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Merriman C, Freeth D. Interprofessional ward rounds in an adult intensive care unit: an appreciative inquiry into the central collaboration between the consultant and the bedside nurse. J Interprof Care 2024; 38:435-443. [PMID: 34846951 DOI: 10.1080/13561820.2021.1985441] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/11/2021] [Accepted: 09/11/2021] [Indexed: 10/19/2022]
Abstract
Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varies. An improvement-focused appreciative inquiry (AI) into a large intensive care unit's WR practices identified a pivotal axis of collaboration between the most senior medical role (the consultant) and the bedside nurse (BSN). This paper examines that axis of interprofessional collaboration (IPC) to deepen understanding of its implications. Data included ethnographic observations, interviews, and co-constructed AI with groups of staff. Four key concepts emerged from cyclical interpretive analysis: "need," "presence," "ability" and "willingness." BSNs and consultants needed the interprofessional WR to enable their work; WR effectiveness was affected by whether they were both present, then able and willing to participate in IPC. BSN presence was necessary for effective and efficient IPC between these key roles. Indirect contributions, based on prior exchanges with colleagues or through written notes, reduced the joint problem-solving through discussion and negotiation that characterizes IPC to less efficient asynchronous interprofessional coordination. Factors affecting "presence," "ability" and "willingness" are discussed alongside potential mitigations and acknowledgment of asymmetric power. Appreciative examination of interprofessional WRs identified mechanisms supporting and undermining effective WR IPC and the centrality of consultants' and BSNs' collaboration.
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Affiliation(s)
- Clair Merriman
- Queens Mary University of London, Oxford Brookes University, Oxford, UK
| | - Della Freeth
- Royal College of Physicians, Queens Mary University of London, London, UK
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Merriman C, Freeth D. SIN-BARRSS - Developing a mnemonic to support nurses' participation in interprofessional ward rounds in intensive care: An appreciative inquiry for quality improvement. Intensive Crit Care Nurs 2024; 81:103609. [PMID: 38155052 DOI: 10.1016/j.iccn.2023.103609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES To develop and pilot a mnemonic to increase the willingness and ability of bedside nurses to contribute to patient reviews in the daily interprofessional ward round. RESEARCH METHODOLOGY/DESIGN Appreciative inquiry quality improvement study, using ethnographic observations and appreciative inquiry discussions, augmented by quantitative data collection of basic facts. SETTING Large (44 beds) critical care unit in the United Kingdom. MAIN OUTCOME MEASURES Interprofessional development and acceptance of mnemonic; successful preparation for pilot; use and usability of mnemonic; improvements in bedside nurses' contributions to ward round discussions (frequency and focus). RESULT/FINDINGS Interprofessional development of a usable and useful mnemonic was successful, pilot implementation showed promising levels of take up and acceptance. Compared to before the quality improvement project bedside nurses were more willing and able to participate in ward round discussions, did so more often, and used the mnemonic script with insight and flexibility. CONCLUSIONS The implementation of a mnemonic supported bedside nurses' contributions to the ward round. This could provide a framework for introducing similar programmes to other intensive care units. Appreciative inquiry methodology could be replicated in other settings to aid the improvement of interprofessional ward rounds, or to address other quality improvement priorities. IMPLICATIONS FOR CLINICAL PRACTICE A mnemonic can provide a structure which supports bedside nurses' contributions in ways that make good use of bedside nurses' professional expertise and most up to date knowledge of patients' clinical state. Furthermore, a well-designed mnemonic can be used flexibly and provides an outline script that supports less experienced and less confident nurses to make well-focused and well received contributions to rapid interprofessional discussions. In turn, this can increase these nurses' confidence and capability. More experienced and confident nurses, and ward round leaders, can use the same mnemonic flexibly as an aide memoir that guards against missing information and insights that could affect the quality and safety of patient care.
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Affiliation(s)
- Clair Merriman
- London and Queen Mary University of London, Oxford Brookes University, United Kingdom.
| | - Della Freeth
- London and Queen Mary University of London, The Science Council, United Kingdom
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Johnson NL, Moeckli J. Conceptualizations of interprofessional communication in intensive care units: findings from a scoping review. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024:1-13. [PMID: 38197399 DOI: 10.1080/17538068.2023.2297124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Clinical errors in intensive care units (ICUs) are consistently attributed to communication errors. Despite its importance for patient safety and quality in critical care settings, few studies consider interprofessional communication as more than the basic exchange of information. METHODS We conducted a scoping review of interprofessional communication in ICUs to (1) characterize how communication is defined and measured and (2) identify contributions the field of health communication can make to team communication in ICUs. Through a series of queries in PubMed and Communication and Mass Media Complete databases, we identified and compared persistent gaps in how communication is framed and theorized in 28 publications from health services and 6 from social science outlets. We identified research priorities and suggested strategies for discussing communication more holistically in future health services research. RESULTS 34 articles published from 1999 to 2021 were included. Six explicitly defined communication. Six were published in social science journals, but none were authored by a communication studies scholar. Half of the articles addressed communication as a transaction focused on information transfer, and the other half addressed communication as a process. CONCLUSIONS Methodological implications are identified with the intent to encourage future interdisciplinary collaboration for studying communication in ICUs. We discuss the importance of (1) using language to describe communication that facilitates interdisciplinary engagement, (2) prioritizing communication as a process and using qualitative methods to provide insight, and (3) engaging health communication theories and experts to assist in developing more fruitful research questions and designs.
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Affiliation(s)
- Nicole L Johnson
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jane Moeckli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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August F, Nyamhanga T, Kakoko D, Nathanaeli S, Frumence G. Perceptions and Experiences of Health Care Workers on Accountability Mechanisms for Enhancing Quality Improvement in the Delivery of Maternal Newborns and Child Health Services in Mkuranga, Tanzania. Front Glob Womens Health 2022; 3:868502. [PMID: 35846559 PMCID: PMC9279912 DOI: 10.3389/fgwh.2022.868502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMaternal mortality estimates globally show that by 2017 there were still 211 deaths per 100,000 live births; more strikingly, 99% of them happen in low and middle-income countries, including Tanzania. There has been insufficient progress in improving maternal and newborn health despite the efforts to strengthen the health systems, to improve the quality of maternal health in terms of training and deploying human resources for health, constructing health facilities, and supplying medical products. However, fewer efforts are invested in enhancing accountability toward the improvement of the quality of maternal health care. This the study was conducted to explore the perceptions of healthcare workers regarding accountability mechanisms for enhancing quality improvement in the delivery of maternal newborn and child health services in Tanzania.MethodsWe adopted phenomenology as a study design to understand how health workers perceive accountability and data were collected using semi-structured interviews. We then used thematic analysis to analyze themes and sub- themes.ResultsThe study revealed four categories of perceptions namely, differences in the conceptualization of accountability and accountability mechanisms, varied opinions about the existing accountability mechanisms, perceived the usefulness of accountability mechanisms, together with perceived challenges in the enforcement of accountability mechanisms.ConclusionPerceived variations in the understanding of accountability among healthcare workers signaled a proper but fragmented understanding of accountability in maternal care. Accountability mechanisms are perceived to be useful for enhancing hard work in the provision of maternal health services. Moreover, inadequate motivation resulting from health system bottlenecks tend to constrain enforcement of accountability in the provision of maternal care services. Thus, we recommend that the government should deal with health system constraints and enforce regular monitoring and supervision.
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Affiliation(s)
- Francis August
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Francis August
| | - Tumaini Nyamhanga
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deodatus Kakoko
- Department of Behavioral Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sirili Nathanaeli
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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"It Is Difficult to Always Be an Antagonist": Ethical, Professional, and Moral Dilemmas as Potentially Psychologically Traumatic Events among Nurses in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031454. [PMID: 35162485 PMCID: PMC8834915 DOI: 10.3390/ijerph19031454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 02/05/2023]
Abstract
AIMS We explore social and relational dynamics tied to an unexplored potentially psychologically traumatic event (PPTE) that can impact nurses' well-being and sense of their occupational responsibilities: namely, the moral, ethical, or professional dilemmas encountered in their occupational work. DESIGN We used a semi-constructed grounded theory approach to reveal prevalent emergent themes from the qualitative, open-ended component of our survey response data as part of a larger mixed-methods study. METHODS We administered a national Canadian survey on nurses' experiences of occupational stressors and their health and well-being between May and September 2019. In the current study, we analyzed data from four open text fields in the PPTE section of the survey. RESULTS In total, at least 109 participants noted that their most impactful PPTE exposure was a moral, professional, and/or ethical dilemma. These participants volunteered the theme as a spontaneous addition to the list of possible PPTE exposures. CONCLUSIONS Emergent theme analytic results suggest that physicians, other nurses, staff, and/or the decision-making power of patients' families can reduce or eliminate a nurse's perception of their agency, which directly and negatively impacts their well-being and may cause them to experience moral injury. Nurses also report struggling when left to operationalize patient care instructions with which they disagree. IMPACT Nurses are exposed to PPTEs at work, but little is known about factors that can aggravate PPTE exposure in the field, impact the mental wellness of nurses, and even shape patient care. We discuss the implications of PPTE involving moral, professional, and ethical dilemmas (i.e., potentially morally injurious events), and provide recommendations for nursing policy and practice.
