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Wittenberg E, Goldsmith JV, Chen C(K, Prince-Paul M. A conceptual model of the nurse's role as primary palliative care provider in goals of care communication. PEC INNOVATION 2024; 4:100254. [PMID: 38298557 PMCID: PMC10828588 DOI: 10.1016/j.pecinn.2024.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/10/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
Objective Nurses have opportunities to engage in goals of care conversations that can promote palliative care communication. The purpose of this study was to describe nurses' experiences in goals of care communication as summarized in the literature and to present a conceptual model of communication pathways for nurses. Methods An integrative review of the literature (2016-2022) addressing nurses' experiences in goals of care communication was conducted using PubMed, CINAHL, and PsychInfo databases. A total of 92 articles were retrieved. A total of 12 articles were included for this review after applying the inclusion and exclusion criteria. Results Of the 12 articles, the majority were qualitative studies (n = 8). Qualitative analysis of findings from all articles revealed three dominant themes: nurses' ambiguous role responsibilities, goals of care as end-of-life communication, and the need for nurse communication training. Conclusion This article suggests an innovative conceptual model for advancing nurse communication about goals of care to facilitate primary palliative care. Innovation The framework characterizes two communication pathways for Advanced Practice Nurses who direct goals of care discussions and Registered Nurses who support goals of care communication. The model informs future communication training aimed at supporting primary palliative care.
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Affiliation(s)
- Elaine Wittenberg
- From California State University Los Angeles, Department of Communication Studies, Los Angeles, CA, USA
| | - Joy V. Goldsmith
- From University of Memphis, Department of Communication and Film, Memphis, TN, USA
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Mann RA, Cleveland BE, Albersheim JA, Koyle MA. Turning the "Page" Again: Decreasing Inappropriate After-Hours Pages. Urology 2024:S0090-4295(24)00653-8. [PMID: 39147166 DOI: 10.1016/j.urology.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 07/02/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES To decrease the number of inappropriate pages after-hours by 50%. METHODS Over nine weeks, after-hours pages to the on-call resident at [INSTITUTION] Department of Urology were documented. Pages were deemed "appropriate" or "inappropriate" by three independent reviewers. The source of each page was reviewed and after several plan-do-study-act (PDSA) cycles, three separate interventions were created, directed at floor nursing, patient phone calls, and the call triage center. After a six-weeks implementation period, data was re-collected for nine weeks. Descriptive statistics were generated, and a Mann-Whitney U test was used to compare inappropriate pages pre- and post- interventions. RESULTS In phase I, 48 shifts were recorded. The mean number of pages per shift was 8.9 (range 1-27), with 52.7% of pages considered "inappropriate." Most pages came from the wards (48.9%) followed by the emergency department (20.4%), patient phone calls (19.4%), and the call center (2.6%). From these domains, the call center had the highest proportion of inappropriate pages (90.9%). In phase II, 39 shifts were recorded. The mean number of pages per shift decreased to 6.0 (range 1-20), and inappropriate pages per shift decreased by 68.4%, (p<0.0001). CONCLUSIONS By improving communication to nurses, patients, and call center personnel, inappropriate after-hours pages decreased by 68.4%- exceeding our aim. Future studies are needed to assess if the impact was sustainable over time.
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Affiliation(s)
- Rachel A Mann
- The University of Minnesota Department of Urology, Minneapolis, MN.
| | | | | | - Martin A Koyle
- The University of Minnesota Department of Urology, Minneapolis, MN
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Verhagen MJ, Frouws MA, Timmer RA, Schepers A, Brunsveld-Reinders AH, de Vos MS, Hamming JF. How to Support Communication Between Nurses and Residents During Shift Work: A Mixed-Methods Study Into Local Practices and Perceptions. JOURNAL OF SURGICAL EDUCATION 2024; 81:1034-1043. [PMID: 38879374 DOI: 10.1016/j.jsurg.2024.05.017] [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: 02/29/2024] [Revised: 04/15/2024] [Accepted: 05/20/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE The aim of this study was to explore local practices and perceptions of effective nurse-resident communication during shifts. Subsequently, effective communication was sought to be reinforced by implementing an initiative for improvement. DESIGN A mixed-methods study was performed, combining a questionnaire with focus groups. Following qualitative analysis, 3 initiatives for improvement of nurse-resident communication were scrutinized, after which 1 initiative was implemented. Overall contentment with the implementation and effectiveness of communication was reassessed through a questionnaire at 3 months postimplementation. SETTING This study took place between 2022 and 2023 at the Department of Surgery of the Leiden University Medical Center, a tertiary center in the Netherlands. PARTICIPANTS All surgical nurses (n = 150) and residents (n = 20) were invited to participate, by responding to the questionnaire and take part in the focus groups. A total of 38 nurses (response rate 25.3%) and 12 residents (60%) completed the questionnaire, and 31 nurses and 13 residents participated in the focus groups. RESULTS The themes "clarity," "mutual respect," "accessibility" and "approach" were critical for effective communication, in which there were interdisciplinary differences in the interpretation and needs regarding "clarity." In response, structured moments for interdisciplinary consultation during shifts were implemented, which were foremostly useful according to nurses (73.9%), compared to residents (40.0%). A majority of the nurses agreed that communication during shifts improved through fixed moments (60.9%). CONCLUSION Differences in the perception of critical elements for efficient nurse-resident communication during shifts can be found, which could possibly be explained by differences in training and culture. Mutual awareness for each other's tasks, responsibilities and background seems vital for the ability to deliver good patient care during shifts. To improve interprofessional practice and overcome concerns of quality of care, attention for local practices is imperative. Practical arrangements, such as fixed moments for peer communication, can strengthen partnership during shift work.
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Affiliation(s)
| | | | | | - Abbey Schepers
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Marit S de Vos
- Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Leiden University Medical Center, Leiden, The Netherlands
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Hotta S, Ashida K, Tanaka M. Night Physician-Nurse Collaboration: Developing the Scale of Physicians' Difficulties and Exploring Related Factors in Acute Care Hospitals. J Multidiscip Healthc 2024; 17:2831-2845. [PMID: 38881754 PMCID: PMC11180433 DOI: 10.2147/jmdh.s454578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 06/18/2024] Open
Abstract
Background Responding to inpatient deterioration is less favorable at night than during the day, and this may be related to barriers in collaboration between physicians and nurses. However, there had been no way to assess the problem. This study aimed to develop a scale for physicians to measure difficulties in nighttime collaboration with nurses in response to deteriorating inpatients and to identify factors associated with the developed scale scores. Methods We developed a draft scale of Nighttime Collaboration Difficulties between Nurses and Physicians for Physicians (NCDNP-P) based on key informant interviews with physicians. Psychometric validations, including structural validity, criterion-related validity, and reliability tests, were conducted among physicians who worked on night duty or on call in acute-care hospitals in Japan using a cross-sectional web-based questionnaire. Multiple linear regression analyses were performed using independent variables including individual backgrounds, style of working at night, and facility characteristics. Results By performing exploratory factor analysis, we confirmed the structural validity of the NCDNP-P, consisting of seven items and two domains (Domain 1: Dissatisfaction with reporting, Domain 2: Barriers to working with nurses). Cronbach's alpha and McDonald's omega coefficients were 0.81-0.84 and 0.81-0.89, respectively. The criterion-related validity for interprofessional collaboration was confirmed. Multiple regression analysis revealed that the variables employment status, number of night shifts, frequency of nighttime calls about patients under another physician's charge, and handover between physicians before changing shifts were statistically significantly associated with NCDNP-P scores. Conclusion We developed the NCDNP-P, confirming its reliability and validity. Identified factors reflect physicians' characteristics and the problems experienced working at night and may be associated with barriers in nighttime collaboration. The NCDNP-P can highlight issues in clinical settings and lead to the consideration of initiatives to address such issues.
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Affiliation(s)
- Soichiro Hotta
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kaoru Ashida
- Department of Nursing, College of Nursing, Kanto Gakuin University, Kanazawa-ku, Yokohama, Japan
| | - Makoto Tanaka
- Department of Adult Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Vatani H, Sharma H, Azhar K, Kochendorfer KM, Valenta AL, Dunn Lopez K. Required data elements for interprofessional rounds through the lens of multiple professions. J Interprof Care 2024; 38:453-459. [PMID: 33190565 DOI: 10.1080/13561820.2020.1832447] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
The lack of a proper system for ongoing open interprofessional communication among care providers increases miscommunications and medical errors. Seamless access to patient information is important for care providers to prevent miscommunication and improve patient safety. A shared understanding of the information needs of different care providers in an interprofessional team is lacking. Our purpose is to identify care providers' information needs from the perspective of different professions for communication, shared understanding about the patient, and decision-making. We conducted semi-structured interviews with 10 subject matter experts representing eight professions, including dentistry, dietetics, medicine, nursing, occupational therapy, pharmacy, physical therapy, and social work in a 465-bed academic hospital at a large urban Midwestern city. We used an in-house rounding tool presenting physicians' information needs and a hypothetical patient scenario to collect participants' feedback. Interview notes were coded using direct content analysis. We identified 22 additional essential data elements for an interprofessional rounding tool. We categorized those into six domains: discharge-related, social determinants of health, hospital safety, nutrition, interprofessional situation awareness, and patient history. A well-designed validated rounding tool that includes an interprofessional team of care providers' information needs could improve communication, care planning, and decision-making among them.
