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Klafke N, Bossert J, Boltenhagen U, Froehlich D, Mahler C, Joos S, Wensing M. Counseling lifestyle medicine in oncology: A qualitative analysis of interprofessional patient-nurse-physician interactions. PATIENT EDUCATION AND COUNSELING 2024; 127:108352. [PMID: 38905751 DOI: 10.1016/j.pec.2024.108352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 05/23/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVES Counseling plays a key role in promoting health behaviors, providing evidence-based information, and supporting patients with cancer during and after treatment. This study aimed to evaluate an interprofessional counseling service on Complementary and Integrative Health (CIH) for patients being treated at Comprehensive Cancer Centers (CCCs) in Southern Germany. METHODS Patients participating in the CCC-Integrativ study received three CIH counseling sessions within three months in addition to their conventional cancer treatment. Medical and nursing staff participated in a study-specific blended learning training program before conducting the counseling. As part of the process evaluation, 30 audio-recorded counseling sessions were transcribed verbatim and analyzed by conducting a content analysis using MAXQDA 2020. RESULTS Throughout the counseling, patients were conceded to address various health issues, which mainly revolved around symptom management interlaced with the areas of nutrition, exercise, and relaxation. The interprofessional teams conducted the counseling in a structured and patient-oriented manner. They worked together to motivate the patients to apply procedures from the CIH field independently, even if patients sometimes experienced difficulties in implementation. CONCLUSIONS Interprofessional collaboration improved healthcare quality, as patients received comprehensive and evidence-based advice on their supportive needs and lifestyle issues. Both professions could equally contribute their areas of knowledge and expertise and apply them to the benefit of the patients. PRACTICE IMPLICATIONS Providing an integrative counseling service and adequate training on interpersonal communication and CIH for healthcare professionals will improve patient-centered care.
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Affiliation(s)
- Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
| | - Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Boltenhagen
- Institute of Health Sciences, Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Daniela Froehlich
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia Mahler
- Institute of Health Sciences, Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Choi HR, Ho MH, Lin CC. Navigating tensions when life-sustaining treatment is withdrawn: A thematic synthesis of nurses' and physicians' experiences. J Clin Nurs 2024; 33:2337-2356. [PMID: 38323726 DOI: 10.1111/jocn.17059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/18/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
AIM To synthesise nurses' and physicians' experiences with withdrawing life-sustaining treatment in an intensive care unit. DESIGN The chosen methodology is thematic synthesis. The Preferred Reporting Items for Systematic Review and Meta-Analyses and Enhancing Transparency are used in Reporting the Synthesis of Qualitative Research Statement. METHODS AND DATA SOURCES A systematic search is conducted in APA PsycINFO, CINAHL Plus, EMBASE, PubMed and Web of Science following the inclusion and exclusion criteria in April 2023. Two reviewers independently screened and extracted the qualitative data. Subsequently, data analysis was conducted using thematic analysis of qualitative research. This study was not registered with any review registry due to the irrelevance of the data to health-related outcomes. RESULTS From the 16 articles, 267 quotes were extracted and analysed. The findings of the study revealed five analytical themes: (1) tensions between interdependent collaboration and hierarchical roles; (2) tensions between dignified dying or therapeutic perspectives; (3) family members' reflections of patient's wishes; (4) tensions in family members' positions; and (5) double-sidedness of distress. CONCLUSION This study contributes to nursing knowledge by providing a more nuanced understanding of this complex phenomenon of withdrawing life-sustaining treatment. The findings of this study have revealed significant variations globally in the practices surrounding the withdrawal of life-sustaining treatment in intensive care units, emphasising the need for further research to inform clinical practices that cater to diverse contexts. REPORTING METHOD Enhancing Transparency are used in Reporting the Synthesis of Qualitative Research Statement (ENTREQ statement). PATIENT OR PUBLIC CONTRIBUTION Since this study reported a potential collision between the patient's dignified dying and the family member's perceptions and interests, the family member's wishes should be carefully distinguished from the patient's quality of end of life in practice.
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Affiliation(s)
- Hye Ri Choi
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mu-Hsing Ho
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- Alice Ho Miu Ling Nethersole Charity Foundation, School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong
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Crevacore C, Coventry L, Duffield C, Jacob E. Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study. J Clin Nurs 2024; 33:2153-2164. [PMID: 38556781 DOI: 10.1111/jocn.17127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
AIMS To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. DESIGN Mixed method explanatory sequential design. METHODS A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. RESULTS Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. CONCLUSIONS Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. IMPACT Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. REPORTING METHOD Complied with the APA Style JARS-MIXED reporting criteria for mixed method research. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Carol Crevacore
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Linda Coventry
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Christine Duffield
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Elisabeth Jacob
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Australian Catholic University, Fitzroy, Victoria, Australia
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Jeong H, Lee W, Jang SG, Pyo J, Choi EY, Baek SJ, Ock M. Perception gaps of patient engagement for patient safety between healthcare professionals and the public in Korea. Curr Med Res Opin 2024:1-9. [PMID: 38646669 DOI: 10.1080/03007995.2024.2346334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND To ensure effective patient engagement, patients' efforts, partnerships with healthcare professionals, and the organisation's role in providing safe healthcare settings must be emphasised. Perception gaps regarding patient engagement between the public and healthcare professionals could prevent healthy partnerships from forming and hinder patient engagement activities. This study examined healthcare professionals' perception of patient engagement and compared the findings with that determined for the public in a previous study. METHODS An anonymous online survey was conducted in February 2020 among 1,007 healthcare professionals (physicians, nurses). The questionnaire comprised five parts regarding the perception of patient engagement. Descriptive analysis and Chi-squared/Fisher's exact tests determined the frequency and significant differences among the public from previous study and healthcare professionals in this study. RESULTS The perception of the importance of patient safety was high among healthcare professionals and the public. However, statistically significant differences in perceptions were observed among the public and healthcare professionals in all categories. The perception gaps were substantial between the groups in sub-categories of engagement for patient safety during medical treatment; 86% of physicians and 90% of nurses agreed that patients participate in the decision-making for the treatment process. Conversely, 58% of the public agreed. Only 22% of the public agreed with confirming healthcare professionals' hand washing to prevent infection, versus 57% of physicians and 65% of nurses. More than 89% of healthcare professionals positively perceived medical dispute mediation versus only half of the public. In certain areas such as "medical dispute mediation and arbitration programs", "fall prevention", and "infection prevention", there was a statistically significant difference in the perception of patient involvement among healthcare professionals, with nurses' perception being particularly more positive than that of physicians. CONCLUSIONS The healthcare professionals' perception of patient engagement was more positive than that of the public. To narrow the perception gaps and enhance the public's perception, strategies involving changes in healthcare systems, promotional efforts, and educational initiatives should be developed. Additionally, strategies should be formulated for healthcare professionals to better engage as partners in patient care.
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Affiliation(s)
- Hyeran Jeong
- Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City, Ulsan, Republic of Korea
- Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Lee
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | | | - Jeehee Pyo
- Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City, Ulsan, Republic of Korea
- Department of Preventive Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Young Choi
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Seung Ju Baek
- Department of Nursing, Graduate School of Chung-Ang University, Seoul, Republic of Korea
| | - Minsu Ock
- Task Forces to Support Public Health and Medical Services in Ulsan Metropolitan City, Ulsan, Republic of Korea
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Goto Y, Miura H. An Exploratory Study of Issues in Training Facilitators for Online Training in Advance Care Planning: Mixed Methods Research. NURSING REPORTS 2024; 14:1000-1013. [PMID: 38651487 PMCID: PMC11036261 DOI: 10.3390/nursrep14020075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
Advance care planning (ACP) has attracted increasing research attention in recent years. In Japan, extensive training has been conducted to improve communication through workshops, such as role-playing. In training, including trainee-centered work, the facilitator who assists trainee learning plays an important role. However, only a few studies have focused on the training of facilitators. Therefore, we exploratorily analyzed by the mixed method the differences in the approaches of experienced and inexperienced facilitators during workshops and conducted a study that could contribute to facilitator training in the future. We recorded the comments and attitudes of 12 facilitators who participated in ACP training conducted in 2022. Based on analysis of the obtained data, a distinct difference was confirmed in the progression of trainee-based learning, encouragement to deepen learning among trainees, and trainees' responses to questions. Thus, this study indicated the importance of having the opportunity for fellow facilitators to learn through facilitation with experienced facilitators and involvement in issue awareness.
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Affiliation(s)
- Yuko Goto
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Hospital, Obu 474-8511, Aichi, Japan
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Ohta R, Nitta T, Shimizu A, Sano C. Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach. BMC PRIMARY CARE 2024; 25:121. [PMID: 38641569 PMCID: PMC11027398 DOI: 10.1186/s12875-024-02379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. METHODS This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. RESULTS Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. CONCLUSIONS The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan.
| | - Tachiko Nitta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Akiko Shimizu
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo, Shimane, 693-8501, Japan
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Yoshida Y, Hirakawa Y, Hong YJ, Mamun MR, Shimizu H, Nakano Y, Yatsuya H. Factors influencing interprofessional collaboration in long-term care from a multidisciplinary perspective: a case study approach. Home Health Care Serv Q 2024:1-20. [PMID: 38521999 DOI: 10.1080/01621424.2024.2331452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Systematic assessments of interprofessional collaboration barriers and enablers in long-term care settings are critical for delivering person-centered healthcare. However, research on factors influencing interprofessional collaboration in long-term care settings is limited. For this study, 65 healthcare professionals across multiple facilities experienced in long-term care in Japan participated in online focus group discussions and individual interviews to discuss cases. The qualitative data were analyzed using qualitative content analysis. Seven themes emerged: coordination, the need for care manager training, hierarchy among healthcare professionals, specialization but not the mind-set of overspecialization, casual conversations, electronic group communication tools, and excessive fear of personal information protection. These findings highlight the need to develop coordinator roles and for interprofessional education on the proper approach to personal information protection laws. Furthermore, daily casual conversations, the use of online platforms, and the prevention of patients being left behind due to overspecialization are required.
