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Bouchez T, Cagnon C, Hamouche G, Majdoub M, Charlet J, Schuers M. Interprofessional clinical decision-making process in health: A scoping review. J Adv Nurs 2024; 80:884-907. [PMID: 37705486 DOI: 10.1111/jan.15865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
AIMS To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. DESIGN Scoping review of the literature. DATA SOURCES MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. REVIEW METHODS References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. CONCLUSION Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. IMPACT The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. IMPACT STATEMENT Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.
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Affiliation(s)
- Tiphanie Bouchez
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
| | - Clémence Cagnon
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Gouraya Hamouche
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Marouan Majdoub
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Jean Charlet
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Assistance Publique-Hôpitaux de Paris/DRCI, Paris, France
| | - Matthieu Schuers
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Department of General Practice, University of Rouen, Rouen, France
- Department of Medical Informatic, Academic Hospital of Rouen, Rouen, France
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Kitto S, Wondwossen Fantaye A, Davies N, McFadyen AK, Rivera J, Birch I, Barr H, Fletcher S, Fournier K, Xyrichis A. The evidence base for interprofessional education within health professions education: A protocol for an update review. J Interprof Care 2022; 37:515-518. [PMID: 36031805 DOI: 10.1080/13561820.2022.2097651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Interprofessional education (IPE) interventions aiming to promote collaborative competence and improve the delivery of health and social care processes and outcomes continue to evolve. This paper reports on a protocol for an update review that we will conduct to identify and describe how the IPE evidence base has evolved in the last 7 years. We will identify literature through a systematic search of the following electronic databases: Medline, Embase, CINAHL, Education Source, ERIC, and BEI. We will consider all IPE interventions delivered to health professions students and accredited professionals. Peer-reviewed empirical research studies published in any language from June 2014 onwards will be eligible for inclusion. The outcomes of interest are changes in the reaction, attitudes/perceptions, knowledge/skills acquisition, behaviors, organizational practice, and/or benefits to patients. We will perform each task of screening, critical appraisal, data abstraction, and synthesis using at least two members of the review team. The review will enable an update and comprehensive understanding of the IPE evidence base to inform future IPE developments, delivery and evaluation across education and clinical settings.
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Affiliation(s)
- Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | | | - Nigel Davies
- Interprofessional Learning, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | | | - Josette Rivera
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Ivan Birch
- Sheffield Teaching Hospitals NHS Foundation Trust Woodhouse Clinic, Sheffield, UK
| | - Hugh Barr
- Emeritus Professor and Honorary Fellow, The University of Westminster, UK
| | - Simon Fletcher
- Kingston and St Georges University London, Centre for Health, Social Care and Education, St Georges University, London, UK
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
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Choi YR, Kwon DY, Chang SO. The Development and Effectiveness of a Web-Based Emergency Management Educational Program for Long-Term Care Facility Interprofessional Practitioners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312671. [PMID: 34886397 PMCID: PMC8657401 DOI: 10.3390/ijerph182312671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
Abstract
Long-term care facility (LTCF) interprofessional practitioners who care for residents at high risk of emergencies due to old age, frailty, and complex diseases must be able to manage such emergencies collaboratively. A shared mental model (SMM) enhances performance toward a common goal by allowing effective collaboration through promoting the sharing of knowledge and skills among interprofessional team members. Therefore, this study developed a web-based educational program for LTCF interprofessional practitioners based on an SMM. We followed a network-based instructional system design that consists of analysis, design, development, implementation, and evaluation for developing the program. A total of 54 participants completed the educational program in four LTCFs in South Korea. A significant improvement was identified in communication knowledge, communication confidence, role recognition, transactive memory system, and team effectiveness in the experimental group. The results show that the program improved the emergency management process and reliability among interprofessional practitioners, positively impacting interprofessional collaboration and ensuring the safety of patients during emergencies in LTCFs.
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Affiliation(s)
- Young-Rim Choi
- Institute of Nursing Research, College of Nursing, Korea University, Seoul 02841, Korea;
| | - Dai-Young Kwon
- Gifted Education Center, Korea University, Seoul 02841, Korea;
| | - Sung-Ok Chang
- BK21 FOUR R&E Center for Learning Health Systems, College of Nursing, Korea University, Seoul 02841, Korea
- Correspondence:
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Wubben N, van den Boogaard M, van der Hoeven JG, Zegers M. Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study. BMJ Open 2021; 11:e050134. [PMID: 34380728 PMCID: PMC8359489 DOI: 10.1136/bmjopen-2021-050134] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members. DESIGN Qualitative study. SETTING Two Dutch tertiary centres. PARTICIPANTS 19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay. RESULTS Three themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family. CONCLUSIONS Interviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients' values and needs in the decision-making process.
