Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review

Empirical evidence indicates that collaborative interprofessional practice leads to positive health outcomes. Further, there is an abundance of evidence examining student and/or faculty perceptions of learning or satisfaction about the interprofessional education (IPE) learning experience. However, there is a dearth of research linking IPE interventions to patient outcomes. The objective of this scoping review was to describe and summarize the evidence linking IPE interventions to the delivery of effective patient care. A three-step search strategy was utilized for this review with articles that met the following criteria: publications dated 2015-2020 using qualitative, quantitative or mixed methods; the inclusion of healthcare professionals, students, or practitioners who had experienced IPE or training that included at least two collaborators within coursework or other professional education; and at least one of ten Centers for Medicare & Medicaid Services quality measures (length of stay, medication errors, medical errors, patient satisfaction scores, medication adherence, patient and caregiver education, hospice usage, mortality, infection rates, and readmission rates). Overall, n=94 articles were identified, providing overwhelming evidence supporting a positive relationship between IPE interventions and several key quality health measures including length of stay, medical errors, patient satisfaction, patient or caregiver education, and mortality. Findings from this scoping review suggest a critical need for the development, implementation, and evaluation of IPE interventions to improve patient outcomes.

The Supportive Oncology Collaborative: Expanding upon Collaborative Care to Increase Supportive Care Access in Underserved Populations

Background: Access to supportive services in community-based oncology is challenging but essential, particularly for underserved populations. Methods: We developed the Supportive Oncology Collaborative (SOC), built upon the tenets of Collaborative Care, an existing model used to increase access to behavioral health in community settings. Using a population-health-based approach with screening, a registry, and shared care, we added palliative care specialists to a team of social workers and a consulting psychiatrist. We provided integrated psychosocial and palliative care at community-based sites of a large comprehensive cancer center. Results: We implemented the model in 2020 at a community site with a racially and ethnically diverse patient population. Encounters grew from 527 in our first year to 2,130 in 2022. Using screening tools, we identify the highest-risk patients for discussion in team meetings. Discussion: We are expanding the SOC across the Dana-Farber Cancer Institute regional campuses and believe it can increase access to integrated psychosocial and palliative care in cancer centers across the country.

Partnered pharmacist medication charting and prescribing in Australian hospitals

Medication charting and prescribing errors commonly occur at hospital admission and discharge. Pharmacist medication reconciliation, after medicines are ordered by a medical officer, can identify and resolve errors, but this often occurs after the errors have reached the patient. Partnered pharmacist medication charting and prescribing are interprofessional, collaborative models that are designed to prevent medication errors before they occur, by involving pharmacists directly in charting and prescribing processes. In the partnered charting model, a pharmacist and medical officer discuss the patient's current medical and medication-related problems and agree on a medication management plan. Agreed medicines are then charted by the pharmacist on the inpatient medication chart. A similar collaborative model can be used at other points in the patient journey, including at discharge. Studies conducted at multiple Australian health services, including rural and regional hospitals, have shown that partnered charting on admission, and partnered prescribing at discharge, significantly reduces the number of medication errors and shortens patients' length of stay in hospital. Junior medical officers report benefiting from enhanced interprofessional learning and reduced workload. Partnered pharmacist medication charting and prescribing models have the best prospect of success in environments with a strong culture of interprofessional collaboration and clinical governance, and a sufficiently resourced clinical pharmacist workforce.

High-quality patient-centered palliative care: interprofessional team members' perceptions of social workers' roles and contribution

A core tenet of interprofessional collaborative practice (IPCP) is that efficient and effective teams are critical for the delivery of high-quality, patient-centered care. Although palliative care has a history of excellent care, increasing demands and larger patient loads are challenging teams to adapt and strengthen team functioning in hospital settings. The purpose of this qualitative study was to better understand the IPCP contributions of advanced palliative social workers (PSWs) through the eyes of their colleagues. Twenty-four interprofessional palliative care (IPPC) team members from other professions (i.e. nurse practitioners, physicians, physician assistants) from 16 hospitals across the U.S. participated in 20-minute semi-structured interviews. The Patient-Centered Clinical Method (PCCM) was used as a conceptual model to aid in the interpretation of the data. This model illuminated the centrality of PSWs' role in building and sustaining a therapeutic alliance between the patient and the IPPC team, through assessing and promoting care that centers the patient's experience with illness, creating space to initiate, process and revisit difficult healthcare conversations and helping to modulate the pace and intensity of emotionally laden discussions. PSWs also support the therapeutic relationship with the IPPC team by providing continuity and connection across and during the hospital experience and supporting the well-being of the IPPC team. This study offers novel insights into how PSWs contribute to patient-centered IPPC and furthers the articulation of the role of PSWs in hospital settings.

The Importance of Primary Care Physicians in the Diagnosis and Exclusion of Rare Syndromes: A Case Study of Ruling Out PHACE Syndrome

PHACE (posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities) syndrome is an extremely uncommon condition that requires a team of physicians to properly diagnose, treat, and follow. Patients are at risk of posterior fossa malformations, hemangiomas, and arterial, cardiac, eye, and sternal cleft abnormalities. These syndrome hallmarks can cause severe functional and developmental issues or, in the worst case, death. The pediatrician's role is even more essential for pediatric patients who present with rare and intricate syndromes. Primary care physicians are the first line of defense for patients. They recognize alarm signs, coordinate patient care, and promote participation. This case report aims to describe the process by which a multisystemic and potentially lethal syndrome was excluded and illustrates the significance of a primary care physician for the diagnosis and management of such conditions.

Healthcare professionals' perceptions of working on lifestyle management for patients with early rheumatoid arthritis - a qualitative study

AIM

To explore HPs' perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA).

METHODS

In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified.

RESULTS

HPs' perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach.

CONCLUSIONS

HPs' perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach.

The Specialty Chaplain on the Palliative Care Team: A Narrative Review

BACKGROUND

Spiritual care is a vital component of palliative care. Provision of specialty spiritual care is required by the guiding principles of palliative care as expressed in the National Consensus Project guidelines.

OBJECTIVE

This review examines the role and duties of the specialty palliative care chaplain in contributing to the overall work of the interdisciplinary palliative care team.

METHODS

The PUBMED, EMBASE, and CINAHL electronic databases were searched using identified key words including studies published between January 2008 and September 2022. Review articles met pre-established selection and exclusion criteria. A thematic approach was used to synthesize and discuss the findings in the form of a narrative review.

