Hierarchies in interprofessional training

Perceptions of an acute medical unit in internal medicine on interprofessional collaboration

We aimed to assess perceptions about interprofessional collaboration (IPC) of healthcare professionals working in an acute medical unit (AMU) in an internal medicine department in the United Arab Emirates. The AMU provides care during the initial 24 to 72 hours of admission and emphasizes interprofessional collaboration. Using the Assessment of Interprofessional Team Collaboration Scale II, the study measured partnership, cooperation, and coordination among team members. Between November 5, 2022, and January 5, 2023, 81 participants completed the survey, including physicians (n = 45; 55.5%), nurses (n = 18; 22.2%), and clinical and non-clinical allied health professionals (n = 18; 22.2%). On a Likert-type scale of one to five, most respondents perceived partnership, cooperation, and team coordination as good collaboration on the AMU, with mean scores of 4.29, 4.16, and 4.15, respectively. There was no significant difference between physicians' (4.18) and nurses' (4.45) perspectives of IPC on the AMU (p = .10), but physicians were less likely to notice collaborative practice changes compared to other professionals. Introducing IPC early in medical education might enhance future collaborative practice. This study sheds light on IPC in non-Western contexts and provides insights into how collaboration is perceived and practiced in diverse healthcare settings.

Bulwark Effect of Response in a Causal Model of Disruptive Clinician Behavior: A Quantitative Analysis of the Prevalence and Impact in Japanese General Hospitals

Background: Disruptive clinician behavior (DCB) negatively affects patient safety by impairing healthcare team communication. In Japanese hospitals, hierarchical structures and traditional leadership styles contribute to its persistence. This study examines the prevalence and impact of DCB in two general hospitals and evaluates the role of response strategies in mitigating its effects. Methods: A quantitative web-based survey was conducted among 256 healthcare professionals from two general hospitals (751 and 661 beds). The survey included demographic data, a validated DCB scale, and a structured questionnaire assessing triggers, responses, and impacts. Statistical analyses included principal component analysis (PCA), structural equation modeling (SEM), and moderated mediation analysis. Results: Among participants, 79.3% reported experiencing or witnessing DCB. Psychological/social impact partially mediated the relationship between DCB and hospital management issues (β = 0.19, p = 0.001). Response strategies reduced the psychological/social impact of DCB (β = -0.20, p < 0.001) but did not mitigate its direct effect on hospital management. Conclusions: While prompt responses can alleviate the psychological burden on victims, they do not prevent broader institutional damage caused by DCB. Effective interventions should focus on both individual and organizational measures to reduce the occurrence of DCB.

Healthcare Undergraduates' Attitudes and Readiness Toward Interprofessional Education at a Saudi University

Objective

Interprofessional education (IPE) is widely recognized as an effective practice in healthcare education that helps healthcare students understand different professional roles, and values related to collaboration, teamwork, and leadership within healthcare teams. This study was conducted to measure attitudes and readiness for IPE among healthcare students at Taif University and to explore any differences in students' attitudes in relation to their healthcare program, year of study and other related factors.

Methods

Healthcare undergraduates participated in a cross-sectional study conducted from January 2024 to March 2024. Data was collected electronically by filling out an electronic version of The Readiness for Interprofessional Learning Scale (RIPLS), which was sent to students in advanced years of study, 3rd year and higher, depending on the program. Data was analyzed descriptively and statistically using appropriate univariate and bivariate analyses.

Results

A total of 263 healthcare students participated in the study (68.8% female, 31.2% male), and the majority were from pharmacy program (55.1%), followed by nursing (25.1%) and medicine (19.8%). The overall RIPLS score for all students was 76.58, indicating positive attitudes towards IPE. The RIPLS score differed significantly (P=0.01) in relation to the program of study, with nursing students showing the highest readiness (77.59), and medical students showed the least (73.56). For the other factors, no significant difference was found in RIPLS scores in relation to gender, clinical training experience, attending previous IPE sessions, or the year of study.