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Schmutz JB, Lei Z, Eppich WJ. Reflection on the Fly: Development of the Team Reflection Behavioral Observation (TuRBO) System for Acute Care Teams. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1337-1345. [PMID: 33788785 DOI: 10.1097/acm.0000000000004105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Acute care teams work in dynamic and complex environments and must adapt to changing circumstances. A team process that helps teams process information and adapt is in-action team reflection (TR), defined as concurrent collective reflection on group objectives, strategies, or processes during an ongoing care event. However, the health care field lacks a means for systematically observing and ultimately training in-action TR in acute care teams. To bridge this gap, the authors developed a theoretically and empirically informed framework, Team Reflection Behavioral Observation (TuRBO), for measuring in-action TR. METHOD In 2018 at ETH, Zurich, Switzerland, the authors developed a theoretical framework based on the literature and theory. They then conducted exploratory reviews of preexisting videos of acute care teams training simulated emergencies. The authors adapted observation codes using an iterative approach. Using the developed coding framework, they coded 23 video recordings of acute care teams and provided validity evidence from the 3 sources: content, internal structure (interrater reliability), and relations to other variables. RESULTS The final TuRBO framework consists of 3 general dimensions-seeking information, evaluating information, and planning-that are further specified in 7 subcodes. Interrater agreement of the coding was substantial (κ = 0.80). As hypothesized, the data showed a positive relationship between in-action TR and team performance. Also, physicians spent significantly more time on in-action TR than nurses. CONCLUSIONS The TuRBO framework for assessing in-action TR in acute care teams provides positive validity evidence of the data. TuRBO integrates different team communication and calibration processes under the overarching concept of in-action TR and provides descriptive behavioral markers. TuRBO taps into powerful cultural and normative components of patient safety. This tool can augment team training that allows all team members to serve as an important resource for flexible, resilient, and safer patient care.
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Affiliation(s)
- Jan B Schmutz
- J.B. Schmutz is researcher and lecturer, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland; ORCID: https://orcid.org/0000-0002-0181-807X
| | - Zhike Lei
- Z. Lei is associate professor of applied behavioral science, Graziadio Business School, Pepperdine University, Malibu, California
| | - Walter J Eppich
- W.J. Eppich is professor of simulation education and research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Redley B, Njambi M, Rawson H. An Examination of Nurses' Empowerment and Speaking Up During Postanesthesia Clinical Hand Overs. AORN J 2021; 113:621-634. [PMID: 34048035 DOI: 10.1002/aorn.13399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 11/11/2022]
Abstract
Hierarchical relationships can negatively affect nurses' psychological empowerment and interprofessional hand overs. We explored nurses' perceptions of their psychological empowerment, teamwork, and work engagement; relationships between these concepts during interprofessional clinical hand overs; and observed interactive communication behaviors during hand overs. We used surveys and observations of interprofessional clinical hand overs to collect data from 39 nurses in a postanesthesia care unit in Australia. Nurses reported high scores for psychological empowerment and work engagement. Relationships between empowerment and teamwork (r = 0.41, P = .01) and empowerment and work engagement (r = 0.65, P < .001) were positive and significant. Relationships between nurses' observed communication behaviors and perceptions of empowerment, teamwork, and work engagement were nonsignificant. Additional research is needed to better understand how empowerment, teamwork, and work engagement affect nurses' interactive communication behaviors during interprofessional clinical hand overs in the postanesthesia care unit.
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Al-Shamaly HS. A focused ethnography of the culture of inclusive caring practice in the intensive care unit. Nurs Open 2021; 8:2973-2985. [PMID: 34318598 PMCID: PMC8510735 DOI: 10.1002/nop2.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/05/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
Aim To explore and understand the culture of nurses' multidimensional “caring‐for” practice in intensive care unit (ICU). Design A focused ethnography. Methods Data were collected from 35 Registered Nurses through participant observations, field notes, documentation reviews, interviews, informal conversations and Participants' additional information forms over 6 months in one ICU. Thematic data analysis was used. Findings Different dimensions of nursing caring in ICU were found. The inclusivity of a culture of nurses' “caring‐for” involved the following: oneself, patients and their families, different colleagues, and caring as ecological consciousness in the ICU environment and organization.
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Pérez E, Dzubay DP. A scheduling-based methodology for improving patient perceptions of quality of care in intensive care units. Health Care Manag Sci 2021; 24:203-215. [PMID: 33496922 DOI: 10.1007/s10729-021-09544-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Research has found that hospitals with better scores on patient experience of care surveys have better patient safety records and outcomes. Therefore, targeting ways of improving patient experience of care is becoming relevant for hospitals not only for the patient health outcomes but also for the financial implications. Therefore, the goal of this paper is to develop new operation management strategies for improving patient experience of care in intensive care units (ICUs). A new scheduling-based methodology is developed that considers two of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey dimensions, doctor communication and discharge information. Two hypotheses are studied. The first hypothesis postulates that to improve doctor communication with the patient, a nurse must be present in the patient room when the doctor performs ward rounds. The second hypotheses states that to improve the patient-doctor communication of discharge information aspect, doctors must see the patient expected to be discharged early in the day. A computational study is performed to gather insights and to measure the performance of the scheduling-based methodology on a case study from an intensive care unit located in a hospital in central Texas. The results show hospital improvement in the studied dimensions of the HCAHPS survey after 1 year of the hospital adoption of the study recommendations.
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Affiliation(s)
- Eduardo Pérez
- Ingram School of Engineering, Texas State University, 601 University Drive, San Marcos, TX, 78666, USA.
| | - David P Dzubay
- Ingram School of Engineering, Texas State University, 601 University Drive, San Marcos, TX, 78666, USA
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Kurhila S, Lehtimaja I, Drew P. Correcting medical decisions: a study in nurses' patient advocacy in (Finnish) hospital ward rounds. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1709-1726. [PMID: 33460158 DOI: 10.1111/1467-9566.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/13/2020] [Accepted: 06/22/2020] [Indexed: 06/12/2023]
Abstract
During daily hospital ward rounds, medical teams, led by doctors, assess the progress of an individual patient's health. It is widely reported in the research literature that nurses play a relatively passive role during these rounds, because although they may have valuable information about the patient's condition and progress, and indeed their role includes advocacy on behalf of their patients, nurses nevertheless can experience difficulties in participating during case constructions. Here we report an instance from a (gastro-surgical) ward round in a Finnish hospital, in which nurses played a key role in reversing a consultant's initial decision to discharge a patient. They did so not by directly challenging the consultant's opinion, but by employing indirect means to introduce their discrepant perspective: they provide descriptions and ask questions that draw attention to information that results in the doctor coming to a different assessment than theirs of the patient's condition, and a different decision about what should be done (the patient was not discharged from hospital). The encounter reported here is taken from a corpus of ward round discussions in a Finnish hospital. The method of our study is Conversation Analysis.
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Affiliation(s)
- Salla Kurhila
- Department of Finnish Language, University of Helsinki, Helsinki, Finland
| | - Inkeri Lehtimaja
- Department of Finnish Language, University of Helsinki, Helsinki, Finland
| | - Paul Drew
- Department of Sociology, University of York, York, UK
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Beaird G, Baernholdt M, Byon HD, White KR. Interprofessional rounding design features and associations with collaboration and team effectiveness. J Interprof Care 2020; 35:343-351. [PMID: 32530333 DOI: 10.1080/13561820.2020.1768058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multiple models of interprofessional rounding (IPR) exist. However, researchers find mixed effects for the impact of IPR, pointing to the possibility that variations in design may influence the effectiveness of the practice. We explored whether IPR design variations (location, use of script, and role of the leader) are associated with team collaboration (partnership and cooperation) and team effectiveness as perceived by practitioners and patients (i.e., patient inclusion). A cross-sectional, survey-based method design was used targeting practitioners on 15 different hospital units at two academic health centers. Routinely collected Hospital Consumer Assessment of Healthcare Practitioners and Systems scores were used to capture patients' perceptions. Statistical methods included multilevel modeling with moderation analysis. There were several significant relationships among design, team collaboration, and team effectiveness. For the design, role of the leader and use of a script had a significant positive association with cooperation. Practitioners' perceptions of team effectiveness were associated with use of script, and cooperation moderated the relationships between practitioners' perceptions of team effectiveness and location, as well as the role of the leader. There was a significant inverse relationship between cooperation and patient inclusion. Results can inform organizations that are exploring, implementing, or improving IPR as well as considering alternative ways to evaluate their practices.
