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Herulf Scholander L, Vikström S, Boström AM, Josephsson S. Inquiring into conditions for engaging in narrative relations on a geriatric ward - how interpretation matters in everyday practices. Int J Qual Stud Health Well-being 2024; 19:2367851. [PMID: 38870415 DOI: 10.1080/17482631.2024.2367851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024] Open
Abstract
Drawing on data from ethnographic fieldwork and interprofessional focus group discussions, this study enquires into staff's everyday life on a geriatric ward to explore and understand conditions for engaging in narrative relations in in-patient geriatric care. Avoiding individualistic understandings of narrative practices, we applied a narrative-in-action methodology built on a relational understanding of narrativity, where individual narratives are not separated from social and cultural features. This helped us explore how individual interpretations of the conditions for everyday practices come together with broader social or cultural understandings to gain situated insights about how these are continuously related and reformed by one another in everyday situations of geriatric care. The findings offer insights into the opportunities to engage in narrative relations based on how healthcare staff on a geriatric ward interpret conditions for their practices, and how they act based on such interpretations. While some interpretations were associated with attitudes and activities encouraging narrative relations, others simultaneously thwarted narrative relations by enacting task-orientation, division, or a focus on measurable biomedical or function-related outcomes. Moreover, the findings suggest and discuss consequences of the tensions created as interpretations are enacted in everyday healthcare situations, thus questioning assumptions about conditions as something static and linear.
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Affiliation(s)
- Lisa Herulf Scholander
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- R&D Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Sofia Vikström
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Anne-Marie Boström
- R&D Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Staffan Josephsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Seelandt JC, Schneider J, Kolbe M, Grande B. Effective debriefings in the clinical setting: a pilot study to test the impact of an evidence based debriefing app on anesthesia care providers' performance. Front Med (Lausanne) 2024; 11:1427061. [PMID: 39131087 PMCID: PMC11310000 DOI: 10.3389/fmed.2024.1427061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024] Open
Abstract
Background Debriefing enhances team learning, performance, and patient safety. Despite its benefits, it's underused. To address this, we developed an evidence-based debriefing app. Methods This pilot study, conducted at a Swiss hospital, evaluated team performance during two anesthesia inductions using the Team Performance Scale (TPS). Following the first induction, teams engaged with the Zurich Debriefing App, with debriefing sessions meticulously recorded for subsequent evaluation. To mitigate bias, raters underwent comprehensive TPS training. The debriefings were analyzed through the DE-CODE framework. We utilized paired t-tests to examine performance improvements and linear regressions to assess the impact of reflective statements on performance, moderated by psychological safety. Results Team performance significantly improved from the first to the second induction (t (9) = -2.512, p = 0.033). Senior physicians' (n = 8) reflective statements predicted post-assessment TPS scores (R 2 = 0.732, p = 0.061), while consultants (n = 7) and nurse anesthetists (n = 10) did not. Interaction analysis revealed no moderation effects, but a main effect indicated the significance of senior physicians' reflective statements. Conclusion This pilot study confirms the efficacy of the evidence-based debriefing app in enhancing anesthesia team performance. Senior physicians' reflective statements positively influenced performance; however, no moderation effects were observed. The study highlights the potential of debriefing apps to streamline and enhance team debriefing processes, with significant implications for improving clinical practice and patient safety. Further research is needed to validate these findings on a larger scale and optimize the integration of debriefing into routine clinical practice.
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Affiliation(s)
- Julia C Seelandt
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
| | - Jeannine Schneider
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michaela Kolbe
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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3
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Lodge J, Neptune C, Tun NN. Factors Affecting Engagement With Portfolio-Based Reflection Among Internal Medicine Trainees: A Survey-Based Study. Cureus 2024; 16:e63022. [PMID: 38915838 PMCID: PMC11194999 DOI: 10.7759/cureus.63022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 06/26/2024] Open
Abstract
Background Contemporary medical education emphasizes that postgraduate clinicians should look at their daily experiences as an opportunity to learn and advance their knowledge and practice of medicine. This is the concept of reflective practice. Internal medicine trainees (IMT) in the UK are encouraged to record written reflections in their electronic portfolios but it is not a mandatory requirement. There is literature suggesting that the level of engagement with these written reflections is varied and that when these are produced, they can be superficial. Thus, the aim of this research was to ascertain what percentage of trainees engaged in written reflections and the factors that affected the likelihood they would reflect. There are no studies that have attempted to quantify de novo engagement with reflective practice and to quantify the significance of different theorized barriers to reflection. Methods This study was in the form of a quasi-experimental cross-sectional study. A 15-item survey was sent out to the IMT in the northwest deanery of England (n=592). The survey remained open for approximately three months with periodic reminders sent out to the trainees. The survey was closed to further responses when the number of responses reached the predetermined sample size of 240 (5% margin of error at a confidence interval of 95%). The data were analyzed by chi-square testing and represented using descriptive statistics. Results There were 243 responses to this survey. A total of 81.5% (n=198) wrote reflections in their portfolio and 19.5% (n=45) did not write any reflections. The main content of written reflections were clinical outcomes (positive and negative), teaching, and new learning. Several background factors had a statistically significant influence on the likelihood that trainees would write reflections in their portfolios. These included their stage of training, years practicing medicine, location of primary medical training, first exposure to reflective practice, and whether they have ever been tutored on reflection. Concerns about legal or General Medical Council (GMC) use of reflective notes against trainees also significantly impacted on reflection. The main perceived barriers to written reflections were the fact that trainees felt they had no time to properly reflect and the lack of perceived benefits from reflections. Conclusion Most trainees wrote reflections in their portfolios, but the majority did not perceive any benefits in doing this. The varied backgrounds of trainees seem to have an impact on their likelihood to reflect and strategies to increase engagement would need to address this.