RESULTS

Two main categories of articles were identified: (1) articles explicitly illustrating the tasks or duties of the palliative care chaplain and (2) case study articles including the input of the palliative care chaplain. These duties were comprehensive in nature and support the contributions of the specialty chaplain to the interdisciplinary plan of care.

CONCLUSION

The role of the palliative care chaplain has evolved over time as has chaplain training. Current research calls for standardizing inclusion of the palliative care chaplain on the interdisciplinary team to improve care and expand team function. Future research could examine contributions of chaplains to plan of care, the role of the chaplain in supporting the interdisciplinary team, and how the chaplain contributes to ongoing team growth.

Health Care Provider Attitudes and Beliefs Toward Nonmedical Opioid Use in Patients with Cancer Pain

Background: Data on health care providers' (HCPs') perceptions about patients with cancer pain and nonmedical opioid use (NMOU) are lacking. We examined the perceptions and attitudes of HCPs and assessed the usefulness of an interdisciplinary opioid stewardship program (OSP) while caring for these patients. Methods: An anonymous cross-sectional survey was conducted among the supportive care HCPs between September and November 2021. Results: Of 85 HCPs, 64 responded (75%) to the survey. Participants perceived that NMOU is underdiagnosed (42/64; 67%), and caring for such patients is difficult (58/64, 91%) and time consuming (54/64, 87%). A majority (50/51, 98%) were aware of the OSP, and (48/51; 94%) found it helpful. Conclusion: HCPs reported that NMOU is underdiagnosed and is challenging to manage. They endorsed the utility of an OSP in managing patients with concurrent cancer pain and NMOU. Future research should identify ways to standardize care and integrate OSP in routine supportive oncology practice.

The Significance of Cooperation in Interdisciplinary Health Care Teams as Perceived by Polish Medical Students

Teamwork, as the preferred method of cooperation in healthcare, became prevalent in the 1960s, and since then has been universally recognized as a measure to improve the quality of healthcare. Research indicates that medical care based on interdisciplinary cooperation is associated with increased patient safety, lower hospitalization rates, and reduced rates of complications and medical errors. Furthermore, it enhances the coordination of care and improves patient access to medical services. This model of providing medical care also results in considerable benefits for medical professionals. These include greater job satisfaction and a reduced risk of professional burnout syndrome.

AIM

The aim of the study was to explore the opinions of medical students with regard to cooperation in the interdisciplinary team, as well as the factors affecting the formation of opinions.

MATERIAL AND METHODS

The study was conducted using the Polish version of the questionnaire Attitudes Towards Interprofessional Health Care Teams. The study involved 1266 participants, including students of medicine (n = 308), midwifery (n = 348), nursing (n = 316) and physiotherapy (n = 294).

RESULTS

According to the opinions of the students participating in the study, the therapeutic process based on the interdisciplinary model improves the quality of medical care provided, increases patient safety, and improves communication between members of the therapeutic team. The factors affecting the assessment of cooperation in interdisciplinary medical care teams included the faculty and the year of studies, gender, as well as participation in the multidisciplinary courses.

CONCLUSIONS

Students recognize the need for interdisciplinary medical teams. The training of future medical professionals should incorporate the elements of interprofessional education. This form of education allows students to develop both a professional identity and identification with their own profession, as well as encourages teamwork skills and shapes the attitude of openness towards representatives of other medical professions. However, in order to provide the students with the relevant knowledge, skills and competencies, it is essential to respect their diversity in terms of the faculty, as well as to account for the impact of gender and the year of studies which may affect their readiness to engage in teamwork.

Interprofessional Team-based Care of the Hematopoietic Cell Transplantation Patient With Hepatic Veno-occlusive Disease/Sinusoidal Obstruction Syndrome

Hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) is a well-recognized complication of allogeneic and autologous hematopoietic cell transplantation (HCT). The diagnosis and treatment of VOD/SOS require the involvement of multiple specialists covering a wide range of expertise. Interprofessional team-based medical care is standard practice for patients undergoing HCT and has been shown to improve patient and provider satisfaction, enhance efficiency, and improve patient outcomes, particularly for patients in complex medical situations like those with VOD/SOS post-HCT. Interdisciplinary team-based models focus on the synthesis and harmonization of knowledge and methods from different disciplines to create an integrative approach to patient care that both maximizes the expertise of each involved specialist and encourages thought beyond each specialist's discipline. Multidisciplinary team members provide additive support and work collaboratively with the core team to provide knowledge from their field. The composition of the interdisciplinary HCT team should center on the needs of the patient and institutional resources and involve the expertise of additional multidisciplinary team members based on clinical needs. This review focuses on interdisciplinary and multidisciplinary team-based care of patients with VOD/SOS post-HCT and provides an example of a collaborative VOD/SOS team that includes transplant physicians, nurses, pharmacists, nutrition/dietary specialists, and intensive care teams.

Two-year outcomes following the HIDOC program: expanding outpatient care delivery to meet the needs of medically complex, high-utilizing patients with a broader interprofessional care team

This article describes the Highly Individualized Dedicated Onsite Care (HIDOC) intensive primary care program implemented at a university clinic, comprising (a) care by an interprofessional team, (b) new logistical capacity, and (c) clinician skills training. Measured outcomes include Emergency Department (ED) visits and hospitalizations at a university and a community hospital over 2 years, using a within-subjects design. We demonstrate decreased hospitalizations at the University Hospital, and a decrease in ED visits at both sites. Team-based strategies to provide intensive primary care can decrease utilization, allowing for greater continuity of care.

Establishing a Health Information Technology for the Vaccination of National Institutes of Health Staff

Introduction

Healthcare organizations faced unique operational challenges during the COVID-19 pandemic. Assuring the safety of both patients and healthcare workers in hospitals has been the primary focus during the COVID-19 pandemic.

Methods

The NIH Vaccine Program (VP) with the Vaccine Management System (VMS) was created based on the commitment of NIH leadership, program leadership, the development team, and the program team; defining Key Performance Indicators (KPIs) of the VP and the VMS; and the NIH Clinical Center's (NIH CC) interdisciplinary approach to deploying the VMS.

Results

This article discusses the NIH business requirements of the VP and VMS, the target KPIs of the VP and the VMS, and the NIH CC interdisciplinary approach to deploying an organizational VMS for vaccinating the NIH workforce. The use of the DCRI Spiral-Agile Software Development Life Cycle enabled the development of a system with stakeholder involvement that could quickly adapt to changing requirements meeting the defined KPIs for the program and system. The assessment of the defined KPIs through a survey and comments from the survey support that the VP and VMS were successful.

