1
|
Butler JI, Fox MT. 'Our Voices Aren't Being Heard': A qualitative descriptive study of nurses' perceptions of interprofessional collaboration in care supporting older people's functioning during a hospital stay. Scand J Caring Sci 2024; 38:398-408. [PMID: 38323707 DOI: 10.1111/scs.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Older people admitted to hospital are highly susceptible to functional decline and related complications. Care supporting their functioning is complex and requires healthcare professionals working in concert, with nurses playing a central role. Yet, little is known about nurses' perceptions of interprofessional collaboration (IPC) in care supporting functioning in acutely admitted older people. To fill this knowledge gap, we elucidate the perspectives of nurses in Ontario, Canada, on IPC in care supporting older people's functioning during a hospital stay. METHODS We employed a qualitative methodology in conjunction with a qualitative descriptive design. Thirteen focus groups were held with a purposeful, criterion-based sample of 57 acute care nurses practising in a range of acute care settings (e.g. Emergency, General Medicine, General Surgery, Intensive Care, Coronary Care). Data were thematically analysed. RESULTS We identified two overarching themes: (1) IPC is improving, but nurses are excluded from decision-making and (2) nurse advocacy causes friction with other professionals. The first theme captures nurses' perception that IPC in older people's care is improving, but nurses are marginalised in interprofessional decision-making. As a result, nurses perceive that their knowledge is devalued, and their contributions to care supporting older people's functioning are undermined. The second theme underlines a tension between interprofessional team practices and patient- and family-centred care, while also demonstrating nurses' increasing willingness to act as patient and family advocates. CONCLUSIONS Findings can be used to enhance IPC in care supporting the functioning of acutely hospitalised older people. To improve IPC, clinical and administrative leaders should cultivate more egalitarian team relationships that encourage nurses to contribute to decision-making and advocate on behalf of older patients and their families.
Collapse
Affiliation(s)
- Jeffrey I Butler
- Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Mary T Fox
- Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Rogers L, Hughes Spence S, Aivalli P, De Brún A, McAuliffe E. A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings. J Interprof Care 2024; 38:156-171. [PMID: 36708308 DOI: 10.1080/13561820.2023.2168632] [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: 07/22/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.
Collapse
Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Shannon Hughes Spence
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Praveenkumar Aivalli
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation (UCD IRIS), UCD School of Nursing, Midwifery and Health Systems, Dublin 4, Ireland
| |
Collapse
|
3
|
McGilton KS, Krassikova A, Wills A, Bethell J, Boscart V, Escrig-Pinol A, Iaboni A, Vellani S, Maxwell C, Keatings M, Stewart SC, Sidani S. Nurse practitioner led implementation of huddles for staff in long term care homes during the COVID-19 pandemic. BMC Geriatr 2023; 23:713. [PMID: 37919676 PMCID: PMC10623826 DOI: 10.1186/s12877-023-04382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Staff working in long-term care (LTC) homes during COVID-19 frequently reported a lack of communication, collaboration, and teamwork, all of which are associated with staff dissatisfaction, health concerns, lack of support and moral distress. Our study introduced regular huddles to support LTC staff during COVID-19, led by a Nurse Practitioner (NP). The objectives were to evaluate the process of huddle implementation and to examine differences in outcomes between categories of staff (direct care staff, allied care and support staff, and management) who attended huddles and those who did not. METHODS All staff and management at one LTC home (< 150 beds) in Ontario, Canada were included in this pre-experimental design study. The process evaluation used a huddle observation tool and focused on the dose (duration, frequency) and fidelity (NP's adherence to the huddle guide) of implementation. The staff attending and non-attending huddles were compared on outcomes measured at post-test: job satisfaction, physical and mental health, perception of support received, and levels of moral distress. The outcomes were assessed with validated measures and compared between categories of staff using Bayesian models. RESULTS A total of 42 staff enrolled in the study (20 attending and 22 non-attending huddles). Forty-eight huddles were implemented by the NP over 15 weeks and lasted 15 min on average. Huddles were most commonly attended by direct care staff, followed by allied care/support, and management staff. All huddles adhered to the huddle guide as designed by the research team. Topics most often addressed during the huddles were related to resident care (46%) and staff well-being (34%). Differences were found between staff attending and non-attending huddles: direct care staff attending huddles reported lower levels of overall moral distress, and allied care and support staff attending huddles perceived higher levels of support from the NP. CONCLUSIONS NP-led huddles in LTC homes may positively influence staff outcomes. The process evaluation provided some understanding of why the huddles may have been beneficial: the NP addressed resident care issues which were important to staff, encouraged a collaborative approach to solving issues on the unit, and discussed their well-being. TRIAL REGISTRATION NUMBER NCT05387213, registered on 24/05/2022.
Collapse
Affiliation(s)
- Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Aria Wills
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, Canada
| | - Astrid Escrig-Pinol
- Mar School of Nursing, Universitat Pompeu Fabra, Barcelona, Spain
- Social Determinants and Health Education Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shirin Vellani
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Steven C Stewart
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Souraya Sidani
- Faculty of Nursing, Toronto Metropolitan University, Toronto, Canada
| |
Collapse
|
4
|
Xiong B, Stirling C, Martin-Khan M. The implementation and impacts of national standards for comprehensive care in acute care hospitals: An integrative review. Int J Nurs Sci 2023; 10:425-434. [PMID: 38020841 PMCID: PMC10667310 DOI: 10.1016/j.ijnss.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/07/2023] [Accepted: 09/17/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To synthesise current evidence addressing implementation approaches, challenges and facilitators, and impacts of national standards for comprehensive care in acute care hospitals. Methods Using Whittemore & Knafl's five-step method, a systematic search was conducted across five databases, including Medline (EBSCO), CINAHL (EBSCO), Cochrane Library, Web of Science, and Scopus, to identify primary studies and reviews. In addition, grey literature (i.e., government reports and webpages) was also searched via Google and international government/organisation websites. All searches were limited to January 1, 2000 to January 31, 2023. Articles relevant to the implementation or impacts of national standards for comprehensive care in acute care hospitals were included. Included articles underwent a Joanna Briggs Institute quality review, followed by qualitative content analysis of the extracted data adhering to PRISMA reporting guidelines. Results A total of 16 articles were included in the review (5 primary studies, 5 government reports, and 6 government webpages). Three countries (Australia, Norway, and the United Kingdom [UK]) were identified as having a national standard for comprehensive care. The Australian standard contains a unique component of minimising patient harm. Norway does not have a defined implementation framework for the standard, whereas Australia and the UK do. Limited research suggests that challenges in implementing a national standard for comprehensive care in acute care hospitals include difficulties in implementing governance processes, end-of-life care actions, minimising harms actions, and developing comprehensive care plans with multidisciplinary teams, the absence of standardised care plans and patient-centred goals in documentation, and excessive paperwork. Implementation facilitators include a new care plan template using the Identify, Situation, Background, Assessment and Recommendation framework for handover, promoting efficient documentation, clinical decision-making and direct patient care, and proactivity among patients and care professionals with collaboration skills. Limited research suggests introducing the Australian standard demonstrated some positive effects on patient outcomes. Conclusion The components and implementation approaches of the national standards for comprehensive care in Australia, Norway and the UK were slightly different. The scarcity of studies found during the review highlights the need for further research to evaluate the implementation challenges and facilitators, and impacts of national standards for comprehensive care in acute care hospitals.
Collapse
Affiliation(s)
- Beibei Xiong
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Melinda Martin-Khan
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
- School of Nursing, University of Northern British Columbia, Prince George, Canada
| |
Collapse
|
5
|
van Staalduinen DJ, van den Bekerom PE, Groeneveld SM, Stiggelbout AM, van den Akker-van Marle ME. Relational coordination in value-based health care. Health Care Manage Rev 2023; 48:334-341. [PMID: 37615943 PMCID: PMC10476589 DOI: 10.1097/hmr.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND An important element of value-based health care (VBHC) is interprofessional collaboration in integrated practice units (IPUs) for the delivery of the complete cycle of care. High levels of interprofessional collaboration between clinical and nonclinical staff in IPUs are assumed rather than proven. Factors that may stimulate interprofessional collaboration in the context of VBHC are underresearched. PURPOSE The aim of this study was to examine relational coordination (RC) in VBHC and its antecedents. APPROACH A questionnaire was used to examine the association of both team practices and organizational conditions with interprofessional collaboration in IPUs. Gittell's Relational Coordination Survey was drawn upon to measure interprofessional collaboration by capturing the relational dynamics in coordinated working. The questionnaire also included measures of team practices (team meetings and boundary spanning behavior) and organizational conditions (task interdependence and time constraints). RESULTS The number of different professional groups participating in team meetings is positively associated with RC in IPUs. Boundary spanning behavior, task interdependence, and time constraints are not associated with RC. CONCLUSIONS In IPUs, the diversity within interprofessional team meetings is important for establishing high-quality communication and relationships. PRACTICE IMPLICATIONS Hospital managers should prioritize facilitating and encouraging shared meetings to enhance RC levels among professional groups in IPUs.
Collapse
|
6
|
Duffy CC, Bass GA, Yura C, Dymek M, Lorenzi C, Kaplan LJ, Clapp JT, Atkins JH. Thematic mapping of perioperative incident reporting data to relational coordination domains. J Interprof Care 2023; 37:245-253. [PMID: 36739556 DOI: 10.1080/13561820.2022.2057454] [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: 02/06/2023]
Abstract
Communication failure is a common root cause of adverse clinical events. Problematic communication domains are difficult to decipher, and communication improvement strategies are scarce. This study compared perioperative incident reports (IR) identifying potential communication failures with the results of a contemporaneous peri-operative Relational Coordination (RC) survey. We hypothesised that IR-prevalent themes would map to areas-of-weakness identified in the RC survey. Perioperative IRs filed between 2018 and 2020 (n = 6,236) were manually reviewed to identify communication failures (n = 1049). The IRs were disaggregated into seven RC theory domains and compared with the RC survey. Report disaggregation ratings demonstrated a three-way inter-rater agreement of 91.2%. Of the 1,049 communication failure-related IRs, shared knowledge deficits (n = 479, 46%) or accurate communication (n = 465, 44%) were most frequently identified. Communication frequency failures (n = 3, 0.3%) were rarely coded. Comparatively, shared knowledge was the weakest domain in the RC survey, while communication frequency was the strongest, correlating well with our IR data. Linking IR with RC domains offers a novel approach to assessing the specific elements of communication failures with an acute care facility. This approach provides a deployable mechanism to trend intra- and inter-domain progress in communication success, and develop targeted interventions to mitigate against communication failure-related adverse events.
