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Hsiao WL, Hsieh PY, Hsu LF, Lai YH, Wang ML, Yeh YC. Effectiveness of a delirium risk assessment and multidisciplinary care approach in reducing delirium incidence among surgical intensive care unit patients: A retrospective pre-post intervention study. J Clin Anesth 2024; 98:111566. [PMID: 39084094 DOI: 10.1016/j.jclinane.2024.111566] [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: 01/06/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Delirium is a common complication in intensive care unit (ICU) patients. It can lead to various adverse events. In this study, we investigated the effectiveness of combining the use of the PREdiction of DELIRium (PRE-DELIRIC) model for delirium risk assessment and the use of a multicomponent care bundle for delirium assessment, prevention, and care in terms of reductions in the incidence of delirium among surgical ICU patients. METHODS This retrospective study included surgical ICU patients who had received PRE-DELIRIC-guided SMART/SmART care (SMART care: SmART bundle plus multidisciplinary team; SmART care: Sleep/sweet sense of home (creating a comforting and restful environment for patients), Assessment (regular and thorough evaluation of patient needs and conditions), Release (revised endotracheal tube care/removal, restraint device care, and immobility reduction for patient comfort), and Time (reorientation of time to optimize patient care schedules) in our hospital between May 2022 and March 2023 (intervention group) and individuals who had received usual care between January 2021 and April 2022 (historical control group). The SmART intervention involves providing care in the following domains: sleep/sweet sense of home, assessment, release, and time. Patients with a PRE-DELIRIC score of >30% received SMART care, which includes multidisciplinary (physicians, pharmacists, respiratory therapists, and physiotherapists) care in addition to SmART care. For the control group, usual care was provided following the guidelines for the prevention and management of pain, agitation, delirium, immobility, and sleep disruption. The primary outcome was delirium incidence during ICU stay, which was assessed using the Intensive Care Delirium Screening Checklist. The secondary outcomes were the duration of ICU stay, rate of unplanned self-extubation, and status of ICU discharge. RESULTS The intervention and control groups comprised 184 and 197 patients, respectively; their mean ages were 63.7 ± 18.4 years and 62.4 ± 19.5 years, respectively. The incidence of delirium was significantly lower (p = 0.001) in the intervention group (22.3%) than in the control group (47.7%). CONCLUSION Our findings suggest that the PRE-DELIRIC-guided SMART/SmART care intervention is effective in preventing and managing delirium among surgical ICU patients.
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Affiliation(s)
- Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Yin Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Ling-Fang Hsu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yeur-Hur Lai
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Man-Ling Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Chang Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Paxino J, Molloy E, Denniston C, Abdelmotaleb R, Woodward-Kron R. The work performed through interprofessional meeting discourse: an observational study. J Interprof Care 2024; 38:652-663. [PMID: 38678369 DOI: 10.1080/13561820.2024.2343833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
The effectiveness of work performed through interprofessional practice is contingent on the nature and extent of communication between professionals. To date, there is little research exploring how the patterns of communication may impact interprofessional work. This study focused on communication during interprofessional meetings to better understand the interprofessional work performed through these encounters. Specifically, it examined how interactional discourse, that is, the patterns of language, influenced work performed during interprofessional meetings. A series of four interprofessional meetings in a rehabilitation unit were observed. Twenty-one participants were observed, including medical, nursing, allied health clinicians, and health professions students. Follow-up stimulated-recall interviews were conducted with five meeting participants. The data collection consisted of video and audio recordings and detailed field notes. Data were analyzed using a combination of genre analysis, a form of discourse analysis, and activity system analysis, drawing on Cultural Historical Activity Theory. This facilitated an in-depth examination of the structure of discourse and its influence on meeting outcomes. The meeting structure was defined and predictable. Two distinct forms of discourse were identified and labeled scripted and unscripted. Scripted discourse was prompted by standardized documents and facilitated the completion of organizational work. In contrast, unscripted discourse was spontaneous dialogue used to co-construct knowledge and contributed to collaboration. There was constant shifting between scripted and unscripted discourse throughout meetings which was orchestrated by experienced clinicians. Rather than fragmenting the discussion, this shifting enabled shared decision making. This research provides further insights into the interprofessional work performed during interprofessional meetings. The scripted discourse was highly influenced by artifacts (communication tools) in meetings, and these were used to ensure organizational imperatives were met. Unscripted discourse facilitated not only new insights and decisions but also social cohesion that may influence work within and outside the meeting.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Elizabeth Molloy
