Are interprofessional healthcare teams meeting patient expectations? An exploration of the perceptions of patients and informal caregivers

Understanding the Needs and Wishes of Older Adults in Interprofessional Treatment for Malnutrition and Sarcopenia: A Grounded Theory Study

Background

Malnutrition and sarcopenia impact the physical health and quality of life of community-dwelling older adults. Managing these conditions requires integrating nutritional and exercise interventions delivered by professionals from diverse backgrounds. Interprofessional collaboration holds promise for providing integrated, person-centered care to older adults. However, to tailor such care, it is essential to understand the needs and wishes of older adults, which remain underexplored. This study aimed to understand the needs and wishes of community-dwelling older adults regarding interprofessional treatment for (risk of) malnutrition and sarcopenia.

Methods

We conducted a grounded theory study. Data collection involved semi-structured interviews and focus groups with community-dwelling older adults who are undergoing treatment or have been treated for (risk of) malnutrition and/or sarcopenia. We systematically analyzed the data using open, axial, and selective coding and developed a conceptual model.

Results

Interviews and focus groups were conducted with 18 older adults. Three selective codes were identified: 1) older adults need to be involved in their interprofessional treatment, 2) older adults need healthcare professionals to be well-informed about their interprofessional treatment, and 3) older adults need collaboration amongst involved healthcare professionals in interprofessional treatment. Our conceptual model addresses the needs and wishes of older adults in relation to interprofessional collaboration. Older adults' needs highlight what is missing, while their wishes offer ways to fulfill these needs.

Conclusion

Older adults' need for involvement in interprofessional treatment can be met by engaging them actively in healthcare decisions and as partners to healthcare professionals. The need for well-informed healthcare professionals can be fulfilled by ensuring accessible healthcare information, the prevention of conflicting advice, and the prevention of repeating medical history. Finally, the need for collaboration among healthcare professionals can be fulfilled by healthcare professionals communicating openly and directly and working closely together.

A Systematic Review on Nurse-Physician Collaboration and Its Relationship With Nursing Workforce Outcomes: Implications for Nursing Administration

OBJECTIVE

This systematic review appraised and synthesized the literature examining the relationship between nurse-physician collaboration and nursing workforce outcomes.

BACKGROUND

Nurse-physician collaboration is vital for effective healthcare delivery, with implications for nursing workforce outcomes. Knowledge of this relationship is crucial when designing strategies and interventions to enhance collaboration and improve nursing practice and outcomes.

METHODS

This is a systematic review of 19 articles. Two independent researchers extracted and analyzed the data from articles that met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to ensure transparency and rigor in the review process.

RESULTS

Content analysis identified nursing workforce outcomes of nurse-physician collaboration, which were clustered into motivation-based outcomes (eg, professional autonomy), behavior/performance-based outcomes (eg, job performance, turnover intention), and affective-based outcomes (eg, job satisfaction, moral distress).

CONCLUSION

The findings of this review underscore the value of fostering collaborative relationships between nurses and physicians to improve nursing workforce outcomes and promote a supportive work environment.

Partnership in care: Organic systems framework strategies for patients and care providers

The organic systems framework is a conceptual social sciences theoretical framework developed by renowned author Barry Oshry. Oshry outlines how we are often blind to the context we are in and our reactions to those conditions, which leads to certain experiences. This article emanates from the author's reflections on bringing organic systems insights to groups and organizations worldwide and how such strategies in relational systems may apply to patients and care providers working together in partnership. As patients and care providers engage in such partnerships, they enter distinctly different contexts, each with unique challenges and opportunities. Written from a first-person perspective, the author moves beyond seeing the patient as a client in the healthcare system and into the possibilities of how patients and providers can work together across contexts to create and sustain meaningful care-based partnerships.

Interprofessional collaboration in the home care setting: perspectives of people receiving home care, relatives, nurses, general practitioners, and therapists-results of a qualitative analysis

BACKGROUND

About one million people in need of home care in Germany are assisted by 15,400 home care services. Home healthcare is mostly a complex endeavour because interprofessional collaboration is often challenging. This might negatively impact patient safety. The project interprof HOME aims to develop an interprofessional person-centred care concept for people receiving home care in a multistep approach. In one of the work packages we explored how people receiving home care, relatives, nurses, general practitioners, and therapists (physiotherapists, occupational therapists, and speech therapists) perceive collaboration in this setting.