Collapse
Affiliation(s)
- Caoimhe C Duffy
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary A Bass
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Yura
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Malwina Dymek
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cara Lorenzi
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Surgical Critical Care, Corporal Michael Crescencz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Justin T Clapp
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua H Atkins
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
7
|
Tang KS, Maher S, Lee SWH. Exploring Team-Based Teaching of Basic Sciences and Clinical Practice: Experiences of Pharmacy Students at a Malaysian Pharmacy School. MEDICAL SCIENCE EDUCATOR 2023; 33:83-89. [PMID: 37008431 PMCID: PMC10060609 DOI: 10.1007/s40670-022-01703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/19/2023]
Abstract
Interdisciplinary learning combining foundational science concepts and clinical practice applications is important in many healthcare-related programmes, including pharmacy. The coherent, structured interdisciplinary curricula designed by specialists may not always be perceived as integrated by students. Team teaching, an education approach where two or more instructors share teaching responsibilities within a classroom setting, may help eliminate this perception. This study aims to explore whether team teaching can improve Asian students' experience of learning in an undergraduate pharmacy programme in Malaysia. A single 2-h interactive lecture session was delivered using a team-based approach to year 4 undergraduate pharmacy students enrolled at the School of Pharmacy, Monash University Malaysia, from 2015 to 2017. All students who attended the team-based teaching lectures were provided with an anonymous link, which requested responses on their views towards team-based teaching. Fifty out of 104 participants from three different cohorts responded to the survey of this study. Over 75% of students reported that they learnt better with the team teaching approach compared to traditional lectures delivered by one lecturer and that the team teaching approach was superior to private study. About 60% of the participants agreed that the team-based teaching approach helped develop their information-synthesising and problem-solving skills. This study provides evidence for using team teaching for design and delivery in an Asian context. The approach was well received by the participants.
Collapse
Affiliation(s)
- Kim San Tang
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor 47500 Malaysia
| | - Sheryl Maher
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052 Australia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor 47500 Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor 47500 Malaysia
| |
Collapse
|
8
|
House S, Crandell J, Stucky C, Kitzmiller R, Jones C, Gittell JH. Relational Coordination as a Predictor of Job Satisfaction and Intent to Stay Among Nurses and Physicians in the Military Health System. Mil Med 2023; 188:e316-e325. [PMID: 35050374 DOI: 10.1093/milmed/usab464] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/05/2021] [Accepted: 10/25/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Job satisfaction and retention of military and civilian nurses and physicians who work in military treatment facilities (MTFs) are critical to maintaining quality of care and operational readiness. Civilian nurses and physicians working in MTFs supplement staffing for active duty military nurses and physicians and support operational readiness when military nurses and physicians deploy in wartime crises or humanitarian efforts. Decreased retention of military and civilian nurses and physicians can negatively impact operational readiness and patient care outcomes. Although several factors (e.g., burnout, pay, and leadership) influence job satisfaction and retention among nurses and physicians in both military and civilian healthcare settings, high-quality communication and relationships between nurses and physicians are associated with better job satisfaction and retention. However, little is known about how high-quality communication and relationships affect job satisfaction and retention among nurses and physicians in MTFs. Relational coordination (RC) is a process of high-quality communication supported by relationships of shared knowledge, shared goals, and mutual respect among members of the healthcare team. By strengthening RC, hospital leaders can more effectively achieve desired outcomes. The purpose of this study was to explore how RC influences job satisfaction and intent to stay among nurses, residents, and physicians in an Army hospital, and whether job satisfaction mediated the relationship between RC and intent to stay. MATERIALS AND METHODS We conducted an exploratory, cross-sectional study in a 138-bed MTF in the southeastern USA and invited a convenience sample of military and civilian nurses, residents, and physicians to complete a 47-item survey on RC, job satisfaction, and intent to stay. We used Pearson's correlation to explore relationships between RC, job satisfaction, and intent to stay and then employed multiple regression to explore whether RC predicts job satisfaction and intent to stay, after controlling for professional role, demographic characteristics, and other covariates. Furthermore, we explored whether job satisfaction mediates the relationship between RC and intent to stay. RESULTS Two hundred and eighty-nine participants completed the survey. Seventy percentage of respondents were civilian, were Caucasian (61%), and had a mean age of 40 years old. The RCs within roles (β = 0.76, P < .001) and between roles (β = 0.46, P < .001) were both positively associated with job satisfaction. RCs within roles was associated with higher intent to stay (β = 0.38, P = .005). Civilian nurses and physicians reported higher intent to stay, followed by officers and enlisted service members. Job satisfaction mediated the relationship between RC within roles and intent to stay. CONCLUSION Our findings suggest that RC is a powerful workplace dynamic that influences job satisfaction and intent to stay, for nurses, residents, and physicians in MTFs. Specifically, we found that RC was positively associated with job satisfaction and intent to stay and that job satisfaction mediates the relationship between RC and intent to stay. We recommend that hospital leaders in MTFs explore interventions to strengthen RC among health professionals by including relational, work process and structural interventions as part of their strategy for retaining military healthcare professionals.
Collapse
Affiliation(s)
- Sherita House
- Indiana University School of Nursing, Indianapolis, IN 46202, USA
| | - Jamie Crandell
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | | | - Cheryl Jones
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | |
Collapse
|
9
|
Kozicka I, Guligowska A, Chrobak-Bień J, Czyżewska K, Doroba N, Ignaczak A, Machała A, Spałka E, Kostka T, Borowiak E. Factors Determining the Occurrence of Frailty Syndrome in Hospitalized Older Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12769. [PMID: 36232069 PMCID: PMC9564663 DOI: 10.3390/ijerph191912769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Frailty syndrome (FS) is a condition characterized by a decline in reserves, observed with aging. The most important consequences of the frailty syndrome include disability, hospitalization, fractures, institutionalization, and early mortality. The aim of this study was to identify the most important risk factors for FS in a group of older hospitalized patients in Poland. A total of one hundred and forty-one (78 women, 63 men) elderly patients from the Departments of Internal Medicine of the Medical University of Lodz (Poland) were recruited for this study. Frailty Instrument of the Survey of Health, Aging and Retirement in Europe (SHARE-FI), handgrip strength (HGS), depressive symptoms using the Geriatric Depression Scale (GDS), and functional ability (FA) using the Instrumental Activities of Daily Living (IADL) were assessed. According to SHARE-FI score, participants were divided into control group, frail, and pre-frail patients. Out of all 141 tested patients, FS was confirmed in 55 patients, and pre-frailty was observed in 52 patients. The occurrence of FS in the group of studied patients was related to age (p < 0.001), widowhood (p < 0.001), comorbidities (p < 0.001), heart diseases (p = 0.04), more medications taken (p < 0.001), lower FA (p < 0.001), weaker HGS, and depression (p < 0.001). The strongest positive correlations were between Share-FI score and the number of diseases (rS = 0.31), GDS (rS = 0.32), while negative correlations with IADL (rS = -0.47) and HGS (rS = -0.35). The study shows that FS is associated with age, comorbidities, number of medications taken, and widowhood. The present study has also demonstrated that FA, depression, and especially HGS are essential determinants of FS of elderly hospitalized people.
Collapse
Affiliation(s)
- Izabela Kozicka
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Joanna Chrobak-Bień
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Katarzyna Czyżewska
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Natalia Doroba
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Anna Ignaczak
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Anna Machała
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Ewelina Spałka
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Ewa Borowiak
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| |
Collapse
|
10
|
Aging and Women's Health: An Update from the National Institute on Aging. Clin Geriatr Med 2021; 37:533-541. [PMID: 34600720 DOI: 10.1016/j.cger.2021.05.002] [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: 11/21/2022]
Abstract
Older women outnumber older men in the United States and may experience a range of physical, cognitive, social, and emotional challenges. The "Geriatric 5 Ms"-Multicomplexity, Mind, Mobility, Medications, and What Matters Most-provide a useful framework for understanding and addressing the health and wellness needs of older women in the clinic. The National Institute on Aging, a component of the US National Institutes of Health, supports a vibrant program of aging research with many immediately implementable findings and useful resources for the busy clinician.
Collapse
|
11
|
Improving Community Health Workers' Attitudes toward Collaborative Practice in the Care of Older Adults: An In-Service Training Intervention Trial in the Philippines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199986. [PMID: 34639285 PMCID: PMC8508240 DOI: 10.3390/ijerph18199986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
The objective of this study was to evaluate the efficacy of an in-service, short-term training program in improving the attitudes toward, and readiness and activities for collaboration among community health workers (CHWs) in a primary care setting in the Philippines. A randomized controlled trial was adopted dividing participants into an intervention (n = 42) and a control group (n = 39). Attitudes toward, and readiness and activities for collaboration were measured using three standardized scales before and at 6 months after the training. A significant difference (p < 0.001) was observed in the Attitudes Toward Health Care Teams Scale (ATHCTS) scores between pre- and post-test in the intervention (6.3 ± 8.3 [Mean ± SD]) and control groups (0.7 ± 8.2). Multivariate linear regression analysis showed an independent positive association between the intervention and greater improvement in the ATHCTS score (Coefficient β = 6.17; 95% CI = 0.82, 11.53; p = 0.03) at follow-up, after adjustment for age, years in current occupation, and social support role of participants. The results demonstrated the efficacy of the intervention for improving the attitudes of CHWs toward collaborative practice in the care of older adults.