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Affiliation(s)
- Jeorghino Lodge
- Internal Medicine, Blackpool Victoria Hospital, Blackpool, GBR
| | - Cornelius Neptune
- Acute Medicine, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, GBR
| | - Nwe Ni Tun
- Internal Medicine, Blackpool Teaching Hospitals, Blackpool, GBR
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4
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Hoofs JH, Klein DO, Bleakley A, Rennenberg RJ. Making Sense of Patient Safety Through Cultural-Historical Activity Theory and Complexity Modeling. J Patient Saf 2024; 20:e40-e44. [PMID: 38526082 DOI: 10.1097/pts.0000000000001229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Jos Hj Hoofs
- From the Department of Quality and Safety, Maastricht University Medical Center
| | | | - Alan Bleakley
- Peninsula School of Medicine, Faculty of Health, Plymouth University, United Kingdom
| | - Roger Jmw Rennenberg
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
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5
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Tanzi S, Artioli G, Bertocchi E, Balestra GL, Ghirotto L, Cagna M, Laurenti F, Sacchi S. Experiential training course on spirituality for multidisciplinary palliative care teams in a hospital setting: a feasibility study. BMC Palliat Care 2024; 23:38. [PMID: 38336683 PMCID: PMC10858494 DOI: 10.1186/s12904-024-01341-6] [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: 02/24/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND There is widespread agreement about the importance of spiritual training programs (STPs) for healthcare professionals caring for cancer patients, and that reflecting on one's spirituality is the first step. Health professionals (HPs) working in hospitals must develop this dimension to guarantee the quality of life as well as spiritual and emotional support. In this paper, we propose a possible training format for hospital professionals and assess its implementation. METHODS This is a phase 0-I study that follows the Medical Research Council (MRC) framework. The program was implemented for hospital palliative care specialists. The program included one theory lesson, three spiritual interactions, four pieces of reflective writing, and two individual follow-up sessions for each participant. The evaluation was performed quantitatively according to the MRC framework and qualitatively according to Moore's framework with data triangulation from interviews, reflective writings, and indicators. RESULTS The program was implemented for palliative care physicians, nurses, psychologists, and bioethicists according to the plan, and the program components were highly appreciated by the participants. The results suggest the feasibility of a training course with some corrections, regarding both the components of the training and organizational issues. The qualitative analysis confirmed a shift in the meaning of the themes we identified. The trainees went from intrapersonal spirituality to interpersonal spirituality (engagement with the other person's spirituality, acknowledging their unique spiritual and cultural worldviews, beliefs, and practices), with colleagues, patients, and people close to them. The training had an impact on Moore's Level 3b. CONCLUSIONS Spiritual training for hospital professionals working in palliative care is feasible. Having time dedicated to spirituality and the ongoing mentorship of spiritual care professionals were suggested as key elements. The next step is increasing awareness of spirituality from our hospital reality and creating a stable competent group (with nurses, chaplains, nuns, counselors, etc.) with the support of the management.
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Affiliation(s)
- Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS, Reggio Emilia, Italy.
| | - Giovanna Artioli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | | | | | - Simona Sacchi
- Palliative Care Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
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Doyle AJ, Sullivan C, O'Toole M, Tjin A, Simiceva A, Collins N, Murphy P, Anderson MJ, Mulhall C, Condron C, Nestel D, MacAulay R, McNaughton N, Coffey F, Eppich W. Training simulated participants for role portrayal and feedback practices in communication skills training: A BEME scoping review: BEME Guide No. 86. MEDICAL TEACHER 2024; 46:162-178. [PMID: 37552799 DOI: 10.1080/0142159x.2023.2241621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Providing feedback is a key aspect of simulated participants' (SPs) educational work. In teaching contexts, the ability to provide feedback to learners is central to their role. Suboptimal feedback practices may deny learners the valuable feedback they need to learn and improve. This scoping review systematically maps the evidence related to SPs' role as educators and identifies how SPs prepare for their role and feedback practices. METHODS The authors conducted a scoping review and included a group of international stakeholders with experience and expertise in SP methodology. Five online databases were systematically searched and ERIC, MedEdPortal and MedEdPublish were hand searched to identify relevant studies. Inclusion/exclusion criteria were developed. Data screening and subsequently data charting were performed in pairs. The results of data charting were thematically analysed including categories relating to the Association of SP Educators (ASPE) Standards of Best Practice (SOBP). RESULTS From 8179 articles identified for the title and abstract screening, 98 studies were included. Studies reported the benefit of SPs' authentic role portrayal and feedback interactions for learners and on the reported learning outcomes. Data was heterogeneous with a notable lack of consistency in the detail regarding the scenario formats for communication skills training interventions, SP characteristics, and approaches to training for feedback and role portrayal. CONCLUSIONS The published literature has considerable heterogeneity in reporting how SPs are prepared for role portrayal and feedback interactions. Additionally, our work has identified gaps in the implementation of the ASPE SOBP, which promotes effective SP-learner feedback interactions. Further research is required to identify effective applications of SP methodology to prepare SPs for their role as educators.
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Affiliation(s)
- Andrea J Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Tjin
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anastasija Simiceva
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- Department of Visual & Human Centred Computing, Dundalk Institute of Technology, Co. Louth
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin Ireland
| | - Michael J Anderson
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Debra Nestel
- School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia
- Department of Surgery, University of Melbourne, Australia
| | - Robert MacAulay
- School of Medicine, University of California San Diego, United States of America
| | - Nancy McNaughton
- The Wilson Centre for Research in Education, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Frank Coffey
- DREEAM (Department of Research and Education in Emergency and Acute medicine, Nottingham University Hospitals' NHS Trust)
- School of Health Sciences, University of Nottingham, UK
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [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: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Webster CS, Coomber T, Liu S, Allen K, Jowsey T. Interprofessional Learning in Multidisciplinary Healthcare Teams Is Associated With Reduced Patient Mortality: A Quantitative Systematic Review and Meta-analysis. J Patient Saf 2024; 20:57-65. [PMID: 37921751 DOI: 10.1097/pts.0000000000001170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of the study is to identify quantitative evidence for the efficacy of interprofessional learning (IPL) to improve patient outcomes. METHODS We conducted a systematic review and meta-analysis of quantitative patient outcomes after IPL in multidisciplinary healthcare teams reported in the Medline, Scopus, PsycInfo, Embase, and CINAHL databases. RESULTS In 2022, we screened 15,248 reports to include 20 and extracted rates of mortality and primary outcomes in conventional care groups and intervention groups (involving initiatives to promote IPL in multidisciplinary teams). The meta-analysis of the 13 studies reporting mortality outcomes demonstrated that the 7166 patients in the intervention group had a significant 28% (95% confidence interval [CI], 40%-14%; P < 0.0003) reduced risk of dying compared with the 6809 patients in the conventional care group. The meta-analysis of the 14 studies reporting other treatment-related adverse outcomes demonstrated that the 4789 patients in the intervention group had a significant 23% (95% CI, 33%-12%; P < 0.0001) reduced risk of experiencing an adverse outcome during care compared with the 4129 patients in the conventional care group. Sensitivity analysis, involving the exclusion of the 20% of individual studies with the widest 95% CIs, confirmed the precision and reliability of our findings. CONCLUSIONS We believe that our results are the first to demonstrate significant quantitative evidence for the efficacy of IPL to translate into changes in clinical practice and improved patient outcomes. Our results reinforce earlier qualitative work of the value of IPL, but further prospective quantitative and mixed-methods research is needed to better define such benefits.
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Affiliation(s)
- Craig S Webster
- From the Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Ties Coomber
- From the Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Sue Liu
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Kaitlin Allen
- From the Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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9
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Manojlovich M, Rizvi-Toner A, DasGupta R, Farris K, Friese C, Kostoff D, Mackler E, Millisor V, Titler MG. Video reflexive ethnography as an intervention to improve oral anti-cancer agent patient education: A pilot study. PEC INNOVATION 2023; 2:100148. [PMID: 37214518 PMCID: PMC10194178 DOI: 10.1016/j.pecinn.2023.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 05/24/2023]
Abstract
Objective Oral anticancer agents (OAAs) are associated with side effects that interfere with medication adherence, despite patient education regarding side effect management. Video reflexive ethnography (VRE) captures care processes on video that allow participants to learn from videos. The purpose of this pilot study was to assess the usefulness and impact of VRE on improving OAA education. Methods This qualitative study was conducted in a pharmacist-managed OAA clinic: two pharmacists and four patients participated. We filmed each pharmacist providing education to two patients. We conducted patient interviews and one reflexivity session with both pharmacists to learn participants' perspectives. We used thematic content analysis to analyze data. Results Two themes emerged: what patients liked/helped, and things that were unclear. Patients liked instructions on temperature taking, directions to safely handle and store OAAs. Unclear areas included knowing the timing of the worst side effects.During the reflexivity session, pharmacists found patients' comments useful to improve their practice. Conclusion VRE was acceptable to pharmacists and patients. Pharmacists recognized VRE as a helpful technique to improve patient education on OAAs. Innovation The use of video enables participants to scrutinize and reshape their practices, making VRE a powerful innovation and adjunct to quality improvement initiatives.