Conclusion

A comprehensive program to maintain a healthy workforce includes asymptomatic COVID testing, symptomatic COVID testing, contact tracing, vaccinations, and policy-driven education. The need to develop systems during the pandemic resulted in changes to build software quickly with the input of many more users and stakeholders then typical in a decreased amount of time.

Top Ten Tips Palliative Care Clinicians Should Know About Navigating the Needs of Adults with Intellectual Disabilities

As many people with intellectual disabilities (ID) live longer, the need for access to quality palliative care (PC) rises. People with ID realize significant barriers and inequities in accessing health care and PC. The need for integrated disability and PC services with extensive collaboration is great. The following tips are for PC clinicians caring for people with ID, their families, caregivers, and the community. While patient-centered care is difficult to distill into "tips," this article, written by an interdisciplinary team of PC and ID specialists, offers resources and references to improve the care provided to people with ID and serious illnesses.

Specialty Palliative Care in a Code Blue: An Unexpected Role

Resuscitation codes in the hospital are intensely stressful events that impact the goals and outcomes of patients. Regardless of the outcome of the code, the event itself can be traumatic for the patient, surrogate decision makers, and health care team. The unique skills of each interdisciplinary specialty palliative care team member can assist with each step of the code to improve support and minimize suffering. We discuss a case of a hospitalized patient for whom a code blue was called and the roles of each specialty palliative care team member before, during, and after the event.

Swedish Clinical Professionals' Perspectives on Evaluating Cognitive and Communicative Function in Dementia

Objectives: This study investigated Swedish clinical professionals' experiences of diagnostic pathways in dementia, focusing on the assessment of cognitive and communicative abilities.Methods: Interdisciplinary teams in Memory Clinics, General Practitioners in Primary Health Care, and Speech Language Pathologists were interviewed. The transcripts were analyzed using qualitative Content Analysis.Results: The study sheds light upon the perceived barriers and facilitators of good practice, e.g. time and clinical collaborations. Perspectives among professionals vary as to how informal and formal information and procedures are to be integrated and weighted. External factors (e.g. physical proximity of professions) have considerable influence on information availability, transmission, and diagnostic processes. Communication impairment does not emerge as a clinical priority.Conclusions: Published clinical guidelines notwithstanding, there is in practice no "gold standard" regarding diagnostic processes. Reorganization of services that impact feasibility of cross-disciplinary contact may negatively impact diagnostics.Clinical implications: Interprofessional collaboration is impacted by many factors, e.g. physical proximity and availability of specific professions. In order to optimize collaboration in dementia diagnosis, communication channels between professions need to be optimized. Additionally, making clinical impressions and "gut-feelings" explicit could contribute valuable information to the diagnostic process.

[Three-Step Interdisciplinary Team Program for Nasogastric Tube Care]

Patients with chewing disorders and dysphagia often take nutrition via nasogastric tube feeding. Patients with indwelling nasogastric tubes often experience discomfort, resulting in increased incidences of self-extubation and slippage. Frequent changes or misplacement of the nasogastric tube may also cause patient safety issues such as aspiration pneumonia, gastrointestinal trauma, and pneumothorax. Collaboration within the interdisciplinary team is needed to provide proper nasogastric tube care prior to placement, during the indwelling process, and during the removal of the nasogastric tube. Interdisciplinary teams should develop standardized procedures for nasogastric tube care, initiate swallow screening, oral care and training early, and develop a care plan for nasogastric tube removal. An evidence-based, practical example of nasogastric tube care implemented by an interdisciplinary team in a neurology unit is presented in this article. Interdisciplinary teams may assist patients to prepare to return to a normal tube-free life using individualized, safe, and dignified nasogastric tube care to improve quality of life.

Out-of-the-ICU Mobilization in Critically Ill Patients: The Safety of a New Model of Rehabilitation

Early mobilization of ICU patients has been reported to be safe and feasible. Recently, our ICU implemented out-of-the-ICU wheelchair excursions as a daily rehabilitation practice. The aim of this study is to investigate the safety of participation in the out-of-the-ICU program for early mobilization.

Workplace Conflict in Applied Behavior Analysis: Prevalence, Impact, and Training

Conflict, albeit normal in every relationship, can increase stress and tension. Workplace conflict is highly prevalent in the field of health care and has been correlated with lowered job satisfaction and burnout. However, little is known about workplace conflict for practicing Board Certified Behavior Analysts® (BCBAs®). We distributed an electronic survey through the Behavior Analysis Certification Board® (BACB®⁾ to determine the impact and prevalence of workplace conflict for practicing BCBAs. Most of our participants reported various levels of conflict with different workplace professionals including teachers, caregivers, colleagues, and supervisees. We found that a high proportion of practitioners reported losing cases and wanting to leave their jobs because of workplace conflict. Most of our participants did not feel that they had the training they needed to have sufficient skills to resolve workplace conflict effectively. Therefore, in this article we outlined the component skills necessary to manage conflict effectively and made recommendations for training these skills.

Leveraging Interdisciplinary Teams for Pre-Visit Planning to Improve Pneumococcal Immunization Rates Among Internal Medicine Subspecialty Practices

Background:

Despite the ready availability of pneumococcal vaccines and recommendation of vaccination by Center for Disease Control and Prevention (CDC), the immunization rates among adults less than 65 years of age with chronic and immunocompromised conditions remain low.

Methods:

This interventional (cohort) study aimed to improve the pneumococcal vaccination rate for patients with an increased risk of pneumococcal disease by utilizing a three-pronged approach. This included: (1) clinician education webinar, (2) pre-visit counseling performed by registered nurses, targeted toward patients with upcoming appointments, to address vaccination status, and (3) modified pre-visit interdisciplinary team huddle with clinicians and registered nurses to review which patients are amenable to vaccination at the time of visit and those who may benefit from re-engagement and further motivational interviewing. After the completion of the 10-week intervention, study organizers reviewed the percent of patients with completed pneumococcal vaccinations.

Results:

In this 10-week rapid cycle initiative, a total of 482 patients were eligible for vaccination. During the intervention phase, 370 patients were contacted and of these 38% of patients were amenable to receiving a vaccine during the pre-visit counseling, 5% were previously vaccinated, 18% were not amenable, and 38% were unreachable prior to visit. This initiative resulted in a 43% increase in the vaccination rate in this cohort.