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Affiliation(s)
- Genevieve Beaird
- Department of Family and Community Health, Virginia Commonwealth University School of Nursing
| | | | - Ha Do Byon
- University of Virginia School of Nursing, USA
| | - Kenneth R White
- Office of the Dean, Strategic Partnerships & Innovation, University of Virginia School of Nursing
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Verd-Aulí X, Maqueda-Palau M, Miró-Bonet M. Interprofessional collaboration in joint clinical sessions in an intensive care unit: Perceptions of nurses and physicians. ENFERMERIA INTENSIVA 2020; 32:3-10. [PMID: 32389439 DOI: 10.1016/j.enfi.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/22/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Collaborative practice is an interpersonal process in which different professional disciplines that share objectives interact, participate in decision-making and provide comprehensive and quality care. The joint clinical sessions offer the opportunity to interact and improve communication between professionals and optimise results in practice. AIM To explore perceptions of nurses and physicians about collaborative practice in joint Intensive Care Unit clinical sessions. METHOD Critical discourse analysis, through semi-structured interviews and field journals, using as theoretical reference the concepts of Campus, Capital and Habitus by Pierre Bourdieu. PARTICIPANTS nurses and physicians of the Intensive Care Unit, who were recruited by intentional sampling. Semi-structured interviews were conducted and a discourse analysis was then performed. The interviews were coded by all the researchers, then shared and the data were interpreted in the context in which they were collected. RESULTS Five categories emerged: 1) Concept: integration and involvement of a team with collective contributions and shared objectives, 2) importance: it increases patient safety, improves professional satisfaction and quality of care, 3) factors: the absence of culture organisations make collaborative practice difficult, 4) role: the nurse perceived that she plays a passive role (listener) during the clinical rounds and the physician an active role (communicator) and, 5) improvement strategies: to establish a schedule and balance interprofessional tasks. CONCLUSIONS There is a need for empowerment in active participation by nursing staff in joint clinical sessions. The medical group should be more aware of the humanistic perceptions that other professionals can bring. Encouraging active listening in physicians, improving real communication by nursing staff and generating a space where respect and confidence prevail, will favour interprofessional work dynamics.
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Affiliation(s)
- X Verd-Aulí
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, España.
| | - M Maqueda-Palau
- Unidad de Cuidados Intensivos, Hospital Universitari Son Espases, Palma, España; Grup d'Investigació en Cures, cronicitat i evidències en salut (CurES-IdISBa), España
| | - M Miró-Bonet
- Grup d'Investigació en Cures, cronicitat i evidències en salut (CurES-IdISBa), España; Departamento de Enfermeria y Fisioterapia, Universitat de les Illes Balears, Secretaria académica de la Facultad de Enfermeria y Fisioterapia de la Universitat Illes Balears, Palma, España
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Bressers G, Brydges M, Paradis E. Ethnography in health professions education: Slowing down and thinking deeply. MEDICAL EDUCATION 2020; 54:225-233. [PMID: 31923340 DOI: 10.1111/medu.14033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/19/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Ethnography has been gaining appreciation in the field of health professions education (HPE) research, yet it remains misunderstood. Our article contributes to this growing literature by describing some of the key tensions with which both aspiring and seasoned ethnographers should productively struggle. METHODS We respond to the injunction made by Varpio et al (2017) that HPE researchers should ground their methodological ventures in their historical and philosophical tenets. To do so, we first review core ethnographic texts that provide a background for ethnographic research in HPE, then provide an orienting definition to bind the specificities of ethnographic research. Finally, we review core theoretical and practical considerations for ethnographic research. RESULTS Ethnography is a slow and deep approach to knowledge production, and as such it requires careful engagement with theory and deliberate choice of methods. Core theoretical tensions include the ontological, epistemological and axiological dimensions of ethnography, and concerns with quality and rigour. Practical tensions include the scope and remit of ethnography, the importance of observing naturally occurring behaviour and the crafting of rich field notes. CONCLUSIONS We encourage ethnographers to pursue scholarship that challenges the status quo. Ethnographers should favour deep encounters with research participants, dig deep into the cultural and structural aspects of HPE and be reflexive about knowledge outputs. At a time in HPE when the pressures to publish are high, using ethnography as a research methodology offers an opportunity to slow down and think deeply.
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Affiliation(s)
- Guusje Bressers
- Department of Educational Research and Development, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Madison Brydges
- Department of Health, Aging and Society, McMaster University, Hamilton, Canada
| | - Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Rind E, Emerich S, Preiser C, Tsarouha E, Rieger MA. Exploring Drivers of Work-Related Stress in General Practice Teams as an Example for Small and Medium-Sized Enterprises: Protocol for an Integrated Ethnographic Approach of Social Research Methods. JMIR Res Protoc 2020; 9:e15809. [PMID: 32044759 PMCID: PMC7055789 DOI: 10.2196/15809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background An increasing shortage of skilled personnel, including medical personnel, has been reported in many postindustrial economies. Persisting and growing trends in absenteeism and incapacity to work due to mental disorders are concerning and have increased political, economic, and scientific interest in better understanding and management of determinants related to the work environment and health. Objective This study protocol describes an integrated approach of social research methods to explore determinants of work-related stress in general practice teams as an example for micro, small, and medium-sized enterprises (SMEs). Methods The methods applied will allow an in-depth exploration of work practices and experiences relating to psychological well-being in general practice teams. An ethnographic approach will be used to develop an in-depth understanding of the drivers of work-related stress in general practice teams. We will combine participating observation and individual interviews with five to seven general practitioners (GPs), and five to seven focus group discussions with the nonphysician staff (3-4 participants per group) in approximately four GP group practices and one single practice in Germany. Data collection and analysis will follow a grounded theory approach. Results The Ethics Committee of the Medical Faculty, University Hospital of Tuebingen, Germany, has approved this study (reference number: 640/2017BO2). Recruitment has commenced with study completion anticipated in mid-2020. Conclusions The data from this project will be used in follow-up projects to develop and test an intervention to reduce and prevent work-related stress in GP practices and other SMEs. International Registered Report Identifier (IRRID) DERR1-10.2196/15809
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Affiliation(s)
- Esther Rind
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Sigrid Emerich
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Christine Preiser
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany.,Centre for Public Health and Health Services Research, Core Facility for Health Services Research, University Hospital Tuebingen, Tuebingen, Germany
| | - Elena Tsarouha
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, University of Tuebingen, Tuebingen, Germany
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- See Acknowledgments section for more information and for collaborators/group members,
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Beaird G, Baernholdt M, White KR. Perceptions of interdisciplinary rounding practices. J Clin Nurs 2020; 29:1141-1150. [PMID: 31889345 DOI: 10.1111/jocn.15161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore practitioner perspectives on the facilitators, barriers and outcomes associated with interdisciplinary rounding practices (IDR). BACKGROUND Interdisciplinary rounding practices is frequently used intervention to promote collaboration and patient-centred care in hospital units. Previous research supports that having IDR in place can lead to greater perceptions of collaboration and practitioner satisfaction; however, the practice does not always lead to better outcomes for patients. For IDR to be successful, unit leadership needs a greater understanding of facilitators and barriers as perceived by team members. At both the individual and organisational levels, there is limited understanding on what influences the success of IDR. This study seeks to explore factors influencing interdisciplinary rounding and perceived outcomes by team members. DESIGN A quasi-qualitative design was used to address the aim of this study. Four open-ended questions were emailed to practitioners across fifteen units in two academic health centres. All units identified as having IDR in place. METHODS A directed content analysis of practitioner responses was used to identify key themes. The Standards for Reporting Qualitative Research checklist was consulted for reporting of the results. RESULTS A total of 141 practitioners responded to the open-ended questions. Three themes emerged from the data: (a) setting the stage; (b) the work of the team; and 3) benefits to patient care. CONCLUSIONS The study provides a nuanced perspective of facilitators, barriers and potential outcomes associated with IDR. Future research is needed to gain additional perspective on the role the organisation plays in promoting a healthy workplace environment as well as providing patient-centred care. RELEVANCE TO CLINICAL PRACTICE This study provides insight into facilitators and barriers to conducting interdisciplinary rounding practices in the inpatient setting. Results can be useful to unit leaders and staff that advocate for more collaborative and patient-centred rounding practices.