Conclusion

Attitudes and readiness for IPE among healthcare undergraduates at Taif University were positive, particularly among nursing students. The reasons behind differences in readiness for IPE among programs need further investigation by researchers and healthcare educators. Offering introductory sessions to introduce the concept of IPE to healthcare programs with lower readiness might be helpful to raise students' awareness of the value of IPE.

Learning and working on an interprofessional training ward in neonatology improves interprofessional competencies

Introduction

Interprofessional education (IPE) is essential for healthcare professionals to prepare them for future interprofessional collaboration (IPC). Interprofessional training wards (ITWs) have been set up for IPE and results have been published. There are no published studies on ITWs in neonatology. We have designed and established the Interprofessional Training Ward in Neonatology (IPANEO) for nursing trainees (NT) and medical students (MS) in a neonatological intermediate care (IMC) ward. We report on the concept and the results with regard to the interprofessional competencies of the participants, including parent satisfaction.

Methods

Supervision by medical and nursing learning facilitators, 2week blocks each with 2 NT (n = 30) and 2 MS (n = 23) in their final year, ward-in-ward concept, 3 patients cared for. Evaluation of the participants (pre/post) with the Interprofessional Socialisation and Valuing Scale (ISVS), the Interprofessional Collaboration Scale (ICS) with questions on IP communication, accommodation and isolation as well as with an IPANEO-specific evaluation (IPQ), an external evaluation with the "Observational Questionnaire for Learning Facilitators" (OQLF) and a "Questionnaire on Parent Satisfaction" (PSQ) (n = 33).

Results

IPANEO participants showed significant increases in competencies in IP communication, accomodation and isolation (ICS), a better IP-collaboration and a higher role definition (IPANEO specific questionnaire). The ISVS 9A/B global scores increased. According to the self-assessment there were significant improvements in the external evaluation in all IP-categories (OQLF). The feedback from the parents was significantly positive (PSQ).

Conclusion

Interprofessional learning and working on IPANEO had a positive impact on interprofessional competencies with high parent satisfaction.

Sonographer Experiences of Interprofessional Ultrasound Education: A Qualitative Study

INTRODUCTION

Point-of-care ultrasound (POCUS) technology has evolved rapidly and is being embraced by many health professionals as a valuable clinical tool. Sonographers are now teaching ultrasound skills to other health professionals in the clinical setting, including doctors, nurses, midwives, paramedics, and physiotherapists. The purpose of this study was to understand the breadth of the opportunities, transitions, and challenges experienced by sonographer educators navigating new interprofessional teaching roles.

METHODS

Sonographers, who had participated in an initial phase Delphi study defining sonographer competencies in POCUS education, were invited to participate in a follow-up interview. Semi-structured interviews were conducted, and the interview data were thematically analyzed to understand the experiences and perceptions of participants.

RESULTS

Twenty sonographer educators were interviewed. Participants were clinically experienced sonographers from Australia and New Zealand with diverse professional experience in clinical teaching, university academic, ultrasound leadership, health management, and corporate roles. The transition to teaching interprofessional cohorts of learners in different clinical settings was substantial. The experiences of sonographers undertaking these new roles were described under the themes of "sonographer perceptions"; "educator knowledge"; "understanding learners"; "teaching dynamics"; and "ultrasound evolution."

CONCLUSION

This study is the first to describe the experiences of sonographers engaged in interprofessional POCUS teaching. The results provide insight into the training needs of sonographers in this emerging area and will be used to inform the development of continuing education resources.