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Affiliation(s)
- Yuko Yoshida
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Psychiatry, Daido Hospital, Kojunkai Social Medical Corporation, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Department of Health Research and Innovation, Aichi Comprehensive Health Science Center (Aichi Health Plaza), Chita-Gun, Japan
| | - Young Jae Hong
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Md Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroko Shimizu
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Nakano
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Lee CY, Lai HY, Lee CH, Chen MM, Yau SY. Collaborative clinical reasoning: a scoping review. PeerJ 2024; 12:e17042. [PMID: 38464754 PMCID: PMC10924455 DOI: 10.7717/peerj.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Collaborative clinical reasoning (CCR) among healthcare professionals is crucial for maximizing clinical outcomes and patient safety. This scoping review explores CCR to address the gap in understanding its definition, structure, and implications. Methods A scoping review was undertaken to examine CCR related studies in healthcare. Medline, PsychInfo, SciVerse Scopus, and Web of Science were searched. Inclusion criteria included full-text articles published between 2011 to 2020. Search terms included cooperative, collaborative, shared, team, collective, reasoning, problem solving, decision making, combined with clinical or medicine or medical, but excluded shared decision making. Results A total of 24 articles were identified in the review. The review reveals a growing interest in CCR, with 14 articles emphasizing the decision-making process, five using Multidisciplinary Team-Metric for the Observation of Decision Making (MDTs-MODe), three exploring CCR theory, and two focusing on the problem-solving process. Communication, trust, and team dynamics emerge as key influencers in healthcare decision-making. Notably, only two articles provide specific CCR definitions. Conclusions While decision-making processes dominate CCR studies, a notable gap exists in defining and structuring CCR. Explicit theoretical frameworks, such as those proposed by Blondon et al. and Kiesewetter et al., are crucial for advancing research and understanding CCR dynamics within collaborative teams. This scoping review provides a comprehensive overview of CCR research, revealing a growing interest and diversity in the field. The review emphasizes the need for explicit theoretical frameworks, citing Blondon et al. and Kiesewetter et al. The broader landscape of interprofessional collaboration and clinical reasoning requires exploration.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Yi Lai
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Mi-Mi Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Sze-Yuen Yau
- (CG-MERC) Chang Gung Medical Education Research Centre, Linkou, Taoyuan, Taiwan
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Ricci L, Minary L, Kivits J, Ayav C, Rat AC. Use of qualitative methods to optimize collaborative practices by highlighting differences in perceptions between professionals: an example of patient education. J Interprof Care 2024; 38:264-272. [PMID: 38375794 DOI: 10.1080/13561820.2023.2289509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/27/2023] [Indexed: 02/21/2024]
Abstract
Interprofessional working must be approached within health promotion interventions using systematic methods to identify areas of suboptimal collaboration. We designed a qualitative study with a purposive sample of seven French therapeutic patient education programs. Semi-structured individual interviews were conducted with 14 healthcare providers and seven clinician leaders (coordinators) involved in patient education. We used the same interview guide and thematic grid regardless of the professional's profile to compare their perceptions on elements affecting outcome, participation and sustainability of programs. Healthcare providers and coordinators addressed non-convergent issues at both ends of a continuum from a micro-level nested in the program delivery to a macro-level corresponding to the structured implementation and sustainability of the program. Meso-level issues featured convergent perspectives. Our methodology could be used at the level of health services in a health system to provide a complete recovery of stakeholders' perspectives (without "blind spots" from one stakeholder or another). In our study, we focused on patient education in the French health system and pointed out possible considerations to optimize the functioning of programs. Such considerations include specific training plan development, encouraging reflection on the content and use of initial assessment, leading sessions in pairs to save on work time, and communication on the ins and outs of organizational imperatives that require healthcare providers' contributions.
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Affiliation(s)
- Laetitia Ricci
- Epidémiologie Clinique, CHRU-Nancy, INSERM, Université de Lorraine, CIC, Nancy, France
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
| | | | - Joëlle Kivits
- APEMAC, équipe MICS, Université de Lorraine, Nancy, France
| | - Carole Ayav
- Epidémiologie Clinique, CHRU-Nancy, INSERM, Université de Lorraine, CIC, Nancy, France
| | - Anne-Christine Rat
- APEMAC, équipe MICS, Université de Lorraine, Nancy, France
- UMR-S 1075-Mobilités: Vieillissement, Pathologie, Santé COMETE, Caen, France, Rheumatology Department, CHU Caen, Caen Normandie University, Caen, France
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Breton M, Deville-Stoetzel N, Gaboury I, Duhoux A, Maillet L, Abou Malham S, Légaré F, Vedel I, Hudon C, Touati N, Jbilou J, Loignon C, Lussier MT. Comparing the implementation of advanced access strategies among primary health care providers. J Interprof Care 2024; 38:209-219. [PMID: 36772809 DOI: 10.1080/13561820.2023.2173157] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 02/12/2023]
Abstract
The advanced access (AA) model is among the most recommended innovations for improving timely access in primary health care (PHC). Originally developed for physicians, it is now relevant to evaluate the model's implementation in more interprofessional practices. We compared AA implementation among family physicians, nurse practitioners, and nurses. A cross-sectional online open survey was completed by 514 PHC providers working in 35 university-affiliated clinics. Family physicians delegated tasks to other professionals in the team more often than nurse practitioners (p = .001) and nurses (p < .001). They also left a smaller proportion of their schedules open for urgent patient needs than did nurse practitioners (p = .015) and nurses (p < .001). Nurses created more alternatives to in-person visits than family physicians (p < .001) and coordinated health and social services more than family physicians (p = .003). During periods of absence, physicians referred patients to walk-in services for urgent needs significantly more often than nurses (p = .003), whereas nurses planned replacements between colleagues more often than physicians (p <.001). The variations among provider categories indicate that a one-size-fits-all implementation of AA principles is not recommended.
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Affiliation(s)
- Mylaine Breton
- Department of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | | | - Isabelle Gaboury
- Department of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - Arnaud Duhoux
- Department of Nursing, Université de Montreal, Quebec, Canada
| | - Lara Maillet
- National School of Public Administration (ENAP), Quebec, Canada
| | - Sabina Abou Malham
- Department of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Nassera Touati
- National School of Public Administration (ENAP), Quebec, Canada
| | - Jalila Jbilou
- Centre de formation médicale du Nouveau-Brunswick and School of Psychology, Université de Moncton, New Brunswick, Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Quebec, Canada
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Skidmore KL, Drinkard J, Randall HM, Varrassi G, Shekoohi S, Kaye AD. The Significance of Equipment Availability and Anesthesia Educational Conferences to Decision-Making for EKG Lead V5 Abnormalities. Cureus 2024; 16:e53620. [PMID: 38449953 PMCID: PMC10915713 DOI: 10.7759/cureus.53620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction To predict postoperative myocardial infarction rates in patients who undergo noncardiac surgery, the Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management recommends assessment of brain natriuretic peptide (BNP) in certain patients. Serial troponins are measured if the BNP level is elevated. In certain cases, Revised Cardiac Risk Index (RCRI) alone does not perform well, for example, during vascular surgery. Cardiac events occur in 20% of all vascular surgery patients. The odds ratio for such events is 9.2 if ST segments were depressed by 1 mm intraoperatively (relative to the PR interval) within the first 48 hours postoperatively. Increasing the number of cables and pads from three to five for electrocardiogram (EKG) increases the sensitivity from around 30% to over 80% for ischemic events relative to a formal EKG stress test, and then the monitor continuously displays not only lead II but also lead V5. Methods Our hypothesis was that raising awareness about diagnostic and therapeutic options to reduce the risk of postoperative myocardial infarction would increase the use of five pads. We conducted open-ended surveys at six hospitals to assess the reasons for choosing three pads. In our university hospital practice, we measured a cross-sectional incidence of using three pads before and, once again, a month after an intervention during a single morning. Several resident conferences encouraged the use of five pads. Education included weekly lectures and informal discussions with other staff during surgery, demonstrating that using five pads allows interrogation of an entire 12-lead EKG. In comparison, three pads only allow viewing three leads. Results At baseline, only three pads were available in 96% of our 23 operating rooms. Five cables were available in eight of those surgeries, but two were taped off to the side. Surveys unveiled scarcity of equipment and, more importantly, disempowerment (i.e., knowing how to diagnose or when to treat ischemia). After several conferences, the prevalence of equipment availability of only three pads fell to 47%. Conclusions Education enumerated details of recognizing ischemic configurations of ST depression. Next, education revealed methods to interrupt the progression of ischemia to infarction such as elevated blood pressure and hematocrit, reducing heart rate, and calling a cardiology consultant if the anesthesiologist wishes to draw serial troponins. Barriers to implementing an enhanced recovery after surgery (ERAS) pathway began with a need for more access to manage stress tests or optimize blood pressure medications after a preoperative anesthesia evaluation. The intraoperative barrier was knowing what to do if ST depression occurs. Therefore, we began raising awareness by encouraging the addition of an element of a future ERAS pathway, adding a cost of only $1 to monitor lead V5. Future ERAS pathways can include preoperative stress tests and consults, as found in published guidelines.
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Affiliation(s)
- Kimberly L Skidmore
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Joseph Drinkard
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Henson M Randall
- Department of Medicine, Edward Via College of Osteopathic Medicine, Monroe, USA
| | | | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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12
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Ohta R, Yakabe T, Sano C. Decision-Making in the Admission of Older Patients: A Thematic Analysis From Multiple-Stakeholder Perspectives. Cureus 2024; 16:e51966. [PMID: 38333500 PMCID: PMC10851036 DOI: 10.7759/cureus.51966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction As rural healthcare systems grapple with an aging population, understanding the factors influencing hospital admission decisions for elderly patients is crucial. This study explores the complex interplay of medical, social, and psychological factors that shape these decisions, as perceived by multiple stakeholders, including physicians, patients, and their families. Method This study was conducted in Unnan City Hospital, a rural community hospital in Unnan, Japan, using a qualitative thematic analysis approach. Participants included general physicians, patients admitted more than once, and their families. One-on-one semi-structured interviews were conducted in Japanese, recorded, transcribed, and analyzed. The analysis focused on identifying themes that influence decision-making processes regarding the admission of elderly patients. The research team, comprising family medicine, public health, and community health care experts, ensured a multi-perspective approach through collaborative coding and discussion. Results Three primary themes emerged from the analysis: "dilemma between medical indications and social admissions," "risks and benefits of hospitalization in response to unpredictable changes in the elderly," and "social factors intertwined with the multilayered nature of hospital admission decisions." Physicians reported a conflict between their medical training and the social needs of patients, often leading to stress and negative emotions. The unpredictable health trajectories of elderly patients necessitated a nuanced risk-benefit analysis for hospitalization. In addition, social factors, such as bed availability, patient's living environment, and psychosocial contexts, significantly influenced admission decisions. Conclusion The study highlights the need for a more holistic approach to medical education and practice, especially in rural healthcare settings. Recognizing the complexity of factors influencing hospitalization decisions, including medical, social, and individual patient circumstances, is vital. The findings underscore the importance of integrating biopsychosocial aspects into the decision-making process for the hospitalization of elderly patients, advocating for patient-centered care that respects the unique challenges in rural healthcare environments.