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Affiliation(s)
- Haleh Vatani
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Himanshu Sharma
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Kamel Azhar
- Department of Family Medicine, University of Illinois, Chicago, IL, USA
| | | | - Annette L Valenta
- College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
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Pantha S, Jones M, Moyo N, Pokhrel B, Kushemererwa D, Gray R. Association between the Quantity of Nurse-Doctor Interprofessional Collaboration and in-Patient Mortality: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:494. [PMID: 38673405 PMCID: PMC11050129 DOI: 10.3390/ijerph21040494] [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: 02/01/2024] [Revised: 03/16/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
The level of nurse-doctor interprofessional collaboration may influence patient outcomes, including mortality. To date, no systematic reviews have investigated the association between the quantity of nurse-doctor interprofessional collaboration and inpatient mortality. A systematic review was conducted. We included studies that measured the quantity of nurse-doctor interprofessional collaboration and in-patient mortality. Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Register) were searched. Two researchers undertook the title, abstract, and full-text screening. The risk of bias was determined using the Effective Public Health Practice Project (EPHPP) critical appraisal tool. Six reports from three observational studies met the inclusion criteria. Participants included 1.32 million patients, 29,591 nurses, and 191 doctors. The included studies had a high risk of bias. Of the three studies, one reported a significant association and one found no association between the quantity of nurse-doctor collaboration and mortality. The third study reported on the quantity of nurse-doctor collaboration but did not report the test of this association. We found no high-quality evidence to suggest the amount of nurse-doctor interprofessional collaboration was associated with mortality in medical and surgical inpatients. There is a need for further high-quality research to evaluate the association between the amount of nurse-doctor collaboration and patient outcomes.
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Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; (M.J.); (N.M.); (B.P.); (D.K.); (R.G.)
| | - Martin Jones
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; (M.J.); (N.M.); (B.P.); (D.K.); (R.G.)
- Department of Rural Health, University of South Australia, Whyalla Norrie, SA 5608, Australia
| | - Nompilo Moyo
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; (M.J.); (N.M.); (B.P.); (D.K.); (R.G.)
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC 3000, Australia
| | - Bijaya Pokhrel
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; (M.J.); (N.M.); (B.P.); (D.K.); (R.G.)
| | - Diana Kushemererwa
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; (M.J.); (N.M.); (B.P.); (D.K.); (R.G.)
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; (M.J.); (N.M.); (B.P.); (D.K.); (R.G.)
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Shandilya S, Aprile JM. Improvements in Interdisciplinary Communication Following the Implementation of a Standardized Handoff Curriculum: SAFETIPS (Statistics, Assessment, Focused Plan, Pertinent Exam findings, to Dos, If/Thens, Pointers/Pitfalls, and Severity of Illness). Cureus 2024; 16:e56384. [PMID: 38633949 PMCID: PMC11022978 DOI: 10.7759/cureus.56384] [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: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Background Handoffs between medical providers serve a crucial patient safety function. While most published literature on the topic studies the handover process among physicians, robust literature is available on interdisciplinary medical communication. Little is known about the downstream effects of effective physician handover on subsequent physician and nursing interactions. Objective Our objective was to implement a handoff curriculum, SAFETIPS (Statistics, Assessment, Focused plan, pertinent Exam findings, To dos, If/thens, Pointers/pitfalls, and Severity of illness), for pediatric residents and to investigate its impact on nurses' perceptions of resident preparedness, efficiency, and competency. Methods Nurses were asked to score residents in five domains and describe the frequency of nurse-to-resident and resident-to-nurse interruptions. The survey was distributed before and after the SAFETIPS introduction. Results Statistical analysis revealed significant post-intervention mean score increases of one full point in four categories, namely organization and efficiency, communication, content, and clinical judgment. The percentage of nurses using the term "reasonable/relevant" to describe interactions with residents significantly increased from 45% to 76% (p = 0.004). The percentage of nurses reporting that residents gave "unsure response[s]," made decisions that differed from nurses' decisions, and made decisions without family/parental interests significantly decreased by 31 (p = 0.004), 22 (p = 0.034), and 30 (p = 0.002) percentage points, respectively. Conclusion The introduction of a structured handoff curriculum significantly improves communication among residents. This is then associated with improved interactions between residents and nurses.
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Affiliation(s)
| | - Justen M Aprile
- Pediatrics, Penn State Health Children's Hospital, Hershey, USA
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8
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Bouchez T, Cagnon C, Hamouche G, Majdoub M, Charlet J, Schuers M. Interprofessional clinical decision-making process in health: A scoping review. J Adv Nurs 2024; 80:884-907. [PMID: 37705486 DOI: 10.1111/jan.15865] [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: 12/27/2021] [Revised: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
AIMS To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. DESIGN Scoping review of the literature. DATA SOURCES MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. REVIEW METHODS References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. CONCLUSION Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. IMPACT The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. IMPACT STATEMENT Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.
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Affiliation(s)
- Tiphanie Bouchez
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
| | - Clémence Cagnon
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Gouraya Hamouche
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Marouan Majdoub
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Jean Charlet
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Assistance Publique-Hôpitaux de Paris/DRCI, Paris, France
| | - Matthieu Schuers
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Department of General Practice, University of Rouen, Rouen, France
- Department of Medical Informatic, Academic Hospital of Rouen, Rouen, France
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Asadi M, Ahmadi F, Mohammadi E, Vaismoradi M. A grounded theory of the implementation of medical orders by clinical nurses. BMC Nurs 2024; 23:113. [PMID: 38347548 PMCID: PMC10863222 DOI: 10.1186/s12912-024-01775-6] [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: 06/13/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE To explore the process of implementing medical orders by clinical nurses, and identify specific areas of concern in the implementation process, and uncover strategies to address these concerns. BACKGROUND The implementation of medical orders is a crucial responsibility for clinical nurses, as they bear legal accountability for the precise implementation of directives issued by medical practitioners. The accurate implementation of these orders not only shapes the quality and safety of healthcare services but also presents numerous challenges that demand careful consideration. METHOD This study employed a qualitative design using a grounded theory approach to construct a comprehensive theoretical framework grounded in the insights and experiences of nurses operating within the hospital settings of Iran. The study encompassed 20 participants, comprising 16 clinical nurses, two nurse managers, and two specialist doctors working in hospital settings. The selection process involved purposeful and theoretical sampling methods to ensure diverse perspectives. Data collection unfolded through in-depth, individual, semi-structured interviews, persisting until data saturation was achieved. The analytical framework proposed by Corbin and Strauss (2015) guided the process, leading to the development of a coherent theory encapsulating the essence of the study phenomenon. FINDINGS The primary finding of the study underscores the significance of 'legal threat and job prestige' highlighting diverse repercussions in case of errors in the implementation of medical orders. At the core of the investigation, the central variable and the theory of the study was the 'selective and tasteful implementation of orders to avoid legal and organizational accountability.' This indicated a set of strategies employed by the nurses in the implementation of medical orders, encapsulated through three fundamental concepts: 'accuracy in controlling medical orders,' 'untruth documentation,' and 'concealment of events. The formidable influence of legal threats and job prestige was further compounded by factors such as heavy workloads, the doctor's non-compliance with legal instructions for giving verbal orders, the addition of orders by the doctor without informing nurses, and pressure by nursing managers to complete documentation. The resultant psychological distress experienced by nurses not only jeopardized patient safety but also underscored the intricate interplay between legal implications and professional standing within the healthcare framework. CONCLUSION Alleviating staff shortages, enhancing the professional rapport between doctors and nurses, offering legal support to nursing staff, implementing measures such as recording departmental phone conversations to deter the non-acceptance of verbal orders, fostering an organizational culture that embraces nurse fallibility and encourages improvement, and upgrading equipment can ameliorate nurses' apprehensions and contribute to the safe implementation of medical orders.
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Affiliation(s)
- Monireh Asadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box. 14155-4838, Tehran, Iran
| | - Fazlollah Ahmadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box. 14155-4838, Tehran, Iran.
| | - Easa Mohammadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box. 14155-4838, Tehran, Iran
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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Lottonen T, Kaihlanen AM, Nadav J, Hilama P, Heponiemi T. Nurses' and physicians' perceptions of the impact of eHealth and information systems on the roles of health care professionals: A qualitative descriptive study. Health Informatics J 2024; 30:14604582241234261. [PMID: 38364792 DOI: 10.1177/14604582241234261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
The increased use of eHealth and information systems impacts health care work broadly, including cultural and social aspects of work such as the roles of health care professionals. This qualitative descriptive study examined the perceptions of health care professionals in terms of how eHealth and information systems have changed their roles. The data was collected via 15 semi-structured thematic interviews and analysed using content analysis with an inductive approach. The analysis indicated mainly unconscious changes in the roles of professional groups. The professionals perceived that the role of digitally competent professionals in the working community was important. Moreover, high digital competency was seen to have led to an increase or change in work tasks. Professionals' own working environments and job opportunities were seen to have affected to their roles when using information systems. eHealth was perceived to have created inequalities in work tasks, increased skills gaps and complicated work. However, eHealth made cooperation between professionals easier than before. Organisations should pay more attention to equal opportunities to increase professional's digital competency, even out workloads between professionals, and provide equal access to eHealth and information systems.
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Affiliation(s)
- Taija Lottonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Janna Nadav
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pirjo Hilama
- Wellbeing Services County of South Savo, Mikkeli, Finland
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11
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Pantha S, Jones M, Gray R. Stakeholders' Perceptions of How Nurse-Doctor Communication Impacts Patient Care: A Concept Mapping Study. NURSING REPORTS 2023; 13:1607-1623. [PMID: 37987412 PMCID: PMC10661264 DOI: 10.3390/nursrep13040133] [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: 08/12/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
There is some evidence that aspects of nurse-doctor communication are associated with the quality of care and treatment patients receive whilst they are in hospital. To date, no studies have examined stakeholder perceptions on how patient care is influenced by clinical communication between nurses and doctors. We conducted a concept mapping study to generate a deep understanding of how clinical communication impacts patient care. Concept mapping has six phases: preparation, idea generation, structuring, representation, interpretation, and utilization. A total of 20 patients, 21 nurses, and 21 doctors participated in the study. Brainstorming generated 69 discreet statements about how nurse-doctor communication impacts patient care. The structuring (rating and clustering) phase was completed by 48 participants. The data interpretation workshop selected a five-cluster solution: effective communication, trust, patient safety, impediments to patient care, and interpersonal skills. On the final concept map, the five clusters were arranged in a circle around the center of the map. Clusters were relatively equal in size, suggesting that each concept makes a broadly equal contribution to how nurse-doctor communication influences patient care. Our study suggests that there are multiple aspects of clinical communication that impact patient care. Candidate interventions to enhance nurse-doctor communication may need to consider the complex nature of interprofessional working. Registration: This study was prospectively registered with the Open Science Framework (OSF) on 09.07.2020 (osf.io/9np8v/) prior to recruiting the first participant.