METHODS

Semi-structured interviews were conducted with 20 people receiving home care and with 21 relatives. Additionally, we worked with nine monoprofessional focus groups involving nurses of home care services (n = 17), general practitioners (n = 14), and therapists (n = 21). The data were analysed by content analysis.

RESULTS

Three main categories evolved: "perception of interprofessional collaboration", "means of communication", and "barriers and facilitators". People receiving home care and relatives often perceive little to no interprofessional collaboration and take over a significant part of the organisational coordination and information exchange. Interprofessional collaboration in steady care situations does exist at times and mostly occurs in coordination tasks. Contact and information exchange are rare, however, interprofessional personal encounters are sporadic, and fixed agreements and permanent contact persons are not standard. These trends increase with the complexity of the healthcare situation. Joint collaborations are often perceived as highly beneficial. Means of communications such as telephone, fax, or e-mail are used differently and are often considered tedious and time-consuming. No interprofessional formal written or electronic documentation system exists. Personal acquaintance and mutual trust are perceived as being beneficial, while a lack of mutual availability, limited time, and inadequate compensation hinder interprofessional collaboration.

CONCLUSIONS

Interprofessional collaboration in home care occurs irregularly, and coordination often remains with people receiving home care or relatives. While this individual care set-up may work sufficiently well in low complex care situations, it becomes vulnerable to disruptions with increasing complexity. Close interactions, joint collaboration, and fixed means of communication might improve healthcare at home. The findings were integrated into the development of the person-centred interprofessional care concept interprof HOME.

TRIAL REGISTRATION

This study is registered on the International Clinical Trails registry platform ClinicalTrials.gov as NCT05149937 on 03/11/2021.

What Patients Think: A Study Examining Perceptions of Teamwork, Self-Management, and Quality of Life of Patients Diagnosed With Diabetic Foot Ulceration

Identifying strategies to support patients diagnosed with diabetic foot ulceration (DFU) is essential to affect not only wound outcomes but also mortality and quality of life. This article reports on a cross-sectional, descriptive, correlational study of patients receiving treatment for DFU at a specialty clinic. Most participants were <60 years of age and had been diagnosed with diabetes for >5 years. Results indicated that patients with higher self-management scores reported improved general health, physical functioning, and quality of life. These findings, in a younger patient population with normal work and family obligations, suggest that interventions supporting self-management behaviors can improve physical, emotional, and general health and, ultimately, quality of life. The involvement of an interprofessional care team enhances these self-management behaviors.

Chiropractors in interprofessional practice settings: a narrative review exploring context, outcomes, barriers and facilitators

To determine the added value of interprofessional interventions over existing mono-professional practice, elucidation of specific health care issues, service delivery contexts and benefits of combining multiple service provider is required. However, from existing literature, it is difficult to develop a sense of the evidence that supports interprofessional practice initiatives involving chiropractors. This review aims to describe and explore the contexts, outcomes, and barriers and facilitators relating to interprofessional practice involving chiropractors available in current literature. A search of Scopus, CINAHL, Cochrane, and Web of Science databases covering the literature from 2005 to October 2021 was conducted, after which a narrative review of identified peer-reviewed articles written in English was performed. We included data from seven studies, conducted across four distinct service delivery contexts. Eight interprofessional practice partners were identified, and eight factors appear to act as barriers and facilitators. Data suggests that incorporating chiropractors into community health and sports medicine interprofessional practice interventions is achievable and appears to impact collaborative practice positively. For older adults with low back pain, quality of life and care-related satisfaction are potential relevant outcomes for the evaluation of interprofessional practice interventions. There is currently very limited evidence from which to judge the value of interprofessional practice interventions, as available literature appears to focus mainly on interprofessional collaboration. Studies conducted specifically to evaluate interprofessional practice solutions and addressing specific health care issues or practice domains are urgently required.

Patient and family perceptions of interprofessional collaborative teamwork: An integrative review

AIMS

To understand the patient and family perceptions of teamwork by synthesising existing evidence using the Interprofessional Education Collaborative Core Competencies for Interprofessional Collaborative Practice as a guiding framework.

BACKGROUND

Advances in healthcare have resulted in more people living longer with health conditions, and patients and families have become the primary caregivers. The role of the interprofessional collaborative team supports a paradigm shift to a care model with the patient and family at the centre of healthcare decisions. However, patient and family views of interprofessional collaborative team care have rarely been studied.