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Charlotte Denniston
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | | | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Parkville, Australia
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Kwok A, Cheung D, Gordon M, Mudryk E, Manns PJ. Patient and therapist perspectives on physical therapy outcome measures and engagement after stroke: A case study. Physiother Theory Pract 2023; 39:2639-2650. [PMID: 35786128 DOI: 10.1080/09593985.2022.2092801] [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: 10/27/2021] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Outcome measures are highly recommended in stroke physical therapy, however, most of the existing research has been performed from the provider perspective. Understanding the patient perspective of outcome measures in conjunction with the therapist perspective may help to better support patient engagement and autonomy. PURPOSE The purpose of this study was to explore patient and therapist perspectives on physical therapy outcome measures post-stroke. METHODS This qualitative case study of a Canadian rehabilitation facility is based on patient-oriented research principles, with three patient partners embedded in the research team. Data collection included chart reviews, observations of physical therapy sessions, patient interviews, and therapist interviews. Field notes of observations and interview transcripts were analyzed using thematic analysis. RESULTS Ten patients and seven therapists participated. Analysis revealed the following two themes: 1) tracking progress; and 2) partnership. Tracking progress included the expectations patients had for improvement, the importance of objectively measuring change and the functional improvement observed day by day. Partnership described the relationship between therapist and patient including communication, encouragement and affirmation, the therapist as expert and the gradual shift in autonomy from therapist to patient. CONCLUSION Patients valued the objective results of outcome measures and were encouraged by measurable changes. Maximizing the use of physical therapy outcome measures may improve patient engagement and support relational autonomy.
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Affiliation(s)
- Alyson Kwok
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Healthcare Improvement Team, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Deacon Cheung
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maysyn Gordon
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Evan Mudryk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Wohlin Wottrich A, Braekke I, Johansson L, von Koch L. Therapists acting as data collectors in a post stroke research project - a door to development. Top Stroke Rehabil 2023; 30:101-107. [PMID: 34340638 DOI: 10.1080/10749357.2021.1956045] [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: 02/01/2023]
Abstract
METHODS Participants in the present study were eight clinically experienced occupational therapists and physiotherapists who collected data in an observational longitudinal study of the rehabilitation process after stroke. Semi-structured interviews were conducted, and transcripts of the interviews were analyzed using content analysis. The transcripts revealed the informants' perspectives and their experiences of follow-ups in the patient's home. RESULTS There was one main category, a door to development, and three subcategories: the entrance, discovery in place, and the exit. All informants expressed that they had gained new knowledge of the situation of people who have had a stroke and that taking part in research uncovered a wider perspective of the patients' situations and the importance of follow-ups in general. CONCLUSION New insights into the patients' situation with clinical implications for interprofessional care can be gained by collecting data in a research project that is related to, but different from, everyday clinical practice. Such an assignment can be experienced as professionally rewarding, and we propose that offering such a role change/transition may open the door to development for rehabilitation team members.
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Affiliation(s)
| | - Isidor Braekke
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Lisa Johansson
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Science and Society, Karolinska Institutet, Sweden.,Theme Neuro, Karolinska University Hospital, Stockholm, Sweden
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Paxino J, Molloy E, Denniston C, Woodward-Kron R. Dynamic and distributed exchanges: an interview study of interprofessional communication in rehabilitation. Disabil Rehabil 2022:1-11. [PMID: 35802465 DOI: 10.1080/09638288.2022.2096125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Interprofessional communication (IPC) in rehabilitation is important for patient care yet it has been shown to be variable and challenging. Existing research does not address the complexity of IPC in this setting. Understanding the influence of contextual factors on IPC may guide improvements to increase the effectiveness of communication within interprofessional teams. METHODS From July 2020 to February 2021 semi-structured interviews were conducted with 24 healthcare professionals across Australia and New Zealand. Cultural Historical Activity Theory provided a guiding theoretical and analytical framework for this qualitative study. RESULTS Participants described engaging in IPC through evolving interactions, piecing together information that underpinned patient care. Meetings occurred frequently, however communication