An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice

"I feel like I'm walking on eggshells": a qualitative study of moral distress among Chinese emergency doctors

BACKGROUND

While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources.

AIM

This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it.

METHOD

Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi's phenomenological analysis method.

STUDY FINDINGS

This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress.

CONCLUSION

The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors' communication skills.

General practice nurse perceptions of barriers and facilitators to implementation of best-practice dementia care recommendations-a qualitative interview study

INTRODUCTION

With an aging population and a growing prevalence of people living with dementia, the demand for best-practice dementia care in general practice increases. There is an opportunity to better utilise the nurse role within the primary care team to meet this increasing demand in the provision of care for people living with dementia. However, general practice nurses have limited knowledge in the provision of best-practice care for people living with dementia and their carer(s). A number of best-practice dementia care recommendations contained in the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia have been identified as highly relevant to the role of the general practice nurse.

AIMS

To explore general practice nurses' perspectives on published best-practice dementia care recommendations relevant to their role and identify barriers and facilitators to their implementation into clinical practice.

METHODS

Thirteen Australian general practice nurses took part in this qualitative interview study. The research questions for this study were addressed within a paradigmatic framework of social constructionism. Data were transcribed verbatim and thematically analysed.

RESULTS

There was a high level of agreement between general practice nurses that the recommendations were important, reflected best-practice dementia care and were relevant to their role. However the recommendations were perceived as limited in their usefulness to nurses' clinical practice due to being too vague and lacking direction. Four main themes were identified describing barriers and facilitators to operationalising best-practice dementia care.: creating a comfortable environment; changing approach to care; optimising the general practice nurse role and working collaboratively. Nine sub-themes were described: physical environment; social environment; complexity of care; care planning for the family; professional role and identity, funding better dementia care, education, networking and resources; different roles, one team; and interagency communication.

CONCLUSION

This study identified several factors that need addressing to support general practice nurses to integrate best-practice dementia care recommendations into daily clinical practice. The development of interventions needs to include strategies to mitigate potential barriers and enhance facilitators that they perceive impact on their delivery of best-practice care for people living with dementia and their carer(s). The knowledge gained in this study could be used to develop multi-faceted interventions informed by theoretical implementation change models to enable the general practice nurse to operationalise best-practice dementia care recommendations.

The process of nurses' role negotiation in general practice: A grounded theory study

AIM

To explain the process by which nurses' roles are negotiated in general practice.

BACKGROUND

Primary care nurses do important work within a social model of health to meet the needs of the populations they serve. Latterly, in the face of increased demand and workforce shortages, they are also taking on more medical responsibilities through task-shifting. Despite the increased complexity of their professional role, little is known about the processes by which it is negotiated.

DESIGN

Constructivist grounded theory.

METHODS

Semi-structured interviews were conducted with 22 participants from 17 New Zealand general practices between December 2020 and January 2022. Due to COVID-19, 11 interviews were via Zoom™. Concurrent data generation and analysis, using the constant comparative method and common grounded theory methods, identified the participants' main concern and led to the construction of a substantive explanatory theory around a core category.

RESULTS

The substantive explanatory theory of creating place proposes that the negotiation of nurse roles within New Zealand general practice is a three-stage process involving occupying space, positioning to do differently and leveraging opportunity. Nurses and others act and interact in these stages, in accordance with their conceptualizations of need-responsive nursing practice, towards the outcome defining place. Defining place conceptualizes an accommodation between the values beliefs and expectations of individuals and pre-existing organizational norms, in which individual and group-normative concepts of need-responsive nursing practice are themselves developed.

CONCLUSION

The theory of creating place provides new insights into the process of nurses' role negotiation in general practice. Findings support strategies to enable nurses, employers and health system managers to better negotiate professional roles to meet the needs of the populations they serve, while making optimum use of nursing skills and competencies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Findings can inform nurses to better negotiate the complexities of the primary care environment, balancing systemic exigencies with the health needs of populations.

IMPACT

What Problem Did the Study Address? In the face of health inequity, general practice nurses in New Zealand, as elsewhere, are key to meeting complex primary health needs. There is an evidence gap regarding the processes by which nurses' roles are negotiated within provider organizations. A deeper understanding of such processes may enable better use of nursing skills to address unmet health need. What Were the Main Findings? Nurses' roles in New Zealand general practice are determined through goal-driven negotiation in accordance with individual concepts of need-responsive nursing practice. Individuals progress from occupying workspaces defined by the care-philosophies of others to defining workplaces that incorporate their own professional beliefs, values and expectations. Negotiation is conditional upon access to role models, scheduled dialogue with mentors and decision-makers, and support for safe practice. Strong clinical and organizational governance and individuals' own positive personal self-efficacy are enablers of effective negotiation. Where and on Whom Will the Research Have Impact? The theory of Creating Space can inform organizational and individual efforts to advance the roles of general practice nurses to meet the health needs of their communities. General practice organizations can provide safe, supported environments for effective negotiation; primary care leaders can promote strong governance and develop individuals' sense of self-efficacy by involving them in key decisions. Nurses themselves can use the theory as a framework to support critical reflection on how to engage in active negotiation of their professional roles.

REPORTING METHOD

The authors adhered to relevant EQUATOR guidelines using the COREQ reporting method.

PATIENT OR PUBLIC CONTRIBUTION

Researchers and participants currently working in general practice were involved in the development of this study. By the process of theoretical sampling and constant comparison, participants' comments helped to shape the study design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: An understanding of the processes by which health professionals negotiate their roles is important to support them to meet the challenges of increased complexity across all health sectors globally.

Survey of collaboration supporting students who are deaf and hard of hearing

Collaboration between teachers of students who are deaf and hard of hearing (TSDHH) and educational audiologists is essential when developing successful, comprehensive service delivery plans for students who are deaf and hard of hearing. Despite the importance, little is known about how these two professions work together. This study sought to describe the current state of collaboration between educational audiologists and TSDHH and to explore the barriers and facilitators to this collaboration. Anonymous survey responses from 752 educational audiologists and TSDHH showed that collaboration is considered valuable and is occurring frequently, via a variety of formats and despite significant barriers. More research is needed to understand how efforts to minimize barriers to collaboration might improve the quality of collaboration and ultimately impact the success of student support.

[Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study]

Interprofessional collaboration of general practitioners and nurses in primary care: A qualitative study Abstract. Background: There is a need to strengthen interprofessional collaboration of general practitioners and home care nurses in the primary care of people with chronic diseases and long-term care needs. Aim: This study investigated a) how general practitioners and nurses in Germany perceive their collaboration in primary care and b) which development perspectives of collaboration exist from their point of view. Methods: Expert interviews were conducted with seven general practitioners and eight home care nurses. The data were analysed using thematic-structured qualitative content analysis. Results: The interviewees from both professional groups report that their collaboration is hindered by poor mutual accessibility. At the same time, they emphasise their appreciation of the professional exchange with the other professional group. Nevertheless, the perceptions of the professional competence of home care nurses differ. To improve their cooperation, the interviewees recommend the establishment of interprofessional meetings and cooperation in spatial proximity for regular professional exchange. They expect this to lead to a joint development of trust and competence and to an expansion of the area of responsibility of home care nurses in primary care. Conclusions: Binding communication structures, cooperation in spatial proximity and an expansion of the area of responsibility of home care nurses offer high potential for strengthening primary care in Germany.