Interprofessional collaboration in primary care for patients with chronic illness: a scoping review protocol mapping leadership and followership

Effective interprofessional collaboration (IPC) in primary care is essential for providing high-quality care for patients with chronic illness. However, the traditional role-based leadership approach in which physicians are the sole leaders, may hinder IPC. To improve IPC, leadership roles may need to shift dynamically based on expertise and experience, allowing for fluid transitions between leaders and followers within teams. Until now, most studies exploring this phenomenon focus on secondary care settings where teamwork is often physician-led, protocol-driven, and time-limited. Our understanding of followership in primary care remains limited. Therefore, we present a protocol for a scoping review to map the research on leadership and followership within IPC in primary care settings for patients with chronic illness and relevant training interventions within this context. An electronic search will be conducted across PubMed, Embase, and Web of Science to identify studies published in English. Three independent reviewers will assess publications for eligibility. Data will be extracted on definitions, conceptualizations, and training programs of leadership and followership. Through descriptive and thematic analysis, the review will map the landscape of leadership and followership, and provide insights into related competencies necessary for effective IPC in primary care for patients with chronic illness.

Interprofessional collaboration in primary care for patients with chronic illness: a scoping review mapping leadership and followership

BACKGROUND

Effective interprofessional collaboration (IPC) in primary care is essential in providing high-quality care for patients with chronic illness. However, the traditional role-based leadership approach may hinder IPC. Instead, physicians should also take followership roles, allowing other healthcare team members (OHCTMs) to lead when they have expertise and/or experience. Understanding of leadership and followership within IPC remains limited in primary care for patients with chronic illness. Hence, this review aims to explore the definitions and conceptualisations of leadership and followership and to map relevant training in this context.

METHODS

Following the Joanna Briggs Institute methodology for scoping reviews, an electronic search was conducted across PubMed, Embase and Web of Science. Three independent reviewers assessed publications for eligibility. Descriptive and thematic analysis were employed.

RESULTS

From 2194 identified articles, 57 were included. Only two articles defined leadership approaches, and none explicitly addressed followership. Nevertheless, our analysis identified leadership shifts from physicians to OHCTMs, and vice versa for followership, driven by complexity of care, physician shortages and healthcare costs. Enablers of these shifts included physician trusting OHCTMs, collaborative practice agreements and physicians' interprofessional experience. Barriers included traditional hierarchies, OHCTMs' lack of competence and physicians' lack of IPC experience. Four articles mentioned relevant training however without detailed information.

DISCUSSION

Leadership in IPC for chronic illness in primary care is rarely defined, and followership is largely neglected. Nevertheless, leadership-followership shifts do occur in leadership and followership roles of physicians and OHCTMs. Further research needs to explore physicians' followership and relevant competencies, and relevant training is required.

Assessment of communication skills in health professions education; Ottawa 2024 consensus statement

Despite the increasing inclusion of communication skills in accreditation standards and an increase in time dedicated to teaching these skills, communication is often regarded as a separate skill and is therefore, not consistently represented in overall systems of assessment in Health Professions Education (HPE). The ascendence of competency-based medical education, programmatic assessment, artificial intelligence, and widespread use of telehealth, alongside changing patient expectations warrant an update in thinking about the assessment of communication skills in health professions education. This consensus statement draws on existing literature, expert pinion, and emerging challenges to situate the assessment of communication skills in the contemporary health professions education context. The statement builds on previous work to offer an update on the topic and include new developments related to assessment, particularly: the challenges and opportunities associated with systems of assessment; patient and peer perspectives in assessment; assessment of interprofessional communication, cross-cultural communication, digital communication; and assessment using digital technologies. Consensus was reached through extensive discussion among the authors and other experts in HPE, exploration of the literature, and discussion during an Ottawa 2024 conference workshop. The statement puts forward a summary of available evidence with suggestions for what educators and curriculum developers should consider in their planning and design of the assessment of communication.