extended well beyond formalised interactions, often requiring individuals to balance clinical workload with communication tasks. IPC reportedly relied on communication tools, however navigating information from multiple sources was demanding. CONCLUSIONS Our results indicate that IPC contributes significantly to the workload of healthcare professionals in rehabilitation. IPC was integral in the provision of cohesive patient care, however it proved time consuming, effortful and at times frustrating and potentially erroneous. Our findings promote the need for rigorous examination of communication practices to ensure they are meeting the needs of an increasingly interprofessional workforce. IMPLICATIONS FOR REHABILITATIONHealthcare professionals should recognise that time spent communicating within their team is a legitimate and important part of patient care.Rehabilitation teams should consider how they allocate resources for communication tasks.Teams should reconsider how they can use communication more effectively to save time by reducing repetition and errors.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Elizabeth Molloy
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Charlotte Denniston
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
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van der Veen R, Oosterlaan J, Bos M, van Dooren M, Düdükçü I, van Iperen A, Kooiman L, Nicolas K, Peerdeman S, Königs M. Measurement Feedback System for Intensive Neurorehabilitation after Severe Acquired Brain Injury. J Med Syst 2022; 46:24. [PMID: 35377012 PMCID: PMC8979932 DOI: 10.1007/s10916-022-01809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/23/2022] [Indexed: 11/01/2022]
Abstract
AbstractOutcome of acquired brain injury (ABI) and the potential for neurorehabilitation are subject to distinct heterogeneity between patients. Limited knowledge of the complex constellation of determinants at play interferes with the possibility to deploy precision medicine in neurorehabilitation. Measurement Feedback Systems (MFS) structure clinical data collection and deliver the measurement results as feedback to clinicians, thereby facilitating progress monitoring, promoting balanced patient-centered discussion and shared decision making. Accumulation of clinical data in the MFS also enables data-driven precision rehabilitation medicine. This article describes the development and implementation of a MFS for neurorehabilitation after ABI. The MFS consists of specialized measurement tracks which are developed together with representatives of each discipline in the multidisciplinary team. The MFS is built into a digital platform that automatically distributes measurements among clinicians, at predetermined time points during the inpatient treatment, outpatient treatment and follow-up. The results of all measurements are visualized in individual patient dashboards that are accessible for all clinicians involved in treatment. Since step-wise implementation, 124 patients have been registered on the MFS platform so far, providing an average of more than 200 new measurements per week. Currently, more than 15,000 clinical measurements are captured in the MFS. The current overall completion rate of measurements is 86,4%. This study shows that structured clinical assessment and feedback is feasible in the context of neurorehabilitation after severe ABI. The future directions are discussed for MFS data in our Health Intelligence Program, which aims at periodic care evaluation and the transition of neurorehabilitation care towards precision medicine.
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Which Factors Promote Shared Understanding Between Physicians and Nurses in Inpatient Oncology Care Settings?: A Qualitative Exploration. Cancer Nurs 2022; 45:E338-E344. [PMID: 34010215 PMCID: PMC8602402 DOI: 10.1097/ncc.0000000000000959] [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: 01/03/2023]
Abstract
BACKGROUND Effective communication between physicians and nurses is crucial to the safety of patients, especially for those with cancer, which is a complex disease requiring multidisciplinary treatment. However, little is known about the factors that contribute to effective communication, which is defined as the development of shared understanding between two or more people. OBJECTIVE This qualitative secondary analysis was conducted to identify factors that contribute to shared understanding between physicians and nurses from video-recorded conversations that occurred between them during inpatient rounds on oncology units. METHODS We used inductive grounded theory to identify videos depicting moments of shared understanding. We then searched for preceding events to develop a preliminary conceptual model that described the factors contributing to shared understanding. RESULTS Four factors emerged as contributors to shared understanding: engagement, clarification, confirmation, and resolution. These factors occurred in sequence with engagement occurring first and resolution occurring last, as the closure of a communication exchange. CONCLUSIONS Existing interventions to improve communication include some of the factors identified as contributing to shared understanding (eg, closed-loop communications require clarification and confirmation). However, nurses may need to pay attention to all four factors to develop shared understanding that will promote effective communication with physicians and thereby enhance cancer care. IMPLICATIONS FOR PRACTICE Nurses achieve effective communication when they are assertive and avoid indirect communication. A greater awareness of body language and positioning in relation to a physician at the start of a communication exchange may increase the effectiveness of nurse-physician communication.
