHW/SW collaboration. Best practices include standardized training, delineated roles and scopes of practice, clear workflows, regular communication, a shared system for documentation, and ongoing support or supervision.
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Affiliation(s)
- Liana Petruzzi
- Author Affiliations: Dell Medical School at the University of Texas at Austin, Austin, Texas (Drs Petruzzi, Valdez, and Jones); Center for Community Health Alignment, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (Mss Smithwick and Fox); Knowledge Transfer Exchange Strategies, LLC, Corona, California (Dr Lee); Center for Innovation in Social Work Health, Boston University School of Social Work, Boston, Massachusetts (Dr Delva and Mr Wilkinson); Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas (Drs Vohra-Gupta, Valdez, and Jones); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California (Dr Aranda)
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González-López MM, Esquinas-López C, Romero-García M, Benito-Aracil L, Martínez-Momblan MA, Villanueva-Cendán M, Jaume-Literas M, Hospital-Vidal MT, Delgado-Hito P. Intensity of Interprofessional Collaboration and related factors in Intensive Care Units. A descriptive cross-sectional study with an analytical approach. ENFERMERIA INTENSIVA 2024; 35:188-200. [PMID: 38944574 DOI: 10.1016/j.enfie.2023.10.002] [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: 12/29/2022] [Accepted: 10/02/2023] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To determine the Intensity of Collaboration between the intensive care professionals of a third level hospital. METHOD Descriptive cross-sectional study with an analytical approach. SETTING 6 intensive care units of a third level hospital. SAMPLE nurses and doctors. Consecutive type non-probabilistic sampling. DATA COLLECTION sociodemographic, economic, motivation and professional satisfaction variables, and the intensity of collaboration using the "Scale of Intensity of Interprofessional Collaboration in Health." RESULTS A total of 102 health professionals (91 nurses and 11 doctors) were included. The mean overall Intensity of Collaboration (IoC) was moderate. Men showed higher scores in all factors (p<.05). The IoC global score was higher in the group of professionals with ≤10 years of experience (p=.043) and those who were highly satisfied with the profession (p=.037). Physicians presented higher scores in the global IdC (p=.037) and in the Collaboration mean (p=.020) independently in the multivariate models. A negative linear relationship (rho: -0,202, p=.042) was observed between age and the overall IoC score. Professionals aged ≤30years reported a higher perception of Shared Activities (p=.031). Negative linear relationships were observed between years of experience and total IoC score (rho: -0,202, p=.042) and patients' Perception score (rho: -0.241, p=0.015). The research activity also showed to be a variable related to a greater degree of Collaboration at a global level and in some of the factors (p<.05). The scale of IoC obtained a Cronbach's α of 0,9. CONCLUSIONS The intensity of interprofessional collaboration in ICUs is moderate. Professionals with experience of ≤10 years, a higher level of satisfaction and participation in research activities show a greater intensity of collaboration. Doctors perceive collaboration more intensely than nurses. All factors contribute equally to the internal consistency of the questionnaire.
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Affiliation(s)
- M M González-López
- Unidad de Cuidados Intensivos Quirúrgicos, Hospital Clínic de Barcelona, Barcelona, Spain; Departamento de Enfermería Fundamental y Médico-quirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain
| | - C Esquinas-López
- Departamento de Enfermería de Salud pública, Salud Mental y Materno-Infantil, Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain.
| | - M Romero-García
- Departamento de Enfermería Fundamental y Médico-quirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain; Grupo de Investigación Enfermera-Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
| | - L Benito-Aracil
- Departamento de Enfermería Fundamental y Médico-quirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain; Grupo de Investigación Enfermera-Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain
| | - M A Martínez-Momblan
- Departamento de Enfermería Fundamental y Médico-quirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain
| | - M Villanueva-Cendán
- Unidad de Cuidados Intensivos Quirúrgicos, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Jaume-Literas
- Unidad de Cuidados Intensivos Quirúrgicos, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M T Hospital-Vidal
- Unidad de Cuidados Intensivos Quirúrgicos, Hospital Clínic de Barcelona, Barcelona, Spain
| | - P Delgado-Hito
- Departamento de Enfermería Fundamental y Médico-quirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain; Grupo de Investigación Enfermera-Instituto de Investigación Biomédica de Bellvitge (GRIN-IDIBELL), Barcelona, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
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Klafke N, Bossert J, Boltenhagen U, Froehlich D, Mahler C, Joos S, Wensing M. Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions. PATIENT EDUCATION AND COUNSELING 2024; 127:108352. [PMID: 38905751 DOI: 10.1016/j.pec.2024.108352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 05/23/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany. METHODS Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020. RESULTS Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation. CONCLUSIONS Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients. PRACTICE IMPLICATIONS Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.
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Affiliation(s)
- Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Boltenhagen
- Institute of Health Sciences, Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Daniela Froehlich
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia Mahler
- Institute of Health Sciences, Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Eið RC, Strøyer de Voss S, Wilson P, Overbeck G. Collaboration between general practitioners and health visitors about children of concern in Denmark: a qualitative study. J Interprof Care 2024:1-9. [PMID: 38813754 DOI: 10.1080/13561820.2024.2357118] [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: 03/21/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
Primary health care services are responsible for preventive measures to optimize child development in the first years of life. In Denmark, these services are shared between general practitioners and municipality health visitors. National guidelines mandate collaboration between these professionals but in reality, they work in parallel. We aimed to explore how professionals experience collaboration and communication regarding children with professional concern about their wellbeing. Seventeen semi-structured interviews were conducted with general practitioners, and health visitors. Both professions considered closer collaboration to be important in meeting children's needs. Barriers to collaboration and communication included differing legal obligations, Information Technology-systems (IT), lack of financial incentives, lack of mutual professional acknowledgment and respect, and absence of routines for sharing knowledge. The traditional division of responsibilities between physicians and nurses in which all professionals involved in preventive child health care are acculturated seems to impede collaboration based on unequal professional status. IT infrastructure needs to support information sharing and structures to support informal meetings between professionals are warranted to support more collaborative practice.
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Affiliation(s)
- Rebekka Consuelo Eið
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Sarah Strøyer de Voss
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Philip Wilson
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Centre for Rural Health, University of Aberdeen, Aberdeen, UK
| | - Gritt Overbeck
- Centre for General Practice, Institute of Public Health, University of Copenhagen, Kobenhavn, Denmark
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Bulut A, Sengül H, Mumcu Çİ, Mumcu B. Physician-nurse collaboration in the relationship between professional autonomy and practice behaviors. Nurs Ethics 2024:9697330241252971. [PMID: 38768998 DOI: 10.1177/09697330241252971] [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: 05/22/2024]
Abstract
BACKGROUND Nurses and physicians are key members of healthcare teams. While physicians are responsible for the diagnosis and treatment of patients, nurses are part of the treatment and the primary practitioners of patient care. Nurses' professional autonomy, collaboration with physicians, and practice behaviors in treatment and patient care practices are interrelated. OBJECTIVES In the present study, we examined the mediating effect of physician-nurse collaboration on the relationship between nurses' practice behaviors and their professional autonomy. DESIGN The present study utilized a cross-sectional survey design following quantitative methods. METHODS This study was conducted in the Istanbul Province of Turkiye from September to October 2022. The sampling method used was a convenience sampling strategy to provide easier access to participants when selecting nurses from different health institutions. The mean age of the 295 nurses was 31.23 years, with ages ranging from 21 to 59 years. The data analysis was conducted using IBM's SPSS 24.0 software package and the Process Macro 4.0 plug-in. ETHICAL CONSIDERATION Research ethics approval was obtained from the researcher's university. RESULTS Physician-nurse collaboration is positively associated with practice behaviors and professional autonomy. Nurses' professional autonomy in practice behaviors through physician-nurse collaboration is significant (95% CI [0.043, 0.135]). DISCUSSION Our results revealed the relationships among physician‒nurse collaboration, professional autonomy, and practice behaviors among nurses. CONCLUSION Our results provide evidence on the underlying factors of nurses' practice behaviors in patient care and guide the development of an intervention program to enhance this collaboration. Hospital managers can contribute to a collaborative physician‒nurse working environment.
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House S, Naim Ali HA, Stucky C. Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center. Qual Manag Health Care 2024:00019514-990000000-00074. [PMID: 38654420 DOI: 10.1097/qmh.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVES High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center. METHODS We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other. RESULTS Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00). CONCLUSIONS We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.
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Affiliation(s)
- Sherita House
- Author Affiliations:University of North Carolina at Greensboro School of Nursing (Dr House); The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Dr Naim Ali); and Center for Nursing Science and Clinical Inquiry (CNSCI), Landstuhl Regional Medical Center, Landstuhl, AE, Germany (Dr Stucky)
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Yoshida Y, Hirakawa Y, Hong YJ, Mamun MR, Shimizu H, Nakano Y, Yatsuya H. Factors influencing interprofessional collaboration in long-term care from a multidisciplinary perspective: a case study approach. Home Health Care Serv Q 2024:1-20. [PMID: 38521999 DOI: 10.1080/01621424.2024.2331452] [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: 03/25/2024]
Abstract
Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required.