Physiotherapy private practitioners' opinions regarding interprofessional collaborative practice: A qualitative study

Physiotherapy private practitioners comprise a growing proportion of Australia's primary care workforce, yet their views and experiences of interprofessional collaborative practice (IPCP) are poorly documented. The aim of this study was to explore Australian physiotherapy private practitioners' opinions regarding IPCP. Twenty-eight semi-structured interviews were conducted with physiotherapists in 10 private practice sites in Queensland, Australia. Interviews were analyzed using reflexive thematic analysis. Data analysis produced five themes that characterized physiotherapists' perceptions of IPCP: (a) quality of care considerations; (b) not a one-size-fits-all approach; (c) the need for effective interprofessional communication; (d) fostering a positive work culture; and (e) fear of losing clientele. The findings from this study suggest that physiotherapy private practitioners value IPCP because it can deliver superior client outcomes, can strengthen interprofessional relationships, and has the potential to enhance the professional reputation of the organizations within which they work. Physiotherapists also claimed that IPCP can contribute to poor client outcomes when performed inappropriately, while some reported approaching interprofessional referrals with caution following instances of lost clientele. The mixed views toward IPCP in this study highlight the need to explore the facilitators and barriers to IPCP in the Australian physiotherapy private practice setting.

[Between New Responsibility and Daily Routines - The Role of the VERAH in GP Care: A Qualitative Secondary Data Case Study of the Introduction of Software-Based Case Management]

BACKGROUND

The concept of Care Assistant in General Practice (VERAH) was developed in order to integrate non-medical staff more strongly into primary care and thus to meet the increasing demand for care and the simultaneous shortage of medical staff. VERAHs are increasingly responsible for software-supported case management and are thus confronted with new tasks. The aim of this study was therefore to explore the role of the VERAH in primary care practices.

METHODS

The present study is a qualitative secondary data analysis; the data collection took place within the projects VESPEERA and TelePraCMan. Twenty individual interviews and two focus group meetings were conducted with a total of 30 physicians, VERAHs and medical assistants from primary care. The data were analysed qualitatively according to Emerson. Contextual and socio-demographic data were collected with an accompanying questionnaire.

RESULTS

The VERAHs of all primary care practices from which interview partners participated performed tasks within software-supported case management. Concerning the role of the VERAH, three themes were identified in the interviews: a) concrete tasks of the VERAH in software-supported case management within the practice team, b) relevance of software-supported case management within the activities of the VERAHS and c) relationship between VERAHs and patients.

CONCLUSION

Taking over tasks in software-supported case management can contribute to strengthening and expanding the role of the VERAH. In the future, more attention should be paid to a clear description of the new role, and the conditions of the VERAHs' task fulfilment should be considered.

Best-practice recommendations to inform general practice nurses in the provision of dementia care: a Delphi study

BACKGROUND

Worldwide, responsibility for dementia diagnosis and management is shifting to primary care, in particular to the general practitioner (GP). It has been acknowledged that primary care nurses, working collaboratively with GPs, have a role in dementia care by utilising their unique knowledge and skills. However, there are no best-practice guidelines or care pathways to inform nurses in general practice on what best-practice dementia care comprises and how to implement this into their practice. This study identified the recommendations in the Australian guidelines for dementia management most relevant to the role of the nurse working in general practice.

METHODS

Seventeen experts active in clinical practice and/or research in primary care nursing in general practice participated in an online three-round Delphi study.

RESULTS

All 17 participants were female with a nursing qualification and experienced in general practice clinical nursing and/or general practice nursing research. Five recommendations were identified as the most relevant to the role of the nurse in general practice. These recommendations all contained elements of person-centred care: the delivery of individualised information, ongoing support, including the carer in decision-making, and they also align with the areas where GPs want support in dementia care provision.

CONCLUSION

This novel study identified best-practice dementia care recommendations specific to nurses in general practice. These recommendations will inform a model of care for nurses in the provision of dementia care that supports GPs and better meets the needs of people living with dementia and their carer(s).

Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation

BACKGROUND

In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting.

OBJECTIVE

We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff.

METHODS

We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory.

RESULTS

Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice.

CONCLUSIONS

This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.

The experiences and needs of nurses providing home-based palliative care: A qualitative meta-synthesis

Objective(s): We conducted a qualitative meta-synthesis of qualitative studies on nurses' experiences when caring for palliative patients to (1) identify the needs of nurses and (2) describe their experiences to provide more in-depth information. Methods: Qualitative articles published in English from 2000 to 2022 were identified from several databases through a searching strategy. Authors screened through the title, abstract, and full text of relevant studies. Articles were read repeatedly and discussed. The thematic analysis methodology was adopted to analyze the data. Results: Of 967 articles, 22 were included in our review. Notions reflecting community nurses providing palliative home care were clustered into four themes: (1) nature of community-based palliative nursing, (2) teamwork, (3) relationship with patient and family, and (4) resources. Findings also suggest establishing a sound support system, strengthening palliative education, and creating more decisive referral criteria and systems. Conclusions: The growing need for palliative home care has become challenging for community health care systems. Our study summarized various aspects of nurses providing home-based palliative care. The findings provide information for health care and education settings to improve home care systems and recruit more staff to meet the needs.

The relationships between perceived individual and team characteristics, individual and team learning activities with effectiveness in nursing teams

Introduction

Team learning plays a crucial role in addressing the shortage of nurses and ensuring that there are enough trained and capable nurses available during times of crisis. This study investigates the extent to which individual learning activities (1) contribute to knowledge sharing in teams and (2) impact the effectiveness of nursing teams. Furthermore, we want to obtain more insight into whether (3) the antecedents of individual psychological empowerment, teamwork preference, and team boundedness contribute to individual learning activities and knowledge sharing in nursing teams.

Method

We conducted a cross-sectional questionnaire study of 149 gerontological nurses working in 30 teams in Germany. They completed a survey measuring knowledge sharing, teamwork preference, team boundedness, individual learning activities, psychological empowerment, and team effectiveness (as an indicator of performance).

Results

The results from structural equation modeling revealed that individual learning activities contribute to knowledge sharing in teams and, as a result, enhance team effectiveness. In particular, psychological empowerment was found to be associated with individual learning activities, while teamwork preference and team boundedness were related to knowledge sharing.

Discussion

The results indicated that the accomplishment of individual learning activities plays an important role in nursing teams, as it is linked to knowledge sharing and, as a result, contributes to team effectiveness.