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Affiliation(s)
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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13
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Zinsou C, Guedegbe G, Dossou L, Ognin J, Raobelison AT, Flomen L, Bouanchaud P. Lessons Learned in Improving the Quality of a Free Reproductive Health Hotline in Benin. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200296. [PMID: 38123953 PMCID: PMC10749658 DOI: 10.9745/ghsp-d-22-00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Since 2006, the Ligne Verte project-a toll-free national hotline that provides counseling and provider linkages to family planning, HIV, and sexually transmitted infection services-has been implemented by the Association Béninoise pour le Marketing Social et la Communication pour la Santé (ABMS) in Benin. Annual evaluations have been conducted to monitor client satisfaction, with feedback mechanisms to learn from callers and staff, aiming to continually improve the program. We document lessons learned from these evaluations, outline the adaptation process to improve the quality of the hotline, present results from Ligne Verte caller and counselor studies, and describe how the studies fed client-driven changes to the project. METHODS Annual rounds of semistructured phone interviews with Ligne Verte callers and call center advisors were conducted. The sample of clients interviewed included consenting men and women aged 18 years and older who had used Ligne Verte services in the 3 months preceding the evaluation. All advisors working on the helpline were also eligible for inclusion in qualitative interviews. RESULTS From 2013 to 2020, most callers were satisfied with the Ligne Verte project. Users reported appreciating the accurate, timely, and confidential support they received from the helpline but noted the need to expand the service to other local languages and improve call quality. Call center advisors requested mental health support. In employing a systematic approach to program improvement, ABMS was able to add extended language services, upgrade their telecommunication hardware, and provide a psychologist for call center advisors. These program adaptations have increased caller satisfaction by 20 percentage points, and in 2020, 95% of callers reported being satisfied with their Ligne Verte experience. CONCLUSION Taking a consumer-centered approach, listening to user feedback, and making evidence-based recommendations to improve the Ligne Verte project has led to an overall increase in caller satisfaction.
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Affiliation(s)
- Cyprien Zinsou
- Association Béninoise pour le Marketing Social et la Communication pour la Santé, Cotonou, Benin
| | - Ghyslain Guedegbe
- Association Béninoise pour le Marketing Social et la Communication pour la Santé, Cotonou, Benin
| | - Leonce Dossou
- Association Béninoise pour le Marketing Social et la Communication pour la Santé, Cotonou, Benin
| | - Judith Ognin
- Association Béninoise pour le Marketing Social et la Communication pour la Santé, Cotonou, Benin
| | - Ando Tiana Raobelison
- Association Béninoise pour le Marketing Social et la Communication pour la Santé, Cotonou, Benin
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Breton M, Deville-Stoetzel N, Gaboury I, Duhoux A, Maillet L, Abou Malham S, Hudon C, Vedel I, Légaré F, Berbiche D, Touati N. Taxonomy of advanced access practice profiles among family physicians, nurse practitioners and nurses in university-affiliated team-based primary healthcare clinics in Quebec. BMJ Open 2023; 13:e074681. [PMID: 38086598 PMCID: PMC10729211 DOI: 10.1136/bmjopen-2023-074681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The advanced access model is highly recommended to improve timely access to primary healthcare (PHC). However, its adoption varies among PHC providers. We aim to identify the advanced access profiles of PHC providers. DESIGN A cross-sectional study was conducted between October 2019 and March 2020. Latent class analysis (LCA) measures were used to identify PHC provider profiles based on 14 variables, 2 organisational context characteristics (clinical size and geographical area) and 12 advanced access strategies. SETTING AND PARTICIPANTS All family physicians, nurse practitioners and nurses working in the 49 university-affiliated team-based PHC clinics in Quebec, Canada, were invited, of which 35 participated. PRIMARY OUTCOME MEASURE The LCA was based on 335 respondents. We determined the optimal number of profiles using statistical criteria (Akaike information criterion, Bayesian information criterion) and qualitatively named each of the six advanced access profiles. RESULTS (1) Low supply and demand planification (25%) was characterised by the smallest proportion of strategies used to balance supply and demand. (2) Reactive interprofessional collaboration (25%) was characterised by high collaboration and long opening periods for appointment scheduling. (3) Structured interprofessional collaboration (19%) was characterised by high use of interprofessional team meetings. (4) Small urban delegating practices (13%) was exclusively composed of family physicians and characterised by task delegation to other PHC providers on the team. (5) Comprehensive practices in urban settings (13%) was characterised by including as many services as possible on each visit. (6) Rural agility (4%) was characterised by the highest uptake of advanced access strategies based on flexibility, including adjusting the schedule to demand and having a large number of open-slot appointments available in the next 48 hours. CONCLUSION The different patterns of advanced access strategy adoption confirm the need for training to be tailored to individuals, categories of PHC providers and contexts.
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Affiliation(s)
- Mylaine Breton
- Department of Community Health, University of Sherbrooke, Longueuil, Quebec, Canada
| | | | - Isabelle Gaboury
- Department of Family Medecine and Emergency Medicine, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, University of Montreal, Montreal, Québec, Canada
| | - Lara Maillet
- National School of Public Administration, ENAP, Montreal, Québec, Canada
| | - Sabina Abou Malham
- School of Nursing Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medecine and Emergency Medicine, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, Québec, Canada
| | - Djamal Berbiche
- Department of Community Health, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Nassera Touati
- National School of Public Administration, ENAP, Montreal, Québec, Canada
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15
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Gong X, Dong B, Li L, Shen D, Rong Z. TikTok video as a health education source of information on heart failure in China: a content analysis. Front Public Health 2023; 11:1315393. [PMID: 38146471 PMCID: PMC10749320 DOI: 10.3389/fpubh.2023.1315393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023] Open
Abstract
Background Heart failure (HF) is a complex and life-threatening syndrome associated with significant morbidity and mortality. While TikTok has gained popularity as a social media platform for sharing HF-related information, the quality of such content on TikTok remains unexplored. Methods A cross-sectional analysis was conducted on TikTok videos related to HF in China. The sources of the videos were identified and analyzed. The content comprehensiveness of the videos was evaluated using six questions that covered definition, signs and symptoms, risk factors, evaluation, management, and outcomes. The reliability and quality of the videos were assessed using three standardized evaluation instruments: DISCERN, JAMA benchmarks, and the Global Quality Scale. Additionally, the correlation between video quality and video characteristics was further investigated. Results Among the video sources, 92.2% were attributed to health professionals, while news agencies and non-profit organizations accounted for 5.7% and 2.1%, respectively. The content comprehensiveness score for the videos was 3.36 (SD 3.56), with news agencies receiving the highest scores of 4.06 (SD 3.31). The median DISCERN, JAMA, and GQS scores for all 141 videos were 26.50 (IQR 25.00-28.750), 2.00 (IQR 2.00-2.00), and 2.00 (IQR 2.00-2.00), respectively. Videos from health professionals had significantly higher JAMA scores compared to those from non-profit organizations (P < 0.01). Correlation analysis between video quality and video characteristics showed positive correlations between content comprehensiveness scores and video duration (r = 0.420, P < 0.001), number of comments (r = 0.195, P < 0.05), and number of shares (r = 0.174, P < 0.05). GQS scores were negatively or positively correlated with the number of days since upload (r = -0.212, P < 0.05) and video duration (r = 0.442, P < 0.001). Conclusion The overall quality of the videos was found to be unsatisfactory, with variations in quality scores observed across different video sources. Content comprehensiveness was inadequate, the reliability and quality of the information presented in the videos was questionable. As TikTok continues to grow as a platform for health information, it is essential to prioritize accuracy and reliability to enhance patients' self-care abilities and promote public health.
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Affiliation(s)
- Xun Gong
- Department of Cardiology and Cardiac Rehabilitation Center, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
| | | | | | | | - Zhiyi Rong
- Department of Cardiology and Cardiac Rehabilitation Center, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China
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Mohanasundari SK, Kalpana M, Madhusudhan U, Vasanthkumar K, B R, Singh R, Vashishtha N, Bhatia V. Can Artificial Intelligence Replace the Unique Nursing Role? Cureus 2023; 15:e51150. [PMID: 38283483 PMCID: PMC10811613 DOI: 10.7759/cureus.51150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Artificial intelligence (AI) is transforming healthcare, offering potential benefits and challenges. In healthcare, AI enhances efficiency, streamlines processes, and supports decision-making. However, challenges include potential errors and biases in algorithms, data privacy concerns, legal and ethical issues, and resistance to change. In nursing, a delicate balance emerges between AI and human touch. While AI aids in data-driven decision-making and administrative tasks, it lacks the emotional intelligence, empathy, and nuanced understanding crucial to nursing care. Nurses excel in critical thinking, adaptability to dynamic situations, patient advocacy, collaboration, and establishing human connections. AI supports these functions by automating routine tasks and offering decision support tools, yet its rigidity in dynamic situations and lack of human touch pose limitations. This review underscores the necessity of careful AI integration in healthcare, acknowledging its advantages while mitigating drawbacks. In nursing, the symbiosis between AI and human qualities is vital. The role of AI should be to complement, not replace, the unique skills and empathetic aspects of nursing care. Addressing concerns related to bias, transparency, data privacy, and professional training is essential for maximizing the benefits of AI in healthcare while preserving the human touch in patient care. This article explores whether AI can replace unique nursing roles.
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Affiliation(s)
- S K Mohanasundari
- Pediatric Nursing, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - M Kalpana
- Physiology, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - U Madhusudhan
- Physiology, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - Kasturi Vasanthkumar
- Psychiatric Nursing, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - Rani B
- Community Health Nursing, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - Rashmi Singh
- Obstetrics and Gynaecology Nursing, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - Neelam Vashishtha
- Medical Surgical Nursing, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
| | - Vikas Bhatia
- Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bibinagar, Bibinagar, IND
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Huang KX, Chen CK, Pessegueiro AM, Dowling E, Dermenchyan A, Natarajan A, Krishnan D, Vangala SS, Simon WM. Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds. J Hosp Med 2023; 18:888-895. [PMID: 37584618 DOI: 10.1002/jhm.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient-centered care. However, there is limited understanding of optimal IDR structures and procedures. OBJECTIVE This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication. DESIGNS, SETTINGS AND PARTICIPANTS Trained observers audited general medicine ward rounds at an academic medical center using a standardized tool to record physician and nurse behavior and communication in 1007 patient encounters in October 2019 to March 2020. RESULTS There were significant differences in physician and nurse interaction time among physicians with different levels of training, with attendings demonstrating higher interaction time than residents (5.4 ± 4.6 vs. 4.3 ± 3.7 min, p = .02) and interns or medical students (3.0 ± 3.2 min, p = .002). Attendings were more likely to initiate a conversation about nurse concerns (76.9%) compared to residents (67.9%) and interns or medical students (59.3%, p = .03). Early nurse participation in bedside visits was associated with increased physician and nurse interaction time (5.0 ± 4.6 vs. 1.9 ± 1.7 min, p < .001) and physician initiative to ask about nurse concerns (74.8% vs. 64.3%, p = .04). In addition, physician initiative to ask the nurse for concerns rather than waiting for the nurse to offer concerns without being prompted was associated with a subsequent conversation about those concerns (74.5% vs. 61.8%, p < .001) and the physician asking about patient or family concerns (94.2% vs. 88.4%, p = .01). CONCLUSIONS Implementing IDR structures and procedures that promote attending physician involvement, physician initiative, and early nurse participation could optimize interdisciplinary communication and quality of care.