Collapse
|
12
|
Dukes C, Dahlke S, Pietrosanu M, Kalogirou MR. Improving student nurses' perspectives towards older people with an e-learning activity: A quasi-experimental pre-post design. Int J Older People Nurs 2021; 17:e12425. [PMID: 34553494 DOI: 10.1111/opn.12425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite older people being the largest demographic accessing health care, nurses often lack knowledge about how to work with them and may hold ageist perceptions towards them. Previous research has identified the gaps in their education program and offered suggestions on what and how to fill those gaps in education related to older people. E-learning activities to fill these gaps were developed. OBJECTIVE The aim of this study was to determine if nursing students' perceptions about older people could be improved through an e-learning activity focused on communication and understanding older people. METHODS A quasi-experimental pre-post design was used to test whether the understanding and communication with older people e-learning activity improved student nurses' perceptions about older people. A feedback survey was also analyzed using descriptive statistics to understand students' perceptions of the learning activity. RESULTS There was a statistically significant decrease in participant's negative perceptions towards older people after completing the e-learning activity. Participants enjoyed the activity and believed that it improved their knowledge of older people, their confidence in working with older people, and their perceptions about older people. CONCLUSIONS The strength of the e-learning activity in this study is that the educator need not be an expert in order to use the activity in their course. In this way, knowledge about older people is facilitated despite the dearth of nurse educators with gerontological expertise. More research to test this activity in other universities is needed. IMPLICATIONS FOR PRACTICE Improved understanding and communicating with older people could improve person-centered-care. The flexible delivery of this learning activity could facilitate practicing nurses understanding and communication strategies if offered to them.
Collapse
Affiliation(s)
- Cassidy Dukes
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Maya R Kalogirou
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
13
|
Lauring J, Drogendijk R, Kubovcikova A. The role of context in overcoming distance-related problems in global virtual teams: an organizational discontinuity theory perspective. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2021. [DOI: 10.1080/09585192.2021.1960584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Dahlke S, Hunter KF. Harnessing nursing to diminish ageism. Int J Older People Nurs 2021; 17:e12417. [PMID: 34420260 DOI: 10.1111/opn.12417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The common practice of making fun of aging and older people demonstrates that ageism towards older people is socially acceptable. It is so accepted that even those of us who are aging or have moved into the 'third act' believe and fear the negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Ageism is evident in work places, family relationships, when older people purchase goods and services, in health and social institutions and extends throughout professions that work with older people. OBJECTIVES We explore how nurses-the largest group of healthcare professions- may be inadvertently perpetuating negative perceptions about older people in nursing practice, nursing education, and through common misconceptions about what gerontological nursing means. METHODS This is discussion paper using the literature. RESULTS We suggest that nursing education is well situated to diminish negative perspectives of ageing by incorporating theories of life-course and harmonious aging into the holistic perspective of individuals that nursing is well known for. CONCLUSIONS Greater understanding about the diversity of ageing and the context that have influenced older persons could encourage nurses to treat them holistically with dignity, which would ultimately improve older people's experiences. Improving older persons' experiences is like paying it forward, as we all are ageing and if we are to have a different experience when we are old, it is necessary to diminish stereotypes about ageing, and work towards inclusion of older people in social and healthcare institutions. IMPLICATIONS FOR PRACTICE It is important for nurses, particularly those in nursing education, to support the incorporation of a life course and harmonious view of aging in which the social, political, and environmental context of individuals are viewed as part of the difference of ageing.
Collapse
Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, USA
| | | |
Collapse
|
15
|
Kalogirou MR, Dahlke S, Davidson S, Hunter KF, Pollard C, Salyers V, Swoboda N, Fox M. Working with older people: Beginning or end of a nurse's career? Int J Older People Nurs 2021; 16:e12407. [PMID: 34288414 DOI: 10.1111/opn.12407] [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: 01/27/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increasing numbers of older people (age 65+) make it important to understand how to attract nurses to work with this population. METHODS A secondary analysis using qualitative descriptive methods was used to understand how student nurses' perceptions about older people may influence their desire to work with older people. RESULTS Student nurses perceive a generational divide between them and older people, regardless of practice settings. They believe working with older people is heavy work, and not high acuity, and although good to learn skills as a student, not a population they want to work with until they are close to retirement themselves. CONCLUSIONS It is important to enhance nursing education so that students understand the older generation, how to communicate with them and the prevalence of older people in healthcare settings, so that they are more likely to choose to work with older people.
Collapse
Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Sandra Davidson
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Cheryl Pollard
- Faulty of Nursing, MacEwan University, Edmonton, AB, Canada
| | - Vince Salyers
- School of Nursing & Human Physiology, Gonzaga University, Spokane, WA, USA
| | | | - Mary Fox
- Faculty of Health Sciences, York University, Toronto, ON, Canada
| |
Collapse
|
16
|
How to Ensure Referral and Uptake for COPD Rehabilitation - Part 2: A Case of Integrated Care on How to Translate Findings of Cross-Sectorial Workflow to Improve Cross-Sectorial Rehabilitation. Int J Integr Care 2021; 21:10. [PMID: 33716593 PMCID: PMC7934799 DOI: 10.5334/ijic.5503] [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] [Indexed: 11/20/2022] Open
Abstract
Background: Patients with chronic obstructive pulmonary disease (COPD) can greatly benefit from rehabilitation initiatives, but referral to rehabilitation is sparse. Before we initiated activities to ensure hospital referrals for prevention initiatives at the municipality, we investigated referral patterns and relevant factors in the cross-sectorial workflow. Objective: To ensure referral to municipality COPD rehabilitation, by simplifying the referral procedures, and by facilitating relational coordination across the two health care settings. Methods: We simplified the referral procedure by initiating all referrals to contain standard wording, all send to the same electronic location, and assuring that all patients were referred to the same initial interview. We facilitated cross-sectorial relational coordination by establishing local- and cross-sectional network groups. We monitored the network groups, and send questionnaires to obtain knowledge of network activities. We used indicators to measure the cross-sectorial quality and questionnaires to measure the patient experienced quality. Results: We detected flaws in the referral system that meant that several referrals were neglected. Based on knowledge and experiences the networks called for adjustments. This led to adjustments in patient inclusion and data collection. Conclusion: We succeeded in simplifying referral procedures and facilitated cross-sectorial relational coordination. We had to make ongoing adjustments of procedures, information, content, population and data infrastructure.in simplifying referral procedures and facilitated cross-sectorial relational coordination. We had to make ongoing adjustments of procedures, information, content, population and data infrastructure.
Collapse
|
17
|
Dahlke S, Kalogirou MR, Swoboda NL. Registered nurses' reflections on their educational preparation to work with older people. Int J Older People Nurs 2021; 16:e12363. [PMID: 33470029 PMCID: PMC7988531 DOI: 10.1111/opn.12363] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Negative perceptions about working with older people within nursing contribute to the deficit of educators with expertise to teach student nurses, and nurses graduating ill-equipped to work with the ageing population. The perceptions of nurses who have recently graduated from a nursing programme can provide insights into what they wished they knew about working with older people before they graduated. METHODS A qualitative descriptive study design examined recently graduated registered nurses' reflections on their education preparation to work with older people. Content and thematic analysis was used to develop the themes of first impressions and preparation to work with older people. RESULTS Key findings were that nurses did not recognise the importance of learning about older people until they had graduated. Only then did they realise that the ageing population was so complex and prevalent. They perceived a lack of education particularly related to working with older people with dementia and their behaviours, as well as learning how to communicate to an older population. Participants perceived that as students, it was up to them to fit in learning about working with older people without the support of faculty. CONCLUSIONS Faculty need to be supported in learning how to best incorporate content about older people into their curriculum. This could include the development of learning activities that dispel negative stereotypes about ageing and facilitates interest in older people, as this is the population, students are most likely to work with when they graduate. IMPLICATIONS FOR PRACTICE Nurses in practice may require education on working with people with dementia as it is a deficit in nursing programmes.
Collapse
Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Nicholas L Swoboda
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Alberta Health Services, Edmonton, AB, Canada
| |
Collapse
|
18
|
Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. The micropolitics of implementation; a qualitative study exploring the impact of power, authority, and influence when implementing change in healthcare teams. BMC Health Serv Res 2020; 20:1059. [PMID: 33228702 PMCID: PMC7684932 DOI: 10.1186/s12913-020-05905-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022] Open
Abstract
Background Healthcare organisations are complex social entities, comprising of multiple stakeholders with differing priorities, roles, and expectations about how care should be delivered. To reach agreement among these diverse interest groups and achieve safe, cost-effective patient care, healthcare staff must navigate the micropolitical context of the health service. Micropolitics in this study refers to the use of power, authority, and influence to affect team goals, vision, and decision-making processes. Although these concepts are influential when cultivating change, there is a dearth of literature examining the mechanisms through which micropolitics influences implementation processes among teams. This paper addresses this gap by exploring the role of power, authority, and influence when implementing a collective leadership intervention in two multidisciplinary healthcare teams. Methods The multiple case study design adopted employed a triangulation of qualitative research methods. Over thirty hours of observations (Case A = 16, Case B = 15) and twenty-five interviews (Case A = 13, Case B = 12) were completed. An in-depth thematic analysis of the data using an inductive coding approach was completed to understand the mechanisms through which contextual factors influenced implementation success. A context coding framework was also employed throughout implementation to succinctly collate the data into a visual display and to provide a high-level overview of implementation effect (i.e. the positive, neutral, or negative impact of contextual determinants on implementation). Results The findings emphasised that implementing change in healthcare teams is an inherently political process influenced by prevailing power structures. Two key themes were generated which revealed the dynamic role of these concepts throughout implementation: 1) Exerting hierarchical influence for implementation; and 2) Traditional power structures constraining implementation. Gaining support across multiple levels of leadership was influential to implementation success as the influence exercised by these individuals persuaded follower engagement. However, the historical dynamics of each team determined how this influence was exerted and perceived, which negatively impacted some participants’ experiences of the implementation process. Conclusion To date, micropolitics has received scant attention in implementation science literature. This study introduces the micropolitical concepts of power, authority and influence as essential contextual determinants and outlines the mechanisms through which these concepts influence implementation processes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05905-z.