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Caronia L, Saglietti M, Chieregato A. Challenging the interprofessional epistemic boundaries: The practices of informing in nurse-physician interaction. Soc Sci Med 2019; 246:112732. [PMID: 31884237 DOI: 10.1016/j.socscimed.2019.112732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 01/25/2023]
Abstract
Interprofessional management of knowledge in health care settings appears to be particularly vital for the ways in which information circulates, medical decisions are taken, and nursing practices are implemented. Drawing on an extensive ethnographic fieldwork in an Italian Intensive Care Unit, this article investigates how the nurses orient to and concurrently challenge the nurse-physician epistemic boundaries by the different ways through which they perform "informing", and make it work as a diagnostic-relevant activity. Adopting an ethnographic-nurtured discursive approach to a dataset of video-recorded morning briefings, we analyze the nurses' informing contributions in terms of sequential position, turn-taking and turn design. We identify five practices of informing and show how they display different degrees of agency and differently impact on the team's "infectious diseases diagnostic reasoning". This article contributes to nurse-physician interaction studies by showing how the epistemic imbalance at play is interactionally accomplished by participants one interaction at a time. Particularly, the analysis demonstrates that the nurses actively contribute to the teamwork by a skillful management of knowledge that precedes the exercise of the physicians' epistemic and deontic rights implied in diagnosing and planning. Our findings illustrate how the nurses: a) exert their interactional agency without crossing the institutionally sanctioned epistemic and deontic boundaries to which they are observably oriented to; b) cautiously challenge the epistemic imbalance at play in nurse-physician interaction and c) actively contribute in setting the premises of the team's collective decisions. Conclusion and practical implications are proposed.
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Magner K, Bragg D, Treat R, Lee KJ. Understanding mothers' perception of child's illness: Adapting the CONNECT Instrument for pediatrics. J Clin Nurs 2019; 28:3279-3287. [PMID: 31063655 DOI: 10.1111/jocn.14905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 04/13/2019] [Accepted: 05/02/2019] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To adapt the CONNECT Instrument for use in the paediatric population, to assess validity of this instrument after its adaptation and to assess concordance between mothers' perception of their child's illness and providers' understanding of mothers' perceptions. BACKGROUND The CONNECT Instrument (Patient Education and Counseling, 73, 2008, 232-239) was validated in an adult outpatient population to characterise both patients' perspectives and physicians' understanding of their patients' perspectives for several dimensions of the illness experience. However, this did not include the paediatric population or advanced practice providers. DESIGN A two-part prospective, cross-sectional, observational study to assess the validity of CONNECT for Pediatrics and to assess perception of illness. METHODS The CONNECT Instrument (Patient Version) was adapted from its original form and modified to CONNECT for Pediatrics to facilitate use in the inpatient paediatric population. Eighty-five participants were enrolled including mothers, advanced practice providers and physicians from 2013-2014 during a child's scheduled admission to a paediatric epilepsy monitoring unit. Principal components analysis and inter-item reliability were analysed, and differences in the six mean domain scores were assessed using repeated measures analysis of variance (RM-ANOVA). Reporting of this research adheres to the STROBE guidelines (See Appendix S1). RESULTS Our analysis indicated that the modifications made provided a relatively valid and reliable instrument. There were overall statistically significant differences between the mother and physician groups, specifically in the domains of meaning and preference for partnership. CONCLUSIONS Paediatric advanced practice providers and physicians do have an understanding of mothers' perception of illness. RELEVANCE TO CLINICAL PRACTICE The ability of physicians and advanced practice providers to understand mothers' perceptions of illness is increasingly important in a changing healthcare environment. CONNECT for Pediatrics facilitates the identification of mothers' perception of their child's illness and provides the opportunity for paediatric advanced practice providers and physicians to understand parents' perception of illness.
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Affiliation(s)
- Kristin Magner
- Division of Pediatric Critical Care, Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn Bragg
- University of South Dakota, Sanford School of Medicine, Vermillion, South Dakota
| | - Robert Treat
- Department of Academic Affairs, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - K Jane Lee
- Complex Care Program, Children Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, Wisconsin
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Critical emancipatory reflection on a practice-based issue in relation to the working relationship between doctors and nurses in China. FRONTIERS OF NURSING 2019. [DOI: 10.2478/fon-2019-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
Reflection is viewed as the most significant skill and should be advocated for lifelong learning. In order to grasp the process of reflection and embrace the reflective skill, one of the authors of this paper reflects on a practice-based issue in relation to the communication between doctors and nurses, to gain new understanding and thus improve the authors’ clinical practice.
Methods
Smyth’s framework with four stages is utilized as an ideal framework to guide the author’s reflection on the practice-based issue to free the author from her entrenched assumptions and the oppressive forces that limit her practice.
Results
The espoused and enacted theory, together with the critical reflection theory, are used to explore the values and beliefs that essentially govern the author’s practice and how these are distinct from the author’s worldviews. Following this, critical emancipatory reflection is undertaken to explore the dominant power structures within the author’s workplace. Furthermore, given the hegemonic and chaotic working context of this issue, hegemony and symbolic interaction theory are applied to unearth the various hidden constraining and oppressive forces. Additionally, socialization theory is utilized to help the author achieve professional identity.
Conclusions
Reconstructing the practice-based issue empowers the author to realize that in the future, she should act as a reflective practitioner, creating a daily habit, staying alert to practice, seeing things freshly, finding support systems, improving communication skills, conducting reflective research, and reifying reflective practice. Ultimately, the author will be sufficiently equipped to be able to transform her practice and change its outcomes.
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Caronia L, Saglietti M. Knowledge and agency in interprofessional care: How nurses contribute to the case-construction in an Intensive Care Unit. J Interprof Care 2018; 32:592-602. [DOI: 10.1080/13561820.2018.1463199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Letizia Caronia
- Department of Education, School of Psychology and Science of Education, University of Bologna, Bologna, IT
| | - Marzia Saglietti
- Department of Education, School of Psychology and Science of Education, University of Bologna, Bologna, IT
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Fletcher S, Sinclair C, Rhee J, Goh D, Auret K. Rural health professionals' experiences in implementing advance care planning: a focus group study. Aust J Prim Health 2018; 22:423-427. [PMID: 26330201 DOI: 10.1071/py15004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/28/2015] [Indexed: 11/23/2022]
Abstract
Advance care planning (ACP) is described as an ongoing discussion between a patient, their family and healthcare professionals (HCPs) to understand a patient's wishes for future health care. Legislation supporting ACP in Western Australia is relatively new and HCPs are still learning about the process and implementation. This study aimed to provide a rich description of rural health professionals' perceptions and experiences with ACP within the context of their professional role and to identify systemic issues and training needs. Ten focus groups were conducted throughout 2014 with a total of 55 rural participants including general practitioners (n=15), general practice registrars (n=6), practice nurses (n=18), community nurses (n=4) and hospital nurses (n=12) in the south-western regions of Western Australia. Thematic analysis has identified the following themes regarding ACP: benefits to patients and families; professional roles in ACP; barriers and enablers; and systems for communicating ACP. HCPs have self-determined their roles in the ACP process, which currently leaves some components of the process unaccounted for, suggesting that collaboration between HCPs working together in a rural health setting and a standardised system for distributing these documents may assist with the implementation of ACP.
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Affiliation(s)
- Sophie Fletcher
- The Rural Clinical School of Western Australia, UWA Albany Centre, 31 Stirling Terrace, Albany, WA 6330, Australia
| | - Craig Sinclair
- The Rural Clinical School of Western Australia, UWA Albany Centre, 31 Stirling Terrace, Albany, WA 6330, Australia
| | - Joel Rhee
- UNSW Medicine, UNSW Australia, Sydney, NSW 2052, Australia
| | - Desiree Goh
- The Rural Clinical School of Western Australia, M701, Hackett Avenue, Crawley, WA 6009, Australia
| | - Kirsten Auret
- The Rural Clinical School of Western Australia, UWA Albany Centre, 31 Stirling Terrace, Albany, WA 6330, Australia
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Jones C, Durbridge M. Culture, silence and voice: The implications for patient safety in the operating theatre. J Perioper Pract 2018; 26:281-284. [PMID: 29328767 DOI: 10.1177/175045891602601204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022]
Abstract
Team culture is an important antecedent to safety behaviours such as speaking up. A positive safety culture in the operating theatre has been linked to fewer adverse events. Psychological safety, a component of safety culture, is the belief that the team is safe to take risks such as raising concerns. Power dynamics can influence active speaking up behaviour or 'voice'. When theatre team members chose to remain silent rather than voice concerns this can be a protective or defensive strategy rather than passive inactivity.