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Affiliation(s)
- Kelly X Huang
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Caitlin K Chen
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Erin Dowling
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Anna Dermenchyan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | | | - Dhwani Krishnan
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
| | - Sitaram S Vangala
- Department of Medicine Statistics Core, UCLA Health, Los Angeles, California, USA
| | - Wendy M Simon
- Department of Medicine Quality, UCLA Health, Los Angeles, California, USA
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18
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Sun X, Chen R, Fang P, Yu R, Wang X, Liu J, Chen Y, Ling H. Model construction of factors influencing intensive care unit nurses' medical device-related pressure injury knowledge, attitude, and practice. Int Wound J 2023; 20:2582-2593. [PMID: 36891887 PMCID: PMC10410357 DOI: 10.1111/iwj.14129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
The ability of knowledge, attitude, and practice of intensive care unit (ICU) nurses to perform medical device-related pressure injuries (MDRPIs) can affect the incidence of MDRPI in ICU patients. Therefore, in order to improve ICU nurses' understanding and nursing ability of MDRPIs, we investigated the non-linear relationship (synergistic and superimposed relationships) between the factors influencing ICU nurses' ability of knowledge, attitude, and practice. A Clinical Nurses' Knowledge, Attitude, and Practice Questionnaire for the Prevention of MDRPI in Critically Ill Patients was administered to 322 ICU nurses from tertiary hospitals in China from January 1, 2022 to June 31, 2022. After the questionnaire was distributed, the data were collected and sorted out, and the corresponding statistical analysis and modelling software was used to analyse the data. IBM SPSS 25.0 software was used to conduct Single factor analysis and Logistic regression analysis on the data, so as to screen the statistically significant influencing factors. IBM SPSS Modeler18.0 software was used to construct a decision tree model of the factors influencing MDRPI knowledge, attitude, and practice of ICU nurses, and ROC curves were plotted to analyse the accuracy of the model. The results showed that the overall passing rate of ICU nurses' knowledge, attitude, and practice score was 72%. The statistically significant predictor variables ranked in importance were education background (0.35), training (0.31), years of working (0.24), and professional title (0.10). AUC = 0.718, model prediction performance is good. There is a synergistic and superimposed relationship between high education background, attended training, high years of working and high professional title. Nurses with the above factors have strong MDRPI knowledge, attitude, and practice ability. Therefore, nursing managers can develop a reasonable and effective scheduling system and MDRPI training program based on the study results. The ultimate goal is to improve the ability of ICU nurses to know and act on MDRPI and to reduce the incidence of MDRPI in ICU patients.
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Affiliation(s)
- Xiao‐Xuan Sun
- School of NursingNanchang UniversityNanchangPeople's Republic of China
- Nursing Departmentthe First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
| | - Rui‐Bin Chen
- Information Office of the First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
| | - Ping‐Ping Fang
- Nursing Departmentthe First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
| | - Ran Yu
- School of NursingNanchang UniversityNanchangPeople's Republic of China
- Nursing Departmentthe First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
| | - Xu‐Xing Wang
- School of NursingNanchang UniversityNanchangPeople's Republic of China
- Nursing Departmentthe First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
| | - Jia‐Qiu Liu
- School of NursingNanchang UniversityNanchangPeople's Republic of China
- Nursing Departmentthe First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
| | - Ying Chen
- School of NursingNanchang UniversityNanchangPeople's Republic of China
- Nursing Departmentthe First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
| | - Hua Ling
- School of NursingNanchang UniversityNanchangPeople's Republic of China
- Nursing Departmentthe First Affiliated Hospital of Nanchang UniversityNanchangPeople's Republic of China
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You W, Cusack L, Donnelly F. A lack of nurse autonomy impacts population health when compared to physician care: an ecological study. Sci Rep 2023; 13:12047. [PMID: 37491376 PMCID: PMC10368668 DOI: 10.1038/s41598-023-38945-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/17/2023] [Indexed: 07/27/2023] Open
Abstract
This study highlights that the contribution of nursing is secondary to physicians in overall population health (indexed with life expectancy at birth, e(0)). Scatter plots, bivariate correlation and partial correlation models were performed to analyse the correlations between e(0) and physician healthcare and nursing healthcare respectively. Affluence, urbanization and obesity were incorporated as the potential confounders. The Fisher's r-to-z transformation was conducted for comparing the correlations. Multiple linear regression analyses were implemented for modelling that physicians' contributions to e(0) explain nurses'. Nursing healthcare correlated to e(0) significantly less strongly than physician healthcare in simple regressions. Nursing healthcare was in weak or negligible correlation to e(0) when physician healthcare was controlled individually or together with the three confounders. Physician healthcare remains significantly correlational to e(0) when nursing healthcare alone was controlled or when the three confounders were controlled. Linear regression revealed that nursing healthcare was a significant predictor for e(0) when physician healthcare was "not added" for modelling, but this predicting role became negligible when physician healthcare was "added". Our study findings suggested that nurses still work under the direction of physicians due to lack of autonomy. Without correction, health services will continue to transmit the invisibility of nursing healthcare from one generation of nurses to another.
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Affiliation(s)
- Wenpeng You
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.
- Heart and Lung, Royal Adelaide Hospital, Adelaide, Australia.
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Lynette Cusack
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Frank Donnelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
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20
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Petri CR, Beltran CP, Russell K, FitzGerald J, Sullivan AM, Anandaiah AM. "A Lot to Offer": Nurses as Educators for Medical Residents in an Academic Medical Center Intensive Care Unit. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00080. [PMID: 37341561 DOI: 10.1097/ceh.0000000000000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION The role of fully trained interprofessional clinicians in educating residents has not been rigorously explored. The intensive care unit (ICU), where multiprofessional teamwork is essential to patient care, represents an ideal training environment in which to study this role. This study aimed to describe the practices, perceptions, and attitudes of ICU nurses regarding teaching medical residents and to identify potential targets to facilitate nurse teaching. METHODS Using a concurrent mixed-methods approach, we administered surveys and focus groups to ICU nurses from September to November 2019 at a single, urban, tertiary, academic medical center. Survey data were analyzed with descriptive and comparative statistics. Focus group data were analyzed using the Framework method of content analysis. RESULTS Of nurses surveyed, 75 of 96 (78%) responded. Nurses generally held positive attitudes about teaching residents, describing it as both important (52%, 36/69) and enjoyable (64%, 44/69). Nurses reported confidence in both clinical knowledge base (80%, 55/69) and teaching skills (71%, 49/69), but identified time, uncertainty about teaching topics, and trainee receptiveness as potential barriers. Ten nurses participated in focus groups. Qualitative analysis revealed three major themes: nurse-specific factors that impact teaching, the teaching environment, and facilitators of teaching. DISCUSSION ICU nurses carry positive attitudes about teaching residents, particularly when facilitated by the attending, but this enthusiasm can be attenuated by the learning environment, unknown learner needs, and trainee attitudes. Identified facilitators of nurse teaching, including resident presence at the bedside and structured opportunities for teaching, represent potential targets for interventions to promote interprofessional teaching.
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Affiliation(s)
- Camille R Petri
- Dr. Petri is a Faculty Member in the Division of Pulmonary, Critical Care, and Sleep Medicine, and the Shapiro Institute for Education and Research at Beth Israel Deaconess Medical Center and Instructor in Medicine at Harvard Medical School, Boston, MA. Beltran is Senior Research Coordinator at the New York University Grossman School of Medicine, New York, NY. Russell is the Nursing Director for the Medical Intensive Care Unit at Beth Israel Deaconess Medical Center, Boston, MA. FitzGerald is the Nursing Director for the Medical/Surgical Intensive Care Unit at Beth Israel Deaconess Medical Center, Boston, MA. Sullivan is Director of Education Research at the Shapiro Institute for Education and Research and Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA. Dr. Anandaiah is Program Director of the Massachusetts General Hospital/Beth Israel Deaconess Medical Center/Harvard Pulmonary and Critical Care Medicine Fellowship, and Assistant Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
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Ghammari F, Khodayari-Zarnaq R, Jalilian H, Gholizadeh M. Barriers to health care utilization among patients with type 2 diabetes living in slums: a qualitative study from providers' perspective. Glob Health Res Policy 2023; 8:13. [PMID: 37081526 PMCID: PMC10120110 DOI: 10.1186/s41256-023-00296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Due to slum dwellers' deprivation, they are more likely to develop Type 2 Diabetes (T2D) and its complications. Type 2 Diabetes is a long-life disease that requires continuous health care utilization. One of the negative outcomes of slum-dwelling is health care underutilization. Therefore, this study aimed to understand barriers to health care utilization among those with T2D living in Tabriz slums, Iran, from the perspective of healthcare providers, in 2022. METHODS A phenomenological approach was used in this study. Purposive sampling for conducting in-depth interviews was used to select 23 providers consisting of general practitioners, midwives, nutritionists, and public health experts. We conducted a content analysis using the 7 stages recommended by Colaizzi. We used four criteria recommended by Lincoln and Guba for ensuring the research's trustworthiness. RESULTS Three main themes and 8 categories were developed. Three main themes are 1) health care provision system barriers, including four categories: lack of motivation, non-availability of facilities and doctors, poor relationship between patients and providers, and disruption in the process 2) coverage problems, including two categories: insurance inefficiency, and limited access, and 3) contextual barriers, including two categories: environmental problems, and socioeconomic barriers. CONCLUSIONS Recommendations are presented in three levels to improve implementation. The health care system needs to modify the payment methods, Patients-providers relationship improvement, and increase the number of providers. Insurance organizations should consider sufficient coverage of costs for slum-dwellers with T2D and expand the benefits package for them. Government should consider infrastructure upgrading in slums to eliminate barriers related to slum-dwelling. Overall, health care utilization promotion needs intersection cooperation.