Integrated Case Presentation Seminar: Bridging Parallel Fields to Improve Psychiatry and Psychology Learner Experience

Daily clinical practice of mental health professionals often requires interaction between providers from diverse training and professional backgrounds. Efforts to engage mental health trainees across disciplines are necessary and have had varied outcomes. The current study reviews the development and implementation of a monthly one-hour integrated case presentation seminar (ICPS) as part of independent psychology and psychiatry two-year fellowships at a Midwestern teaching hospital. The training integrated a semi-structured seminar to facilitate case presentation within a group setting. The focus of the seminar was to allow for exposure to conceptualization, diagnostic, and treatment strategies and skills, as well as science-based practice techniques for trainees. Learner survey results and the sustained offering of the seminar suggest the format and goals of the seminar are feasible and acceptable. Based on the current preliminary findings, similar training programs may find benefit in strategies to enhance integrated training opportunities for psychiatry and psychology trainees.

Transitioning from specialisation to collaboration: interprofessional clinical simulation, metacognition and the phenomenon of convergence

Research into metacognitive processes within interprofessional clinical simulation has been largely overlooked in the literature. This study explores how interprofessional simulation may influence cognitive and metacognitive processes across several professional programmes; medicine, nursing, pharmacy, and occupational therapy. This study focused on changes in performance pre- and post-simulation, with undergraduate students from each profession answering a set of questions related to the simulation case, requiring specialized knowledge from each profession. Question scores, item confidence judgment ratings, and calibration values were collected and analyzed. The data revealed a pattern of convergence in post-simulation assessments, where professions initially with lower performance in the pre-simulation phase improved, and those initially performing well demonstrating a decline in performance. Calibration values indicated that medical students developed metacognitive errors from their interactions in the simulation, which were not present pre-simulation, and that occupational therapy students suffered a loss of confidence and calibration in questions within their own field resulting from their experience (being more accurate pre-simulation). The authors anticipate that the phenomenon of convergence may have longer-term consequences, potentially fostering distrust among professions for those with declining performance. The authors propose that expanding awareness of convergence phenomena and conducting repeated simulations (thus facilitating further team development) could mitigate this issue.

How do mandatory emergency medicine rotations contribute to the junior residents' professional identity formation: a qualitative study

BACKGROUND

This study aims to investigate the impact of short-term mandatory emergency medicine rotations on professional identity formation of Japanese junior residents. Using situated learning theory as a theoretical framework, we explore how this rotation, which is part of a two-year Junior residency in the transition period from students to qualified physicians.

METHODS

We conducted a qualitative study conducting semi-structured face-to-face interviews with Year 1 postgraduate residents in the 2020-2021 classes of the junior residency program in Okinawa Chubu Hospital, Japan (n = 10). The data obtained from the interviews were analysed using inductive thematic analysis to identify the themes regarding professional identity formation.

RESULTS

Four main themes regarding professional identity formation emerged from the data analysis: patient care, teamwork, role models, and peers. Junior residents said they had the opportunity to participate in the emergency department community and experience training in authentic clinical contexts. Clinical exposure influenced the professional identity formation of the junior residents. Nurses and peers played a crucial role in this. Junior residents see the training in the emergency department as the beginning of their careers.

CONCLUSION

Short-term mandatory rotations enabled junior residents to integrate into the emergency department community, demonstrating autonomy and responsibility. These experiences fostered their professional identity by helping their socialisation within the community of practice.

Psychometric evaluation of the Australian interprofessional socialisation and valuing scale: An invariant measure for health practitioners and students

OBJECTIVES

This study aimed to evaluate the psychometric properties of the Australian Interprofessional Socialisation and Valuing Scale (ISVS)-21 and provide an invariant measure for health practitioners and students to assess interprofessional socialisation.

METHODS

The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were used as guidelines. This research began with a key step: conducting a pilot study to assess content validity, a requirement of COSMIN for item development. The ISVS-21 has not yet been validated in Australia. Content validity checks ensure the developed items accurately represent the measured construct in the intended cultural context. In addition to conducting more comprehensive tests of psychometric properties compared to previous studies on ISVS-21, this paper introduces something new by evaluating the internal structure of the instrument involving measurement invariance and hypothesis testing for construct validity based on several assumptions related to interprofessional socialisation and values. An invariant measure validates the use of the Australian ISVS-21 on practitioner and student equivalently, allowing the comparison of outcomes at both levels.