The development of an instrument to measure interprofessional collaboration competency for primary care teams in the district health system of health region 2, Thailand

BACKGROUND

Evidence shows that interprofessional collaboration (IPC) practice contributes to the quality of health care. However, there are limited instruments to assess IPC in providing primary care in the district health system (DHS) in Thailand. The aim of this study is to develop a valid and reliable instrument to assess the IPC competency of primary care team members in DHSs.

METHODS

This study was designed as an exploratory mixed methods study. In the qualitative phase, 37 participants, including policymakers, practitioners, and academics with experience in primary care, were involved. Data were analysed using thematic analysis, and trustworthiness was verified by triangulation and peer debriefing. In the quantitative phase, content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability were conducted, and the final version of the questionnaire was evaluated with 497 participants.

RESULTS

The findings showed an I-CVI range of 0.86-1.00 and S-CVI/UA = 0.87 for 49 items with a 5-point Likert scale. EFA suggested six factors: 1) collaborative teamwork, 2) population- and community-centred care, 3) communication and mutual respect, 4) clarification of roles and responsibilities, 5) interprofessional reflection, and 6) interprofessional values and mixed skills. In the CFA results, the model fit indices were acceptable (CFI = 0.99, RMSEA = 0.049, SRMR = 0.043) or slightly less than the goodness-of-fit values (GFI = 0.84). All subscales showed acceptable Cronbach's alpha values with a range of 0.86-0.94.

CONCLUSIONS

The developed IPC competency instrument was confirmed its validity and reliability that contributes to assessing the IPC competency of primary care teams in DHSs. This information provides evidence to support tailored intervention to promote the IPC competency of primary care team work to achieve a common goal.

Nurse-doctor co-teaching: A path towards interprofessional collaboration

BACKGROUND

Nurse-doctor collaborations are essential for team-based patient care. Although there are increasing calls for interprofessional education, teaching and learning together is rare. In 2019, we designed a Nurse-Doctor Co-Teaching pilot programme to provide an opportunity for nurses and doctors to co-teach junior doctors and nurses. We aimed to explore the experiences of the co-teachers and understand their perceptions of teaching together. The study was conducted through the lens of positioning theory.

METHODS

We held an hour-long focus group discussion and follow-up one-on-one interviews with nurses and doctors who participated as co-teachers. Conversations were audio-video recorded, transcribed, and thematically analysed. The Partners Institutional Review Board approved this study.

RESULTS

Three nurses and four doctors participated in the focus group conversation, and four nurses and two doctors participated in individual interviews. Participant narratives provided insight into shifts in hospital culture that would be necessary to promote effective interprofessional learning and collaboration: (1) break down professional silos, (2) invite the nursing perspective, (3) flatten professional hierarchies, and (4) recognise nurses as clinical teachers.

CONCLUSION

Nurses and doctors felt they shared a collegial and equal partnership as co-teachers. But this relationship was not typical of their daily clinical roles. Institutional barriers presented challenges to collaboration on the hospital floor and nursing participation in teaching. Successful interprofessional education may require culture and policy shifts that formally recognise nurses as valuable clinical teachers.

Organizational support and Nurse-Physician collaboration during SARS-CoV-2 pandemic: A qualitative study

Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes - negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.

Health promotion partnership to promote physical activity in Swedish children with ASD and ADHD

Children with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) have a higher risk of inactivity, and efforts to promote physical activity among this population have been limited. Physical activity on prescription (PAP) may be a suitable tool for motivating participation in physical activity among children with these diagnoses. However, PAP calls for synergy and partnership between health care and other sectors of the community. The aim of this study was to describe a health promotion partnership for physical activity targeting children with ASD or ADHD. Data were obtained through individual interviews with professionals at CAP (n = 11) and three focus-group interviews with coaches from local sports clubs. We used the Bergen Model of Collaborative Functioning as the theoretical framework and used qualitative content analysis as the method of analysis to study partnerships between professionals from the Child and Adolescent Psychiatry outpatient clinic (CAP) and coaches from local sport clubs. The findings demonstrate that the partnerships included both positive and negative processes. Although the two partners shared values regarding the project, such as working for a good cause for the children and seeing the potential in the collaboration, there were doubts about sharing common resources and uncertainties about the sustainability of the PAP project. Challenges remain and further research is needed into developing, monitoring and evaluating health promotion partnerships when promoting physical activity for all.

The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada

BACKGROUND

Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care.

METHODS

This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses' time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results.

DISCUSSION

This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.

A review of the growth and development of Australian practice nursing: Insights for the dietetic workforce

Aim

The aim of this scoping review was to provide an overview of the development of practice nurses, and the learnings that could be applied to improve the profile of dietetics practice in primary care.

Methods

A scoping review synthesising peer‐reviewed and other literature relevant to the development of Australian practice nurses was conducted. Structured searches using keywords ‘general practice’, ‘nurse’ and ‘Australia’ were conducted in PubMed and Google Scholar in June 2021. Key government websites, Department of Health and Services Australia, were searched to identify grey literature. One reviewer screened the titles and abstracts against inclusion criteria; two reviewers conducted full‐text screening independently. Data on the evolution of practice nursing were extracted based on its interest and transferability to the dietetics workforce.

Results

A total of 102 results (82 peer‐reviewed and 20 other literature) were included in the review. Key drivers for practice nurse role development in Australia were government funding, practice nurse practice standards, cost–benefit analyses of practice nurses, career and education opportunities, general practitioner and patient perspectives of practice nurses and, individual, community and local needs.

Conclusions

The practice nurse role has grown and strengthened and there are three key learnings that could be translated to strengthen the dietetics workforce in primary care. (1) Use and expansion of government funding, (2) furthering post‐tertiary education and career opportunities, including dietetic primary care practice standards and (3) targeting underserviced areas such as those that are rural and remote and building positive relationships with other stakeholders including practice nurses, general practitioners, patients and the broader primary care team.

Optimising care coordination strategies for physical activity referral scheme patients by Australian health professionals

Physical activity (PA) has been identified as an essential tool for the prevention and management of multi-morbidity in patients. Coordination of patients’ care through interventions like physical activity referral schemes (PARS) could foster the utilization of PA. This study explored the views of General Practitioners (GPs) and Exercise Physiologists (EPs) as key stakeholders, for optimizing patient care and efficiency of PARS. Sequential explanatory mixed methods design was used to explore the perceptions of these health professionals on PA and coordination strategies for PARS patient care. Data analyses included descriptive and inferential statistics for questionnaires and theoretical framework analysis for the semi-structured interviews. Participants demonstrated a good knowledge of PA and valued PARS. However, the findings unravelled external factors, inter-organisational mechanisms, and relational coordination obstacles that hinder efficient coordination of PARS patient care and delay/limit beneficial health outcomes for patients. Incentivising the PARS initiative and empowering patients to seek referral into the programme, are strategies that could boost PARS efficiency. Improving inter-professional relationships between GPs and EPs could lead to enhanced PARS functionality and efficient coordination of care for patients with chronic diseases.

