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Babu D, Rowett D, Kalisch Ellett L, Marotti S, Wisdom A, Lim R, Harmon J. Exploration of 'micro' level factors that affect the involvement of clinical pharmacists in interprofessional ward rounds in hospitals: Through the lens of social cognitive theory. Res Social Adm Pharm 2024; 20:654-664. [PMID: 38627153 DOI: 10.1016/j.sapharm.2024.04.007] [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: 02/07/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Macro and meso level factors that influence the participation by clinical pharmacists in ward rounds include pharmacy management culture, commitment to ward rounds and adequate time for ward rounds being included in workload models. The 'micro' level factors that affect the involvement of clinical pharmacists in ward rounds have not been widely explored. OBJECTIVE Explore 'micro' level factors to gain insight into clinical pharmacists' participation in interprofessional ward rounds in inpatient settings through the lens of social cognitive theory. METHOD A qualitative focused ethnographic study with five clinical pharmacists, four medical practitioners, one allied health professional and one nurse was conducted in three metropolitan hospitals in Southern Australia. Seven hours of semi-structured interview (n = 11) and 76-h of observations (n = 5) were conducted. A qualitative descriptive analysis was conducted (guided by Spradley) followed by reflexive thematic-analysis (according to Braun and Clarke's technique). RESULTS Three micro level factors influencing clinical pharmacist participation in ward rounds are: (1) Cognitive mindset of clinical pharmacists, (2) Behavioural conduct of clinical pharmacists, and (3) Social rules of the ward. Clinical pharmacists that did not participate in ward round reconciled their moral distress by transferring information without clinical judgement or interpretation of the patient scenario to medical practitioners. Clinical pharmacists that did participate in ward rounds demonstrated credibility by making relevant recommendations with a holistic lens. This enabled clinical pharmacists to be perceived as trustworthy by medical practitioners. Positive experiences of participating in ward rounds contributed to their cognitive upward spiral of thoughts and emotions, fostering continued participation. CONCLUSION Clinical pharmacists participate in ward rounds when they develop a positive mindset about ward round participation and perceive ward rounds as an enabler to the establishment of trusted professional relationships with medical practitioners. This trusted relationship creates an environment where the pharmacist develops confidence in making relevant recommendations.
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Affiliation(s)
- Dona Babu
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia.
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; Drug and Therapeutics Information Service, Southern Adelaide Local Health Network, Adelaide, SA, 5000, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Sally Marotti
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Alice Wisdom
- SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Joanne Harmon
- Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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Denicu MM, Preda SD, Râmboiu S, Bratiloveanu T, Nemes R, Chiutu L. The Crucial Role of Nurses in the Comprehensive Management of Postoperative Enteroatmospheric Fistula: A Narrative Review. CURRENT HEALTH SCIENCES JOURNAL 2024; 50:12-19. [PMID: 38854421 PMCID: PMC11157346 DOI: 10.12865/chsj.50.01.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/21/2024] [Indexed: 06/11/2024]
Abstract
Postoperative enteroatmospheric fistula (EAF) presents a complex challenge in surgical care, with multifactorial causes and significant implications for patient outcomes and quality of life. This narrative review explores the essential role of nurses in the comprehensive management of EAF, encompassing preoperative, intraoperative, and postoperative care. It emphasizes the importance of wound care management, nutritional support, psychosocial assistance, patient education, collaboration, continuous professional development, and research engagement in optimizing patient outcomes. By addressing these facets, healthcare providers can enhance their understanding and management of EAF, ultimately improving patient care in this intricate surgical complication.