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Affiliation(s)
- Fawzieh Ghammari
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Habib Jalilian
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masumeh Gholizadeh
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
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Liaw SY, Tan JZ, Lim S, Zhou W, Yap J, Ratan R, Ooi SL, Wong SJ, Seah B, Chua WL. Artificial intelligence in virtual reality simulation for interprofessional communication training: Mixed method study. NURSE EDUCATION TODAY 2023; 122:105718. [PMID: 36669304 DOI: 10.1016/j.nedt.2023.105718] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Virtual reality simulations are shown to be an effective approach for interprofessional nurse-physician communication training. However, its scalability is constrained by unequal medical-nursing cohort size, rendering a great challenge for all nursing students to form an interprofessional team with medical students. With the evolution of artificial intelligence (AI), an AI medical team player can be integrated into virtual reality simulations for more nursing students to engage in interprofessional team training. OBJECTIVES To describe the development of a novel AI-enabled virtual reality simulation (AI-enabled VRS) and to evaluate nursing students' competencies and experiences in communicating with an AI medical doctor. METHODS A mixed-methods design using a one-group pretest-posttest design and focus group discussions were employed in the evaluation phase. Nursing students from a university were recruited to undertake the 2-hour AI-enabled VRS. Pre-test and post-tests were administered to evaluate the participants' communication knowledge and self-efficacy. Survey questionnaires were administered to examine their experiences with the virtual reality environment and the AI doctor. Five focus group discussions were conducted to gain deeper insight into their learning experiences. RESULTS The participants demonstrated significant improvements in communication knowledge and interprofessional communication self-efficacy after the learning. They reported positively on the acceptability, feasibility and usability of the AI-enabled VRS. The subscale of "human-like" feature of the AI medical doctor was rated the lowest. Three themes surrounding participants' experiences of the virtual learning emerged: "relate to the real world", "artificial intelligence versus human intelligence" and "complement with face-to-face learning". CONCLUSIONS This study demonstrates initial evidence on the potential of AI-enabled VRS in fostering nursing students' learning on interprofessional communication skills. The findings have also provided insights on how to improve the AI-enabled VRS, in particular, the expressiveness of the AI pedagogical agent and facilitating more dialogue trainings with learner-agent conversations.
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Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Jian Zhi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siriwan Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John Yap
- NUS Information Technology, National University of Singapore, 2 Engineering Drive 4, 117584, Singapore
| | - Rabindra Ratan
- Department of Media & Information, Michigan State University, Address: 404 Wilson Rd, Communication Arts and Sciences Building, East Lansing, MI, USA
| | - Sim Leng Ooi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shu Jing Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Saiki M, Takemura Y, Kunie K. Relationship between Unit-Level Nurses' Expectations from Nursing Assistant Roles and Individual Nursing Assistants' Information-Sharing Behaviors: A Multilevel Mediation Analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2023; 17:1-7. [PMID: 36481418 DOI: 10.1016/j.anr.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This study aimed to investigate the relationship between the expectations of unit-level nurses from nursing assistants (NAs), frequency of individual NAs' information-sharing behaviors with nurses, and the effect of NAs' self-perceived roles on this relationship. NAs provide patient care along with nurses, and their information-sharing behaviors with nurses may be influenced by the expectations of the nurses. METHODS Nurses and NAs from 104 integrated community care (sub- and postacute) units were included in this Japanese cross-sectional study conducted from July to September 2018. Nurses' expectations from NAs and the NAs' self-perceived roles and information-sharing frequency were measured. Multilevel mediation analysis was performed for NAs' information-sharing behaviors, such as expressing, asking, providing linguistic responses, and providing feedback. RESULTS Unit-level nurses' expectations from NAs were associated with the frequency of NAs' asking and responding behaviors with nurses (p < .05), mediated by the NAs' self-perceived roles. The frequency of NAs' expressing behaviors and feedback were also associated with their self-perceived roles (p < .001). CONCLUSIONS High expectations of unit-level nurses from NAs led to better perception by NAs of their roles and led to better information-sharing behaviors. Educating nurses on NAs' roles may improve information-sharing between nurses and NAs that leads to safe and appropriate care to patients.
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Affiliation(s)
- Masatoshi Saiki
- Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate School of Nursing, Chiba University, Japan; Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan.
| | - Yukie Takemura
- Nursing Department, The University of Tokyo Hospital, Japan
| | - Keiko Kunie
- Department of Nursing Administration, School of Nursing, Tokyo Women's Medical University, Japan; Department of Nursing Administration, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan
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Jenkins AM, Weber DE, Arfaa JJE, Arken A, Clark DL, Dobbs E, Lahbabi B, Myers K, Tu J, Clarke-Myers K. Using participatory research to identify actionable facilitators and barriers to effective inpatient interdisciplinary communication. J Hosp Med 2023; 18:130-138. [PMID: 36448186 DOI: 10.1002/jhm.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Communication failures occur often in the inpatient setting. Efforts to understand and improve communication often exclude patients or are siloed by discipline. OBJECTIVE We aimed to identify barriers and facilitators to effective communication within interdisciplinary inpatient internal medicine (IM) teams using a participatory research approach. DESIGN We conducted a single-center participatory mixed methods study using group-level assessment (GLA) and concept mapping to iteratively engage stakeholders. Stakeholder groups included patients/families, IM faculty, IM residents, nurses and ancillary staff, and care managers. Stakeholder-specific GLA sessions were conducted. Participants responded to prompts addressing interdisciplinary communication then worked in small groups to synthesize the qualitative data into unique ideas. A subset of each stakeholder group then sorted ideas through a concept mapping exercise. Multidimensional scaling and hierarchical cluster analysis were used to generate a concept map of the data. RESULTS Participants generated 97 unique ideas that were then sorted. The research team chose an eight-cluster concept map representing patient inclusion and engagement, processes and resources, team morale and inclusive dynamics, attitudes and behaviors, effective communication, barriers to communication, the culture of healthcare, and clear expectations. Three larger domains of patient inclusion and engagement, organizational conditions and role clarity, and team dynamics and behaviors were noted. CONCLUSION Use of a participatory research approach made it feasible to engage diverse stakeholders including patients. Our results highlight the need to identify context-specific facilitators and barriers of interdisciplinary communication. The importance of clear expectations was identified as a prioritized area to target communication improvement efforts.
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Affiliation(s)
- Ashley M Jenkins
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Danielle E Weber
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Danielle L Clark
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily Dobbs
- Department of Biology, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Betina Lahbabi
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Kurt Myers
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Jamie Tu
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Katherine Clarke-Myers
- Quality and Value, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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LeBaron V, Flickinger T, Ling D, Lee H, Edwards J, Tewari A, Wang Z, Barnes LE. Feasibility and acceptability testing of CommSense: A novel communication technology to enhance health equity in clinician-patient interactions. Digit Health 2023; 9:20552076231184991. [PMID: 37456129 PMCID: PMC10338668 DOI: 10.1177/20552076231184991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Quality patient-clinician communication is paramount to achieving safe and compassionate healthcare, but evaluating communication performance during real clinical encounters is challenging. Technology offers novel opportunities to provide clinicians with actionable feedback to enhance their communication skills. Methods This pilot study evaluated the acceptability and feasibility of CommSense, a novel natural language processing (NLP) application designed to record and extract key metrics of communication performance and provide real-time feedback to clinicians. Metrics of communication performance were established from a review of the literature and technical feasibility verified. CommSense was deployed on a wearable (smartwatch), and participants were recruited from an academic medical center to test the technology. Participants completed a survey about their experience; results were exported to SPSS (v.28.0) for descriptive analysis. Results Forty (n = 40) healthcare participants (nursing students, medical students, nurses, and physicians) pilot tested CommSense. Over 90% of participants "strongly agreed" or "agreed" that CommSense could improve compassionate communication (n = 38, 95%) and help healthcare organizations deliver high-quality care (n = 39, 97.5%). Most participants (n = 37, 92.5%) "strongly agreed" or "agreed" they would be willing to use CommSense in the future; 100% (n = 40) "strongly agreed" or "agreed" they were interested in seeing information analyzed by CommSense about their communication performance. Metrics of most interest were medical jargon, interruptions, and speech dominance. Conclusion Participants perceived significant benefits of CommSense to track and improve communication skills. Future work will deploy CommSense in the clinical setting with a more diverse group of participants, validate data fidelity, and explore optimal ways to share data analyzed by CommSense with end-users.
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Affiliation(s)
| | | | - David Ling
- University of Virginia School of Medicine, Charlottesville, VA
| | - Hansung Lee
- University of Virginia School of Medicine, Charlottesville, VA
| | - James Edwards
- University of Virginia School of Nursing, Charlottesville, VA
| | - Anant Tewari
- University of Virginia School of Medicine, Charlottesville, VA
| | - Zhiyuan Wang
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA
| | - Laura E Barnes
- University of Virginia School of Engineering & Applied Science, Charlottesville, VA
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Yilmaz K, Taşçi-Duran E. Examining the views of nurses working in gynecology and obstetrics clinics on collaborative practice. Health Care Women Int 2022:1-21. [PMID: 36409711 DOI: 10.1080/07399332.2022.2144861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
We aimed to reveal the attitudes and perceptions of a group of nurses toward collaborative work and the barriers to collaborative practice. At the end of the study, we obtained four main themes: leadership in health services, interpersonal interaction factors, cooperation in patient care, standardization. The nurses emphasized the critical elements of respect, relationships and communication as components of effective collaborative practice. As a result, it was stated that the practice of cooperation between doctors and nurses is weak and there are some difficulties and obstacles.
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Affiliation(s)
- Kubra Yilmaz
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
| | - Emel Taşçi-Duran
- Health Sciences Faculty, Obstetrics and Gynecology Nursing Department, Süleyman Demirel University, Isparta, Turkey
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27
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Tesseyman S, Peterson K, Beaumont E. The nurse apprentice and fundamental bedside care: An historical perspective. Nurs Inq 2022:e12540. [DOI: 10.1111/nin.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
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Agnese BL, Daniel ACQG, Pedrosa RBDS. Communicating bad news in the practice of nursing: an integrative review. EINSTEIN-SAO PAULO 2022; 20:eRW6632. [PMID: 35894377 PMCID: PMC9337845 DOI: 10.31744/einstein_journal/2022rw6632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To analyze current scientific knowledge about communication of bad news by nurses. Methods This is an integrative literature review carried out by searching articles published in national and international journals indexed at SciELO, MEDLINE® (PubMed®), Scopus, Bireme and CINAHL, from 2010 to 2020, by crossing the controlled descriptors “communication”, “revelation of the truth”, and “nursing”, and the uncontrolled descriptor “bad news”. Results Ten articles with qualitative and cross-sectional design, as well as case reports were included. The analysis indicated the evidence available in the literature showed the nurses’ lack of ability to communicate bad news, although they are professionals who have close contact with patients and families and who establish a strong bond with them, and often face challenging situations for communicating bad news. Conclusion There is an evident need to invest in training of nurses on skills to communicate bad news and establish a nurse-patient bond when dialoguing with the family. There are few studies in the literature addressing this issue; therefore, it is recommended to perform research that can contribute to improvements in the clinical practice and developing protocols to promote such care.