Cancer survivorship care and general practice: A qualitative study of roles of general practice team members in Australia

Primary care providers, including general practice teams (GPTs), are well positioned within the community to integrate cancer survivorship care into ongoing health management. However, roles of GPT members in delivery of cancer survivorship care have not been explored. The purpose of this study is to explore these roles from the perspectives of General Practitioners (GPs), Practice Nurses (PNs) and Practice Managers (PMs). An interpretive qualitative study using semi-structured in-depth telephone interviews with ten GPs, nine PNs and five PMs was conducted. Interviews were recorded, transcribed and analysed using grounded theory methods. Perspectives of roles in delivery of cancer survivorship care were highly variable. Variation was evident among perceptions of needs of cancer survivors, individual team members' scopes of practice, and individual professional knowledge and skills. A lack of clarity in roles and responsibilities of GPT members was thought to contribute to a lack of consistency in survivorship care. Reducing variations in perceptions of survivorship care in the primary care setting should be a priority. Such efforts may include development of practical guidance to support GPT members to clarify scopes of practice within the team. In addition to accessible comprehensive education programs, other innovative, tailored individualised education approaches may be helpful. System-level support in clarifying and supporting the roles of the primary care team is needed to facilitate a survivorship delivery system at general practice level where those within GPT can ensure that individual patients' needs are met in a timely and effective manner.

School Reintegration Following Psychiatric Hospitalization: A Review of Available Transition Programs

OBJECTIVES

This study aimed to 1) identify transition programs for school reintegration after youth psychiatric hospitalization, and 2) assess these programs using criteria established by Blueprints for Healthy Youth Development.

METHOD

Principles outlined by the Evidence for Policy and Practice Information and Coordinating Centre were used to systematically search 15 electronic databases up to October 2021 for both published and unpublished reports of transition programs. Reports meeting inclusion criteria were examined through three steps: 1) coding of available information, 2) synthesis of programs and 3) assessment of intervention specificity.

RESULTS

Thirteen reports met the inclusion criteria and identified eight transition programs. Program theories were rarely explicit about the causal mechanisms and outcomes of their interventions. Nevertheless, areas of consensus emerge as to core components of these programs including: 1) the involvement of a multidisciplinary team, 2) the implementation of a multicomponent intervention, 3) the development of a reintegration plan, 4) the need for gradual transitions, and 5) extended support through frequent contact.

CONCLUSION

School reintegration programs following psychiatric hospitalization are still rare. They can be hard to implement due to the challenges they impose for inter-professional and intersectoral collaborations. Despite this, four of the eight programs are in a good position for an evaluation of their promising standing. Nevertheless, well-designed controlled trials and cohort studies are needed.

Percepción de la administración segura de medicamentos en atención primaria

Objetivo

El propósito de este estudio fue conocer la percepción de enfermeras sobre la seguridad en la preparación y administración de medicamentos en un departamento de salud de atención primaria del Sistema Nacional de Salud de España.

Diseño

Estudio descriptivo transversal.

Sitio

Realizado en el Departamento de Salud 21 (Alicante-España) en los meses de septiembre hasta noviembre del 2021.

Participantes

Sesenta y seis enfermeras, con predominio de mujeres (88,9%).

Intervenciones

Se utilizó una entrevista semiestructurada con 10 preguntas. El criterio de inclusión tuvo en cuenta las enfermeras con más de dos años de experiencia trabajando en el centro de salud.

Medidas principales

Se evaluó la percepción de las enfermeras sobre el grado de seguridad en la preparación y administración de medicamentos.

Resultados

El 81,9% de la muestra no notifican los eventos adversos. Los pasos para la administración segura fueron variados. Se observó asociación significativa en la hora correcta de la medicación (p < 0,031) y la antisepsia (p < 0,026), según el número de enfermeras en las zonas básicas de salud.

Conclusión

Nuestros resultados indican las percepciones de enfermeras sobre mejoras en el grado de implementación de estándares o herramientas para la administración segura de medicamentos, con especial atención en la falta de conocimientos, la sobrecarga asistencial (elevada ratio paciente/enfermera) y los dilemas asociados con la notificación.

Enhancing diabetes care with community pharmacist-involved collaborative care model: A multi-centre randomised controlled trial

AIM

To evaluate the clinical and humanistic outcomes of a community pharmacist-involved collaborative care model in diabetes management.

METHODS

This was a parallel arm, open-label, multi-centre randomized controlled trial conducted over 6 months. Subjects with type 2 diabetes, HbA1c ≥ 7.0% (53 mmol/mol) and taking ≥ 5 medications were included. Participants were randomized into intervention (collaborative care) and control groups (physician-centric care). The intervention included medication therapy management and telephonic follow-up with visits to family physicians, nurses, and dietitians. Clinical outcomes included changes in HbA1c, systolic blood pressure (SBP), lipids, and hypoglycaemic incidences. Humanistic outcomes included self-care capabilities and quality of life. Linear mixed models were constructed. Intention-to-treat analyses, with sensitivity analyses, were conducted.

RESULTS

A total of 264 participants were randomized (intervention: 131, control: 133). Significantly greater reduction in HbA1c was observed in the intervention group (intervention: -0.32% (-3.52 mmol/mol) vs. control: -0.06% (-0.66 mmol/mol), p = 0.038). Changes in SBP, lipids, and incidences of hypoglycaemia were not significant over 6 months between both groups. Significantly greater improvements in self-management (p < 0.001) and quality of life (p = 0.003) were observed within the intervention group.

CONCLUSION

Partnering community pharmacists in a collaborative care team improved glycaemic control, quality of life and self-care capabilities of patients with diabetes and polypharmacy.

Barriers and facilitators to nurse-led advance care planning and palliative care practice change in primary healthcare: a qualitative study

Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation.

How do multi-morbidity and polypharmacy affect general practice attendance and referral rates? A retrospective analysis of consultations

Background

As prevalence of multimorbidity and polypharmacy rise, health care systems must respond to these challenges. Data is needed from general practice regarding the impact of age, number of chronic illnesses and medications on specific metrics of healthcare utilisation.

Methods

This was a retrospective study of general practices in a university-affiliated education and research network, consisting of 72 practices. Records from a random sample of 100 patients aged 50 years and over who attended each participating practice in the previous two years were analysed. Through manual record searching, data were collected on patient demographics, number of chronic illnesses and medications, numbers of attendances to the general practitioner (GP), practice nurse, home visits and referrals to a hospital doctor. Attendance and referral rates were expressed per person-years for each demographic variable and the ratio of attendance to referral rate was also calculated.