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Affiliation(s)
- Yuko Yoshida
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Psychiatry, Daido Hospital, Kojunkai Social Medical Corporation, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Health Research and Innovation, Aichi Comprehensive Health Science Center (Aichi Health Plaza), Chita-Gun, Japan
| | - Young Jae Hong
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Md Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroko Shimizu
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Nakano
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Ali KJ, Goeschel CA, Eckroade MM, Carlin KN, Haugstetter M, Shofer M, Rosen MA. The TeamSTEPPS for Improving Diagnosis Team Assessment Tool: Scale Development and Psychometric Evaluation. Jt Comm J Qual Patient Saf 2024; 50:95-103. [PMID: 37996307 DOI: 10.1016/j.jcjq.2023.08.009] [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: 02/01/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION One in three patients is affected by diagnosis-related communication failures. Only a few valid and reliable instruments that measure teamwork and communication exist, and none of those focus on improving diagnosis. The authors developed, refined, and psychometrically evaluated the TeamSTEPPSⓇ for Improving Diagnosis Team Assessment Tool (TAT), which assesses diagnostic teamwork and communication in five critical teamwork domains and can be used to identify strengths and opportunities for improvement and monitor performance. METHODS The TAT was administered as a cross-sectional survey to 360 health professionals across nine diverse US health systems. Content and construct validity were evaluated through pilot implementation and subject matter expert review. Reliability and internal consistency were assessed with Cronbach's alpha. To understand sources of variation in TAT scores and assess the tool's consistency across diverse health care organizations, generalizability theory (G-theory) was used. Best practices in screening for careless responding identified participants with random or nonvarying responses. RESULTS Analyses indicated strong support for the tool. Content validity findings indicated that the TAT encompassed relevant diagnostic improvement teamwork and communication content. Construct validity, evaluated through pilot implementations, demonstrated the tool's effectiveness in assessing teamwork categories. Reliability analyses confirmed the TAT's internal consistency, with an overall Cronbach's alpha of 0.97. Each dimension of the TAT exhibited good reliability coefficients, ranging from 0.83 to 0.95. G-theory analysis showed that variations in TAT scores were primarily attributed to respondents (28.0%) and scale dimensions (59.6%); both are desirable facets of variation. Further, examination of careless respondents ensured the accuracy and quality of the results, enhancing the TAT's credibility as a valuable diagnostic improvement tool. CONCLUSION Psychometric evaluation demonstrated that the TAT is a reliable and valid instrument for assessing teamwork and communication among and across diagnostic teams. The TAT adds a novel, evidence-based, psychometrically sound measurement tool to help advance diagnostic teamwork and communication to improve patient care and outcomes.
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Harton L, Skemp L. Have our backs-medical-surgical nurses' safety culture experiences: An inductive qualitative descriptive study. Nurs Open 2024; 11:e2095. [PMID: 38391106 PMCID: PMC10825071 DOI: 10.1002/nop2.2095] [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: 09/17/2022] [Revised: 01/08/2023] [Accepted: 12/25/2023] [Indexed: 02/24/2024] Open
Abstract
AIM This study aims to describe medical-surgical registered nurses' experiences with safety culture. DESIGN Qualitative, Inductive descriptive. METHODS Registered nurses were recruited from a Midwestern community hospital in the United States using purposive sampling. The participants were interviewed using semi-structured interview questions from February 6, 2020-April 9, 2020. Safety huddles were observed and key documents were collected. The interviews were transcribed and analyzed using inductive qualitative content analysis. The COREQ checklist was followed. RESULTS A total of 16 registered nurses were interviewed. Six themes emerged: Time to know my patient to keep them safe, using my gut and nursing interventions, getting extra eyes on the patient, not always having what is needed to provide safe care, organization prioritizes patient safety, and learning: have our backs. No Patient or Public Contribution.
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Affiliation(s)
- Lisa Harton
- FACHE Loyola University ChicagoChicagoIllinoisUSA
- Marcella Niehoff School of NursingLoyola University ChicagoChicagoIllinoisUSA
| | - Lisa Skemp
- Marcella Niehoff School of NursingLoyola University ChicagoChicagoIllinoisUSA
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Gustad LT, Bangstad IL, Torsvik M, Rise MB. Nurses' and Physicians' Experiences After Implementation of a Quality Improvement Project to Improve Sepsis Awareness in Hospitals. J Multidiscip Healthc 2024; 17:29-41. [PMID: 38192738 PMCID: PMC10773249 DOI: 10.2147/jmdh.s439017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose Previous research has explored nurses´ experience with the implementation of early detection alert systems, and nurses and physicians' perceptions of sepsis management and use of sepsis triage. As one of the first, this study aims to investigate the perceived usefulness of an interdisciplinary quality improvement project including standardized sepsis patient pathway to improve the early identification and treatment of sepsis patients. Participants and Methods This study was a qualitative study that employed semi-structured interviews with thirteen ward nurses and five ward physicians recruited by convenience and respondent-driven sampling, respectively. The interviews explored the perceived usefulness of mutual training in sepsis care in medical hospital wards. We applied Systematic Text Condensation to analyze the experiences and knowledge of professional identification and cooperation in early identification of sepsis patients. Results The results revealed three main themes: Awareness of sepsis, collaboration between nurses and physicians, and clinical assessment and judgement. The findings highlighted the positive impact of the project in terms of raising awareness, improving communication, and enhancing the ability to detect and treat sepsis. The study also identified the importance of repetition and reminders to maintain awareness, the need for ongoing training for new healthcare professionals, and the challenges of collaboration and decision-making processes. Conclusion The sepsis intervention seemed successful in improving awareness of sepsis and enhancing interprofessional collaboration between nurses and physicians. Health professionals continued to rely on their clinical judgment but increased the use of objective measurements and communication of vital signs. Continuous repetition and education for new colleagues were identified as important factors for the sustainability of the intervention. Overall, the study highlights the importance of standardized protocols and training for early detection and management of sepsis in healthcare settings.
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Affiliation(s)
- Lise Tuset Gustad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Nord-Trøndelag Hospital Trust, Department of Medicine, Levanger Hospital, Levanger, Norway
| | | | - Malvin Torsvik
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Marit By Rise
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Witmer HDD, Morris-Levenson JA, Keçeli Ç, Godley FA, Dhiman A, Adelman D, Turaga KK. Novel Application of a Dynamic, In-room Survey Platform to Measure Surgical Team Satisfaction. Ann Surg 2024; 279:71-76. [PMID: 37436888 DOI: 10.1097/sla.0000000000005993] [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: 07/14/2023]
Abstract
OBJECTIVE To elucidate the potential usage of continuous feedback regarding team satisfaction and correlations with operative performance and patient outcomes. BACKGROUND Continuous, actionable assessment of teamwork quality in the operating room (OR) is challenging. This work introduces a novel, data-driven approach to prospectively and dynamically assess health care provider satisfaction with teamwork in the OR. METHODS Satisfaction with teamwork quality for each case was assessed utilizing a validated prompt displayed on HappyOrNot Terminals placed in all ORs, with separate panels for circulators, scrub nurses, surgeons, and anesthesia providers. Responses were cross-referenced with OR log data, team familiarity indicators, efficiency parameters, and patient safety indicator events through continuous, semiautomated data marts. Deidentified responses were analyzed through logistic regression modeling. RESULTS Over a 24-week period, 4123 responses from 2107 cases were recorded. The overall response rate per case was 32.5%. Greater scrub nurse specialty experience was strongly associated with satisfaction (odds ratio: 2.15, 95% CI: 1.53-3.03, P < 0.001). Worse satisfaction was associated with longer than expected procedure time (odds ratio: 0.91, 95% CI: 0.82-1.00, P = 0.047), nighttime (0.67, 95% CI: 0.55-0.82, P < 0.001), and add-on cases (0.72, 95% CI: 0.60-0.86, P < 0.001). Higher material costs (22%, 95% CI: 6-37, P = 0.006) were associated with greater team satisfaction. Cases with superior teamwork ratings were associated with a 15% shorter length of hospital stay (95% CI: 4-25, P = 0.006). CONCLUSIONS This study demonstrates the feasibility of a dynamic survey platform to report actionable health care provider satisfaction metrics in real-time. Team satisfaction is associated with modifiable team variables and some key operational outcomes. Leveraging qualitative measurements of teamwork as operational indicators may augment staff engagement and measures of performance.
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Affiliation(s)
- Hunter D D Witmer
- Department of Surgery, University of Chicago Medicine, Chicago, IL
- Department of Operations Management, University of Chicago Booth School of Business, Chicago, IL
| | | | - Çağla Keçeli
- Department of Operations Management, University of Chicago Booth School of Business, Chicago, IL
| | | | - Ankit Dhiman
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Daniel Adelman
- Department of Operations Management, University of Chicago Booth School of Business, Chicago, IL
| | - Kiran K Turaga
- Department of Surgery, University of Chicago Medicine, Chicago, IL
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Alexander AB, Funches L, Katta-Charles S, Williamson FA, Wright C, Kara A, Slaven JE, Nabhan Z. Facilitators and Barriers to the Adoption of Holistic Practices for Inclusive Recruitment in Graduate Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241260243. [PMID: 38868679 PMCID: PMC11168044 DOI: 10.1177/23821205241260243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 05/17/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE A diverse physician workforce ensures equitable care. The holistic review of residency applications is one strategy to enhance physician diversity; however, little is known about current adoption and the factors that facilitate/impede the adoption of holistic recruitment practices (HRPs) by graduate medical education (GME) residency, and fellowship program directors (PDs). To describe the current state and explore, the barriers/facilitators to the adoption of HRPs at our institution. METHODS We disseminated information about HRP within our program between 2021 and 2022. In May 2022, a survey of 73 GME PDs assessed current recruitment practices and self-reported barriers to holistic recruitment. Holistic Recruitment Scores (HRSs) reflecting the adoption of best practices were tabulated for each program and compared to identify predictors of adoption. RESULTS 73/80 (92%) of PDs completed the survey. Programs whose PDs had higher academic rank, total number of trainees, and female trainees in the past 3 years had higher HRSs. Program size was directly correlated with HRS. Most (93%) PDs felt their current efforts were aligned to increase diversity and 58% felt there were no barriers to the adoption of holistic review. The most reported barriers were lack of time and knowledge/expertise in diversity, equity, and inclusion (DEI), both reported by 16 out of 73 PDs (22%). CONCLUSION While most PDs implemented some HRP, institutional and departmental support of program directors through the commitment of resources (eg, staffing help and subject matter experts/coaches hiring) are crucial to overcome barriers.
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Affiliation(s)
- Andreia B. Alexander
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Levi Funches
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sheryl Katta-Charles
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Francesca A. Williamson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Curtis Wright
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Areeba Kara
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James E. Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zeina Nabhan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Office of Graduate Medical Education, Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Woldring JM, Gans ROB, Paans W, Luttik ML. Physicians and nurses view on their roles in communication and collaboration with families: A qualitative study. Scand J Caring Sci 2023; 37:1109-1122. [PMID: 37248644 DOI: 10.1111/scs.13185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Families are introduced as new partners in interprofessional communication and collaboration during hospitalisation of an adult patient. Their introduction into the healthcare team has consequences for the roles and responsibilities of all healthcare professionals. Role clarification is thus needed to create optimal communication and collaboration with families. AIM To gain insight into how physicians and nurses view their own roles and each other's roles in communication and collaboration with families in the care of adult patients. METHODS A qualitative interpretive interview design was used. Fourteen semi-structured interviews, with seven physicians and seven nurses, were conducted. Data were analysed according to the steps of thematic analysis. For the study design and analysis of the results, the guidelines of the consolidated criteria for reporting qualitative studies (COREQ) were followed. The ethical committee of the University Medical Center Groningen approved the study protocol (research number 202100640). FINDINGS Thematic analysis resulted in three themes, each consisting of two or three code groups. Two themes "building a relationship" and "sharing information" were described as roles that both nurses and physicians share regarding communication and collaboration with families. The role expectations differed between physicians and nurses, but these differences were not discussed with each other. The theme "providing support to family" was regarded a nurse-specific role by both professions. CONCLUSION Physicians and nurses see a role for themselves and each other in communication and collaboration with families. However, the division of roles and expectations thereof are different, overlapping, and unclear. To optimise the role and position of family during hospital care, clarification and division of the roles between physicians and nurses in this partnership is necessary.
