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Janssens O, Haerens L, Valcke M, Embo M, Debacker J, Van Hecke A, Gauwe V, Van Hecke M, De Vriendt P, Pype P. The development of a research-based interprofessional communication behaviors repository in healthcare education: A systematic review. J Interprof Care 2024; 38:918-935. [PMID: 39074503 DOI: 10.1080/13561820.2024.2372017] [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: 05/18/2023] [Revised: 03/23/2024] [Accepted: 06/18/2024] [Indexed: 07/31/2024]
Abstract
Interprofessional communication is crucial for patient care, yet there is a dearth of comprehensive assessment tools essential to train and assess healthcare students. While the Interprofessional Educational Collaborative framework (IPEC) outlines eight sub-competencies, it lacks detailed behavioral indicators. This study aimed to create a repository of interprofessional communication behaviors to complement the IPEC sub-competencies. From 12,448 articles, 55 were selected and thematically analyzed with NVivo18®. We identified 230 interprofessional communication behaviors, organized into 10 themes and 61 sub-themes, aligning with the IPEC sub-competencies. This comprehensive repository could be foundational for developing interprofessional communication assessment tools in healthcare education and aiding healthcare institutions in improving interprofessional communication practices.
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Affiliation(s)
- Oona Janssens
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Leen Haerens
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Martin Valcke
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mieke Embo
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
- Department of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Jens Debacker
- Vrije Universiteit Brussel (VUB),Molecular Imaging and Therapy Research Group (MITH), Brussels, Belgium
- Department of Nuclear Medicine, Vrije Universiteit Brussel (VUB),University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Vanessa Gauwe
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Marlies Van Hecke
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Patricia De Vriendt
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
- Frailty in Ageing (FRIA) research group, Mental Health and Wellbeing research group (MENT), Gerontology department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Ghent, Belgium
| | - Peter Pype
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Centre for Interprofessional Collaboration in Education, Research and Practice, Ghent University, Ghent, Belgium
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e10-e48. [PMID: 38363241 DOI: 10.1016/j.jogn.2023.11.001] [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: 02/17/2024] Open
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Wisner K, Holschuh C. Fetal Heart Rate Auscultation, 4th Edition. Nurs Womens Health 2024; 28:e1-e39. [PMID: 38363259 DOI: 10.1016/j.nwh.2023.11.001] [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: 02/17/2024]
Abstract
Intermittent auscultation (IA) is an evidence-based method of fetal surveillance during labor for birthing people with low-risk pregnancies. It is a central component of efforts to reduce the primary cesarean rate and promote vaginal birth (American College of Obstetricians and Gynecologists, 2019; Association of Women's Health, Obstetric and Neonatal Nurses, 2022a). The use of intermittent IA decreased with the introduction of electronic fetal monitoring, while the increased use of electronic fetal monitoring has been associated with an increase of cesarean births. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues; and strategies to implement IA.
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Macena de Almeida ME, Mendes SS, Maria de Vasconcelos Oliveira N, Vasconcelos Neto JA, Lopes LG, Moreira Vasconcelos CT. Peanut Ball Utilization Protocols in Women During Labour and Delivery: An Integrative Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102185. [PMID: 37473916 DOI: 10.1016/j.jogc.2023.07.005] [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: 02/13/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE This review aimed to assess the evidence available in the literature about the protocols for using peanut ball (PB) in women during labour and delivery. DATA SOURCES A systematic search was carried out by 2 independent researchers in the PubMed/MedLine, Web of Science, Embase, Cochrane and Scopus databases, and the reference lists were scanned for additional articles. STUDY SELECTION Search terms employed were selected from MeSH (Medical Subject Headings) and DeCS (Descriptors in Health Sciences) and combined in each database: "Pregnant Women" AND "Peanut Ball", "Peanut Ball" AND "Labor, Obstetric", as well as "Peanut Ball" AND "Parturition". There were no limits regarding the publication period or language. Studies that answered the following question were included: What are the protocols for the use of the PB in women during labour and childbirth described in the literature? Secondary studies were excluded. Disagreements were resolved by a third researcher. DATA EXTRACTION The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement guided this review. The authors prepared a standardized data extraction sheet to extract data and used the Mendeley software to organize the analyzed studies. DATA SYNTHESIS Ten studies made up the final sample of this review. Eight articles presented the protocol for using the PB: 2 studies included it after epidural analgesia and removed it at complete cervical dilation and effacement; 4 addressed the frequency of position changes during labour; and 3 reported data on maternal positions that were adopted. Five studies showed lower rates of cesarean delivery, and 2 reported that PB reduces the length of labour. Only 1 article associated the use of PB with the reduction of instrumental deliveries and perineal lacerations. One study showed a positive evaluation of parturients regarding the use of PB. CONCLUSION PB was associated with a reduction in cesarean and instrumental deliveries, and the length of labour. Despite its benefits, there is no standardized protocol for the use of PB, preventing it from predicting outcomes with its use. PROSPERO ID CRD42023392238.
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Affiliation(s)
| | | | | | | | - Lia Gomes Lopes
- Nursing Department, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Dalton ED, Pjesivac I, Eldredge S, Miller L. From Vulnerability to Disclosure: A Normative Approach to Understanding Trust in Obstetric and Intrapartum Nurse-Patient Communication. HEALTH COMMUNICATION 2021; 36:616-629. [PMID: 32122160 DOI: 10.1080/10410236.2020.1733225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study qualitatively examined how nurses, nurse practitioners, and nurse midwives construct the meaning of patient trust in their work caring for pregnant and laboring women. Twenty-two interviews were conducted with nurse participants employed at clinics, hospitals, and birth centers across Southeastern United States. Using a normative theoretical approach within the multiple goals framework, we identified five emergent themes that characterize trust as it shapes nurses' communicative goals: trust as the woman's acceptance of vulnerability and risk, the woman relinquishing control, the woman conceding to the nurse's expertise, the woman feeling heard, and the woman's disclosure of information. The results support previous studies, which conceptualized trust as vulnerability, risk, and disclosure whereas the remaining themes are original to this study. The results are interpreted both in light of existing links between trust and communication and the shifting and conflicting goals of nurses as they attempt to achieve their primary goal of optimal health outcomes. Passive constructions of trust that conflate it with women's acquiescent behaviors could have implications for the quality of communication between nurses and patients. In addition, trust, as understood by these participants, becomes situated as an instrumental means to achieving patient cooperation and desired health outcomes rather than a relational goal that supports women's agency throughout obstetric and intrapartum processes. This may be at odds with the modern movement toward patient-centered care and shared decision-making in U.S. maternity care.
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Affiliation(s)
| | - Ivanka Pjesivac
- Grady College of Journalism and Mass Communication, University of Georgia
| | | | - Laura Miller
- Department of Communication Studies, University of Tennessee
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Abstract
Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits for the procedure should be explained to women so that they can make informed decisions. Clinicians should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing is required to monitor the mother and fetus to promote the best possible outcomes. This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels and skills needed to provide safe and effective care during cervical ripening and labor induction and augmentation.