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Jung JH, Kang JY, Ko CH, Ko JY, Lim JY. Effect of Communication and Education within the Rehabilitation Team: Therapists' and Nurses' Views. Ann Geriatr Med Res 2021; 25:301-308. [PMID: 34662935 PMCID: PMC8749033 DOI: 10.4235/agmr.21.0085] [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: 08/01/2021] [Accepted: 10/12/2021] [Indexed: 11/02/2022] Open
Abstract
Objective To improve the rehabilitation team's awareness of patient mobility and participation by improving communication between therapists and nurses and conducting patient education. Design This study used a non-equivalent control group with a nonsynchronized design. To facilitate communication between therapists and nurses, we used a manual for mobility management to improve the sharing of information on the functional status of patients. We also implemented patient education to improve their awareness of mobility and participation. Finally, we conducted newly devised surveys related to patient functional status and awareness that were applied by therapists and nurses. Results The nurses reported significantly lower functional levels of patients compared to those assessed by therapists. After the intervention, the kappa values representing the concordance between therapists and nurses improved to almost perfect agreement for transfer ability (κ=0.836), mobility (κ=0.664), and toileting (κ=1.000). We also observed a statistically significant increase in questionnaire scores with respect to nurses' awareness (p < 0.05). Conclusion Improving communication among the rehabilitation team, including nurses through the use of a continuous education program, was effective in promoting the mobility and functional level of patients in the inpatient ward.
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Affiliation(s)
- Jae Hyu Jung
- Department of Rehabilitation, Gyeonggi Provincial Medical Center, Korea
| | - Ji-Young Kang
- Department of Rehabilitation, Seoul National University Bundang Hospital, Korea
| | - Chang-Hee Ko
- Department of Rehabilitation, Seoul National University Bundang Hospital, Korea
| | - Jin Young Ko
- Department of Rehabilitation, Gyeonggi Provincial Medical Center, Korea.,Department of Public Health Care (rehabilitation), Seoul National University Bundang Hospital, Korea
| | - Jae Young Lim
- Department of Rehabilitation, Seoul National University Bundang Hospital, Korea
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Nakanishi N, Liu K, Kawakami D, Kawai Y, Morisawa T, Nishida T, Sumita H, Unoki T, Hifumi T, Iida Y, Katsukawa H, Nakamura K, Ohshimo S, Hatakeyama J, Inoue S, Nishida O. Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives. J Clin Med 2021; 10:3870. [PMID: 34501316 PMCID: PMC8432235 DOI: 10.3390/jcm10173870] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has been advanced, the outbreak of coronavirus disease 2019 (COVID-19) posed an additional challenge to PICS. The prevalence of PICS after COVID-19 extensively varied with 28-87% of cases pertaining to physical impairments, 20-57% pertaining to cognitive impairments, and 6-60% pertaining to mental health problems after 1-6 months after discharge. Each component of the ABCDEF bundle is not sufficiently provided from 16% to 52% owing to the highly transmissible nature of the virus. However, new data are emerging about analgesia, sedation, delirium care, nursing care, early mobilization, nutrition, and family support. In this review, we summarize the recent data on PICS and its new challenge in PICS after COVID-19 infection.
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Affiliation(s)
- Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan;
| | - Keibun Liu
- Critical Care Research Group, Faculty of Medicine, University of Queensland and The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD 4032, Australia;
| | - Daisuke Kawakami
- Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan;
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan;
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Takeshi Nishida
- Osaka General Medical Center, Division of Trauma and Surgical Critical Care, 3-1-56, Bandai-Higashi, Sumiyoshi, Osaka 558-8558, Japan;
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi 441-0105, Japan;
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo 060-0011, Japan;
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan;
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, 20-1, Matsushita, Ushikawa, Toyohashi 440-8511, Japan;
| | - Hajime Katsukawa
- Department of Scientific Research, Japanese Society for Early Mobilization, 1-2-12, Kudan-kita, Chiyoda-ku, Tokyo 102-0073, Japan;
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan;
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan;
| | - Junji Hatakeyama
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan;
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan;
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan;
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Paxino J, Denniston C, Woodward-Kron R, Molloy E. Communication in interprofessional rehabilitation teams: a scoping review. Disabil Rehabil 2020; 44:3253-3269. [PMID: 33096000 DOI: 10.1080/09638288.2020.1836271] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Effective communication in interprofessional rehabilitation teams is essential for optimal patient care. Despite the established importance, it remains unclear how interprofessional communication (IPC) within teams contributes to rehabilitation service delivery. The aim of this scoping review was to investigate how IPC has been described in rehabilitation literature. METHODS Databases (Medline, CINAHL, ERIC, Embase, PsychInfo, and Academic Search Complete) were searched for studies including rehabilitation interprofessional communication. Inclusion and exclusion criteria were identified and applied, data were charted, and thematic analysis