Results

Of the 72 practices invited to participate, 68 (94%) accepted, providing complete data on a total of 6603 patients’ records and 89,667 consultations with the GP or practice nurse; 50.1% of patients had been referred to hospital in the previous two years. The attendance rate to general practice was 4.94 per person per year and the referral rate to the hospital was 0.6 per person per year, giving a ratio of over eight attendances for every referral. Increasing age, number of chronic illnesses and number of medications were associated with increased attendance rates to the GP and practice nurse and home visits but did not significantly increase the ratio of attendance to referral rate.

Discussion

As age, morbidity and number of medications rise, so too do all types of consultations in general practice. However, the rate of referral remains relatively stable. General practice must be supported to provide person centred care to an ageing population with rising rates of multi-morbidity and polypharmacy.

What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review

BACKGROUND

Improving the patient experience is one of the quadruple aims of healthcare. Therefore, understanding patient experiences and perceptions of healthcare interactions is paramount to quality improvement. This integrative review aimed to explore how patients with chronic conditions experience Interprofessional Collaborative Practice in primary care.

METHODS

An integrative review was conducted to comprehensively synthesize primary studies that used qualitative, quantitative, and mixed methods. Databases searched were Medline, Embase, CINAHL and Web of Science on June 1st, 2021. Eligible studies were empirical full-text studies in primary care that reported experiences or perceptions of Interprofessional Collaborative Practice by adult patients with a chronic condition, in any language published in any year. Quality appraisal was conducted on included studies using the Mixed Method Appraisal Tool. Data on patients' experiences and perceptions of Interprofessional Collaborative Practice in primary care were extracted, and findings were thematically analyzed through a meta-synthesis.

RESULTS

Forty-eight (n = 48) studies met the inclusion criteria with a total of n = 3803 participants. Study quality of individual studies was limited by study design, incomplete reporting, and the potential for positive publication bias. Three themes and their sub-themes were developed inductively: (1) Interacting with Healthcare Teams, subthemes: widening the network, connecting with professionals, looking beyond the condition, and overcoming chronic condition collectively; (2) Valuing Convenient Healthcare, subthemes: sharing space and time, care planning creates structure, coordinating care, valuing the general practitioner role, and affording healthcare; (3) Engaging Self-care, subthemes: engaging passively is circumstantial, and, engaging actively and leading care.

CONCLUSIONS

Patients overwhelmingly had positive experiences of Interprofessional Collaborative Practice, signaling it is appropriate for chronic condition management in primary care. The patient role in managing their chronic condition was closely linked to their experience. Future studies should investigate how the patient role impacts the experience of patients, carers, and health professionals in this context.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42020156536.

Primary care networks: navigating new organisational forms

Background

NHS England (NHSE) instigated primary care networks (PCNs) as a collaboration of general practices working together at scale to improve population health in the local community.

Aim

To capture GP PCN leaders’ perceptions of the opportunities and pitfalls of PCNs, as well as points of learning, during their inception and development, in order to guide the future development of PCN form and function.

Design & setting

A qualitative study in UK primary care.

Method

Nine PCN GP leaders were interviewed in depth to gather their views and experiences of PCNs. In addition, 31 free-text survey responses pertaining to how participants perceived the purpose of PCNs were collated.

Results

Four key themes were identified: defining purpose and managing ambiguity; bureaucracy versus local autonomy; relational working; and facilitative leadership. The need for purpose setting to remain adaptive was seen as crucial in avoiding the constraints of too rigid a structure in order to retain local ownership, while remaining focused around meeting complex population needs and reducing variation. Participants reported navigating their way through striking a balance between the ‘top-down’ mandate and recognising local need. Of importance to the success of PCNs was the necessity of effective relational working and facilitative leadership.

Conclusion

While the desire to be proactive and collaborative was emphasised by the PCN leaders, the importance of distributed leadership and time given to building trust and effective working relationships within new organisational forms cannot be underestimated.

The impact of COVID-19 on primary health care delivery in Australia

AIMS

To validate the 'safe and effective staffing tool' and explore the impact of COVID-19 on the quality of Australian primary health care (PHC).

DESIGN

A national survey was conducted from October to December 2020.

METHODS

The online survey was distributed via social media and professional organisations to PHC nurses.

RESULTS

Three-hundred fifty-nine PHC nurses participated. A two-factor solution was found with factors named; 'Perception of quality of care provided' and 'Personal satisfaction with care delivered'. Cronbach's alpha demonstrated good internal consistency for the total scale (α = .915) and each subscale (α = .879/α = .864). Nearly three-quarters of participants (71.3%) were satisfied with the quality of care they delivered. Participants working in general practice, and those with more nursing experience had significantly higher scores in the factor 'perceptions of quality of care provided' and the total 'quality and satisfaction with care'. A lack of time, inadequate supervision and support, and performing non-nursing duties were reported to be impacting care quality. Most participants (80.5%) reported that COVID-19 had impacted negatively on the detection and management of non-COVID related health conditions.

CONCLUSION

The 'safe and effective staffing tool' is a valid and reliable measure of perceived quality of care and satisfaction with care delivered. Many PHC nurses perceive that there has been an overall reduction in the quality of care delivered due to COVID-19 and feel that there is a lack of adequate supervision and workplace support. Given the limited baseline data, further research is required to understand the extent that COVID-19 impacts these findings. However, this study demonstrates that strategies need to be implemented to support PHC nurses to provide high-quality care to optimise health outcomes and maintain nurse satisfaction.

IMPACT

This is the first attempt to evaluate care quality in Australian PHC. Policymaking requires this evidence to drive changes to better support PHC nurses.

Barriers and facilitators to the implementation of nurse's role in primary care settings: an integrative review

Background

The rapid evolution of the epidemiological picture and the recent SARS-COV-2 pandemic has expressed the vulnerabilities of health systems and focuses attention on the population’s needs.

The nurse’s figure in the care teams is universally identified; however, the implementation of the role within some care settings turns out to be complex and challenging. This integrative review aims to identify the barriers and facilitators in implementing the role of the nurse in primary care settings.

Methods

An integrative review was conducted on the Medline and Cinahl databases until 9 June 2020. Qualitative, quantitative, and Mixed-method research studies were selected to identify studies related to the barriers and facilitators of the nurse’s role in nursing facilities’ primary care. For the extraction of the results, the Consolidating Framework for Research Implementation (CFIR) was used to identify the factors that influence implementation in health care.

Results

Following the duplicates’ removal, the search identified 18,257 articles, of which 56 were relevant to the inclusion criteria; therefore, they were included in the summary.

The selected studies were conducted in thirteen countries, most from Oceania, Europe, North America, Latin America, and the Caribbean.

The barriers reported most frequently concern the nursing profession’s regulatory and regulatory aspects within the contexts of care, cultural and organizational aspects, training, and the transfer of specific skills, which were previously designated to doctors.

The facilitators are mainly linked to the nurse’s adaptability to the various contexts of care, recognizing the patient’s role, and the desire to develop multidisciplinary and effective working groups to respond to the health needs of the population in primary care contexts.