RESULTS

The evaluation of content validity indicated that the items were relevant, comprehensible (practitioners and students had an agreement score of >70% for all 21 items), and comprehensive to the concepts intended to be measured. Structural validity confirms ISVS-21 Australia as unidimensional, with good internal consistency reliabilities, Cronbach's α scores = 0.96 (practitioner) and 0.96 (student). Measurement invariance tests confirm ISVS-21 Australia is configural, metric and scalar invariance (ΔCFI ≤ 0.01) across the tested groups of practitioner and student, and therefore suitable for use by both cohorts in Australia. Age and length of work/study were discriminant factors for interprofessional socialisation in both cohorts; the professional background was a differentiating factor for practitioners but not for students. Hypotheses testing results support the COSMIN construct validity requirement for the measure, with 83.3% of assumptions tested accepted.

CONCLUSION

The Australian ISVS has good psychometric properties based on evaluating the content validity, internal structure, and hypotheses testing for construct validity. In addition, Australian ISVS is an invariant measure for use by health practitioners and students and, therefore, confirmed as a quality measure to assess interprofessional socialisation for both cohorts in Australia.

Exploring the dark side of informal mentoring: Experiences of nurses and midwives working in hospital settings in Uganda

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions of 35 nurses and midwives from three public hospitals located in the Western, Northern and North-western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self-improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity.

An evaluation of the psychometric properties of the Australian Collaborative Practice Assessment Tool

OBJECTIVES

This study aimed to validate the Collaborative Practice Assessment Tool (CPAT) in the Australian setting and provide a quality instrument in terms of psychometric properties that can be used to measure interprofessional outcomes for both healthcare practitioners and students. The outcomes evaluated include the capacity to work in an interprofessional team, good interprofessional communication skills, leadership skills, ensuring clear division of tasks and roles in a team, effective conflict management, and being actively involved with patients and their families/communities in care.

METHODS

The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) taxonomy and standards were used as guides for evaluating the psychometric properties of the Australian CPAT, which include evaluations regarding instrument development requirements of sample target and size, content validity, internal structure (structural validity, internal consistency reliability and measurement invariance), and hypotheses testing. CPAT Australia was developed through two stages involving pilot studies and a validation study, both of which included healthcare practitioners and students as participants. A pilot study examined content validity regarding item relevance, item comprehensibility, and instrument comprehensiveness. The validation study was carried out to assess the internal structure of CPAT Australia for aspects of structural validity, internal consistency reliabilities, and configural, metric and scalar measurement invariance. The structural validity was explored using the following three steps: exploratory, confirmatory, and multi-group factor analysis. Construct validity was evaluated to confirm direct and indirect paths of assumptions based on a previously validated model. Data collected between August 2021 and May 2022.

RESULTS

The content validity evaluation confirmed that all items were relevant, understandable and comprehensive for measuring interprofessional collaborative care in Australia. Three hundred ninety-nine participants contributed to the validation study (n=152 practitioners; n=247 students). The original instrument model of 8-Factor 56-Item was improved in the Australian CPAT. Two items, Item 27 (Physicians assume the ultimate responsibility) and Item 49 (Final decision rest with the physician), were consistently rejected and therefore discarded. The internal structure of the 7-Factor 54-Item solution was confirmed as a suitable model with fit indices meeting COSMIN standards for a good model in practitioner and student cohorts. Configural, metric and scalar invariances were confirmed, indicating the invariance of the instruments when used for the practitioner and student cohorts. The construct validity evaluation indicated that 81.3% of direct and indirect assumptions were accepted, fulfilling the COSMIN requirement of >75% of proposed assumptions being accepted.