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Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2020; 30:747-754. [PMID: 33168635 PMCID: PMC8140397 DOI: 10.1136/bmjqs-2020-011441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units. METHODS Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis. RESULTS A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or individual interviews; we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness. CONCLUSIONS Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.
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Affiliation(s)
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megan Lafferty
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Chodzaza E, Mbiza C, Gadama L, Kafulafula U. Midwives' and Medical professionals' perspectives of collaborative practice at Queen Elizabeth Central Hospital Maternity Unit, Malawi: The discovery phase of an appreciative inquiry project. Malawi Med J 2020; 32:13-18. [PMID: 32733654 PMCID: PMC7366164 DOI: 10.4314/mmj.v32i1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background This paper reports on part of a larger study, the aim of which was to develop an intervention to collaboratively develop innovative strategies to promote effective collaborative practices among midwives and medical professionals working in intrapartum care unit. Collaborative practice is a critical marker for success in improving quality of maternity care. To date, there has been limited exploration of collaborative practices between midwives and medical professionals working in intrapartum care from the African perspective. Aim This paper reports findings of the discovery phase of appreciative inquiry (AI) set out to understand the perspectives of midwives and medical professionals on collaborative practices at Queen Elizabeth Central Hospital labour and delivery ward in Malawi. Methods The study used an exploratory qualitative approach framed in an Appreciative Inquiry theoretical perspective. Appreciative Inquiry consists of four phases :(discovery, dream, design and destiny).The discovery phase consisted of 16 in-depth interviews and 2 focus group discussions among purposively selected midwives (4 nurse midwives, 2 midwifery unit matrons) and medical professionals (2 obstetricians, 4 registrars, 2 intern doctors, 2 clinical officers) working in the labour ward. All interviews and discussions were audiotaped and transcribed verbatim. Data were analysed using thematic analysis. Results Five dominant themes emerged: collaborative breakdown, benefits of collaboration, the importance of positive and respectful attitude, barriers to effective collaborative practices and strategies to improve collaborative practice. Conclusion/Recommendations Aligning the perspectives of the members of the two disciplines is significant to effective implementation of collaborative intrapartum care. Participants demonstrated that there is increased parallel working of midwives and doctors at QECH. This is not professionally healthy. Therefore, putting together the viewpoints of the professions to create a mutually agreeable professional framework of collaborative intrapartum practice is significant. Additionally, there is an obvious need to address the professional concerns of both disciplines.
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Affiliation(s)
- Elizabeth Chodzaza
- University of Malawi Kamuzu College of Nursing, Faculty of Midwifery, Neonatal and Reproductive Health Studies, Blantyre, Malawi
| | - Christina Mbiza
- Queen Elizabeth Central Hospital, Department of Obstetrics and Gynecology, Blantyre, Malawi
| | - Luis Gadama
- University of Malawi, College of Medicine, School of Medicine, Blantyre, Malawi
| | - Ursula Kafulafula
- University of Malawi Kamuzu College of Nursing, Faculty of Midwifery, Neonatal and Reproductive Health Studies, Blantyre, Malawi
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Abstract
Cervical ripening and induction and augmentation of labor are common procedures in labor and birth units. The potential risks and benefits for the procedure should be explained to women so that they can make informed decisions. Clinicians should be knowledgeable about the methods and medications used and be skilled in maternal-fetal assessment. Adequate nurse staffing is required to monitor the mother and fetus to promote the best possible outcomes. This practice monograph includes information on mechanical and pharmacologic methods for cervical ripening; labor induction and augmentation with oxytocin, a high alert drug; and nurse staffing levels and skills needed to provide safe and effective care during cervical ripening and labor induction and augmentation.
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Anna MA, Olga CV, Rocío CS, Isabel SP, Xavier ET, Pablo RC, Montserrat PA, Cristina GB, Ramon E. Midwives' experiences of the factors that facilitate normal birth among low risk women in public hospitals in Catalonia (Spain). Midwifery 2020; 88:102752. [PMID: 32521407 DOI: 10.1016/j.midw.2020.102752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal birth has major benefits for women and infants. Nevertheless, during the last few decades, the advancement in technology and an increasing domination of obstetrician-led childbirths have resulted in the medicalization of childbirth. Midwives are interested in amending this trend and aim to support women to achieve the best possible birth experience for them. OBJECTIVE This study aimed to explore midwives' experiences on the facilitators and barriers of normal birth in conventional obstetric units. DESIGN A descriptive qualitative study. Three focus groups were audio recorded and transcribed verbatim. Recurrent themes were identified and formulated. Feedback from data were analysed using thematic analysis. Investigator triangulation was used during the analysis. SETTING Midwives from eleven different public hospitals in Catalonia participated in the study. PARTICIPANTS A purposive sample of 33 midwives participated in the focus groups. FINDINGS Midwives identified several factors that complicated their task of facilitating normal birth. Barriers included: (1) inadequate institutional support; (2) existing obstetrician-led practices, (3) lack of evidence-based practice and (4) midwives' lack of awareness of professional competencies. Factors facilitating normal birth included: (1) midwives' positive perceptions of normal birth, (2) midwives' additional effort and (3) women's awareness of normal birth. KEY CONCLUSIONS Midwives wishing to promote normal birth in obstetric units face a number of challenges and often feel unsupported. Nonetheless, the midwives perceive the increasing women's demand for normal births as an opportunity to implement changes in such a way that women are involved in the decision-making process and midwives act as their advocates. IMPLICATIONS FOR PRACTICE There is a need to increase the midwifery workforce and enhance regulations and funding strategies to support their practice as well as normal birth. Policy makers in settings without well-functioning midwife-led care should consider implementing this model after successfully scaling up of the number of midwives and ensuring an effective midwifery training.
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Affiliation(s)
- Martin-Arribas Anna
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.; School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Canet-Velez Olga
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Casañas Sanchez Rocío
- Escola Superior d'Infermeria del Mar (ESIM), Universidad Pompeu Fabra (UPF), Carrer Dr. Aiguader 80, 08003 Barcelona, Spain.; Centre d'Higiene Mental Les Corts, CHM Salut Mental Barcelona, Carrer de Numància 103 Baixos, 08029 Barcelona, Spain..
| | - Salgado Poveda Isabel
- Vall d'Hebron University Hospital, Carrer Vall d'Hebron 119-129, 08035 Barcelona, Spain..
| | - Espada-Trespalacios Xavier
- Obstetric care area. Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Bacelona, Spain..
| | - Rodriguez Coll Pablo
- Maternal and Child Healthcare Department. Fundació Sanitària de Mollet, Ronda Pinetons 8, 08100 Mollet del Vallès, Bacelona, Spain..
| | | | - González-Blázquez Cristina
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain..
| | - Escuriet Ramon
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain..