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Affiliation(s)
- Josien M Woldring
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolter Paans
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
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Ma X, Duan Y, Ma Y, Gao Z, Zhang H. Co-teaching in medicine and nursing in training nurse anesthetists: a before-and-after controlled study. BMC MEDICAL EDUCATION 2023; 23:856. [PMID: 37953254 PMCID: PMC10641995 DOI: 10.1186/s12909-023-04827-8] [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: 02/01/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Clarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training. METHOD The study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed. RESULTS Participants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved. CONCLUSION In comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills.
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Affiliation(s)
- Xiaobei Ma
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing, 102218, China
| | - Yi Duan
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing, 102218, China
| | - Yanli Ma
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing, 102218, China
| | - Zhifeng Gao
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing, 102218, China.
| | - Huan Zhang
- Department of Anesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing, 102218, China
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Pantha S, Jones M, Gray R. Stakeholders' Perceptions of How Nurse-Doctor Communication Impacts Patient Care: A Concept Mapping Study. NURSING REPORTS 2023; 13:1607-1623. [PMID: 37987412 PMCID: PMC10661264 DOI: 10.3390/nursrep13040133] [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: 08/12/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
There is some evidence that aspects of nurse-doctor communication are associated with the quality of care and treatment patients receive whilst they are in hospital. To date, no studies have examined stakeholder perceptions on how patient care is influenced by clinical communication between nurses and doctors. We conducted a concept mapping study to generate a deep understanding of how clinical communication impacts patient care. Concept mapping has six phases: preparation, idea generation, structuring, representation, interpretation, and utilization. A total of 20 patients, 21 nurses, and 21 doctors participated in the study. Brainstorming generated 69 discreet statements about how nurse-doctor communication impacts patient care. The structuring (rating and clustering) phase was completed by 48 participants. The data interpretation workshop selected a five-cluster solution: effective communication, trust, patient safety, impediments to patient care, and interpersonal skills. On the final concept map, the five clusters were arranged in a circle around the center of the map. Clusters were relatively equal in size, suggesting that each concept makes a broadly equal contribution to how nurse-doctor communication influences patient care. Our study suggests that there are multiple aspects of clinical communication that impact patient care. Candidate interventions to enhance nurse-doctor communication may need to consider the complex nature of interprofessional working. Registration: This study was prospectively registered with the Open Science Framework (OSF) on 09.07.2020 (osf.io/9np8v/) prior to recruiting the first participant.
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Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Noorie, SA 5608, Australia;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
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18
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Krecko LK, Stalter LN, Quamme SRP, Steege LM, Zelenski AB, Greenberg CC, Jung S. Discussion-based interprofessional education: A positive step toward promoting shared understanding between surgical residents and nurses. J Interprof Care 2023; 37:974-989. [PMID: 37161400 PMCID: PMC10636242 DOI: 10.1080/13561820.2023.2206434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lily N Stalter
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sudha R Pavuluri Quamme
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah Jung
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Carter C, Mohammed S, Upshur R, Kontos P. "I don't see the whole picture of their health": a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care. BMC PRIMARY CARE 2023; 24:225. [PMID: 37898764 PMCID: PMC10612350 DOI: 10.1186/s12875-023-02171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/04/2023] [Indexed: 10/30/2023]
Abstract
CONTEXT Interprofessional collaboration is recommended in caring for frail older adults in primary care, yet little is known about how interprofessional teams approach end-of-life (EOL) conversations with these patients. OBJECTIVE To understand the factors shaping nurses' and allied health clinicians' involvement, or lack of involvement in EOL conversations in the primary care of frail older adults. METHODS/SETTING A critical ethnography of a large interprofessional urban Family Health Team in Ontario, Canada. Data production included observations of clinicians in their day-to-day activities excluding direct patient care; one-to-one semi-structured interviews with clinicians; and document review. Analysis involved coding data using an interprofessional collaboration framework as well as an analysis of the normative logics influencing practice. PARTICIPANTS Interprofessional clinicians (n = 20) who cared for mildly to severely frail patients (Clinical Frailty Scale) at the Family Health Team. RESULTS Findings suggest primary care nurses and allied health clinicians have the knowledge, skills, and inclination to engage frail older adults in EOL conversations. However, the culture of the clinic prioritizes biomedical care, and normalizes nurses and allied health clinicians providing episodic task-based care, which limits the possibility for these clinicians' engagement in EOL conversations. The barriers to nurses' and allied health clinicians' involvement in EOL conversations are rooted in neoliberal-biomedical ideologies that shapes the way primary care is governed and practiced. CONCLUSIONS Our findings help to explain why taking an individual-level approach to addressing the challenge of delayed or avoided EOL conversations, is unlikely to result in practice change. Instead, primary care teams can work to critique and redevelop quality indicators and funding models in ways that promote meaningful interprofessional practice that recognize the expertise of nursing and allied health clinicians in providing high quality primary care to frail older patients, including EOL conversations.
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Affiliation(s)
- Celina Carter
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Shan Mohammed
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Ross Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
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Voultsos P, Zymvragou CE, Raikos N. Perceptions and experiences of female nurses when confronted with expressing a conscientious objection towards end-of-life care in Greece. BMC Nurs 2023; 22:372. [PMID: 37817234 PMCID: PMC10563366 DOI: 10.1186/s12912-023-01555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Conscientious objection in nursing has been a topic of much discussion in recent years. Healthcare providers' conscientious objection has been included in Greek legislation. However, little is known about the real experiences of nurses who want to apply conscientious objections in their practice. This study aimed to contribute to filling that gap. METHODS This qualitative study was conducted with eighteen experienced female nurses. Data were collected through semi-structured in-depth qualitative interviews conducted with purposively selected nurses during the period from October 2019 to January 2020. Interviews were transcribed verbatim and analysed thematically. The ethical principles of anonymity, voluntary participation and confidentiality were considered. RESULTS Eight major themes and seven subthemes emerged from the thematic data analysis. Oppressive behaviors in the workplace and subservient interactions between nurses and physicians, suboptimal communication and inadequate support of nurses, perceived ineffectiveness of nurses' conscientious objections, missing legal protection against job insecurity, provision of care labeled 'futile', nurses' false knowledge and perceptions on medical situations related to conscientious objections, nurses' fears of isolation bullying and negative gossip in the workplace and a trivial amount of nurses' involvement in medical decisions emerged as barriers to nurses raising conscientious objection. Furthermore, from data analysis, it emerged that some nurses had false knowledge and perceptions on medical situations related to conscientious objections, some nurses experienced mild uncertainty distress about their ethical concerns, nurses considered their remote contribution as participation that can give rise to conscientious objection, a collective conscientious objection raised by nurses might have increased chances of being effective, and upbringing, childhood experiences, education and religion are factors shaping the nurses' core values. CONCLUSION A total of fifteen themes and subthemes emerged from this study. Most of the findings of this study were previously unknown or undervalued and might be helpful to inform nurses and nursing managers or leaders as well as healthcare policy makers. The results of this study might contribute to addressing the need for creating ethically sensitive health care services and ensuring nurses' moral integrity and high quality of patient care.
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Affiliation(s)
- Polychronis Voultsos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, GR, Greece.
| | - Christina-Erato Zymvragou
- Laboratory of Forensic Medicine & Toxicology (Division: Medical law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, GR, Greece
| | - Nikolaos Raikos
- Laboratory of Forensic Medicine & Toxicology (Division: Medical law and Ethics), School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, GR, Greece
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Pande CK, Stayer K, Rappold T, Alvin M, Koszela K, Kudchadkar SR. Comfort and Coordination among Interprofessional Care Providers Involved in Intubations in the Pediatric Intensive Care Unit. Crit Care Res Pract 2023; 2023:4504934. [PMID: 37829150 PMCID: PMC10567513 DOI: 10.1155/2023/4504934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/14/2023] [Accepted: 08/10/2023] [Indexed: 10/14/2023] Open
Abstract
Background Successful execution of invasive procedures in acute care settings, including tracheal intubation, requires careful coordination of an interprofessional team. The stress inherent to the intensive care unit (ICU) environment may threaten the optimal communication and planning necessary for the safe execution of this complex procedure. The objective of this study is to characterize the perceptions of interprofessional team members surrounding tracheal intubations in the pediatric ICU (PICU). Methods This is a single-center survey-based study of staff involved in the intubation of pediatric patients admitted to a tertiary level academic PICU. Physicians, nurses, and respiratory therapists (RT) involved in tracheal intubations were queried via standardized, discipline-specific electronic surveys regarding their involvement in procedural planning and overall awareness of and comfort with the intubation plan. Qualitative variables were assessed by both Likert scales and free-text comments that were grouped and analyzed thematically. Results One hundred and eleven intubation encounters were included during the study time period, of which 93 (84%) had survey responses from at least 2 professional teams. Among those included in the analysis, the survey was completed 244 times by members of the PICU teams including 86 responses from physicians, 76 from nurses, and 82 from RTs. Survey response rates were >80% from each provider team. There were significant differences in interprofessional team comfort with nurses feeling less well informed and comfortable with the intubation plan and process compared to physicians and RTs (p < 0.001 for both). Qualitative themes including clear communication, adequate planning and preparation prior to procedure initiation, and clear definition of roles emerged among both affirmative and constructive comments. Conclusions Exploration of provider perceptions and emergence of constructive themes expose opportunities for teamwork improvement strategies involving intubations in the PICU. The use of a preintubation checklist may improve organization and communication amongst team members, increase provider morale, decrease team stress levels, and, ultimately, may improve patient outcomes during this high stakes, coordinated event.