conducted. RESULTS Twenty-nine papers were identified, and analysis revealed interrelated themes: communication processes, and inputs and effects. Formal communication processes were most prevalent, portraying variability in professional participation and a lack of patient involvement in dialogue and decision making. Inputs and effects were described at an organisational, team and individual level, highlighting the importance of communication throughout the healthcare hierarchy. CONCLUSIONS IPC in rehabilitation is central to effective team function and patient care. To further our understanding, empirical studies examining everyday informal IPC, as well as formal ritualised encounters are needed. Additionally, conceptualisations of IPC would benefit from including the patients' perspective and by using theoretical framing to attend to places, spaces, and artefacts identified in this review.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Charlotte Denniston
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Elizabeth Molloy
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
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Santaguida PL, Oliver D, Gilsing A, Lamarche L, Griffith LE, Mangin D, Richardson J, Kastner M, Raina P, Dolovich L. Delphi consensus on core criteria set selecting among health-related outcome measures (HROM) in primary health care. J Clin Epidemiol 2020; 127:105-116. [PMID: 32417261 DOI: 10.1016/j.jclinepi.2020.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/30/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There has been a lack of consensus on which criteria are important when selecting health-related outcome measures (HROM), especially in primary health care A Delphi consensus was undertaken to identify core criteria for selecting among different HROM and contextual factors affecting decision-making. STUDY DESIGN AND SETTING A Delphi survey using standard methodology (consensus set as 75% agreement) was sent to primary care practitioners, administrators, policymakers, researchers and experts in HROM development. Criteria (n = 35) were selected from a targeted literature search; questions probed contextual factors that may influence selection of core criteria including the following: 1) weighting, 2) clinical contexts, and 3) core areas. RESULTS Participants (n = 45) achieved consensus on 17 items in round 1 (plus four new criteria), with one more item in round 2. Unequal weighting of criteria was favored, and the type of clinical scenario did not influence selection of HROM. CONCLUSION Eighteen core criteria from 39 were identified for inclusion in a core set, reflected predominately aspects of feasibility and acceptability. This is the first study providing evidence that contextual factors affect selection of HROM in a core criteria set. Care in primary health care is complex, and therefore, the items not reaching consensus may reflect this heterogeneity.
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Affiliation(s)
- Pasqualina L Santaguida
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 1280 Main Street W, Room 3N52G, Hamilton, Ontario L8P 0A1, Canada.
| | - Douglas Oliver
- Department of Family Medicine (DFM), DBHSC, McMaster University, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6, Canada
| | - Anne Gilsing
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 175 Longwood Rd. S, Suite 309, Hamilton, Ontario L8P 0A1, Canada
| | - Larkin Lamarche
- Department of Family Medicine (DFM), DBHSC, McMaster University, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 175 Longwood Rd. S, Suite 309, Hamilton, Ontario L8P 0A1, Canada
| | - Deidre Mangin
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 175 Longwood Rd. S, Suite 309, Hamilton, Ontario L8P 0A1, Canada
| | - Julie Richardson
- Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, 4th Floor, 1400 Main St. W. IAHS 443, Hamilton, Ontario L8S 1C7, Canada
| | - Monica Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, 175 Longwood Rd. S, Suite 309, Hamilton, Ontario L8P 0A1, Canada
| | - Lisa Dolovich
- Department of Family Medicine (DFM), DBHSC, McMaster University, 5th Floor 100 Main St West, Hamilton, Ontario L8P 1H6, Canada
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Roberts NA, Alexander K, Wyld D, Janda M. What is needed by staff to implement PROMs into routine oncology care? A qualitative study with the multi-disciplinary team. Eur J Cancer Care (Engl) 2019; 28:e13167. [PMID: 31603590 DOI: 10.1111/ecc.13167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 07/30/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to identify strategies to implement patient-reported outcome measures (PROMs) into routine oncology outpatients' clinical care. METHODS Qualitative focus groups were conducted with staff from multiple disciplines using a semistructured interview guide, with supporting data collected in field notes. Data were analysed using a Directed Content Analysis guided by an implementation science framework. The synthesis of the extracted data aimed to identify key requirements which correspond to intrinsic enablers and barriers for implementation. RESULTS 52 staff members from the multi-disciplinary team participated. Data extracted showed five key themes and three key requirements regarding implementation of PROMs. Staff would consider using PROMs if there was strong research evidence that demonstrates benefits for patient outcomes, if PROM data was relevant to current clinical practice, and if applied appropriately in the specific setting. These findings add pragmatic detail and new knowledge to the current evidence on pathways to PROM implementation. This data can be used to inform implementation of PROMs into health services. CONCLUSION Staff have valuable tacit knowledge of what works in practice that offers a unique opportunity to increase successful implementation of a PROM intervention for patient symptom reporting.
