"What is found there": qualitative analysis of physician-nurse collaboration stories

Rheumatology Clinic Staff Needs: Barriers and Strategies to Addressing High Blood Pressure and Smoking Risk

OBJECTIVE

Patients with rheumatologic conditions are at elevated risk of cardiovascular disease (CVD) due to inflammatory and traditional risk factors, such as high blood pressure (BP) and smoking. However, rheumatology clinics rarely address traditional risk factors, although they are routinely assessed and modifiable in primary care. The present study sought to (1) characterize rheumatology clinic staff's work process for addressing high BP and smoking and (2) identify barriers and strategies for effective management of these risk factors.

METHODS

We conducted 7 focus groups with medical assistants, nurses, and scheduling staff from 4 adult rheumatology clinics across 2 health systems (BP focus groups, n = 23; smoking, n = 20). Transcripts were analyzed using thematic analysis to elucidate barriers and strategies.

RESULTS

We found 3 clinic work processes for the management of high BP and smoking risk: (1) risk identification, (2) follow-up within the clinic, and (3) follow-up with primary care and community resources. Within these processes, we identified barriers and strategies grouped into themes: (1) time, (2) clinic workflows, (3) technology and resources, (4) staff's attitudes and knowledge, and (5) staff's perceptions of patients. The most pervasive barriers were (1) no structured system for follow-up and (2) staff confidence and skill in initiating conversations about health-related behavior change.

CONCLUSIONS

Our study identified generalizable gaps in rheumatology staff's work processes and competencies for addressing high BP and smoking in patients. Future efforts to support staff needs should target (1) systems for follow-up within and outside the clinic and (2) conversation support tools.

Perception of interdisciplinary collaboration between ICU nurses and resident physicians during the COVID-19 pandemic

Multidisciplinary collaboration is the hallmark of quality critical care. Prior studies have shown that nurses and physicians have different perceptions on communication and collaboration in the ICU. The Covid-19 pandemic has served to both strain and strengthen relationships between nurses and resident physicians in the ICU. This study used a survey-based approach sought to identify the similarities and differences between perception of collaboration between ICU nurses and resident physicians taking care of patients during the pandemic, and to identify whether they felt that the pandemic impacted the collaborative spirit of critical care. Although findings from this study suggest that overall residents and nurses perceive collaboration similarly, the COVID-19 pandemic may be differentially affecting the interdisciplinary dynamics of the ICU.

Developing an interprofessional learning and working culture to improve person-centred care in nursing homes: a realist action research protocol

INTRODUCTION

Healthcare is changing due to the ageing of the general population, complex care demands and growing attention to person-centred care. To deal with these changes and provide the best possible person-centred care, the different professionals in nursing homes should all collaborate intensively. However, most professionals work within the field of their own expertise and share very little knowledge, experiences and insights. A lack of an interprofessional learning and working culture also prevents professionals with different expertise from working and learning intensively together to achieve high-quality person-centred care. There is a gap of knowledge about how to develop such a culture. Our aim is to provide insights into what actions, in what context and to what extent can contribute to an impactful development of an interprofessional learning and working culture.

METHODS AND ANALYSIS

The realist action research design will be applied. It consists of three iterative steps: plan, act and observe, and reflect. First, we will formulate the theory about interprofessional learning and working culture and measure this culture by means of interviews, focus groups and questionnaires. Second, we will apply the nine principles of Practice Development to coach professionals from six Dutch nursing homes to improve their interprofessional learning and working culture. Finally, we will evaluate the impact of the changed attitudes and skills on healthcare practice.

ETHICS AND DISSEMINATION

Approval for the project was given by the Hogeschool van Arnhem en Nijmegen (HAN) Research Ethics Committee, the Netherlands, registration number EACO 164.12/19. All organisations, professionals and residents/family members will be informed verbally and by letter about the study and asked for informed consent. The results will be presented in peer-reviewed scientific journals, professional journals and at symposia and conferences. The findings will be transferred to an online toolbox and e-learning modules for graduated professionals and students.

Twelve tips on how to motivate healthcare professions students and their supervisors for Interprofessional Education

This article was migrated. The article was marked as recommended. Special efforts in rotations are necessary to have students from different professions learn with, from and about each other to improve their collaboration and the quality of care. The twelve tips derived from the lived experiences and research from the authors, are intended to stimulate motivation for interprofessional education in students and their supervisors. Internalization of the value students place on interprofessional learning will improve their readiness for future interprofessional collaboration. While creating an autonomy-supportive learning environment, supervisors are capable of both scaffolding the learning of students from all professions, and learning themselves from these authentic situations. The authors promote a central place for the clinical reasoning of each profession in both the profession specific skills as well as in the communication, collaboration and team skills, thus enhancing the 'T shaped-professional' ( Visser, 2018).