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Affiliation(s)
- Chetna K. Pande
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Kelsey Stayer
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Thomas Rappold
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Madeleine Alvin
- Department of Anesthesiology,Critical Care,and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Keri Koszela
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Asadi M, Ahmadi F, Mohammadi E, Vaismoradi M. Unsafe doctor-nurse interactions in the process of implementing medical orders: A qualitative study. Nurs Open 2023; 10:6808-6816. [PMID: 37353880 PMCID: PMC10495711 DOI: 10.1002/nop2.1927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/25/2023] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
AIM This study aimed to explore challenges faced by clinical nurses in the process of implementing medical orders. DESIGN A qualitative study using inductive content analysis. METHODS Semi-structured individual interviews were carried out with 17 participants including nurses, nurse managers and medical doctors who were purposefully selected. The collected data underwent inductive qualitative content analysis. RESULTS The main research finding was the category of 'unsafe doctor-nurse interaction'. It included three subcategories: 'conflicts in documenting and executing orders', 'not accepting the nurse's suggestions for writing and correcting orders' and 'failure to accept the responsibility of orders by the doctor'. Challenges in the professional relationship between doctors and nurses cause mistrust and conflict. They also enhance nurses' concerns about professional and legal issues in the workplace and endanger patient safety.
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Affiliation(s)
- Monireh Asadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Easa Mohammadi
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
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Al-Moteri M, Alzahrani AA, Althobiti ES, Plummer V, Sahrah AZ, Alkhaldi MJ, Rajab EF, Alsalmi AR, Abdullah ME, Abduelazeez AEA, Caslangen MZM, Ismail MG, Alqurashi TA. The Road to Developing Standard Time for Efficient Nursing Care: A Time and Motion Analysis. Healthcare (Basel) 2023; 11:2216. [PMID: 37570456 PMCID: PMC10418769 DOI: 10.3390/healthcare11152216] [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: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.
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Affiliation(s)
- Modi Al-Moteri
- Nursing Department, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Amer A. Alzahrani
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Ensherah Saeed Althobiti
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Virginia Plummer
- Institute of Health and Wellbeing, Federation University, Berwick, VIC 3806, Australia;
| | - Afnan Z. Sahrah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Maha Jabar Alkhaldi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Eishah Fahad Rajab
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Amani R. Alsalmi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Merhamah E. Abdullah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | | | - Mari-zel M. Caslangen
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Mariam G. Ismail
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Talal Awadh Alqurashi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
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You W, Cusack L, Donnelly F. A lack of nurse autonomy impacts population health when compared to physician care: an ecological study. Sci Rep 2023; 13:12047. [PMID: 37491376 PMCID: PMC10368668 DOI: 10.1038/s41598-023-38945-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
This study highlights that the contribution of nursing is secondary to physicians in overall population health (indexed with life expectancy at birth, e(0)). Scatter plots, bivariate correlation and partial correlation models were performed to analyse the correlations between e(0) and physician healthcare and nursing healthcare respectively. Affluence, urbanization and obesity were incorporated as the potential confounders. The Fisher's r-to-z transformation was conducted for comparing the correlations. Multiple linear regression analyses were implemented for modelling that physicians' contributions to e(0) explain nurses'. Nursing healthcare correlated to e(0) significantly less strongly than physician healthcare in simple regressions. Nursing healthcare was in weak or negligible correlation to e(0) when physician healthcare was controlled individually or together with the three confounders. Physician healthcare remains significantly correlational to e(0) when nursing healthcare alone was controlled or when the three confounders were controlled. Linear regression revealed that nursing healthcare was a significant predictor for e(0) when physician healthcare was "not added" for modelling, but this predicting role became negligible when physician healthcare was "added". Our study findings suggested that nurses still work under the direction of physicians due to lack of autonomy. Without correction, health services will continue to transmit the invisibility of nursing healthcare from one generation of nurses to another.
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Affiliation(s)
- Wenpeng You
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.
- Heart and Lung, Royal Adelaide Hospital, Adelaide, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Lynette Cusack
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Frank Donnelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
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Petri CR, Beltran CP, Russell K, FitzGerald J, Sullivan AM, Anandaiah AM. "A Lot to Offer": Nurses as Educators for Medical Residents in an Academic Medical Center Intensive Care Unit. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00080. [PMID: 37341561 DOI: 10.1097/ceh.0000000000000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION The role of fully trained interprofessional clinicians in educating residents has not been rigorously explored. The intensive care unit (ICU), where multiprofessional teamwork is essential to patient care, represents an ideal training environment in which to study this role. This study aimed to describe the practices, perceptions, and attitudes of ICU nurses regarding teaching medical residents and to identify potential targets to facilitate nurse teaching. METHODS Using a concurrent mixed-methods approach, we administered surveys and focus groups to ICU nurses from September to November 2019 at a single, urban, tertiary, academic medical center. Survey data were analyzed with descriptive and comparative statistics. Focus group data were analyzed using the Framework method of content analysis. RESULTS Of nurses surveyed, 75 of 96 (78%) responded. Nurses generally held positive attitudes about teaching residents, describing it as both important (52%, 36/69) and enjoyable (64%, 44/69). Nurses reported confidence in both clinical knowledge base (80%, 55/69) and teaching skills (71%, 49/69), but identified time, uncertainty about teaching topics, and trainee receptiveness as potential barriers. Ten nurses participated in focus groups. Qualitative analysis revealed three major themes: nurse-specific factors that impact teaching, the teaching environment, and facilitators of teaching. DISCUSSION ICU nurses carry positive attitudes about teaching residents, particularly when facilitated by the attending, but this enthusiasm can be attenuated by the learning environment, unknown learner needs, and trainee attitudes. Identified facilitators of nurse teaching, including resident presence at the bedside and structured opportunities for teaching, represent potential targets for interventions to promote interprofessional teaching.
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Affiliation(s)
- Camille R Petri
- Dr. Petri is a Faculty Member in the Division of Pulmonary, Critical Care, and Sleep Medicine, and the Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center and Instructor in Medicine at Harvard Medical School, Boston, MA. Ms. Beltran is Senior Research Coordinator at the New York University Grossman School of Medicine, New York, NY. Ms. Russell is the Nursing Director for the Medical Intensive Care Unit at Beth Israel Deaconess Medical Center, Boston, MA. Dr. FitzGerald is the Nursing Director for the Medical/Surgical Intensive Care Unit at Beth Israel Deaconess Medical Center, Boston, MA. Dr. Sullivan is Director of Education Research at the Shapiro Institute for Education and Research and Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA. Dr. Anandaiah is Program Director of the Massachusetts General Hospital/Beth Israel Deaconess Medical Center/Harvard Pulmonary and Critical Care Medicine Fellowship, and Assistant Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
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Daheshi N, Alkubati SA, Villagracia H, Pasay-an E, Alharbi G, Alshammari F, Madkhali N, Alshammari B. Nurses' Perception Regarding the Quality of Communication between Nurses and Physicians in Emergency Departments in Saudi Arabia: A Cross Sectional Study. Healthcare (Basel) 2023; 11:healthcare11050645. [PMID: 36900650 PMCID: PMC10000906 DOI: 10.3390/healthcare11050645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Background: One of the defining characteristics of safe and highly reliable patient care is effective team communication. It is becoming increasingly crucial to improve communication among healthcare team members since social and medical conditions change quickly. Main aim: The present study seeks to assess nurses' perception of the quality of communications between physicians and nurses and associated factors in the emergency departments of selected government hospitals in Saudi Arabia. Methods: A cross-sectional study was carried out in five hospitals in Jazan and three hospitals in Hail City, Saudi Arabia, on a convenience sample of 250 nurses total using self-administered questionnaires. Independent sample t-tests and one-way ANOVA were used for the data analysis. Ethical considerations were adhered to throughout the conduct of the study. Results: The mean score of all domains of nurses' perceptions of the quality of nurse-physician communication in emergency departments was 60.14 out of 90. The highest mean score was observed in the openness subdomain, followed closely by relevance and satisfaction, with mean percentages of 71.65% and 71.60%, respectively. Age, level of education, years of experience, and job position had significant positive correlations with nurses' perceptions of the quality of nurse-physician communication. (p = 0.002, 0.016, 0.022, and 0.020, respectively). Post hoc tests showed that nurses older than 30, those with diplomas, those with more than 10 years' experience, and those in supervisory positions had more positive perceptions of the quality of nurse-physician communication. On the other hand, there was no significant difference in the mean scores of quality of nurse-physician communication with regard to participants' sex, marital status, nationality, and working hours (p > 0.05). Multiple linear regression showed that none of the independent factors affected the nurses' perceptions of the quality of nurse-physician communication in emergency departments (p > 0.05). Conclusions: Overall, the quality of communication between nurses and physicians was not satisfactory. Future research should be meticulously planned, using validated outcome measures, that will capture and reflect the goals of communication among healthcare teams.
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Affiliation(s)
- Nawal Daheshi
- Jazan Academic Affairs and Training Administration, Jazan 85539, Saudi Arabia
- Correspondence: (N.D.); (B.A.)
| | - Sameer A. Alkubati
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida P.O. Box 3114, Yemen
| | - Hazel Villagracia
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
| | - Eddieson Pasay-an
- Maternal and Child Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
| | - Ghadeer Alharbi
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 2440, Saudi Arabia
| | - Norah Madkhali
- Department of Nursing, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
| | - Bushra Alshammari
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
- Correspondence: (N.D.); (B.A.)
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Intensive Care Nurses' Experience of Caring in Greece; A Qualitative Study. Healthcare (Basel) 2023; 11:healthcare11020164. [PMID: 36673532 PMCID: PMC9859179 DOI: 10.3390/healthcare11020164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Whilst nurses and critical care services have been at the forefront of the COVID-19 pandemic, it has become more apparent that intensive care nurses are presented with challenging ethical and clinical decisions and are required to care for individuals with critical illnesses under high-pressure conditions. This is not a new phenomenon. The aim of this study, which was conducted before the outbreak of COVID-19, was to explore the experience of caring through the narratives of intensive care nurses in Greece. METHODS A qualitative study was conducted through in-depth, semi-structured interviews with nineteen ICU nurses in Athens. Transcripts were subjected to Braun and Clarke's thematic analysis and organised with Atlas.ti v8 QDA software. RESULTS The intensive care nurses' experience of caring in Greece encompassed four themes: (A) being "proximal", "co-present" and caring with empathy, (B) being "responsible" for your patient and negotiating with the doctors, (C) technology and "fighting with all you've got", and (D) "not being kept informed" and disappointment. CONCLUSIONS The narratives of this study highlight that ICU nurses in Greece provide patient-centred and compassionate care. Nurse leaders should develop appropriate healthcare policies so as to ensure the adequate provision of staff, specialist education, and support to nurses working in critical care. Failure to address these issues may lead to poor quality of care and negative patient outcomes.