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Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Noorie, SA 5608, Australia;
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia;
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12
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Krecko LK, Stalter LN, Quamme SRP, Steege LM, Zelenski AB, Greenberg CC, Jung S. Discussion-based interprofessional education: A positive step toward promoting shared understanding between surgical residents and nurses. J Interprof Care 2023; 37:974-989. [PMID: 37161400 PMCID: PMC10636242 DOI: 10.1080/13561820.2023.2206434] [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: 07/07/2022] [Revised: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lily N Stalter
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sudha R Pavuluri Quamme
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah Jung
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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O'Shay S. 'The Chronicle of Nightmares': Emergency Nurses' Frontstage and Backstage Communication in the Emergency Department. HEALTH COMMUNICATION 2023; 38:2259-2270. [PMID: 35437074 DOI: 10.1080/10410236.2022.2062835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Effective emergency nurse-patient (EN) communication and ENs' communication with other healthcare workers have implications for patient outcomes. Effective EN-patient communication informs and empowers patients. This study sought to better understand ENs frontstage and backstage interactions in a metropolitan emergency department (ED). The researcher engaged in participant observation of 15 different ENs' healthcare interactions with patients and other healthcare workers in the ED for a total of 47 hours and 30 minutes. Iterative analysis of field notes builds reveal two key observations. First, frontstage and backstage spaces are fluid in nature, where healthcare workers simultaneously engage in backstage and frontstage communication regardless of physical space or audience. Second, frontstage communication processes can be categorized into three groups: information seeking and sharing, informally attending to patients and rapport building, and acting out of character. Further, a novel type of front stage interaction, "acting out of character" is conceptualized as when ENs act in ways that are inconsistent with their typical role when communicating with a patient. Implications for health communication practice and theorizing are discussed.
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Affiliation(s)
- Sydney O'Shay
- Department of Communication Studies & Philosophy, Utah State University
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14
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Padigos J, Reid S, Kirby E, Anstey C, Broom J. Nursing experiences in antimicrobial optimisation in the intensive care unit: A convergent analysis of a national survey. Aust Crit Care 2023; 36:769-781. [PMID: 36404269 DOI: 10.1016/j.aucc.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied. OBJECTIVE The objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia. METHODS An anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated. RESULTS A total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement. CONCLUSION The multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles.
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Affiliation(s)
- Junel Padigos
- Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Simon Reid
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney NSW, 2052, Australia
| | - Chris Anstey
- School of Medicine and Dentistry, Griffith University, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - Jennifer Broom
- Infectious Diseases Research Network, Sunshine Coast University Hospital, Birtinya, QLD, 4575, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
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15
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Li B, Chen J, Howard N. Community nursing delivery in urban China: A social power perspective. Soc Sci Med 2023; 326:115923. [PMID: 37116431 DOI: 10.1016/j.socscimed.2023.115923] [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: 12/30/2022] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
Community nurses remain understudied in research on interactional power, especially in China where community healthcare is an emerging practice. Grounded in French & Raven's typology of social power, this article conceptualises the power of community nurses in a Chinese urban context. Through thematic analysis of textual data from 26 semi-structured interviews and two additional focus group discussions with community nurses in Shenzhen, we identified six power varieties, i.e. indirect reward, indirect coercion, legitimate position, peer reference, field expertise, and caring information. We classified these powers trichotomously, as nurse-to-doctor, nurse-to-nurse, and nurse-to-patient, to show the potential influences nurses bring to healthcare relationships. Our analysis indicated nurses' exercise of some powers was constrained by two elements, i.e. doctor-nurse power polarity and patient prejudices against nursing, which together contributed to nurses' adverse power loss. These power adversities permeated the community health environment, contributing to healthcare delivery dysfunctions by undermining nurses' self-improvement, self-assurance, enthusiasm, and cooperation in care. Our analysis, using the insights of social power, develops a novel reading of community nursing delivery in urban China. We argue that nurse empowerment could promote community healthcare delivery. Role enhancement and pro-nursing policy development would reduce adverse power scenarios for community nurses and help convert their potential power resources into practical powers in support of patients' needs.
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Affiliation(s)
- Bo Li
- The Hong Kong Polytechnic University, Department of Applied Social Sciences, Hung Hom, Kowloon, Hong Kong.
| | - Juan Chen
- The Hong Kong Polytechnic University, Department of Applied Social Sciences, Hung Hom, Kowloon, Hong Kong; The Hong Kong Polytechnic University, Mental Health Research Centre, Hung Hom, Kowloon, Hong Kong.
| | - Natasha Howard
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, 117549, Singapore; London School of Hygiene & Tropical Medicine, Department of Global Health & Development, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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16
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Duffy CC, Bass GA, Yura C, Dymek M, Lorenzi C, Kaplan LJ, Clapp JT, Atkins JH. Thematic mapping of perioperative incident reporting data to relational coordination domains. J Interprof Care 2023; 37:245-253. [PMID: 36739556 DOI: 10.1080/13561820.2022.2057454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Communication failure is a common root cause of adverse clinical events. Problematic communication domains are difficult to decipher, and communication improvement strategies are scarce. This study compared perioperative incident reports (IR) identifying potential communication failures with the results of a contemporaneous peri-operative Relational Coordination (RC) survey. We hypothesised that IR-prevalent themes would map to areas-of-weakness identified in the RC survey. Perioperative IRs filed between 2018 and 2020 (n = 6,236) were manually reviewed to identify communication failures (n = 1049). The IRs were disaggregated into seven RC theory domains and compared with the RC survey. Report disaggregation ratings demonstrated a three-way inter-rater agreement of 91.2%. Of the 1,049 communication failure-related IRs, shared knowledge deficits (n = 479, 46%) or accurate communication (n = 465, 44%) were most frequently identified. Communication frequency failures (n = 3, 0.3%) were rarely coded. Comparatively, shared knowledge was the weakest domain in the RC survey, while communication frequency was the strongest, correlating well with our IR data. Linking IR with RC domains offers a novel approach to assessing the specific elements of communication failures with an acute care facility. This approach provides a deployable mechanism to trend intra- and inter-domain progress in communication success, and develop targeted interventions to mitigate against communication failure-related adverse events.
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Affiliation(s)
- Caoimhe C Duffy
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary A Bass
- Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Yura
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Malwina Dymek
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cara Lorenzi
- Division of Perioperative & Procedural Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Section of Surgical Critical Care, Corporal Michael Crescencz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Justin T Clapp
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua H Atkins
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Daheshi N, Alkubati SA, Villagracia H, Pasay-an E, Alharbi G, Alshammari F, Madkhali N, Alshammari B. Nurses' Perception Regarding the Quality of Communication between Nurses and Physicians in Emergency Departments in Saudi Arabia: A Cross Sectional Study. Healthcare (Basel) 2023; 11:healthcare11050645. [PMID: 36900650 PMCID: PMC10000906 DOI: 10.3390/healthcare11050645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/08/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Background: One of the defining characteristics of safe and highly reliable patient care is effective team communication. It is becoming increasingly crucial to improve communication among healthcare team members since social and medical conditions change quickly. Main aim: The present study seeks to assess nurses' perception of the quality of communications between physicians and nurses and associated factors in the emergency departments of selected government hospitals in Saudi Arabia. Methods: A cross-sectional study was carried out in five hospitals in Jazan and three hospitals in Hail City, Saudi Arabia, on a convenience sample of 250 nurses total using self-administered questionnaires. Independent sample t-tests and one-way ANOVA were used for the data analysis. Ethical considerations were adhered to throughout the conduct of the study. Results: The mean score of all domains of nurses' perceptions of the quality of nurse-physician communication in emergency departments was 60.14 out of 90. The highest mean score was observed in the openness subdomain, followed closely by relevance and satisfaction, with mean percentages of 71.65% and 71.60%, respectively. Age, level of education, years of experience, and job position had significant positive correlations with nurses' perceptions of the quality of nurse-physician communication. (p = 0.002, 0.016, 0.022, and 0.020, respectively). Post hoc tests showed that nurses older than 30, those with diplomas, those with more than 10 years' experience, and those in supervisory positions had more positive perceptions of the quality of nurse-physician communication. On the other hand, there was no significant difference in the mean scores of quality of nurse-physician communication with regard to participants' sex, marital status, nationality, and working hours (p > 0.05). Multiple linear regression showed that none of the independent factors affected the nurses' perceptions of the quality of nurse-physician communication in emergency departments (p > 0.05). Conclusions: Overall, the quality of communication between nurses and physicians was not satisfactory. Future research should be meticulously planned, using validated outcome measures, that will capture and reflect the goals of communication among healthcare teams.
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Affiliation(s)
- Nawal Daheshi
- Jazan Academic Affairs and Training Administration, Jazan 85539, Saudi Arabia
- Correspondence: (N.D.); (B.A.)
| | - Sameer A. Alkubati
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida P.O. Box 3114, Yemen
| | - Hazel Villagracia
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
| | - Eddieson Pasay-an
- Maternal and Child Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
| | - Ghadeer Alharbi
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK
| | - Farhan Alshammari
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 2440, Saudi Arabia
| | - Norah Madkhali
- Department of Nursing, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
| | - Bushra Alshammari
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia
- Correspondence: (N.D.); (B.A.)