Conclusions:

The significant increase in vaccination rate supports the utilization of a framework in the multidisciplinary approach to pre-visit planning in non-primary care specialties and other vaccination efforts, especially emerging diseases such as COVID-19. Future directions of study include the efficacy of telemedicine counseling with a same-day appointment for vaccination, co-location of registered nurses within the practice sites, as well as the use of other ancillary staff (such as medical office assistants) to engage patients in pre-visit planning.

Severity of Dementia Is Associated with Increased Periodontal Inflamed Surface Area: Home Visit Survey of People with Cognitive Decline Living in the Community

No studies have measured the periodontal inflamed surface area in people with dementia, although periodontal disease is a major health issue in this group. This study aimed to determine the relationship between dementia severity and periodontal inflamed surface area. An interdisciplinary team, including a dentist and psychiatrist, conducted an in-home survey of older people living in the community. This cross-sectional study was designed as part of a larger cohort study. The interdisciplinary team visited 198 individuals with cognitive decline. We surveyed the clinical dementia rating, periodontal inflamed surface area, number of teeth, and other health issues. We used multiple linear regression analysis to assess the 75 people who were able to take part in all the visits. Number of teeth (Beta = 0.479, p < 0.001), clinical dementia rating (Beta = 0.258, p = 0.013), and age (Beta = 0.250, p = 0.017) were independently associated with periodontal inflamed surface area after adjusting for biological sex, depression, diabetes, collagen disease, visual disorder, and osteoporosis medication. To make communities more dementia-friendly, we must protect older people with dementia from developing poor oral health, which may require home visits for dental assessment.

Follow the protocol and kickstart the heart-Intensive care nurses' reflections on being part of rescue situations in interdisciplinary teams

Aim

To describe intensive care nurses' reflections on being part of interdisciplinary emergency teams involved in in‐hospital cardiopulmonary resuscitation.

Design

A qualitative descriptive design. Methods: Eighteen intensive care nurses from two regions and three hospitals in Sweden were interviewed. The data were analysed with General Inductive Analysis.

Results

The work for intensive care nurses in the emergency team was reflected in three phases: prevention, intervention and mitigation—referred as before, during and after the CPR situation.

Conclusions

The findings describe the complexity of being an intensive care nurse in an interdisciplinary emergency team, which entails managing advanced care with limited and unknown resources in a non‐familiar environment. The present findings have important clinical implications concerning the value of having debriefing sessions to reflect on and to talk about obstacles to and prerequisites for performing successful resuscitation.

Implementing quality improvement efforts in spiritual care: outcomes from the interprofessional spiritual care education curriculum

The Interprofessional Spiritual Care Curriculum (ISPEC) was created to train interdisciplinary health care teams to recognize and address the spiritual needs of seriously or chronically ill patients. The curriculum, in a train-the-trainer format, employs didactic presentations, discussions, lab sessions, skill demonstrations, and video clips. In course applications, participants were required to submit goals to achieve and demonstrate institutional support. For the first ISPEC course, in July 2018, 48 clinician-chaplain teams attended. Following the 2½ day course, participants had access to online training modules for 1-year, ISPEC faculty mentoring support, and regular conference calls on goal implementation progress. Participants reported recognizing the importance of providing spiritual care and a new understanding of how collaborating as interprofessional teams enabled them to integrate this care into their home institution settings. In a mixed-methods evaluation survey completed 12 months after the ISPEC course, participants reported on the percentage of their goals completed, number and types of professionals they had educated in spiritual care, and personal confidence regarding spiritual care leadership skills. This data can serve as a model to guide other organizations striving to improve spiritual care, practiced collaboratively by clinicians and chaplains, as an essential aspect of overall QI efforts in palliative care.

Roleplay as an Educational Strategy in Palliative Care: A Systematic Integrative Review

INTRODUCTION

Simulation activities, such as roleplay, have become established in undergraduate and graduate education in several subjects of healthcare. The objective of this study was to synthesize the evidence available in the literature on the use of roleplay as an educational strategy in palliative care.

METHODS

Using the method proposed by Whittemore and Knafl, this integrative systematic review was carried out based on the following guiding question: "What is the available evidence in the literature on the use of roleplay as an educational strategy in the teaching of palliative care?" The databases used for the selection of articles were the following: Web of Science, Scopus, Cochrane Library, PubMed, CINAHL, EMBASE, and LILACS. There were no limitations regarding the year of publication or language.

RESULTS

The articles (n = 34) were grouped into 3 categories, according to the purpose of roleplay use: 1) Use of roleplay as an educational strategy to teach communication in palliative care; 2) Use of roleplay as an educational strategy to teach the communication of bad news, and 3) Use of roleplay as an educational strategy to teach end-of-life care.

CONCLUSION

Roleplay has been employed in the teaching of palliative care in order to develop skills related to communication and to the provision of end-of-life care. These educational activities have mainly been directed to healthcare students and professionals. Future investigations should further evaluate the efficacy of this teaching strategy, based on studies with more robust designs that allow the establishment of cause-and-effect relationships.

Differential impact of on-site or telepharmacy in the intensive care unit: a controlled before-after study

BACKGROUND

Clinical pharmacists have an important role in the intensive care unit (ICU) team but are scarce resources. Our aim was to evaluate the impact of on-site pharmacists on medical prescriptions in the ICU.

METHODS

This is a retrospective, quasi-experimental, controlled before-after study in two ICUs. Interventions by pharmacists were evaluated in phase 1 (February to November 2016) and phase 2 (February to May 2017) in ICU A (intervention) and ICU B (control). In phase 1, both ICUs had a telepharmacy service in which medical prescriptions were evaluated and interventions were made remotely. In phase 2, an on-site pharmacist was implemented in ICU A, but not in ICU B. We compared the number of interventions that were accepted in phase 1 versus phase 2.

RESULTS

During the study period, 8797/9603 (91.6%) prescriptions were evaluated, and 935 (10.6%) needed intervention. In phase 2, there was an increase in the proportion of interventions that were accepted by the physician in comparison to phase 1 (93.9% versus 76.8%, P < 0.001) in ICU A, but there was no change in ICU B (75.2% versus 73.9%, P = 0.845).

CONCLUSION

An on-site pharmacist in the ICU was associated with an increase in the proportion of interventions that were accepted by physicians.