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Mhyre J, Ward N, Whited TM, Anders M. Randomized Controlled Simulation Trial to Compare Transfer Procedures for Emergency Cesarean. J Obstet Gynecol Neonatal Nurs 2020; 49:272-282. [PMID: 32101767 DOI: 10.1016/j.jogn.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To test the hypothesis that capping intravenous and epidural lines would reduce time to transfer women in labor to the operating room and time to readiness for general anesthesia for emergency cesarean. The secondary purpose was to identify latent threats to patient safety. DESIGN Mixed methods analysis of a randomized, controlled, in situ simulation trial. SETTING Labor and delivery unit at high-risk referral center. PARTICIPANTS Fifteen interprofessional teams that included labor and delivery nurses and anesthesiology residents. METHODS Immediately before simulation, we randomized bedside nurses and anesthesiology residents to one of two groups: usual transfer or the cap and run procedure. Simulation scenarios started with fetal heart rate decelerations that necessitated position changes followed by emergency cesarean. An embedded simulated obstetrician announced the decision for cesarean; completion of an OR checklist confirmed team readiness to induce general anesthesia. Postsimulation debriefing was focused on teamwork and opportunities to improve safety, and we used qualitative analysis to synthesize results. RESULTS We found no statistically significant difference in the overall time from decision for cesarean to readiness for general anesthesia between the two groups (usual transfer median = 445 seconds [interquartile range, 425-465] vs. cap and run 390 seconds [interquartile range, 383-443], p = .12). The time in the operating room was less in the cap and run group than in the usual transfer group (median = 300 seconds vs. 250 seconds, p = .038). Qualitative analysis of the debriefing data indicated advantages of the capping procedure, including better bed maneuverability and fewer tangled lines. CONCLUSION We found no evidence of decreased overall time from decision for cesarean to readiness for general anesthesia based on whether the nurse capped the intravenous and epidural lines or pushed the intravenous pole alongside the bed. However, nurses perceived improved patient safety with the cap and run procedure.
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Abstract
OBJECTIVE Develop a multidisciplinary, consensus-driven, evidence-based approach to oxytocin use, while adhering to national guidelines. DESIGN This was a quality improvement project that used the Plan Do Study Act method to create cycles of change over several years. To initiate discussion, a survey was administered at a social event for providers from divergent community practices that addressed the controversial aspects of oxytocin use. Graphic feedback was provided showing divergences between answers and the evidence. The perinatal team directed design and implementation of this project with specific involvement of a nurse quality improvement coordinator and nurse educator. MEASURES Process, outcome, and balancing measures were used to evaluate the program. Process measure: use of a standardized order-set. OUTCOME MEASURE rate of adherence to the resultant protocol. Balancing measures: 1) maximum oxytocin dose, 2) time from oxytocin initiation to birth, 3) cesarean birth rates, and 4) Apgar scores. RESULTS An initial increase in adherence to the protocol decreased with the loss of the "paper" order-set. Adherence improved when computerized physician order entry was adjusted: 2006: 73%, 2007: 95%; 2011: 57%, 2013: 100% (p = 0.007, 2006 vs. 2007) (p < 0.001, 2006 vs. 2013). Compliance with the protocol was associated with a decrease in maximum oxytocin dose and in time between oxytocin initiation and birth (p < 0.001). CONCLUSION Consistency and safety in patient care can be accomplished using literature-based evidence and active consensus building among members of the perinatal team. A standardization process must be integrated into the electronic medical record to become a sustained part of a practice culture.
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Lamé G, Liberati E, Burt J, Draycott T, Winter C, Ward J, Dixon-Woods M. IMproving the practice of intrapartum electronic fetal heart rate MOnitoring with cardiotocography for safer childbirth (the IMMO programme): protocol for a qualitative study. BMJ Open 2019; 9:e030271. [PMID: 31256041 PMCID: PMC6609047 DOI: 10.1136/bmjopen-2019-030271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/22/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Suboptimal electronic fetal heart rate monitoring (EFM) in labour using cardiotocography (CTG) has been identified as one of the most common causes of avoidable harm in maternity care. Training staff is a frequently proposed solution to reduce harm. However, current approaches to training are heterogeneous in content and format, making it difficult to assess effectiveness. Technological solutions, such as digital decision support, have not yet demonstrated improved outcomes. Effective improvement strategies require in-depth understanding of the technical and social mechanisms underpinning the EFM process. The aim of this study is to advance current knowledge of the types of errors, hazards and failure modes in the process of classifying, interpreting and responding to CTG traces. This study is part of a broader research programme aimed at developing and testing an intervention to improve intrapartum EFM. METHODS AND ANALYSIS The study is organised into two workstreams. First, we will conduct observations and interviews in three UK maternity units to gain an in-depth understanding of how intrapartum EFM is performed in routine clinical practice. Data analysis will combine the insights of an ethnographic approach (focused on the social norms and interactions, values and meanings that appear to be linked with the process of EFM) with a systems thinking approach (focused on modelling processes, actors and their interactions). Second, we will use risk analysis techniques to develop a framework of the errors, hazards and failure modes that affect intrapartum EFM. ETHICS AND DISSEMINATION This study has been approved by the West Midlands-South Birmingham Research Ethics Committee, reference number: 18/WM/0292. Dissemination will take the form of academic articles in peer-reviewed journals and conferences, along with tailored communication with various stakeholders in maternity care.
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Affiliation(s)
- Guillaume Lamé
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Elisa Liberati
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
| | - Tim Draycott
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - Cathy Winter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Women and Children's Health, North Bristol NHS Trust, Westbury on Trym, UK
| | - James Ward
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge, UK
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Abstract
The use of intermittent auscultation (IA) for fetal surveillance during labor decreased with the introduction of electronic fetal monitoring (EFM). The increased use of EFM is associated with an increase in cesarean births. IA is an evidence-based method of fetal surveillance during labor for women with low risk pregnancies and considered one component of comprehensive efforts to reduce the primary cesarean rate and promote vaginal birth. Many clinicians are not familiar with IA practice. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues, and strategies to promote implementation of IA into practice.
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Gleddie M, Stahlke S, Paul P. Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery. J Interprof Care 2018:1-11. [PMID: 30596305 DOI: 10.1080/13561820.2018.1562422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 07/29/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.