Collapse
Affiliation(s)
- Lisa Rogers
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland.
| | - Aoife De Brún
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, Noth Carolina, USA
| | - Carmel Davies
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| | - Eilish McAuliffe
- University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin School of Nursing, Midwifery and Health Systems, Dublin, Ireland
| |
Collapse
|
19
|
Swoboda NL, Dahlke S, Hunter KF. Nurses' perceptions of their role in functional focused care in hospitalised older people: An integrated review. Int J Older People Nurs 2020; 15:e12337. [PMID: 32790240 DOI: 10.1111/opn.12337] [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: 01/17/2020] [Revised: 07/01/2020] [Accepted: 07/20/2020] [Indexed: 12/01/2022]
Abstract
AIM The aim of this integrative review was to identify nurses' perspectives of their role in influencing the functional status of hospitalised older people. METHODS An integrative review using Whittemore and Knafls' method was conducted using EBSCOhost CINAHL, Ovid MEDLINE(R), EBSCOhost, Social Gerontology, Cochrane Database of Systematic Reviews and ProQuest Dissertations & Theses data bases. Only studies with nurses' perspectives, or beliefs about their role in function-focused care were included. Content analysis was used to develop the themes nurses' role in function-focused care and barriers to functional care. RESULTS The review found 12 relevant articles. Nurses believed that they were responsible for function-focused care, yet functional care tasks were often missed. Organisational contexts created many barriers to providing function-focused care for patients. Nurses felt powerless to address these overarching problems in their organisations. CONCLUSION Nurses understand the importance of functional care yet often fail to carry out functional care interventions. Lack of organisational support creates a workplace that is short on staff, time and equipment and does not prioritise functional care needs. Nurse leaders and healthcare organisations need to reprioritise function-focused care for the good of patients, families and healthcare budgets.
Collapse
Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | |
Collapse
|
20
|
Chen HL, Chen P, Zhang Y, Xing Y, Guan YY, Cheng DX, Li XW. Retention of volunteers and factors influencing program performance of the Senior Care Volunteers Training Program in Jiangsu, China. PLoS One 2020; 15:e0237390. [PMID: 32776995 PMCID: PMC7416946 DOI: 10.1371/journal.pone.0237390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background As the country with the largest aging population, China faces an enormous challenge with its elderly support and care. One of the proposed solutions is the development of volunteerism for elderly care. The Senior Care Volunteers Training Program (SCVTP) was initiated by the Red Cross Society of China with the purpose of training volunteers to care for community seniors. As one of the four pilot provinces, Jiangsu Province launched the program since 2017. Aims The present study was conducted to investigate the dropout rate of trained volunteer group leaders, the characteristics of the retained trained volunteer group leaders and the activities that their groups conducted. Additionally, the exploration of the factors influencing the SCVTP’s performance was listed as another aim. Methods A cross-sectional study was designed. The study used purposive sampling to select participants who meet the criteria from all the trained volunteer group leaders (n = 623). Demographic questionnaire, volunteer role identity (VRI) scale, attitude toward helping others (AHO) scale, team climate and atmosphere (TCA) scale, and volunteer program performance evaluation (VPPE) questionnaire were used to collect the data online. Descriptive statistics were used to determine the dropout rate and general characteristics of the retained volunteers and the activities. A multiple linear regression equation was developed to study the factors that influence program performance. Results In total, 307 questionnaires were valid in the study. About 67.9%, 53.7%, and 30.0% of the trained volunteer group leaders dropped out of the program in the year of 2017, 2018, and 2019, respectively. The retained trained volunteer group leaders were more likely to be females (84.7%), those in excellent health (75.2%) and with a bachelor’s degree or above (87.6%). Less attention has been paid to frailty care (n = 76) than other volunteer caring activities (e.g., safe care: n = 277, diet care: n = 250, drug management care: n = 226). VRI (β = 0.118, p = 0.017), AHO (β = 0.134, p = 0.021), TCA (β = 0.459, p<0.001), and financial sustainability (β = 0.179, p<0.001) affected the SCVTP’s performance significantly (adjusted R2 = 0.356). Conclusion High rate of trained volunteer group leaders’ dropout should be brought to the policymaker’s attention. The characteristics of the retained trained volunteer group leaders provide a useful reference for the recruitment of trainees in the future. Frailty care may need more training by the volunteer service provider. In order to enhance program performance, a better team climate and atmosphere, financial sustainability, and volunteers with appropriate attitude and role identity are also necessary for the volunteer program.
Collapse
Affiliation(s)
- Hong-Li Chen
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Pei Chen
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Zhang
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Xing
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan-Yuan Guan
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Dao-Xiang Cheng
- Red Cross Society of Jiangsu Branch, Nanjing, Jiangsu, China
| | - Xian-Wen Li
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China
- * E-mail:
| |
Collapse
|
21
|
Rosen MI, Martino S, Sellinger J, Lazar CM, Fenton BT, Mattocks K. Access to Pain Care From Compensation Clinics: A Relational Coordination Perspective. Fed Pract 2020; 37:336-342. [PMID: 32908339 PMCID: PMC7473717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Compensation and Pension (C&P) determination process is a potential gateway to accessing pain treatment in the Veterans Health Administration (VHA). However, attitudes about C&P as a gateway and about collaboration with C&P clinics among VHA staff are unknown. METHODS In preparation for an initiative to link veterans seeking compensation for musculoskeletal disorders to treatment, clinical and administrative staff from the 8 VHA medical centers in New England were invited to complete a relational coordination survey that examined how different workgroups collaborate (communication and relationships) to provide pain care to veterans. A subset of those staff also participated in a semistructured interview about pain treatment referral practices within their medical centers. VHA staff were from primary care, administration, pain management, and C&P teams. RESULTS Eighty-three VHA staff were invited to complete the relational coordination survey; 66 completed the survey and 39 participated in the semistructured interview. Most C&P staff interviewed thought of the compensation examination as a forensic process and that C&P-based efforts to engage veterans might interfere with the examination or were not their responsibility. However, some examiners described their efforts to determine new veterans' eligibility for VHA care and to connect them to specific treatments. VHA staff reported that there was little communication between the C&P team and other teams. The survey results supported this finding. The C&P group's relational coordination composite scores were lower than any other workgroup. CONCLUSION Outreach to veterans at New England C&P clinics was inconsistent, and C&P teams rated low on a measure of coordination with workgroups involved in pain treatment. Compensation examinations appear to be underused opportunities to help veterans access treatment. C&P-based treatment engagement is feasible; it is being done by some Compensation teams.
Collapse
Affiliation(s)
- Marc I Rosen
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Steve Martino
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - John Sellinger
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Christina M Lazar
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Brenda T Fenton
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| | - Kristin Mattocks
- is the Director of Addictions Firm, is the Chief of Psychology, is the Director of Clinical Health Psychology, is the Associate Director, Methods and Biostatistics Core, PRIME Center; all at VA Connecticut Healthcare System in West Haven. is the Associate Chief of Staff for Research at the VA Central Western Massachusetts Healthcare System in Leeds. Marc Rosen and Steve Martino are Professors of Psychiatry, John Sellinger is an Assistant Professor of Psychiatry, and is a Research Associate, all at Yale University in New Haven, Connecticut. Kristin Mattocks is an Associate Professor of Population and Quantitative Health Sciences at the University of Massachusetts Medical School in Worcester
| |
Collapse
|
22
|
Aeyels D, Bruyneel L, Seys D, Sinnaeve PR, Sermeus W, Panella M, Vanhaecht K. Better hospital context increases success of care pathway implementation on achieving greater teamwork: a multicenter study on STEMI care. Int J Qual Health Care 2020; 31:442-448. [PMID: 30256962 DOI: 10.1093/intqhc/mzy197] [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: 02/13/2018] [Revised: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate whether hospital context influences the effect of care pathway implementation on teamwork processes and output in STEMI care. DESIGN A multicenter pre-post intervention study. SETTING Eleven acute hospitals. PARTICIPANTS Cardiologists-in-chief, nurse managers, quality staff, quality managers and program managers reported on hospital context. Teamwork was rated by professional groups (medical doctors, nurses, allied health professionals, other) in the following departments: emergency room, catheterization lab, coronary care unit, cardiology ward and rehabilitation. INTERVENTION Care pathway covering in-hospital care from emergency services to rehabilitation. MAIN OUTCOME MEASURES Hospital context was measured by the five dimensions of the Model for Understanding Success in Quality: microsystem, quality improvement team, quality improvement support, high-level organization, external environment. Teamwork process measures reflected teamwork between professional groups within departments and teamwork between departments. Teamwork output was measured through the level of organized care. Two-level regression analysis accounted for clustering of respondents within hospitals and assessed the influence of hospital context on the impact of care pathway implementation on teamwork. RESULTS Care pathway implementation significantly improved teamwork processes both between professional groups (P < 0.001) and between departments (P < 0.001). Teamwork output also improved (P < 0.001). The effect of care pathway implementation on teamwork was more pronounced when the quality improvement team and quality improvement support and capacity were more positively reported on. CONCLUSIONS Hospitals can leverage the effect of quality improvement interventions such as care pathways by evaluating and improving aspects of hospital context.