Building an Interdisciplinary Team for Disaster Response Research: A Data-Driven Approach

Building an interdisciplinary team is critical to disaster response research as it often deals with acute onset events, short decision horizons, constrained resources, and uncertainties related to rapidly unfolding response environments.  This article examines three teaming mechanisms for interdisciplinary disaster response research, including ad hoc and/or grant proposal driven teams, research center or institute based teams, and teams oriented by matching expertise toward long-term collaborations. Using hurricanes as the response context, it further examines several types of critical data that require interdisciplinary collaboration on collection, integration, and analysis. Last, suggesting a data-driven approach to engaging multiple disciplines, the article advocates building interdisciplinary teams for disaster response research with a long-term goal and an integrated research protocol.

Die Rolle von Pflegefachpersonen in der onkologischen Rehabilitation

Nurse's role in oncological rehabilitation - A scoping review Abstract. Background: For people with cancer the offer for inpatient or outpatient oncological rehabilitation is more and more increasing. Oncological rehabilitation has an interdisciplinary approach to prepare people with cancer for their life at home. Nurses are part of the interdisciplinary team, but little is known about their special role in this setting. Objective: The aim of this study is to identify the role of nurses and their functions in cancer rehabilitation. Methods: A scoping review was conducted. A literature search was conducted in MEDLINE via PubMed and CINAHL, Google Scholar and in reference lists. There was no limitation of publication period. After evaluation of the included publications a thematic analysis was undertaken. Results: All in all, 7 publications (1 qualitative study, 1 editorial book, 1 white paper, 1 article and 3 literature reviews) were included. Through thematic analysis 3 main topics were identified: nurse's role as emotional and psychological support, coach and part of the interdisciplinary team. In addition to general care, they promote self-management, advise and train, carry out symptom management and take on a coordinative function. Conclusion: This scoping review offers a first overview about the role of nurses in oncological rehabilitation. The focus is on preparation of cancer survivors for their new and changed life.

Multidisciplinary Approach for Managing Complex Pain and Addiction in Primary Care: A Qualitative Study

PURPOSE

Primary care providers (PCPs) may feel ill-equipped to effectively and safely manage patients with chronic pain, an addiction, or both. This study evaluated a multidisciplinary approach of supporting PCPs in their management of this psychosocially complex patient population, to inform subsequent strategies clinics can use to support PCPs.

METHODS

Four years ago, at our academic community health safety-net system, we created a multidisciplinary consultation service to support PCPs in caring for complex patients with pain and addiction. We collected and thematically analyzed 66 referral questions to understand PCPs' initially expressed needs, interviewed 14 referring PCPs to understand their actual needs that became apparent during the consultation, and identified discrepancies between these sets of needs.

RESULTS

Many of the PCPs' expressed needs aligned with their actual needs, including needing expertise in the areas of addiction, safe prescribing of opioids, nonopioid treatment options, and communication strategies for difficult conversations, a comprehensive review of the case, and a biopsychosocial approach to management. But several PCP needs emerged after the initial consultation that they did not initially anticipate, including confirming their medical decision-making process, emotional validation, feeling more control, having an outside entity take the burden off the PCP for management decisions, boundary setting, and reframing the visit to focus on the patient's function, values, and goals.

CONCLUSIONS

A multidisciplinary consultation service can act as a mechanism to meet the needs of PCPs caring for psychosocially complex patients with pain and addiction, including unanticipated needs. Future research should explore the most effective ways to meet PCP needs across populations and health systems.

Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report

Placenta accreta spectrum encompasses a group of conditions of abnormal placental infiltration of the uterine wall and surrounding tissues. It is associated with significant blood loss, perioperative morbidity, and risk of death. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease. We describe the successful management of a patient with placenta percreta who required supra-massive transfusion of blood products and interventions by different specialized teams in a tertiary care center.

The Silver Lining of COVID-19

The 2020-2021 school year has been a challenging year like no other. This article shares one large, suburban school district's experience in using data to make nimble decisions related to COVID-19 (coronavirus disease 2019), and lessons learned from that experience.

Unveiling the silent threat among us: leveraging health information technology in the search for asymptomatic COVID 19 healthcare workers

Assuring the safety of both patients and healthcare workers (HCWs) in hospitals has been the primary focus of every healthcare organization during the COVID 19 pandemic. This article discusses the NIH Clinical Center's interdisciplinary approach to deploying an organizational Asymptomatic Staff Testing System.

Pain and Function in Chronic Musculoskeletal Pain-Treating the Whole Person

Chronic pain is often associated with functional limitations that have a huge impact on patients' lives. However, despite being relatively common, chronic musculoskeletal pain is still viewed by some as a symptom of another disease rather than its own condition, and is therefore poorly addressed. This is compounded by other challenges in the field, including education gaps for both healthcare professionals and patients, a lack of universal and comprehensive assessment tools, poor societal perceptions of chronic pain, and the current stigma around the use of opioids. Here, we review the current chronic musculoskeletal pain management landscape in the United States and offer professional insight into emerging methods that can be used to improve patient outcomes, in particular, the achievement of meaningful functional goals. This perspective incorporates our combined multidisciplinary (psychiatry, psychology, nursing, physical therapy, and general medicine) experience and insights. We believe that chronic pain is a multifactorial experience and treatment requires an integrated, multidisciplinary approach from a range of healthcare providers. For the best patient outcomes, this team should work together to assess and treat the patient as a whole, addressing their pain and also providing education, empowerment, and support to enable patients to set and achieve meaningful functional goals that will provide real improvement in their quality of life. We believe that the healthcare community should elevate the conversation around chronic musculoskeletal pain management beyond that of just pain, to encompass the meaningful benefits that improvement in functional outcomes brings to patients.

The GeriPACT Initiative to Prevent All-Cause 30-Day Readmission in High Risk Elderly

Background: Suboptimal care transitions increases the risk of adverse events resulting from poor care coordination among providers and healthcare facilities. The National Transition of Care Coalition recommends shifting the discharge paradigm from discharge from the hospital, to transfer with continuous management. The patient centered medical home is a promising model, which improves care coordination and may reduce hospital readmissions. Methods: This is a quality improvement report, the geriatric patient-aligned care team (GeriPACT) at Tennessee Valley Healthcare System (TVHS) participated in ongoing quality improvement (Plan, Do, Study, Act (PDSA)) cycles during teamlet meetings. Post home discharge follow-up for GeriPACT patients was provided by proactive telehealth communication by the Registered Nurse (RN) care manager and nurse practitioner. Periodic operations data obtained from the Data and Statistical Services (DSS) coordinator informed the PDSA cycles and teamlet meetings. Results: at baseline (July 2018–June 2019) the 30-day all-cause readmission for GeriPACT was 21%. From July to December 2019, 30-day all-cause readmissions were 13%. From January to June 2020, 30-day all-cause readmissions were 15%. Conclusion: PDSA cycles with sharing of operations data during GeriPACT teamlet meetings and fostering a shared responsibility for managing high-risk patients contributes to improved outcomes in 30-day all-cause readmissions.

Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

INTRODUCTION

Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine's (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice.

OBJECTIVE

The purpose of the study was to examine the factors that influence health professional's likelihood of accomplishing the IOM core competencies.

METHODS

A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey.

RESULTS

The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts.

CONCLUSION

There is a need to understand how health professionals' age and experience impact their engagement with IOM's core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers' age and experience.

Outcomes and prognosis of diabetic foot ulcers treated by an interdisciplinary team in Canada

The aim of this study was to determine the wound healing outcomes of patients with a plantar diabetic foot ulcer (DFU) treated with an interdisciplinary team approach, and to identify associated variables. A retrospective observational cohort study of 140 adult patients, with a plantar DFU, treated between 2012 and 2018 at a wound care clinic of a University affiliated hospital was conducted. Predictive and explicative analyses were conducted with logistic multivariate methods and with a Receiver Operating Characteristics curve. The best predictor of wound healing at 3 months was a 41.8% wound size reduction at 4 weeks (AUC: 0.86; sensitivity: 83.1%; specificity: 67.2%, positive predictive value: 72.8%; negative predictive value: 78.9%; positive and negative likelihood ratios: 2.53 and 0.25, respectively). Main baseline variables independently associated with this predictor were: a monophasic Doppler waveform (OR 7.52, 95% CI [2.64–21.39]), cigarette smoking (OR 4.7, 95% CI [1.44–15.29]), and male gender (OR 3.58, 95% CI [1.30–9.87]). The health care provider should be cautious and intensify its management of DFUs particularly with patients of male gender; smoking, having a monophasic waveform with a hand‐held Doppler, and not achieving a minimal 41.8% wound area reduction at 4 weeks of treatment.

"Percorso Giacomo": An Italian Innovative Service of Perinatal Palliative Care

The perspective proposed by this article will focus on perinatal palliative care as a strategy for improving the quality of life of neonates with life-limiting conditions when extending the patient's life is no longer the goal of care. This manuscript reports the creation of an innovative program of perinatal palliative care called "Percorso Giacomo" (Giacomo's Pathway) at Sant'Orsola Hospital in Bologna, Italy in 2013. Key features include interdisciplinary collaboration between professionals from obstetrics, neonatology and other specialties aiming to reach the most detailed fetal and neonatal diagnosis and prognosis; communication and engagement with the family to discuss goals of care and prepare a birthing plan that follows the family's desires and expectations; and personalized care to achieve comfort for each newborn and support for families according to their social, cultural, and religious backgrounds.

Establishing Consensus for Essential Elements in Returning to Learn Following a Concussion

BACKGROUND

Returning to learn following a concussion is the process of managing a student's recovery during the school day by implementation of academic supports with varying intensity. Due to a lack of consensus or even guidance on Return to Learn, this paper set out to establish cross discipline consensus on some essential elements of Return to Learn using a Delphi method.

METHODS

Sixteen national organizations participated in a Delphi process to reach consensus on overarching themes of Return to Learn focused on: returning a student to school, composition of the school-based concussion management team, progress-monitoring, educational safeguards, neuropsychological testing, and legislation. Two rounds of questionnaires were disseminated via email using a Delphi process. Consensus was established during round 2.

RESULTS

Twelve national organizations were able to reach consensus and endorse 13 essential elements of Return to Learn following a concussion.

CONCLUSIONS

There continues to be limited research on concussion Return to Learn leading to confusion in the field. In this paper, we demonstrate consensus on a number of essential elements, from a wide variety of professional disciplines who participate in the care of students following a concussion, as a starting place for some guidance on Return to Learn.

Quality of Diabetic Foot Ulcer Care: Evaluation of an Interdisciplinary Wound Care Clinic Using an Extended Donabedian Model Based on a Retrospective Cohort Study

OBJECTIVES

Diabetic foot ulcer (DFU), a serious complication of diabetes, is associated with increased morbidity and mortality and presents a substantial socioeconomic burden. However, DFU quality of care has been insufficiently studied. Therefore, the aim of this study was to evaluate the quality of DFU care at an interdisciplinary wound care clinic in Canada, based on an extended Donabedian model: structure, process and outcome quality indicators combined with patient characteristics.

METHODS

This was a retrospective cohort study of 140 adult patients with diabetes who were treated between 2012 and 2018 at a wound care clinic in a university-affiliated hospital in the Québec City area of Canada. Twenty-two internationally recognized quality-of-care indicators were identified from the literature. Data were collected from medical files, and the results were used to document the selected quality-of-care indicators.

RESULTS

The principal indicators regarding structure and process were met, and outcome indicators were influenced by study population characteristics, particularly peripheral artery disease and critical limb ischemia. Moreover, this study highlights that quality-of-care indicators are essential when evaluating DFU outcomes, as structure and process indicators can also affect wound healing outcomes.

CONCLUSIONS

This study suggests that DFU care at a Canadian wound care clinic, with an interdisciplinary approach, meets most quality-of-care indicators. The socioeconomic burden of DFUs for patients, health-care organizations and policymakers, and the paucity of quality and performance evaluations, call for more studies evaluating DFU care.

Comprehensive Rare Disease Care model for screening and diagnosis of rare genetic diseases - an experience of private medical college and hospital, South India

Rare diseases (RD) of genetic origin are raising public health concern contributing to a massive economic burden in India. Establishing Specialty Centers to bridge the RD community with apex centers is felt as a need in developing countries. Hence a Comprehensive Rare Disease Care (CRDC) model was set up at the department of pediatrics under Center for Human Genomics and Counseling at a medical college hospital in South India. The patients suspected to have genetic disease were evaluated as per the work flow of the designed model. The utilization statistics depict the outcome of this model. In the face of limited resources, it was possible to establish a functional RD unit with meticulous planning, supportive administration and trained interdisciplinary staff. A scalable prototype that could be replicated in other Medical colleges and Hospitals of India is described.