CONCLUSION

The Australian CPAT with a 7-factor 54-item solution was confirmed as a quality measure for assessing interprofessional education and collaborative practice for both healthcare practitioners and students in Australia with robust psychometric properties.

Preaching Through the Choir. What Interprofessional Education Can Learn From Choir Singing

Collaboration between healthcare professionals from different backgrounds is a true art to be mastered. During interprofessional education (IPE), learners from different professions learn with, from and about each other. Landscape of Practice (LoP) theory can offer insight into social learning in IPE, but its application is rather complex. We argue that choir singing offers a helpful metaphor to understand different concepts in LoP (brokers, engagement, imagination and alignment) and how they are manifested in IPE. Based on similarities between choir singing and IPE, we present four lessons: 1) The teacher sets the tone: a lesson for brokers; 2) You can only learn so much alone: a lesson for engagement; 3) Listening is not as easy as it sounds: a lesson for imagination and 4) A song is more than the sum of its parts: a lesson for alignment. Moreover, we reflect on differences between choir singing and IPE, and insights from these differences.

How relational leadership can enhance nurses' well-being and productivity

Leadership is an essential skill in nursing and has a fundamental role in ensuring high-quality patient care and the effective functioning of healthcare systems. Effective nursing leadership is vital to support nursing teams as they negotiate the challenges confronting the profession, such as ageing populations and the increased use of healthcare technology. This article discusses various relational leadership styles that can be used to promote nurses' health and well-being and enhance productivity. The author also explores the benefits and challenges of implementing relational leadership in nursing.

Exploring value creation in a virtual community of practice: a framework analysis for knowledge and skills development among primary care professionals

BACKGROUND

Healthcare professionals traditional education reflects constraints to face the complex needs of people with chronic diseases in primary care settings. Since more innovative and practical solutions are required, Virtual Community of Practices (vCoP) seem to better respond to learning updates, improving professional and organizational knowledge. However, little is known about the value created in vCoPs as social learning environments. The objective of this project was to explore the value creation process of a gamified vCoP ("e-mpodera vCoP") aimed at improving the knowledge and attitudes of primary healthcare professionals (PCPs) (nurses and general practitioners) to the empowerment of people with chronic conditions.

METHODS

A framework analysis assessed the value creation process using a mixed methods approach. The framework provided awareness about knowledge and usefulness in a learning community through five cycles: (1) immediate value, (2) potential value, (3) applied value, (4) realized value, and (5) reframing value. Quantitative data included vCoP analytics such as logins, contributions, points, badges, and performance metrics. Qualitative data consisted of PCPs' forum contributions from Madrid, Catalonia, and Canary Islands over 14 months.

RESULTS

A total of 185 PCPs had access to the e-mpodera vCoPs. The vCoP showed the dynamic participation of 146 PCPs, along 63 content activities posted, including a total of 3,571 contributions (including text, images, links to webpages, and other files). Regarding the value creation process, the e-mpodera vCoP seems to encompass a broad spectrum of value cycles, with indicators mostly related to cycle 1 (immediate value - activities and interactions) and cycle 2 (potential value - knowledge capital); and to a lesser extent for cycle 3 (applied value - changes in practice) and for cycle 4 (realized value - performance improvement). The presence of indicators related to cycle 5 (reframing value), was minimal, due to few individual redefinitions of success.

CONCLUSION

To reach a wider range of value possibilities, a combination of learning objectives, competence framework, challenged-based gamified platform, and pathway model of skill development seems crucial. However, additional research is required to gain clearer insights into organizational values, professionals' lifelong educational needs in healthcare, and the long-term sustainability of performance improvement.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02757781. Registered on 02/05/2016.

Providing Gender Sensitive and Responsive Trauma-Informed Psychiatric Nursing Care. How Hard Can It Be?