Conclusion

This review highlighted the main barriers and facilitators in implementing the nurse’s role in primary care settings. These results offer useful elements for stakeholders to identify effective strategies in preparing programs and activities for implementing the nurse’s role, acting on the elements identified as barriers and favouring the aspects that emerge as facilitators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00696-y.

Barriers and facilitators to interprofessional collaborative practice for community-dwelling older adults: An integrative review

AIMS AND OBJECTIVES

The aim of this integrative review was to synthesise empirical reports of interprofessional collaborative practice (IPCP) for community-dwelling older adults and uncover barriers and facilitators related to its success as a model of care for this population.

BACKGROUND

IPCP is a model of care that has demonstrated positive outcomes for community-dwelling older adults. However, a summary of barriers and facilitators to IPCP models has not been presented.

METHODS

An integrative review using the method posited by Whittemore and Knafl was completed to identify barriers and facilitators to IPCP for community-dwelling older adults. The literature search was reported following PRISMA guidelines.

RESULTS

Four themes emerged as barriers to IPCP: (1) A (Potential) Logistical Nightmare, (2) All About the Money, (3) If We Can't Test It, Can We Recommend It? and (4) Challenging for the Team, Challenging for the Client. Three themes emerged as facilitators to IPCP: (1) Reducing Resource Waste, (2) The "C" in IPCP and (3) What Matters Most.

CONCLUSIONS

IPCP models for community-dwelling older adults must adapt to the setting of care and client needs. Interprofessional education opportunities for team members facilitate effective IPCP. Healthcare policies and funding structures need to address IPCP for community-dwelling older adults for this model to be successful and sustainable.

RELEVANCE TO CLINICAL PRACTICE

Nurses participate on and lead IPCP teams caring for community-dwelling older adults and, therefore, need to be aware of barriers and facilitators to this model of care.

Interprofessional collaboration between general practitioners and primary care nurses in Belgium: a participatory action research

Given the sociodemographic challenges facing the Belgian primary care system, it is essential to strengthen interprofessional collaboration (IPC) between healthcare providers. Therefore, our aims for this study were to assess IPC between general practitioners (GPs) and nurses; identify target priorities for improving IPC; and facilitate the planning and implementation of the proposed improvement strategies. Based on diversity criteria, six groups of GPs and nurses were chosen for a participatory action research. Participants performed a SWOT analysis of their IPC to identify strengths and weaknesses of their collaboration practice configurations. Main factors limiting IPC were related to the type of financing system which impeded or facilitated multidisciplinary team meetings, a weak functional integration, and a lack of interprofessional education. Overall, communication and task delegation were co-identified as common priorities. Actions prioritized by each group were related to these two priorities and accounted for local, specific needs. Communication could be supported through improved tools and dedicating time for multidisciplinary team meetings. Task delegation was more challenging and raised questions related to nurses' training, legislation, and payment systems. IPC seems to be easier to achieve when healthcare professionals belong to the same organization and consider themselves a team.

The impact of power on health care team performance and patient safety: a review of the literature

Communication failure within health care teams is a major cause of patient harm across health care settings. Factors which contribute to communication failure include actual or perceived 'power'. Whilst a great deal of ergonomics research has focussed on teamwork in health care, the role of power in relation to measurable patient safety and performance outcomes remains relatively unknown. This article presents the findings from a review of the literature on power within multidisciplinary health care team settings. Following a systematic literature search, nineteen studies were evaluated in terms of research design, methods and analyses across the included studies. The main impacts resulting from power imbalances include negative effects on team collaboration, decision-making, communication and overall performance. Wider patient safety research, and more specifically the ergonomics discipline, is encouraged to address the complex interplay between power and teamwork in the health care sector.Practitioner Statement: We conducted a review of studies focussed on the influence of power on teamwork in health care. The findings show that power can have negative impacts on collaboration, decision-making, communication, and team performance. We conclude that power represents an important area for ergonomics, both in health care and other settings.Abbreviations: CRM: crew resource management; TEM: threat and error management; SNA: social network analysis; EAST: event analysis of systemic teamwork.

An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators

Introduction:

Interprofessional collaboration (IPC) is becoming more widespread in primary care due to the increasing complex needs of patients. However, its implementation can be challenging. We aimed to identify barriers and facilitators of IPC in primary care settings.

Methods:

An overview of reviews was carried out. Nine databases were searched, and two independent reviewers took part in review selection, data extraction and quality assessment. A thematic synthesis was carried out to highlight the main barriers and facilitators, according to the type of IPC and their level of intervention (system, organizational, inter-individual and individual).

Results:

Twenty-nine reviews were included, classified according to six types of IPC: IPC in primary care (large scope) (n = 11), primary care physician (PCP)-nurse in primary care (n = 2), PCP-specialty care provider (n = 3), PCP-pharmacist (n = 2), PCP-mental health care provider (n = 6), and intersectoral collaboration (n = 5). Most barriers and facilitators were reported at the organizational and inter-individual levels. Main barriers referred to lack of time and training, lack of clear roles, fears relating to professional identity and poor communication. Principal facilitators included tools to improve communication, co-location and recognition of other professionals’ skills and contribution.

Conclusions:

The range of barriers and facilitators highlighted in this overview goes beyond specific local contexts and can prove useful for the development of tools or guidelines for successful implementation of IPC in primary care.

The provision of dementia care in general practice: practice nurse perceptions of their role

Background

Primary care nurses can assist General Practitioner’s to identify cognition concerns and support patient health self-management for those experiencing cognitive impairment or dementia. This support may lead to more appropriate care and better health outcomes for this group. Consequently, there is a need to identify the role of the primary care nurse in dementia care provision, nurse perceptions of this role and to also understand the barriers and enablers that may influence any current or potential primary care nurse role in dementia care provision.

Methods

Eight focus groups were conducted with a total of 36 primary care nurses. Data was transcribed verbatim and thematically analysed.

Results

There was a high level of agreement between primary care nurses that they had a role in provision of dementia care. This role was largely attributed to the strong therapeutic relationship between nurses and patients. However, dementia care provision was not without its challenges, including a perceived lack of knowledge, limited resources and the hierarchical nature of general practice. Three main themes were identified: personal attributes of the primary care nurse; professional attributes of the primary care nurse role and the context of practice. Six sub-themes were identified: knowing the person; overcoming stigma; providing holistic care; knowing what to do; team culture and working in the system.

Conclusions

The findings of this study suggest primary care nurses have a role in dementia care provision and, there is a need to provide support for the nurse to deliver person-centred health care in the context of cognitive impairment. As the demand for good quality primary care for people living with dementia increases, the role of the primary care nurse should be considered in primary care policy discussions. The knowledge gained from this study could be useful in informing dementia training content, to provide better prompts in the health assessment and care planning templates used by primary care nurses to better identify the care needs of people with a cognitive impairment and to develop dementia care guidelines for primary care nurses.

