Influence of Teamwork on Health Care Workers' Perceptions About Care Delivery and Job Satisfaction

Consensus on the definition and attributes of person-centered teamwork: An e-Delphi study

BACKGROUND

Effective health care relies on person-centeredness and teamwork, which are known to improve outcomes. These two concepts have been defined individually, but we could not find a definition of the combined concept. A preliminary definition was developed through a concept analysis; however, consensus on the concept has not been reached.

AIM

The aim of this study was to reach consensus on the definition and attributes of person-centered teamwork.

METHODS

A consensus design allowed experts to collaborate and share their experience and wisdom to refine and reach consensus on the definition and attributes of person-centered teamwork. An e-Delphi was used to engage the experts.

RESULTS

Three rounds of online engagement with 12 experts were needed to reach consensus on the definition and attributes of person-centered teamwork. The attributes reached consensus of 82% after the first round. The definition had 82% consensus after the three rounds. The definition had been adjusted and refined according to the expert input. The newly adjusted definition was established.

LINKING EVIDENCE TO ACTION

We successfully used the e-Delphi method to obtain consensus on the attributes and definition of person-centered teamwork. The definition of person-centered teamwork can be further developed and included in clinical practice to guide improved clinical outcomes. The consensus definition of person-centered teamwork provides a clear understanding of the meaning thereof, which may in turn enrich the usability thereof in clinical practice. Person-centered teams improve outcomes for persons receiving care in hospitals. Building person-centered teams are now better understood and the foundation of building these teams defined. We engaged with 12 experts in the academic and clinical field of person-centeredness and teamwork. The use and value of the Delphi method to obtain consensus is now better understood and can assist future research development.

Current situation, strengths and problems in intra- and interprofessional collaboration in German nursing homes - A holistic multiple case study

BACKGROUND

The increasing care complexity of nursing home residents living with dementia requires new care models that strengthen professional collaboration. To contribute to the sustainable implementation of new care models, it is important that they are linked to the care reality. However, little is known about intra- and interprofessional organization and provision of care in German nursing homes. Therefore, the aim of this study was to explore the current care situation, problems and strengths regarding intra- and interprofessional collaboration in the care of residents living with dementia.

METHODS

We conducted a holistic multiple case study. The individual care units in which residents living with dementia are cared for were defined as cases. The context was built by the respective nursing homes and their regional affiliation to the federal state of North Rhine-Westphalia. We used qualitative face-to-face interviews, documents and context questionnaires for data collection. The different sources of evidence served to capture complementary perspectives and to validate the findings. First, the collected qualitative data were analyzed using deductive-inductive content analysis. Second, similarities and differences between the cases were identified to elaborate case-specific and cross-case patterns and themes. The reporting followed the EQUATOR reporting guideline for organizational case studies.

RESULTS

We included four care units comprising 21 professionals (nurses, physicians, social worker, physiotherapist, pharmacist) and 14 relatives of residents living with dementia. The analysis revealed four categories to describe current intra- and interprofessional collaboration in all cases: actors and their roles, service delivery, coordination and governance, and communication channel. Moreover, we identified three categories that relate to the strengths and problems of intra- and interprofessional collaboration in all cases: role understanding, teamwork, and communication and exchange. Although we examined similar care units, we found differences in the realization of professional collaboration and resulting problems and strengths that are connected to the organizational contexts and strategies used.

CONCLUSIONS

Even though professional collaboration follows given patterns; these patterns do differ context-specifically and are perceived as problematic and fragmentary. Therefore, the identified differences and problems in collaboration need to be addressed in future research to develop and successfully implement tailored innovative care models.

'Our Voices Aren't Being Heard': A qualitative descriptive study of nurses' perceptions of interprofessional collaboration in care supporting older people's functioning during a hospital stay

INTRODUCTION

Older people admitted to hospital are highly susceptible to functional decline and related complications. Care supporting their functioning is complex and requires healthcare professionals working in concert, with nurses playing a central role. Yet, little is known about nurses' perceptions of interprofessional collaboration (IPC) in care supporting functioning in acutely admitted older people. To fill this knowledge gap, we elucidate the perspectives of nurses in Ontario, Canada, on IPC in care supporting older people's functioning during a hospital stay.