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Affiliation(s)
| | - Amna Rizvi-Toner
- University of Michigan College of Pharmacy, United States of America
| | | | - Karen Farris
- University of Michigan College of Pharmacy, United States of America
| | - Chris Friese
- University of Michigan School of Nursing, United States of America
| | | | - Emily Mackler
- University of Michigan College of Pharmacy, United States of America
| | | | - Marita G. Titler
- University of Michigan School of Nursing, United States of America
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10
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Volpi L, Giusino D, Pietrantoni L, De Angelis M. Does Organizational Commitment to Mental Health Affect Team Processes? A Longitudinal Study. J Healthc Leadersh 2023; 15:339-353. [PMID: 38020722 PMCID: PMC10680482 DOI: 10.2147/jhl.s429232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Team processes, such as reflexivity and participation, are critical for organizational sustainability, especially in high-reliability professions such as healthcare. However, little is known about health-related predictors of team processes. Basing our hypotheses on the Input-Process-Output (IPO) model, this study investigates the influence of perceived organizational commitment to mental health (OCMH) on healthcare workers' team reflexivity and participation via mental health-specific leadership (MHsL) and team autonomy. Patients and Methods The study involved 82 participants (ie, physicians, nurses, healthcare assistants, healthcare technicians, and physiotherapists) working in the Medicine, Emergency, and Neurological Departments at a large public healthcare organization in Italy. Data was gathered at 2-time points, 14 months apart. Results The results suggest that healthcare workers' perception of their organization's support for mental health at T1 significantly impacts team participation at T2 through MHsL and team autonomy. Likewise, the indirect effect of OCMH through MHsL and team autonomy was also significant in the model predicting team reflexivity. However, in both models, no direct relationship of OCMH on the dependent variables was found. Conclusion The findings highlight the importance of a mental health-supportive environment and leadership to foster team autonomy and, subsequentially, team processes, which are fundamental for performance and patient care.
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Affiliation(s)
- Lucia Volpi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Davide Giusino
- Department of Psychology, University of Bologna, Bologna, Italy
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11
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Choi JJ, Rosen MA, Shapiro MF, Safford MM. Towards diagnostic excellence on academic ward teams: building a conceptual model of team dynamics in the diagnostic process. Diagnosis (Berl) 2023; 10:363-374. [PMID: 37561698 DOI: 10.1515/dx-2023-0065] [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: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Achieving diagnostic excellence on medical wards requires teamwork and effective team dynamics. However, the study of ward team dynamics in teaching hospitals is relatively underdeveloped. We aim to enhance understanding of how ward team members interact in the diagnostic process and of the underlying behavioral, psychological, and cognitive mechanisms driving team interactions. METHODS We used mixed-methods to develop and refine a conceptual model of how ward team dynamics in an academic medical center influence the diagnostic process. First, we systematically searched existing literature for conceptual models and empirical studies of team dynamics. Then, we conducted field observations with thematic analysis to refine our model. RESULTS We present a conceptual model of how medical ward team dynamics influence the diagnostic process, which serves as a roadmap for future research and interventions in this area. We identified three underexplored areas of team dynamics that are relevant to diagnostic excellence and that merit future investigation (1): ward team structures (e.g., team roles, responsibilities) (2); contextual factors (e.g., time constraints, location of team members, culture, diversity); and (3) emergent states (shared mental models, psychological safety, team trust, and team emotions). CONCLUSIONS Optimizing the diagnostic process to achieve diagnostic excellence is likely to depend on addressing all of the potential barriers and facilitators to ward team dynamics presented in our model.
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Affiliation(s)
- Justin J Choi
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael A Rosen
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Institute for Clinical and Translational Research, and JHSOM Simulation Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin F Shapiro
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Monika M Safford
- Department of Medicine, Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
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12
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Verhagen MJ, de Vos MS, van Schaik J, van der Vorst JR, Schepers A, Marang-van de Mheen PJ, Hamming JF. Surgical team dynamics in a reflective team meeting to improve quality of care: qualitative analysis of a shared mental model. Br J Surg 2023; 110:1271-1275. [PMID: 37190915 PMCID: PMC10480032 DOI: 10.1093/bjs/znad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/27/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Merel J Verhagen
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Marit S de Vos
- Directorate of Quality and Patient Safety, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jan van Schaik
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joost R van der Vorst
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Centre, Leiden, the Netherlands
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13
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de Quadros DV, Wachs P, de Magalhães AMM, Severo IM, Tavares JP, Dal Pai D. Daily work variability in falls prevention of hospitalized patients: nursing team's perception. BMC Health Serv Res 2023; 23:931. [PMID: 37653512 PMCID: PMC10468876 DOI: 10.1186/s12913-023-09956-w] [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: 09/20/2022] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The identification of safety incidents and establishment of systematic methodologies in health services to reduce risks and provide quality care was implemented by The World Health Organization. These safety incidents allowed the visualization of a vast panorama, ranging from preventable incidents to adverse events with catastrophic outcomes. In this scenario, the issue of fall(s) is inserted, which, despite being a preventable event, can lead to several consequences for the patient, family, and the healthcare system, being the second cause of death by accidental injury worldwide, this study aims to identify the variability inherent in the daily work in fall prevention, the strategies used by professionals to deal with it and the opportunities for improvement of the management of work-as-imagined. METHOD A mixed method approach was conducted, through process modeling and semi-structured interviews. The study was conducted in a public university hospital in southern Brazil. Study steps: modeling of the prescribed work, identification of falls, modeling of the daily work, and reflections on the gap between work-as-done and work-as-imagined. Medical records, management reports, notification records, protocols, and care procedures were consulted for modeling the work process, and semi-structured interviews were conducted with 21 Nursing professionals. The study was conducted between March 2019 and December 2020. RESULTS From July 2018 to July 2019, 447 falls occurred, 2.7% with moderate to severe injury. The variability occurred in the orientation of the companion and the assurance of the accompanied patient's de-ambulation. The professionals identified individual strategies to prevent falls, the importance of multi-professional work, learning with the work team, and the colleague's expertise, as well as suggesting improvements in the physical environment. CONCLUSION This study addressed the need for fall prevention in the hospital setting as one of the main adverse events that affect patients. Identifying the variability inherent to the work allows professionals to identify opportunities for improvement, understand the risks to which patients are subjected, and develop the perception of fall risk as a way to reduce the gap between work-as-imagined and work-as-done.
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Affiliation(s)
- Deise Vacario de Quadros
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil.
- Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil.
| | - Priscila Wachs
- Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
| | | | - Isis Marques Severo
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Juliana Petri Tavares
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
- Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Daiane Dal Pai
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
- Federal University of Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
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Shields GS, Fisher M, Vega MO. Teaching power skills to improve physician self-efficacy, reduce burnout, and improve patient outcomes. Future Healthc J 2023; 10:119-123. [PMID: 37786631 PMCID: PMC10540802 DOI: 10.7861/fhj.2023-0050] [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: 10/04/2023]
Abstract
If doctors had a way to improve their patients' healthcare experience, improve service feedback, reduce complaints, increase treatment adherence and reduce non-attendance, while at the same time combatting burnout and compassion fatigue in clinicians and enhancing collaborative working between staff and care teams, and all for zero direct cost, could anyone argue against such an intervention? In this paper, we present the views of the educators and clinicians at Maudsley Learning that training in communication and psychological 'power skills' is not only feasible, but crucially important for physicians at all stages of training to improve both patient care and the wellbeing of clinicians themselves. We explore some of the key relevant skills and present examples of high-fidelity simulation training that demonstrate the efficacy of this modality in improving individual skills and confidence as well as inter-team and interdisciplinary working.
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Affiliation(s)
- Gregory S Shields
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
| | - Megan Fisher
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
| | - Marta Ortega Vega
- Maudsley Learning, South London & Maudsley NHS Foundation Trust, London, UK
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15
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AlQuzi F, Bowers A, Alexander K, Bradford N. Assessment of Symptoms and Adverse Events Related to Immunotherapy in Patients With Cancer: An Integrative Review. J Pain Symptom Manage 2023; 66:e69-e84. [PMID: 36858244 DOI: 10.1016/j.jpainsymman.2023.02.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
CONTEXT Clinical practice guidelines advocate for routine assessment of symptoms and adverse events during immunotherapy treatment of cancer. Outside the clinical trial setting, there are few examples of such assessment in practice. OBJECTIVES To identify, appraise, and synthesize the available literature regarding the assessment of immune-related symptoms and adverse events in patients with cancer beyond the clinical trial setting. Specifically, we aimed to identify the measurement instruments used, who completes these and when. METHODS We completed an integrative review following established methods including a systematic literature search of electronic databases, a dual process for screening, quality appraisal, and data extraction. We included primary studies (retrospective or prospective) reporting the use of instruments or strategies to assess symptoms or adverse events in patients with cancer treated with immunotherapy. Outcomes of interest included: 1) how immune-related symptoms and adverse events were assessed; 2) types of assessment instruments; 3) frequency of instrument use and mode of administration; 4) the reported duration and intensity of symptoms and 5) adverse events and associated management strategies. Data were synthesized narratively. RESULTS We screened 2138 articles and included 16 articles representing 2553 patients with cancer undergoing immunotherapy. All articles were published between 2018 and 2022 and were of sound methodological quality. Seven studies were retrospective chart reviews, and the remaining studies prospectively collected data, with seven collecting patient reported outcomes. In studies where data were collected at more than one time point (n = 6), weekly assessment during immunotherapy was the most common frequency. The potential for implementation of assessment into routine clinical practice was described in just four studies. CONCLUSION Despite recommendations from clinical practice guidelines for routine assessment of symptoms and adverse events during immunotherapy treatment for cancer, there are few examples of how this is undertaken in clinical practice. The use of patient reported outcome measures to assess toxicity from immunotherapy is uncommon but offers the potential to identify symptoms early and facilitate timely intervention. Our review highlights the available instruments, how they have been used and the need for more applied research in this field to optimize patient outcomes.
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Affiliation(s)
- Fatimah AlQuzi
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; School of Nursing (F.A.), Umm AL-Qura University, Mecca, Kingdom of Saudi Arabia
| | - Alison Bowers
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Kimberley Alexander
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia
| | - Natalie Bradford
- School of Nursing (F.A., A.B., K.A., N.A.), Queensland University of Technology, Kelvin Grove, Australia; Cancer and Palliative Care Outcomes Centre for Children's Health Research (A.B., K.A., N.B.), Queensland University of Technology, South Brisbane, Australia.
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16
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de Vos MS, Verhagen MJ, Hamming JF. The Morbidity and Mortality Conference: A Century-Old Practice with Ongoing Potential for Future Improvement. Eur J Pediatr Surg 2023; 33:114-119. [PMID: 36720246 PMCID: PMC10023258 DOI: 10.1055/s-0043-1760836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To discuss practical strategies to consider for morbidity and mortality conferences (M&M). MATERIALS AND METHODS This article reflects on (i) insights that can be drawn from the M&M literature, (ii) practical aspects to consider when organizing M&M, and (iii) possible future directions for development for this long-standing practice for routine reflection. RESULTS M&M offers the opportunity to learn from past cases in order to improve the care delivered to future patients, thereby serving both educational and quality improvement purposes. For departments seeking to implement or improve local M&M practice, it is difficult that a golden standard or best practice for M&M is nonexistent. This is partly because comparative research on different formats is hampered by the lack of objective outcome measures to evaluate the effectiveness of M&M. Common practical suggestions include the use of (i) a skillful and active moderator; (ii) structured formats for case presentation and discussion; and (iii) a dedicated committee to guide improvement plans that ensue from the meeting. M&M practice is affected by various sociological factors, for which qualitative research methods seem most suitable, but in the M&M literature these are sparsely used. Moreover, aspects influencing an open and blame-free atmosphere underline how local teams should tailor the format to best fit the local context and culture. CONCLUSION This article presents practice guidance on how to organize and carry out M&M This practice for routine reflection needs to be tailored to the local setting, with attention for various sociological factors that are at play.
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Affiliation(s)
- Marit S. de Vos
- Directorate of Quality and Patient Safety, Leiden University Medical Center, Rotterdam, the Netherlands
- Address for correspondence Marit S. de Vos, MD, PhD Directorate of Quality and Patient Safety, Leiden University Medical CenterAlbinusdreef 2, 2333 ZA Leidenthe Netherlands
| | - Merel J. Verhagen
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap F. Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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An Exploration of Critical Care Professionals' Strategies to Enhance Daily Implementation of the Assess, Prevent, and Manage Pain; Both Spontaneous Awakening and Breathing Trials; Choice of Analgesia and Sedation; Delirium Assess, Prevent, and Manage; Early Mobility and Exercise; and Family Engagement and Empowerment: A Group Concept Mapping Study. Crit Care Explor 2023; 5:e0872. [PMID: 36890874 PMCID: PMC9988323 DOI: 10.1097/cce.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
The goals of this exploratory study were to engage professionals from the Society for Critical Care Medicine ICU Liberation Collaborative ICUs to: 1) conceptualize strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle from different perspectives and 2) identify strategies to prioritize for implementation. DESIGN Mixed-methods group concept mapping over 8 months using an online method. Participants provided strategies in response to a prompt about what was needed for successful daily ABCDEF bundle implementation. Responses were summarized into a set of unique statements and then rated on a 5-point scale on degree of necessity (essential) and degree to which currently used. SETTING Sixty-eight academic, community, and federal ICUs. PARTICIPANTS A total of 121 ICU professionals consisting of frontline and leadership professionals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A final set of 76 strategies (reduced from 188 responses) were suggested: education (16 strategies), collaboration (15 strategies), processes and protocols (13 strategies), feedback (10 strategies), sedation/pain practices (nine strategies), education (eight strategies), and family (five strategies). Nine strategies were rated as very essential but infrequently used: adequate staffing, adequate mobility equipment, attention to (patient's) sleep, open discussion and collaborative problem solving, nonsedation methods to address ventilator dyssynchrony, specific expectations for night and day shifts, education of whole team on interdependent nature of the bundle, and effective sleep protocol. CONCLUSIONS In this concept mapping study, ICU professionals provided strategies that spanned a number of conceptual implementation clusters. Results can be used by ICU leaders for implementation planning to address context-specific interdisciplinary approaches to improve ABCDEF bundle implementation.