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Becker V, Jedlicska N, Scheide L, Nest A, Kratzer S, Hinzmann D, Wijnen-Meijer M, Berberat PO, Haseneder R. Changes in medical students´ and anesthesia technician trainees´ attitudes towards interprofessionality - experience from an interprofessional simulation-based course. BMC MEDICAL EDUCATION 2022; 22:273. [PMID: 35418136 PMCID: PMC9006475 DOI: 10.1186/s12909-022-03350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Interprofessional simulation based education (IPSBE) programs positively impact participants' attitudes towards interprofessional collaboration and learning. However, the extent to which students in different health professions benefit and the underlying reasons for this are subject of ongoing debate. METHODS We developed a 14-h IPSBE course with scenarios of critical incidents or emergency cases. Participants were final year medical students (FYMS) and final year anesthesia technician trainees (FYATT). To assess attitudes towards interprofessionalism, the University of the West of England Interprofessional Questionnaire was administrated before and after the course. Using focus group illustration maps, qualitative data were obtained from a subcohort of the participants (n = 15). RESULTS After the course, self-assessment of communication and teamwork skills, attitudes towards interprofessional interactions and relationships showed comparative improvement in both professions. Attitudes towards interprofessional learning improved only in FYMS. Qualitative data revealed teamwork, communication, hierarchy and the perception of one's own and other health profession as main topics that might underlie the changes in participants' attitudes. An important factor was that participants got to know each other during the course and understood each other's tasks. CONCLUSIONS Since adequate communication and teamwork skills and positive attitudes towards interprofessionality account to effective interprofessional collaboration, our data support intensifying IPSBE in undergraduate health care education.
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Affiliation(s)
- Veronika Becker
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Nana Jedlicska
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Laura Scheide
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Alexandra Nest
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Stephan Kratzer
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - Dominik Hinzmann
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - Marjo Wijnen-Meijer
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Pascal O Berberat
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Rainer Haseneder
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany.
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care, Munich, Germany.
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Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme? Int J Integr Care 2022; 22:22. [PMID: 35756340 PMCID: PMC9205373 DOI: 10.5334/ijic.6005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Inter-organisational collaboration is challenging but essential in managing the complex and comprehensive needs of frail older people. Therefore, there is a need to investigate the influence of different barriers to inter-organisational collaboration when implementing an integrated care programme. The aim of this study was to investigate both inpatient and outpatient staff views on the factors they deemed to be influential to inter-organisational collaboration for an integrated care programme. Methods The study was a cross-sectional study and included staff from hospitals, primary care and municipal health and social care. Results There were no significant differences between staff from inpatient and outpatient care in measuring factors that may cause difficulties for inter-organisational collaboration. Staff views diverged significantly on all factors, such as educational level at long physical distances, laws and regulations, knowledge of each others work settings, experience from inter-organisational collaboration, different professions, variations in professional status and power, psychosocial factors such as positive work environment and interpersonal chemistry. Discussion A multidisciplinary team culture and avenues for inter-organisational collaboration need to be developed for improved care continuity. Conclusion The staffs' educational level influenced what was perceived as barriers to inter-organisational collaboration, and may guide future development of integrated care programmes.
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LeBaron V, Boukhechba M, Edwards J, Flickinger T, Ling D, Barnes LE. Exploring the use of wearable sensors and natural language processing technology to improve patient-clinician communication: Protocol for a feasibility study (Preprint). JMIR Res Protoc 2022; 11:e37975. [PMID: 35594139 PMCID: PMC9166632 DOI: 10.2196/37975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Mehdi Boukhechba
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
| | - James Edwards
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Tabor Flickinger
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - David Ling
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Laura E Barnes
- School of Engineering & Applied Science, University of Virginia, Charlottesville, VA, United States
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The Institutional Factors Affecting the Growth of Korean Migrant Care Market and Sustainability in Long-Term Care Quality. SUSTAINABILITY 2022. [DOI: 10.3390/su14063366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due to an increase in the ageing population, the migrant care market now includes new home-based long-term care (LTC) under the national long-term care insurance. This study underlines a perspective of the Korean migrant care market in terms of long-term care quality in South Korea. Thus, the study explored the institutional factors that restrict and promote the migrant care workers (MCWs). Two migrant workers groups were analysed: migrant care workers in home-based long-term care versus nursing hospitals. Designed as an in-depth policy-oriented content analysis, this study used three types of data including interviews with eight participants (MCWs, the nursing hospital manager, and the LTC home manager), organisational documents (employment eligibility criteria), and institutional texts (law, administration rules, etc.). Our results indicate that the factors hindering employment of MCWs in home-based LTC were visa status, qualification requirements (the National Qualified License), wage regulation policies, and social security obligations. A promoting factor was jobs that hired on an on-call basis. In conclusion, our findings suggest that the growth of the migration care market and sustainability in LTC quality depend on the policy directions of the Korean long-term care insurance.
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Blake Gornall A, Hutchinson AM, Redley B. Clinician perspectives of pregnant women's participation in antiemetic decision-making: A qualitative study. Nurs Health Sci 2022; 24:54-64. [PMID: 35174947 DOI: 10.1111/nhs.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
This study explored clinician perceptions of women's participation in decision-making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi-structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician-led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision-making about antiemetic treatments: (i) information gathering; (ii) developing an understanding; (iii) using knowledge; and (iv) making decisions. Clinician attitudes and perspectives, as well as their self-reported styles of communication and negotiation, influenced how they engaged with women during decision-making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision-making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician-related barriers to shared decision-making.
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Affiliation(s)
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
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King O, Shaw N. ' … breaks down silos': allied health clinicians' perceptions of informal interprofessional interactions in the healthcare workplace. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:47-63. [PMID: 33661074 DOI: 10.1080/14461242.2021.1886865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
Informal interprofessional interactions have gained interest in recent interprofessional care, education, health services and social sciences research literature. Some of the established benefits associated with these interactions include enhanced communication, teamwork, research translation and the provision of safer care. Limited evidence about how informal interprofessional interactions are perceived by the allied health workforce, exists. The survey conducted at a large Australian health service explored allied health clinicians' perceptions of the benefits, challenges and enablers of informal interprofessional interactions and their recommendations to improve opportunities for these workplace interactions. Sixty-four responses were analysed descriptively (for close-ended questions) and using a framework analysis approach, informed by Bourdieu's social space theory (for open-ended questions). Perceived benefits were aligned with three themes: teams and organisations, individual clinicians and service-users. Challenges to, and enablers of, informal interprofessional interactions were identified according to five themes: socio-cultural practices, physical environment, timing-related factors, individual and organisational factors. Participant recommendations to increase opportunities for informal interprofessional workplace interactions for allied health reflected three of the aforementioned themes: socio-cultural practices, physical environment and organisational factors. This theoretically-informed analysis may aid in the development of strategies to support these types of workplace interactions and realise the benefits identified.
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Affiliation(s)
- Olivia King
- Allied Health, University Hospital Geelong, Geelong, Australia
- Allied Health, South West Healthcare, Warrnambool, Australia
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Australia
| | - Nicole Shaw
- Clinical Education and Training, University Hospital Geelong, Geelong, Australia
- School of Psychology, Deakin University, Geelong, Australia
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The Case for Interprofessional Teaching in Graduate Medical Education. ATS Sch 2022; 3:20-26. [PMID: 35634009 PMCID: PMC9131883 DOI: 10.34197/ats-scholar.2021-0091ps] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
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Melo LC, Lima FR, Bracarense CF, Ferreira JFMF, Ruiz MT, Parreira BDM, Goulart BF. Inter-professional relationships in the Family Health Strategy: perception of health management. Rev Bras Enferm 2022; 75:e20210636. [DOI: 10.1590/0034-7167-2021-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: to analyze the teamwork in the Family Health Strategy from the perspective of professionals from the Primary Care Department and the municipal manager/secretary of health of a Municipal Health Secretariat. Methods: an exploratory/qualitative study. All professionals of the Department and municipal manager/municipal health secretary/interior of Minas Gerais participated. Data collection was through semi-structured interviews/May to November/2019. Data analysis: Content analysis/thematic mode and work process theoretical referential. Results: three categories emerged: Inter-professional relations permeated by non-material instruments of work; Professional training, experience, and profile influence teamwork; and Proposals for the realization of teamwork in the Family Health Strategy. Results revealed assumptions for teamwork in the referred Strategy, facilitators/difficulties/strategies for its realization, according to the professionals. Final Considerations: collaboration/communication/proactivity to facilitate teamwork. Need for approximation between municipal management and Family Health Strategy to achieve teamwork.
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Pyfer BJ, Hernandez JA, Glener AD, Cason RW, Levinson H, Phillips BT. Leadership and Advanced Degrees: Evaluating the Association Between Dual Degrees and Leadership Roles in Academic Plastic Surgery. Ann Plast Surg 2022; 88:118-121. [PMID: 34928245 DOI: 10.1097/sap.0000000000003029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are increasingly prevalent formal educational programs for physicians who seek to be better trained to advance their fields. Although higher education and advanced degrees are not necessarily linked to leadership, we hypothesize that leaders in plastic surgery commonly have dual degrees. We sought to evaluate the prevalence of and association between additional advanced degrees in academic plastic surgery and plastic surgery leadership. METHODS Plastic surgery faculty from 96 academic training programs and all executive committee and board of directors' members from national, regional, and local plastic surgery societies were evaluated. Surgeons' institutional online profile pages, personal web pages, societal websites, and LinkedIn profiles were all evaluated for current/past leadership roles, as well as for advanced degree. Odds ratios (ORs) were used to determine if the presence of extra degrees increased their likelihood of leadership roles. RESULTS A total of 1036 plastic surgeons were evaluated. Sixteen percent of academic faculty have a dual degree. Furthermore, 25.5% of plastic surgeons holding formal academic leadership roles have a dual degree (OR, 2.15; P = 0.043), as do 34.4% of those serving on the executive committee or board of directors in national plastic surgery societies (OR, 2.23; P = 0.026) and 29.2% of those serving in local/regional societal leadership roles (OR, 1.96; P = 0.043). Among all dual degrees, Masters in Business Administration has the highest association with leadership roles (OR, 3.45; P = 0.002). CONCLUSIONS Academic plastic surgeons with dual degrees are approximately twice as likely to hold a formal academic or societal leadership role. Additional studies are needed to determine if causative relationships exist.