METHODS

We employed a qualitative methodology in conjunction with a qualitative descriptive design. Thirteen focus groups were held with a purposeful, criterion-based sample of 57 acute care nurses practising in a range of acute care settings (e.g. Emergency, General Medicine, General Surgery, Intensive Care, Coronary Care). Data were thematically analysed.

RESULTS

We identified two overarching themes: (1) IPC is improving, but nurses are excluded from decision-making and (2) nurse advocacy causes friction with other professionals. The first theme captures nurses' perception that IPC in older people's care is improving, but nurses are marginalised in interprofessional decision-making. As a result, nurses perceive that their knowledge is devalued, and their contributions to care supporting older people's functioning are undermined. The second theme underlines a tension between interprofessional team practices and patient- and family-centred care, while also demonstrating nurses' increasing willingness to act as patient and family advocates.

CONCLUSIONS

Findings can be used to enhance IPC in care supporting the functioning of acutely hospitalised older people. To improve IPC, clinical and administrative leaders should cultivate more egalitarian team relationships that encourage nurses to contribute to decision-making and advocate on behalf of older patients and their families.

Meanings of troubled conscience in nursing homes: nurses' lived experience

BACKGROUND

Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses.

OBJECTIVE

The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled conscience among registered nurses (RNs) working in nursing homes.

RESEARCH DESIGN

This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach.

ETHICAL CONSIDERATIONS

Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data.

FINDINGS

The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers.

DISCUSSION

Troubled conscience meant experiencing continuous and simmering tension between one's ideals and realities and feeling a drive to preserve accountability and one's moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation.

CONCLUSION

Nurses' troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state's intentions can be realised within the given framework are important for individual nurses' occupational health as well as the quality of care provided to patients.

Not Just How Many but Who Is on Shift: The Impact of Workplace Incivility and Bullying on Care Delivery in Nursing Homes

BACKGROUND AND OBJECTIVES

Much of the literature examining the staffing-care quality link in long-term care (LTC) homes focuses on staffing ratios; that is, how many staff are on shift. Far less attention is devoted to exploring the impact of staff members' workplace relationships, or who is on shift. As part of our work exploring workplace incivility and bullying among residential care aides (RCAs), we examined how RCAs' workplace relationships are shaped by peer incivility and bullying and the impact on care delivery.

RESEARCH DESIGN AND METHODS

Using critical ethnography, we conducted 100 hr of participant observation and 33 semistructured interviews with RCAs, licensed practical nurses, support staff, and management in 2 nonprofit LTC homes in British Columbia, Canada.

RESULTS

Three key themes illustrate the power relations underpinning RCAs' encounters with incivility and bullying that, in turn, shaped care delivery. Requesting Help highlights how exposure to incivility and bullying made RCAs reluctant to seek help from their coworkers. Receiving Help focuses on how power relations and notions of worthiness and reciprocity impacted RCAs' receipt of help from coworkers. Resisting Help/ing outlines how workplace relationships imbued with power relations led some RCAs to refuse assistance from their coworkers, led longer-tenured RCAs to resist helping newer RCAs, and dictated the extent to which RCAs provided care to residents for whom another RCA was responsible.

DISCUSSION AND IMPLICATIONS

Findings highlight "who" is on shift warrants as much attention as "how many" are on shift, offering additional insight into the staffing-care quality link.

Managing Ambiguity When Caring for Women Who Experience Stillbirth

OBJECTIVE

To examine the interactions and social processes involved when nurses care for women who experience fetal demise and subsequent stillbirth.

DESIGN

Qualitative design using grounded theory.

SETTING

Single-site urban medical center in New York City.

PARTICIPANTS

Twenty registered nurses who worked in the labor and delivery department.