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Affiliation(s)
- Maria Mădălina Denicu
- University of Medicine and Pharmacy of Craiova
- ICU Clinic, Craiova Emergency Clinical Hospital
| | - Silviu Daniel Preda
- University of Medicine and Pharmacy of Craiova
- First Clinic of Surgery, Craiova Emergency Clinical Hospital
| | - Sandu Râmboiu
- University of Medicine and Pharmacy of Craiova
- First Clinic of Surgery, Craiova Emergency Clinical Hospital
| | - Tudor Bratiloveanu
- University of Medicine and Pharmacy of Craiova
- First Clinic of Surgery, Craiova Emergency Clinical Hospital
| | | | - Luminita Chiutu
- University of Medicine and Pharmacy of Craiova
- ICU Clinic, Craiova Emergency Clinical Hospital
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McCormack G, Mehta PC. Engaging Chief Medical Officers to Improve Multidisciplinary Rounds. HCA HEALTHCARE JOURNAL OF MEDICINE 2023; 4:397-405. [PMID: 38223469 PMCID: PMC10783564 DOI: 10.36518/2689-0216.1487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Background Multidisciplinary rounds (MDRs), a model of care in which multiple members of the care team, representing different disciplines, come together to discuss the care of a patient in real-time. MDRs are a valuable tool for clinical teams to improve patient length of stay (LOS), reduce healthcare-associated infections, and increase care coordination. HCA Healthcare's data science and performance improvement teams created a data visualization tool called Next-gen Analytics for Treatment and Efficiency (NATE) Tempo to support care teams in managing rounds and barriers. Methods A pilot implementation of MDRs using the NATE Tempo tool was initiated in 10 hospitals, accompanied by a survey for Chief Medical Officers (CMOs) of each of the participating hospitals. Results Implementation of MDRs using the NATE Tempo tool was associated with an average reduction in LOS ratio from 135% to 114% across the 10 hospitals. CMO survey feedback identified areas of improvement related to MDR participation, and incorporation of NATE Tempo. CMO leadership within each facility and the use of the interactive dashboard facilitated the identification of high performers and areas of opportunity for improvement. Conclusion CMO engagement can help physicians take steps to decrease variation in practice, leading to compliance with best practice guidelines and decreasing the overall LOS in hospitals. The MDR process can support these efforts. Empowering CMOs through the use of the NATE Tempo tool improved engagement. Through the tool, the CMO promotes coordination of patient care throughout the hospital experience and during the post-discharge phase.
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Affiliation(s)
| | - Pranav C Mehta
- Chief Medical Officer, American Group, HCA Healthcare, Nashville, TN
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Srinivas V, Choubey U, Motwani J, Anamika F, Chennupati C, Garg N, Gupta V, Jain R. Synergistic strategies: Optimizing outcomes through a multidisciplinary approach to clinical rounds. Proc AMIA Symp 2023; 37:144-150. [PMID: 38174031 PMCID: PMC10761132 DOI: 10.1080/08998280.2023.2274230] [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: 09/08/2023] [Accepted: 10/12/2023] [Indexed: 01/05/2024] Open
Abstract
Multidisciplinary rounds (MDR) constitute a patient-centered care model wherein professionals from diverse disciplines collaborate in real time to provide specialized expertise. The MDR team, encompassing care partners, hospitalists, nurses, pharmacists, and more, employs a collaborative approach that optimizes patient care through shared goals, electronic record access, regular reviews, and patient involvement. MDRs have evolved to reduce patient mortality, complications, length of stay, and readmissions, and they enhance patient satisfaction and utilization of ancillary services. Family engagement in MDRs further transforms relationships from adversarial to collaborative, leading to improved comprehension of treatment strategies and smoother navigation of challenging conversations. Despite challenges such as time constraints, limited patient coverage, and hierarchical barriers, MDRs are being increasingly conducted across healthcare settings, with positive outcomes.