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Affiliation(s)
- Ceri Jones
- University Hospitals Leicester and University of Cardiff, UK
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Abstract
Aims and MethodA postal questionnaire was sent to consultant psychiatrists in the West Midlands to establish their current ward round practice. This questionnaire addressed ward round etiquette, practical issues and educational function. Consultants received only one mailing.ResultsA total of 96 (out of 139) consultants replied (69% response rate). The majority of consultants saw patients on the ward round (97%) and all consultants introduced both themselves and team members to the patient; 72% explained the purpose of the ward round. A median of seven professionals attended the ward round with psychology (6.5%) and pharmacy services (0%) being underrepresented. When consultants added comments, the recurrent themes were that ward rounds were an effective use of professional time but were often daunting for patients.Clinical ImplicationsOur results indicate some uniformity in the conduct of ward rounds. The lack of representation at ward rounds for certain professional groups may adversely affect the range of opinions and therapies for patients. Changes could be made to incorporate the views of users, which would make ward rounds more productive for users and professionals.
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A systems analysis of ward rounds in plastic surgery at a single center. INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY 2017; 2:e18. [PMID: 29177228 PMCID: PMC5673158 DOI: 10.1097/ij9.0000000000000018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Ward rounds permeate health care delivery worldwide and form an important daily activity within all hospitals. In this study, the daily morning ward round in plastic surgery was examined from a teleological and systems point of view.
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Oxelmark L, Nordahl Amorøe T, Carlzon L, Rystedt H. Students' understanding of teamwork and professional roles after interprofessional simulation-a qualitative analysis. Adv Simul (Lond) 2017; 2:8. [PMID: 29450009 PMCID: PMC5806292 DOI: 10.1186/s41077-017-0041-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study explores how interprofessional simulation-based education (IPSE) can contribute to a change in students' understanding of teamwork and professional roles. A series of 1-day training sessions was arranged involving undergraduate nursing and medical students. Scenarios were designed for practicing teamwork principles and interprofessional communication skills by endorsing active participation by all team members. Methods Four focus groups occurred 2-4 weeks after the training. Thematic analysis of the transcribed focus groups was applied, guided by questions on what changes in students' understanding of teamwork and professional roles were identified and how such changes had been achieved. Results The first question, aiming to identify changes in students' understanding of teamwork, resulted in three categories: realizing and embracing teamwork fundamentals, reconsidering professional roles, and achieving increased confidence. The second question, regarding how participation in IPSE could support the transformation of students' understanding of teamwork and of professional roles, embraced another three categories: feeling confident in the learning environment, embodying experiences, and obtaining an outside perspective. Conclusions This study showed the potential of IPSE to transform students' understanding of others' professional roles and responsibilities. Students displayed extensive knowledge on fundamental teamwork principles and what these meant in the midst of participating in the scenarios. A critical prerequisite for the development of these new insights was to feel confident in the learning environment. The significance of how the environment was set up calls for further research on the design of IPSE in influencing role understanding and communicative skills in significant ways.
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Affiliation(s)
- Lena Oxelmark
- 1Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, PO Box 457, Gothenburg, SE 405 30 Sweden
| | - Torben Nordahl Amorøe
- 2Simulation Centre West, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Liisa Carlzon
- 2Simulation Centre West, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Hans Rystedt
- 3Department of Education, Communication & Learning, University of Gothenburg, Gothenburg, Sweden
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Accomplishing professional jurisdiction in intensive care: An ethnographic study of three units. Soc Sci Med 2017; 181:102-111. [PMID: 28388452 DOI: 10.1016/j.socscimed.2017.03.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 03/18/2017] [Accepted: 03/22/2017] [Indexed: 11/20/2022]
Abstract
This paper reports an ethnographic study examining health professional jurisdictions within three intensive care units (ICUs) in order to draw out the social processes through which ICU clinicians organised and delivered life-saving care to critically ill patients. Data collection consisted of 240 h observation of actual practice and 27 interviews with health professionals. The research was conducted against a backdrop of international political and public pressure for national healthcare systems to deliver safe, quality and efficient healthcare. As in many Western health systems, for the English Department of Health the key to containing these challenges was a reconfiguration of responsibilities for clinicians in order to break down professional boundaries and encourage greater interprofessional working under the guise of workforce modernisation. In this paper, through the analysis of health professional interaction, we examine the properties and conditions under which professional jurisdiction was negotiated and accomplished in day-to-day ICU practice. We discuss how staff seniority influenced the nature of professional interaction and how jurisdictional boundaries were reproduced and reconfigured under conditions of routine and urgent work. Consequently, we question theorisation that treats individual professions as homogenous groups and overlooks fluctuation in the flow and intensity of work; and conclude that in ICU, urgency and seniority have a part to play in shaping jurisdictional boundaries at the level of day-to-day practice.
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26
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Mock Pages Are a Valid Construct for Assessment of Clinical Decision Making and Interprofessional Communication. Ann Surg 2017; 265:116-121. [DOI: 10.1097/sla.0000000000001575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paradis E, Leslie M, Gropper MA. Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:735-48. [PMID: 26704051 DOI: 10.1007/s10459-015-9662-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/13/2015] [Indexed: 05/28/2023]
Abstract
Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed.
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Affiliation(s)
- Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- The Wilson Centre, 144 College St Room 702, Toronto, ON, M5S 3M2, Canada.
| | - Myles Leslie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, 750 East Pratt Street, 15th Floor, Baltimore, MD, 21202, USA
| | - Michael A Gropper
- Department of Anesthesia and Perioperative Care, University of California San Francisco, 500 Parnassus Ave, MUE 410, San Francisco, CA, 94143-0648, USA
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28
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Nedfors K, Borg C, Fagerström C. Communication with physicians in hospital rounds: An interview with nurses. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0107408315606633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A hospital round is a long tradition in which nurses and physicians communicate to develop an integrated plan of care together with the patient. There is insufficient knowledge of care professionals’ experiences of communication during hospital rounds, particularly in surgical units, where the physician is frequently absent during daily care. Hence, the aim of this study was to describe nurses’ experiences of communication with physicians during hospital rounds in a surgical unit. Nine qualitative unstructured interviews with nurses were conducted and analysed using Burnard’s description of content analysis. ‘An encounter involving opportunities for and challenges to teamwork’ was found to be the predominant theme. The hospital round in a surgical unit is a short encounter that can be challenged by missing patient care goals, difficulties in transmitting messages and frustration over unshared information. Further studies are needed to overcome existing knowledge gaps about communication during hospital rounds.
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Affiliation(s)
- Karin Nedfors
- Blekinge Centre of Competence, Sweden
- Department of Health, Blekinge Institute of Technology, Sweden
| | - Christel Borg
- Department of Health, Blekinge Institute of Technology, Sweden
| | - Cecilia Fagerström
- Blekinge Centre of Competence, Sweden
- Department of Health, Blekinge Institute of Technology, Sweden
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Reese J, Simmons R, Barnard J. Assertion Practices and Beliefs Among Nurses and Physicians on an Inpatient Pediatric Medical Unit. Hosp Pediatr 2016; 6:275-81. [PMID: 27126798 DOI: 10.1542/hpeds.2015-0123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Teamwork and communication are critical elements of safe and effective patient care. Standardized communication tools have been implemented in many health care organizations, but little is known about attitudes and perceptions of assertion, the willingness to "speak up," by nurses and physicians at an academic pediatric institution. METHODS We conducted 6 focus groups with nurses, residents, and attending physicians using a standardized semistructured focus group guide to promote discussion. Focus groups were recorded and transcribed, and results were analyzed by 2 independent reviewers to identify thematic content. RESULTS Three themes emerged: (1) interpersonal factors, (2) organizational factors, and (3) complexity of care environment. Subthemes were the roles of hierarchy, relationships, and communication and personality style; the value of using standardized communication tools such as SBAR (Situation, Background, Assessment, Recommendation), direct face-to-face communication, and geographic and technology factors; and the need for coordinated communication and agreement across care team members about the care plans. Nurses reported reliance on peers for decision-making, on when and how to assert on behalf of patient care. Nurses and residents experienced barriers to assertion from concerns of relationships and their position within professional hierarchies. Attending physicians were supportive of being asserted to by any care team provider. CONCLUSIONS Interpersonal relationships, power dynamics, and organizational factors impact care team providers' willingness to assert in the inpatient setting. Standardized communication tools are effective. Further development and implementation of communication models that support experience, peer reliance, and direct face-to-face communication are warranted to improve assertion communication in the inpatient setting
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Walton V, Hogden A, Johnson J, Greenfield D. Ward rounds, participants, roles and perceptions: literature review. Int J Health Care Qual Assur 2016; 29:364-79. [DOI: 10.1108/ijhcqa-04-2015-0053] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants’ perception of each other’s role during the respective ward rounds.