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A Controlled Adaptive Computational Network Model of a Virtual Coach Supporting Speaking Up by Healthcare Professionals to Optimise Patient Safety. COGN SYST RES 2023. [DOI: 10.1016/j.cogsys.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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19
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Lee SE, Kim E, Lee JY, Morse BL. Assertiveness educational interventions for nursing students and nurses: A systematic review. NURSE EDUCATION TODAY 2023; 120:105655. [PMID: 36462396 DOI: 10.1016/j.nedt.2022.105655] [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: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The purpose of this study was three-fold: to (1) synthesize evidence from experimental studies regarding educational interventions for developing nursing students' and nurses' assertiveness, (2) examine such interventions and identify their effective components, and (3) recommend future research considerations in this area. DESIGN A systematic review of the literature. DATA SOURCES Literature searches were conducted using three electronic databases (PubMed, CINAHL, and PsycINFO) in addition to hand searches to identify original research articles published between 2012 and 2022. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for the systematic review and reporting process. Included studies were critically appraised using the Joanna Briggs Institute Critical Appraisal Checklists. RESULTS Fourteen articles were included in this review, with most of the studies conducted in Asian countries. Four intervention methods were used for assertiveness education across the studies: (1) simulation-based learning, (2) classroom-based learning, (3) classroom-based learning with peer support, and (4) hybrid learning. Classroom-based learning interventions were the most common. Among all types of interventions, key concepts included assertiveness, differentiating between assertive and non-assertive behaviors, and assertive communication skills. Most studies measured participants' speaking-up behaviors by self-report. Mixed results were observed in terms of intervention effectiveness, but providing participants with opportunities to practice assertive communication skills benefited their speaking-up. CONCLUSIONS Educational interventions can strengthen the skills, confidence, and capacity of current and future nurses to employ assertive communication. Intervention developers should create programs that involve classroom teaching and provide participants with opportunities for practice, either through simulation or role-play. Also, researchers should observe participants' post-intervention use of assertive communication in simulations or clinical practice as opposed to surveying participants' intention to speak up.
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Affiliation(s)
- Seung Eun Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea.
| | - Eunkyung Kim
- Brain Korea 21 FOUR Project, College of Nursing, Yonsei University, Seoul, South Korea
| | - Ji Yea Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Brenna L Morse
- Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Lowell, MA 01854, USA.
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Aziz S, Barber J, Singh A, Alayari A, Rassbach CE. Resident and nurse perspectives on the use of secure text messaging systems. J Hosp Med 2022; 17:880-887. [PMID: 36036216 DOI: 10.1002/jhm.12953] [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: 05/13/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND As hospitals shift away from pagers and towards secure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors. OBJECTIVE This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital. DESIGN This was a qualitative study with focus groups. SETTING AND PARTICIPANTS Participants were pediatric residents and nurses at Lucile Packard Children's Hospital. INTERVENTION Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached. MAIN OUTCOME AND MEASURES Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being. RESULTS Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume. CONCLUSION Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.
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Affiliation(s)
- Sara Aziz
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Barber
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Amit Singh
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Clinical Informatics, Stanford Children's Health, Palo Alto, California, USA
| | - Amethyst Alayari
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Ye L, Chen J, Qi Q, Zhou J, Zhu C, Jiang Y, Wang L. A physician-nurse partnership via online healthcare platforms protects infertile women from anxiety and depression: A multi-center prospective study from Shanghai, China. Glob Health Med 2022; 4:273-277. [PMID: 36381566 PMCID: PMC9619114 DOI: 10.35772/ghm.2022.01049] [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: 06/23/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022]
Abstract
Effective health interventions are a priority for future infertility research, and effective interventions in patient-centered care are still needed. A multi-center prospective study was conducted in order to investigate the effects of a physician-nurse partnership (patients receive guidance and health education via online healthcare platforms) on depression and anxiety disorders in infertile women. The women were randomly assigned to a physician-nurse partnership group (n = 90) or a routine treatment group (n = 90). The primary endpoints were self-rating anxiety scale and self-rating depression scale scores. This study also examined the waiting time as an outpatient and the frequency of using online medical platforms. Compared to the routine treatment group, scores on the self-rating anxiety scale (48.4) and the self-rating depression scale (48.0) were significantly lower in the physician-nurse partnership group (p = 0.004, p = 0.001). Moreover, the mean waiting time (3.4) was shorter and online platforms (6.1) were used more frequently in the physician-nurse partnership group than in the routine treatment group (p < 0.001, p < 0.001). These data suggest that a physician-nurse partnership could reduce patients' anxiety, depression, and their waiting time as an outpatient.
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Affiliation(s)
- Lingcha Ye
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Chen
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei, China;,Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture & Moxibustion, Wuhan, Hubei, China
| | - Qing Qi
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China;,The Academy of Integrative Medicine of Fudan University, Shanghai, China;,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China;,The Academy of Integrative Medicine of Fudan University, Shanghai, China;,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Chengying Zhu
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Jiang
- Department of Nursing, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China;,The Academy of Integrative Medicine of Fudan University, Shanghai, China;,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,Address correspondence to:Ling Wang, Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai 200011, China. E-mail:
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22
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Communication, an important link between healthcare providers: a best practice implementation project. INT J EVID-BASED HEA 2022; 20:S41-S48. [DOI: 10.1097/xeb.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hwang S, Shin S. Factors affecting triage competence among emergency room nurses: A cross‐sectional study. J Clin Nurs 2022. [DOI: 10.1111/jocn.16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/02/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Seokhwa Hwang
- College of Nursing Ewha Womans University Seoul Republic of Korea
| | - Sujin Shin
- College of Nursing Ewha Womans University Seoul Republic of Korea
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Bachmann C, Pettit J, Rosenbaum M. Developing communication curricula in healthcare education: An evidence-based guide. PATIENT EDUCATION AND COUNSELING 2022; 105:2320-2327. [PMID: 34887158 DOI: 10.1016/j.pec.2021.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To present a guide for communication curriculum development in healthcare professions for educators and curriculum planners. METHODS We collated a selection of theories, frameworks and approaches to communication curriculum development to provide a roadmap of the main factors to consider when developing or enhancing communication skills curricula. RESULTS We present an evidence-based guide for developing and enhancing communication curriculum that can be applied to undergraduate and postgraduate healthcare education. Recommended steps to consider during the communication curricula development process include thoughtful examination of current communication education, needs assessment, focused learning goals and objectives, incorporation of experiential educational strategies allowing for skills practice and feedback and use of formative and summative assessment methods. A longitudinal, developmental and helical implementation approach contributes to reinforcement and sustainment of learners' knowledge and skills. CONCLUSION AND PRACTICE IMPLICATIONS Drawing on best practices in developing communication curricula can be helpful in ensuring successful approaches to communication skills training for any level of learner or healthcare profession. This position paper provides a guide and identifies resources for new and established communication curriculum developers to reflect on strengths and opportunities in their own approaches to addressing the communication education needs of their learners.
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Affiliation(s)
- Cadja Bachmann
- Office of the Dean of Education, Medical Faculty, University of Rostock, Germany.
| | - Jeffrey Pettit
- Department of Family Medicine, Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, USA
| | - Marcy Rosenbaum
- Department of Family Medicine, Office of Consultation and Research in Medical Education, University of Iowa Carver College of Medicine, USA
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Louwagie V, Ness B, O'Laughlin D, Fisher K, Halasy M. Understanding attributes and characteristics of the PA leader-physician relationship. JAAPA 2022; 35:52-56. [PMID: 35762957 DOI: 10.1097/01.jaa.0000832608.87699.1e] [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: 11/26/2022]
Abstract
PURPOSE This study sought to evaluate the attributes and characteristics of physician mentors, dual-roled physician assistant (PA) leaders, and how this relationship affects PA leaders and the PA leader-physician relationship. Dual-role PA leaders may possess additional formal job titles and duties as well as having direct reports. METHOD We surveyed PA leaders at a single large academic medical center and its associated health system. The survey instrument evaluated perceptions, attitudes, and characteristics of the PA leader and influential physician and their relationship. RESULTS Of the 56 PA leaders surveyed, 34 responded, for a 60.7% response rate. Effective communication was the most prevalent relational characteristic ranked as most important for both PA leaders (30%) and physician mentors (36%). Additional self-identified positive attributes of the team included collaborative mindset, reliability/trustworthiness, work ethic, and delivery of patient care. Influential physician mentors may have a significant effect on PA leader job satisfaction and career advancement. CONCLUSIONS This is a novel study of PA leaders examining perceptions, beliefs, and characteristics of the PA leader-physician relationship. PAs are integral healthcare team members and medical providers. As PAs work closely in physician-led teams, further understanding the PA leader-physician relationship could influence PA and physician professional development, career trajectory, and healthcare team outcomes.
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Affiliation(s)
- Victoria Louwagie
- Victoria Louwagie is clinical codirector of development and an assistant professor in the PA program at the Mayo Clinic in Rochester, Minn. She also practices in community gastroenterology and hepatology in the Mayo Clinic Health System in Mankato, Minn. Becky Ness practices in the Division of Nephrology at the Mayo Clinic Health System in Mankato, Minn. At the Mayo Clinic, Danielle O'Laughlin practices in the Division of Community Internal Medicine, and Karen Fisher and Michael Halasy practice in the Division of Health Service Research. The authors have disclosed no potential conflicts of interest, financial or otherwise. This project was supported by NIH/NCRR/NCATS CTSA Grant Number UL1 TR002377. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health
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Kato H, Clouser JM, Talari P, Vundi NL, Adu AK, Karri K, Isaacs KB, Williams MV, Chadha R, Li J. Bedside Nurses' Perceptions of Effective Nurse-Physician Communication in General Medical Units: A Qualitative Study. Cureus 2022; 14:e25304. [PMID: 35774666 PMCID: PMC9236637 DOI: 10.7759/cureus.25304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background There is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions. Methods We conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes and associated quotes. Results The presence of direct communication between physicians and nurses was identified as the first theme and perceived by nurses as very important. Additional themes related to physician communication and attributes emerged including collegiality and respect (e.g., engaging nurses as partners in patient care), attentiveness and responsiveness (e.g., listening carefully and addressing concerns), and directness and support (e.g., backing nurses up in difficult situations). Effective NPC is further facilitated by organizational structure, relationship development separate from patient care, and consistent/timely use of technology. Conclusions Hospital bedside nurses provided valuable insight into improved physician communication and what attributes contribute to more effective NPC. Most importantly, they emphasized the significance of physicians in supporting them with difficult patients.