Comparing the attitude of doctors and nurses toward factor of collaborative relationships

Background and Objectives:

Effective relationship and collaboration between doctors and nurses is considered the main factor in achieving positive medical results, which is the most important goal of the healthcare system. This study aims to compare attitude of doctors and nurses toward factors associated with doctor-nurse collaboration, including shared education and teamwork, caring as opposed to curing, physician's dominance, and nurses’ autonomy.

Methods:

In this cross sectional, descriptive-comparative study, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration was used to assess doctor–nurse collaboration in four domains, including shared education and teamwork, caring as opposed to curing, physician's dominance, and nurses’ autonomy. To this end, descriptive (mean, standard deviation) and inferential statistics including independent t test, Chi-square, and variance analysis were used.

Results:

According to the results obtained, compared to doctors, nurses showed a more positive attitude toward shared education and teamwork, caring as opposed to curing, and physicians’ dominance, but there was no significant difference between the two groups in nurses’ autonomy.

Conclusion:

With regard to doctor-nurse collaboration, it is essential that doctors and nurses be acculturated in the course of their academic education. Moreover, policies to change pattern of professional relationships from hierarchical to complementary can be effective in enhancing professional autonomy of nurses and reducing impaired professional interactions.

The role of relational routines in hindering transdisciplinary collaboration: the case of the setting up of a team in an Italian Breast Unit

Interprofessional teamwork is one of the main characteristics of centers specialized in the treatment of breast cancer, known as Breast Units, which since 2016 European legislation has made mandatory for Member States. However, interprofessional collaborative practice (ICP) has often been applied in traditional healthcare contexts on the basis of mono-disciplinary approaches. This paper reports the results of a case study of an Italian Breast Unit carried out through a qualitative research strategy. To understand the case being studied in its complexity the data were drawn from multiple sources of evidence: documents, in-depth interviews with Breast Unit members and field notes from the participant observation of team meetings. The case study shows that, despite the healthcare organization promoting interprofessional collaboration through the creation of protocols, organizational environments and structures aimed at encouraging communication and collaboration between the professionals of the team, a series of older routine relational practices remain. These are based on traditional communication models, cultural and professional barriers between members of the team, which hinder the development of innovative ICPs, thus preventing professionals from seeing the need for change in their relational practices towards a trans-disciplinary approach.

Iranian Nurses' Attitudes Toward Nurse-Physician Collaboration and its Relationship with Job Satisfaction

Introduction: Although nurses and physicians are known to share the common goal of improving the quality of health care, there has traditionally been a relational gap between them. The aim of the present study was to investigate the attitude of Iranian nurses about physician-nurse collaboration and its relationship with their job satisfaction. Methods: In this cross-sectional study, a total of 232 nurses were recruited from three educational hospitals of Zanjan University of medical sciences. Three questionnaires were used in this study; (a) Demographic data questionnaire, (2) Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC), and (3) Minnesota Satisfaction Questionnaire. Results: In this study, the mean age of the participants was 33.22(SD= 6.13) years, 83.8% of nurses were female, 90.8% had a baccalaureate degree in nursing, and 82.5 % had rotational work shifts. The mean score of physician-nurse collaboration was found to be 48.07 (SD= 8.95) (ranged from 15 to 60), and the mean score of job satisfaction scale was 57.78 (SD = 14.67) (ranged from 20 to 100). There was a significant positive correlation between the attitudes toward physician-nurse collaboration and job satisfaction among the nurses (r=0.59, P≤0.001). Conclusion: The results indicated that the collaboration between nurses and physicians increases the job satisfaction of nurses working in clinical settings. Therefore, nurses and physicians should develop a new culture of collaboration with each other with the mutual goal of high quality patient care. Moreover, health care administrators should implement the strategies that strengthen the development of physician-nurse collaboration.

Perceptions of residents, medical and nursing students about Interprofessional education: a systematic review of the quantitative and qualitative literature

BACKGROUND

To identify facilitators and barriers that residents, medical and nursing students perceive in their Interprofessional Education (IPE) in a clinical setting with other healthcare students.