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Affiliation(s)
- Varsha Srinivas
- PES Institute of Medical Sciences and Research, Kuppam, India
| | | | - Jatin Motwani
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Fnu Anamika
- University College of Medical Sciences, New Delhi, India
| | | | - Nikita Garg
- Children’s Hospital of Michigan, Detroit, Michigan, USA
| | - Vasu Gupta
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Rohit Jain
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Evans MK, Lane H, Hitch DP, Tull V, Pepin G. Are two occupational therapists better than one? Occupational therapists' perspectives of intra-disciplinary practice within community health. Aust Occup Ther J 2023; 70:678-689. [PMID: 37438958 DOI: 10.1111/1440-1630.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Intra-disciplinary practice is rarely discussed in occupational therapy and the broader health-care literature. Community-based occupational therapists often work autonomously in clients' homes and consequently have limited access to routine intra-disciplinary practices. Additionally, the community-based role covers a large scope of practice requiring comprehensive expertise. This study aimed to describe occupational therapists' perspectives on intra-disciplinary practice within community health settings. METHODS This study utilised an online cross-sectional survey design, collecting quantitative and qualitative data to explore perspectives of occupational therapists working within Australian community health services. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. Both forms of data were compared and contrasted. RESULTS/FINDINGS Eighty occupational therapists completed the survey. Seventy-eight participants (97%) previously used or currently use intra-disciplinary practice in their workplace. Participants predominantly consult their peers when client needs are perceived as complex. Participants indicated that intra-disciplinary practice can benefit the client, therapist, and workplace. Enablers and barriers to the use of intra-disciplinary practice had overlapping themes, including access to therapists, attitudes towards intra-disciplinary practice, management support, and funding influences. Most participants expressed a desire to utilise intra-disciplinary practices (n = 70, 87%) and were also likely or extremely likely to incorporate it into their clinical work (n = 73, 91%). Participants who did not want to utilise intra-disciplinary practices or who were unsure provided reasons related to cost, practice inefficiencies, and being uncertain of the benefit. CONCLUSIONS Occupational therapists perceive intra-disciplinary practice as beneficial for problem-solving and an opportunity for knowledge sharing that supports therapist confidence with clinical reasoning. Conversely, some therapists believe its use may lead to client confusion, a greater need for communication and coordination among therapists, and that power differentials between therapists may discourage equal collaboration. Greater understanding of intra-disciplinary practice will help guide how it is used and supported in community health settings.
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Affiliation(s)
| | | | - Danielle Patricia Hitch
- Western Health, St Albans, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Victoria Tull
- Fight Parkinson's, Surrey Hills, Victoria, Australia
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Ho JT, See MTA, Tan AJQ, Levett-Jones T, Lau TC, Zhou W, Liaw SY. Healthcare professionals' experiences of interprofessional collaboration in patient education: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 116:107965. [PMID: 37677919 DOI: 10.1016/j.pec.2023.107965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/14/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES This study explores interprofessional collaboration amongst healthcare professionals in patient education. METHODS A systematic review was conducted. A search in seven databases was conducted from 2011 to 2022 and screened against the inclusion criteria. Quality appraisal was done independently by two reviewers. Studies were extracted and synthesised using the data-based convergent synthesis design. RESULTS Twenty-one studies were included. Five themes on factors affecting interprofessional collaboration in patient education emerged: 1) role clarification, 2) communication infrastructure, 3) shared space for collaboration, 4) interprofessional trust, and 5) organisational support. CONCLUSION Findings highlighted the importance of developing trustful relationships within the multidisciplinary team in delivering patient education. Channels for additional infrastructural support, guidelines and training in patient education delivery is required. Future research could explore patients' perspectives on how their learning needs in patient education may be optimised through a multidisciplinary approach. PRACTICE IMPLICATIONS Healthcare leaders could promote shared goals within the team by facilitating a common space and time for interprofessional team rounding, and by developing shared patient education resources and documentation processes. Interprofessional education focusing on the delivery of team-based patient education could be implemented to foster understanding of the interdependent role of multidisciplinary healthcare professionals.
