"Discrimination", the Main Concern of Iranian Nurses over Inter-Professional Collaboration: an Explorative Qualitative Study

Perception and engagement in unprofessional behaviors of medical students and residents: a mixed-method study

BACKGROUND

The present study aimed to investigate perception and engagement in unprofessional behavior of residents and medical interns and explore the factors affecting their engagement in unprofessional behavior.

METHOD

This study has an explanatory (quantitative-qualitative) mixed-method design. This study was conducted at Shahid Sadoughi University of Medical Sciences in 2022-2023. Participants, including residents and medical interns (n = 169), were entered by stratified random sampling. A survey was conducted in the quantitative step. A by an unprofessional behavior in clinical practice questionnaire (29 items) was used. For each behavior, the participants were asked to report whether they (a) participated in the behavior and (b) stated that the behavior Is unprofessional. In the qualitative step, 17 participants contributed. The qualitative data were collected by semi-structured interviews and analyzed according to the conventional content analysis approach Graneheim and Lundman introduced.

RESULTS

The highest ratio of participants' engagement in unprofessional behavior was reported in 'failure to introduce yourself and nurses and physician assistants to the patient and his family' (n = 145 (85.8%)). The results showed the proportion of participants who engaged in unprofessional behavior more than those who did not participate. There were associations between participants' engagement in each behavior and their perception of that particular behavior as unprofessional. (p = 0.0001). In the following behaviors, although the participants acknowledged that these behaviors were unprofessional, those who participated in the unprofessional behaviors were significantly more than those who did not participate: failure to comply with clinic regulations and policy (p = 0.01), eating or drinking in the hallway of the clinic (p = 0.01), medical negligence in duties in the clinic setting (p = 0.04) and failure to perform duties in teamwork (p = 0.04). The qualitative results were explored in a theme entitled "internalized unprofessional culture," including three categories "encouraging contextual risk factors towards unprofessionalism," "suppressing of unprofessionalism reporting," and "disbelieving professionalism as a key responsibility."

CONCLUSION

The results indicated that most participants engaged in unprofessional behaviors. The findings resulted from the internalized unprofessional culture in the workplace. The findings showed that engagement in unprofessional behaviors resulted from personal and systemic factors. The weakness of responsibility recognition and identity formation as a professional facilitated the engagement in unprofessional behaviors at the personal level. Furthermore, systemic factors including the contextual risk factors (such as deficiency of explicit and hidden curriculum), and the suppression of unprofessionalism reporting mechanism as a hidden factor played an important role in normalizing unprofessional behavior and promoting engagement in unprofessional behaviors among the participants. Recognition of the nature and extent of students' unprofessional behaviors facilitates educational discussion among teachers and students in this field. The results might assist to establish an assessment system and feedback mechanism to solve the problem of the "failure to fail" problem. In addition, these results provide medical educators insights into the development of professional courses that equip learners with adherence to professionalism and coping skills to deal with unprofessionalism in the healthcare system.

Workplace discrimination and its relationship with organizational commitment among the surgical technologist: A national cross-sectional study in Iran

Background

Discrimination in healthcare centers can reduce care quality and job satisfaction, weaken the morale of the personnel and increase the cost of health care and finally lead to turnover intention. Discrimination in hospitals can affect the work outcomes and performance indicators of nurses such as their organizational commitment. Due to the vital role of surgical technologists in surgery and justice as the basis of effective performance, as well as the role of organizational commitment in care quality, the present study was conducted aimed to determine the level of workplace discrimination from viewpoint of the surgical technologists and its relationship with the organizational commitment.

Methods

This cross-sectional study was conducted on 615 surgical technologists in 8 metropolises of Iran in 2022. The sampling method in this study was multi-stage. The data collection tools included three questionnaires (demographic information, workplace discrimination, and Allen and Meyer's organizational commitment). Data were collected within 2 months and analyzed by SPSS version 22. Descriptive and inferential analyzes including independent t-test and analysis of variance were used for data analysis. p-value ≥ 0.05 was considered significant.

Results

The average age of the participants in the study were 29.90 ± 5.83 years with the participation of 464 women. The results of the data analysis showed an inverse and significant correlation between workplace discrimination and organizational commitment (r = -0.149, p-value < 0.001). The mean and standard deviation for workplace discrimination was 108.20 ± 11.53, which is average. Also, the mean and standard deviation for total organizational commitment was 100.56 ± 19.14, which is higher than the average.