This paper addresses the challenge of providing gender sensitive and responsive trauma-informed care (TIC) in psychiatric nursing practice. Gender identity, gender subordination, and gender-related trauma history are examined as three key individual-level factors that affect nurses' capacity to engage therapeutically to provide gender sensitive and responsive TIC. Using Peplau's Interpersonal Theory and building on a shared trauma and resilience model, gender-sensitive and responsive TIC is situated within interpersonal science and the ability of the psychiatric nurse to attune to her own and her patient's gender ideologies. Strategies for transforming practice including self-reflection, self-compassion, and peer and supervisor support are reviewed. Noting the import of the practice environment, several observations of changes needed at the level of the unit, organization, and society to effect gender equitable policies that enable the implementation of gender-sensitive and responsive TIC are made.

A systematic review critically appraising quantitative survey measures assessing power dynamics among multidisciplinary teams in acute care settings

By valuing the knowledge of each discipline holistic patient-centered care can be achieved as decisions arise from expertise rather than established hierarchies. While healthcare has historically operated as a hierarchical power structure (i.e., some voices have more influence), these dynamics are rarely discussed. This review addresses this issue by appraising extant quantitative measures that assess multidisciplinary team (MDT) power dynamics. By identifying psychometrically sound measures, change agents can uncover the collective thought processes informing power structures in practice and develop strategies to mitigate power disparities. Several databases were searched. English language articles were included if they reported on quantitative measures assessing power dynamics among MDTs in acute/hospital settings. Results were synthesized using a narrative approach. In total, 6,202 search records were obtained of which 62 met the eligibility criteria. The review reveals some promising measures to assess power dynamics (e.g., Interprofessional Collaboration Scale). However, the findings also confirm several gaps in the current evidence base: 1) need for further psychometric and pragmatic testing of measures; 2) inclusion of more representative MDT samples; 3) further evaluation of unmatured power dimensions. Addressing these gaps will support the development of future interventions aimed at mitigating power imbalances and ultimately improve collaborative working within MDTs.

Clinical Interprofessional Education in Inpatient Pharmacy: Findings From a Secondary Analysis of a Scoping Review

OBJECTIVES

Clinical interprofessional education (IPE) is defined as learning that occurs within clinical learning environments such as hospitals, primary care clinics, and long-term care facilities where learners collaborate to deliver care to real patients. The objective of this secondary analysis of a scoping review is to identify, characterize, and summarize evidence from the published literature regarding clinical IPE for pharmacy learners in the inpatient setting.

FINDINGS

PubMed, CINAHL, and Scopus databases were searched for clinical IPE articles that met the following inclusion criteria: ≥ 2 health professions, ≥ 2 learner groups, and involvement of real patients/patient care. For this secondary analysis, 12 articles involving pharmacy learners in an inpatient setting were included. The most common interprofessional partner was medicine (66%), and the median number of student participants involved in the activity was 19 (range, 10-525). Five studies conducted clinical IPE in the context of advanced pharmacy practice experiences. Clinical IPE activities were described primarily as inpatient rounding with the medical team, but were often outside the normal clinical workflow (66%). Incorporation of Interprofessional Education Collaborative competencies was limited, as was the use of validated IPE assessment tools to measure outcomes.

SUMMARY

Current literature is limited in reports of pharmacy learner involvement in inpatient clinical IPE. Expansion of pharmacy partnerships and alignment of team outcomes with the Interprofessional Education Collaborative competencies are needed to demonstrate the relationship between clinical IPE and patient care outcomes within established workflows.

Preparing Medical and Nursing Students for Interprofessional Feedback Dialogues

Background

In healthcare education, preparing students for interprofessional feedback dialogues is vital. However, guidance regarding developing interprofessional feedback training programs is sparse. In response to this gap, the Westerveld framework, which offers principles for interprofessional feedback dialogue, was developed.