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Affiliation(s)
| | - Min Ting Alicia See
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Tracy Levett-Jones
- School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Tang Ching Lau
- Yong Loo Lin School Medicine, National University of Singapore, Singapore
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Maia BB, Campelo FG, Rodrigues ECG, Oliveira-Cardoso ÉA, Santos MAD. Perceptions of health professionals in providing care for people with anorexia nervosa and bulimia nervosa: a systematic review and meta-synthesis of qualitative studies. CAD SAUDE PUBLICA 2023; 39:e00223122. [PMID: 37585904 PMCID: PMC10494704 DOI: 10.1590/0102-311xen223122] [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: 11/22/2022] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 08/18/2023] Open
Abstract
This study sought to synthesize and reinterpret findings from primary qualitative studies on the experience of health professionals in caring for people with anorexia nervosa and bulimia nervosa. We conducted a systematic review of the literature with the SPIDER search strategy assessing six databases. A meta-synthesis was performed with data from qualitative studies. Two independent reviewers screened and assessed the articles, extracted data from the articles and elaborated thematic synthesis. Nineteen articles met the inclusion/exclusion criteria. The meta-synthesis revealed three descriptive themes: Going outside the comfort zone: hard relational experiences of health professionals in providing care for people with anorexia nervosa and bulimia nervosa; Reflecting on treatment: relevance of discussion, communication, and flexibility in health professionals' work with anorexia nervosa and bulimia nervosa; and Dealing with ambivalences: experiences of health professionals with family members of people with anorexia nervosa and bulimia nervosa. We elaborated two analytical themes: Making work with eating disorders palatable: malleability necessary for health professionals in bonding with people with anorexia and bulimia nervosa and their families; and Leaving the professional comfort zone: transition from multi to interdisciplinary. Thus, mental health professionals who work with people diagnosed with anorexia and bulimia nervosa cope with hard emotional experiences that makes them feel out of their comfort zone, requiring flexibility to benefit a good therapeutic alliance, but there are still difficulties in promoting interdisciplinarity.
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Affiliation(s)
- Bruna Bortolozzi Maia
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Felipe Gonçalves Campelo
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | | | | | - Manoel Antonio Dos Santos
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
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Morris M, Mulhall C, Murphy PJ, Eppich WJ. Interdisciplinary collaborative working on surgical ward rounds: reality or rhetoric? A systematic review. J Interprof Care 2022; 37:674-688. [DOI: 10.1080/13561820.2022.2115023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Marie Morris
- Department of Surgical Affairs, 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
| | - Paul J. Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter J. Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Binda DD, Weinberg JM, Nguyen T, Morone NE. Characterizing Interprofessional Collaboration and Referral to Mindfulness-Based Stress Reduction Programs. Glob Adv Health Med 2022; 11:2164957X221126484. [PMID: 36118601 PMCID: PMC9478712 DOI: 10.1177/2164957x221126484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, the American College of Physicians (ACP) designated Mindfulness-Based Stress
Reduction (MBSR), an eight-week group program, as first-line non-pharmacological
treatment for chronic low back pain. However, interprofessional collaboration between
mindfulness instructors and Primary Care Providers (PCP) remains largely unknown. Objective We developed a survey to assess communication between mindfulness instructors and PCPs,
identify predictors of referral to MBSR, and determine areas where interventions could
increase patient access to MBSR. Methods The 25-question survey was sent via email to PCPs at the Division of General Internal
Medicine, University of Pittsburgh, PA, the Piedmont Health Services Family Medicine
Section, Chapel Hill, NC, the Boston Medical Center General Internal Medicine and Family
Medicine Sections, Boston, MA, and the UMass Memorial Medical Center Family Medicine
Section, Worcester, MA. We used descriptive statistics and logistic regression to
analyze the data. Results Among 118 eligible respondents, 85 (72.0%) were female PCPs, mean age was approximately
41.5±10.1, and the majority (65.2%) had been in medical practice ≤10 years. Of these
PCPs, 83 (70.1%) reported familiarity with MBSR (95% CI: 62.1, 78.5), and 49 (59.0%) of
them referred patients at least yearly. Of those who referred, 8 (16.3%) reported
collaboration with mindfulness instructors. PCPs who were quite a bit or very much
familiar with MBSR had 5.10 (1.10, 22.50) times the odds (P=.03), and those who were 50
years or younger had 3.30 times the odds (P=.04) of referring patients to MBSR.