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Affiliation(s)
- Nina Wubben
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | | | - Marieke Zegers
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Paquette L, Kilpatrick K. L’autonomie décisionnelle d’infirmières de soins intensifs lors du sevrage de la ventilation mécanique : une analyse de concept. Rech Soins Infirm 2021:76-91. [PMID: 33485287 DOI: 10.3917/rsi.143.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nurses have a leading role in weaning patients from mechanical ventilation (WMV) given their constant presence and their continuous monitoring. To promote proper WMV, nurses must exercise autonomy and be involved in decision-making. However, in certain care contexts, there is little involvement of nurses. The purpose of this text is to establish the characteristics of the concept of autonomous decision-making applied to nursing during WMV. An analysis of this concept was carried out according to the evolutionary method of Rodgers. The identification of the attributes, antecedents, and consequences made it possible to note ambiguity in the definition of this concept. Nurses use autonomous decision-making for the execution of assigned tasks and when they make decisions according to a pre-prescribed decision-making algorithm. Significant foundations for the decision-making autonomy of critical care nurses during WMV emerged from this analysis : scope of practice, in-depth knowledge of the patient, and commitment to the success of WMV. Participation in interdependent decision-making allows nurses to bring the patient’s perspective into decisions. Avenues of reflection have also emerged, including decisions based on evidence to provide new avenues for autonomous decision-making.
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Perceptions of Ethical Decision-Making Climate Among Clinicians Working in European and U.S. ICUs: Differences Between Nurses and Physicians. Crit Care Med 2020; 47:1716-1723. [PMID: 31625980 DOI: 10.1097/ccm.0000000000004017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine perceptions of nurses and physicians in regard to ethical decision-making climate in the ICU and to test the hypothesis that the worse the ethical decision-making climate, the greater the discordance between nurses' and physicians' rating of ethical decision-making climate with physicians hypothesized to rate the climate better than the nurses. DESIGN Prospective observational study. SETTING A total of 68 adult ICUs in 13 European countries and the United States. SUBJECTS ICU physicians and nurses. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Perceptions of ethical decision-making climate among clinicians were measured in April-May 2014, using a 35-items self-assessment questionnaire that evaluated seven factors (empowering leadership by physicians, interdisciplinary reflection, not avoiding end-of-life decisions, mutual respect within the interdisciplinary team, involvement of nurses in end-of-life care and decision-making, active decision-making by physicians, and ethical awareness). A total of 2,275 nurses and 717 physicians participated (response rate of 63%). Using cluster analysis, ICUs were categorized according to four ethical decision-making climates: good, average with nurses' involvement at end-of-life, average without nurses' involvement at end-of-life, and poor. Overall, physicians rated ethical decision-making climate more positively than nurses (p < 0.001 for all seven factors). Physicians had more positive perceptions of ethical decision-making climate than nurses in all 13 participating countries and in each individual participating ICU. Compared to ICUs with good or average ethical decision-making climates, ICUs with poor ethical decision-making climates had the greatest discordance between physicians and nurses. Although nurse/physician differences were found in all seven factors of ethical decision-making climate measurement, the factors with greatest discordance were regarding physician leadership, interdisciplinary reflection, and not avoiding end-of-life decisions. CONCLUSIONS Physicians consistently perceived ICU ethical decision-making climate more positively than nurses. ICUs with poor ethical decision-making climates had the largest discrepancies.
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Interprofessional Shared Decision-Making in the ICU: A Systematic Review and Recommendations From an Expert Panel. Crit Care Med 2020; 47:1258-1266. [PMID: 31169620 DOI: 10.1097/ccm.0000000000003870] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision-making. The aim of this project is to use systematic review and normative analysis by experts to examine existing evidence regarding interprofessional shared decision-making, describe its principles and provide ICU clinicians with recommendations regarding its implementation. DATA SOURCES We conducted a systematic review using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases and used normative analyses to formulate recommendations regarding interprofessional shared decision-making. STUDY SELECTION Three authors screened titles and abstracts in duplicate. DATA SYNTHESIS Four papers assessing the effect of interprofessional shared decision-making on quality of care were identified, suggesting that interprofessional shared decision-making is associated with improved processes and outcomes. Five recommendations, largely based on expert opinion, were developed: 1) interprofessional shared decision-making is a collaborative process among clinicians that allows for shared decisions regarding important treatment questions; 2) clinicians should consider engaging in interprofessional shared decision-making to promote the most appropriate and balanced decisions; 3) clinicians and hospitals should implement strategies to foster an ICU climate oriented toward interprofessional shared decision-making; 4) clinicians implementing interprofessional shared decision-making should consider incorporating a structured approach; and 5) further studies are needed to evaluate and improve the quality of interprofessional shared decision-making in ICUs. CONCLUSIONS Clinicians should consider an interprofessional shared decision-making model that allows for the exchange of information, deliberation, and joint attainment of important treatment decisions.