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Affiliation(s)
- Natasha A Roberts
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Qld, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Kim Alexander
- School of Nursing, Queensland University of Technology, Brisbane, Qld, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Qld, Australia.,School of Medicine, University of Queensland, Woolloongabba, Qld, Australia
| | - Monika Janda
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Qld, Australia.,Centre for Health Services Research, The University of Queensland, Woolloongabba, Qld, Australia
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13
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Franz S, Muser J, Thielhorn U, Wallesch CW, Behrens J. Inter-professional communication and interaction in the neurological rehabilitation team: a literature review. Disabil Rehabil 2018; 42:1607-1615. [PMID: 30457016 DOI: 10.1080/09638288.2018.1528634] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Neurological early rehabilitation aims at regaining cooperativity and acquiring rehabilitation capability with brain-injured patients, most of whom are transferred from Intensive Care Units, most of whom still require intensive care and suffer from disorders of consciousness. In neurological early rehabilitation, therapeutic nursing is an integral part of the therapeutic team. Other than the specialized therapists, nurses are present on the ward 24/7, which gives them a closer perspective on the patient. The research question was how do nurses, physiotherapists, occupational therapists and speech therapists communicate and interact as teams in neurological rehabilitation wards. A literature review was conducted aiming at inter-professional communication and interaction with special regard to the role of these four professionals being the core team members in these settings.Methods: A literature search was conducted in the period from August to October 2016 within the following electronic Databases: Medline, CINAHL, PSYNDEX, SpeechBITE, PEDro und OTseeker. Further searches were undertaken in the reference lists of obtained studies to locate other relevant material. The aim was to gather and evaluate the evidence about inter-professional teamwork in neurological early rehabilitation. The main inclusion criterion was the presence of the following professionals as participants in the study: Nurses, physiotherapists, occupational therapists and speech therapists. Twenty-seven studies were found relevant, of which 17 (12 qualitative and five quantitative) bore empirical results that related to the research questions. These 17 studies were qualitatively analysed for the grade of evidence, methods and the relevance for the conditions and processes in rehabilitation units. Out of 17 studies, four were performed in neurological rehabilitation settings, five in stroke units, six in general rehabilitation, one in short-term care rehabilitation and one in geriatric rehabilitation. Due to the scarcity of material, all these studies were analysed under the perspective of relevance for neurological early rehabilitation.Results: The results of this exploratory literature review indicate that the efficiency and quality of cooperation in rehabilitation teams could be improved through a better patient-oriented inter-professional communication. This is achieved through cross-professional team organization, team supervision and by including team communication in vocational and on-the-job-training. Profession-specific terminologies and differences in understanding of roles could be barriers for collaboration in teams.Conclusions: According to this literature review, successful inter-professional patient-orientated care is promoted by being informed about the various functions of team members from different disciplines, about the role each member plays within the team and communication styles. Means of improving communication are being outlined.Implications for RehabilitationInter-professional communication is promoted by cross-professional team organization.Inter-professional communication should be included in vocational and on-the-job-training and supervision.Barriers for communication in teams are different terminologies and differences in role perception.