Collapse
Affiliation(s)
- Daan Aeyels
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | | | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Vercelli, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
23
|
Wu CJJ, Ramis MA, Skerman H. Integrated approaches for comorbidity. Nurs Health Sci 2019; 21:413-415. [PMID: 31820558 DOI: 10.1111/nhs.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Mater Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Mary-Anne Ramis
- Queensland Centre for Evidence Based Nursing and Midwifery: A Joanna Briggs Institute Centre of Excellence, Mater Health, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Helen Skerman
- Institute of Health and Biomedical Innovation, Brisbane, Queensland, Australia
| |
Collapse
|
24
|
Doekhie KD, Strating MMH, Buljac‐Samardzic M, Paauwe J. Trust in older persons: A quantitative analysis of alignment in triads of older persons, informal carers and home care nurses. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1490-1506. [PMID: 31347234 PMCID: PMC6852099 DOI: 10.1111/hsc.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 06/18/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Abstract
Self-management by older persons could be influenced by the level of trust found in triads of informal carers, formal care providers and care recipient, the older person. Little research has been done on care providers' trust in older persons. This study aims to explore the level of trust that informal carers and home care nurses have in older persons, the extent of alignment in triads and the relationship between trust in older persons and self-management. We conducted a cross-sectional survey study in the Netherlands, sampling 133 older persons, 64 informal carers and 72 nurses, which resulted in 39 triads. Alignment level was analysed through Intraclass Correlation Coefficient 1 scores and absolute and mean difference scores. Correlation analysis and one-way analysis of variance measured the relationship between trust and self-management. The results show that triads contain both alignment and misalignment. Misalignment occurs mostly when informal carers and nurses have little trust in the older person while this person views their own behaviour towards their caregivers positively. Care providers' trust levels relate significantly to their perception of the person's ability to self-manage, but not to the person's self-rated ability. This could be explained by care providers not communicating their intrinsic trust in the older person to them. Trust building could be enhanced by organising discussions of mutual expectations of trust and both formal and informal care providers could benefit from compassionate assessment training, to learn how to openly express their trust in the older person.
Collapse
Affiliation(s)
- Kirti D. Doekhie
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Mathilde M. H. Strating
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Martina Buljac‐Samardzic
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
| | - Jaap Paauwe
- Erasmus School of Health Policy & Management (ESHPM)Erasmus University RotterdamRotterdamThe Netherlands
- Department of Applied EconomicsErasmus University RotterdamRotterdamThe Netherlands
- Department of Human Resource StudiesTilburg UniversityTilburgThe Netherlands
| |
Collapse
|
25
|
Seuren LM, Stommel W, van Asselt D, Sir Ö, Stommel M, Schoon Y. Multidisciplinary meetings at the emergency department: A conversation-analytic study of decision-making. Soc Sci Med 2019; 242:112589. [PMID: 31629160 DOI: 10.1016/j.socscimed.2019.112589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
Abstract
Multidisciplinary meetings (MDMs) have become an established part of many medical disciplines. Much research has been done to investigate the conditions under which they work best. This research, however, has been mostly retrospective and has had little consideration for the actual workings of MDMs. The aim of this study was to determine how Multidisciplinary Teams (MDTs) come to a shared decision and thus how they organize MDMs moment by moment. For this purpose we recorded twenty MDMs at the Department of Emergency Medicine (ED) of the Radboud University Medical Center in The Netherlands between November 2017 and June 2018. These meetings, contrary to those discussed in the literature, were scheduled ad-hoc as patients were seen at the ED and were conducted by small MDTs of between three and six participants, always involving a surgeon, a geriatrician, and an emergency physician. Using Conversation Analysis we found that despite the ad hoc nature of these meetings, teams collaboratively developed a structure that was grounded in everyday medical practice and reached a decision in on average slightly over 10 min. First they do a case presentation in which they share the patient's medical history and results of the physical examination and any medical tests. They subsequently agree on a differential diagnosis, and then develop a work plan. Finally, the decision is often formulated to invite confirmation and make it an interactionally shared decision. The benefit of having an MDM was evidenced by discussion of patients' frailty in particular: it was sometimes omitted during the case presentation, but then consistently requested by the geriatrician. And as we show, it was occasionally invoked as a definitive argument for deciding between surgical or conservative treatment. Our analysis suggests that MDMs can have added value in other disciplines where it is feasible to schedule meetings ad hoc.
Collapse
Affiliation(s)
- Lucas M Seuren
- Radboud University Medical Center, Department of Emergency Medicine, Geert Grooteplein Zuid 22, 6525 GA, Nijmegen, the Netherlands.
| | - Wyke Stommel
- Radboud University, Center for Language Studies, Erasmusplein 1, 6525 HT Nijmegen, the Netherlands
| | - Dieneke van Asselt
- Radboud University Medical Center, Department of Geriatrics, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Özcan Sir
- Radboud University Medical Center, Department of Emergency Medicine, Geert Grooteplein Zuid 22, 6525 GA, Nijmegen, the Netherlands
| | - Martijn Stommel
- Radboud University Medical Center, Department of Surgery, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Yvonne Schoon
- Radboud University Medical Center, Department of Emergency Medicine, Geert Grooteplein Zuid 22, 6525 GA, Nijmegen, the Netherlands; Radboud University Medical Center, Department of Geriatrics, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 28, 6525 GA, Nijmegen, the Netherlands
| |
Collapse
|
26
|
Dahlke S, Davidson S, Duarte Wisnesky U, Kalogirou MR, Salyers V, Pollard C, Fox MT, Hunter KF, Baumbusch J. Student Nurses’ Perceptions About Older People. Int J Nurs Educ Scholarsh 2019; 16:ijnes-2019-0051. [DOI: 10.1515/ijnes-2019-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/26/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Educating nursing students about the ageing population is situated within negative societal, heath care and nursing perceptions. A cross-sectional design using Burbank’s perceptions towards older people scale was used to survey students in a pre-licensure nursing program in western Canada. Findings revealed that students’ perceptions about older people were lower in the third year of the nursing program and after four clinical experiences. We suggest that students’ first experiences in long-term care settings, in which they learn to provide basic care to older people, be balanced with experiences of older people in a variety of settings. Such experiences would allow students to develop the knowledge and skill needed to work with an ageing population with complex healthcare needs. More research is needed to better understand students’ experiences and perceptions about where in the program more learning strategies about how to best work with older people would be helpful.
Collapse
Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada
| | - Sandra Davidson
- Faculty of Nursing , University of Calgary , Calgary , Alberta , Canada
| | | | - Maya R. Kalogirou
- Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada
| | | | | | - Mary T. Fox
- York University , Toronto , Ontario , Canada
| | - Kathleen F. Hunter
- Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada
| | | |
Collapse
|
27
|
Zou P, Luo Y, Krolak K, Hu J, Liu LW, Lin Y, Sun W. Student's Experiences on Learning Therapeutic Relationship: A Narrative Inquiry. Can J Nurs Res 2019; 53:78-87. [PMID: 31533468 DOI: 10.1177/0844562119873760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Despite the importance of the therapeutic relationship on nursing practice, the literature regarding teaching and learning therapeutic relationship is limited. This paper discussed how an undergraduate nursing student learned therapeutic relationship in an acute care setting. Narrative inquiry was applied as a research methodology. The student's reflection served as the narrative in this paper. Collaboratively, researchers conducted data analysis, common themes were drawn, and a summative narrative was presented. Based on the student's narrative, a three-dimensional model, including practical knowledge, theory, and reflection, has been created as our summative narrative. This model suggests that, to facilitate a learning process on creating therapeutic nurse-patient relationship, practical knowledge is the foundation, theory is a leading guide, and constant reflection is a learning tool which transforms learning into a reflective and meaningful experience. To promote learning on therapeutic relationship, nurse educators should emphasize the importance of both practical knowledge and theory. Constant reflection as a learning tool should be encouraged and embedded in nursing curriculum. Diverse approaches of reflection should be promoted.
Collapse
Affiliation(s)
- Ping Zou
- School of Nursing, Nipissing University, Toronto, ON, Canada
| | - Yan Luo
- Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, P. R. China
| | - Kathren Krolak
- Nipissing University Alumna, Nipissing University, Toronto, ON, Canada
| | - Jiale Hu
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Lichun W Liu
- Centre for Women's Studies in Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Yanxia Lin
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Winnie Sun
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| |
Collapse
|
28
|
Abstract
Interprofessional collaboration is understood to improve efficiencies and quality of care but is associated with challenges such as professionals' differing routines, knowledge, and identities, as well as professional hierarchies and time constraints. Given these challenges, there is limited understanding of how professionals collaborate effectively in providing patient-centred care. This study, with a convergence triangulation mixed-methods study design, explored interprofessional staffs' perceptions of interprofessional collaboration and patient-centred care when working with hospitalized older adults. Thirty-six staff responded to a survey which included the Patient-Centred Care measure and the Modified Index of Interdisciplinary Collaboration; we also interviewed 14 nursing staff. Although all scores suggested a high value was placed on interprofessional collaboration, scores were low related to activities that facilitated team processes. We identified three themes from the data: knowing the patient/family, functional needs, and communication processes. Staff identified daily rounds with interprofessional teams as supportive of interprofessional collaboration and patient-centred-care.