Conclusion

According to the results of this study, managers need to pay attention to reduce discrimination in the operating room and establish organizational justice, to improve the motivation of surgical technologists and the quality of their performance. It is also suggested that operating room managers and supervisors, by creating a safe, confidential, and fearless environment to encourage the personnel to express what they understand about discriminatory conditions.

The effect of continuing interprofessional education on improving learners' self-efficacy and attitude toward interprofessional learning and collaboration

We aimed to assess the effect of continuing interprofessional education on collaborative self-efficacy, attitude toward the team, and interprofessional learning in workplace-based learning situations. This was a quasi-experimental study conducted in two educational hospitals. Two hundred and ten participants including nursing and medicine from general medicine, internal medicine, and emergency medicine, entered the study and were categorized in the census's intervention group (n = 97) and control group (n = 113). Continuing interprofessional education interventions included interprofessional rounds and workshops. Attitudes toward the team and interprofessional learning and collaborative self-efficacy were assessed using the Readiness for Interprofessional Learning, Attitudes Toward Health Care Teams, and Interprofessional Collaborator Assessment. Participants' attitude toward the team (p-value <.001), attitude toward interprofessional learning (p-value <.001), and interprofessional collaborative self-efficacy (p-value <.001) were significantly improved compared to participants' scores in the control group. Integrating the principles of continuing education, interprofessional education, and workplace-based learning provided an effective learning situation through interactive relationships and active collaboration of participants. The findings revealed a significant educational effect of the intervention on attitude toward interprofessional learning and the team, and a small effect on self-efficacy of interprofessional collaboration.

Nurses' perception of workplace discrimination

BACKGROUND

Discrimination and injustice are big obstacles in nurses' way to socialization and are among the major clinical challenges faced by nurses. Workplace discrimination is associated with such negative consequences as stress, fatigue, demoralization, loss of professional commitment, tension and conflicts at work, and resignation. A review of literature shows that not much research has been dedicated to workplace discrimination in nursing.

OBJECTIVE

This study aims to investigate nurses' perception of workplace discrimination.

METHOD

This cross-sectional study was conducted in the hospitals affiliated with a university of medical sciences in the largest city in the south of Iran in 2019. The participants consisted of 597 nurses who were selected through stratified random sampling. Data were collected using a researcher-made workplace discrimination questionnaire and analyzed in SPSS v. 21.

FINDINGS

The mean of the nurses' workplace discrimination scores was found to be 102.57 ± 14.5, which is considered as moderate. The nurses' mean scores for the dimensions of vertical and horizontal discrimination (44.53 ± 6.8), consequences of discrimination (20.52 ± 5.55), and unfair promotion (12.38 ± 2.44) were moderate. As for the two other dimensions of workplace discrimination, namely, gender discrimination (14.41 ± 3.28) and cultural-organizational discrimination (11.88 ± 2.99), the participants' mean scores were low. There was a significant relationship between the nurses' workplace discrimination mean score on the one hand and their employment status (p = 0.016) and work experience (p = 0.002) on the other. However, the nurses' workplace discrimination mean score was not found to correlate with their level of education (p = 0.65), marital status (p = 0.274), and gender (p = 0.479).

ETHICAL CONSIDERATION

This study has been approved by the ethics committee of the university. All the participants had signed the written informed consent form before participation.

CONCLUSION

Hospital managers should take measures to reduce discrimination and establish organizational justice to raise nurses' morale and improve the quality of their performance as caregivers.

Interprofessional education in a community-based setting: An opportunity for interprofessional learning and collaboration

BACKGROUND

An interprofessional community-based education provides proper situations that learners can be prepared to play their professional responsibilities and team duties in the community. This study aims to assess the effect of interprofessional community-based education on attitudes and performances of learners toward interprofessional collaboration and their readiness for interprofessional learning.

MATERIALS AND METHODS

The study is a quasi-experimental design. The learners in six different disciplines, including medicine, pharmacy, nursing, midwifery, public health, and nutrition (n=122) at Shahid Sadoughi University of Medical Sciences were participated in the present study. in the present study, interprofessional education intervention was conducted in two steps. First, the interprofessional learning situation brought learners the familiarity with the concepts of interprofessional collaboration, teamwork, and educational medical content, such as backache, fatty liver, diabetes, and HIV. Second, learners from different disciplines participated in interprofessional teams in community settings. These learners taught people about health-related topics, such as backache, fatty liver, and HIV. Participants filled out the questionnaires before and after interventions. Data were analyzed by Student's t-test and one-way ANOVA in SPSS 16.0 software (SPSS, Inc., Chicago, IL, USA).