Perspectives of nurses' role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses

OBJECTIVES

To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC).

DESIGN

Qualitative study conducted through semi-structured in-depth interviews.

SETTING

Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care.

PARTICIPANTS

In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC.

DATA COLLECTION AND ANALYSIS

All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads.

RESULTS

340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC.

CONCLUSIONS

European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.

Conflict management and teamwork in workplace from the perspective of nurses

PURPOSE

To examine the relationship between nurses' conflict management strategies and teamwork attitudes.

METHOD

This cross-sectional, descriptive, and relational study was conducted with 228 nurses in a hospital in southern Turkey. Data were collected through The TeamSTEPPS Teamwork Attitudes Questionnaire and the Rahim Organizational Inventory-II.

RESULTS

Of all the nurses, 91.2% reported to have had conflicts. Nurses stated that they mostly used compromising and integrating strategies. Teamwork attitudes questionnaire mean score was 108.28 ± 11.45. Conflict management strategies are significant predictors of teamwork attitudes and these explain 46% (model 1; R²   = 0.46; P <.01), and education, gender, units, years of experience explain 2% of the total variance in teamwork attitudes (model 2; R²   = 0.48; P < .01).

PRACTICE IMPLICATIONS

Mental health nurses together with manager nurses should focus on improving nurses' teamwork attitudes and constructive conflict management strategies within the team.

Driving Digital Transformation During a Pandemic: Case Study of Virtual Collaboration in a German Hospital

Background

The COVID-19 pandemic has not only changed the private lives of millions of people but has significantly affected the collaboration of medical specialists throughout health care systems worldwide. Hospitals are making changes to their regular operations to slow the spread of SARS-CoV-2 while ensuring the treatment of emergency patients. These substantial changes affect the typical work setting of clinicians and require the implementation of organizational arrangements.

Objective

In this study, we aim to increase our understanding of how digital transformation drives virtual collaboration among clinicians in hospitals in times of crisis, such as the COVID-19 pandemic.

Methods

We present the lessons learned from an exploratory case study in which we observed the introduction of an information technology (IT) system for enhancing collaboration among clinicians in a German hospital. The results are based on 16 semistructured interviews with physicians from various departments and disciplines; the interviews were generalized to better understand and interpret the meaning of the statements.

Results

Three key lessons and recommendations explain how digital transformation ensures goal-driven collaboration among clinicians. First, we found that implementing a disruptive change requires alignment of the mindsets of the stakeholders. Second, IT-enabled collaboration presupposes behavioral rules that must be followed. Third, transforming antiquated processes demands a suitable technological infrastructure.

Conclusions

Digital transformation is being driven by the COVID-19 pandemic. However, the rapid introduction of IT-enabled collaboration reveals grievances concerning the digital dissemination of medical information along the patient treatment path. To avoid being caught unprepared by future crises, digital transformation must be further driven to ensure collaboration, and the diagnostic and therapeutic process must be opened to disruptive strategies.

Understanding the general practice nursing workforce in New Zealand: an overview of characteristics 2015-19

Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.

A Realist Synthesis of Interprofessional Collaboration in the Early Years; Becoming Familiar with Other Professionals

Research into interprofessional collaboration (IPC) has predominantly focused on health care and specialized care settings, but there is an increasing interest in interprofesssional 'teams around the child' in community-based settings. We conducted a realist synthesis of empirical studies into IPC between youth professionals, often in regular community settings, to explore barriers and facilitators of IPC. Included studies were coded with an elaborated scheme to chart the focus of studies and to identify moderators and context-mechanism-outcome configurations of IPC. Professional and normative integration was the main focus of the included studies. Most studies emphasized the challenges of IPC in practice, like unclear roles of self and others, lack of trust and inadequate communication. Other perceived barriers are excluding others in the planning of interventions, taking ownership of plans (vs. sharing) and different modes of communication. Interprofessional education, co-location of staff, acting as a mediator in the team, organising formal and informal meetings, conflict resolutions, self-sacrifice, and conceptualizing practice were perceived as facilitators of IPC. Future IPC research into community-based settings should include all professional stakeholders and the children and their families to evaluate outcomes at both interprofessional and clinical level.

Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation

Background

Percutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients’ awareness of spinal endoscopy and their election of endoscopic techniques?

Objective

To analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation.

Methods

Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed.

Results

The postoperative feeding time in the experimental group was 8.319 ± 1.374 h, the postoperative time to get out of bed was 16.64 ± 3.728 h, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 h, the postoperative time to get out of bed was 45.06 ± 9.027 h, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p > 0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p < 0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p < 0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p < 0.05; there was no significant difference between the two groups, p > 0.05.

Conclusion

The integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.

Interprofessional education and collaboration between general practitioner trainees and practice nurses in providing chronic care; a qualitative study

BACKGROUND

Effective interprofessional collaboration (IPC) is essential for the delivery of chronic care. Interprofessional education (IPE) can help support IPC skills. This makes IPE interesting for GP practices where chronic care is delivered by GPs together with practice nurses, especially for GP trainees who have to learn to collaborate with practice nurses during their training. The aim of this study is to gain insights in how IPE and IPC occur between GP trainees and practice nurses during the delivery of chronic care in GP training practices.

METHODS

We conducted a qualitative research using semi structured focus groups and interviews with GP trainees, practice nurses and GP supervisors. All respondents were primed to the subject of IPE as they had followed an interprofessional training on patient-centred communication. The verbatim transcripts of the focus groups and interviews were analysed using thematic analysis.

RESULTS

Despite the overall positive attitude displayed by respondents towards IPE and IPC, the occurrence of IPE and IPC in GP training practices was limited. Possible explanations for this are impeding factors such as limited knowledge, prejudice, lack of role models and a hierarchical organisational structure. Contributing to IPE and IPC use was the integration of IPE in daily practice, e.g. via recurring scheduled meetings.

CONCLUSION

We found a limited occurrence of IPE and IPC in GP training practices. Our results show a discrepancy between respondents enthusiasm for IPE and IPC and their actual behaviour. IPE activities have to be initiated in GP training practices, otherwise, despite good intentions, IPE and IPC will be ineffective.

Effect of a rapid e-learning module and brief interprofessional simulation event on medical and nursing student collaborative attitudes and behaviors

Objectives Undergraduate nursing and first-year medical students participated in a brief, scenario-based, interprofessional event. The experimental group only was provided an innovative, rapid e-learning instructional module focused on interprofessional roles/responsibilities and communication prior to the event. Methods Pre-post attitudes toward physician-nurse collaboration were surveyed, and collaborative behaviors were observed during the event. Results For the experimental group, a statistically significant (p<0.05) attitude improvement was found between pre-post e-learning module scores as well as pre-e-learning module and post-simulation event scores. For the control group, a statistically significant (p=0.001) attitude improvement was found between pre-post simulation event scores. No statistically significant differences in team collaborative behaviors were observed between experimental and control. Conclusions The combination of module and simulation event was not a more effective option than the event alone. As both interventions present unique challenges in regards to technology and facility requirements, having multiple effective intervention options will be of benefit to educational institutions.