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Odunaiya N, Muonwe C, Agbaje SA. Perspectives of healthcare professionals in Nigeria about physiotherapists’ scope of practice and skills in ICU patients’ management: a cross-sectional study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2022. [DOI: 10.1186/s43161-021-00066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is growing evidence for physiotherapy in the intensive care unit (ICU), but physiotherapy in the ICU and patients’ referral rate remains low in Nigeria. This study assessed the healthcare professionals’ perception of the physiotherapists’ scope of practice and skills in managing patients in the ICU of selected teaching hospitals in Southern Nigeria. The study was a cross-sectional survey that involved seventy healthcare professionals working in the ICU who completed an adapted and validated questionnaire. The data obtained from the cross-sectional study were presented using descriptive statistics of mean, standard deviation, frequency distribution, and percentage.
Results
The mean age of the participants was 39.74 ± 7.08 years. The majority of the participants had a bachelor’s degree and had worked for a minimum of 5 years in the ICU, with all the participants working in a mixed ICU and 46.7% work in ICUs with four to six beds. Physiotherapists (PTs) are not posted exclusively to the ICUs, and PTs were reported to be on call in most of the ICUs during the weekdays and weekends. Patients were referred for physiotherapy by the physicians. Healthcare professionals had negative perceptions about PTs’ scope in airway suctioning, nebulization, weaning, and adjustment of mechanical ventilators, intubation, extubation, and changing tracheostomy tubes for ICU patients. Participants had a positive perception about PTs’ assessment skills in the ICU except for hypoxemia calculation, readiness for weaning, and the need for humidification.
Conclusion
Healthcare professionals working in the ICU in the selected hospitals had both negative and positive perceptions regarding certain areas about the scope of practice and skills of PTs in managing patients in the ICU.
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Monfre J, Knudsen ÉA, Sasse L, Williams MJ. Nurses' perceptions of nurse-physician collaboration. Nurs Manag (Harrow) 2022; 53:34-42. [PMID: 34979526 DOI: 10.1097/01.numa.0000805036.69747.d1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jill Monfre
- At University of Wisconsin Health in Madison, Wisc., Jill Monfre is a clinical nurse specialist, Élise Arsenault Knudsen is a clinical nurse specialist, Laura Sasse is a clinical nurse specialist, and Mary Jane Williams is a nurse manager
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Haddeland K, Marthinsen GN, Söderhamn U, Flateland SM, Moi EM. Experiences of using the ISBAR tool after an intervention: A focus group study among critical care nurses and anaesthesiologists. Intensive Crit Care Nurs 2022; 70:103195. [DOI: 10.1016/j.iccn.2021.103195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/16/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
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Naseri S, Ghafourifard M, Ghahramanian A. The Impact of Work Environment on Nurses’ Compassion: A Multicenter Cross-Sectional Study. SAGE Open Nurs 2022; 8:23779608221119124. [PMID: 36032413 PMCID: PMC9411735 DOI: 10.1177/23779608221119124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Compassionate care is considered as the main part of the nurses’ identity and a core component of nursing care. One clinical environment where patients experience a lot of pain and nurses play a vital role in delivering care is the intensive care unit (ICU). Objective Considering the importance of compassionate care in intensive care units, this study aimed to assess the relationship between the work environment and nurses’ compassion in intensive care units. Methods In this cross-sectional survey, a total of 235 nurses were randomly selected from the intensive care units of four educational hospitals of Tabriz University of Medical Sciences from January to March 2021. Data were collected by demographic questionnaire, the Sussex-Oxford Compassion for Others Scale (SOCS-O) and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Results The results showed that there was a significant and inverse relationship between the patient per nurse ratio and the mean score of nurses’ compassion (P < .05). Moreover, Pearson correlation coefficient showed that the mean total score of the nursing work index had a significant positive relationship with the mean score of the compassion for others (r = 0.16, P = .016). Conclusion Health care managers and leaders should pay more attention to the promotion of nurses’ working environments and they should remove the organizational barriers of compassionate care delivery.
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Affiliation(s)
- Sepideh Naseri
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akram Ghahramanian
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Bloemhof J, Knol J, Van Rijn M, Buurman BM. The implementation of a professional practice model to improve the nurse work environment in a Dutch hospital: A quasi-experimental study. J Adv Nurs 2021; 77:4919-4934. [PMID: 34605566 PMCID: PMC9293086 DOI: 10.1111/jan.15052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/12/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
Abstract
Aims To evaluate the effects of the implementation of a professional practice model based on Magnet principles on the nurse work environment in a Dutch teaching hospital. Design A quasi‐experimental study. Methods Data were collected from registered nurses working on the clinical wards and outpatient clinics of the hospital in June/July 2016 (baseline) and in June/September 2019 (measurement of effects). Participants completed the Dutch Essentials of Magnetism II survey, which was used to measure their perception of their work environment. After baseline measurements were collected, interventions based on a professional practice model incorporating Magnet principles were implemented to improve the nurse work environment. Descriptive statistics and independent t‐tests were conducted to examine differences between survey outcomes in 2016 and 2019. Results Survey outcomes revealed significant changes in the nurse work environment between 2016 and 2019. Seven of the eight subscales (essentials of magnetism) improved significantly. Score for overall job satisfaction increased from 7.3 to 8.0 and score for quality of care increased from 7.0 to 7.6. On unit level, 17 of the 19 units showed improvement in the nurse work environment. Conclusion The implementation of a professional practice model positively affects the nurse work environment, job satisfaction and quality of care. Impact Nowadays, the quality of care is threatened by workload pressure and the low autonomy experienced by nurses. Considering the global shortage of nurses and growing complexity of healthcare, it is important to invest in improving the nurse work environment. The Magnet concept created a work environment in which nurses can deliver optimal quality of care. Knowledge of how Magnet principles affect the nurse work environment in the Netherlands is missing. These study results, including the description of how the interventions were implemented, will assist other hospitals to develop improvement strategies by focusing on the nurse work environment.
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Affiliation(s)
- Janet Bloemhof
- Department of Nursing Staff, Tergooi Hospital, Hilversum, The Netherlands.,Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jeannette Knol
- Department of Nursing Staff, Tergooi Hospital, Hilversum, The Netherlands
| | - Marjon Van Rijn
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Jemal M, Kure MA, Gobena T, Geda B. Nurse-Physician Communication in Patient Care and Associated Factors in Public Hospitals of Harari Regional State and Dire-Dawa City Administration, Eastern Ethiopia: A Multicenter-Mixed Methods Study. J Multidiscip Healthc 2021; 14:2315-2331. [PMID: 34475760 PMCID: PMC8407677 DOI: 10.2147/jmdh.s320721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nurse–physician communication remains a public health challenge in the health care setting of developing countries. Clear and respectful nurse–physician communication is very crucial for the health of the patients. Numerous studies have shown that inter-professional communication gaps are the leading cause of adverse medical events that compromise the quality of patient care in the clinical setting. Although it has negative consequences and wider effects on patient care, nurse–physician communication in patient care is rarely studied in Africa. In eastern Ethiopia, predictors of nurse–physician communication in patient care have not been studied. Therefore, this study was aimed to assess nurse–physician communication in patient care in public hospitals of Harari Regional State and Dire-Dawa city administration, Eastern Ethiopia. Methods The multicenter-mixed methods (a quantitative cross-sectional and phenomenological qualitative) were conducted from March 07 to April 07, 2019 in public Hospitals of Eastern Ethiopia. A total of 440 nurses and physicians working in public hospitals in the Harari Regional State and Dire-Dawa administration were enrolled in the study. Participants were approached through a simple random sampling technique. Data were collected using a pretested, self-administered questionnaire and entered into Epi-Data version 3.1, and exported to STATA software (version SE 14) for further analysis. Descriptive statistics were carried out using frequency tables, proportions, and summary measures. Multivariable logistic regression analysis was carried out to identify the true effects of the selected predictor variables on the outcome variable after controlling for possible confounders. Statistical significance was declared at p-value <0.05. Qualitative data were collected from 10 key informants using a semi-structured questionnaire and analyzed using statistical software, Open Code (version 4.2) by thematic analysis method. Results Overall, the magnitude of the level of nurse–physician communication in patient care was found to be 53.2% [95% CI (48.9–58.0)]. In the final model of multivariable analysis, being in the age group of 31–40 [(AOR=0.42, 95% CI (0.25–0.72)], ever married nurse or physician [(AOR=2.28, 95% CI(1.41–3.69)], being a nurse professional [AOR=2.36, 95% CI (1.23–4.54)], a salary class of 2250–3562ETB [(AOR=0.25, 95% CI (0.08–0.84)], higher score for organizational related factors [(AOR=0.58, 95% CI (0.36–0.92)], and higher score for work-related attitude behaviors [(AOR=0.62, 95% CI(0.39–0.984)] were factors independently associated with the poor level of nurse–physician communication in patient care. In the qualitative findings, unattractive working environments and negative attitudes of professionals were found to be barriers to nurse–physician communication in patient care. Conclusion In this study, the nurse–physician communication in patient care was relatively low because more than half of the level of nurse–physician communication was found to be poor. Increasing in age, getting a lower monthly salary, higher report for work-related attitude, and organizational related factors were the potential predictors that would decrease the good level of nurse–physician communication in patient care. This result provides cue due attention to improving nurse–physician communication in patient care through various techniques.
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Affiliation(s)
- Mehammedamin Jemal
- Department of Nursing, Hiwot Fana Specialized University Hospital, Haramaya University, Harar, Ethiopia
| | - Mohammed Abdurke Kure
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Gobena
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Xiao SQ, Liu JE, Chang H. Physician-Nurse Communication Surrounding Computerized Physician Order Entry Systems From Social and Technical Perspective: An Ethnographic Study. Comput Inform Nurs 2021; 40:258-268. [PMID: 35394959 DOI: 10.1097/cin.0000000000000809] [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: 11/26/2022]
Abstract
Although computerized physician order entry systems improve order transmission and patient safety, overdependence on these systems can impede users' communication. This ethnographic study explored physician-nurse communication surrounding computerized physician order entry systems using a sociotechnical framework. Fieldwork conducted in a tertiary teaching hospital comprised 89 hours of participant observation, and individual semistructured interviews were held with seven nurses and five physicians. In addition, documents and artifacts were collected. Three core themes emerged. First, computerized physician order entry quality-related issues undermined the work efficiency of physicians and nurses. Specifically, usability was error prone because of cognitive overload, and the system was unable to perform relevant traces and raise alerts, demonstrating poor interoperability. Second, social factors, including insufficient training, unclear responsibilities, and a lack of awareness concerning interdisciplinary communication, compounded communication problems. Last, environmental factors, including noncoterminous spaces and times and insufficient technical support, impeded the resolution of communication problems. Technical and social contextual factors relating to computerized physician order entry systems jointly affected physician-nurse communication. Cognitive issues and insufficient alerts impacted work efficiency the most and were compounded by contextual individual- and team-related factors and environmental factors. Therefore, improved functions of computerized physician order entry systems and interprofessional communication training are required to optimize technical and social aspects of physician-nurse communication.