Frequency of PCPs’ personal practice of mindfulness was not significantly associated
with referrals (P=.30). Conclusion This is the first study to assess interprofessional collaboration between mindfulness
instructors and PCPs. Suggestions for a potential integrative health care model are
included; further studies on methods to augment communication and education are
warranted to improve the referral process and ultimately increase accessibility and
utilization of mindfulness-based programs.
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Affiliation(s)
- Dhanesh D Binda
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Tra Nguyen
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Natalia E Morone
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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Miles G, Quinlan A, Frederick N, Brown A. Are shifting communication styles crumbling old silos? JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221110898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clear communication is essential to provide high-quality health care. The medical environment is changing. Older physicians and nurses are retiring being replaced with younger professionals who are not as concerned with gender roles and who appreciate technical communication. Along with the changing setting is the introduction of communication frameworks that are more comprehensive and consider both verbal and nonverbal modems of communication. This article provides an anecdotal event evaluated by the Hannawa ‘SACCIA Safe Communication” framework but also considers the changing medical landscape which may be helping to dissolve miscommunication silos. The fast-paced, fluid medical environment calls for a more robust, interactive communication tool. Healthcare providers would benefit from education on the entire communicative process needed for successful communication.
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Affiliation(s)
- Gayla Miles
- Trauma Research, Texas Health Harris Methodist Hospital, Fort Worth, TX, USA
| | - Ann Quinlan
- Trauma Administration, Texas Health Harris Methodist Hospital, Fort Worth, TX, USA
| | - Nicole Frederick
- Trauma Services Program, Texas Health Harris Methodist Hospital, Fort Worth, TX, USA
| | - Aaron Brown
- Trauma Services Program, Texas Health Harris Methodist Hospital, Fort Worth, TX, USA
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Effects of Continuous Care Combined with Evidence-Based Nursing on Mental Status and Quality of Life and Self-Care Ability in Patients with Liver from Breast Cancer: A Single-Center Randomized Controlled Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3637792. [PMID: 35529261 PMCID: PMC9071876 DOI: 10.1155/2022/3637792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/25/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022]
Abstract
Objective To explore the multidisciplinary collaborative extended care combined with EBN to improve breast cancer liver metastasis patients' psychological status and self-care ability. Background In the past ten years, the number of breast cancer patients with liver metastases has increased year by year, becoming a global public health problem. Studies have shown that 30% of breast cancer patients with liver metastases show varying degrees of anxiety and depression, and their quality of life is significantly lower than that of the normal population. Multidisciplinary collaborative continuous care can improve the prognosis of breast cancer treatment to a certain extent and is the key to meeting the needs of cancer patients. Materials and Methods The clinical data of 96 patients with liver metastases from breast cancer were selected as the study subjects and divided into a comparison group and an observation group of 48 cases each according to a random number table. Among them, the comparison group implemented evidence-based nursing (EBN) and the observation group implemented multidisciplinary collaborative extended care based on the comparison group. The effects of psychological status, quality of life, self-care ability, and sleep quality were compared between the two groups before and after nursing care. Results After nursing, the sleep quality scores, increased awakening scores, sleep quality that shows weakness because important things are not steady or strong scores, and night terrors scores of the two groups of breast cancer patients with liver the spread of diseases through the body were very much improved, and the sleep quality scores of the instance of watching, noticing, or making a statement group were much lower than those of the comparison group (P < 0.05). After nursing, the fear and stress-related score, depression score, tiredness and distress score, and anger score of the two groups of breast cancer patients with liver (the spread of diseases through the body) were very much improved, and the mental state score of the instance of watching, noticing, or making a statement group was much lower than that of the comparison group (P < 0.05). The scores of self-care skills, self-responsibility, health knowledge, and self-idea of patients in the instance of watching, noticing, or making a statement group after nursing were higher than those in the comparison group (P < 0.05). After nursing, the scores of mental energy, social interaction, emotional restriction, and mental status of patients in (instance of watching, noticing, or making a statement) were much higher than those in the comparison group (P < 0.05). Conclusion Multidisciplinary collaborative continuous nursing combined with EBN can effectively improve the sleep quality and psychological state of patients with breast cancer and liver metastases and improve self-care ability.