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Affiliation(s)
- Megan Gleddie
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
| | - Sarah Stahlke
- b Faculty of Nursing , University of Alberta, Edmonton Clinic Health Academy , Alberta , Canada
| | - Pauline Paul
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
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Effects of an Interdisciplinary Practice Bundle for Second-Stage Labor on Clinical Outcomes. MCN Am J Matern Child Nurs 2018; 43:184-194. [PMID: 29634578 DOI: 10.1097/nmc.0000000000000438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is renewed interest in second-stage labor practices as recent evidence has challenged historical perspectives on safe duration of second-stage labor. Traditional practices and routine interventions during second-stage have uncertain benefit for low-risk women and may result in cesarean birth. PURPOSE The purpose of this quality improvement project was to implement an interdisciplinary second-stage practice bundle to promote safe outcomes including method of birth and women's birth experience. METHODS Standardized second-stage labor evidence-based practice recommendations structured into a 5 Ps practice bundle (patience, positioning, physiologic resuscitation, progress, preventing urinary harm) were implemented across 34 birthing hospitals in the Trinity Health system. RESULTS Significant improvements were observed in second-stage practices. Association of Women's Health, Obstetric and Neonatal Nurses' perinatal nursing care quality measure Second-Stage of Labor: Mother-Initiated Spontaneous Pushing significantly improved [pre-implementation 43% (510/1,195), post-implementation 76% (1,541/2,028), p < .0001]. Joint Commission Perinatal Care-02: nulliparous, term, singleton, vertex cesarean rate significantly decreased (p = 0.02) with no differences in maternal morbidity, or negative newborn birth outcomes. Unexpected complications in term births significantly decreased in all newborns (p < 0.001), and for newborns from vaginal births (p = 0.03). Birth experience satisfaction rose from the 69th to the 81st percentile. CLINICAL IMPLICATIONS Implementing 13 evidence-based second-stage labor practices derived from the Association of Women's Health, Obstetric and Neonatal Nurses and the American College of Nurse-Midwives professional guidelines achieved our goals of safely reducing primary cesarean birth among low-risk nulliparous women, and optimizing maternal and fetal outcomes associated with labor and birth. By minimizing routine interventions, nurses support physiologic birth and improve women's birth satisfaction.
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Abstract
Oxytocin is one of the most commonly used medications in obstetrics and has been associated with claims of negligence in cases of adverse outcomes. Errors involving intravenous oxytocin administration for induction or augmentation of labor are most commonly dose related and include failure to avoid or treat tachysystole or failure to asses or treat a fetal heart rate pattern indicative of disruption in oxygenation. Clinicians should be knowledgeable regarding pharmacokinetics of oxytocin and the effect of uterine contractions on fetal oxygenation as well as safe titration of oxytocin to achieve the desired effect while minimizing harm.
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Daemers DOA, van Limbeek EBM, Wijnen HAA, Nieuwenhuijze MJ, de Vries RG. Factors influencing the clinical decision-making of midwives: a qualitative study. BMC Pregnancy Childbirth 2017; 17:345. [PMID: 28985725 PMCID: PMC5639579 DOI: 10.1186/s12884-017-1511-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/15/2017] [Indexed: 11/22/2022] Open
Abstract
Background Although midwives make clinical decisions that have an impact on the health and well-being of mothers and babies, little is known about how they make those decisions. Wide variation in intrapartum decisions to refer women to obstetrician-led care suggests that midwives’ decisions are based on more than the evidence based medicine (EBM) model – i.e. clinical evidence, midwife’s expertise, and woman’s values - alone. With this study we aimed to explore the factors that influence clinical decision-making of midwives who work independently. Methods We used a qualitative approach, conducting in-depth interviews with a purposive sample of 11 Dutch primary care midwives. Data collection took place between May and September 2015. The interviews were semi-structured, using written vignettes to solicit midwives’ clinical decision-making processes (Think Aloud method). We performed thematic analysis on the transcripts. Results We identified five themes that influenced clinical decision-making: the pregnant woman as a whole person, sources of knowledge, the midwife as a whole person, the collaboration between maternity care professionals, and the organisation of care. Regarding the midwife, her decisions were shaped not only by her experience, intuition, and personal circumstances, but also by her attitudes about physiology, woman-centredness, shared decision-making, and collaboration with other professionals. The nature of the local collaboration between maternity care professionals and locally-developed protocols dominated midwives’ clinical decision-making. When midwives and obstetricians had different philosophies of care and different practice styles, their collaborative efforts were challenged. Conclusion Midwives’ clinical decision-making is a more varied and complex process than the EBM framework suggests. If midwives are to succeed in their role as promoters and protectors of physiological pregnancy and birth, they need to understand how clinical decisions in a multidisciplinary context are actually made.
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Affiliation(s)
- Darie O A Daemers
- Research Centre for Midwifery Science Maastricht, Zuyd University, PO Box 1256, 6201 BG, Maastricht, The Netherlands.
| | - Evelien B M van Limbeek
- Research Centre for Midwifery Science Maastricht, Zuyd University, PO Box 1256, 6201 BG, Maastricht, The Netherlands
| | - Hennie A A Wijnen
- Research Centre for Midwifery Science Maastricht, Zuyd University, PO Box 1256, 6201 BG, Maastricht, The Netherlands
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht, Zuyd University, PO Box 1256, 6201 BG, Maastricht, The Netherlands
| | - Raymond G de Vries
- Research Centre for Midwifery Science Maastricht, Zuyd University, PO Box 1256, 6201 BG, Maastricht, The Netherlands.,Caphri School for Public Health and Primary Care, Maastricht University, PO Box 1256, 6201 BG, Maastricht, The Netherlands
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M'Rithaa DKM, Fawcus SR, De la Harpe M, Korpela M. Development spots in communication during the management of the intrapartum period: An interpretive multiple case study in a developing context. Afr J Prim Health Care Fam Med 2017; 9:e1-e6. [PMID: 28828876 PMCID: PMC5566129 DOI: 10.4102/phcfm.v9i1.1239] [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: 06/28/2016] [Revised: 01/31/2017] [Accepted: 03/23/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Health care activities are influenced by information communication between women during pregnancy, birth and motherhood and skilled birth attendants (SBAs) and further, between the health care workers during the continuum of care. Therefore, effective information communication processes (ICP) within and between health care facilities are a requirement for appropriate management of patients or clients. The management of the intrapartum period requires swift responses while managing critical information required for further referral and management processes. The involvement of multiple actors at different times with the same client carries the risk of communication breakdown at different points and at different levels of care. The information communicated during the intrapartum period is critical and should be accurate, timely and more importantly appropriate to enable better maternal and neonatal outcomes. PURPOSE The purpose of this article is to discuss the complexities around ICP identified within a developing context that influence the management of the intrapartum period. METHODS Multi-method, multiple case study approach was used to analyse two case studies. Only the challenges from one case study (A) are discussed in this article. In-depth interviews were conducted with the SBAs. The role of observer-as-participant was utilised during the observation; field notes and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. RESULTS The findings identified challenges with information and communication that influenced the management of the intrapartum period. CONCLUSION This study exhibited the challenges identified as development points that can influence the management of the intrapartum period. These challenges were also identified as desirable changes from the present state depending on the perspective of the actor.