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Kolbe M, Grande B, Lehmann-Willenbrock N, Seelandt JC. Helping healthcare teams to debrief effectively: associations of debriefers' actions and participants' reflections during team debriefings. BMJ Qual Saf 2023; 32:160-172. [PMID: 35902231 DOI: 10.1136/bmjqs-2021-014393] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/21/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Debriefings help teams learn quickly and treat patients safely. However, many clinicians and educators report to struggle with leading debriefings. Little empirical knowledge on optimal debriefing processes is available. The aim of the study was to evaluate the potential of specific types of debriefer communication to trigger participants' reflection in debriefings. METHODS In this prospective observational, microanalytic interaction analysis study, we observed clinicians while they participated in healthcare team debriefings following three high-risk anaesthetic scenarios during simulation-based team training. Using the video-recorded debriefings and INTERACT coding software, we applied timed, event-based coding with DE-CODE, a coding scheme for assessing debriefing interactions. We used lag sequential analysis to explore the relationship between what debriefers and participants said. We hypothesised that combining advocacy (ie, stating an observation followed by an opinion) with an open-ended question would be associated with participants' verbalisation of a mental model as a particular form of reflection. RESULTS The 50 debriefings with overall 114 participants had a mean duration of 49.35 min (SD=8.89 min) and included 18 486 behavioural transitions. We detected significant behavioural linkages from debriefers' observation to debriefers' opinion (z=9.85, p<0.001), from opinion to debriefers' open-ended question (z=9.52, p<0.001) and from open-ended question to participants' mental model (z=7.41, p<0.001), supporting our hypothesis. Furthermore, participants shared mental models after debriefers paraphrased their statements and asked specific questions but not after debriefers appreciated their actions without asking any follow-up questions. Participants also triggered reflection among themselves, particularly by sharing personal anecdotes. CONCLUSION When debriefers pair their observations and opinions with open-ended questions, paraphrase participants' statements and ask specific questions, they help participants reflect during debriefings.
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Affiliation(s)
- Michaela Kolbe
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland .,ETH Zürich, Zurich, Switzerland
| | - Bastian Grande
- Simulation Centre, University Hospital Zurich, Zurich, Switzerland.,Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
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Abstract
OBJECTIVES The objective of this article is to present a comprehensive view on the topic of nursing leadership discussing the theoretical frameworks that underpin its manifestation, the leadership styles in nursing, the overall landscape in nursing leadership including the context where leadership is being practiced, and finally looking at the educational pathways for building leadership capacity and sustainability DATA SOURCES: Relevant studies on the topic as well professional associations, national and international organizations' evidence have formed the basis for this article. CONCLUSION The role of the nurse leaders is complex and demanding within the context of health care. Its value has been increasingly drawing the attention of national and international organizations. The nurse leader is performing tasks within rapidly shifting environments that require constant changes to best address the organizational goals but remain true to the values and perspectives envisioned by the nursing profession. Through the implementation of corresponding competency frameworks, the capacity and preparedness of nurse leaders can be cultivated ideally in a multidisciplinary context. IMPLICATIONS FOR NURSING PRACTICE Nurse leaders are increasingly assuming positions of authority across the structures of health care organizations. There is need to timely and appropriately increase the preparedness of nurse leaders to assume and sustain these challenging and dynamic roles.
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Affiliation(s)
- Andreas Charalambous
- Associate Professor, Oncology and Palliative Care, Cyprus University of Technology, Limassol, Cyprus; Adjunct Professor, University of Turku, Turku, Finland.
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20
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Jamshed S, Majeed N. Mapping knowledge-sharing behavior through emotional intelligence and team culture toward optimized team performance. TEAM PERFORMANCE MANAGEMENT 2023. [DOI: 10.1108/tpm-06-2022-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose
Research unveiled that interdisciplinary health-care teams are often found to be ineffective because of deprived team mechanisms. Considering effective team functioning, a leader’s non-cognitive abilities, knowledge-sharing behavior and the role of culture remain central concerns of health-care teams. This study aims to investigate how a leader’s emotional intelligence (EI) in a prevailing team culture can nurture the sharing of knowledge and enhance team EI that influences team performance.
Design/methodology/approach
The authors used multisource data representing a sample of 195 teams (735 respondents) to examine the hypothesized relationships by using the analytic strategy of partial least squares-structural equation modeling. This study bridged the methodological gap by using the repeated indicator approach that includes the reflective-formative second-order hierarchical latent variable model.
Findings
The results revealed a standpoint that leaders practicing the ability of EI influences team performance by understanding each other emotions in the leader–member relationship. Further, culture adds value and maps knowledge-sharing behavior which is tailored and beneficial for effective team outcomes.
Practical implications
This study provides valuable inputs by articulating uniquely modeled variables for health-care teams confronting high work demands. This study highlights that leaders' EI can enhance understanding of the emotions of the team and can exchange information by harnessing knowledge-sharing behavior amongst professionals.
Originality/value
This study provides a novel contribution by integrating leaders’ EI, knowledge-sharing behavior, the role of culture and team performance in a single framework. The integrated theoretical model sheds light on team working in the health-care setting and advances the understanding of a leader’s EI and team culture through mapping knowledge sharing particularly being central to enhancing team performance.
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21
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Han C, Zhang L, Liu J, Zhang P. Mediating Role of Teamwork in the Influence of Team Role on Team Performance. J Multidiscip Healthc 2023; 16:1057-1066. [PMID: 37096239 PMCID: PMC10121380 DOI: 10.2147/jmdh.s394670] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/04/2023] [Indexed: 04/26/2023] Open
Abstract
Objective As an important hospital task, the quality and efficiency of nursing practice directly affect the medical quality and sustainable development of the hospital. Increasing attention is now paid by managers to nursing teamwork. From the level of the nursing team, this study explored the relationship between team roles, using teamwork as the intermediate variable, and team performance to provide a theoretical foundation for the human resource management of nursing managers. Methods Taking 29 general inpatient areas of a tertiary general hospital in Beijing as research objects, a questionnaire survey was used to collect basic information on nursing staff, teamwork, team roles and team performance. The collected data were analysed. A pathway analysis based on a multiple regression analysis was used to interpret the effect of each team role on teamperformance. Results ①The mean and maximum value of emotional type (Teamworker and Finisher) were the largest in the role combination of nursing team. In the team role combination, the average value of emotional type was 12.58 ± 1.48, with significant difference (P<0.001). ② The average level of emotion, thinking and decision of team role combination is positively correlated with work performance; The average level and maximum value of emotion have a positive correlation with team cooperation; The average level of willingness was negatively correlated with team cooperation, job performance and satisfaction (P<0.05). ③ Teamwork plays a certain intermediary role in the mean value of emotion to improve level of team satisfaction and performance. Conclusion This study identified the important roles of different types of nursing staff in work performance and used a pathway analysis to create a path showing each role. Increasing the emotional-type nursing staff in a team can not only improve the mean level of team emotion but also effectively improve both teamwork and work performance.