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Affiliation(s)
- Shu-Qin Xiao
- Author Affiliations: School of Nursing (Ms Xiao and Dr Liu) and Department of Neurology, Xuanwu Hospital (Ms Chang), Capital Medical University, Beijing, China
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Huang CH, Wang Y, Wu HH, Yii-Ching L. Assessment of patient safety culture during COVID-19: a cross-sectional study in a tertiary a-level hospital in China. TQM JOURNAL 2021. [DOI: 10.1108/tqm-01-2021-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The aims of this study are to (1) evaluate physicians and nurses' perspectives on patient safety culture amid the COVID-19 pandemic and (2) integrate the emotional exhaustion of physicians and nurses into an evaluation of patient safety culture to provide insights into appropriate implications for medical care.
Design/methodology/approach
Patient safety culture was assessed with the Chinese version of the Safety Attitudes Questionnaire. Confirmatory factor analysis was conducted to validate the structure of the data (i.e. reliability and validity), and Pearson's correlation analysis was performed to identify relationships between safety-related dimensions.
Findings
Safety climate was strongly associated with working conditions and teamwork climate. In addition, working conditions was highly correlated with perceptions of management and job satisfaction, respectively. It is worth noting that the stress and emotional exhaustion of the physicians and nurses during this epidemic were high and needed attention.
Practical implications
For healthcare managers and practitioners, team-building activities, power of public opinions, IoT-focused service, and Employee Assistance Programs are important implications for inspiring the patient safety-oriented culture during the period of the COVID-19 pandemic.
Originality/value
This paper considers the role of emotional state into patient safety instrument, a much less understood but equally important dimension in the field of patient safety.
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35
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Stocker M, Szavay P, Wernz B, Neuhaus TJ, Lehnick D, Zundel S. What are the participants' perspective and the system-based impact of a standardized, inter-professional morbidity/mortality-conferences in a children's hospital? Transl Gastroenterol Hepatol 2021; 6:48. [PMID: 34423169 DOI: 10.21037/tgh-20-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/20/2020] [Indexed: 11/06/2022] Open
Abstract
Background Morbidity and mortality conferences (MMC) are well established but little data exists on inter-professional aspects, system-based outcomes and characteristics in pediatric departments. Our study aim was to analyze the system-based impact and to assess participant's perspectives on standardized, inter-professional MMCs in a children's hospital. Methods In a prospective observational analysis the inter-professional MMCs held at a tertiary teaching children's hospital in Switzerland were analyzed for (I) resulting clinical consequences and (II) participants perception on format, usefulness and no-blame atmosphere. Results Eighteen MMC, discussing 29 cases were analyzed. Twenty-seven clinical errors/problems were identified and 17 clinical recommendations were developed: ten new or changed clinical guidelines, two new therapeutic alternatives, three new teaching activities, and two guidelines on specific diagnostics. Altogether, the 466 participants evaluated the conferences favorably. Little differences were seen in the evaluations of physicians of different disciplines or seniority but non-physicians scored all questions lower than physicians. Overall, three quarters of the participants felt that there was a no-blame culture during the conferences but results varied depending on the cases discussed. Conclusions An inter-professional MMC can have relevant impact on clinical practice and affect system-based changes. Inter-professional conferences are profitable for all participants but evaluated differently according to profession. A standardized format and the presence of a moderator are helpful, but not a guarantee for a no-blame culture. Highly emotional cases are a risk factor to relapse to "blame and shame". A time gap between the event and the MMC may have a beneficial effect. Keywords Inter-professional communication; inter-professional health care; learning from failure; morbidity and mortality conference (MMC); patient safety; psychological safety.
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Affiliation(s)
- Martin Stocker
- Pediatric and Neonatal Intensive Care Unit, Children's Hospital Lucerne, Luzern, Switzerland.,Department of Pediatrics, Children's Hospital Lucerne, Luzern, Switzerland
| | - Philipp Szavay
- Department of Pediatric Surgery, Children's Hospital Lucerne, Luzern, Switzerland
| | - Birgit Wernz
- Department of Nursing, Children's Hospital Lucerne, Luzern, Switzerland
| | - Thomas J Neuhaus
- Department of Pediatrics, Children's Hospital Lucerne, Luzern, Switzerland
| | - Dirk Lehnick
- Biostatistics and Methodology, University of Lucerne, Luzern, Switzerland
| | - Sabine Zundel
- Department of Pediatric Surgery, Children's Hospital Lucerne, Luzern, Switzerland
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Cherba M, Grosjean S, Bonneville L, Nahon-Serfaty I, Boileau J, Waldolf R. The essential role of nurses in supporting physical examination in telemedicine: Insights from an interaction analysis of postsurgical consultations in orthopedics. Nurs Inq 2021; 29:e12452. [PMID: 34428319 DOI: 10.1111/nin.12452] [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: 01/24/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 12/28/2022]
Abstract
Telemedicine changes clinical practice and introduces new ways of distributing tasks between physicians and nurses, and particularly the delegation of sensory assessments during remote physical examinations. As nurses become more involved in patient assessment and clinical decision-making, the quality of physician-nurse collaboration has been recognized as essential to ensure quality patient care. However, few studies have examined physician-nurse interactions during teleconsultations. This article presents the results of an empirical study of nurse-physician communication during remote physical examinations. In partnership with a university-affiliated hospital in Ontario, Canada, we observed and recorded 10 simulated postsurgical consultations in orthopedics (involving a physician, a patient, and an on-site nurse) and conducted auto-confrontation interviews with physicians. The results of the thematic analysis of the interviews informed the selection of consultation sequences for in-depth interaction analysis. The findings demonstrate the nurse's essential role during remote physical examinations and reveal specific practices accomplished by the nurse to ensure successful nurse-physician collaboration. The interview data shows how physicians view the nurse's role and contributions. The findings contribute to our understanding of the collaborative nature of sensory assessments during remote physical examinations in telemedicine and can inform the development of training programs for professionals focusing on communication skills. Implications for clinical practice are discussed.
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Affiliation(s)
- Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvie Grosjean
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Luc Bonneville
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Isaac Nahon-Serfaty
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Judith Boileau
- Department of Clinical Services, Hôpital Montfort, Ottawa, Ontario, Canada
| | - Richard Waldolf
- Institut du Savoir Montfort, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Aebi NJ, Caviezel S, Schaefert R, Meinlschmidt G, Schwenkglenks M, Fink G, Riedo L, Leyhe T, Wyss K. A qualitative study to investigate Swiss hospital personnel's perceived importance of and experiences with patient's mental-somatic multimorbidities. BMC Psychiatry 2021; 21:349. [PMID: 34253168 PMCID: PMC8274261 DOI: 10.1186/s12888-021-03353-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mental-somatic multimorbidity in general hospital settings is associated with long hospital stays, frequent rehospitalization, and a deterioration of disease course, thus, highlighting the need for treating hospital patients more holistically. However, there are several challenges to overcome to address mental health conditions in these settings. This study investigated hospital personnel's perceived importance of and experiences with mental-somatic multimorbidities of patients in hospital settings in Basel, Switzerland, with special consideration of the differences between physicians and nurses. METHODS Eighteen semi-structured interviews were conducted with nurses (n = 10) and physicians (n = 8) in different hospitals located in Basel, Switzerland. An inductive approach of the framework analysis was used to develop the themes. RESULTS Four themes emerged from the data analysis: 1) the relevance of mental-somatic multimorbidity within general hospitals, 2) health professionals managing their emotions towards mental health, 3) knowledge and competencies in treating patients with mental-somatic multimorbidity, and 4) interprofessional collaboration for handling mental-somatic multimorbidity in hospital settings.The mental-somatic multimorbidities in general hospital patients was found to be relevant among all hospital professionals, although the priority of mental health was higher for nurses than for physicians. This might have resulted from different working environments or in efficient interprofessional collaboration in general hospitals. Physicians and nurses both highlighted the difficulties of dealing with stigma, a lack of knowledge of mental disorders, the emphasis place on treating somatic disorders, and competing priorities and work availability, which all hindered the adequate handling of mental-somatic multimorbidity in general hospitals. CONCLUSION To support health professionals to integrate mental health into their work, proper environments within general hospitals are needed, such as private rooms in which to communicate with patients. In addition, changes in curriculums and continuing training are needed to improve the understanding of mental-somatic multimorbidities and reduce negative stereotypes. Similarly, interprofessional collaboration between health professionals needs to be strengthened to adequately identify and treat mentally multimorbid patients. A stronger focus should be placed on physicians to improve their competencies in considering patient mental health in their daily somatic treatment care.