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Platis C, Theodoros A, Psomiadi ME, Theodorou P. Interdisciplinary Collaboration and Communication Among Doctors and Nurses in ICUs During the COVID-19 Pandemic and Their Importance in Professional Life Quality Improvement. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:331-343. [PMID: 37581807 DOI: 10.1007/978-3-031-31986-0_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
To investigate interdisciplinary cooperation and communication among doctors and nurses along with its role in improving the quality of their professional life, a cross-sectional survey was designed. The study was carried out from February to April 2021 through the application of an anonymous, structured, self-completed, closed-ended questionnaire in a convenience sample consisting of 110 healthcare professionals currently working in the intensive care units (ICUs) of three distinct hospitals (response rate: 76.4%). It was observed that medical personnel manifested a more positive stance toward interdisciplinary collaboration than nursing while women seemed to believe more than men that nurses' administrative skills are not valued enough by doctors. Nurses with limited work experience reported that doctors show scarce respect to nurses in the presence of patients' parents and companions while male nurses acknowledged more the provision of multidimensional care given to patients. Occupational stress, professional satisfaction, and burnout levels were mainly moderate across study participants.
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Affiliation(s)
| | | | - Maria-Elissavet Psomiadi
- Directory of Operational Preparedness for Public Health Emergencies, Ministry of Health, Athens, Greece
| | - Panagiotis Theodorou
- School of Social Sciences, Postgraduate Course - Health Care Management, Hellenic Open University, Patra, Greece
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Zhong H, Liang A, Luo H, Hu X, Xu S, Zheng Z, Zhu X. Application Analysis of Multidisciplinary Diagnosis and Treatment Nursing Mode Based on Doctor-Nurse-Integration for Stroke Patients Undergoing Emergency Intervention Surgery. Emerg Med Int 2022; 2022:6299676. [PMID: 36406931 PMCID: PMC9674415 DOI: 10.1155/2022/6299676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/07/2022] [Indexed: 02/02/2024] Open
Abstract
Purpose To analyze the application value of multidisciplinary diagnosis and treatment (MDT) nursing mode based on doctor-nurse-integration for stroke patients undergoing emergency intervention surgery. Methods In this study, a historical comparative study method was adopted. 118 stroke patients and medical staff (9 doctors and 11 nurses) who met the diagnosis and inclusion criteria of emergency intervention surgery admitted from July 2021 to February 2022 were treated clinically according to the traditional medical care mode (TMC group), 87 stroke patients and medical staff (9 doctors and 11 nurses) who met the diagnosis and inclusion criteria of emergency intervention surgery admitted from February 2022 to June 2022 were treated and cared according to the MDT nursing mode based on medical integration (MDT group). Comparison of perioperative time indicators, postoperative outcome indicators, treatment compliance, secondary complications and visit satisfaction between the two groups of patients, and comparison of cooperation satisfaction between the two groups of medical staff. Results The MDT group had shorter onset-emergency physician's reception time, arrival at CT room-completion time of CT/MR, notify intervention chamber-arrival time at catheter chamber, admission-femoral artery puncture time, admission-first vessel recanalization time, mean postural restraint time than the TMC group (P < 0.05). The postoperative mortality rate in the MDT group (5.75%) was comparable to that in the TMC group (8.47%) (P > 0.05); the postoperative disability rate in the MDT group (28.74%) was less than that in the TMC group (45.76%) (P < 0.05); the NIHSS score in the MDT group was lower than that in the TMC group, and the FMA score and BI score were both higher than those in the TMC group (P < 0.05). The MDT group had higher treatment compliance than the TMC group, fewer secondary complications than the TMC group, and higher patient visit satisfaction and medical staff cooperation satisfaction than the TMC group (P < 0.05). Conclusion The implementation of the MDT nursing mode based on the doctor-nurse-integration for stroke patients undergoing emergency intervention surgery can improve the work efficiency of rescuing patients, improve the clinical treatment outcome of patients, and improve the satisfaction of doctors, nurses, and patients.
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Affiliation(s)
- Hai Zhong
- Wuhan University School of Nursing, Wuhan, Hubei 430071, China
- Intervention Operating Room, Zhongshan City People's Hospital, Zhongshan, Guangdong 528403, China
| | - Aiqun Liang
- Intervention Operating Room, Zhongshan City People's Hospital, Zhongshan, Guangdong 528403, China
| | - Huanhuan Luo
- Intervention Operating Room, Zhongshan City People's Hospital, Zhongshan, Guangdong 528403, China
| | - Xiaolong Hu
- Intervention Operating Room, Zhongshan City People's Hospital, Zhongshan, Guangdong 528403, China
| | - Shengxiang Xu
- Intervention Operating Room, Zhongshan City People's Hospital, Zhongshan, Guangdong 528403, China
| | - Ziming Zheng
- Intervention Operating Room, Zhongshan City People's Hospital, Zhongshan, Guangdong 528403, China
| | - Xiaoping Zhu
- Wuhan University School of Nursing, Wuhan, Hubei 430071, China
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Cassidy DJ, Jogerst K, Coe T, Monette D, Sell N, Eurboonyanum C, Hamdi I, Sampson M, Petrusa E, Stearns D, Gee DW, Chyn A, Saillant N, Takayesu JK. Simulation versus reality: what can interprofessional simulation teach us about team dynamics in the trauma bay? GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2022; 1:56. [PMID: 38013715 PMCID: PMC9614190 DOI: 10.1007/s44186-022-00063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022]
Abstract
Purpose Surgical consultation and the joint management of trauma patients is a common scenario in the emergency department. The goal of this study was to utilize interprofessional trauma team training to understand the role of simulation and its impact on the overall culture of trauma-related care. Methods Interdisciplinary trauma simulation scenarios were completed by 12 groups of emergency medicine residents, general surgery residents, and emergency medicine nurses across two academic years. Following each simulation, a debriefing session was held to reflect on the scenario, focusing on team interactions. Debriefing sessions were audio-recorded, transcribed, deidentified, and independently, inductively coded by two members of the research team. Using the constant comparative method, a codebook was developed and refined until interrater reliability was confirmed with a kappa of > 0.9. Codes were organized into higher level themes. Results There were 72 participants, including 23 general surgery residents, 19 emergency medicine residents, and 30 emergency medicine nurses. 214 primary codes were collapsed into 29 coding categories, with 6 emerging themes. Pre-trauma bay impact describes how interactions prior to the trauma scenario can impact how team members communicate, trust one another, and ultimately care for the patient. Role and team identity explores the importance of one knowing their individual role in the trauma bay and how it impacts overall team identity. Resource allocation describes the balance of having appropriate resources to efficiently care for patients while not negatively impacting crowd control or role identity. Impact of the simulation experience highlights the impact of the lower stakes simulation scenario on learning and reflection as well as concerns with simulation fidelity. Trauma leader traits and actions outlines inherent traits and learned actions of trauma leaders that impact how the trauma scenario unfolds. Interprofessional team performance describes the overall performance of the trauma team, including but not limited to the type of communication used, teamwork behaviors, and transition of care of the patient. Conclusions Interdisciplinary trauma simulations and structured debriefing sessions provide insights into team dynamics and interprofessional relationships. Simulations and debriefing sessions can promote understanding, respect, and familiarity of team members' roles; recognition of key characteristics of high functioning leaders and teams; and discovery of conflict mitigating strategies for future interdisciplinary team improvement. Simulation sessions allow implementation of quality improvement measures and communication and leadership strategy practice in a safe, collaborative learning environment. The lessons learned from these sessions can encourage participants to reexamine how they interact and function as a team within the real-life trauma bay.
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Affiliation(s)
| | - Kristen Jogerst
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ USA
| | - Taylor Coe
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Naomi Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | | | - Isra Hamdi
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Michael Sampson
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Dana Stearns
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Denise W. Gee
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Angela Chyn
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - James K. Takayesu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA
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Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Pype P, Remmen R, Van Bogaert P. Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care. BMJ Open 2022; 12:e062111. [PMID: 36302577 PMCID: PMC9621161 DOI: 10.1136/bmjopen-2022-062111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care. DESIGN Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science. STUDY SELECTION In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020. DATA EXTRACTION AND SYNTHESIS From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors. RESULTS The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences. CONCLUSIONS We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.
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Affiliation(s)
- Muhammed Mustafa Sirimsi
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Centre of Research and Innovations in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of pharmaceutic sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Peter Pype
- Center for family medicine, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Van Bogaert
- Centre for research and innovation in care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Endris Y, W/Selassie M, Edmealem A, Ademe S, Yimam W, Zenebe Y. Nurse-Physician Inter-Professional Collaboration and Associated Factors at Public Hospitals in Dessie City, Amhara, Northeastern Ethiopia, 2021. J Multidiscip Healthc 2022; 15:1697-1708. [PMID: 35971397 PMCID: PMC9375560 DOI: 10.2147/jmdh.s373599] [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: 05/20/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Nurse–physician collaboration is an integral part of quality improvement in health care. Collaboration enables individuals to work together to achieve defined and common health purposes. There is limited evidence related to nurse–physician inter-professional collaboration and its associated factors in Ethiopia, particularly in Dessie city public hospitals. Objective To assess nurse–physician inter-professional collaboration and associated factors at public hospitals in Dessie city, Ethiopia, 2021. Methods An institutional-based cross-sectional study was conducted among nurses and physicians at public hospitals in Dessie city. A self-administered questionnaire was used for data collection. Stratified simple random sampling techniques were used to select study participants proportional to the sample size allocation. The final sample size was 260 and allocated proportionally to Dessie Comprehensive Specialized Hospital and Boru Meda General Hospital. The data were entered and analyzed using EPI-data version 4.6 and SPSS version 26 software respectively. During analysis, p-values less than 0.25 in binary logistic regression were entered into multivariable logistic regression. Finally, p-values less than 0.05 in multi-variable logistic regression were considered statically significant. Results The mean score for inter-professional collaboration was 97.40 ± 19.6SD. In this study, inter-professional collaboration among nurses and physicians was 44.2%. This study showed that favorable attitude [AOR=3.205; CI: 1.781–5.766], respondents working in the gynecological department [AOR=0.210; CI: 0.052–0.849], satisfied organizational support [AOR=2.062; CI: 1.140–3.729] and urban residents [AOR=3.996; CI: 1.069–14.931] were factors associated with nurse–physician inter-professional collaboration. Conclusion In this study, nurse–physician inter-professional collaboration was low. Training on the importance of health teamwork, timely monitoring and evaluation of organizational support, and professional empowerment towards a favorable attitude of nurse–physician inter-professional collaboration shall be provided at hospital levels. Routine assessment and timely intervention of the gynecological department for nurse–physician inter-professional collaboration shall be done at hospital levels. Moreover, both quantitative and qualitative research shall be performed for future research.