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Van den Bulcke B, Metaxa V, Reyners AK, Rusinova K, Jensen HI, Malmgren J, Darmon M, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Kompanje EJO, Vlerick P, Roels J, Vansteelandt S, Decruyenaere J, Azoulay E, Vanheule S, Piers R, Benoit D. Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States. Intensive Care Med 2019; 46:46-56. [PMID: 31690968 PMCID: PMC6954133 DOI: 10.1007/s00134-019-05829-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/10/2019] [Indexed: 11/13/2022]
Abstract
Purpose Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one’s job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics. Methods Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries. Results Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62–0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77–0.98]) were all associated with a lower intent to leave. Conclusion This is the first large multicenter study showing an independent association between clinicians’ intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL. Electronic supplementary material The online version of this article (10.1007/s00134-019-05829-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Van den Bulcke
- Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium.
| | | | - Anna K Reyners
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Katerina Rusinova
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Hanne I Jensen
- Department of Intensive Care Medicine, Institute of Regional Research, Vejle Hospital, Vejle, Denmark
| | - J Malmgren
- Department of Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,University of Southern Denmark, Odense, Denmark
| | - Michael Darmon
- Hôpital Saint-Louis and University Paris-7, Paris, France
| | - Daniel Talmor
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anne-Pascale Meert
- Service des Medicine Interne, Soins Intensifs et Urgences Oncologiques, Institut Jules Bordet, ULB, Brussels, Belgium
| | - Laura Cancelliere
- SCDU Anestesia e Rianimazione, Azienda and Ospedaliero Universitaria, Maggiore della Carità, Novara, Italy
| | - László Zubek
- Semmelweis University Budapest, Budapest, Hungary
| | - Paulo Maia
- Intensive Care Department, Hospital S.António, Porto, Portugal
| | | | - Erwin J O Kompanje
- Department of Intensive Care Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Vlerick
- Faculty of Psychology and Educational Sciences, Department of Personnel Management, Work and Organizational Psychology, Ghent University, Ghent, Belgium
| | - Jolien Roels
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium.,London School of Hygiene and Tropical Medicine, London, UK
| | - Johan Decruyenaere
- Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
| | - Elie Azoulay
- Hôpital Saint-Louis and University Paris-7, Paris, France
| | - Stijn Vanheule
- Department of Psycho-analysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, Ghent, Belgium
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Boydston J. Use of a standardized care communication checklist during multidisciplinary rounds in pediatric cardiac intensive care: a best practice implementation project. ACTA ACUST UNITED AC 2019; 16:548-564. [PMID: 29419625 DOI: 10.11124/jbisrir-2017-003350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES This project aimed to improve thoroughness and continuity of care of patients in a pediatric cardiac intensive care unit. Specific objectives were to increase support of clinical nurse and family participation in multidisciplinary rounds (MDR), as well as full use of a multi-component Complex Care Checklist (CCC) by all nurses in this unit. INTRODUCTION Communication and collaboration are paramount for safe care and positive outcomes of critically ill patients hospitalized in intensive care units. Nurse participation in daily patient rounding enhances individualized goal-setting. Concomitant use of a communication checklist promotes comprehensive delivery of care. METHODS Evidence-based audit criteria were developed for this project which used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) tools for promoting change in health practice. Direct observation of MDR processes was used to conduct a baseline and post-implementation audit. Intervention strategies relied primarily on nurse education tactics. RESULTS Although attending physicians' and charge nurses' support and facilitation of clinical nurse presence during MDR rose substantially to 95% compliance, only moderate compliance (67%) was demonstrated for clinical nurses' attendance at and participation in MDR. Compliance with nurses' report of the patient's daily care plan and completion of CCC components during MDR improved moderately (52% and 54%). Family attendance at MDR did not improve. CONCLUSIONS Project aims of enhanced thoroughness and continuity of care of patients with congenital heart defects were realized through an improved MDR process enhanced with a care communication checklist and clinical nurse participation. With the support of attending physicians and charge nurses, clinical nurses felt more empowered to address care concerns during MDR. The project outcomes indicated further activities are needed to assist nurses with a higher level of participating in MDR and using the CCC to its full potential. Continued evolution of the rounding process is imperative to adapting to patient needs and improving care.