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Affiliation(s)
- Nicola Julia Aebi
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Seraina Caviezel
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Rainer Schaefert
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland ,grid.461709.d0000 0004 0431 1180Division of Clinical Psychology and Cognitive Behavioural Therapy, International Psychoanalytic University, Berlin, Germany ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- grid.6612.30000 0004 1937 0642Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Günther Fink
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Lara Riedo
- Department of Health Canton Basel-Stadt, Division of Prevention, Basel, Switzerland
| | - Thomas Leyhe
- grid.6612.30000 0004 1937 0642University of Basel, Geriatric Psychiatry, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland ,grid.412556.10000 0004 0479 0775University of Basel, Center of Old Age Psychiatry, Psychiatric University Hospital, Basel, Switzerland
| | - Kaspar Wyss
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
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Hayward C. Community specialist practitioner's role in enhancing interprofessional collaboration. Br J Community Nurs 2021; 26:354-357. [PMID: 34232717 DOI: 10.12968/bjcn.2021.26.7.354] [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] [Indexed: 11/11/2022]
Abstract
Communication failures not only fail the patient but also the multidisciplinary team involved in patient care in the community. All nurses are expected to have good communication skills, but advanced skills in coaching, teaching and collaborating are expected of the community specialist practitioner (CSP). The skill of communication is intricate, influenced by intrinsic and extrinsic factors, affecting the ability of both the sender and receiver to understand the messages sent and received. Communication should be tailored to the individual to enhance the dialogue. The CSP is best placed, together with the patient, to align the priorities of each contributor to the patient's health to enhance person-centred care. Enhanced communication skills used in conjunction with emotional intelligence can improve interprofessional collaboration, which, in turn, increases the quality of care.
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Affiliation(s)
- Christina Hayward
- Community Specialist Practitioner (District Nurse), Merseycare NHS Foundation Trust, Southport
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Pantha S, Jones M, Gray R. Stakeholders' perceptions of how nurse-physician communication may impact patient care: protocol for a concept mapping study. J Interprof Care 2021; 36:479-481. [PMID: 34014127 DOI: 10.1080/13561820.2021.1923466] [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: 10/21/2022]
Abstract
Effective nurse-physician interprofessional communication is important to ensure that patients receive evidence-based care and treatment. There is a gap in knowledge about how nurse-physician communication impacts patient care. We propose using concept mapping to develop an in-depth understanding of patients, nurses, and physicians' perspectives on how physician-nurse communication affects patient care. There are six phases to concept mapping: determining the focus, generating statements, structuring statements, producing the map, interpretating the map, and map utilization. We will use 'Ariadne', a concept mapping software package for data collection and analysis. The study outcome will be a two-dimensional concept map providing a visual representation of how nurse-physician communication influences patient care. We will report similarity and differences among three stakeholder groups. Our research will inform the development of testable hypotheses about nurse-physician communication and patient care.
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Affiliation(s)
- Sandesh Pantha
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla Norrie, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
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Vatn L, Dahl BM. Interprofessional collaboration between nurses and doctors for treating patients in surgical wards. J Interprof Care 2021; 36:186-194. [PMID: 33980107 DOI: 10.1080/13561820.2021.1890703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Interprofessional collaboration will be one of the main factors in the effort to increase patient safety in the coming years. Research has identified several challenges to interprofessional collaboration between nurses and doctors, where fragmentation of both education and clinical practice contributes to a strong affiliation to one's own profession with little emphasis on collaboration. The aim of this study was to generate more knowledge about how nurses and doctors experience interprofessional collaboration in observation and treatment of patients on a surgical ward. The study was conducted in 2018 and used an explorative qualitative design that was based on four semi-structured focus group interviews. The respondents were 11 nurses and seven doctors with experience from different surgical specialties and employed in three different surgical wards in a Norwegian hospital. The data were analyzed using systematic text-condensation. The following three main categories, each with two subcategories, emerged: 1) Organization and culture: a lack of interprofessional meeting places and experience-based hierarchy; 2) Communication: use of communication tools and little room for professional discussions; and 3) Trust and respect: dependence and recognition and a blurred distribution of responsibility. Both nurses and doctors wished for closer interprofessional collaboration in observation and treatment in the surgical ward; however, organizational limitations with few interprofessional meeting places and time pressure made this difficult.
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Affiliation(s)
- Line Vatn
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Berit Misund Dahl
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Ålesund, Norway
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Iwanow L, Jaworski M, Gotlib J, Panczyk M. A Model of Factors Determining Nurses' Attitudes towards Learning Communicative Competences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041544. [PMID: 33562889 PMCID: PMC7915510 DOI: 10.3390/ijerph18041544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Abstract
The aim of the study was to assess the empirical model of factors determining the attitude towards acquiring communicative competences among nurses participating in the program of specialist training courses. Research was conducted using a cross-sectional study. A representative group of 1010 Polish registered nurses that took part in the postgraduate education course answered a self-report survey (three instruments: NEO-PI-R questionnaire, Communication Skills Attitude Scale (CSAS), and Empathy Understanding Questionnaire (KRE II)) from the beginning of March to the end of May 2018, which was evaluated using path analysis. The research results conducted confirmed the soundness of the created theoretical model (χ2 = 0.278, p = 0.598, RMSEA < 0.05). It was proved that acquiring communicative competences in nurses is determined by factors such as professional experience, empathic tendency, and the intensity of agreeableness, whereby these factors are bound with each other creating a homogeneous network. The developed model demonstrated that skills can most effectively be shaped in an individual’s attitude based on positive mentoring in work environment.
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Kawamoto E, Ito-Masui A, Esumi R, Ito M, Mizutani N, Hayashi T, Imai H, Shimaoka M. Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study. J Med Internet Res 2020; 22:e23184. [PMID: 33258785 PMCID: PMC7808885 DOI: 10.2196/23184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/29/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
Background Use of wearable sensor technology for studying human teamwork behavior is expected to generate a better understanding of the interprofessional interactions between health care professionals. Objective We used wearable sociometric sensor badges to study how intensive care unit (ICU) health care professionals interact and are socially connected. Methods We studied the face-to-face interaction data of 76 healthcare professionals in the ICU at Mie University Hospital collected over 4 weeks via wearable sensors. Results We detail the spatiotemporal distributions of staff members’ inter- and intraprofessional active face-to-face interactions, thereby generating a comprehensive visualization of who met whom, when, where, and for how long in the ICU. Social network analysis of these active interactions, concomitant with centrality measurements, revealed that nurses constitute the core members of the network, while doctors remain in the periphery. Conclusions Our social network analysis using the comprehensive ICU interaction data obtained by wearable sensors has revealed the leading roles played by nurses within the professional communication network.
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Affiliation(s)
- Eiji Kawamoto
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan.,Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Asami Ito-Masui
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan.,Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Ryo Esumi
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan.,Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Mami Ito
- Emergency and Critical Care Center, Mie University Hospital, Tsu-City, Japan
| | - Noriko Mizutani
- Emergency and Critical Care Center, Mie University Hospital, Tsu-City, Japan
| | - Tomoyo Hayashi
- Emergency and Critical Care Center, Mie University Hospital, Tsu-City, Japan
| | - Hiroshi Imai
- Department of Emergency and Disaster Medicine, Graduate School of Medicine, Mie University, Tsu-City, Japan
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Graduate School of Medicine, Mie University, Tsu-City, Japan
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Hirschmann K, Rosler G, Fortin VI AH. "For Me, This Has Been Transforming": A Qualitative Analysis of Interprofessional Relationship-Centered Communication Skills Training. J Patient Exp 2020; 7:1007-1014. [PMID: 33457539 PMCID: PMC7786664 DOI: 10.1177/2374373520962921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2018, Yale Medicine (YM)-an academic multispecialty practice-and Yale New Haven Health System (YNHH), partnered with the Academy of Communication in Healthcare to develop a one-day interprofessional workshop to introduce relationship-centered communication skills to all of their nurses and physicians. Relationship-centered communication skills include showing positive regard, listening actively and expressing empathy and have been demonstrated to improve patient outcomes. A professionally diverse group of 12 nurses and physicians, committed to improving patient experiences, were purposefully selected for training to teach the workshop. Individual interviews with trainers 3 months post training revealed themes reflecting the intrapersonal, interpersonal, and organizational impact of participation in the Train-the-Trainer program. At the intrapersonal level, training contributed to personal growth, skillfulness, and confidence. At the interpersonal level, it expanded and strengthened professional networks. As an organizational catalyst, training transformed the work experience among nurse and physician trainers, thereby supporting YM/YNHH's vision to provide interprofessional relationship-centered care. Results suggest that trainer training had additional benefits beyond learning to deliver the workshop, including improving the quality of trainers' personal and professional relationships, and enhancing organizational efficiency and interprofessionalism.
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Affiliation(s)
| | - Greta Rosler
- Academy of Communication in Healthcare, Lexington, KY, USA
| | - Auguste H Fortin VI
- Department of Medicine, Yale School of Medicine, Academy of Communication in Healthcare, New Haven, CT, USA
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Keizer J, Beerlage-De Jong N, Al Naiemi N, van Gemert-Pijnen JEWC. Finding the match between healthcare worker and expert for optimal audit and feedback on antimicrobial resistance prevention measures. Antimicrob Resist Infect Control 2020; 9:125. [PMID: 32758300 PMCID: PMC7405438 DOI: 10.1186/s13756-020-00794-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background The potentials of audit and feedback (AF) to improve healthcare are currently not exploited. To unlock the potentials of AF, this study focused on the process of making sense of audit data and translating data into actionable feedback by studying a specific AF-case: limiting antimicrobial resistance (AMR). This was done via audit and feedback of AMR prevention measures (APM) that are executed by healthcare workers (HCW) in their day-to-day contact with patients. This study’s aim was to counterbalance the current predominantly top-down, expert-driven audit and feedback approach for APM, with needs and expectations of HCW. Methods Qualitative semi-structured interviews were held with sixteen HCW (i.e. physicians, residents and nurses) from high-risk AMR departments at a regional hospital in The Netherlands. Deductive coding was succeeded by open and axial coding to establish main codes, subcodes and variations within codes. Results HCW demand insights from audits into all facets of APM in their working routines (i.e. diagnostics, treatment and infection control), preferably in the form of simple and actionable feedback that invites interdisciplinary discussions, so that substantiated actions for improvement can be implemented. AF should not be seen as an isolated ad-hoc intervention, but as a recurrent, long-term, and organic improvement strategy that balances the primary aims of HCW (i.e. improving quality and safety of care for individual patients and HCW) and AMR-experts (i.e. reducing the burden of AMR). Conclusions To unlock the learning and improvement potentials of audit and feedback, HCW’ and AMR-experts’ perspectives should be balanced throughout the whole AF-loop (incl. data collection, analysis, visualization, feedback and planning, implementing and monitoring actions). APM-AF should be flexible, so that both audit (incl. collecting and combining the right data in an efficient and transparent manner) and feedback (incl. persuasive and actionable feedback) can be tailored to the needs of various target groups. To balance HCW’ and AMR-experts’ perspectives a participatory holistic AF development approach is advocated.