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Affiliation(s)
- Yimer Endris
- Department of Adult Health Nursing, Tropical College of Medicine, Dessie, Ethiopia
| | - Mulugeta W/Selassie
- Department of Pediatrics and Child Health Nursing, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
| | - Afework Edmealem
- Department of Comprehensive Nursing, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
| | - Sewunet Ademe
- Department of Comprehensive Nursing, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
| | - Wondwossen Yimam
- Department of Comprehensive Nursing, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
| | - Yosef Zenebe
- Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia
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YLITÖRMÄNEN TUIJA, KVIST TARJA, TURUNEN HANNELE. Intraprofessional collaboration: A qualitative study of registered nurses’ experiences. Collegian 2022. [DOI: 10.1016/j.colegn.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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House S, Crandell J, Stucky C, Wilmoth M. Relational Coordination Among Military and Civilian Nurses and Physicians in an Army Hospital: Do Demographic Characteristics and Professional Roles Matter? J Nurs Adm 2022; 52:293-300. [PMID: 35467595 DOI: 10.1097/nna.0000000000001150] [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: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to explore whether demographic characteristics and professional roles are associated with relational coordination (RC) among nurses and physicians. BACKGROUND The increased race, age, and gender diversity in the nursing and medical workforce raises questions regarding how well nurses and physicians communicate and interact. Relational coordination is a unique framework to enhance teamwork and care coordination among healthcare professionals. METHODS An exploratory cross-sectional study was conducted in a military hospital. The study variables were examined using multiple regression. RESULTS Two-hundred eighty-nine participants completed the survey. Professional role, race, age, gender, and experience were not associated with RC. Rank and education were significantly associated with RC. Enlisted service members reported higher RC between roles, and participants with graduate degrees reported lower RC within roles. CONCLUSION Hospital leaders can implement RC to foster inclusivity and teamwork among healthcare professionals despite demographic characteristics and professional roles.
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Affiliation(s)
- Sherita House
- Author Affiliations: Postdoctoral Fellow (Dr House), Indiana University School of Nursing, Indianapolis; Biostatistician (Dr Crandell) and Executive Vice Dean/Associate Dean, Academic Affairs (Dr Wilmoth), University of North Carolina at Chapel Hill School of Nursing; and Deputy Chief, Center for Nursing Science and Clinical Inquiry (Dr Stucky), Fort Bragg, North Carolina
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Pedersen BS, Kirk JW, Olesen MK, Grønfeldt BM, Stefánsdóttir NT, Brødsgaard R, Tjørnhøj-Thomsen T, Nilsen P, Andersen O, Bandholm T, Pedersen MM. Feasibility and implementation fidelity of a co-designed intervention to promote in-hospital mobility among older medical patients-the WALK-Copenhagen project (WALK-Cph). Pilot Feasibility Stud 2022; 8:80. [PMID: 35397574 PMCID: PMC8994315 DOI: 10.1186/s40814-022-01033-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobility interventions can prevent functional decline among older patients, but implementation of such interventions may be complicated by barriers in the clinical setting. The WALK-Copenhagen project (WALK-Cph) is aimed at promoting a 24-h mobility among older medical patients during hospitalization. The WALK-Cph intervention was co-designed by researchers and stakeholders to tailor the intervention to the clinical context. The aim of this study was to investigate the feasibility and implementation fidelity of the WALK-Cph intervention before evaluating clinical effectiveness in a randomized controlled trial (ClinicalTrials.gov NCT03825497). METHODS The WALK-Cph intervention consisted of six components: a welcome folder explaining the importance of in-hospital activity, a WALK-plan prescribing up to three daily walking sessions during and after hospitalization, a WALK-path in the hallway that patients were motivated to use daily, exercise posters in the hallways and bedrooms, self-service on beverages and clothes, and discharge with a WALK-plan. The present study reports on phase 2 of WALK-Cph and consists of a feasibility and a fidelity component. The study was conducted at the two WALK-Cph intervention departments after the initiation of the WALK-Cph intervention. A cohort of older medical patients (+65) was recruited for the feasibility study to assess recruitment and data collection procedures and the method for assessment of activity. Simultaneously, implementation fidelity was assessed by observing clinical practice and intervention delivery at the intervention departments. RESULTS A feasibility cohort of 48 patients was included. Inclusion was considered feasible with recruitment rates between 62% and 70% of all eligible patients. Also, data collection was conducted without obstacles, and all patients accepted to wear activity monitors. The fidelity observations showed that three of the six intervention components were partially implemented as planned whereas three components were not implemented as planned. CONCLUSION The WALK-Cph intervention was found feasible, and although the intervention was not implemented with fidelity, the level of fidelity was considered sufficient to continue with further testing of the WALK-Cph intervention in a large-scale trial. TRIAL REGISTRATION ClinicalTrials.gov NCT03825497 (retrospectively registered). Protocol PubMed ID (PMID): 29523569.
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Affiliation(s)
- Britt Stævnsbo Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Maren Kathrine Olesen
- Department of Endocrinology, Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Birk Mygind Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Rasmus Brødsgaard
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.,The Emergency Department, Copenhagen University Hospital, Amager and Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager and Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Kettegård Alle 30, Hvidovre, 2650, Copenhagen, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Hawes K, Goldstein J, Vessella S, Tucker R, Lechner BE. Providing Support for Neonatal Intensive Care Unit Health Care Professionals: A Bereavement Debriefing Program. Am J Perinatol 2022; 39:401-408. [PMID: 32894870 DOI: 10.1055/s-0040-1716481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate formal bereavement debriefing sessions after infant death on neonatal intensive care unit (NICU) staff. STUDY DESIGN Prospective mixed methods study. Pre- and postbereavement debriefing intervention surveys were sent to clinical staff. Evaluation surveys were distributed to participants after each debriefing session. Notes on themes were taken during each session. RESULTS More staff attended sessions (p < 0.0001) and attended more sessions (p < 0.0001) during the postdebriefing intervention epoch compared with the predebriefing epoch. Stress levels associated with the death of a patient whose family the care provider have developed a close relationship with decreased (p = 0.0123). An increased number of debriefing session participants was associated with infant age at the time of death (p = 0.03). Themes were (1) family and provider relationships, (2) evaluation of the death, (3) team cohesion, (4) caring for one another, and (5) emotional impact. CONCLUSION Bereavement debriefings for NICU staff reduced the stress of caring for dying infants and contributed to staff well-being. KEY POINTS · Providing end-of-life care in NICU is challenging.. · Debriefings assist staff in coping with grief.. · Staff well-being impacts patient care..
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Affiliation(s)
- Katheleen Hawes
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women and Infants Hospital, Providence, Rhode Island
| | - Justin Goldstein
- Department of Neonatology, Women and Infants Hospital, Providence, Rhode Island
| | - Sharon Vessella
- Department of Neonatology, Women and Infants Hospital, Providence, Rhode Island
| | - Richard Tucker
- Department of Neonatology, Women and Infants Hospital, Providence, Rhode Island
| | - Beatrice E Lechner
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Neonatology, Women and Infants Hospital, Providence, Rhode Island
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Wei H, Horns P, Sears SF, Huang K, Smith CM, Wei TL. A systematic meta-review of systematic reviews about interprofessional collaboration: facilitators, barriers, and outcomes. J Interprof Care 2022; 36:735-749. [DOI: 10.1080/13561820.2021.1973975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Holly Wei
- PhD Program, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Phyllis Horns
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Samuel F. Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Kun Huang
- College of Nursing, East Carolina University, Greenville, NC, USA
| | | | - Trent L. Wei
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Expanding nurses' authority - Physicians' and nurses' attitudes. Appl Nurs Res 2022; 63:151550. [PMID: 35034693 DOI: 10.1016/j.apnr.2021.151550] [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: 07/15/2020] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/22/2022]
Abstract
AIM To examine and compare the attitudes of physicians and registered nurses regarding extending nurses' authority. DESIGN This was a comparative quantitative study, which used a questionnaire that examined the attitudes of nurses and physicians regarding expanding nurses' authority. METHODS The study comprised a sample of 134 nurses (62.7%) and physicians (37.3%), who filled out the self-report questionnaire that included sociodemographic data and questions designed to examine the participants' attitudes and perceptions on expanding nurses' authority. The general reliability of the questionnaire was Cronbach's α = 0.931. Participants were sampled through the convenience-snowball method. RESULTS Differences were found between the attitudes of physicians and nurses to expanding nurses' authority. Nurses tended to be in favor, whereas physicians tended to be against (t(86.29) = 7.713; p < 0.05). Nurses' attitudes are also more positive specifically to procedures related to drug administration (t(132) = 6.894; p < 0.05) and resuscitation (t(132) = 2.974; p < 0.05), compared to physicians. CONCLUSIONS Nurses have more positive attitudes toward expanding nurses' authority than physicians do, specifically toward drug administration and resuscitation. Further study is proposed to identify factors which affect the physician-nurse relationship and attitudes on a large scale through a qualitative study.