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Affiliation(s)
- Chunjie Han
- Department of Rehabilitation Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
| | - Lingli Zhang
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
| | - Jihong Liu
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, People’s Republic of China
- Correspondence: Jihong Liu, Department of Neurology, Beijing Luhe Hospital, Capital Medical University, No. 82 of Xin Hua South Road, Tongzhou District, Beijing, 101149, People’s Republic of China, Tel +86 10-69543901-1041, Fax +86 10 69531069, Email
| | - Ping Zhang
- Department of Nursing, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, People’s Republic of China
- Ping Zhang, Department of Nursing, Beijing Rehabilitation Hospital, Capital Medical University, No. 15 of Xixiazhuang South Road, Shijingshan District, Beijing, 100144, People’s Republic of China, Tel +86 10 5689 1513, Fax +86 10 5698 1555, Email
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22
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Factors Associated with Post-Traumatic Growth in Healthcare Professionals: A Systematic Review of the Literature. Healthcare (Basel) 2022; 10:healthcare10122524. [PMID: 36554048 PMCID: PMC9777806 DOI: 10.3390/healthcare10122524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Post-traumatic growth (PTG) research is flourishing across various disciplines; however, it is only emerging in healthcare. Recently, a flurry of studies assessed PTG among healthcare professionals. However, to date, no systematic review has identified the factors that predict their experiences of PTG among healthcare professionals. The current paper aims to address this gap. Of 126 papers, 27 were selected for this systematic review. The analysis identified a range of demographic, individual (work-related and personal), interpersonal and environmental factors that contributed to healthcare professionals' experiences of PTG. Analysis of findings offers a novel perspective on individual factors by dividing them into personal and work-related factors. Results also highlight a variety of psychological interventions that can be used in healthcare to cultivate PTG. In addition, the gaps in current research, implications for further research, policy and practice that can facilitate the experience of PTG among healthcare professionals are discussed.
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McHugh S, Sheard L, O'Hara J, Lawton R. The feasibility and acceptability of implementing video reflexive ethnography (VRE) as an improvement tool in acute maternity services. BMC Health Serv Res 2022; 22:1308. [PMID: 36324173 PMCID: PMC9629879 DOI: 10.1186/s12913-022-08713-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Video-reflexive ethnography (VRE) has been argued to be an alternative approach to collaborative learning in healthcare teams, more able to capture the complexities of the healthcare environment than simulation. This study aims to explore the feasibility and acceptability of employing VRE as an improvement tool in acute maternity services. METHOD Focused ethnography and semi-structured interviews (n = 17) explored the feasibility of employing VRE from the perspective of the researcher-facilitator, and that of the healthcare staff participants. Reflexive thematic analysis was used to generate key themes. RESULTS We identified four themes related to feasibility of employing VRE as an improvement approach: laying the groundwork; challenges of capturing in-situ video footage; effective facilitation of reflexive feedback; and, power to change. Of note was the central role of the facilitator in building and maintaining staff trust in the process, particularly in being able to guide collaborative, non-punitive discussion during reflexive feedback sessions. Interestingly, when considering implementation of change, structural hierarchies were evident with more senior staff better able to develop and effect ideas. Two themes related to acceptability of VRE among healthcare staff were identified: staff response to the role of VRE in improvement; and the power of a different perspective. Staff were overwhelmingly positive about their experience of VRE, particularly appreciating the time, space and autonomy it afforded them to navigate and articulate ideas for change and improvement. CONCLUSION VRE is both feasible and acceptable as an improvement tool with acute, multi-disciplinary maternity staff teams. It is an important healthcare improvement tool that could prompt the development and maintenance of team resilience factors in the face of increasing stress and burn-out of healthcare staff in maternity services.
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Affiliation(s)
- Siobhan McHugh
- School of Healthcare, University of Leeds, Baines Wing, Leeds, LS2 9JT, UK. .,School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
| | - Laura Sheard
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Jane O'Hara
- School of Healthcare, University of Leeds, Baines Wing, Leeds, LS2 9JT, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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Zumstein-Shaha M, Grace PJ. Competency frameworks, nursing perspectives, and interdisciplinary collaborations for good patient care: Delineating boundaries. Nurs Philos 2022; 24:e12402. [PMID: 35761762 PMCID: PMC10078421 DOI: 10.1111/nup.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/29/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. These are some of the reasons behind current movements to develop competency frameworks that can enhance cross-disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care.
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Affiliation(s)
- Maya Zumstein-Shaha
- Department of Health, Master of Science in Nursing Program, Adjunct Head of Program, Bern University of Applied Sciences, Bern, Switzerland.,Department of Nursing, Faculty for Health, University of Witten/Herdecke, Witten, Germany
| | - Pamela J Grace
- Boston College, William F. Connell School of Nursing, Boston, Massachusetts, USA
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25
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Fernández Fernández E, Fernández-Ordoñez E, García-Gamez M, Guerra-Marmolejo C, Iglesias-Parra R, García-Agua Soler N, González-Cano-Caballero M. Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review. J Clin Nurs 2022; 32:2339-2360. [PMID: 35293058 DOI: 10.1111/jocn.16287] [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: 10/05/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVES The aim of this study is to identify preoperative indicators and/or predictors of complications or inefficiencies in the surgical process that can be modified within nursing practice. BACKGROUND Due to rapid sociodemographic and technological change, the global demand for surgical attention is rising exponentially, requiring new strategies for optimisation and sustainability in perioperative care. DESIGN We conduced the scoping review using the methodology recommended by the Joanna Briggs Institute supported with The PAGER framework and guided by the PRISMA-ScR Checklist. METHODS Four databases (CINAHL, MEDLINE, SCOPUS and PUBMED) were examined to extract relevant published results for elective surgery on adult patients during the period 2011-2021. This process identified 609 records. Exclusion criteria were applied, and the sample was then evaluated with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD), after which 15 studies remained. RESULTS The following preoperative indicators and/or predictors were considered: (1) Anxiety; (2) Pain; (3) Health education, knowledge and training; (4) Satisfaction; (5) Management/organisation (including costs, resources used/available, organisational issues, hospital stay (preoperative), standardisation and protocolisation. CONCLUSION The identification of five indicators and/or predictors of complications or inefficiencies in the surgical process, which can be modified by nursing, allows the effective application of interventions in the preoperative phase, optimising care and improving health outcomes. RELEVANCE TO CLINICAL PRACTICE The development and implementation of specific nursing skills in the preoperative phase are essential to optimise the surgical process.