Collapse
|
29
|
Runtu TM, Novieastari E, Handayani H. How does organizational culture influence care coordination in hospitals? A systematic review. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
Hunter KF, Dahlke S, Negrin K, Kalogirou MR, Fox M, Antonio N, Buckborough N, Morgan A, Wagg A. The feasibility of implementing education on older person care to practice on medical units: Nurses' perceptions and the influence of practice context. Int J Older People Nurs 2019; 14:e12265. [PMID: 31441244 DOI: 10.1111/opn.12265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/03/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022]
Abstract
AIM As part of a larger primary study on evidence-informed practice with hospitalised older people, we aimed to (a) examine nursing staffs' perceptions of the interactive geriatric educational intervention and to explore how perceptions of their work context may influence their ability to enact the evidence-informed assessment and care approaches discussed during the educational sessions and (b) compare differences in perceptions of context between RNs, LPNs and HCAs. METHOD A survey-based evaluation that used both closed and open-ended questions was conducted as part of an interactive educational intervention on cognitive impairment and managing responsive behaviours. Data were gathered on participants' perceptions of the education intervention and organisational context. RESULTS Findings from this study suggest when education is tailored to nurses' articulated educational needs, it is well received; however, barriers to implementation exist. Assessment of the context by using a standardised survey tool to get the nursing staffs' perceptions of organisational context revealed strengths in leadership support and day-to-day interactions with other nurses and healthcare professionals, but potential barriers related to lack of facilitation to transfer new knowledge into practice existed. CONCLUSION Providing evidence-based education related to care of older patients and evaluating nursing staffs' perceptions of the education and their context has laid the groundwork for a long-term relationship with the managers and nursing staff on the participating medical units. Further investigation about how best to incorporate the facilitator role into the medical units to support evidence-based practices with older patients is warranted. IMPLICATIONS FOR PRACTICE: While nurses are receptive to new knowledge, the unpredictable workload of acute care creates challenges to implementing this new knowledge. Assessment of contextual factors that influence evidence-informed practice facilitates planning for implementation of new knowledge and support practice change.
Collapse
Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Kelly Negrin
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | - Mary Fox
- York University, Toronto, ON, Canada
| | | | | | - Angela Morgan
- University of Alberta Hospital, Edmonton, AB, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
31
|
Butler JI, Fox MT. Nurses' Perspectives on Interprofessional Communication in the Prevention of Functional Decline in Hospitalized Older People. HEALTH COMMUNICATION 2019; 34:1053-1059. [PMID: 29565683 DOI: 10.1080/10410236.2018.1455141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Older people present with complex health issues on admission to hospital and are at high risk for functional decline and related complications. Thus, they require the services of diverse health-care professionals working in concert to support their functioning. Despite nurses' central role in caring for this patient population, and evidence indicating that interprofessional communication is a persistent challenge for nurses in acute-care settings, little is known about nurses' views on interprofessional communication in care preserving functioning in acutely admitted older people. To fill this knowledge gap, we gathered acute-care staff nurses' perspectives on interprofessional communication in a function-focused, interprofessional approach to hospital care for older adults. Thirteen focus groups were conducted with a purposeful, criterion-based sample of 57 nurses working in acute-care hospitals. Thematic analysis revealed two overarching themes capturing nurses' perspectives on key factors shaping interprofessional communication in a function-focused interprofessional approach to care (1) context of direct communication and (2) context of indirect communication. The first theme demonstrates that nurses preferred synchronous modes of communication, but some ascribed greater importance to unstructured forms of direct information-sharing, while others stressed structured direct communication, particularly interprofessional rounds. The second theme also documents divergence in nurses' views on asynchronous communication, with some emphasizing information technology and others analog tools. Perceptions of some modes of interprofessional communication were found to vary by practice setting. Theoretical and pragmatic conclusions are drawn that can be used to optimize interprofessional communication processes supporting hospitalized older people's functioning.
Collapse
Affiliation(s)
- Jeffrey I Butler
- a Faculty of Health, School of Nursing , York University, York University Centre for Aging Research and Education , Toronto , Ontario , Canada
| | - Mary T Fox
- a Faculty of Health, School of Nursing , York University, York University Centre for Aging Research and Education , Toronto , Ontario , Canada
| |
Collapse
|
32
|
The influence of leadership facilitation on relational coordination among primary care team members of accountable care organizations. Health Care Manage Rev 2019; 45:302-310. [PMID: 30908316 PMCID: PMC6755061 DOI: 10.1097/hmr.0000000000000241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Teamwork is a central aspect of integrated care delivery and increasingly critical to primary care practices of accountable care organizations. Although the importance of leadership facilitation in implementing organizational change is well documented, less is known about the extent to which strong leadership facilitation can positively influence relational coordination among primary care team members. PURPOSE The aim of this study was to examine the association of leadership facilitation of change and relational coordination among primary care teams of accountable care organization-affiliated practices and explore the role of team participation and solidarity culture as mediators of the relationship between leadership facilitation and relational coordination among team members. METHODOLOGY/APPROACH Survey responses of primary care clinicians and staff (n = 764) were analyzed. Multilevel linear regression estimated the relationships among leadership facilitation, team participation, group solidarity, and relational coordination controlling for age, time, occupation, gender, team tenure, and team size. Models included practice site random effects to account for the clustering of respondents within practices. RESULTS Leadership facilitation (β = 0.19, p < .001) and team participation (β = 0.18, p < .001) were positively associated with relational coordination, but solidarity culture was not associated. The association of leadership facilitation and relational coordination was only partially mediated (9%) by team participation. CONCLUSIONS Leadership facilitation of change is positively associated with relational coordination of primary care team members. The relationship is only partially explained by better team participation, indicating that leadership facilitation has a strong direct effect on relational coordination. Greater solidarity was not associated with better relational coordination and may not contribute to better team task coordination. PRACTICE IMPLICATIONS Leadership facilitation of change may have a positive and direct impact on high relational coordination among primary care team members.
Collapse
|
33
|
Engaging Stakeholders to Co-design an Academic Practice Strategic Plan in an Integrated Health System: The Key Roles of the Nurse Executive and Planning Team. Nurs Adm Q 2019; 43:186-192. [PMID: 30839455 DOI: 10.1097/naq.0000000000000340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As key members of the executive team, nurse executives play an integral role in the planning process and operationalization of strategic imperatives to ensure the overall success of the organization. Nurse executives are leading organizations through transition periods that require transformational leadership. Leaders must design a shared vision and set strategic priorities; empower others to lead; ensure access to resources needed for safe care delivery; and inspire people to meet the demands of the future. Paramount to effective strategic planning and achievement of positive outcomes is a leadership team that engages key stakeholders in the strategic planning process. This article provides an overview of a recently integrated health system's strategic planning process that included the engagement of patients and caregivers. This can serve as a blueprint for others in their efforts to implement a systematic approach for enhancing collaborative academic practice in their organizations.
Collapse
|
34
|
McCrory V. An overview of the role of the district nurse caring for individuals with complex needs. Br J Community Nurs 2019; 24:20-26. [PMID: 30589587 DOI: 10.12968/bjcn.2019.24.1.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The role of the district nurse is imperative in the care of patients in a district nursing team's caseload. Through the role of care manager, district nurses are accountable for the overall coordination of the care patients receive. Their responsibilities include caring for acutely ill patients, those with long-term conditions and people who require end-of-life care, in addition to health promotion and patient education. They provide personcentred, preventive and coordinated care, which reduces unnecessary hospital admissions and enables patients who have a range of complex needs to remain at or return to home. In this article, a case study is used to provide an overview of the role and accountability of the district nurse in the care of patients who have complex needs.
Collapse
|
35
|
Melchior I, Moser A, Veenstra MY, Jie KS. Involving "authentic" cancer patients, their caregivers, and multidisciplinary professionals in a quality improvement trajectory in a hospital cancer pathway: a study protocol. J Multidiscip Healthc 2018; 11:661-671. [PMID: 30519034 PMCID: PMC6233706 DOI: 10.2147/jmdh.s177957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The implementation of oncology care pathways that standardize organizational procedures has improved cancer care in recent years. However, the involvement of "authentic" patients and caregivers in quality improvement of these predetermined pathways is in its infancy, especially the scholarly reflection on this process. We, therefore, aim to explore the multidisciplinary challenges both in practice, when cancer patients, their caregivers, and a multidisciplinary team of professionals work together on quality improvement, as well as in our research team, in which a social scientist, health care professionals, health care researchers, and experience experts design a research project together. Methods and design Experience-based co-design will be used to involve cancer patients and their caregivers in a qualitative research design. In-depth open discovery interviews with 12 colorectal cancer patients, 12 breast cancer patients, and seven patients with cancer-associated thrombosis and their caregivers, and focus group discussions with professionals from various disciplines will be conducted. During the subsequent prioritization events and various co-design quality improvement meetings, observational field notes will be made on the multidisciplinary challenges these participants face in the process of co-design, and evaluation interviews will be done afterwards. Similar data will be collected during the monthly meetings of our multidisciplinary research team. The data will be analyzed according to the constant comparative method. Discussion This study may facilitate quality improvement programs in oncologic care pathways, by increasing our real-world knowledge about the challenges of involving "experience experts" together with a team of multidisciplinary professionals in the implementation process of quality improvement. Such co-creation might be challenging due to the traditional paternalistic relationship, actual disease-/treatment-related constraints, and a lack of shared language and culture between patients, caregivers, and professionals and between professionals from various disciplines. These challenges have to be met in order to establish equality, respect, team spirit, and eventual meaningful participation.