Design/methodology/approach
– A literature review of face-to-face ward rounds in medical wards was conducted. Peer reviewed journals and government publications published between 2000 and 2014 were searched. Articles were classified according to the type of round described in the study. Purposes were identified using keywords in the description of why the round was carried out. Descriptions of tasks and interactions with team members defined participant roles.
Findings
– Eight round classifications were identified. The most common were the generalised ward; multidisciplinary; and consultant rounds. Multidisciplinary rounds were the most collaborative round. Medical officers were the most likely discipline to attend any round. There was limited reference to allied health clinicians and patient involvement on rounds. Perceptions attendees held of each other reiterated the need to continue to investigate teamwork.
Practical implications
– A collaborative approach to care planning can occur by ensuring clinicians and patients are aware of different ward round processes and their role in them.
Originality/value
– Analysis fulfils a gap in the literature by identifying and analysing the different ward rounds being undertaken in acute medical wards. It identifies the complexities in the long established routine hospital processes of the ward round.
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Pinheiro JPA, de Sousa Uva A. Safety climate in the operating room: Translation, validation and application of the Safety Attitudes Questionnaire. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rpsp.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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A Survey of Rounding Practices in Canadian Adult Intensive Care Units. PLoS One 2015; 10:e0145408. [PMID: 26700860 PMCID: PMC4689549 DOI: 10.1371/journal.pone.0145408] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/03/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement. DESIGN Mixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7). MEASUREMENTS AND MAIN RESULTS Medical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient's bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥ 1 interruption for ≥ 50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning. CONCLUSIONS There is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.
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Mosher HJ, Lose DT, Leslie R, Pennathur P, Kaboli PJ. Aligning complex processes and electronic health record templates: a quality improvement intervention on inpatient interdisciplinary rounds. BMC Health Serv Res 2015; 15:265. [PMID: 26164546 PMCID: PMC4499441 DOI: 10.1186/s12913-015-0932-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interdisciplinary rounds (IDR) with documentation have become a standard of care, but the process has been incompletely described in academic general medical settings. Checklists are promoted, yet standardized formats may not reflect the variability and work flow of rounds or support the cognitive development of medical trainees. We describe IDR processes in an academic general medicine inpatient setting and present a rapid cycle quality improvement (QI) project that improved IDR documentation rates in the electronic health record. METHODS The project team observed existing daily IDR rounds on two medical inpatient units at the Iowa City VA Medical Center, with three resident teams and maximum census of 42 patients. The major intervention was a redesigned note template, with accompanying resident educational materials. The primary outcome was note completion rates by charge nurses; IDR team member satisfaction and participation, discussion time and balancing metrics (i.e., excess bed days of care, length of stay, and 30-day readmissions) were also assessed. RESULTS An electronic template and accompanying educational materials designed to parallel the heuristic problem-solving activities of the IDR team led to improvements in IDR note completion rates from 27 to 69 %. Team member satisfaction was high and participation was stable. Discussion time per patient increased modestly, but varied widely between resident teams and by patient. Balancing metrics were unchanged. Unstructured evaluation indicated that documentation times were reduced, and IDR documentation became more timely and useful. CONCLUSIONS IDR notes designed to support the problem-solving processes of an interdisciplinary group improved the timeliness and perceived value of IDR documentation and met regulatory standards. Aligning complex processes and educational and documentation needs during IDR may create an efficient opportunity for sustainable interdisciplinary work and learning in an academic setting.
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Affiliation(s)
- Hilary J Mosher
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System and VA Quality Scholars Fellowship Program, Iowa City, IA, USA.
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
- Iowa City VA Healthcare System, 601 Highway 6 West, Mailstop 152, 52246-2208, Iowa City, IA, USA.
| | - Daniel T Lose
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System and VA Quality Scholars Fellowship Program, Iowa City, IA, USA.
- College of Nursing, University of Iowa, Iowa City, IA, USA.
| | - Russell Leslie
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System and VA Quality Scholars Fellowship Program, Iowa City, IA, USA.
| | - Priyadarshini Pennathur
- Department of Industrial Engineering, University of Iowa College of Engineering, Iowa City, IA, USA.
| | - Peter J Kaboli
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System and VA Quality Scholars Fellowship Program, Iowa City, IA, USA.
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Ahmed K, Anderson O, Jawad M, Tierney T, Darzi A, Athanasiou T, Hanna GB. Design and validation of the surgical ward round assessment tool: a quantitative observational study. Am J Surg 2015; 209:682-688.e2. [DOI: 10.1016/j.amjsurg.2014.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 10/23/2022]
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Lindberg E, Ekebergh M, Persson E, Hörberg U. The importance of existential dimensions in the context of the presence of older patients at team meetings—in the light of Heidegger and Merleau-Ponty's philosophy. Int J Qual Stud Health Well-being 2015; 10:26590. [PMID: 25700700 PMCID: PMC4336351 DOI: 10.3402/qhw.v10.26590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 11/14/2022] Open
Abstract
The aim of the present study is to explore interpersonal dimensions of the presence of older patients at team meetings. The theoretical foundation of the study is grounded in caring science and lifeworld phenomenology. The results from two empirical studies, that indicated the need for a more in-depth examination of the interpersonal relationships when an older patient is present at a team meeting, were further explicated by philosophical examination in the light of Heidegger and Merleau-Ponty's philosophy. The empirical studies were performed in a hospital ward for older people, where the traditional rounds had been replaced by a team meeting, to which the patients were invited. The analysis of the general structure and philosophical examination followed the principles of reflective lifeworld research. The philosophical examination is presented in four meaning structures: mood as a force in existence; to exist in a world with others; loneliness in the presence of others; and the lived body as extending. In conclusion, professionals must consider patients' existential issues in the way they are expressed by the patients. Existence extends beyond the present situation. Accordingly, the team meeting must be seen in a larger context, including the patients' life as a whole, as well as the ontological and epistemological foundations on which healthcare is based.
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Affiliation(s)
- Elisabeth Lindberg
- Academy of Care, Working Life and Social Welfare, University of Borås, Borås, Sweden;
| | - Margaretha Ekebergh
- Academy of Care, Working Life and Social Welfare, University of Borås, Borås, Sweden.,School of Health and Caring Sciences, Linnæus University, Växjö, Sweden
| | - Eva Persson
- Board of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ulrica Hörberg
- School of Health and Caring Sciences, Linnæus University, Växjö, Sweden
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Shaughnessy L, Jackson J. Introduction of a new ward round approach in a cardiothoracic critical care unit. Nurs Crit Care 2015; 20:210-8. [PMID: 25598478 DOI: 10.1111/nicc.12149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/04/2014] [Accepted: 11/26/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Francis (2013) described inconsistent ward rounds and failures to conduct ward rounds properly as contributing factors to the poor care seen at the Mid Staffordshire Foundation Trust. He suggested that the absence of a nurse at the bedside had clear consequences for communication, ward round efficiency and patient safety. He recommended that nurses should be actively involved in ward rounds and linked this to high quality patient care. AIM To share an experience of introducing a ward round checklist, a bedside nurse verbal summary and the development of standard operating procedure for Ward Rounds in cardiothoracic critical care unit to improve patient safety and care. DESIGN AND METHODS Semi structured interviews of six registered nurses. A questionnaire to 69 registered nurses. An electronic questionnaire sent to 23 members of the MDT. An observational audit of seven ward rounds reviewing 69 patients. RESULTS 97% of nurses agreed that verbal summarizing had improved clarity and 90% felt that it had improved patient care. 87% of the MDT respondents stated that they had noticed an improvement in the attendance of the bedside nurse at the ward round review. The ward round checklist reduced omissions. Communication with patients during ward rounds was an area which needed to be improved. CONCLUSIONS The introduction of a new ward round approach and audit of its practice has enabled an improvement in the quality of patient care by: Giving more opportunity for the nurse to participate and feel part of the ward round. Reduction of omissions through the use of a ward round checklist. Improved clarity among the MDT by the use of bedside nurse verbal summarizing of the plan of care. RELEVANCE TO CLINICAL PRACTICE Nurses' full participation in ward rounds is essential to ensure effective communication and enhance patient safety.