METHODS

A systematic review was carried out to identify the perceptions of medical students, residents and nursing students regarding IPE in a clinical setting. PubMed, CINAHL, ERIC and PsycInfo were searched, using keywords and MeSH terms from each database's inception published prior to June 2014. Interprofessional education involving nursing and medical students and/or residents in IPE were selected by the first author. Two authors independently assessed studies for inclusion or exclusion and extracted the data.

RESULTS

Sixty-five eligible papers (27 quantitative, 16 qualitative and 22 mixed methods) were identified and synthesized using narrative synthesis. Perceptions and attitudes of residents and students could be categorized into 'Readiness for IPE', 'Barriers to IPE' and 'Facilitators of IPE'. Within each category they work at three levels: individual, process/curricular and cultural/organizational. Readiness for IPE at individual level is higher in females, irrespective of prior healthcare experience. At process level readiness for IPE fluctuates during medical school, at cultural level collaboration is jeopardized when groups interact poorly. Examples of IPE-barriers are at individual level feeling intimidated by doctors, at process level lack of formal assessment and at cultural level exclusion of medical students from interaction by nurses. Examples of IPE-facilitators are at individual level affective crises and patient care crises situations that create feelings of urgency, at process level small group learning activities in an authentic context and at cultural level getting acquainted informally. These results are related to a model for learning and teaching, to illustrate the implications for the design of IPE.

CONCLUSIONS

Most of the uncovered barriers are at the cultural level and most of the facilitators are at the process level. Factors at the individual level need more research.

Dissonant role perception and paradoxical adjustments: an exploratory study on Medical Residents' collaboration with Senior Doctors and Head Nurses

A good collaboration between health professionals is considered to have benefits for patients, healthcare staff, and organizations. Nevertheless, effective interprofessional collaboration is difficult to achieve. This is particularly true for collaboration between Medical Residents (MRs) and the immediate colleagues they interact with, as Senior Doctors (SDs) and Head Nurses (HNs). Role understanding is one of the factors that may explain difficulties in interprofessional collaboration. Based on this hypothesis, this paper focuses on MRs' role, devoting particular attention to differences in role perception between MRs, SDs, and HNs, and to their consequences for interprofessional collaboration. An exploratory qualitative study inspired by Grounded Theory was conducted in April 2009 in a small peripheral and non-university hospital in Switzerland. Data came from two focus groups with MRs (13), one with SDs (8), and one with HNs (7), and were analyzed using the constant comparative method. Findings show that the expected and the enacted role of MR are perceived differently by SDs, HNs and MRs themselves. To face the inconsistencies within MR's role, the three professional groups develop some adjustments that eventually prove to be paradoxical: on one side, they make collaboration possible and preserve the functioning of the ward, while on the other side they lead to mutual misunderstanding and discontent. These findings suggest that there is an urgent need of defining the role of MRs, of delimiting its boundaries and thereby distinguishing it from other health workers, and eventually of promoting a shared representation of it.

Interprofessional collaboration on an internal medicine ward: role perceptions and expectations among nurses and residents

BACKGROUND

Effective interprofessional collaboration requires that team members share common perceptions and expectations of each other's roles.

OBJECTIVE

Describe and compare residents' and nurses' perceptions and expectations of their own and each other's professional roles in the context of an Internal Medicine ward.

METHODS

A convenience sample of 14 residents and 14 nurses volunteers from the General Internal Medicine Division at the University Hospitals of Geneva, Switzerland, were interviewed to explore their perceptions and expectations of residents' and nurses' professional roles, for their own and the other profession. Interviews were analysed using thematic content analysis. The same respondents also filled a questionnaire asking their own intended actions and the expected actions from the other professional in response to 11 clinical scenarios.

RESULTS

Three main themes emerged from the interviews: patient management, clinical reasoning and decision-making processes, and roles in the team. Nurses and residents shared general perceptions about patient management. However, there was a lack of shared perceptions and expectations regarding nurses' autonomy in patient management, nurses' participation in the decision-making process, professional interdependence, and residents' implication in teamwork. Results from the clinical scenarios showed that nurses' intended actions differed from residents' expectations mainly regarding autonomy in patient management. Correlation between residents' expectations and nurses' intended actions was 0.56 (p=0.08), while correlation between nurses' expectations and residents' intended actions was 0.80 (p<0.001).

CONCLUSIONS

There are discordant perceptions and unmet expectations among nurses and residents about each other's roles, including several aspects related to the decision-making process. Interprofessional education should foster a shared vision of each other's roles and clarify the boundaries of autonomy of each profession.