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Affiliation(s)
- Shiney Franz
- BDH - Federal Association of Rehabilitation, Bonn, Germany.,Medical Faculty, Institute for Health and Nursing Sciences, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | | | - Ulrike Thielhorn
- Management in Healthcare, Catholic University for Applied Sciences, Freiburg, Germany
| | | | - Johann Behrens
- Medical Faculty, Institute for Health and Nursing Sciences, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
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14
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Greenhalgh J, Dalkin S, Gooding K, Gibbons E, Wright J, Meads D, Black N, Valderas JM, Pawson R. Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05020] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BackgroundThe feedback of patient-reported outcome measures (PROMs) data is intended to support the care of individual patients and to act as a quality improvement (QI) strategy.ObjectivesTo (1) identify the ideas and assumptions underlying how individual and aggregated PROMs data are intended to improve patient care, and (2) review the evidence to examine the circumstances in which and processes through which PROMs feedback improves patient care.DesignTwo separate but related realist syntheses: (1) feedback of aggregate PROMs and performance data to improve patient care, and (2) feedback of individual PROMs data to improve patient care.InterventionsAggregate – feedback and public reporting of PROMs, patient experience data and performance data to hospital providers and primary care organisations. Individual – feedback of PROMs in oncology, palliative care and the care of people with mental health problems in primary and secondary care settings.Main outcome measuresAggregate – providers’ responses, attitudes and experiences of using PROMs and performance data to improve patient care. Individual – providers’ and patients’ experiences of using PROMs data to raise issues with clinicians, change clinicians’ communication practices, change patient management and improve patient well-being.Data sourcesSearches of electronic databases and forwards and backwards citation tracking.Review methodsRealist synthesis to identify, test and refine programme theories about when, how and why PROMs feedback leads to improvements in patient care.ResultsProviders were more likely to take steps to improve patient care in response to the feedback and public reporting of aggregate PROMs and performance data if they perceived that these data were credible, were aimed at improving patient care, and were timely and provided a clear indication of the source of the problem. However, implementing substantial and sustainable improvement to patient care required system-wide approaches. In the care of individual patients, PROMs function more as a tool to support patients in raising issues with clinicians than they do in substantially changing clinicians’ communication practices with patients. Patients valued both standardised and individualised PROMs as a tool to raise issues, but thought is required as to which patients may benefit and which may not. In settings such as palliative care and psychotherapy, clinicians viewed individualised PROMs as useful to build rapport and support the therapeutic process. PROMs feedback did not substantially shift clinicians’ communication practices or focus discussion on psychosocial issues; this required a shift in clinicians’ perceptions of their remit.Strengths and limitationsThere was a paucity of research examining the feedback of aggregate PROMs data to providers, and we drew on evidence from interventions with similar programme theories (other forms of performance data) to test our theories.ConclusionsPROMs data act as ‘tin openers’ rather than ‘dials’. Providers need more support and guidance on how to collect their own internal data, how to rule out alternative explanations for their outlier status and how to explore the possible causes of their outlier status. There is also tension between PROMs as a QI strategy versus their use in the care of individual patients; PROMs that clinicians find useful in assessing patients, such as individualised measures, are not useful as indicators of service quality.Future workFuture research should (1) explore how differently performing providers have responded to aggregate PROMs feedback, and how organisations have collected PROMs data both for individual patient care and to improve service quality; and (2) explore whether or not and how incorporating PROMs into patients’ electronic records allows multiple different clinicians to receive PROMs feedback, discuss it with patients and act on the data to improve patient care.Study registrationThis study is registered as PROSPERO CRD42013005938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Sonia Dalkin
- Department of Public Health, Northumbria University, Newcastle upon Tyne, UK
| | - Kate Gooding
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Judy Wright
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - David Meads
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Nick Black
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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15
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Fyffe D, Kalpakjian CZ, Slavin M, Kisala P, Ni P, Kirshblum SC, Tulsky DS, Jette AM. Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI). J Spinal Cord Med 2016; 39:527-34. [PMID: 26781769 PMCID: PMC5020585 DOI: 10.1080/10790268.2015.1133483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To provide validation of functional ability levels for the Spinal Cord Injury - Functional Index (SCI-FI). DESIGN Cross-sectional. SETTING Inpatient rehabilitation hospital and community settings. PARTICIPANTS A sample of 855 individuals with traumatic spinal cord injury enrolled in 6 rehabilitation centers participating in the National Spinal Cord Injury Model Systems Network. INTERVENTIONS Not Applicable. MAIN OUTCOME MEASURES Spinal Cord Injury-Functional Index (SCI-FI). RESULTS Cluster analyses identified three distinct groups that represent low, mid-range and high SCI-FI functional ability levels. Comparison of clusters on personal and other injury characteristics suggested some significant differences between groups. CONCLUSIONS These results strongly support the use of SCI-FI functional ability levels to document the perceived functional abilities of persons with SCI. Results of the cluster analysis suggest that the SCI-FI functional ability levels capture function by injury characteristics. Clinical implications regarding tracking functional activity trajectories during follow-up visits are discussed.