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Impact of Nurse-Physician Collaboration, Moral Distress, and Professional Autonomy on Job Satisfaction among Nurses Acting as Physician Assistants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020661. [PMID: 35055482 PMCID: PMC8776133 DOI: 10.3390/ijerph19020661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 02/01/2023]
Abstract
Although there is considerable literature on job satisfaction among nurses in various settings, there is little research about contributing factors, including moral distress to job satisfaction among a certain group of nurses, such as nurses acting as physician assistants. The purpose of this study was to verify the impact of nurse-physician collaboration, moral distress, and professional autonomy on job satisfaction among nurses acting as physician assistants. Descriptive and correlational research was conducted on a convenience sample of 130 nurses from five general hospitals in South Korea. In the final regression model, the adjusted R square was significant, explaining 38.2% of the variance of job satisfaction (F = 8.303, p < 0.001), where 'cooperativeness' (β = 0.469, p = 0.001) from nurse-physician collaboration, 'institutional and contextual factor' from moral distress (β = -0.292, p = 0.014), and professional autonomy (β = 0.247, p = 0.015) were included. In hospital environments, a more cooperative inter-professional relationship between nurses and physicians led to less moral distress caused by organisational constraints. A higher level of professional autonomy among nurses acting as physician assistants is required to increase their job satisfaction.
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Domingo L, Sala M, Miret C, Montero-Moraga JM, Lasso de la Vega C, Comas M, Castells X. Perceptions from nurses, surgeons, and anesthetists about the use and benefits of the surgical checklist in a teaching hospital. J Healthc Qual Res 2022; 37:52-59. [PMID: 34344625 DOI: 10.1016/j.jhqr.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess attitudes and perceptions from nursing staff, surgeons and anesthetists about compliance, utility, and impact on patient's safety of the surgical checklist in a teaching hospital. We also aimed to identify improvement opportunities for strengthening the usefulness of the checklist in the operating theater. METHODS We carried out a questionnaire-based an observational cross-sectional study. A questionnaire was distributed to operating room staff, including nursing staff, surgeons, and anesthetists. In addition to the information about surgical checklist, We also collected information regarding years of experience in the operating theater. Fisher's exact was used to compare proportions in each statement. Group discussion meetings with key professionals were held to jointly assess the results, propose improvement actions, and evaluate their feasibility. RESULTS The overall response rate was 36.2% (131/362). Nursing staff was perceived as the most supportive group in the use of surgical checklist. A 64.3% of surgeons considered that using the checklist prevented adverse events vs 84.2% and 85.7% among anesthetists and nurses, respectively; p=0.028. Junior staff showed a supportive attitude toward the use of surgical checklist, considering it as a tool that gives them confidence. We ended up with a list of improvement actions aiming at strengthening the surgical checklist reliability and compliance. CONCLUSIONS The perception of the surgical checklist usefulness as a tool to prevent adverse events was moderate among surgeons, but well appreciated by junior staff. Nursing staff were especially critical regarding compliance and support by other professionals. To reinforce the usefulness perception of the surgical checklist it is needed to increase the involvement of all professionals, especially senior staff and surgical leaders.
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Affiliation(s)
- L Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain.
| | - M Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - C Miret
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - J M Montero-Moraga
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - C Lasso de la Vega
- Methodology, Quality and Nursing Research Department, Consorci Parc de Salut MAR de Barcelona, Barcelona, Spain
| | - M Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - X Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
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Monfre J, Knudsen ÉA, Sasse L, Williams MJ. Nurses' perceptions of nurse-physician collaboration. Nurs Manag (Harrow) 2022; 53:34-42. [PMID: 34979526 DOI: 10.1097/01.numa.0000805036.69747.d1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jill Monfre
- At University of Wisconsin Health in Madison, Wisc., Jill Monfre is a clinical nurse specialist, Élise Arsenault Knudsen is a clinical nurse specialist, Laura Sasse is a clinical nurse specialist, and Mary Jane Williams is a nurse manager
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Zhang Y, Li N, Chen J, Luo X, Li M, Yan J. Breast Cancer-Related Lymphedema Risk-Management Behaviors Among Chinese Breast Cancer Survivors and Relationships with Socio-Demographic and Clinical Characteristics: A Longitudinal Study. Patient Prefer Adherence 2022; 16:797-808. [PMID: 35370404 PMCID: PMC8965334 DOI: 10.2147/ppa.s356750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We sought to determine changes in breast cancer-related lymphedema (BCRL) risk-management behaviors in the six-month period after surgery among Chinese breast cancer survivors and to explore the relationship between their socio-demographic and clinical characteristics and these behaviors. PATIENTS AND METHODS A longitudinal study design was adopted. Females aged ≥18 years with a first breast cancer diagnosis and who had undergone modified radical mastectomy were recruited from a cancer hospital in China. Respondents with a history of other malignant tumors, mental illness, or cognitive impairment were excluded from the study. Socio-demographic and clinical factors were assessed at baseline. BCRL risk-management behaviors were assessed with the Lymphedema Risk-Management Behavior Questionnaire (LRMBQ) and Functional Exercise Adherence Scale (FEAS) in the first, third, and sixth months after surgery. Repeated-measures analysis of variance was used to examine changes in BCRL risk-management behaviors over the three study time periods, and a generalized linear mixed model was used to determine socio-demographic and clinical factors associated with BCRL risk-management behaviors. RESULTS A total of 166 participants completed all three assessments. The scores of the total LRMBQ and its "Skin care" and "Lifestyle" subscales did not change significantly, but those of the "Avoidance of limb compression and injury" and "Other matters requiring attention" subscales changed over the three study time periods. Additionally, scores of the total FEAS and most of its subscales changed over the three study time periods. Furthermore, BCRL risk-management behaviors were significantly related to patients' geographic residence, education level, and tumor stage. CONCLUSION Some dimensions of BCRL risk-management behaviors changed over time, and several socio-demographic and clinical factors are related to BCRL risk-management behaviors. It is recommended that health care professionals consider the dynamic nature of BCRL risk-management behaviors and related factors when planning health education and promotion interventions.
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Affiliation(s)
- Yue Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Na Li
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jing Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xia Luo
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Mingfang Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jun Yan
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Correspondence: Jun Yan, School of Nursing, Sun Yat-sen University, No. 74, Zhongshan II Road, Guangzhou, Guangdong Province, People’s Republic of China, Tel +86-13416347847, Email
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Flanagan R, Worrell C, Kumar N. Enhancing Collaboration in the Endoscopy Suite: Challenges, Perspectives, and Solutions. Dig Dis Sci 2022; 67:5368-5370. [PMID: 36201145 PMCID: PMC9540138 DOI: 10.1007/s10620-022-07710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Ryan Flanagan
- grid.62560.370000 0004 0378 8294Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 USA
| | - Conrad Worrell
- grid.62560.370000 0004 0378 8294Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 USA
| | - Navin Kumar
- grid.62560.370000 0004 0378 8294Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 USA
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Bouillon-Minois JB, Trousselard M, Mulliez A, Adeyemi OJ, Schmidt J, Thivel D, Ugbolue UC, Borel M, Moustafa F, Vallet GT, Clinchamps M, Zak M, Occelli C, Dutheil F. A cross-sectional study to assess job strain of emergency healthcare workers by Karasek questionnaire: The SEEK study. Front Psychiatry 2022; 13:1043110. [PMID: 36684020 PMCID: PMC9850106 DOI: 10.3389/fpsyt.2022.1043110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Emergency healthcare workers (eHCWs) are particularly at risk of stress, but data using the gold standard questionnaire of Karasek are scarce. We assessed the level of stress of eHCWs and aimed to compare it with the general population. METHODS This is a cross-sectional nationwide study in French Emergency Departments (EDs), using the job-content questionnaire of Karasek, compared with the 25,000 answers in the French general population (controls from the SUMER study). The descriptions of job demand, job control, and social support were described as well as the prevalence of job strain and isostrain. Putative factors were searched using mixed-method analysis. RESULTS A total of 166 eHCWs (37.9 ± 10.5 years old, 42% men) from five French EDs were included: 53 emergency physicians and 104 emergency paramedics, compared to 25,000 workers with other occupations. Job demand was highest for physicians (28.3 ± 3.3) and paramedics (25.9 ± 3.8), compared to controls (36.0 ± 7.2; p < 0.001). Job control was the lowest for physicians (61.2 ± 5.8) and paramedics (59.1 ± 6.8), compared to controls (70.4 ± 11.7; p < 0.001). Mean social support did not differ between groups (23.6 ± 3.4 for physicians, 22.6 ± 2.9 for paramedics, and 23.7 ± 3.6 for controls). The prevalence of job strain was massively higher for physicians (95.8%) and paramedics (84.8%), compared to controls (23.9%; p < 0.001), as well as for isostrain (45.1% for physicians, 56.8% for paramedics, and 14.3% for controls, p < 0.001). We did not find any significant impact of sociodemographic characteristics on job control, job demand, or social support. CONCLUSION Emergency healthcare workers have a dramatic rate of job strain, necessitating urgent promotion of policy to take care of them.
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Affiliation(s)
- Jean-Baptiste Bouillon-Minois
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Department, Clermont-Ferrand, France
| | - Marion Trousselard
- French Armed Forces Biomedical Research Institute, Brétigny-sur-Orge, France.,APEMAC/EPSAM, Metz, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Oluwaseun John Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Jeannot Schmidt
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, Emergency Department, Clermont-Ferrand, France
| | - David Thivel
- Université Clermont Auvergne, Laboratory AME2P, Research Center in Human Nutrition, Aubière, France
| | - Ukadike Chris Ugbolue
- Institute for Clinical Exercise and Health Science, University of the West of Scotland, Glasgow, United Kingdom
| | - Marjolaine Borel
- CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France
| | - Farès Moustafa
- CHU Clermont-Ferrand, Emergency Medicine, Clermont-Ferrand, France.,Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Guillaume T Vallet
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Maëlys Clinchamps
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Université Clermont Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Occupational and Environmental Medicine, Clermont-Ferrand, France
| | - Marek Zak
- Collegium Medicum, Institute of Health Sciences, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Céline Occelli
- Department of Emergency, University Hospital, Nice, France
| | - Frédéric Dutheil
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Université Clermont Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Occupational and Environmental Medicine, Clermont-Ferrand, France
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Aggarwal R, Plough A, Henrich N, Galvin G, Rucker A, Barnes C, Berry W, Golen T, Shah NT. The design of "TeamBirth": A care process to improve communication and teamwork during labor. Birth 2021; 48:534-540. [PMID: 34245054 PMCID: PMC9290033 DOI: 10.1111/birt.12566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite evidence that communication and teamwork are critical to patient safety, few care processes have been intentionally designed for this purpose in labor and delivery. The purpose of this project was to design an intrapartum care process that aims to improve communication and teamwork between clinicians and patients. METHODS We followed the "Double-Diamond" design method with four sequential steps: Discover, Define, Develop, and Deliver. In Discover, we searched professional guidelines and peer-reviewed literature to delineate the challenges to quality of intrapartum care and to uncover options for solutions. In Define, we convened an interdisciplinary group of experts to focus the problem scope and prioritize solution features. In Develop, we created initial prototype solutions. In Deliver, we engaged clinicians and patients in rapid cycle testing to iteratively produce a care process called "TeamBirth" that aims to improve team communication. RESULTS We designed TeamBirth, an intrapartum care process composed of brief team meetings ("huddles") between clinicians and patients. Huddles are navigated by a shared planning board placed in the labor and delivery room in view of the patient and their care team. The board promotes transparent and reliable communication and contains four areas to be acknowledged or discussed: (a) the names of the team members, starting with the patient; (b) the patient's preferences; (c) the care plan for the patient, baby, and labor progress; and (d) when the next team huddle is anticipated. DISCUSSION We identified an opportunity to improve the safety and dignity of childbirth care through an intrapartum care process that promotes reliable and structured communication and teamwork. Future work should evaluate the acceptability and feasibility of implementation and potential impact on safety and experience of care.