Collapse
Affiliation(s)
- Inge Melchior
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard, The Netherlands, .,Research Centre Autonomy and Participation of Chronically Ill people, Zuyd University of Applied Sciences, Heerlen, The Netherlands,
| | - Albine Moser
- Research Centre Autonomy and Participation of Chronically Ill people, Zuyd University of Applied Sciences, Heerlen, The Netherlands, .,Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Marja Y Veenstra
- Burgerkracht Limburg [Citizen Power in Limburg], Sittard, The Netherlands
| | - Kon-Siong Jie
- Department of Internal Medicine, Zuyderland Medical Centre, Sittard, The Netherlands, .,Research Centre Autonomy and Participation of Chronically Ill people, Zuyd University of Applied Sciences, Heerlen, The Netherlands,
| |
Collapse
|
36
|
Moser KS, Dawson JF, West MA. Antecedents of team innovation in health care teams. CREATIVITY AND INNOVATION MANAGEMENT 2018. [DOI: 10.1111/caim.12285] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
37
|
Hustoft M, Biringer E, Gjesdal S, Aβmus J, Hetlevik Ø. Relational coordination in interprofessional teams and its effect on patient-reported benefit and continuity of care: a prospective cohort study from rehabilitation centres in Western Norway. BMC Health Serv Res 2018; 18:719. [PMID: 30223847 PMCID: PMC6142375 DOI: 10.1186/s12913-018-3536-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background Rehabilitation services depend on competent professionals who collaborate effectively. Well-functioning interprofessional teams are expected to positively impact continuity of care. Key factors in continuity of care are communication and collaboration among health care professionals in a team and their patients. This study assessed the associations between team functioning and patient-reported benefits and continuity of care in somatic rehabilitation centres. Methods This prospective cohort study uses survey data from 984 patients and from health care professionals in 15 teams in seven somatic rehabilitation centres in Western Norway. Linear mixed effect models were used to investigate associations between the interprofessional team communication and relationship scores (measured by the Relational Coordination [RC] Survey and patient-reported benefit and personal-, team- and cross-boundary continuity of care. Patient-reported continuity of care was measured using the Norwegian version of the Nijmegen Continuity Questionnaire. Results The mean communication score for healthcare teams was 3.9 (standard deviation [SD] = 0.63, 95% confidence interval [CI] = 3.78, 4.00), and the mean relationship score was 4.1 (SD = 0.56, 95% CI = 3.97, 4.18). Communication scores in rehabilitation teams varied from 3.4–4.3 and relationship scores from 3.6–4.5. Patients treated by teams with higher relationship scores experienced better continuity between health care professionals in the team at the rehabilitation centre (b = 0.36, 95% CI = 0.05, 0.68; p = 0.024). There was a positive association between RC communication in the team the patient was treated by and patient-reported activities of daily living benefit score; all other associations between RC scores and rehabilitation benefit scores were not significant. Conclusion Team function is associated with better patient-reported continuity of care and higher ADL-benefit scores among patients after rehabilitation. These findings indicate that interprofessional teams’ RC scores may predict rehabilitation outcomes, but further studies are needed before RC scores can be used as a quality indicator in somatic rehabilitation. Electronic supplementary material The online version of this article (10.1186/s12913-018-3536-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Merethe Hustoft
- Centre for Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway. .,Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway.
| | - Eva Biringer
- Section of Research and Innovation, Helse Fonna Local Health Authority, Haugesund/Stord, Norway
| | - Sturla Gjesdal
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Jörg Aβmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Health and Primary Health Care, University of Bergen, Bergen, Norway
| |
Collapse
|
38
|
Temporal and Atemporal Provider Network Analysis in a Breast Cancer Cohort from an Academic Medical Center (USA). INFORMATICS 2018. [DOI: 10.3390/informatics5030034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Social network analysis (SNA) is a quantitative approach to study relationships between individuals. Current SNA methods use static models of organizations, which simplify network dynamics. To better represent the dynamic nature of clinical care, we developed a temporal social network analysis model to better represent care temporality. We applied our model to appointment data from a single institution for early stage breast cancer patients. Our cohort of 4082 patients were treated by 2190 providers. Providers had 54,695 unique relationships when calculated using our temporal method, compared to 249,075 when calculated using the atemporal method. We found that traditional atemporal approaches to network modeling overestimate the number of provider-provider relationships and underestimate common network measures such as care density within a network. Social network analysis, when modeled accurately, is a powerful tool for organizational research within the healthcare domain.
Collapse
|
39
|
Vestjens L, Cramm JM, Birnie E, Nieboer AP. Evaluating an integrated primary care approach to improve well-being among frail community-living older people: A theory-guided study protocol. BMC Geriatr 2018; 18:173. [PMID: 30071842 PMCID: PMC6091022 DOI: 10.1186/s12877-018-0832-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 06/06/2018] [Indexed: 01/21/2023] Open
Abstract
Background A major challenge in primary healthcare is the substantial increase in the proportion of frail community-dwelling older persons with long-term conditions and multiple complex needs. Consequently, a fundamental transformation of current models of primary care by means of implementing proactive integrated care is necessary. Therefore, an understanding of the effects of integrated primary care approaches and underlying mechanisms is essential. This article presents the design of a theory-based evaluation of an integrated primary care approach to improve well-being among frail community-living older adults, which is called “Finding and Follow-up of Frail older persons” (FFF). First, we present a theoretical model to facilitate a sound theory-guided evaluation of integrated primary care approaches for frail community-dwelling older people. The model incorporates interrelated elements of integrated primary care approaches (e.g. proactive case finding and self-management support). Efforts to improve primary care should integrate these promising components to assure productive patient-professional interactions and to improve well-being. Moreover, cognitive and behavioral components of healthcare professionals and patients are assumed to be important. Second, we present the design of the study to evaluate the FFF approach which consists of the following key components: (1) proactive case finding, (2) case management, (3) medication review, (4) self-management support, and (5) working in multidisciplinary care teams. Methods The longitudinal evaluation study has a matched quasi-experimental design with one pretest and one posttest (12 month follow-up) and is conducted in the Netherlands between 2014 and 2017. Both quantitative and qualitative methods are used to evaluate effectiveness, processes, and cost-effectiveness. In total, 250 frail older persons (75 years and older) of 11 GP (general practitioner) practices that implemented the FFF approach are compared with 250 frail older patients of 4 GP practices providing care as usual. In addition, data are collected from healthcare professionals. Outcome measures are based on our theoretical model. Discussion The proposed evaluation study will reveal insight into the (cost)effectiveness and underlying mechanisms of the proactive integrated primary care approach FFF. A major strength of the study is the comprehensive evaluation based on a theoretical framework. The quasi-experimental design presents some challenges.
Collapse
Affiliation(s)
- Lotte Vestjens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands.
| | - Jane M Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
| | - Erwin Birnie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
| | - Anna P Nieboer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands
| |
Collapse
|
40
|
Ohura T, Higashi T, Ishizaki T, Nakayama T. Occupation-based differences in shared perceptions of older resident needs within multidisciplinary care teams: a cross-sectional study of care workers, nurses, and therapists linked to older residents. J Phys Ther Sci 2018; 30:866-873. [PMID: 29950782 PMCID: PMC6016288 DOI: 10.1589/jpts.30.866] [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: 01/30/2018] [Accepted: 03/27/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To examine whether the needs of older individuals are commonly understood by
multidisciplinary team members at elderly care facilities. [Subjects and Methods] A
questionnaire survey with care workers, nurses, and therapists linked to residents and
structured interviews with residents were conducted at eight facilities in Japan. The
questionnaire comprised 25 items regarding basic activities of daily living, instrumental
activities of daily living (IADL), environment and lifestyle (EL), and emotion. [Results]
The data of 88 residents (83.0% female, 86.4% aged ≥75 years) and 125 staff members (63
care workers, 36 nurses, and 26 therapists) were analyzed. Perceptions regarding the
subjective needs of residents differed significantly by occupation with regard to pace of
eating, pace of dressing, and freedom to brush at any time; shaving or putting on make-up;
personal space, role performance, and health exercises; and feeling good. All three
occupations underestimated the subjective needs of residents for household chores.
[Conclusion] Staff members had insufficient understanding of the subjective needs of
residents, with a tendency to underestimate IADL and EL needs. Perceived subjective needs
also differed by occupation. Sharing the understanding of subjective needs of older
individuals within multidisciplinary care teams is desired.
Collapse
Affiliation(s)
- Tomoko Ohura
- Division of Occupational Therapy, Faculty of Care and Rehabilitation, Seijoh University: 2-172 Fukinodai, Tokai, Aichi 476-8588, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Japan
| |
Collapse
|
41
|
Communication and Relational Ties in Inter-Professional Teams in Norwegian Specialized Health Care: A Multicentre Study of Relational Coordination. Int J Integr Care 2018; 18:9. [PMID: 30127693 PMCID: PMC6095090 DOI: 10.5334/ijic.3432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: The delivery of integrated care depends on the quality of communication and relationships among health-care professionals in inter-professional teams. The main aim of this study was to investigate individual and team communication and relational ties of teams in specific care processes within specialized health care. Methods: This cross-sectional multi-centre study used data from six somatic hospitals and six psychiatric units (N = 263 [response rate, 52%], 23 care processes) using a Norwegian version of the Relational Coordination Survey. We employed linear mixed-effect regression models and one-way analyses of variance. Results: The mean (standard deviation) relational coordination total score ranged from 4.5 (0.33) to 2.7 (0.50). The communication and relationship sub-scale scores were significantly higher within similar functional groups than between contrasting functional groups (P < .05). Written clinical procedures were significantly associated with higher communication scores (P < .05). The proportion of women in a team was associated with higher communication and relationship scores (P < .05). Conclusion: The Relational Coordination Survey shows a marked variation in team functions within inter-professional teams in specialized health-care settings. Further research is needed to determine the reasons for these variations.
Collapse
|
42
|
Nasir S, Anwar S, Ahmed M. Multidisciplinary team (MDT) meeting and Radiologist workload, a prospective review in a tertiary care hospital. Pak J Med Sci 2018; 33:1501-1506. [PMID: 29492086 PMCID: PMC5768852 DOI: 10.12669/pjms.336.12905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To quantify the increase in workload associated with multidisciplinary team meetings for radiologists in a tertiary care hospital over a period of 15 months. Methods Data was collected prospectively regarding number of multidisciplinary team meetings, number of clinical cases discussed, number of individual imaging studies reviewed, and preparation time of residents, senior registrar and consultants and the delivery time of meeting. Results Total 223 meetings were held over 15 months (April 2014 to June 2015) for 12 clinical specialty areas. There were 1120 clinical case discussions and a total of 2759 documented individual imaging studies reviewed. Resident's preparation time was 74.6 hours/month, senior registrar's preparation time was 47.93 hours/month, consultant's preparation time was 18.67 hours/month and the total duration time for meetings was 18 hours/month. Conclusion Multidisciplinary team meetings now represent a significant workload of radiology and has reduced the time for other academic activities within the department.