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Affiliation(s)
| | | | - Marina García-Gamez
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | | | - Rosa Iglesias-Parra
- Department of Nursing, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Nuria García-Agua Soler
- Department of Pharmacology and Pediatrics, Faculty of Medicine, University of Málaga, Málaga, Spain
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Creese J, Byrne JP, Olson R, Humphries N. A catalyst for change: Developing a collaborative reflexive ethnographic approach to research with hospital doctors during the COVID-19 pandemic. METHODOLOGICAL INNOVATIONS 2022; 16:3-14. [PMID: 38603431 PMCID: PMC9713536 DOI: 10.1177/20597991221137813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The understanding of what ethnography looks like, and its purpose, is continuously evolving. COVID-19 posed a significant challenge to ethnographers, particularly those working in health-related research. Researchers have developed alternative forms of ethnography to overcome some of these challenges; we developed the Mobile Instant Messaging Ethnography (MIME) adaptation to ethnography in 2021 to overcome restrictions to our own research with hospital doctors. However, for ethnographic innovations to make a substantial contribution to methodology, they should not simply be borne of necessity, but of a dedicated drive to expand paradigms of research, to empower participant groups and to produce change - in local systems, in participant-collaborators and in researchers and the research process itself. In this paper, we reflect on our experiences using MIME, involving collaborative remote observation and reflection with 28 hospital doctors in Ireland from June to December 2021. After reviewing literature on ethnography in COVID-19 and general epistemological developments in ethnography, we detail the MIME approach and illustrate how MIME presents an evolution of the ethnographic approach, not only practically but in terms of its reflexive shift, its connected and co-creative foundations, and its ability to drive change in research approaches, participant life-worlds and real-world improvement.
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Affiliation(s)
- Jennifer Creese
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - John-Paul Byrne
- Graduate School of Population Healthcare Management, Royal College of Surgeons University of Medicine and Health Sciences, Dublin, Ireland
| | - Rebecca Olson
- School of Social Science, The University of Queensland, Saint Lucia, QLD, Australia
| | - Niamh Humphries
- Graduate School of Population Healthcare Management, Royal College of Surgeons University of Medicine and Health Sciences, Dublin, Ireland
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Wei H, Horns P, Sears SF, Huang K, Smith CM, Wei TL. A systematic meta-review of systematic reviews about interprofessional collaboration: facilitators, barriers, and outcomes. J Interprof Care 2022; 36:735-749. [DOI: 10.1080/13561820.2021.1973975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Holly Wei
- PhD Program, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Phyllis Horns
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Samuel F. Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Kun Huang
- College of Nursing, East Carolina University, Greenville, NC, USA
| | | | - Trent L. Wei
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Fernandes SF, Trigueiro JG, Barreto MAF, Carvalho REFLD, Silva MRFD, Moreira TMM, Costa MVD, Freitas RJMD. Interprofessional work in health in the context of the COVID-19 pandemic: a scoping review. Rev Esc Enferm USP 2021; 55:e20210207. [PMID: 34807228 DOI: 10.1590/1980-220x-reeusp-2021-0207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to map the scientific production on interprofessional relationships in health in the first year of the COVID-19 pandemic. METHOD this is a scoping review performed in PubMed, Scopus, LILACS, CINAHL, Web of Science, Google Scholar and Science Direct databases, covering the period of publication in 2020, using the acronym PCC (Population = health professionals; Concept = interprofessional relationships; Context = health services) and respective search strategies. RESULTS fourteen scientific articles were selected and the content discussed in the manuscripts was standardized, analyzed and organized into categories of affinities and similarities of their results: 1 - Interprofessional collaboration; 2 - Collaborative practice; 3 - Interprofessional work; 4 - Interactive and interprofessional learning. CONCLUSION the pandemic demanded quick and effective responses that were only possible through collaboration and interprofessionalism dimensions. Interprofessional work in health during the first year of the COVID-19 pandemic confirms the importance of interprofessional work and its dimensions for the provision of more comprehensive, resolute and safer health services.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo Viana da Costa
- Universidade Federal do Rio Grande do Norte, Escola Multicampi de Ciências Médicas, Departamento de Medicina, Caicó, RN, Brazil
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29
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Institutionalizing Reflexivity for Sustainability: Two Cases in Health Care. SUSTAINABILITY 2021. [DOI: 10.3390/su132111712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unsustainability in health care comprises diminishing returns and misalignment between the health care regime and the needs of the population. To deal with complex sustainability problems, niche solutions can be collaboratively designed and implemented through reflexive methods. For second-order sustainability, however, the institutionalization of the reflexive element itself is also needed. This paper aims to provide insight into the possibilities of embedding reflexivity into institutions to support second-order sustainability by reporting on two consecutive participatory research programs that sought to address unsustainability in terms of misalignment and diminishing returns. The first case study reflexively monitored the system’s innovation toward an integrated perinatal care system. Reflection within the project and implementation was supported successfully, but for stronger embedding and institutionalization, greater alignment of the reflexive practices with regime standards was needed. Building on these lessons, the second case study, which was part of the IMI-PARADIGM consortium, collaboratively built a structured tool to monitor and evaluate “the return on engagement” in medicine development. To institutionalize reflexivity, the creation of “reflexive standards” together with regime actors appears to be most promising. Broader and deeper institutionalization of reflexive standards can be attained by building enforcement structures for reflexive standards in the collaborative process as part of the reflexive methodologies for addressing complex sustainability problems.
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Cox R, Molineux M, Kendall M, Tanner B, Miller E. Co-produced capability framework for successful patient and staff partnerships in healthcare quality improvement: results of a scoping review. BMJ Qual Saf 2021; 31:134-146. [PMID: 34253682 PMCID: PMC8784995 DOI: 10.1136/bmjqs-2020-012729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Internationally, patient and public involvement (PPI) is core policy for health service quality improvement (QI). However, authentic QI partnerships are not commonplace. A lack of patient and staff capability to deliver successful partnerships may be a barrier to meaningful QI collaboration. OBJECTIVES The research questions for this scoping review were: What is known regarding the capabilities required for healthcare staff and patients to effectively partner in QI at the service level?; and What is known regarding the best practice learning and development strategies required to build and support those capabilities? METHODS A six-stage scoping review was completed. Five electronic databases were searched for publications from January 2010 to February 2020. The database searches incorporated relevant terms for the following concepts: capabilities for PPI in healthcare QI; and best practice learning and development strategies to support those capabilities. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS Forty-nine papers were included. Very little peer-reviewed literature focused explicitly on capabilities for QI partnerships and thus implicit paper content was analysed. A Capability framework for successful partnerships in healthcare quality improvement was developed. It includes knowledge, skills and attitudes across three capability domains: Personal Attributes; Relationships and Communication; and Philosophies, Models and Practices, and incorporates 10 capabilities. Sharing power and leadership was discussed in many papers as fundamental and was positioned across all of the domains. Most papers discussed staff and patients' co-learning (n=28, 57.14%). Workshops or shorter structured training sessions (n=36, 73.47%), and face-to-face learning (n=34, 69.38%) were frequently reported. CONCLUSION The framework developed here could guide individualised development or learning plans for patient partners and staff, or could assist organisations to review learning topics and approaches such as training content, mentoring guidelines or community of practice agendas. Future directions include refining and evaluating the framework. Development approaches such as self-reflection, communities of practice, and remote learning need to be expanded and evaluated.