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Affiliation(s)
- Bryan J Pyfer
- From the Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC
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Status shields and pharmacy work: Differences among workers by role and context. Soc Sci Med 2021; 293:114671. [PMID: 34959044 DOI: 10.1016/j.socscimed.2021.114671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/28/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022]
Abstract
Status and workplace context directly affect employee experiences at work. This study looks at an understudied essential health professional group: pharmacy workers. Using survey data from 298 pharmacy workers in the United States we test how status, status shields, and work context relate to perceptions of one's work. Specifically, we investigate how pharmacy roles (i.e., pharmacy technicians, pharmacists, and PharmD students) and pharmacy context (i.e., independent community, retail chain, and hospital care) affect feelings about work. Following research on status shields at work and the job characteristics model, we pose hypotheses about meaning in work, impact at work, as well as job satisfaction, and intent to quit. This study uses a conceptualization of status shields as both part of the pharmacy hierarchy and associated with work contexts. Further, testing the assumptions of the job characteristics model using varied work roles and contexts offers additional evidence the model's value. We offer implications for health and organizational social science across disciplines, as well as practical implications for scholars and practitioners.
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Developing a Hybrid Platform for Emergency Remote Education of Nursing Students in the Context of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412908. [PMID: 34948516 PMCID: PMC8701025 DOI: 10.3390/ijerph182412908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
Due to the COVID-19 pandemic, many nursing students are being taught remotely. Remote learning has drawbacks, such as decreased motivation for learning and difficulties conveying the instructor's intentions. Strategies that compensate for the shortcomings of remote learning should be identified. This study aimed to evaluate the understanding of the knowledge use and awareness of negotiation methods through cases and teaching tools in nursing student classes on environmental assessment and daily life support, and to examine whether supplementary assistance can compensate for the drawbacks of remote learning. This study used a mixed-method design, and included 59 second-year nursing students attending an environmental assessment course in 2021. Students' knowledge use and awareness of negotiation methods were evaluated using self-assessment worksheets before and after the class. The pre- and post-class scores were compared using the Wilcoxon signed-rank test. The mean knowledge score increased significantly during the study period (p < 0.001). Students acquired awareness of how to use the knowledge gained during class and negotiation awareness by observing role play, factors that strengthen motivation when learning alone. This study provides insight into the potential of class supplements to compensate for the deficits of remote learning. Supplementing the shortcomings of remote learning should be a priority and may be a focal point of hybrid learning.
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Sukhera J, Bertram K, Hendrikx S, Chisolm MS, Perzhinsky J, Kennedy E, Lingard L, Goldszmidt M. Exploring implicit influences on interprofessional collaboration: a scoping review. J Interprof Care 2021; 36:716-724. [PMID: 34602007 DOI: 10.1080/13561820.2021.1979946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interprofessional collaboration (IPC) is fraught with multiple tensions. This is partly due to implicit biases within teams, which can reflect larger social, physical, organizational, and historical contexts. Such biases may influence communication, trust, and how collaboration is enacted within larger contexts. Despite the impact it has on teams, the influence of bias on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within interprofessional teams. Using scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, selecting 159 articles for full-text eligibility. From these, reviewers extracted, coded, and iteratively analyzed key data using a framework derived from socio-material theories. Authors found that many studies demonstrated how biases regarding dominance and expertise were internalized by team members, influencing collaboration in predominantly negative ways. Articles also described how team members dynamically adapted to such biases. Overall, there was a paucity of research that described material influences, often focusing on a single material element instead of the dynamic ways that humans and materials are known to interact and influence each other. In conclusion, implicit biases are relatively under-explored within IPC. The lack of research on material influences and the relationship among racial, age-related, and gender biases are critical gaps in the literature. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings.
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Affiliation(s)
- Javeed Sukhera
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kaitlyn Bertram
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Shawn Hendrikx
- Western University Libraries, Western University, London, Ontario, Canada
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Erin Kennedy
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Penko M, Quirt H, Schindel Martin L, Iaboni A. Behaviour assessment tools in long-term care homes in Canada: a survey. Aging Ment Health 2021; 25:1857-1868. [PMID: 32691610 DOI: 10.1080/13607863.2020.1793904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Many people living in long-term care homes (LTCH) experience changes in behaviour termed the behavioural and psychological symptoms of dementia (BPSD). The valid and reliable assessment of BPSD is essential to guide treatment and monitor the effect of interventions. The aim of this study was to identify behavioural assessment tools implemented in LTCH and factors that impact on their use in clinical care. METHODS We completed an online mixed-design survey of 300 randomly selected Canadian LTCH between September and November 2018. Respondents were asked to report tools used, reasons for use, methods of administration, training/supports available, confidence in use and challenges faced. Survey results were summarized descriptively and the correlation between implementation supports and confidence examined. Free-text responses were analysed qualitatively. RESULTS Of 300 LTCH invited to participate, 103 completed the survey. Homes reported using a mean 2.2 ± 1.1 (range 0-7) different tools. The two most commonly used tools were the Dementia Observation System (DOS) and Cohen-Mansfield Agitation Inventory (CMAI). Overall confidence in most aspects of tool use was reported to be high, with workload identified as the greatest challenge. Training and supports correlated with confidence in tool use. Qualitative findings indicate tools provide valuable data to understand behaviours, facilitate team communication, target interventions and track outcomes. CONCLUSIONS Behavioural assessment tools, in particular a direct observation tool, are widely used in clinical care in Canadian LTCH. Education, enhanced resources, leadership support and applications of technology represent opportunities to improve their use.
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Affiliation(s)
- Marion Penko
- St. Joseph's Healthcare Hamilton, Halton Seniors Mental Health Outreach, Burlington, Ontario, Canada
| | - Hannah Quirt
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Lori Schindel Martin
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Hewko SJ, Clow S, Oyesegun A, Vanleeuwen C. High Turnover in Clinical Dietetics: A Descriptive Analysis. CAN J DIET PRACT RES 2021; 83:46-48. [PMID: 34582259 DOI: 10.3148/cjdpr-2021-023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To identify key attributes of Canadian clinical registered dietitian (RD) jobs associated with high rates of turnover.Methods: Managers of clinical RDs in Canada were eligible to complete a survey on the topic of turnover in clinical RD positions. Specifically, key details were sought regarding positions with the highest and lowest turnover in each manager's portfolio.Results: High turnover (HT) positions turned over an average of 4.0 times in a 5-year period in contrast to 0.3 times in low turnover (LT) positions. Resignation was the top reason for turnover in both HT and LT positions. HT and LT positions were of analogous full-time equivalent, had comparable caseloads, and served clients/patients with similar diagnoses including diabetes and neurological conditions.Conclusions: There is significant variation in the frequency of turnover across positions in clinical dietetics in Canada. What differentiates HT positions from LT positions remains unclear. More research is required to guide managers seeking to balance turnover and preclude uneven nutrition care quality across units and programs.
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Affiliation(s)
- Sarah J Hewko
- University of Prince Edward Island, Charlottetown, PE
| | - Samantha Clow
- Dietetic Intern, University of Prince Edward Island, Charlottetown, PE
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Low S, Gray E, Ewing A, Hain P, Kim L. Remodeling Interprofessional Collaboration Through a Nurse-for-a-Day Shadowing Program for Medical Residents. J Multidiscip Healthc 2021; 14:2345-2349. [PMID: 34475761 PMCID: PMC8407776 DOI: 10.2147/jmdh.s319728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Evidence reflects that effective collaboration leads to improved care quality, patient satisfaction, nurse and physician retention, as well as decreased length of stay, readmissions, and costs. While interprofessional collaboration is widely accepted as the gold standard for health care, room for improvement exists within the nurse–physician relationship. Purpose To evaluate the impact of a shadowing experience on nursing and resident perceptions of communication and collaboration through a shared clinical experience in providing direct patient care. Methods From 2016 to 2020, the Internal Medicine Residency Training Program and Medical-Surgical Nursing Department collaborated to pair all internal medicine residents with a nurse preceptor for a 12-hour shift, where participants worked side-by-side in providing patient care. A total of 148 residents and 75 nurse preceptors participated in the study and were provided with a checklist of nursing activities as a guideline. Both residents and nurses completed a questionnaire regarding the shadowing experience utilizing a 5-point Likert scale, with questions focusing on collaboration and communication, program value, and impact on practice. Results The study found increases in resident communication with nurses from pre-intervention to post-intervention, as well as enjoyment of collaboration with nurses and understanding of the nurse’s role. Residents believed that the program should be included for all residents at the beginning of their training; similarly, nurses advocated for the program, believing that the program would improve physician–nurse communication and collaboration. Conclusion Interprofessional training through a Nurse-for-a-Day Program may strengthen nurse–resident relations by cultivating understanding essential for effective collaboration through mutual role understanding.
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Affiliation(s)
- Sarah Low
- Patient Family Support Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Emily Gray
- Patient Family Support Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Medical Nursing Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Amanda Ewing
- Patient Family Support Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Medical Nursing Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Internal Medicine Residency Training Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patricia Hain
- Patient Family Support Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Medical Nursing Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Internal Medicine Residency Training Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Surgical Nursing Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Linda Kim
- Patient Family Support Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Medical Nursing Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Internal Medicine Residency Training Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Surgical Nursing Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Sørø VL, Aglen B, Orvik A, Søderstrøm S, Haugan G. Preceptorship of clinical learning in nursing homes - A qualitative study of influences of an interprofessional team intervention. NURSE EDUCATION TODAY 2021; 104:104986. [PMID: 34111711 DOI: 10.1016/j.nedt.2021.104986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/30/2021] [Accepted: 05/17/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED This study aimed to explore the influences of an interprofessional preceptor-team intervention (IPPT) on interprofessional collaboration, preceptors' role, confidence, and motivation to precept health care students (nursing, physiotherapy) and apprentices in a Norwegian nursing home. METHODS Qualitative data were collected by two focus group discussions: possible gains and pitfalls of the IPPT-intervention were focused. The group-discussions were tape-recorded, transcribed verbatim and analysed by means of qualitative content analysis. FINDINGS The IPPT-intervention influenced positively on preceptors' confidence and motivation to work as a preceptor and facilitated interprofessional collaboration between the health professionals. The preceptors' role in the ward became clearer and more visible to the peers. Perceived lack of time, a heavy workload, the ward hierarchy, and lack of managerial support were key barriers for preceptorship. CONCLUSIONS To enhance preceptors' work and thus student's learning, the ward hierarchy should be limited and interprofessional collaboration further developed. Enhanced visibility and acknowledgement of the preceptors' role and increased managerial support can reduce barriers for preceptorship.