METHODS

The authors applied Whittmore and Knafl's methodology to conduct an integrative review of the literature. Databases searched included Cumulative Index to Nursing and Allied Health Literature, PubMed and PsycINFO along with reference searches. The studies included were those related to patient and family perceptions of teamwork published from 2000 to 2020. The IPEC Core Competencies for Interprofessional Collaborative Practice served as the guiding framework for analysis. A PRISMA flow chart documented the search, inclusion and exclusion criteria for the review.

RESULTS

Seventeen articles met the inclusion criteria. The findings identified differing perspectives by patients of the impact of the interprofessional collaborative team in their care which suggests that interventions to increase knowledge about interprofessional collaborative team care from the patient and family perspective may be beneficial.

CONCLUSIONS

There is limited research on understanding IPC teams from the patient and family viewpoint. This review reveals incongruencies in patient and provider perspectives of IPC teams and suggests the need for additional research about patient and family perspectives of teamwork. To fully implement the IPC team vision, perceptions of teamwork must be fully understood.

A Swiss Health Care Professionals' Perspective on the Meaning of Interprofessional Collaboration in Health Care of People with MS-A Focus Group Study

Multiple sclerosis (MS) is a chronic, inflammatory autoimmune disease of the central nervous system mainly of adults ranging from 20 to 45 years of age. The risk of developing MS is 50% higher in women than in men. Most people with MS (PwMS) experience a spectrum of symptoms such as spasticity, continence dysfunctions, fatigue, or neurobehavioral manifestations. Due to the complexity of MS and the variety of patient-centered needs, a comprehensive approach of interprofessional collaboration (IPC) of multiple health care professionals (HCP) is necessary. The aim of this qualitative study was to explore the meaning of IPC in the comprehensive care of PwMS from a HCP perspective. Focus groups (FG) with HCP were conducted, recorded, and transcribed verbatim. The sample contained HCP from three MS clinics in different phases of care and rehabilitation. Four main categories emerged: (a) experience with IPC, (b) relevant aspects for IPC in patients’ treatment, (c) differences in in- and outpatient settings, and (d) influence of patient perspective. IPC plays a crucial role in HCP perspective when treating PwMS, which can benefit from an IPC therapeutic approach because HCP work together in a patient-centered way. The inpatient setting of HCP strongly supports the implementation of IPC. This prerequisite does not exist in outpatient settings.

Patient roles in primary care interprofessional teams: a constructivist grounded theory of patient and health care provider perspectives

Health care providers are increasingly asked to work in interprofessional teams to enhance the care provided to and health outcomes of their patients. However, there is little evidence on how to include patients in meaningful roles on these teams to support their health monitoring and management. The purpose of this study was to gain insight into roles that patients can assume within their health care teams and to understand the conditions and processes required for patient roles to be enacted. Ten patients and 10 health care providers from two Family Health Teams in Southwestern Ontario, Canada, participated in individual interviews to learn about their perspectives on patient roles in teams. Data collection and analysis strategies generated theoretical concepts, and member-checking interviews provided final feedback on the framework. This study resulted in a comprehensive framework of two roles and the conditions and processes required for patient-health care provider interactions within primary care interprofessional teams. Further researchers could use this framework to build knowledge of patient roles in interprofessional teams across varying health care settings and patient populations.

An Experimental Education Project for Consultations of Older Adults during the Pandemic and Healthcare Lockdown

Objective: To develop a mentor-supervised, interprofessional, geriatric telemedicine experiential education project in response to the COVID-19 pandemic. Method: Medical and pharmacy students collaborated via remote consultations to address the coexistence of multimorbidity and polypharmacy in geriatric patients. In-depth interviews of students and patients as well as Likert scale-based telephonic survey were performed for a comprehensive evaluation of the project’s significance. Results: To date, 49 consultations have been conducted. Remote consultations performed by medical and pharmacy students working collaboratively were beneficial for both students, participants. Conclusions and Practice Implications: This experimental education project provided students with authentic challenges while simultaneously delivering care to the older adults who are susceptible to disruption of care associated with the pandemic. Further development and expanded implementation of such approaches may be a post-pandemic practice to provide more accessible care for senior patients while incorporating interprofessional education.