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Edmonds JK, O'Hara M, Clarke SP, Shah NT. Variation in Cesarean Birth Rates by Labor and Delivery Nurses. J Obstet Gynecol Neonatal Nurs 2017; 46:486-493. [PMID: 28549612 DOI: 10.1016/j.jogn.2017.03.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine variation in the cesarean birth rates of women cared for by labor and delivery nurses. DESIGN Retrospective cohort study. SETTING One high-volume labor and delivery unit at an academic medical center in a major metropolitan area. PARTICIPANTS Labor and delivery nurses who cared for nulliparous women who gave birth to term, singleton fetuses in vertex presentation. METHODS Data were extracted from electronic hospital birth records from January 1, 2013 through June 30, 2015. Cesarean rates for individual nurses were calculated based on the number of women they attended who gave birth by cesarean. Nurses were grouped into quartiles by their cesarean rates, and the effect of these rates on the likelihood of cesarean birth was estimated by a logit regression model adjusting for patient-level characteristics and clustering of births within nurses. RESULTS Seventy-two nurses attended 3,031 births. The mean nurse cesarean rate was 26% (95% confidence interval [23.9, 28.1]) and ranged from 8.3% to 48%. The adjusted odds of cesarean for births attended by nurses in the highest quartile was nearly 3 times (odds ratio = 2.73, 95% confidence interval [2.3, 3.3]) greater than for births attended by nurses in the lowest quartile. CONCLUSION The labor and delivery nurse assigned to a woman may influence the likelihood of cesarean birth. Nurse-level cesarean birth data could be used to design practice improvement initiatives to improve nurse performance. More precise measurement of the relative influence of nurses on mode of birth is needed.
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Tan TC, Zhou H, Kelly M. Nurse-physician communication - An integrated review. J Clin Nurs 2017; 26:3974-3989. [DOI: 10.1111/jocn.13832] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Huaqiong Zhou
- School of Nursing, Midwifery and Paramedicine; Curtin University; Perth WA Australia
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine; Curtin University; Perth WA Australia
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Nakhaee S, Nasiri A. Inter-professional Relationships Issues among Iranian Nurses and Physicians: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2017; 22:8-13. [PMID: 28382051 PMCID: PMC5364759 DOI: 10.4103/1735-9066.202076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Nurse–physician inter-professional relationship is an important issue in health care system that can affect job satisfaction and patient care quality. The present study explores the major issues of nurse–physician inter-professional relationships in Iran. Materials and Methods: In this in-depth qualitative content analysis study conducted in 2014, 12 participants (5 physicians and 7 nurses) were recruited from two educational hospitals. The data were collected from deep, open, and unstructured interviews, and analyzed based on content analysis. Results: The participants in this study included 12 individuals, 6 females and 6 males, with the age ranging 27–48 years and tenure ranging 4–17 years. Four themes were identified, namely, divergent attitudes, uneven distribution of power, mutual trust destructors, and prudence imposed on nurses. Conclusions: The results revealed some major inter-professional issues and challenges in nurse–physician relationships, some of which are context-specific whereas others should be regarded as universal. It is through a deep knowledge of these issues that nurses and physicians can establish better collaborative inter-professional relationships.
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Affiliation(s)
- Samaneh Nakhaee
- Birjand Health Qualitative Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Ahmad Nasiri
- Birjand Health Qualitative Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Severinsson E, Haruna M, Rönnerhag M, Holm AL, Hansen BS, Berggren I. Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.73030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Delivery Room Quality Improvement Project Improved Compliance with Best Practices for a Community NICU. Sci Rep 2016; 6:37397. [PMID: 27869210 PMCID: PMC5116615 DOI: 10.1038/srep37397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/27/2016] [Indexed: 11/29/2022] Open
Abstract
A Quality Improvement bundle was implemented with the goal of standardizing the multidisciplinary approach to delivery room management. We used a Pre-Post Quality Improvement initiative with the following aims: (1) Placement of a functioning pulse oximeter by two minutes after birth, (2) Delayed intubation, (3) Normothermia on Neonatal Intensive Care Unit Admission, (4) Use of a pre-brief, debrief, and delivery room checklist. Data was collected for 548 infants, which represents every admission to the Palomar Rady Children’s Hospital Neonatal Intensive Care Unit during the 35 month study period from January 1, 2010 to November 30, 2012. The intervention began on May 1, 2011. The objective of increasing the frequency of each goal was met. A significant decrease in rates of retinopathy of prematurity in our post-intervention group was found. Odds ratio 0.00 (0.000, 0.696) p = 0.008. However, this was not confirmed in the multivariable analysis so should be interpreted with caution. This quality improvement project had a positive effect on newborn resuscitation at Palomar Medical Center.
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Adams C, Dawson A, Foureur M. Competing Values Framework: A useful tool to define the predominant culture in a maternity setting in Australia. Women Birth 2016; 30:107-113. [PMID: 27693122 DOI: 10.1016/j.wombi.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/13/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify the predominant culture of an organisation which could then assess readiness for change. DESIGN An exploratory design using the Competing Values Framework (CVF) as a self-administered survey tool. SETTING The Maternity Unit in one Australian metropolitan tertiary referral hospital. SUBJECTS All 120 clinicians (100 midwives and 20 obstetricians) employed in the maternity service were invited to participate; 26% responded. MAIN OUTCOME MEASURE The identification of the predominant culture of an organisation to assess readiness for change prior to the implementation of a new policy. RESULTS The predominant culture of this maternity unit, as described by those who responded to the survey, was one of hierarchy with a focus on rules and regulations and less focus on innovation, flexibility and teamwork. These results suggest that this unit did not have readiness to change. CONCLUSION There is value in undertaking preparatory work to gain a better understanding of the characteristics of an organisation prior to designing and implementing change. This understanding can influence additional preliminary work that may be required to increase the readiness for change and therefore increase the opportunity for successful change. The CVF is a useful tool to identify the predominant culture and characteristics of an organisation that could influence the success of change.
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Affiliation(s)
- Catherine Adams
- Faculty of Health, University of Technology Sydney, PO Box 123, NSW 2007, Australia.
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, PO Box 123, NSW 2007, Australia.
| | - Maralyn Foureur
- Faculty of Health, University of Technology Sydney, PO Box 123, NSW 2007, Australia.
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Hailu FB, Kassahun CW, Kerie MW. Perceived Nurse-Physician Communication in Patient Care and Associated Factors in Public Hospitals of Jimma Zone, South West Ethiopia: Cross Sectional Study. PLoS One 2016; 11:e0162264. [PMID: 27632162 PMCID: PMC5025155 DOI: 10.1371/journal.pone.0162264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 08/21/2016] [Indexed: 11/24/2022] Open
Abstract
Background Nurse–physician communication has been shown to have a significant impact on the job satisfaction and retention of staff. In areas where it has been studied, communication failure between nurses and physicians was found to be one of the leading causes of preventable patient injuries, complications, death and medical malpractice claims. Objective The objective of this study is to determine perception of nurses and physicians towards nurse-physician communication in patient care and associated factors in public hospitals of Jimma zone, southwest Ethiopia. Methods Institution based cross-sectional survey was conducted from March 10 to April 16, 2014 among 341 nurses and 168 physicians working in public hospitals in Jimma zone. Data was collected using a pre-tested self-administered questionnaire; entered into EpiData version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 16.0 for analysis. Factor analysis was carried out. Descriptive statistics, independent sample t-test, linear regression and one way analysis of variance were used. Variables with P-value < 0.05 were considered as statistically significant. Results The response rate of the study was 91.55%. The mean perceived nurse-physician communication scores were 50.88±19.7% for perceived professional respect and satisfaction, and 48.52±19.7% for perceived openness and sharing of patient information on nurse-physician communication. Age, salary and organizational factors were statistically significant predictors for perceived respect and satisfaction. Whereas sex, working hospital, work attitude individual factors and organizational factors were significant predictors of perceived openness and sharing of patient information in nurse-physician communication during patient care. Conclusion Perceived level of nurse-physician communication mean score was low among nurses than physicians and it is attention seeking gap. Hence, the finding of our study suggests the need for developing and implementing nurse-physician communication improvement strategies to solve communication mishaps in patient care.