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Affiliation(s)
- Vera L Sørø
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Bjørg Aglen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Orvik
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Norway
| | - Sylvia Søderstrøm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Faculty of Nursing and Health Science, Nord University, Levanger, Norway
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Promoting Communication and Safety Through Clear and Concise Discharge Orders. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kakiuchi S, Burger K, Lo SHY. Improving Delirium Care in Hospitalized Older Adults: Impact of Education on Hospital Aides as Sitters. J Gerontol Nurs 2021; 47:20-26. [PMID: 34044684 DOI: 10.3928/00989134-20210507-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As one of several hospital team members involved in the management of care for older adults with delirium, hospital aides (HAs) are often relied on to provide direct patient care in the role of a sitter. Yet, many HAs have not received training about delirium, its associated behaviors, or appropriate interventions. As a consequence, there are gaps in quality of care for older adults with delirium and potential missed opportunities for HA sitters to contribute to the interdisciplinary team (IDT) care of these patients. In the current study, a quality improvement project at an urban hospital provided an educational session on delirium to HAs. Accuracy of HA delirium knowledge, delirium behavior recognition, and delivery of care to patients with delirium significantly increased across three postintervention measures (p = <0.001 to 0.016). HAs also reported increased confidence in caring for patients with delirium and in their perceived role on the IDT. [Journal of Gerontological Nursing, 47(6), 20-26.].
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Gustavsson K, Börjesson E, Björklund M, Munck B. Interprofessional collaboration in connection with a medical ship: nurses' experiences. J Clin Nurs 2021; 30:3506-3516. [PMID: 34021657 DOI: 10.1111/jocn.15853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/17/2021] [Accepted: 04/27/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe nurses´ experiences of interprofessional collaboration (IPC) in connection with a medical ship offering primary health care in Papua New Guinea. BACKGROUND More than a third of the population in Papua New Guinea are living in severe poverty, resulting in serious and fatal diseases. Due to rough terrain and lack of infrastructure, most of them cannot benefit from health care in the cities. Thus, a medical ship is used since the sea route is one of the few possible ways to reach the people. DESIGN A qualitative study with an inductive and descriptive approach was performed, and content analysis of the data was used. METHODS In January 2018, eleven nurses from seven countries were interviewed onboard the medical ship assessing their experiences when performing IPC. The COREQ checklist for qualitative studies was applied in the conduct and reporting of this study. RESULTS Three generic categories emerged: Nurses' motivation to achieve the common goal of doing good using IPC; Nurses' view of performing IPC within special conditions; and Nurses' perception of their role in IPC. Overall, the IPC was perceived by the nurses as well functioning. Having a common goal, positive mindset and effective communication improved the team's collaboration. When these aspects were accomplished, the chances of overcoming the challenge of working in new circumstances and limited space with a newly formed team were increased. CONCLUSION Good collaboration within an interprofessional team required repeated sharing of information. This demonstrates the importance of communication and engagement to overcome existing challenges when working interprofessionally. RELEVANCE TO CLINICAL PRACTICE This study recommends the establishment of IPC for similar contexts such as onboard Youth With a Mission and ashore, as well as in disaster situations or home care where the healthcare professional must collaborate and adapt to new circumstances and prevailing situations.
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Affiliation(s)
- Kristoffer Gustavsson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Ellinor Börjesson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Margereth Björklund
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,ADULT research group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Berit Munck
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,ADULT research group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Strand AS, Johnsson B, Hena M, Magnusson B, Hallström IK. Developing eHealth in neonatal care to enhance parents' self-management. Scand J Caring Sci 2021; 36:969-977. [PMID: 33950534 DOI: 10.1111/scs.12994] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Discharge from a neonatal care unit is often experienced as a vulnerable time for parents. By communicating through digital technology, it may be possible to improve the support for parents and thereby make the transition from hospital to home less stressful. AIM To develop an eHealth device supporting the transition from hospital to home for parents with a preterm-born child in Sweden using participatory design. METHOD Employing a framework of complex interventions in health care using participatory design. Parents of preterm-born infants and professionals at a neonatal department identified specific technical requirements for an eHealth device to be developed in the context of neonatal care and neonatal home care. The prospective end-users - parents and professionals - were continuously involved in the process of designing solution prototypes through meetings, verbal and written feedback, and interviews. The interviews were analysed using thematic analysis. RESULTS Technical development was carried out with the perspectives of professionals and parents in mind, resulting in an eHealth application for computer tablets. The findings from the interviews with the parents and professionals revealed three categories: The tablets felt secure, easy to use and sometimes replaced visits to hospital and at home. CONCLUSION The use of participatory design to develop an eHealth device to support a safe transition from hospital to home can benefit parents, the child, the family, and professionals in neonatal care.
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Affiliation(s)
| | - Björn Johnsson
- Department of Computer Science, Faculty of Engineering, Lund University, Lund, Sweden
| | - Momota Hena
- Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden
| | - Boris Magnusson
- Department of Computer Science, Faculty of Engineering, Lund University, Lund, Sweden
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Rezk F, Stenmarker M, Acosta S, Johansson K, Bengnér M, Åstrand H, Andersson AC. Healthcare professionals' experiences of being observed regarding hygiene routines: the Hawthorne effect in vascular surgery. BMC Infect Dis 2021; 21:420. [PMID: 33947338 PMCID: PMC8097954 DOI: 10.1186/s12879-021-06097-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 04/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Hawthorne Effect is the change in behaviour by subjects due to their awareness of being observed and is evident in both research and clinical settings as a result of various forms of observation. When the Hawthorne effect exists, it is short-lived, and likely leads to increased productivity, compliance, or adherence to standard protocols. This study is a qualitative component of an ongoing multicentre study, examining the role of Incisional Negative Pressure Wound Therapy after vascular surgery (INVIPS Trial). Here we examine the factors that influence hygiene and the role of the Hawthorne effect on the adherence of healthcare professionals to standard hygiene precautions. Methods This is a qualitative interview study, investigating how healthcare professionals perceive the observation regarding hygiene routines and their compliance with them. Seven semi-structured focus group interviews were conducted, each interview included a different staff category and one individual interview with a nurse from the Department for Communicable Disease Control. Additionally, a structured questionnaire interview was performed with environmental services staff. The results were analysed based on the inductive qualitative content analysis approach. Results The analysis revealed four themes and 12 subthemes. Communication and hindering hierarchy were found to be crucial. Healthcare professionals sought more personal and direct feedback. All participants believed that there were routines that should be adhered to but did not know where to find information on them. Staff in the operating theatre were most meticulous in adhering to standard hygiene precautions. The need to give observers a clear mandate and support their work was identified. The staff had different opinions concerning the patient’s awareness of the importance of hygiene following surgery. The INVIPS Trial had mediated the Hawthorne effect. Conclusion The results of this study indicate that the themes identified, encompassing communication, behaviour, rules and routines, and work environment, influence the adherence of healthcare professionals to standard precautions to a considerable extent of which many factors could be mediated by a Hawthorne effect. It is important that managers within the healthcare system put into place an improved and sustainable hygiene care to reduce the rate of surgical site infections after vascular surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06097-5.
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Affiliation(s)
- Francis Rezk
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden. .,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,Unit of Vascular Surgery, Department of Surgery, Region Jönköping County, Jönköping, Sweden.
| | - Margaretha Stenmarker
- Unit of Vascular Surgery, Department of Surgery, Region Jönköping County, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Paediatrics, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Karoline Johansson
- Unit of Vascular Surgery, Department of Surgery, Region Jönköping County, Jönköping, Sweden.,Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden
| | - Malin Bengnér
- Unit of Vascular Surgery, Department of Surgery, Region Jönköping County, Jönköping, Sweden.,Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden
| | - Håkan Åstrand
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Unit of Vascular Surgery, Department of Surgery, Region Jönköping County, Jönköping, Sweden
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Reid-Searl K, Crowley K, Anderson C, Blunt N, Cole R, Suraweera D. A medical play experience: Preparing undergraduate nursing students for clinical practice. NURSE EDUCATION TODAY 2021; 100:104821. [PMID: 33751997 DOI: 10.1016/j.nedt.2021.104821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Undergraduate nursing programs are required to prepare nursing students to care for people across the lifespan, however due to limited paediatric nursing content in undergraduate nursing curricula and limited paediatric clinical placements, nursing graduates may lack competence and experience in caring for children. OBJECTIVES The aim of this study was to enhance undergraduate nursing students' work readiness and confidence to care for children by immersing them in a mock paediatric ward experience where students could practice using medical play to communicate and engage with children. PARTICIPANTS Participants (n = 22) were undergraduate nursing students recruited across all years from a Bachelor of Nursing program. DESIGN Participants were involved in a mock paediatric hospital experience providing them the opportunity to engage with children from 2 to 8 years. METHODS A mixed methods approach was used. Participants completed a confidence scale questionnaire pre and post the mock paediatric ward experience and a satisfaction scale post the experience. Inductive thematic analysis was used to analyse qualitative data. Quantitative data was analysed using the Wilcoxon Signed-Ranked Test. RESULTS Findings indicated a marked improvement in paediatric nursing skills and work readiness among the student nurses post intervention. Participants developed confidence in the use of medical play in the mock paediatric nursing setting. Improvements in paediatric nursing skills in relation to clinical learning, clinical reasoning and clinical confidence were reported. CONCLUSIONS The mock children's ward provided a real time paediatric experience for undergraduate nursing students to practice using medical play to communicate and engage with children. Nursing students had the opportunity to experience children's play, practice age related communication and provide explanations to children about hospital related procedures that children may encounter. With the lack of paediatric placements, it is necessary that nursing curricula examine strategies to enhance the learning for undergraduate students about paediatrics.
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Affiliation(s)
- Kerry Reid-Searl
- School of Nursing, Midwifery and Social Sciences, CQUniversity, North Rockhampton, QLD 4701, Australia.
| | - Kate Crowley
- School of Nursing, Midwifery and Social Sciences, CQUniversity, North Rockhampton, QLD 4701, Australia.
| | - Carina Anderson
- School of Nursing, Midwifery and Social Sciences, CQUniversity, North Rockhampton, QLD 4701, Australia.
| | - Nicole Blunt
- School of Nursing, Midwifery and Social Sciences, CQUniversity, North Rockhampton, QLD 4701, Australia
| | - Rachelle Cole
- School of Nursing, Midwifery and Social Sciences, CQUniversity, North Rockhampton, QLD 4701, Australia.
| | - Dayani Suraweera
- School of Nursing, Midwifery and Social Sciences, CQUniversity, 160 Ann St, Brisbane City, QLD 4000, Australia.
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