RESULTS

The present results showed that the scores of learners in readiness for interprofessional learning 3.82 (0.35) versus 4.60 (0.29) (P = 0.001) (P = 0.0001), attitudes to interprofessional teamwork 3.83 (0.40) versus 4.18 (0.30) (P = 0.0001) (P = 0.0001), interprofessional collaboration 7.46 (0.70) versus 8.35 (0.43) (P = 0.001) improved significantly before and after the educational interventions.

CONCLUSION

The present results showed that interprofessional community-based education has improved the readiness of the learners for interprofessional learning. Besides, attitude toward teamwork and interprofessional collaboration performance have also been improved from participants' viewpoints.

The effect of interprofessional education on healthcare providers' intentions to engage in interprofessional shared decision-making: Perspectives from the theory of planned behaviour

AIMS AND OBJECTIVES

The present study aimed to investigate the effects of interprofessional education on healthcare providers' intentions to engage in an interprofessional shared decision-making (IP-SDM) process at emergency department and exploring the affecting factors on their intentions.

METHODS

We conducted the study through a sequential explanatory mixed method (quantitative-qualitative) design. All ED residents and nurses from two university hospitals were invited and assigned to the intervention and control groups. The intervention group was exposed to case-based learning sessions conducted by applying interprofessional strategies. The intentions of the participants engaged in IP-SDM were assessed before and 2 weeks after the intervention by a questionnaire designed based on the theory of planned behaviour. The questionnaire scores were compared between the intervention and control groups using analysis of covariance (ANCOVA). Partial eta-squared (η² ) was used for effect size calculations in ANCOVA. Subsequently, to explore the affecting factors in engagement in IP-SDM, qualitative data were collected through semi-structured individual interviews. The inductive content analysis approach by Elo and Kyngas was employed to analyze the qualitative data.

RESULTS

Out of 117 potentially eligible healthcare professionals, 113 completed the study in the intervention (n = 55) and control (n = 58) groups. The results showed that the difference between the mean scores of the learners in the intervention (1.41 ± 0.27) and control (0.80 ± 0.52) groups was statistically significant (P-value = .00001). The main effect of the intervention and a large educational effect size for the intervention were found to be statistically significant F (1, 11) = 180.54, P-value = .00001, η² = 0.62. The qualitative data analysis showed two main categories of "team-based facilitators" and "contextual challenges" as the main affecting factors in the engagement of participant in IP-SDM.

CONCLUSION

Our findings suggested that applying interprofessional education strategies could improve the learners' intention to engage in IP-SDM. Moreover, the results showed that the interprofessional collaboration among team members, adherence to the team-based care principles, and administrative support at different levels could be the influential factors the intentions of the participants to engage in IP-SDM.

Perceptions of Iranian emergency department directors of interprofessional leadership: an interview study

The aim of this study was to explore the viewpoints of Iranian health-care team directors regarding factors that are influential in leading an interprofessional team in the emergency department. The study was conducted using in-depth individual interviews and inductive content analysis. The study took place in the emergency departments of three teaching hospitals in Tehran. We used purposeful criterion sampling and interviewed 15 health-care team directors including 12 emergency medicine specialists and 3 nursing directors. Each interview lasted 60 to 90 minutes. All interviews were recorded and transcribed verbatim. Participants' statements were used to freely generate the initial data codes (open coding). Then, the initial codes were arranged into subcategories, which were later grouped together into categories. Finally, by comparing and contrasting categories, three main categories were identified: (a) effectiveness of the team-based leadership, (b) strategies of advancing interprofessional collaboration, and (c) weakness in overcoming team challenges. In the present study, the main factors that affected developing interprofessional collaboration in the Iranian emergency department were the development and support of leadership at the team and organizational levels, and implementation of staff development strategies at the individual and team levels.

The consequences of nurses' endeavors to overcome inter-professional discrimination

BACKGROUND

Discrimination in nursing has led to the formation of some taboos that often impact the individual's professional development. Nurses use strategies to overcome discrimination that can lead to consequences.

RESEARCH OBJECTIVE

This study assessed nurses' experiences to explore the consequences of Iranian nurses' strategies to overcome intra-professional discrimination.

RESEARCH DESIGN

This qualitative content analysis study employed purposive sampling to reach 25 nurses working at educational hospitals in Tehran, Tabriz, and Ilam, Iran. The data were collected using deep and unstructured interviews along with notes in a period of time between April 2016 and May 2017. Interviews were simultaneously analyzed using inductive and conventional content analysis method after being transcribed.