Collapse
Affiliation(s)
- Sadaf Nasir
- Sadaf Nasir, MBBS, FCPS.Department of Radiology, Liaquat National Hospital, National Stadium Road, Karachi, Pakistan
| | - Saleha Anwar
- Saleha Anwar, MCPS, FCPS.Department of Radiology, Liaquat National Hospital, National Stadium Road, Karachi, Pakistan
| | - Moinuddin Ahmed
- Moinuddin Ahmed, FCPS. Department of Radiology, Liaquat National Hospital, National Stadium Road, Karachi, Pakistan
| |
Collapse
|
43
|
Differences in Certification and the Effect on Team Climate Among Community Health Workers in Texas. J Ambul Care Manage 2018; 41:138-145. [PMID: 29474253 DOI: 10.1097/jac.0000000000000228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to compare team climate among Texas community health workers (CHWs)/promotoras who were certified by the 2 different methods: (a) completing a state-approved training program, and (b) providing evidence of work experience (grandfathering). Analysis of survey results found no significant differences in Team Climate Inventory scores between CHWs who were certified either through state-approved training or through work experience. This research provides some preliminary evidence in support of experience-based certification, but there continues to be a need for more research evaluating CHW certification requirements and the impact of state certification of CHWs on population health outcomes.
Collapse
|
44
|
Dahlke S, Steil K, Freund-Heritage R, Colborne M, Labonte S, Wagg A. Older people and their families' perceptions about their experiences with interprofessional teams. Nurs Open 2018; 5:158-166. [PMID: 29599991 PMCID: PMC5867281 DOI: 10.1002/nop2.123] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/29/2017] [Indexed: 11/16/2022] Open
Abstract
Aim To examine older people and their families’ perceptions about their experiences with interprofessional teams. Design Naturalistic inquiry using qualitative descriptive methods to provide a comprehensive summary of older people and their families’ experiences with interprofessional teams. Methods Interviews were conducted with 22 people from 11 families. The families had experiences with teams in a variety of settings, such as community, residential care and hospital. Data were analysed using inductive content analysis. NiVivo was used to record preliminary codes. Analysis included comparing and contrasting families’ experiences. Results Older people and their families wanted communication about what was going on, regardless of whether the news was good, bad or unknown. They also wanted care that took the concerns of the older person into consideration. Communication was a necessary ingredient to ensuring that the older person's unique concerns were known to the interprofessional team. These percepectives were discussed in the themes of communication and patient‐centred care.
Collapse
Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing University of Alberta Edmonton AB Canada
| | - Kim Steil
- Glenrose Rehabilitation Hospital Edmonton AB Canada
| | | | | | - Susan Labonte
- Faculty of Nursing University of Alberta Edmonton AB Canada
| | - Adrian Wagg
- Department of Medicine University of Alberta Edmonton AB Canada
| |
Collapse
|
45
|
Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors: a mixed-methods study. BMC FAMILY PRACTICE 2017; 18:111. [PMID: 29281980 PMCID: PMC5745958 DOI: 10.1186/s12875-017-0685-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 12/08/2017] [Indexed: 01/28/2023]
Abstract
Background Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals’ perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions? Methods We conducted a mixed-methods study in the Dutch primary care setting. First, a survey study of 152 professionals representing 12 primary care disciplines was conducted, focusing on their perceptions of which disciplines are part of the team and the degree of relational coordination between professionals from different disciplinary backgrounds. Subsequently, we conducted semi-structured interviews with 32 professionals representing 5 primary care disciplines to gain a deeper understanding of the underlying factors influencing their perceptions and the (mis)alignment between these perceptions. Results Misalignments were found between perceptions regarding which disciplines are members of the team and the relational coordination between disciplines. For example, general practitioners were viewed as part of the team by helping assistants, (district) nurses, occupational therapists and geriatric specialized practice nurses, whereas the general practitioners themselves only considered geriatric specialized practice nurses to be part of their team. Professionals perceive multidisciplinary primary care teams as having multiple inner and outer layers. Three factors influence their perception of being part of a team and acting accordingly: a) knowing the people you work with, b) the necessity for knowledge exchange and c) sharing a holistic view of caregiving. Conclusion Research and practice should take into account the misalignment between primary care professionals’ perceptions of primary care teams, as our study notes variations in the conceptualization of primary care teams. To enhance teamwork between professionals from different disciplinary backgrounds, professionals acknowledge the importance of three underlying conditions: team familiarity, regular and structured knowledge exchange between all professionals involved in the care process and realizing and believing in the added value for patients of working as a team. Electronic supplementary material The online version of this article (10.1186/s12875-017-0685-2) contains supplementary material, which is available to authorized users.
Collapse
|
46
|
The Care of Older Adults Experiencing Cognitive Challenges: How Interprofessional Teams Collaborate. Can J Aging 2017; 36:485-500. [PMID: 28920561 DOI: 10.1017/s0714980817000368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We conducted a scoping study to examine how interprofessional health care teams improve the outcomes of older adults experiencing cognitive challenges. We searched Ovid, Medline 1946, and MEDLINE In-Process and other non-indexed citations, using the concepts multi or interdisciplinary care teams, confusion or cognitive impairment, and elderly adults. Of 4,554 articles the review yielded, 34 relevant to our inquiry, using Arksey and O'Malley's methodological framework. Twenty-nine per cent of authors reported on the processes interprofessional teams use to achieve positive outcomes for older adults. They highlighted the importance of communication, staff strategies, and education interventions in achieving outcomes with older adults and in supporting interprofessional collaboration. The review revealed knowledge gaps about the processes teams use to collaborate in caring for older adults experiencing cognitive challenges, and how to best incorporate older adults and their families' perspectives in team decisions. More research to understand processes interprofessional teams use is needed.
Collapse
|
47
|
Heart transplant centers with multidisciplinary team show a higher level of chronic illness management – Findings from the International BRIGHT Study. Heart Lung 2017. [DOI: 10.1016/j.hrtlng.2017.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
48
|
Dahlke S, Fox M. Navigating Relationships: Nursing Teamwork in the Care of Older Adults. Can J Nurs Res 2017; 47:97-112. [DOI: 10.1177/084456211504700406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
49
|
Cucolo DF, Perroca MG. Assessment of the nursing care product (APROCENF): a reliability and construct validity study. Rev Lat Am Enfermagem 2017; 25:e2860. [PMID: 28403337 PMCID: PMC5396485 DOI: 10.1590/1518-8345.1495.2860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives to verify the reliability and construct validity estimates of the "Assessment of nursing care product" scale (APROCENF) and its applicability. Methods this validation study included a sample of 40 (inter-rater reliability) and 172 (construct validity) assessments performed by nurses at the end of the work shift at nine inpatient services of a teaching hospital in the Brazilian Southeast. The data were collected between February and September/2014 with interruptions. Cronbach's alpha and Spearman's correlation coefficients were calculated, as well as the intraclass correlation and the weighted kappa index (inter-rater reliability). Exploratory factor analysis was used with principal component extraction and varimax rotation (construct validity). Results the internal consistency revealed an alpha coefficient of 0.85, item-item correlation ranging between 0.13 and 0.61 and item-total correlation between 0.43 and 0.69. Inter-rater equivalence was obtained and all items evidenced significant factor loadings. Conclusion this research evidenced the reliability and construct validity of the scale to assess the nursing care product. Its application in nursing practice permits identifying improvements needed in the production process, contributing to management and care decisions.
Collapse
Affiliation(s)
- Danielle Fabiana Cucolo
- PhD, Professor, Departamento de Enfermagem, Universidade Federal de São
Carlos, São Carlos, SP, Brazil
| | - Márcia Galan Perroca
- PhD, Adjunct Professor, Faculdade de Medicina de São José do Rio Preto,
São José do Rio Preto, SP, Brazil
| |
Collapse
|
50
|
Cramm JM, Nieboer AP. The changing nature of chronic care and coproduction of care between primary care professionals and patients with COPD and their informal caregivers. Int J Chron Obstruct Pulmon Dis 2016; 11:175-82. [PMID: 26869783 PMCID: PMC4734725 DOI: 10.2147/copd.s94409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate whether care delivery in accordance with a care model is associated with co-productive relationships between professionals and COPD patients and their informal caregivers. A co-productive relationship refers to productive patient–professional interaction or shared decision making. This cross-sectional study was conducted in 2014 among 411 patients (out of 981) enrolled in the Dutch COPD care program Kennemer Lucht and 62 professionals treating them (out of 97). Kennemer Lucht COPD involved multicomponent interventions within all six dimensions of the chronic care model (organizational support, community, self-management, decision support, delivery system design, and information and communications technology) to improve the quality of care for patients with COPD. This approach was expected to improve relational coproduction of care between professionals and patients with COPD and their informal caregivers. Results show clearly that the perceived quality of chronic care delivery is related significantly to productive interaction/relational coproduction of care. The strength of the relationship between perceptions of quality of chronic care and relational coproduction among patients is strong (r=0.5; P≤0.001) and among professionals moderate (r=0.4; P≤0.001 relational coproduction with patients and informal caregivers). Furthermore, patients’ perceptions of the quality of chronic care were associated with the existence of productive interaction with health care professionals (β=0.7; P≤0.001). The changing nature of chronic care is associated with coproduction of care, leading to the development of more productive relationships between primary care professionals and COPD patients and their informal caregivers. Further research is necessary to determine how best to sustain these developments.
Collapse
Affiliation(s)
- Jane Murray Cramm
- Department of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Anna Petra Nieboer
- Department of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|