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Affiliation(s)
- Liz Shaughnessy
- Registered Teacher, ENB 100, ENB 998, Clinical Nurse Educator, Cardiothoracic Critical Care, Essex Cardiothoracic Centre, Basildon Hospital, Basildon, Essex SS16 5NL, UK
| | - Jo Jackson
- Dean of Health, University of Essex, Colchester, CO4 3SQ, UK
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Aase I, Hansen BS, Aase K. Norwegian nursing and medical students' perception of interprofessional teamwork: a qualitative study. BMC MEDICAL EDUCATION 2014; 14:170. [PMID: 25124090 PMCID: PMC4139134 DOI: 10.1186/1472-6920-14-170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/08/2014] [Indexed: 05/25/2023]
Abstract
BACKGROUND Little is known about the ways in which nursing and medical students perceive and understand their roles in interprofessional teamwork. A 2010 report by the World Health Organization highlights the importance of students' understanding of teamwork in healthcare, and their ability to be effective team players. This study aims at describing nursing and medical students' perceptions of interprofessional teamwork, focusing on experiences and recommendations that can be used to guide future educational efforts. METHODS The study uses a qualitative research design. Data were collected from four focus group interviews: two homogenous groups (one with medical students, one with nursing students) and two mixed groups (medical and nursing students). RESULTS The results show that traditional patterns of professional role perception still prevail and strongly influence students' professional attitudes about taking responsibility and sharing responsibility across disciplinary and professional boundaries. It was found that many students had experienced group cultures detrimental to team work. Focusing on clinical training, the study found a substantial variation in perception with regard to the different arenas for interprofessional teamwork, ranging from arenas with collaborative learning to arenas characterized by distrust, confrontation, disrespect and hierarchical structure. CONCLUSIONS This study underlines the importance of a stronger focus on interprofessional teamwork in health care education, particularly in clinical training. The study results suggest that the daily rounds and pre-visit "huddles," or alternatively psychiatric wards, offer arenas suitable for interprofessional training, in keeping with the students' assessments and criteria proposed in previous studies.
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Affiliation(s)
- Ingunn Aase
- Department of Health Studies, University of Stavanger, Stavanger N-4036, Norway
| | - Britt Sæthre Hansen
- Department of Health Studies, University of Stavanger and Stavanger University Hospital, Stavanger N-4036, Norway
| | - Karina Aase
- Department of Health Studies, University of Stavanger, Stavanger N-4036, Norway
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Anthoine E, Delmas C, Coutherut J, Moret L. Development and psychometric testing of a scale assessing the sharing of medical information and interprofessional communication: the CSI scale. BMC Health Serv Res 2014; 14:126. [PMID: 24625318 PMCID: PMC4008265 DOI: 10.1186/1472-6963-14-126] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 03/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background Interprofessional collaboration is essential in creating a safer patient environment. It includes the need to develop communication and coordination between professionals, implying a better sharing of medical information. Several questionnaires exist in the literature, but none of them have been developed in the French context. The objective was to develop and test the psychometric properties of the communication and sharing information (CSI) scale which assesses specifically interprofessional communication, especially the sharing of medical information and the effectiveness of communication between members of the team. Methods The questionnaire construction process used a literature review and involved a panel of voluntary professionals. A list of 32 items explored the quality of shared information delivered to patients and the effectiveness of interprofessional communication. The study was conducted in 16 voluntary units in a University Hospital (France), which included medical, surgical, obstetrics, intensive care, pediatrics, oncology and rehabilitation care. The scale-development process comprised an exploratory principal component analysis, Cronbach’s α-coefficients and structural equation modeling (SEM). Results From these 16 units, a total of 503 health professionals took part in the study. Among them, 23.9% were physicians (n = 120), 43.9% nurses (n = 221) and 32.2% nurse assistants (n = 162). The validated questionnaire comprised 13 items and 3 dimensions relative to “the sharing of medical information” (5 items), “communication between physicians” (4 items) and “communication between nurses and nurse assistants” (4 items). The 3 dimensions accounted for 63.7% of the variance of the final questionnaire. Their respective Cronbach’s alpha coefficients were 0.80, 0.87 and 0.81. SEM confirmed the existence of the 3 latent dimensions but the best characteristics were obtained with a hierarchical model including the three latent factors and a global “communication between healthcare professionals” latent factor, bringing the 8 items linked to communication together. All the structural coefficients were highly significant (P < 0.001). Conclusions This self-perception CSI scale assessing several facets of interprofessional communication is the first one developed in the French context. The development study exhibited excellent psychometric properties. Further psychometric analysis is needed to establish test-retest reliability, sensibility to change and concurrent validity.
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Affiliation(s)
| | | | | | - Leïla Moret
- PHU11, Public Health Department, University Hospital, Saint-Jacques Hospital, 85, rue Saint-Jacques, Nantes Cedex 44093, France.
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Lindberg E, Persson E, Hörberg U, Ekebergh M. Older patients' participation in team meetings-a phenomenological study from the nurses' perspective. Int J Qual Stud Health Well-being 2013; 8:21908. [PMID: 24369777 PMCID: PMC3873639 DOI: 10.3402/qhw.v8i0.21908] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 11/14/2022] Open
Abstract
Although the importance of patient participation is acknowledged in today's healthcare, many challenges remain before patient participation can become an integral part of care provision. The ward round has traditionally been the forum for crucial decisions about patient care, but often with limited possibilities for patient participation. As part of the process of improving patient participation, the round in the present study has been replaced by a team meeting (TM) to which the patient has been invited. The aim of this study is to highlight nurses' experiences of older patients' participation in TMs. The research process was guided by the principles of phenomenological reflective life world research. Data were collected in a Swedish hospital, in a ward specializing in older patients. Nine nurses, who had invited and planned for a patient to participate in TMs and/or had experienced TMs in which patients participated, were interviewed. The essential meaning of patient participation in the TM, as experienced by the nurses, is that patient participation can be supported by a safe relationship in which the patient can make his or her voice heard. Participation is challenged by the patients' vulnerability and by the subordinated role assigned to the patient. The essential meaning is further described by its constituents: "the need for a guide," "patient participation challenged by structures," and "creating space for the whole human being." In conclusion, the nurse plays a core role in guiding the patient in an unfamiliar situation. The meaning of patient participation in the TM needs to be discussed by professionals so that the patient perspective is present.
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Affiliation(s)
- Elisabeth Lindberg
- School of Health Sciences, University of Borås, Borås, Sweden; School of Health and Caring Sciences, Linnæus University, Växjö, Sweden;
| | - Eva Persson
- School of Health Sciences, University of Borås, Borås, Sweden; Board of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ulrica Hörberg
- School of Health and Caring Sciences, Linnæus University, Växjö, Sweden
| | - Margaretha Ekebergh
- School of Health Sciences, University of Borås, Borås, Sweden; School of Health and Caring Sciences, Linnæus University, Växjö, Sweden
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Abstract
OBJECTIVES Patient care rounds are a key mechanism by which healthcare providers communicate and make patient care decisions in the ICU but no synthesis of best practices for rounds currently exists. Therefore, we systematically reviewed the evidence for facilitators and barriers to patient care rounds in the ICU. DATA SOURCES Search of Medline, Embase, CINAHL, PubMed, and the Cochrane library through September 21, 2012. STUDY SELECTION Original, peer-reviewed research studies (no methodological restrictions) were selected, which described current practices, facilitators, or barriers to healthcare provider rounding in the ICU. DATA EXTRACTION Two authors with methodological and content expertise independently abstracted data using a prespecified abstraction tool. DATA SYNTHESIS The literature search identified 7,373 citations. Reviews of abstracts led to the retrieval of 136 full text articles for assessment; 43 articles in three languages (English, German, Spanish) were selected for review. Of these, 13 were ethnographic studies and 15 uncontrolled before-after studies. Six studies used control groups, including one cross-over randomized, one time-series, three cohort, and one controlled before-after study. A total of 13 facilitators and 9 barriers to patient care rounds were identified through a narrative and meta-synthesis of included studies. Identified facilitators suggest that the quality of rounds is improved when conducted by a multidisciplinary group of providers, with explicitly defined roles, using a standardized structure and goal-oriented approach that includes a best practices checklist. Barriers to quality patient care rounds include poor information retrieval and documentation, interruptions, long rounding times, and allied healthcare provider perceptions of not being valued by rounding physicians. CONCLUSIONS Although the evidence base for best practices of patient care rounds in the ICU is limited, several practical and low-risk practices can be considered for implementation.