The COMFORT Communication Model: A Nursing Resource to Advance Health Literacy in Organizations

The COMFORT Model has recently been revised based on feedback from bedside nurses working in palliative care and oncology and includes the following components: Connect, Options, Making Meaning, Family Caregiver, Openings, Relating, and Team. Based on clinical and nonclinical research in hospital, hospice, palliative care, and interdisciplinary education settings, the authors present the updated COMFORT Model. Originally introduced in 2012 to support the work of the nurse, the model is not a linear guide, an algorithm, a protocol, or a rubric for sequential implementation by nurses, but rather a set of communication principles that are practiced concurrently and reflectively during patient/family care. In its restructuring, we focus on the role of health literacy throughout the COMFORT components in relationship to the health literacy attributes of a health care organization. A brief summary of COMFORT components is provided and includes strategies and competencies contributing to a health-literate care organization. Both health literacy and COMFORT are explored using specific communication challenges that underscore the role of the nurse in accomplishing person-centered and culturally responsive care, especially in chronic and terminal illness. The integration of the COMFORT Model into nursing education is proposed.

Healthcare teams and patient-related terminology: a review of concepts and uses

BACKGROUND

Discussions concerning health care teams and patient-related terminology remain an ongoing debate. Terms such as interdisciplinary, multidisciplinary and transdisciplinary, as well as interprofessional are ambiguously defined and frequently used, rightly or wrongly, interchangeably. Also, clarification on the terminology regarding patients is rarely explicitly addressed in the health care team's literature, potentially resulting in confusion among health professional students, novice researchers, and practitioners.

METHODS

A structured literature review was conducted. Electronic searches were performed from August 2018 to September 2019 on the following databases: CINHAL, Scopus, Science Direct, PubMed, Nursing and Allied Health and JSTOR. The following terms were used: 'terminology', 'team(s)', 'nursing', 'health', 'medical', 'education', 'interprofessional', 'interdisciplinary', 'multidisciplinary', 'transdisciplinary', 'collaboration', 'patient', 'client', 'customer', 'user' and 'person'.

RESULTS

Small but significant nuances in the use of language and its implications for patient care can be made visible for health professional education and clinical practice. Healthcare is necessarily interdisciplinary and therefore we are obligated, and privileged, to think more critically about the use of terminology to ensure we are supporting high-quality evidence and knowledge application.

CONCLUSION

To avoid confusion and lack of consistency in the peer-review literature, authors should be encouraged to offer brief definitions and the rationale for the use of a particular term or group of term. In addition, a deeper understanding of the values that each patient-related term represents for particular disciplines or health care professions is essential to achieve a more comprehensive conceptual rigour.

Optimising professional communication with patients

Communication between a nurse and a patient may seem intuitive. However, communicating effectively with patients while applying the principles of person-centred care can be challenging. Patients' perceptions of suboptimal care and healthcare services may be influenced by how nurses communicate with them, since communication may be used as a quality indicator, as well as an indicator of patient experience. This article considers how nurses can communicate effectively with patients to optimise care. It explores the theoretical principles of interpersonal and professional communication, and discusses practical methods of listening and speaking to patients that nurses can apply in their clinical practice.

Are patients ready for integrated person-centered care? A qualitative study of people with epilepsy in Ireland

The National Clinical Programme for Epilepsy (NCPE) in Ireland aims to deliver a holistic model of integrated person-centered care (PCC) that addresses the full spectrum of biomedical and psychosocial needs of people with epilepsy (PwE). However, like all strategic plans, the model encompasses an inherent set of assumptions about the readiness of the environment to implement and sustain the actions required to realize its goals. In this study, through the lens of PwE, the Irish epilepsy care setting was explored to understand its capacity to adopt a new paradigm of integrated PCC. Focus groups and semi-structured one-to-one interviews were employed to capture the qualitative experiences of a sample of Irish PwE (n = 27) in the context of the care that they receive. Participants were from different regions of the country and were aged between 18 and 55 years with 1 to 42 years since diagnosis (YSD). Highlighting a gap between policy intent and action on the ground, findings suggest that patient readiness to adopt a new model of care cannot be assumed. Expectations, preferences, behaviors, and values of PwE may sustain the more traditional constructions of healthcare delivery rather than the integrated PCC goals of reform. These culturally constituted perceptions illustrate that PwE do not instinctively appreciate the goals of healthcare reform nor the different behavior expected from them within a reformed healthcare system. Recalibrating deep-rooted patient views is necessary to accomplish the aspirations of integrated PCC. Patient engagement emphasizing the meaningful role that they can play in shaping their healthcare services is vital.