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Affiliation(s)
| | | | - Mirkuzie Woldie Kerie
- Department of Health Economics, Management & Policy, Jimma University, Jimma, Ethiopia
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Reese J, Simmons R, Barnard J. Assertion Practices and Beliefs Among Nurses and Physicians on an Inpatient Pediatric Medical Unit. Hosp Pediatr 2016; 6:275-81. [PMID: 27126798 DOI: 10.1542/hpeds.2015-0123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Teamwork and communication are critical elements of safe and effective patient care. Standardized communication tools have been implemented in many health care organizations, but little is known about attitudes and perceptions of assertion, the willingness to "speak up," by nurses and physicians at an academic pediatric institution. METHODS We conducted 6 focus groups with nurses, residents, and attending physicians using a standardized semistructured focus group guide to promote discussion. Focus groups were recorded and transcribed, and results were analyzed by 2 independent reviewers to identify thematic content. RESULTS Three themes emerged: (1) interpersonal factors, (2) organizational factors, and (3) complexity of care environment. Subthemes were the roles of hierarchy, relationships, and communication and personality style; the value of using standardized communication tools such as SBAR (Situation, Background, Assessment, Recommendation), direct face-to-face communication, and geographic and technology factors; and the need for coordinated communication and agreement across care team members about the care plans. Nurses reported reliance on peers for decision-making, on when and how to assert on behalf of patient care. Nurses and residents experienced barriers to assertion from concerns of relationships and their position within professional hierarchies. Attending physicians were supportive of being asserted to by any care team provider. CONCLUSIONS Interpersonal relationships, power dynamics, and organizational factors impact care team providers' willingness to assert in the inpatient setting. Standardized communication tools are effective. Further development and implementation of communication models that support experience, peer reliance, and direct face-to-face communication are warranted to improve assertion communication in the inpatient setting
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Abstract
The purposes of this study were to describe changes in perinatal nurse (n = 70) and physician (n = 88) perceptions of teamwork and safety climate after implementing a 6-month Crew Resource Management training program and compare responses between nurses and physicians. The Teamwork and Safety Climate Survey was administered prior to and 1 year after the intervention. There were significant improvements in nurse and physician perceptions of teamwork and safety climate; however, physicians perceived teamwork more positive than nurses.
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Iravani M, Janghorbani M, Zarean E, Bahrami M. Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e21471. [PMID: 27175303 PMCID: PMC4863155 DOI: 10.5812/ircmj.21471] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/26/2014] [Accepted: 09/03/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. OBJECTIVES The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. MATERIALS AND METHODS This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. RESULTS Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. CONCLUSIONS The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.
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Affiliation(s)
- Mina Iravani
- Department of Midwifery, Reproductive Health Promotion Research Center, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mohsen Janghorbani
- Department of Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Ellahe Zarean
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Masod Bahrami
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Adams C, Dawson A, Foureur M. Exploring a Peer Nomination Process, Attributes, and Responses of Health Professionals Nominated to Facilitate Interprofessional Collaboration. INTERNATIONAL JOURNAL OF CHILDBIRTH 2016. [DOI: 10.1891/2156-5287.6.4.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND:When significant changes are required across an organization, a collaborative approach with wide stakeholder engagement may be beneficial. One of the challenges of stakeholder engagement lies with identifying the most appropriate participants who can most effectively facilitate the process of change.AIM:This article aims to provide insight into a process of identifying individuals, and their attributes, who staff perceive to be effective collaborators, and change agents to decrease intervention in childbirth in one maternity setting in New South Wales, Australia.METHODS:Midwives and obstetricians were invited to nominate a peer from each discipline who they believed to be an effective collaborator and describe the associated personal attributes of these individuals. The 5 highest scoring midwives and obstetricians were then invited to participate in a collaborative project.FINDINGS:The attributes that were most recognized in the collaborators were their effective communication and overall positive attitudes. Collaborator’s skills and knowledge were described less frequently. The nominees chosen identified that they were not usually selected by management for projects with some respondents feeling visible for the first time among their peers.CONCLUSION:This method of peer nomination to recruit participants to facilitate collaborative organizational change may offer an effective method of engaging the whole team in such processes.
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Demirel G, Guler H. The Effect of Uterine and Nipple Stimulation on Induction With Oxytocin and the Labor Process. Worldviews Evid Based Nurs 2015; 12:273-80. [DOI: 10.1111/wvn.12116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Gulbahtiyar Demirel
- Assistant Professor, Department of Midwifery; Faculty of Health Sciences, Cumhuriyet University; Sivas Turkey
| | - Handan Guler
- Assistant Professor, Department of Midwifery; Faculty of Health Sciences, Cumhuriyet University; Sivas Turkey
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van Helmond I, Korstjens I, Mesman J, Nieuwenhuijze M, Horstman K, Scheepers H, Spaanderman M, Keulen J, Vries RD. What Makes for Good Collaboration and Communication in Maternity Care? A Scoping Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2015. [DOI: 10.1891/2156-5287.5.4.210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Good communication and collaboration are critical to safe care for mothers and babies.OBJECTIVE: To identify factors associated with good collaboration and communication among maternity care professionals and between both professionals and parents.METHOD: Scoping study. We searched PubMed and Web of Science for peer reviewed, quantitative and qualitative, original, primary research in Western societies on communication and collaboration in maternity care among professionals (Search 1) and between professionals and parents (Search 2).FINDINGS: The 40 studies (14 in Search 1; 26 in Search 2) that met our selection criteria highlighted several factors associated with good communication and collaboration. We grouped these factors into 6 categories: Expertise, Partnership, Context, Attitude, Trust, and Communication style. Studies of communication and collaboration among professionals foregrounded work-related aspects, whereas studies examining collaboration between professionals and parents paid more attention to interpersonal aspects. Before 2012, few studies covered positive aspects of communication and collaboration. We also found an underrepresentation of parents in study populations.CONCLUSION: Our study is part of a growing trend of identifying the positive aspects of communication and collaboration in maternity care. As the study of collaboration in practice continues, researchers need to be sure to involve all stakeholders, including parents.