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Affiliation(s)
- Denise Fyffe
- Kessler Foundation, West Orange, NJ, USA,Department of Physical Medicine & Rehabilitation, Rutgers – New Jersey Medical School, Newark, NJ, USA,Correspondence to: Denise Fyffe, Department of Physical Medicine and Rehabilitation New Jersey Medical School Rutgers, the State University of New Jersey, DOC Suite 3100, 90 Bergen Street, Newark, NJ 07103-2499, USA.
| | | | - Mary Slavin
- Health & Disability Research Institute, Boston University School of Public Health, Boston, MA, USA
| | - Pamela Kisala
- Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Pengsheng Ni
- Boston Rehabilitation Outcomes Center, Boston University School of Public Health, Boston, MA, USA
| | - Steven C. Kirshblum
- Kessler Foundation, West Orange, NJ, USA,Department of Physical Medicine & Rehabilitation, Rutgers – New Jersey Medical School, Newark, NJ, USA,Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - David S. Tulsky
- Kessler Foundation, West Orange, NJ, USA,Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Alan M. Jette
- Health & Disability Research Institute, Boston University School of Public Health, Boston, MA, USA,Boston Rehabilitation Outcomes Center, Boston University School of Public Health, Boston, MA, USA
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16
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Tyson SF, Burton LJ, McGovern A, Sharifi S. Service users’ views of the assessment process in stroke rehabilitation. Clin Rehabil 2014; 28:824-831. [DOI: 10.1177/0269215514523300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To investigate the service users’ (stroke survivors and care-givers) experiences and views of the rehabilitation assessment process. Design: Qualitative data analysis from three focus groups using a content analysis to identify the major themes. Setting: Participants were recruited from stroke support groups and community rehabilitation services in a large UK city. Subjects: Seventeen community-dwelling stroke survivors who had completed their rehabilitation within the previous year and six care-givers. Results: Five themes emerged: understanding the purpose of the assessment; repetition of assessments; feedback about assessments and progress; format of feedback and barriers to feedback. While all participants reported undergoing assessment, some felt their purpose was not always explained and resented unexplained repetitions of tests. Some participants reported a positive experience, but most wanted more information about their progress and predictions of recovery. They wanted regular, consistent, objective information presented in layman’s terms; verbally and in writing. Some carers reported difficulty accessing information particularly as a result of confidentiality policies. While some participants accepted these short-comings, others considered them due to staff’s disinterest or ineptitude, which undermined their trust in the team. Conclusions: Stroke service users require clear information about the purpose of assessments and regular, consistent, objective feedback about their progress using layman’s language both verbally and in writing.
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Affiliation(s)
- Sarah F Tyson
- University of Manchester, Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Louisa-Jane Burton
- University of Manchester, Stroke and Vascular Research Centre, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Alison McGovern
- Greater Manchester, Lancashire and South Cumbria Strategic Clinical Network and Senate, Stroke Rehabilitation Programme, Manchester, UK
| | - Sudi Sharifi
- University of Salford, Business School, Salford, UK
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17
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Häggqvist B, Stenvall M, Fjellman-Wiklund A, Westerberg K, Lundin-Olsson L. "The balancing act"--licensed practical nurse experiences of falls and fall prevention: a qualitative study. BMC Geriatr 2012; 12:62. [PMID: 23062203 PMCID: PMC3536659 DOI: 10.1186/1471-2318-12-62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are common in old age and may have serious consequences. There are many strategies to predict and prevent falls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. METHODS A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis. RESULTS The result of the licensed practical nurse thoughts and experiences about risk of falling and fall prevention work is represented in one theme, "the balancing act". The theme includes three categories: "the right to decide", "the constant watch", and "the ongoing negotiation" as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients' appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients' risk of falling and to be active to prevent falls. At the acute ward, the words "risk of falling" were not used and fall prevention were not discussed; instead the licensed practical nurses used for example "dizzy and pale". The results also indicated differences in components that facilitate workplace learning and knowledge transfer. CONCLUSIONS Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to prevent falls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.
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Affiliation(s)
- Beatrice Häggqvist
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-90187, Umeå, Sweden
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18
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Burton LJ, Tyson S, McGovern A. Staff perceptions of using outcome measures in stroke rehabilitation. Disabil Rehabil 2012; 35:828-34. [DOI: 10.3109/09638288.2012.709305] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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