A qualitative exploration of the uses of the International Classification of Functioning, Disability and Health at an inpatient neurorehabilitation facility in the Western Cape, South Africa

Purpose of the study: The aim of the study was to describe how healthcare professionals at a neurorehabilitation facility currently use the International Classification of Functioning, Disability and Health (ICF) and to identify further possibilities for its future use.Methods: The study followed an interpretive description approach. Data were collected through four focus group discussions with 21 participants, all health care practitioners, at the study facility. Thematic analysis was conducted by coding the transcripts and generating themes.Findings: Three themes were generated: (1) Current use and gaps in use of the ICF, (2) a non-conducive environment and (3) using the ICF to facilitate holistic, patient-centred management. Current use of the ICF was limited. Gaps in use of the ICF was especially evident in goal setting practices. Goals were generic in nature and did not address participation and the environment. A lack of knowledge, debilitating interpersonal relationships and an unsupportive organisational culture created an environment non-conducive to the implementation of the ICF. Participants felt that the ICF can assist them to work more patient-centred.Conclusion: Participants perceived that the ICF has the potential to improve service delivery at the facility. The implementation process must be well structured, focus on practical use and be supported through an enabling environment created by management.IMPLICATIONS FOR REHABILITATIONThe ICF is not being optimally used in clinical rehabilitation practice, however healthcare practitioners perceive the ICF to have the potential to improve rehabilitation service delivery.Concerted action is required at institutional, interpersonal and individual level to create a conducive environment that facilitates the use of the ICF during rehabilitation service delivery.The ICF can be used to construct a team assessment document that promotes patient-centred goal setting and improves interdisciplinary communication.

Hospice social workers' perception of being valued by the interdisciplinary team and the association with job satisfaction

Being valued and respected by colleagues is an important contributor to job satisfaction in hospice and other health care settings. The purpose of this study was to examine how the perception of feeling valued by different members of the interdisciplinary team and interdependence of team members are related to hospice social workers' job satisfaction. The study aims were to examine: (1) the degree to which hospice social workers feel valued by other members of the interdisciplinary team; and 2) whether this is associated with job satisfaction. A nonprobability sample of 203 hospice social workers completed an online survey assessing job satisfaction, perception of feeling valued by each of the professionals on the interdisciplinary hospice team, interdependence of team members, and professional and personal characteristics. The final regression model for intrinsic job satisfaction included feeling valued by doctors and by other social workers, and interdisciplinary interdependence. The final model for extrinsic job satisfaction did not include any of the perception of feeling valued by others on the interdisciplinary team, although interdependence and the number of social workers at the hospice were significant in this model. Reasons for the difference in these models and the practice and policy implications are discussed.

Palliative care in hematologic malignancies: a multidisciplinary approach

Introduction: Palliative care is specialized health care focused on improving the quality of life amid serious illness. Patients with hematologic malignancies have significant needs that could be addressed by a multidisciplinary palliative care team, but the integration of palliative care into hematology is far behind that of solid tumor oncology.Areas covered: This article considers what is known about the palliative care needs of hematologic malignancy patients, shows how the multidisciplinary palliative care team could improve their care, and explores how barriers to this relationship might be overcome. The evidence to support this review comes from review of recent, relevant papers known to the authors as well as PubMed searches of additional relevant articles over the past 3 years.Expert opinion: Further cultivating this relationship requires us to thoughtfully integrate the multidisciplinary palliative care team to respond to each patient's specific disease and needs, and do so at the ideal time, to maximize benefits.

"It just magically happened overnight!" - support for the digitalization of medical teaching provided by an interdisciplinary e-tutor team

Background: The forced and time-critical changeover to digital teaching and learning formats in the summer semester 2020 brought about numerous new challenges for the teaching staff of the Faculty of Medicine at the University of Regensburg. Didactic and personnel support of clinical lecturers for the preparation, creation, and supervision of digital teaching materials became necessary. Project description: Since interdisciplinary teams seem to be superior in finding creative solutions, an interdisciplinary student e-tutor team was established at the Faculty of Medicine to support the digitalization of the range of courses. After their initial basic training the e-tutors had regular team meetings and internal mini-training sessions to ensure their continuous professional development. The e-tutors could be "requested" by clinical teaching staff and then accompanied the respective course preparation and implementation as required. Results and discussion: Both clinical teachers and students perceived the student e-tutors' support to be very positive. The e-tutors described the interdisciplinarity of the team as an important learning resource and their work as an exciting and instructive task. Conclusion and outlook: Due to the positive experiences with the e-tutors, the faculty is striving to establish sustainable digital teaching and learning services in the coming semesters.

Antimicrobial Stewardship Programs in Community Health Systems Perceived by Physicians and Pharmacists: A Qualitative Study with Gap Analysis

Antimicrobial stewardship program (ASP) is one of the most important strategies for managing infectious disease treatment and preventing antimicrobial resistance. The successful implementation of ASP in the community health system (CHS) has been challenging. We evaluated perceptions of current ASP, potential setbacks of ASP implementation, and future demands on ASP services among physicians and pharmacists in the CHS. The qualitative research was conducted through in-depth individual interviews and focus group discussions with 11 physicians and 11 pharmacists. In addition, a quantitative gap analysis was conducted to assess the different awareness and demands on services of ASP and preferred antimicrobial-related problems (ARP). In overall, perceptions of ASP varied by profession. The identified setbacks were unorganized institutional leadership, the undefined roles of healthcare professionals, a lack of reimbursement, the hierarchical structure of the health system, and the labor-intensive working environment of pharmacy services. Although demands for ASP improvement were similar among professionals, they had different preferences in prioritizing each service item of ASP/ARP development and the profession responsible for each service. Continuous administrative and financial investments, understanding ASP contents, ASP-specific information technology, and interdisciplinary collaboration with good communication among healthcare professions are needed to continue the progression of ASP.