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Affiliation(s)
- Ruth Cox
- Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia .,Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Queensland, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Queensland, Australia
| | - Melissa Kendall
- School of Health Sciences and Social Work, Griffith University, Queensland, Queensland, Australia.,Acquired Brain Injury Outreach Service and Transitional Rehabilitation Program, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Bernadette Tanner
- Consumer Co-Researcher C/O Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Elizabeth Miller
- Consumer Co-Researcher C/O Occupational Therapy Department, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Queensland, Australia
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O'Leary N, Salmon N, Clifford AM. Inside-out: normalising practice-based IPE. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:653-666. [PMID: 33206271 DOI: 10.1007/s10459-020-10017-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
Practice-based interprofessional education (IPE), a key feature in developing a collaboration-ready workforce, is poorly integrated in healthcare curriculums. This study aimed to synthesise educator perspectives on implementing practice-based IPE and develop recommendations to inform sustainable practice-based IPE. An ethnographic case study was carried out at a school of allied health. Data collection involved six observations, 11 interviews and a review of eight documents. Reflexive thematic analysis, informed by Normalisation Process Theory, established two key themes. First, we found that strategic planning is needed, with a coherent implementation agenda and planned reflection on activities. Second, building partnerships with placement partners was identified as essential. This can be achieved by supporting and championing practice-based IPE activities developed by placement sites and establishing how university and clinical educators can work collaboratively to deliver sustainable practice-based IPE. These conditions create a favourable environment for normalising practice-based IPE in healthcare curriculums, benefitting students, patients, and the overall healthcare service.
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Affiliation(s)
- Noreen O'Leary
- School of Allied Health, University of Limerick, Limerick, Ireland.
| | - Nancy Salmon
- School of Allied Health, University of Limerick, Limerick, Ireland
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Yong FR, Hor SY, Bajorek BV. A participatory research approach in community pharmacy research: The case for video-reflexive ethnography. Res Social Adm Pharm 2021; 18:2157-2163. [PMID: 33903066 DOI: 10.1016/j.sapharm.2021.04.013] [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: 11/20/2020] [Revised: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Video-reflexive ethnography (VRE) is a qualitative methodology that explores the complex nature of healthcare 'as it really is'. Its collaborative and reflexive process invites stakeholders (e.g. pharmacists and pharmacy support staff) to participate in analysing their everyday work practices as captured on video footage. Through close collaboration with practitioners and attention to their work contexts, VRE may be a useful methodology to engage a time-poor pharmacy workforce in research about themselves, encouraging more practitioner involvement in practice-based research. Aside from research, VRE has also been used effectively as an intervention to facilitate learning and change in healthcare settings, and could be effective in provoking change in otherwise resistant pharmacy environments. Much like traditional ethnographic approaches, VRE researchers have relied on being present 'in the field' to observe, record and make sense of practices with participants. The COVID-19 pandemic however, has introduced restrictions around travel and physical distancing, which has required researchers to contemplate the conduct of VRE 'at a distance', and to imagine new ways in which the methodological 'closeness' to stakeholders and their workplace contexts can be maintained when researchers cannot be on site. In this commentary, we outline the rationale for participatory methods, in the form of VRE, in pharmacy research. We describe the underlying principles of this innovative methodology, and offer examples of how VRE can be used in pharmacy research. Finally, we offer a reflexive account of how we have adapted the method for use in community pharmacy research, to adapt to physical distancing, without sacrificing its methodological principles. This paper offers not only a new methodology to examine the complexity of pharmacy work, but demonstrates also the responsiveness of VRE itself to complexity, and the potential breadth of future research applications in pharmacy both during and beyond the current pandemic.
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Affiliation(s)
- Faith R Yong
- Pharmacy Department, Graduate School of Health, University of Technology Sydney, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia.
| | - Su-Yin Hor
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Building 10, 15 Broadway, Ultimo, Sydney, NSW, 2007, Australia.
| | - Beata V Bajorek
- Pharmacy Department, Graduate School of Health, University of Technology Sydney, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia.
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. Context counts: a qualitative study exploring the interplay between context and implementation success. J Health Organ Manag 2021; ahead-of-print. [PMID: 33682395 PMCID: PMC9073593 DOI: 10.1108/jhom-07-2020-0296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice. DESIGN/METHODOLOGY/APPROACH The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success. FINDINGS Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams. ORIGINALITY/VALUE By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.
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Affiliation(s)
- Lisa Rogers
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Sarah A Birken
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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Bonaconsa C, Mbamalu O, Mendelson M, Boutall A, Warden C, Rayamajhi S, Pennel T, Hampton M, Joubert I, Tarrant C, Holmes A, Charani E. Visual mapping of team dynamics and communication patterns on surgical ward rounds: an ethnographic study. BMJ Qual Saf 2021; 30:812-824. [PMID: 33563790 DOI: 10.1136/bmjqs-2020-012372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/03/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The effect of team dynamics on infection management and antimicrobial stewardship (AMS) behaviours is not well understood. Using innovative visual mapping, alongside traditional qualitative methods, we studied how surgical team dynamics and communication patterns influence infection-related decision making. MATERIALS/METHODS Between May and November 2019, data were gathered through direct observations of ward rounds and face-to-face interviews with ward round participants in three high infection risk surgical specialties at a tertiary hospital in South Africa. Sociograms, a visual mapping method, mapped content and flow of communication and the social links between participants. Data were analysed using a grounded theory approach. RESULTS Data were gathered from 70 hours of ward round observations, including 1024 individual patient discussions, 60 sociograms and face-to-face interviews with 61 healthcare professionals. AMS and infection-related discussions on ward rounds vary across specialties and are affected by the content and structure of the clinical update provided, consultant leadership styles and competing priorities at the bedside. Registrars and consultants dominate the discussions, limiting the input of other team members with recognised roles in AMS and infection management. Team hierarchies also manifest where staff position themselves, and this influences their contribution to active participation in patient care. Leadership styles affect ward-round dynamics, determining whether nurses and patients are actively engaged in discussions on infection management and antibiotic therapy and whether actions are assigned to identified persons. CONCLUSIONS The surgical bedside ward round remains a medium of communication between registrars and consultants, with little interaction with the patient or other healthcare professionals. A team-focused and inclusive approach could result in more effective decision making about infection management and AMS.
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Affiliation(s)
- Candice Bonaconsa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Oluchi Mbamalu
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Adam Boutall
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Claire Warden
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shreya Rayamajhi
- Division of General Surgery, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Tim Pennel
- Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Mark Hampton
- Dr. Matley & Partners Surgical Practice, Cape Town, South Africa
| | - Ivan Joubert
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alison Holmes
- NIHR Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
| | - Esmita Charani
- NIHR Health Protection Research Unit in Healthcare Associated infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, London, UK
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