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Paradis E, Leslie M, Gropper MA, Aboumatar HJ, Kitto S, Reeves S. Interprofessional care in intensive care settings and the factors that impact it: results from a scoping review of ethnographic studies. J Crit Care 2013; 28:1062-7. [PMID: 23890936 DOI: 10.1016/j.jcrc.2013.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 11/30/2022]
Abstract
At the heart of safe cultures are effective interactions within and between interprofessional teams. Critical care clinicians see severely ill patients who require coordinated interprofessional care. In this scoping review, we asked: "What do we know about processes, relationships, organizational and contextual factors that shape the ability of clinicians to deliver interprofessional care in adult ICUs?" Using the 5-stage process established by Levac et al. (2010), we reviewed 981 abstracts to identify ethnographic articles that shed light on interprofessional care in the intensive care unit. The quality of selected articles is assessed using best practices in ethnographic research; their main insights evaluated in light of an interprofessional framework developed by Reeves et al (Interprofessional Teamwork for Health and Social Care. San Francisco, CA: Wiley-Blackwell; 2010). Overall, studies were of mixed quality, with an average (SD) score of 5.8 out of 10 (1.77). Insights into intensive care unit cultures include the importance of paying attention to workflow, the nefarious impact of hierarchical relationships, the mixed responses to protocols imposed from the top down, and a general undertheorization of sex and race. This review highlights several lessons for safe cultures and argues that more needs to be known about the context of critical care if quality and safety interventions are to succeed.
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Affiliation(s)
- Elise Paradis
- Center for Innovation in Interprofessional Education, University of California, San Francisco, CA, USA
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Perkins C, Kisiel M. Developing the recognition and response skills of student nurses. ACTA ACUST UNITED AC 2013; 22:715-24. [DOI: 10.12968/bjon.2013.22.12.715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Claire Perkins
- Adult and Critical Care Nursing, Birmingham City University
| | - Maria Kisiel
- Adult, Critical Care Nursing, Birmingham City University
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Nadot Ghanem N. La visite médicale sur dossier, un exemple de coordination des « cours d'action » entre médecins et infirmières. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.113.0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lindberg E, Hörberg U, Persson E, Ekebergh M. "It made me feel human"-a phenomenological study of older patients' experiences of participating in a team meeting. Int J Qual Stud Health Well-being 2013; 8:20714. [PMID: 23719214 PMCID: PMC3667216 DOI: 10.3402/qhw.v8i0.20714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2013] [Indexed: 11/14/2022] Open
Abstract
This study focused on older patients participating in a team meeting (TM) in a hospital ward in Sweden. A process had taken place on the ward, in which the traditional round had developed into a TM and understanding what participating in a TM means for the older patient is necessary for the development of care that facilitates older patient's participation. The aim of this study was to describe the caring, as experienced by the older patients on a ward for older persons, with a specific focus on the team meeting. A reflective lifeworld research (RLR) design was used. Fifteen patients, 12 women and three men (mean age of 82 years) were interviewed while they were hospitalized in a hospital ward for older people. In the essential meaning of the phenomenon, the TM is described as being a part of a wider context of both caring and life. The need for hospitalization is an emotional struggle to overcome vulnerability and regain everyday freedom. The way in which the professionals are able to confirm vulnerability and create a caring relationship affects both the struggle for well-being and the possibilities for maintaining dignity. The essence is further explicated through its constituents; Vulnerability limits life; Life is left in the hands of someone else; Life is a whole and Space for existence. The result raises concern about how the care needs to be adjusted to older people's needs as lived bodies. The encounter between the carer and the patient needs to be developed in order to get away from the view of the patient as object. An expanded vision may open up for existential dimensions of what brings meaning to life. One way, as described by the patients, is via the patient's life stories, through which the patients can be seen as a whole human being.
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Have ECMT, Nap RE. Mutual agreement between providers in intensive care medicine on patient care after interdisciplinary rounds. J Intensive Care Med 2013; 29:292-7. [PMID: 23753243 DOI: 10.1177/0885066613486596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Insights regarding the results of interdisciplinary communication about patient care are limited. We explored the perceptions of intensivists, junior physicians, and nurses about patient care directly after the interdisciplinary rounds (IDRs) in the intensive care unit (ICU) to determine mutual agreement. METHODS A single-center survey study adapted from Pronovost "daily goal sheet" was performed in the ICUs for adults at a university medical center. Participants were intensivists, junior physicians, and ICU nurses. This survey, consisting of 14 items, was obtained directly after IDRs. Descriptive statistics of 90 observations of 30 discussed patient plans were computed. The internal consistency of the survey was measured by Cronbach α. RESULTS Differences between the hypothesized agreement of 90% and the saturated agreement revealed significant differences in 12 of the 14 items between the 3 groups of ICU care providers. Results of the differing agreement between intensivist and junior physicians or ICU nurses and between ICU nurses and junior physicians revealed that intensivists tend to agree more with ICU nurses than they do with the junior physicians. Internal consistency showed α = .74. CONCLUSIONS The recommendation of IDRs without mutual agreement in important aspects of patient care hampers safety in daily practice. This study demonstrates that a survey to determine this agreement between the intensivists, junior physicians, and ICU nurses has low agreement, as measured directly after the IDRs.
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Affiliation(s)
- Elsbeth Cornelia Maria Ten Have
- Directorate Medical Affairs, Quality and Safety (ECMTH, REN), University Medical Center Groningen, Groningen, the Netherlands
| | - Raoul Ernesto Nap
- Directorate Medical Affairs, Quality and Safety (ECMTH, REN), University Medical Center Groningen, Groningen, the Netherlands
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Ten Have ECM, Hagedoorn M, Holman ND, Nap RE, Sanderman R, Tulleken JE. Assessing the quality of interdisciplinary rounds in the intensive care unit. J Crit Care 2013; 28:476-82. [PMID: 23428713 DOI: 10.1016/j.jcrc.2012.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/10/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Interdisciplinary rounds (IDRs) in the intensive care unit (ICU) are increasingly recommended to support quality improvement, but uncertainty exists about assessing the quality of IDRs. We developed, tested, and applied an instrument to assess the quality of IDRs in ICUs. MATERIALS AND METHODS Delphi rounds were done to analyze videotaped patient presentations and elaborated together with previous literature search. The IDR Assessment Scale was developed, statistically tested, and applied to 98 videotaped patient presentations during 22 IDRs in 3 ICUs for adults in 2 hospitals in Groningen, The Netherlands. RESULTS The IDR Assessment Scale had 19 quality indicators, subdivided in 2 domains: "patient plan of care" and "process." Indicators were "essential" or "supportive." The interrater reliability of 9 videotaped patient presentations among at least 3 raters was satisfactory (κ = 0.85). The overall item score correlations between 3 raters were excellent (r = 0.80-0.94). Internal consistency in 98 videotaped patient presentations was acceptable (α = .78). Application to IDRs demonstrated that indicators could be unambiguously rated. CONCLUSIONS The quality of IDRs in the ICU can be reliably assessed for patient plan of care and process with the IDR Assessment Scale.
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Affiliation(s)
- Elsbeth C M Ten Have
- Directorate Medical Affairs, Quality and Safety, University Medical Center Groningen, Groningen, The Netherlands.
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Bozeman L. Nurse-led multidisciplinary obstetric patient summaries: improving collaboration, collegiality and patient safety. Nurs Womens Health 2012; 15:382-91. [PMID: 22900651 DOI: 10.1111/j.1751-486x.2011.01662.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu W, Manias E, Gerdtz M. Medication communication during ward rounds on medical wards: Power relations and spatial practices. Health (London) 2012; 17:113-34. [PMID: 22674748 DOI: 10.1177/1363459312447257] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Communication plays a crucial role in the management of medications. Ward rounds are sites where health professionals from different disciplines and patients come together to exchange medication information and make treatment decisions. This article examines power relations and spatial practices surrounding medication communication between patients and health professionals including doctors, nurses and pharmacists during ward rounds. Data were collected in two medical wards of a metropolitan teaching hospital in Melbourne, Australia. Data collection methods involved participant observations, field interviews, video-recordings, together with individual and group reflexive interviews. A critical discourse analysis was undertaken to identify the location sites where power relations were reproduced or challenged in ward rounds. Findings demonstrated that traditional medical hierarchies constructed the ways in which doctors communicated about medications during ward rounds. Nurses and pharmacists ventured into the ward round space by using the discourse of preparation and occupying a peripheral physical position. Doctors privileged the discourse of medication rationalization in their ward round discussions, competing with the discourse of inquiry taken up by patients and families. Ward rounds need to be restructured to provide opportunities for nurses and pharmacists to speak at dedicated times and in strategic locations. By critically reflecting upon the complex process of medication communication during ward rounds, greater opportunities exist for enhanced team communication among health professionals.
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Affiliation(s)
- Wei Liu
- University of Melbourne, Australia.
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Persson E, Määttä S. To provide care and be cared for in a multiple-bed hospital room. Scand J Caring Sci 2012; 26:663-70. [DOI: 10.1111/j.1471-6712.2012.00976.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Exploration of the Association Between Professional Interactions and Emotional Distress of Intensive Care Unit Nursing Personnel. Dimens Crit Care Nurs 2012; 31:37-45. [DOI: 10.1097/dcc.0b013e31823a55b8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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