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Severinsson E, Haruna M, Rönnerhag M, Berggren I. Patient Safety, Adverse Healthcare Events and Near-Misses in Obstetric Care —A Systematic Literature Review. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.512118] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Amsalu E, Boru B, Getahun F, Tulu B. Attitudes of nurses and physicians towards nurse-physician collaboration in northwest Ethiopia: a hospital based cross-sectional study. BMC Nurs 2014; 13:37. [PMID: 25431536 PMCID: PMC4245739 DOI: 10.1186/s12912-014-0037-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 11/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Collaboration between professionals is important in health institutions where most activities are team-performed. Ineffective nurse-physician collaboration affects patient outcome, nurses' job satisfaction and organizational cost and is challenged by personal, interpersonal and organizational factors. The main objective of this study was to assess attitudes of nurses and physicians towards nurse-physician collaboration and the level of satisfaction with regard to quality of collaboration between them at Referral Hospitals of Northwest Ethiopia, from February 1st to April 30, 2013. METHODS An institution based cross-sectional study was conducted among 176 nurses and 53 physicians working in Felegehiwot and Gondar University Referral Hospitals. Data were collected using self-administered questionnaires. Attitudes of nurses and physicians were measured using Jefferson scale of attitudes towards nurse-physician Collaboration. Results were summarized using descriptive statistics and difference of means and proportions were evaluated using student t test p <0.05 was considered as significant. RESULT The overall response rate was 90.50%. Nurses demonstrate more favorable attitudes than physicians with mean score of 49.63 and 47.49 and standard error of mean 0.474 and 0.931 respectively with p = 0.043. For the Jefferson Scale Attitudes towards Nurse-Physician Collaboration includes four subscales, which are: 1) shared education and teamwork, 2) Caring vs curing, 3) nurses autonomy and 4) physician dominance. Nurses scored higher on three subscales (1, 2 and 4). However, statistically significant differences were noted with regard to subscales 2 and 4 (p = 0.01, p = 0.004, respectively). CONCLUSION This study identified that neither nurses nor physicians were satisfied with their current collaboration and nurses demonstrated less satisfaction with the current nurse physician collaboration. As compared with physicians nurses had more favorable attitudes towards collaboration specifically toward nurses' contributions to the psychosocial and educational aspects of patient care, and stronger rejection of a totally dominant physician role.
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Affiliation(s)
- Eden Amsalu
- />Department of Nursing, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Brihanu Boru
- />Department of Nursing, College of Medicine and Health Sciences, University of Gonder, Gonder, Ethiopia
| | - Firehiwot Getahun
- />Department of Nursing, College of Medicine and Health Sciences, University of Gonder, Gonder, Ethiopia
| | - Begna Tulu
- />Department of Microbilogy, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
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Lee HC, Powers RJ, Bennett MV, Finer NN, Halamek LP, Nisbet C, Crockett M, Chance K, Blackney D, von Köhler C, Kurtin P, Sharek PJ. Implementation methods for delivery room management: a quality improvement comparison study. Pediatrics 2014; 134:e1378-86. [PMID: 25332503 PMCID: PMC4210793 DOI: 10.1542/peds.2014-0863] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support. RESULTS There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12,528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.
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Affiliation(s)
- Henry C. Lee
- Divisions of Neonatal & Developmental Medicine and,California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Richard J. Powers
- Division of Neonatology, Department of Pediatrics, Good Samaritan Hospital, San Jose, California
| | - Mihoko V. Bennett
- Divisions of Neonatal & Developmental Medicine and,California Perinatal Quality Care Collaborative, Palo Alto, California
| | - Neil N. Finer
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, California
| | | | - Courtney Nisbet
- Divisions of Neonatal & Developmental Medicine and,California Perinatal Quality Care Collaborative, Palo Alto, California
| | | | - Kathy Chance
- California Children’s Services, Sacramento, California
| | | | - Connie von Köhler
- Miller Children’s Hospital Long Beach, MemorialCare Health System, Long Beach, California
| | - Paul Kurtin
- Rady Children’s Hospital, San Diego, California; and
| | - Paul J. Sharek
- General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California;,California Perinatal Quality Care Collaborative, Palo Alto, California;,Center for Quality and Clinical Effectiveness, Lucile Packard Children’s Hospital, Palo Alto, California
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Matzke B, Houston S, Fischer U, Bradshaw MJ. Using a Team‐Centered Approach to Evaluate Effectiveness of Nurse–Physician Communications. J Obstet Gynecol Neonatal Nurs 2014; 43:684-94. [DOI: 10.1111/1552-6909.12486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/30/2022] Open
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Sims S, Hewitt G, Harris R. Evidence of collaboration, pooling of resources, learning and role blurring in interprofessional healthcare teams: a realist synthesis. J Interprof Care 2014; 29:20-5. [DOI: 10.3109/13561820.2014.939745] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hewitt G, Sims S, Harris R. Evidence of communication, influence and behavioural norms in interprofessional teams: a realist synthesis. J Interprof Care 2014; 29:100-5. [DOI: 10.3109/13561820.2014.941458] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hewitt G, Sims S, Harris R. Using realist synthesis to understand the mechanisms of interprofessional teamwork in health and social care. J Interprof Care 2014; 28:501-6. [PMID: 25051092 DOI: 10.3109/13561820.2014.939744] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Realist synthesis offers a novel and innovative way to interrogate the large literature on interprofessional teamwork in health and social care teams. This article introduces realist synthesis and its approach to identifying and testing the underpinning processes (or "mechanisms") that make an intervention work, the contexts that trigger those mechanisms and their subsequent outcomes. A realist synthesis of the evidence on interprofessional teamwork is described. Thirteen mechanisms were identified in the synthesis and findings for one mechanism, called "Support and value" are presented in this paper. The evidence for the other twelve mechanisms ("collaboration and coordination", "pooling of resources", "individual learning", "role blurring", "efficient, open and equitable communication", "tactical communication", "shared responsibility and influence", "team behavioural norms", "shared responsibility and influence", "critically reviewing performance and decisions", "generating and implementing new ideas" and "leadership") are reported in a further three papers in this series. The "support and value" mechanism referred to the ways in which team members supported one another, respected other's skills and abilities and valued each other's contributions. "Support and value" was present in some, but far from all, teams and a number of contexts that explained this variation were identified. The article concludes with a discussion of the challenges and benefits of undertaking this realist synthesis.
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Affiliation(s)
- Gillian Hewitt
- Cardiff School of Social Sciences, Cardiff University , Cardiff , UK and
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Manojlovich M, Harrod M, Holtz B, Hofer T, Kuhn L, Krein SL. The use of multiple qualitative methods to characterize communication events between physicians and nurses. HEALTH COMMUNICATION 2014; 30:61-69. [PMID: 24483246 DOI: 10.1080/10410236.2013.835894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite the importance of communication to patient safety in hospital settings, we know surprisingly little about communication patterns between physicians and nurses, particularly on general medical-surgical units. Poor communication is the leading cause of preventable adverse events in hospitals, as well as a major root cause of sentinel events. The literature provides little guidance on what qualitative methods are best for capturing different types of communication events and patterns. The purpose of this study was to develop a methodology for identifying and characterizing communication events between physicians and nurses to better understand communication patterns on general medical-surgical units. We used a sequential qualitative mixed method design beginning with general observation, progressing to shadowing and focus groups of physicians and nurses who worked on two medical-surgical units at one academically affiliated U.S. Department of Veterans Affairs (VA) hospital. Each data collection method (observation, shadowing, and focus groups) had its own advantages and disadvantages for capturing communication events and patterns. Through observation we were able to see the "what": communication activities. Shadowing was most useful for understanding "how" physicians and nurses communicated. Focus groups helped answer "why" certain patterns emerged and allowed us to further explore communication events within a group setting. By using all three methods we were able to more thoroughly characterize communication events than by using a single method alone, providing a more holistic picture of how communication occurs on an inpatient medical-surgical unit.