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Affiliation(s)
- Reena Aggarwal
- Guy's and St Thomas' NHS Foundation TrustLondonUK,Ariadne LabsBostonMAUSA
| | | | | | | | | | | | | | - Toni Golen
- Beth Israel Deaconess Medical CenterBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - Neel T. Shah
- Guy's and St Thomas' NHS Foundation TrustLondonUK,Beth Israel Deaconess Medical CenterBostonMAUSA,Harvard Medical SchoolBostonMAUSA
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46
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White JH. "It Was Never Enough": The Meaning of Nurses' Experiences Caring for Patients during the COVID-19 Pandemic. Issues Ment Health Nurs 2021; 42:1084-1094. [PMID: 34170801 DOI: 10.1080/01612840.2021.1931586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This study's aim was to understand nurses' caring experiences during the recent pandemic in the United States. Using an interpretive phenomenological approach, 15 participants provided the meaning of the care they provided. Five major themes were interpreted: If not us, then who?; Accepting uncertainty; It was never enough; Finding self and our voices in a new role; and Believing it was worth it. The study results have implications for psychiatric-mental health nurse clinicians as they identify and meet the needs of individuals of this vulnerable group. Research that uncovers the meaning of the caring experiences of front line nurses can illuminate the discipline's current understanding of this phenomena.
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Affiliation(s)
- Jane H White
- Office of the Chief Nurse Executive, Institute for Nursing, Northwell Health, New Hyde Park, New York, USA
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47
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Tarhan M, Doğan P, Kürklü A. Nurse-physician collaboration, intention to leave job, and professional commitment among new graduate nurses. Nurs Forum 2021; 57:252-259. [PMID: 34816441 DOI: 10.1111/nuf.12672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/18/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The quality of communication and collaboration with colleagues, managers, and physicians affects the intention to leave a job and the profession for new graduate nurses (NGNs). New graduates have difficulties communicating and collaborating with physicians, especially. AIM This study aimed to determine the relationship between the attitudes of nurse-physician collaboration and the levels of intention to leave the current job and professional commitment among NGNs. METHODOLOGY This descriptive, cross-sectional study was carried out with 231 NGNs in four private hospitals affiliated with an university. Data were collected by using a self-administered questionnaire, including a personal information form, the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration, Intention to Leave Scale, and Nursing Professional Commitment Scale. Data analysis was performed using descriptive statistics, and Spearman's rank correlation coefficients. RESULTS NGNs had a high positive attitude towards nurse-physician collaboration with a median score of 49 (45-54). The professional commitment of NGNs was high level with a median score of 75 (69-86). The intention to leave the current job median score was 3 (2.3-3.6) out of 5. There was a statistically significant correlation between attitudes towards nurse-physician collaboration and the levels of intention to leave the current job (rs = -0.22; p < 0.01) and professional commitment (rs = 0.42; p < 0.01). CONCLUSION The results showed that improving NGNs' attitudes towards nurse-physician collaboration increases the professional commitment and reduces turnover intention.
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Affiliation(s)
- Merve Tarhan
- Deparmant of Nursing, Faculty of Health Science, Medipol University, Istanbul, Turkey
| | - Pınar Doğan
- Deparmant of Nursing, Faculty of Health Science, Medipol University, Istanbul, Turkey
| | - Ahu Kürklü
- Deparmant of Nursing, Faculty of Health Science, Bahcesehir University, Istanbul, Turkey
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48
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Clinical Impact of Nurses-Physicians Collaboration Intervention on the Treatment of Immune Recurrent Spontaneous Abortion with Low-Molecular-Weight Heparin. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9290720. [PMID: 34745306 PMCID: PMC8570878 DOI: 10.1155/2021/9290720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022]
Abstract
Anticoagulation is currently the preferred and effective treatment for patients with recurrent spontaneous abortion (RSA), but, due to the prevalence of mood disorders in RSA patients and the high number of adverse effects associated with long-term medication, effective care measures are often required. In this study, 94 patients with immune-type RSA who were admitted to our hospital from January 2018 to June 2019 were selected and randomly divided into a control group and a study group of 47 patients each; both groups received low-molecular-weight heparin treatment after admission, and the control group received conventional nursing interventions during treatment, while the patients in the study group received integrated medical and nursing care interventions. Pregnancy outcomes, pre- and postintervention scores on the Self-Assessment Scale (SAS), Self-Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI), levels of serum gamma-interferon (IFN-γ) and interleukin-4 (IL-4) and their ratios, complications, and patient satisfaction with the intervention were observed in both groups. The results showed that the success rate of fetal preservation in the study group (89.36%) was significantly higher than that in the control group (68.09%) (P < 0.05). After treatment, SAS, SDS, and PSQI scores decreased in both groups, with the study group being lower (P < 0.05). IFN-γ and IFN-γ/IL-4 levels decreased and IL-4 levels increased in both groups after treatment, with IFN-γ and IFN-γ/IL-4 being significantly lower and IL-4 levels being significantly higher in the study group than in the control group (P < 0.05). The incidence of adverse drug reactions in the study group was significantly lower than that in the control group (P < 0.05). Patients in the study group were more satisfied with all aspects of the intervention than the control group (P < 0.05). These results suggest that nurses-physicians collaboration intervention may improve the effectiveness of low-molecular-weight heparin therapy in patients with immune-type RSA. It helps to improve patient pregnancy outcomes, mood, sleep quality, and immune function and increases patient satisfaction.
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49
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Sillero Sillero A, Buil N. Enhancing Interprofessional Collaboration in Perioperative Setting from the Qualitative Perspectives of Physicians and Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010775. [PMID: 34682520 PMCID: PMC8535564 DOI: 10.3390/ijerph182010775] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/26/2021] [Accepted: 10/07/2021] [Indexed: 12/16/2022]
Abstract
Communication failures were a leading cause of sentinel events in the operation room due to frequently the communication breakdown occurs between physicians and nurses. This study explored the perspectives of surgical teams (nurses, physicians, and anaesthesiologists) on interprofessional collaboration and improvement strategies. A surgical team comprising eight perioperative nurses, four surgeons, and four anaesthesiologists from a university-affiliated hospital participated in this qualitative and phenomenological research from December 2018 to April 2019. Data were collected in in-depth interviews and were used in a thematic analysis according to Colaizzi to extract themes and categorised codes with the ATLAS.ti software. The result is presented in three generic categories: Barrier-like disruptive behaviours and lack of coordination of care; consequences by safety threats to the patient; overcoming barriers by shared decision making among professionals, flattened hierarchies, and teamwork/communication training. The conclusion is that different teams’ perspectives can facilitate genuine reflection, discussion, and implementation of targeted interventions to improve operating room interprofessional collaboration and overcome barriers and their consequences. Currently, there is a need to change towards interprofessional collaboration for optimal patient outcomes and to ensure all professionals’ expectations are met.
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Affiliation(s)
- Amalia Sillero Sillero
- Nursing School of Mar (ESimar), University of Pompeu Fabra, 08003 Barcelona, Spain
- Correspondence:
| | - Neus Buil
- Department of Perioperative Nursing, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
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50
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Bloemhof J, Knol J, Van Rijn M, Buurman BM. The implementation of a professional practice model to improve the nurse work environment in a Dutch hospital: A quasi-experimental study. J Adv Nurs 2021; 77:4919-4934. [PMID: 34605566 PMCID: PMC9293086 DOI: 10.1111/jan.15052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/12/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
Abstract
Aims To evaluate the effects of the implementation of a professional practice model based on Magnet principles on the nurse work environment in a Dutch teaching hospital. Design A quasi‐experimental study. Methods Data were collected from registered nurses working on the clinical wards and outpatient clinics of the hospital in June/July 2016 (baseline) and in June/September 2019 (measurement of effects). Participants completed the Dutch Essentials of Magnetism II survey, which was used to measure their perception of their work environment. After baseline measurements were collected, interventions based on a professional practice model incorporating Magnet principles were implemented to improve the nurse work environment. Descriptive statistics and independent t‐tests were conducted to examine differences between survey outcomes in 2016 and 2019. Results Survey outcomes revealed significant changes in the nurse work environment between 2016 and 2019. Seven of the eight subscales (essentials of magnetism) improved significantly. Score for overall job satisfaction increased from 7.3 to 8.0 and score for quality of care increased from 7.0 to 7.6. On unit level, 17 of the 19 units showed improvement in the nurse work environment. Conclusion The implementation of a professional practice model positively affects the nurse work environment, job satisfaction and quality of care. Impact Nowadays, the quality of care is threatened by workload pressure and the low autonomy experienced by nurses. Considering the global shortage of nurses and growing complexity of healthcare, it is important to invest in improving the nurse work environment. The Magnet concept created a work environment in which nurses can deliver optimal quality of care. Knowledge of how Magnet principles affect the nurse work environment in the Netherlands is missing. These study results, including the description of how the interventions were implemented, will assist other hospitals to develop improvement strategies by focusing on the nurse work environment.
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Affiliation(s)
- Janet Bloemhof
- Department of Nursing Staff, Tergooi Hospital, Hilversum, The Netherlands.,Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jeannette Knol
- Department of Nursing Staff, Tergooi Hospital, Hilversum, The Netherlands
| | - Marjon Van Rijn
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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