Clinicians' perceptions of rounding processes and effectiveness of clinical communication

Need for Information and Communication Technology during COVID-19: An Exploratory Study Using Nurses' Activity Diaries

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has led to high levels of burnout among nurses. Information and communication technology (ICT) may offer a solution to prevent a potential collapse in healthcare. The aim of this study was to identify areas where ICT could provide support, by analyzing the work of nurses during the COVID-19 pandemic.

METHODS

This retrospective exploratory descriptive study analyzed qualitative data from the activity diaries of seven nurses working in COVID-19 wards or intensive care units.

RESULTS

The nursing work process during COVID-19 involved "added tasks," "changed tasks," and "reduced tasks" compared to the pre-COVID-19 situation. Nurses reported difficulties in communicating with other healthcare professionals both inside and outside the isolation room, as well as with patients. The use of various ICT solutions, such as real-time video-conferencing systems or mobile robots, could enhance patient monitoring in the isolation room and improve the quality and efficiency of communication.

CONCLUSIONS

The changes in work tasks not only led to nurse exhaustion but also negatively impacted the quality of care. ICT solutions should be explored to minimize the time spent in the isolation room, thereby reducing the risk of infection spread. This could also enhance communication among patients, family caregivers, and healthcare professionals.

Preferences to improve rounding efficiency amongst hospitalists: a survey analysis

Background: There is no ‘gold standard’ method of rounding for hospitalists. This study investigates hospitalist rounding preferences to improve efficiency based on resources categorized under work assignment and communication.

Methods: An anonymous survey containing demographics and questions on preferences for rounding efficiently by hospitalists were widely distributed online. Res6ponses were presented using descriptive statistics and SPSS v26.

Results: There were 143 respondents, majority male (60%) with (40%) female. Most (80%) expect higher patient volumes when working with an advanced practitioner (AP). Half (50%) preferred rounding independently, (34%) with an AP, and majority (62%) with a resident. Geographic rounding was most efficient at 85%. Text messaging for paging was preferred (70.1%) to pagers (23.4%). Respondents preferred calling a consultant (52%) or text messaging (40%). Majority have not used a WOW yet (74%) believe WOWs could improve efficiency. Majority prefer dictation via Dragon (47%) to the phone application (23%). Only 29% believe their EMR is too complex to navigate. Preference difference due to age was insignificant.

Discussion and Conclusion: In this study, 143 hospitalists provided preferences for improving rounding efficiency based on elements from work assignment and communication. This analysis can provide insights on designing best practices for hospitalists rounding efficiently.

When interactions are interruptions: an ethnographic study of information-sharing by speech and language therapists and nurses on stroke units

PURPOSE

To explore how the information-sharing context influences how speech and language therapy (SLT) and nursing staff interact on stroke units and what they discuss.

METHODS

Ethnographic methodology was used, with data collected during 40 weeks of fieldwork across three inner city stroke units in the UK. Data comprised field notes collected during 357 h of participant observation and 43 interviews. Interviews were conducted with 14 SLTs, 1 SLT assistant, 24 registered nurses and 4 nursing assistants.

RESULTS

This paper is focused on informal information-sharing. SLTs and nurses had different experiences of time and space (the temporal-spatial context) with respect to ward presence and proximity to patients, influencing how they interacted, the content of their talk and their relationships. Most interactions had the quality of interruptions, in which SLTs seized moments in between nursing tasks. Conditions were less suited to sharing information about communication than swallowing and SLTs felt more allied to other therapists than nurses.

CONCLUSION

The temporal-spatial context impeded information-sharing, particularly about patients' communication needs. Consideration should be given to developing relationships between SLTs and nurses as key partners for patient care and raising the profile of communication information in ways that are relevant and useful to nursing work.Implications for rehabilitationStrategic waiting for opportunities to interrupt nurses and gain their attention is central to how speech and language therapists manage their need to share information informally with nurses.The small "windows in time" available for interaction influence information-sharing, with a limiting effect on information about patients' communication.There is potential to improve information-sharing between speech and language therapists and nurses by considering how the relevance of information for patient care could be made clearer.

Communication in interprofessional rehabilitation teams: a scoping review

PURPOSE

Effective communication in interprofessional rehabilitation teams is essential for optimal patient care. Despite the established importance, it remains unclear how interprofessional communication (IPC) within teams contributes to rehabilitation service delivery. The aim of this scoping review was to investigate how IPC has been described in rehabilitation literature.

METHODS

Databases (Medline, CINAHL, ERIC, Embase, PsychInfo, and Academic Search Complete) were searched for studies including rehabilitation interprofessional communication. Inclusion and exclusion criteria were identified and applied, data were charted, and thematic analysis conducted.

RESULTS

Twenty-nine papers were identified, and analysis revealed interrelated themes: communication processes, and inputs and effects. Formal communication processes were most prevalent, portraying variability in professional participation and a lack of patient involvement in dialogue and decision making. Inputs and effects were described at an organisational, team and individual level, highlighting the importance of communication throughout the healthcare hierarchy.

CONCLUSIONS

IPC in rehabilitation is central to effective team function and patient care. To further our understanding, empirical studies examining everyday informal IPC, as well as formal ritualised encounters are needed. Additionally, conceptualisations of IPC would benefit from including the patients' perspective and by using theoretical framing to attend to places, spaces, and artefacts identified in this review.

How Do Interprofessional Healthcare Teams Perceive the Benefits and Challenges of Interdisciplinary Ward Rounds

Purpose

Interdisciplinary bedside ward rounds have the capacity to facilitate coordinated interprofessional patient care. To be an effective means of care coordination, clinicians need an explicit understanding of how these rounds contribute to patient care. By identifying benefits and challenges to the effective use of interdisciplinary ward rounds, clinicians create an opportunity to improve interprofessional teamwork, care planning, and coordination of patient care.

Methods

A survey was conducted with frontline professionals in two acute care and two rehabilitation wards from a metropolitan teaching hospital. There were 77 participants, representing medical officers, nurses, and allied health clinicians. Questions examined the perceived benefits and challenges of conducting interdisciplinary ward rounds in their units. Survey findings were coded for meaning and then grouped into themes.

Results

Benefits revealed a desired care delivery model challenged by the complexities of organizational and professional cultures. The themes of “being on the same page”, “focusing on patients”, and “holistic care planning” underpinned the ideas of collaboration and improved patient-centred care, that is, benefits to patients. Challenges centred on health professionals' time constraints and the coordination of teams to enable participation in rounds. The themes were more distinct, logistical barriers of “time”, “workforce”, and “care planning”.

Conclusion

Overall, clinicians recognise there are greater benefits to IBRs and have a willingness to participate. However, careful consideration is required to introduce and continually achieve the best from IBR as they require changes in organizational context and culture.