Allied health professionals' perceptions of interprofessional collaboration in primary health care: an integrative review

This integrative review synthesizes research studies in order to explore the perceptions of allied health professionals regarding interprofessional collaboration in primary health care. A comprehensive literature search was conducted using three electronic databases and a manual search of the Journal of Interprofessional Care. The Crowe Critical Appraisal Tool was used to assess the quality of included papers. Study findings were extracted, critically examined and grouped into themes. Twelve studies conducted in six different countries met the inclusion criteria. Thematic analysis revealed five themes: (1) shared philosophy; (2) communication and clinical interaction; (3) physical environment; (4) power and hierarchy; and (5) financial considerations. This review has identified diverse key elements related to interprofessional collaboration in primary health care, as perceived by allied health professionals. Opportunity for frequent, informal communication appeared essential for interprofessional collaboration to occur. Allied health professionals working in close proximity to health practitioners from other professions had more regular interprofessional interactions than those who were geographically separated. Co-location of multiple primary health care services within the same physical space may offer increased opportunities for interprofessional collaboration. Future research should avoid reporting on allied health professionals in primary health care collectively, and isolate data to the individual professions. Direct observational methods are warranted to investigate whether allied health professionals' perceptions of interprofessional collaboration align with their actual clinical interactions in primary health care settings.

Understanding factors influencing venous leg ulcer guideline implementation in Australian primary care

The aim of this study was to gain a better understanding of the venous leg ulcer (VLU) management in primary health care settings located in Melbourne metropolitan and rural Victoria, Australia. We explored health professionals' perspective on the use of the Australian and New Zealand Venous Leg Ulcer Clinical Practice Guideline (VLU CPG) to identify the main challenges of VLU CPG uptake in clinical practice. We conducted semi-structured interviews with 15 general practitioners (GPs) and 20 practice nurses (PNs), including two Aboriginal health nurses. The Theoretical Domains Framework guided data collection and analysis. Data were analysed using a theory-driven analysis. We found a lack of awareness of the VLU CPGs, which resulted in suboptimal knowledge and limited adherence to evidence-based recommendations. Environmental factors, such as busy nature of clinical environment and absence of handheld Doppler ultrasound, as well as social and professional identity factors, such as reliance on previous experience and colleague's advice, influenced the uptake of the VLU CPGs in primary care. Findings of this study will inform development of interventions to increase the uptake of the VLU CPG in primary care settings and to reduce the evidence-practice gap in VLU management by health professionals.

Complexity as a factor for task allocation among general practitioners and nurse practitioners: a narrative review

BACKGROUND

General practitioner (GP) shortages and increasing demand for care led to the introduction of nurse practitioners (NPs) to primary care. Many concepts for task sharing among health professionals feature complexity. The aim of this narrative review was to examine how complexity is used as a factor for task allocation between GPs and NPs.

METHODS

According to the PRISMA statement, PubMed and CINAHL were searched systematically, and eligibility criteria were applied to detect literature concerning GPs and NPs in primary care and complexity in the context of task allocation. Relevant information was extracted, and a narrative analysis was performed.

RESULTS

Thirty-seven studies from seven countries were included, comprising quantitative, qualitative, and mixed methods. Complexity was used to describe patients, their needs, and health professionals' tasks. The understanding of the use of complexity as a factor for task allocation between NPs and GPs was based on the patient population (specific vs. unspecific), the setting (specific vs. unspecific), the numbers of health professionals involved (two vs. more than two), and the NP role (distinct model of care vs. no model). Despite similarities in these areas, the tasks which NPs perform range from providing minor to complex care. However, there is a slight trend towards NPs treating socially complex patients and GPs focusing on medically complex cases.

CONCLUSION

Complexity as a concept is prominent in primary care but remains broad and inconsistent as a factor for task allocation between NPs and GPs. This review can be used as a point of reference when practitioners are seeking methods for task allocation in a collaborative primary care setting.

"I'm going to push this door open. You can close it": A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care

BACKGROUND

Early palliative care improves quality of life during life-prolonging treatment for patients with cancer, but the role of nurses in facilitating the early involvement of palliative care is unclear.

AIM

To conceptualize the psychosocial processes involved in the introduction and provision of palliative care by oncology nurses.

DESIGN

A constructivist qualitative grounded theory study was conducted.

SETTING/PARTICIPANTS

A total of 20 nurses (6 staff nurses, 10 nurse practitioners, and 4 advanced practice nurses) completed semi-structured interviews. Participants were from multiple ambulatory care oncology clinics (i.e. breast, pancreatic, hematology) in a comprehensive cancer center.

RESULTS

The core category, brokering palliative care, represented the overarching concept of the study that linked other subcategories. The other subcategories were as follows: opening the door-creating the possibility of discussing early palliative care at a time when patients show signs of being receptive to this discussion; building trust-establishing relationships with patients as a starting point for open discussions about palliative care; tackling misconceptions-addressing patients' assumptions about palliative care as signifying death; and advocating with oncologists-seeding the process of referral by bringing patients' concerns forward.

CONCLUSION

Oncology nurses play a central role in "brokering" the introduction of early palliative care; this process is supported by their relational proximity to patients and their location "in between" the patient and the oncologist. Training all nurses in palliative care and empowering them to have proactive discussions in a collaborative practice context would allow greater access to early palliative care.

The characteristics of Queensland private physiotherapy practitioners' interprofessional interactions: a cross-sectional survey study

Effective interprofessional collaboration (IPC) contributes to superior patient outcomes, facilitates cost-efficient health care, and increases patient and practitioner satisfaction. However, there is concern that IPC may be difficult to implement in clinical settings that do not conform to formal team-based processes, such as mono-professional physiotherapy private practice facilities. The aim of this study was to describe the characteristics of private physiotherapy practitioners' interprofessional interactions, including their experiences and perceptions regarding IPC. A custom developed cross-sectional online survey instrument was used to collect data from physiotherapists employed in private practice facilities in Queensland, Australia. In all, 49 (20% response rate) physiotherapists completed the survey. Only a small proportion (14%) indicated that their interprofessional interactions were a daily occurrence, and less than one-third of all respondents (31%) participated in formal, multi-professional face-to-face planned meetings. Most participants (76%) reported a moderate-to-high level of satisfaction regarding their interprofessional interactions. Despite low self-reported levels of interprofessional activity and other data indicating that IPC is necessary for holistic patient care, this study shows that physiotherapists were predominately satisfied when interacting with health practitioners from various professional backgrounds. Further research is required to inform the implementation of robust strategies that will support sustainable models of IPC in physiotherapy private practice.