A Stepwise Pharmacist-Led Medication Review Service in Interdisciplinary Teams in Rural Nursing Homes

Background: The provision of responsible medication therapy to old nursing home residents with comorbidities is a difficult task and requires extensive knowledge about optimal pharmacotherapy for different conditions. We describe a stepwise pharmacist-led medication review service in combination with an interdisciplinary team collaboration in order to identify, resolve, and prevent medication related problems (MRPs). Methods: The service included residents from four rural Norwegian nursing homes during August 2016–January 2017. All residents were eligible if they (or next of kin) supplied oral consent. The interdisciplinary medication review service comprised four steps: (1) patient and medication history taking; (2) systematic medication review; (3) interdisciplinary case conference; and (4) follow-up of pharmaceutical care plan. The pharmacist collected information about previous and present medication use, and clinical and laboratory values necessary for the medication review. The nurses collected information about possible symptoms related to adverse drug reactions. The pharmacist conducted the medication reviews, identified medication-related problems (MRPs) which were discussed at case conferences with the responsible physician and the responsible nurses. The main outcome measures were number and types of MRPs, percentage agreement between pharmacists and physicians and factors associated with MRPs. Results: The service was delivered for 151 (94%) nursing home residents. The pharmacist identified 675 MRPs in 146 (97%) medication lists (mean 4.0, SD 2.6, range 0–13). The MRPs most frequently identified concerned ‘unnecessary drug’ (22%), ‘too high dosage’ (17%) and ‘drug interactions’ (16%). The physicians agreed upon 64% of the pharmacist recommendations, and action was taken immediately for 32% of these. We identified no association between the number of MRPs and sex (p = 0.485), but between the number of MRPs, and the number of medications and the individual nursing homes. Conclusion: The pharmacist-led medication review service in the nursing homes was highly successfully piloted with many solved and prevented MRPs in interdisciplinary collaboration between the pharmacist, physicians, and nurses. Implementation of this service as a standard in all four nursing homes seems necessary and feasible. If such a service is implemented, effects related to patient outcomes, interdisciplinary collaboration, and health economy should be studied.

Moving from stigmatization toward competent interdisciplinary care of patients with functional neurological disorders: focus group interviews

PURPOSE

To explore facilitating and inhibiting factors in the inpatient care of patients with functional neurological disorders as experienced by interdisciplinary teams of healthcare professionals.

METHOD

Qualitative focus group interviews were conducted with 18 healthcare professionals of various professions. Data were analyzed using qualitative content analysis with inductive coding of data.

RESULTS

Two main categories were formulated: (a) Giving the diagnosis to patients - a moment of fragility and opportunities, and (b) Organization of care - ensuring the continuity and protecting patients' self-image. One overarching theme tied the two categories together: Establishing coherence in the inpatient trajectory - moving from stigmatization toward competent care. Coherence and steadiness in care was a prerequisite for transparency in goalsetting and for designating the responsibilities of individual healthcare professionals. Stigma and having clinical experience and knowledge of functional neurological disorders, as two counter-factors, influenced the extent to which this was achieved. Examples of facilitating factors for enhancing competent care were documentation of symptoms, effective ways of passing on clinical information, education, professional dialog, and organizational support.

DISCUSSION

To nurture competent care, guidelines, structured educational initiatives and other supportive actions should be promoted. We provide ideas for the next logical steps for clinical practice and research.IMPLICATIONS FOR REHABILITATIONClose collaboration between interdisciplinary healthcare professionals plays an important role for reaching optimal results in the rehabilitation of inpatients with functional neurological disorder.There is currently limited knowledge regarding the facilitating and inhibiting features encountered by interdisciplinary healthcare professionals in the provision of care for patients with a functional neurological disorder.The findings show that a working environment that endorses a skillful culture of practice and which facilitates actions to reduce problems that hamper effective teamwork needs to be promoted.Solutions that help to solve many obstacles encountered by the team of healthcare professionals in the care provision of patients with functional neurological disorders include open dialog regarding symptoms, diagnosis and treatment, effective ways of documenting and reporting symptoms, and availability of guidelines and supporting educational material.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability

Aim

Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability.

Design

Empirical research ‐ qualitative.

Method

Classic grounded theory with face‐to‐face interviews, 2017–2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients.

Results

To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses’ facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person‐centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work.

Conclusions

Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi‐professional cooperation. The implication is testing the emerged theory at primary health care centres.

Impact

Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.

Imaging Journeys of Recovery and Learning: A Participatory Arts-Based Inquiry

The relationship between processes of mental health recovery and lifelong learning is an area of increasing international interest. Experiences of transformation, positive effects on self-esteem, self-insight, and empowerment have been identified regarding both endeavors. Recognition of these benefits has stimulated collaborative development of educational programs in personal development, self-efficacy, and recovery principles. The importance of evaluating this educational provision has been emphasized; however, there has been little detailed exploration of students' experiences and perceptions of recovery and learning in the context of recovery education programs. In this article, we present a participatory arts-based inquiry with 14 women, including mental health service users, who undertook a recovery training program to support their roles as mental health support workers in Ireland. Participatory visual analysis revealed three recurring themes; the interrelatedness of learning and recovery journeys, knowledge as a source of stability and rescue and the need for resilience in learning and recovery.

The Role of the Ethicist in an Interdisciplinary Transgender Health Care Team

Unique ethical issues arise in the provision of gender-affirming care to transgender and gender diverse people. One of the distinctive trends in transgender health care has been the development of interdisciplinary specialty teams with expertise in gender-affirming care. Clinical ethicists can play an important role on these teams in helping gender variant patients and gender-affirming providers navigate complex ethical issues, creating opportunities for enhancing patient experience, and easing provider moral uncertainty. Many opportunities exist for clinical ethicists to lend their skills to this area of clinical care. It is important for interdisciplinary transgender health care teams and other health care professionals providing transgender-specific care to understand the ethical issues involved in such care, the ways in which ethics expertise can be a resource, and the benefits and drawbacks of integrating a clinical ethicist into their team.

Informal Caregivers' Perceptions of Needs From Hospice Providers: An Integrative Review

INTRODUCTION

In the United States, informal caregivers (ICs) provide care to over 70% of patients at the end of life. Approximately 500 000 ICs contribute to the end-of-life care for patients in the United Kingdom. Hospice care is expanding worldwide to meet the needs of these ICs. Because ICs play an instrumental role in the provision of hospice services, and their perspective of their needs of formal services requires further clarity, the purpose of this review is to synthesize research that elucidates perceptions of ICs regarding their experiences with hospice providers.

METHODS

Twelve research studies regarding perceptions of informal hospice caregivers were obtained by searching CINAHL, PsycINFO, and MEDLINE databases.

RESULTS

Four primary themes emerged that describe what ICs perceive as beneficial contributions of hospice providers in aiding their caregiving: providing easy access to desired care, building up the caregiver, forming a relationship, and utilizing culturally relevant interpersonal skills.

CONCLUSION

Particular attention must be paid to ensuring that the IC is acknowledged as an expert part of the team. Clearly explaining available services, creating better ways to ease the IC's transition from caregiving to bereavement, and recruiting minority hospice providers are other important efforts that could improve the caregiving experience. The needs of ICs are complex, but by listening to their perspective, we can begin to clarify the best ways to aid them in their difficult job.