ETHICAL CONSIDERATION

This study was approved by the Regional Committee of Medical Research Ethics. Also, voluntary participation, anonymity, and confidentiality were considered.

FINDINGS

Two themes emerged from our analysis due to consequences of nurses' efforts to overcome intra-professional discrimination: "seeking justice" and "passivity."

DISCUSSION

Nurses' efforts to overcome professional discrimination have led to outcomes. These outcomes can be affect on their individual effort to achieve organizational goals, provide better care or feel disabling or nurses turnover.

CONCLUSION

Strategies adopted by nurses to overcome intra-professional discrimination have led to consequences which vary from negative to positive and impact their performance.

Readiness to change for interprofessional collaboration in healthcare: Development and validation of a theory-based instrument

This paper presents a study that aimed to develop and validate a theory-based instrument for the assessment of readiness to change for interprofessional collaboration in healthcare (IPC-TTM). The instrument was developed in the Persian language and tested in the Iranian context. Healthcare professionals from medical and nursing professions participated in the assessment of validity and reliability of the instrument. We conducted this psychometric study in two phases: First, the questionnaire was developed based on the transtheoretical model (TTM) through literature review and expert panel. Then, in the validation phase, we held three modified Delphi rounds to assess the content and face validity of the questionnaire. We used confirmatory factor analysis (CFA) to evaluate the fit of the questionnaire as applied to modified TTM. Reliability of the final instrument was tested by assessing the test-retest reliability of instrument items with Kappa coefficient. We also calculated the intraclass correlation coefficient (ICC) and Cronbach's alpha to assess the test-retest reliability and internal consistency of the instrument sub-scales. The initial item pool consisted of 30 items and three sub-scales (Attitude, Intention, and Action). The content validity of the questionnaire was confirmed with 17 items. Based on the CFA results two additional items were deleted to increase the fit of the model. The final instrument was confirmed with 15 items and three sub-scales. Reliability assessment on the 15-item instrument showed an acceptable test-retest reliability of the instrument items. ICC values for the Attitude, Intention, and Action sub-scales of the instrument were calculated as 0.82, 0.73, and 0.71, respectively. Moreover, Cronbach's alpha for the Attitude, Intention, and Action sub-scales were 0.85, 0.73, and 0.77, respectively. This study offers a new theory-based instrument to measure readiness to change for interprofessional collaboration in healthcare in the Iranian context. The questionnaire can be used for 'needs assessment' in developing tailored educational interventions and self-assessments in interprofessional education studies.

Perceived Distributive Injustice, the Key Factor in Nurse's Disruptive Behaviors: A Qualitative Study

Introduction: Disruptive behaviors are one of the most topics affecting the wellbeing of organizations, therefore, it has become a significant research area. The purpose of this study was to determine experiences and perceptions of nurses who were involved in disruptive behaviors. Methods: A qualitative study was conducted by using a conventional content analysis. The data was obtained through 15 unstructured and in-depth interviews with nurses in six hospitals of Tehran city, Iran. A purposive sampling method was used. All interviews were recorded, typed and analyzed simultaneously. Results: The main theme obtained from the nurses' views and experiences analysis about disruptive behaviors were injustice and discrimination in hospitals including injustice in payments, work division, interactions, and judgment and evaluations. Conclusion: It seems that the best way to prevent and correct the disruptive behaviors was to eliminate the perceived nurses' injustice feeling and establishment the justice and fairness in organizations.

Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach," found on pages 449-460, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Explain the recommended framework in teaching and implementing interprofessional competencies. Identify suggested core competencies to implement interprofessional collaborative practice. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose.

BACKGROUND

The aim of this study is to develop and contextualize a competency framework for interprofessional teamwork in Iran.

METHOD

The study was conducted in three phases. First, the competencies of interprofessional teamwork were extracted from the literature. In the second phase, the content validity of the initial framework was assessed by the experts through the Delphi rounds. Content validity ratio (CVR) and item-level content validity index (I-CVI) were used for quantitative analysis. Finally, in the third phase, the importance and utility of interprofessional teamwork competencies were assessed by the experts.

RESULTS

Initial framework was constructed with 28 competencies. Quantitative analysis by CVR indicated a score of less than .49 for three items. These items were excluded from the framework. The I-CVI for all items in the framework was higher than .78. The final framework was developed and validated with 16 competencies.

DISCUSSION

The developed framework is recommended for teaching and assessment of interprofessional teamwork competencies. J Contin Educ Nurs. 2016;47(10):449-460.