Mastering improvement science skills in the new era of quality and safety: the Veterans Affairs National Quality Scholars Program

RATIONALE, AIMS AND OBJECTIVES

Healthcare professionals need a new skill set to ensure the success of quality improvement in healthcare. The Department of Veterans Affairs (VA) initiated the VA National Quality Scholars fellowship in 1998; its mission is to improve the quality of care, ensure safety, accelerate healthcare re-design, and advance the improvement science by educating the next generation of leaders in quality and safety. We describe the critical need for leadership in quality and safety and interprofessional education, illustrate the curriculum, provide lessons learned by fellows, summarize key lessons learned from the implementation of an interprofessional education approach, and present most recent accomplishments.

METHODS

Narrative review.

RESULTS

As of 2011, 106 program alumni are embedded in the health care delivery system across the United States. Since 2009, when nurse fellows joined the program, of the first nine graduating interdisciplinary fellows, the tailored curriculum has resulted in five advanced academic degrees, 42 projects, 29 teaching activities, 44 presentations, 36 publications, six grants funded or submitted, and two awards.

CONCLUSIONS

The VA National Quality Scholars program continues to nurture and develop leaders for the new millennium focusing on interprofessional education. The nations' health care systems need strong interdisciplinary leaders in advanced quality improvement science who are dedicated to improving the overall quality of health and health care.

Training residents and nurses to work as a patient-centered care team on a medical ward

OBJECTIVE

To train medical residents and nurses to work together as a patient-centered care (PCC) team on a medical ward and test its feasibility, nurses' learning, and patient outcomes.

METHOD

Working with administrative leadership, we consolidated residents' patients on one 32-bed ward. Already training residents in an evidence-based patient-centered method, we now trained 5 nurse leaders similarly, and they then trained all staff nurses. A national consultant visited twice. Specific team-building activities for nurses and residents fostered ward interactions. We used a retrospective pre/post/6-month post-design to evaluate nurses' knowledge and self-efficacy of patient-centered skills. Patients were assigned non-randomly to our unit or comparison units from our emergency room; using a post-test only design, the primary endpoint was patient satisfaction.

RESULTS

28 trained nurses showed improvement in knowledge (p=0.02) and self-efficacy (p=0.001). 81 treatment patients showed no improvement in satisfaction (p=0.44).

CONCLUSION

Training nurses in patient-centered practices were effective. Unique in this country, we also trained nurses and residents together as a PCC team on a medical ward and showed it was feasible and well accepted.

PRACTICE IMPLICATIONS

We provide a template for team training and urge that others explore this important new area and contribute to its further development.

Implementing small tests of change to improve patient satisfaction

The Institute of Medicine supports proposed changes in the overall delivery of healthcare and the nurses' work environment to achieve improved patient outcomes and protect the public from unnecessary harm. Allowing nurses to have a voice in decision making and influence over their practice, in an environment that fosters autonomy and interdisciplinary collaboration, enhances nurse satisfaction while improving the quality of patient care. The authors describe how a pediatric medical unit engaged in small tests of change to improve communication and patient satisfaction on an inpatient unit.

Nurses--psychiatrists' main collaborators when treating women with postpartum psychosis

The focus was to describe Swedish psychiatrists' experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. Data were analysed using manifest and latent content analysis. The results of these experiences were categorized in this study as: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards; and decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses' competence, and was exceedingly important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams, e.g. outpatient clinic, child health clinic and community services, was required. The conclusions were that psychiatrists collaborate with different professionals in the various phases of the caring process. They rely extensively on nurses' competence when caring for women with PPP, and consider nurses to be their most important collaborators.

Professional collaboration in students of Medicine Faculty and School of Nursing

This descriptive study has been planned to analyze the professional collaboration among the students of Ege University, Faculty of Medicine and School of Nursing. The study group consisted of 137 5th and 6th grade students from the Faculty of Medicine and 142 3rd and 4th grade students from the School of Nursing. The participation rate is 94%. For data collection, a questionnaire form (30 questions) which was specially developed for the purpose of the study and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (15 questions) were used. Permission was granted for the research by Ege University School of Nursing Ethical Committee and the Office of the Dean of the Faculty of Medicine. The professional collaboration mean score of the students from the Faculty of Medicine who participated in the study was 30.40+/-5.82 and the professional collaboration mean score of the students from the School of Nursing was 26.11+/-5.27. The difference between the mean scores of professional collaboration was found to be significant in terms of their profession (p<0.01). Physicians expressed more positive attitudes toward collaboration than nurses while female physicians expressed more positive attitudes toward collaboration than male physicians.