METHODS

I collected data via in-depth interviews and recorded, transcribed, and analyzed the data using constant comparative analysis.

RESULTS

Managing Ambiguity emerged as the overarching preliminary theory to describe how nurses cared for women who experienced stillbirth. This preliminary theory included three themes: Experiencing a Spectrum of Emotions, Managing Patient Care in an Ambiguous Context, and Managing Institutional Ambiguity. These themes provided an overview of the creative/protective and avoidant/conflicted behaviors that nurses brought to their work with women whose fetuses died in utero and were stillborn. These interactions were complicated by institutional policies and additional factors, such as workload, that often denied nurses the resources needed to engage in the patient care processes required to address the trauma experienced by women and their families.

CONCLUSION

The preliminary theory Managing Ambiguity provided a perspective on the experiences, behaviors, and social processes involved in caring for women who experience stillbirth. The absence of preparatory education, effective protocols, and institutional support contributed to the ambiguity inherent in caring for these women.

Diversity Management as a Tool for Sustainable Development of Health Care Facilities

Organizations providing health services are often criticized because of inadequate and unsuitable management processes or procedures. Today’s challenge is focused on effective management and leadership skills in the area of health care. The aim of the research is to describe, analyze, and evaluate the current state of diversity management in details in the context of human resources management in the selected healthcare facilities. The source of the information was a questionnaire survey. The sample consists of 181 managers from various health care and health service organizations. The method of analysis of variance (ANOVA) was used for data processing. The results were processed in SPSS and Excel programs. Pearson’s coefficient was used to evaluate the cross-correlation of the variables. The level of significance was 5% on both sides. Basic awareness of diversity management in the healthcare facilities is low. Some tools of diversity management are used, but only in isolation, non-conceptually, and unsystematically. The acknowledgment of diversity concept is poor and chaotic. The basic models of this concept defining its goals, activities, programs, responsibilities, and measurements are not known. One of the strong areas of the diversity management in the healthcare facilities is the diversity of working teams. On other hand, the weak side is the diversity as part of the organization culture and diversity as a part of human resource management. The summarizing index Attitudes towards Diversity received a higher average value than the Diversity Management Implementation index. Significant variables influencing the level of aggregate indices were identified: Ownership, size of the organization in terms of number of employees, patients’ satisfaction, and employees’ satisfaction.

What implies registered nurses' leadership close to older adults in municipal home health care? A systematic review

BACKGROUND

Registered nurses are key figures in municipal home health care for older adults. Thus, registered nurses' leadership is crucial to a successful and preventive care process as well as a supportive organization in order to achieve safe care. However, there is limited research on what registered nurses' leadership implies close to older adults in municipal home health care. Thus, the aim is to compile and critically evaluate how international research results describe registered nurses' leadership close to older adults in municipal home health care.

METHODS

A systematic literature review was performed in accordance with a qualitative research study. The main search was conducted on 20 April 2018. The review was reported according to the PRISMA guidelines and is registered in the PROSPERO database (ID# CRD42019109206). Nine articles from PubMed and CINAHL meet the quality criteria. A synthesis of data was performed in four stages according to qualitative research synthesis.

RESULTS

Ten themes describe what registered nurses' leadership close to older adults in municipal home health care entails: trust and control; continuous learning; competence through knowledge and ability; nursing responsibility on an organizational level; application of skills; awareness of the individual's needs and wholeness; mutual support; mutual relationships; collaborating on organizational and interpersonal levels; and exposure to challenges.

CONCLUSIONS

Registered nurses leading close to older adults in municipal home health care implies being multi-artists. Nursing education, including specialist education for registered nurses, should prepare individuals for their unique and complex leadership role as a multi-artist. Municipal employers require knowledge about what registered nurses' leadership implies in order to create adequate conditions for their leadership objectives to achieve safe care. Further research is warranted to explore registered nurses' leadership close to older adults in municipal home health care from different perspectives, such as older adults and next of kin.