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Grafton-Clarke C, Uraiby H, Abraham S, Kirtley J, Xu G, McCarthy M. Live streaming to sustain clinical learning. CLINICAL TEACHER 2022; 19:282-288. [PMID: 35365976 DOI: 10.1111/tct.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/09/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The COVID-19 pandemic has necessitated the need to develop teaching innovations that provide safe, authentic clinical encounters which facilitate experiential learning. In tandem with the dissemination of teleconsultation and online teaching, this pilot study describes, evaluates and justifies a multi-camera live-streaming teaching session to medical students from the clinical environment. APPROACH Multiple audio and video inputs capturing an outpatient clinic setting were routed through Open Broadcast Software (OBS) to create a customised feed streamed to remote learners through a videoconferencing platform. Sessions were conducted between September 2020 and March 2021. Twelve students sequentially interacted with a patient who held an iPad. Higher quality Go-Pro cameras captured the scene, allowing students to view the consultation from the patient and doctor's perspective. A consultant then conducted a 'gold standard' patient consultation observed by students. A faculty member remotely facilitated the session, providing pre-clinic teaching and debriefing. The equipment required with costing for a standard and low-cost version is described, as well as a set-up schematic and overview of ideal conditions and barriers encountered during trials. EVALUATION All students completed a post-participation questionnaire, rating the overall quality of the sessions as 9.7/10. The quality of online facilitation, utility of observing peers' and consultant interaction with the patient, opportunity for peer-to-peer learning and availability of multiple camera angles were particularly valued by students. IMPLICATIONS This innovation permits an authentic clinical interaction to be experienced by multiple students remotely, promoting equitable access to high-quality teaching, while maintaining the safety of students and patients.
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Affiliation(s)
- Ciaran Grafton-Clarke
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hussein Uraiby
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Shalin Abraham
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Joanne Kirtley
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gang Xu
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mark McCarthy
- Department of Clinical Education, University Hospitals of Leicester NHS Trust, Leicester, UK
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Cervantes J, Herber-Valdez C. Perspectives of Inter-professional Education Under a Global Infectious Menace. MEDICAL SCIENCE EDUCATOR 2021; 31:2217-2220. [PMID: 33942019 PMCID: PMC8081279 DOI: 10.1007/s40670-021-01300-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
Health systems worldwide are facing unprecedented challenges, as a result of a convergence of major threats to our social and population health systems. For an epidemic of any magnitude, prevention and preparation by healthcare personnel in clinical settings are essential, both locally and globally. The need for the development of domestic and international training programs in the expanding field of emerging and reemerging infectious diseases is well recognized but particularly urgent at this time. Interprofessional education plays key roles in infectious diseases (ID) and in training the new generation of ID-related specialists.