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Affiliation(s)
- J Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, The Netherlands.
| | - N Beerlage-De Jong
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, The Netherlands
| | - N Al Naiemi
- Department of Infection Prevention, Hospital Group Twente, Almelo/Hengelo, The Netherlands.,LabMicTA, Hengelo, The Netherlands
| | - J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, The Netherlands
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Abstract
Providing optimal health care to patients whose first language is not English remains a major challenge. Medical students, residents, and attendings receive limited cultural competency training, but these short sporadic training courses are not nearly enough to give physicians the proper resources or preparation to understand all their patients’ beliefs. Medical interpreters can fill this gap and strengthen health care for these already marginalized communities. It is important to reconceptualize medical interpreters as true collaborators in medicine who can provide valuable insights that extend beyond language interpretation at the bedside. Physicians would benefit from the insights of these professionals who can function as both language and cultural interpreters who know these patient communities well. Improved communication between physicians and interpreters would not violate traditional physician–patient boundaries but would instead strengthen this relationship to provide the best possible care.
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Cawkwell PB, O'Neill M, Hill EL, Flaherty L, Tsimprea GM, Gerken AT. Improving Communication Between Nursing Staff and On-Call Residents via a Standardized Paging Protocol. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:295-298. [PMID: 31828675 DOI: 10.1007/s40596-019-01148-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Clear and efficient communication between nursing staff and medical providers is an essential component of healthcare delivery. At McLean Hospital, there is an inconsistency in utilization of alphanumeric paging, with many individuals communicating primarily via numeric-only pages that can cause difficulty in triaging importance of pages and lead to disruptions in care. This quality improvement project sought to improve communication between nursing staff and residents by decreasing the number of difficult to triage pages sent to the psychiatrist-on-call at a stand-alone academic psychiatric hospital. METHODS Pages were analyzed during two discrete month-long periods before and after the implementation of a standardized paging protocol, which included an updated online template asking the individual sending the page to include specific information (urgency of page, identifying information of patient, contact information, and name of sender) and dissemination of information on its use. RESULTS The implementation of this protocol resulted in a statistically significant decrease in the percentage of pages that were difficult to triage (22.1 to 15.0%; p < 0.05). Examining specific units in the hospital revealed significant variation of change, with as much as 40% reduction to as large as an 11% increase in difficult to triage pages. CONCLUSIONS The decrease in the percentage of difficult to triage pages suggests that a standard paging protocol can improve delivery of patient care by minimizing interruptions with low-priority pages and may improve quality of communication between nursing staff and physicians on-call, ultimately improving quality of care provided and bettering the resident learning environment.
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Anna MA, Olga CV, Rocío CS, Isabel SP, Xavier ET, Pablo RC, Montserrat PA, Cristina GB, Ramon E. Midwives' experiences of the factors that facilitate normal birth among low risk women in public hospitals in Catalonia (Spain). Midwifery 2020; 88:102752. [PMID: 32521407 DOI: 10.1016/j.midw.2020.102752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal birth has major benefits for women and infants. Nevertheless, during the last few decades, the advancement in technology and an increasing domination of obstetrician-led childbirths have resulted in the medicalization of childbirth. Midwives are interested in amending this trend and aim to support women to achieve the best possible birth experience for them. OBJECTIVE This study aimed to explore midwives' experiences on the facilitators and barriers of normal birth in conventional obstetric units. DESIGN A descriptive qualitative study. Three focus groups were audio recorded and transcribed verbatim. Recurrent themes were identified and formulated. Feedback from data were analysed using thematic analysis. Investigator triangulation was used during the analysis. SETTING Midwives from eleven different public hospitals in Catalonia participated in the study. PARTICIPANTS A purposive sample of 33 midwives participated in the focus groups. FINDINGS Midwives identified several factors that complicated their task of facilitating normal birth. Barriers included: (1) inadequate institutional support; (2) existing obstetrician-led practices, (3) lack of evidence-based practice and (4) midwives' lack of awareness of professional competencies. Factors facilitating normal birth included: (1) midwives' positive perceptions of normal birth, (2) midwives' additional effort and (3) women's awareness of normal birth. KEY CONCLUSIONS Midwives wishing to promote normal birth in obstetric units face a number of challenges and often feel unsupported. Nonetheless, the midwives perceive the increasing women's demand for normal births as an opportunity to implement changes in such a way that women are involved in the decision-making process and midwives act as their advocates. IMPLICATIONS FOR PRACTICE There is a need to increase the midwifery workforce and enhance regulations and funding strategies to support their practice as well as normal birth. Policy makers in settings without well-functioning midwife-led care should consider implementing this model after successfully scaling up of the number of midwives and ensuring an effective midwifery training.
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Affiliation(s)
- Martin-Arribas Anna
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.; School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Canet-Velez Olga
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Casañas Sanchez Rocío
- Escola Superior d'Infermeria del Mar (ESIM), Universidad Pompeu Fabra (UPF), Carrer Dr. Aiguader 80, 08003 Barcelona, Spain.; Centre d'Higiene Mental Les Corts, CHM Salut Mental Barcelona, Carrer de Numància 103 Baixos, 08029 Barcelona, Spain..
| | - Salgado Poveda Isabel
- Vall d'Hebron University Hospital, Carrer Vall d'Hebron 119-129, 08035 Barcelona, Spain..
| | - Espada-Trespalacios Xavier
- Obstetric care area. Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Bacelona, Spain..
| | - Rodriguez Coll Pablo
- Maternal and Child Healthcare Department. Fundació Sanitària de Mollet, Ronda Pinetons 8, 08100 Mollet del Vallès, Bacelona, Spain..
| | | | - González-Blázquez Cristina
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain..
| | - Escuriet Ramon
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain..
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Standardized Hospital Discharge Communication for Patients With Pressure Injury: A Quasi-experimental Trial. J Wound Ostomy Continence Nurs 2020; 47:236-241. [PMID: 32384527 DOI: 10.1097/won.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine if improved communication between certified wound care nurses and home health nurses, through use of standardized electronic wound care order sets and discharge instructions, decreased delay in treatment and 30-day readmission rates and improved wound healing for patients discharged to home with pressure injuries. DESIGN Quasi-experimental, nonequivalent group trial. SUBJECTS AND SETTING Cognitively intact adult patients hospitalized in the Midwestern United States with a stage 2 or higher pressure injury discharged to home care services. METHODS We revised the electronic medical record to include an adapted, standardized version of the Project Re-Engineered Discharge wound care order set that included specific wound care instructions for use following discharge to home care. Medical records of 12 patients were reviewed prior to the change and 9 records were reviewed postchange for information about initiation of care, wound healing, and 30-day readmission. The Pressure Ulcer Scale of Healing tool was used to evaluate wound healing. RESULTS Time to initiation of treatment was 2.4 days for the control group and 1.6 days for the intervention group. Missing documentation made it difficult to evaluate the control group, as 73% of all wound measurements were missing from the electronic medical record. Use of the standardized wound care order set resulted in 100% of wound care orders and 92% of discharge instructions being present in the intervention group's electronic medical record at the time of hospital discharge. There was no statistically significant difference between control and intervention group's Pressure Ulcer Scale of Healing scores for any postdischarge measurement or in 30-day readmission rates. CONCLUSIONS The new standardized wound care order sets at the time of discharge did increase adherence to time to implementation and documentation of executing wound care orders by home care nurses. Further research of standardized order sets is needed to determine the impact on improving patient outcomes.
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Visker JD, Welker K, Rhodes D, Forsyth E, Melvin P, Cox C. Effect of a rapid e-learning module and brief interprofessional simulation event on medical and nursing student collaborative attitudes and behaviors. Int J Nurs Educ Scholarsh 2020; 17:/j/ijnes.ahead-of-print/ijnes-2019-0122/ijnes-2019-0122.xml. [PMID: 32374283 DOI: 10.1515/ijnes-2019-0122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/13/2020] [Indexed: 11/15/2022]
Abstract
Objectives Undergraduate nursing and first-year medical students participated in a brief, scenario-based, interprofessional event. The experimental group only was provided an innovative, rapid e-learning instructional module focused on interprofessional roles/responsibilities and communication prior to the event. Methods Pre-post attitudes toward physician-nurse collaboration were surveyed, and collaborative behaviors were observed during the event. Results For the experimental group, a statistically significant (p<0.05) attitude improvement was found between pre-post e-learning module scores as well as pre-e-learning module and post-simulation event scores. For the control group, a statistically significant (p=0.001) attitude improvement was found between pre-post simulation event scores. No statistically significant differences in team collaborative behaviors were observed between experimental and control. Conclusions The combination of module and simulation event was not a more effective option than the event alone. As both interventions present unique challenges in regards to technology and facility requirements, having multiple effective intervention options will be of benefit to educational institutions.
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Affiliation(s)
| | | | - Darson Rhodes
- SUNY Brockport School of Health and Human Performance, Brockport, NY, USA
| | - Emily Forsyth
- Minnesota State University Mankato, Mankato, MN, USA
| | | | - Carol Cox
- Truman State University, HES, 2123 Pershing Building - HES, 100 E Normal St, Truman State University, Kirksville, MO, USA
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Liaw SY, Ooi SW, Rusli KDB, Lau TC, Tam WWS, Chua WL. Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes. J Med Internet Res 2020; 22:e17279. [PMID: 32267235 PMCID: PMC7177432 DOI: 10.2196/17279] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/02/2020] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Interprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training. Objective This study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students’ communication skill performances and teamwork attitudes. Methods In June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions. Results The team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points. Conclusions Our study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education. Trial Registration ClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924
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Affiliation(s)
- Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Sim Win Ooi
- National University Hospital, Singapore, Singapore
| | | | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Wei Ling Chua
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
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