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Lyndon A, Zlatnik MG, Maxfield DG, Lewis A, McMillan C, Kennedy HP. Contributions of clinical disconnections and unresolved conflict to failures in intrapartum safety. J Obstet Gynecol Neonatal Nurs 2013; 43:2-12. [PMID: 24354506 DOI: 10.1111/1552-6909.12266] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To explore clinician perspectives on whether they experience difficulty resolving patient-related concerns or observe problems with the performance or behavior of colleagues involved in intrapartum care. DESIGN Qualitative descriptive study of physician, nursing, and midwifery professional association members. PARTICIPANTS AND SETTING Participants (N = 1932) were drawn from the membership lists of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN), American College of Obstetricians and Gynecologists (ACOG), American College of Nurse Midwives (ACNM), and Society for Maternal-Fetal Medicine (SMFM). METHODS Email survey with multiple choice and free text responses. Descriptive statistics and inductive thematic analysis were used to characterize the data. RESULTS Forty-seven percent of participants reported experiencing situations in which patients were put at risk due to failure of team members to listen or respond to a concern. Thirty-seven percent reported unresolved concerns regarding another clinician's performance. The overarching theme was clinical disconnection, which included disconnections between clinicians about patient needs and plans of care and disconnections between clinicians and administration about the support required to provide safe and appropriate clinical care. Lack of responsiveness to concerns by colleagues and administration contributed to resignation and defeatism among participants who had experienced such situations. CONCLUSION Despite encouraging progress in developing cultures of safety in individual centers and systems, significant work is needed to improve collaboration and reverse historic normalization of both systemic disrespect and overt disruptive behaviors in intrapartum care.
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Abstract
Safety and quality of health care depend on collaborative efforts of multiprofessional and multidisciplinary teams of care providers. Team research in aviation and the military has produced a wealth of knowledge in terms of concepts and intervention strategies to improve team performance. Research on collaborative work in health care in the past 20 years has uncovered unique characteristics and requirements of teams in hospitals and other health care settings and has provided early assessment of the utility of the theoretical concepts, methodologies, and interventions developed outside health care. In this chapter, we review a set of concepts that have been used in characterizing teams in health care and in improving teamwork. These concepts include the organizational shell to capture the sociotechnical environment in which teams reside as well as nontechnical skills, team leadership, team mental models, and so on. We will review a number of leading interventions to enhance team performance, such as teamwork training (e.g., TeamSTEPPS) and structured communication (e.g., SBAR). Future directions are suggested on better understanding of the interdependencies between teams and their organizational shell, such as standardization of operating procedures and training, and to focus on the patient in terms of teamwork improvement.
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Reframing communication with physicians as sensemaking: moving the conversation along. J Nurs Care Qual 2013; 28:295-303. [PMID: 23475081 DOI: 10.1097/ncq.0b013e31828b1c6d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Poor communication between physicians and nurses is one of the most common causes of adverse events for hospitalized patients and a major root cause of sentinel events. Physician and nurse perspectives on what constitutes good communication differ. This article describes sensemaking as a cognitive process that builds consensus by getting nurses and physicians to answer these questions: What is happening here? What should we do about it? Sensemaking goes beyond communication, requiring that diverse opinions are brought to bear on a situation framed by salient cues.
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Edmonds JK, Jones EJ. Intrapartum Nurses’ Perceived Influence on Delivery Mode Decisions and Outcomes. J Obstet Gynecol Neonatal Nurs 2013; 42:3-11. [DOI: 10.1111/j.1552-6909.2012.01422.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sevdalis N, Hull L, Birnbach D. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. Br J Anaesth 2012; 109 Suppl 1:i3-i16. [DOI: 10.1093/bja/aes391] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cronie D, Rijnders M, Buitendijk S. Diversity in the scope and practice of hospital-based midwives in the Netherlands. J Midwifery Womens Health 2012; 57:469-75. [PMID: 22954077 DOI: 10.1111/j.1542-2011.2012.00164.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Not all midwives in the Netherlands are independent practitioners. One in 4 midwives registered to practice is employed in the hospital setting, where 67% of all births occur. There has not yet been an in-depth examination of hospital-based midwives' practice in the Netherlands, in the context of care in a higher-risk environment. The primary aims of this study were to describe the diversity and scope of practice of hospital-based midwives in the Netherlands. METHODS This was an online survey of all hospitals throughout the Netherlands with labor/birthing rooms and employing hospital-based midwives. The survey covered 5 topic areas: demographic/organizational details, duties, responsibilities, experience/additional qualifications, and how the midwife functioned within the multidisciplinary hospital team. Descriptive statistics are provided. RESULTS A total of 59 secondary and tertiary level hospitals from a possible total of 98 were included for analysis (60% national response rate). Forty percent of all births occurring during the study period were managed solely by a hospital midwife. The provision of midwifery care in the hospital setting was not universal, and where present, hospital-based midwives were not necessarily available 24 hours a day or 7 days a week. Hospital-based midwives reported a high level of autonomy. DISCUSSION Currently there is no universal provision of midwifery care in the hospital setting in the Netherlands. Where there are hospital-based midwives, they appear to manage the majority of births. However, there are no nationally agreed-upon standards for midwifery practice in the hospital setting, and no agreement exists over minimum requirements relating to additional education for midwives in these settings. A national evaluation and setting of minimum standards is needed.
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Bozeman L. Nurse-led multidisciplinary obstetric patient summaries: improving collaboration, collegiality and patient safety. Nurs Womens Health 2012; 15:382-91. [PMID: 22900651 DOI: 10.1111/j.1751-486x.2011.01662.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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An educational intervention to increase "speaking-up" behaviors in nurses and improve patient safety. J Nurs Care Qual 2012; 27:154-60. [PMID: 22192938 DOI: 10.1097/ncq.0b013e318241d9ff] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
"Speaking up" is a critical component in improving patient safety. Studies indicate, though, that most registered nurses prefer using behaviors of avoidance or accommodation in conflict situations. The purpose of this quasi-experimental study was to determine whether an educational intervention using scenarios, personal reflection, and peer support in small groups could improve speaking-up behaviors in registered nurses. Results showed a significant difference in speaking-up behaviors and scores in the intervention group (P < .001).
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