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Affiliation(s)
- Jorge Cervantes
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
| | - Christiane Herber-Valdez
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
- Office of the Provost and Vice President for Academic Affairs, Texas Tech University Health Sciences Center El Paso, El Paso, TX USA
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Coates E, Quisenberry E, Williams B, Blackmore C. Focusing hospitalist roles on either admitting or rounding facilitates unit-based assignment and is associated with improved discharge efficiency. Hosp Pract (1995) 2021; 49:371-375. [PMID: 34551664 DOI: 10.1080/21548331.2021.1985316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Unit-based teams may improve care delivery for hospitalized patients but can be challenging to implement broadly across all acute care units in a hospital. OBJECTIVE To determine the effect of a Lean-guided transition to hospital-wide unit-based assignment on care delivery outcomes. DESIGN, SETTING, AND PARTICIPANTS The study was a retrospective time-series with primary outcomes of discharge efficiency, 30-day readmissions, and length of stay, performed at a 336-bed tertiary academic referral hospital in the Pacific Northwest with approximately 17,000 admissions annually. INTERVENTION Implementation of a Lean-guided quality improvement intervention included division of hospitalist duties into 'admitters' and 'rounders,' with simulated patient flow exercises to determine the optimal staffing model. MAIN OUTCOMES AND MEASURES Discharge efficiency (number of patients discharged by hospitalists divided by the number of hospitalist patient encounter days per month) and 30-day readmissions were compared using the t-test or chi-square, and length of stay was analyzed in a multivariate time-series regression model. RESULTS The intervention was associated with a significant improvement in discharge efficiency, by 0.014 (from 0.168 to 0.181) discharges/encounter (95% CI = 0.024, 0.004), p = 0.009. Mean length of stay decreased by 0.98 days (95% CI 0.50, 1.47) after adjustment for patient age, patient type (medical versus surgical), critical care admissions, and discharge disposition, without a corresponding change in 30-day readmission rate (12.2% (1948/15,902) pre-intervention to 11.7% (397/3379) post-intervention (p = 0.42)). CONCLUSIONS Dividing hospitalist roles into admitters and rounders enabled implementation of unit-based teams across the hospital, with corresponding improvements in discharge efficiency and length of stay.
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Affiliation(s)
- Evan Coates
- Virginia Mason Medical Center, Seattle, WA, USA
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Keniston A, McBeth L, Pell J, Bowden K, Ball S, Stoebner K, Scherzberg E, Moore SL, Nordhagen J, Anthony A, Burden M. Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach. JMIR Hum Factors 2021; 8:e24038. [PMID: 33890860 PMCID: PMC8105757 DOI: 10.2196/24038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/16/2021] [Accepted: 03/29/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Typical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams. OBJECTIVE Applying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings. METHODS We employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys. RESULTS We conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness. CONCLUSIONS Survey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.
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Affiliation(s)
- Angela Keniston
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Lauren McBeth
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Jonathan Pell
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | - Kasey Bowden
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
| | | | | | | | - Susan L Moore
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | | | - Marisha Burden
- Division of Hospital Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, United States
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Koh MYH, Khoo HS, Gallardo MD, Hum A. How Leaders, Teams and Organisations can prevent Burnout and build Resilience: a thematic analysis'. BMJ Support Palliat Care 2020:bmjspcare-2020-002774. [PMID: 33323369 DOI: 10.1136/bmjspcare-2020-002774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/04/2022]
Abstract
CONTENT Burnout occurs commonly in palliative care. Building resilience helps to mitigate the effects of burnout. Little is known about the importance of leaders, teams and organisations in preventing burnout and promoting resilience in palliative care. OBJECTIVES We studied palliative care clinicians with more than a decade's experience looking into their experiences on the role leaders, teams and organisations play in burnout and resilience. PATIENTS AND METHODS This is a thematic analysis focusing on how leaders, teams and organisations influence burnout and resilience. 18 palliative care clinicians-5 doctors, 10 nurses and 3 social workers-who worked in various palliative care settings (hospital, home hospice and inpatient hospice) were interviewed using semistructured questionnaires. The mean age of the interviewees was 52 years old, and the mean number of years practising palliative care was 15.7 years (ranging from 10 to 25 years). The interviews were recorded verbatim and were transcribed and analysed using a thematic analysis approach. RESULTS The following themes featured prominently in our study. For leaders: being supportive, caring and compassionate, being a good communicator and showing protective leadership. With teams: being like-minded, caring for the team, sharing the burden and growing together. For organisations: having a strong commitment to palliative care, supporting staff welfare and development, open communication, adequate staffing and organisational activities promoting staff well-being were described as protective against burnout and promoting resilience. CONCLUSION Leaders, teams and organisations play an important role in helping palliative care teams to reduce burnout and promote resilience.
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Affiliation(s)
| | - Hwee Sing Khoo
- Health Outcomes and Medical Education Research (HOMER), National Healthcare Group, Singapore
| | | | - Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
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