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Affiliation(s)
- Julianna Boydston
- University of California San Francisco (UCSF) Medical Center and UCSF Benioff Children's Hospital.,UCSF Centre for Evidence Synthesis and Implementation: a Joanna Briggs Institute Centre of Excellence
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Getting It Right for Our Patients. Crit Care Med 2019; 47:1279-1281. [DOI: 10.1097/ccm.0000000000003880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peltonen J, Leino-Kilpi H, Heikkilä H, Rautava P, Tuomela K, Siekkinen M, Sulosaari V, Stolt M. Instruments measuring interprofessional collaboration in healthcare - a scoping review. J Interprof Care 2019; 34:147-161. [PMID: 31331216 DOI: 10.1080/13561820.2019.1637336] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Worldwide there is growing understanding of the importance of interprofessional collaboration in providing well-functioning healthcare. However, little is known about how interprofessional collaboration can be measured between different health-care professionals. In this review, we aim to fill this gap, by identifying and analyzing the existing instruments measuring interprofessional collaboration in healthcare. A scoping review design was applied. A systematic literature search of two electronic databases, Medline (PubMed) and CINAHL, was conducted in 03/2018. The search yielded 1020 studies, of which 35 were selected for the review. The data were analyzed by content analysis. In total, 29 instruments measuring interprofessional collaboration were found. Interprofessional collaboration was measured predominantly between nurses and physicians with different instruments in various health-care settings. Psychometric testing was unsystematic, focusing predominantly on construct and content validity and internal consistency, thus further validation studies with comprehensive testing are suggested. The results of this review can be used to select instruments measuring interprofessional collaboration in practice or research. Future research is needed to strengthen the evidence of reliability and validity of these instruments.
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Affiliation(s)
- Johanna Peltonen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Heli Heikkilä
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Centre, Turku University Hospital, Turku, Finland
| | | | - Mervi Siekkinen
- Western Finland Cancer Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Virpi Sulosaari
- Department of Nursing Science, University of Turku, Turku, Finland.,Department of Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje EJO, Azoulay E, Meganck R, Van de Sompel A, Vansteelandt S, Vlerick P, Vanheule S, Benoit DD. Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool. BMJ Qual Saf 2018; 27:781-789. [DOI: 10.1136/bmjqs-2017-007390] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/26/2017] [Accepted: 02/01/2018] [Indexed: 11/04/2022]
Abstract
BackgroundLiterature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).ObjectivesTo better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.MethodsUsing a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.ResultsOf 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.ConclusionsThe 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians’ behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.
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Dunn SI, Cragg B, Graham ID, Medves J, Gaboury I. Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study. J Interprof Care 2018; 32:284-294. [PMID: 29364748 DOI: 10.1080/13561820.2018.1428186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.
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Affiliation(s)
- Sandra I Dunn
- a School of Nursing , University of Ottawa , Ottawa , Ontario , Canada
| | - Betty Cragg
- a School of Nursing , University of Ottawa , Ottawa , Ontario , Canada
| | - Ian D Graham
- a School of Nursing , University of Ottawa , Ottawa , Ontario , Canada
| | - Jennifer Medves
- b School of Nursing , Queen's University , Kingston , Ontario , Canada
| | - Isabelle Gaboury
- c Department of Family Medicine and Emergency Medicine , Université de Sherbrooke , Québec , Canada
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Piers RD, Versluys KJJ, Devoghel J, Lambrecht S, Vyt A, Van Den Noortgate NJ. A Typology of Interprofessional Teamwork in Acute Geriatric Care: A Study in 55 units in Belgium. J Am Geriatr Soc 2017. [PMID: 28631275 DOI: 10.1111/jgs.14958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. DESIGN Cross-sectional multicenter study. SETTING Acute geriatric units in Belgium. PARTICIPANTS Team members of different professional backgrounds. MEASUREMENTS Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members' belief in the power of teamwork, and members' comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. RESULTS The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units (P < .001). Using the mean score on each of the six areas, four clusters that differed significantly in all areas were identified using hierarchical cluster analysis and scree plot analysis (P < .001). CONCLUSION Interprofessional teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams.
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Affiliation(s)
- Ruth D Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karen J J Versluys
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Devoghel
- Department of Geriatric Medicine, St. Jan Hospital Bruges, Bruges, Belgium
| | - Sophie Lambrecht
- Department of Geriatric Medicine, St. Maria Hospital Halle, Halle, Belgium
| | - André Vyt
- Artevelde University College and University of Ghent, Ghent, Belgium
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