Approach

Using the Westerveld framework, we developed and implemented an interprofessional feedback intervention for 4th-year nursing and 5th-year medical students. It encompasses two half-day workshops comprising small group sessions, interactive lectures, and a goal-setting assignment for the rotations. This paper describes the intervention and reflects on students' self-reported goals, as learning outcomes, to inform future interprofessional feedback dialogue education.

Outcomes

To understand student's learning outcomes, we coded the content and specificity of 288 responses to the goal-setting assignment. Students indicated they mainly aimed to improve their feedback actionability, but contrastingly set - largely unspecific - goals, addressing the initiation of feedback dialogues. To better understand the process of setting these goals, we held three focus groups (N = 11): aside from the Westerveld framework, students used previous experience in rotations, outcome expectations, and personal characteristics as sources in their goal-setting process.

Reflection

The contrast between students' aims to improve their actionability and their goals to initiate dialogues, suggests that overcoming practice barriers to initiating dialogues are conditional to developing other feedback dialogue aspects. These and other goal conflicts in the workplace may hinder them setting specific feedback dialogue goals. We recommend explicit discussion of these challenges and conflicts in interprofessional feedback dialogue education.

Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis

OBJECTIVE

To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DESIGN

Systematic review with meta-synthesis.

DATA SOURCES

Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus.

ELIGIBILITY CRITERIA

Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis.

RESULTS

Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services.

CONCLUSION

Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.

Are the stars aligned? Healthcare students' conditions for negotiating tasks and competencies during interprofessional clinical placement

BACKGROUND

Healthcare students must learn to collaborate across professional boundaries so they can make use of each other's knowledge and competencies in a way that benefits the patient. One aspect of interprofessional collaboration implies negotiating what needs to be done and by whom. Research, focused on the conditions under which students perform this negotiation when they are working together during interprofessional clinical placement, needs to be further developed. The study therefore aimed to explore students' negotiation of tasks and competencies when students are working together as an interprofessional team during clinical placement.

METHODS

The study was designed as a focused ethnographic observational study. Two Nordic sites where final-year healthcare students perform clinical interprofessional education were included. Data consists of fieldnotes, together with informal conversations, group, and focus group interviews. In total, 160 h of participating observations and 3 h of interviews are included in the study. The analysis was informed by the theory on communities of practice.

RESULTS

Students relate to intersecting communities of practice when they negotiate what they should do to help a patient and who should do it. When the different communities of practice align, they support students in coming to an agreement. However, these communities of practice sometimes pulled the students in different directions, and negotiations were sometimes interrupted or stranded. On those occasions, observations show how the interprofessional learning practice conflicted with either clinical practice or one of the student's profession-specific practices. Conditions that had an impact on whether or not communities of practice aligned when students negotiated these situations proved to be 'having time to negotiate or not', as well as 'feeling safe or not'.

CONCLUSIONS

Final-year healthcare students can negotiate who in the team has the competence suited for a specific task. However, they must adapt their negotiations to different communities of practice being enacted at the same time. Educators need to be attentive to this and make an effort to ensure that students benefit from these intersecting communities of practice, both when they align and when they are in conflict.

Interprofessional communication in a psychiatric outpatient unit - an ethnographic study

BACKGROUND

Communication in healthcare has been extensively studied, but most research has focused on miscommunication and the importance of communication for patient safety. Previous research on interprofessional communication has mainly focused on relationships between physicians and nurses in non-psychiatric settings. Since communication is one of the core competencies in psychiatric care, more research on interprofessional communication between other clinicians is needed, and should be explored from a broader perspective. This study aimed to explore and describe interprofessional communication in a psychiatric outpatient unit.

METHOD

During spring 2022, data consisting of over 100 h of fieldwork were collected from observations, formal semi-structured interviews and informal conversations inspired by the focused ethnography method. Data was collected at an outpatient unit in central Sweden, and various clinicians participated in the study. The data analysis was a back-and-forth process between initial codes and emerging themes, but also cyclical as the data analysis process was ongoing and repeated and took place simultaneously with the data collection.

RESULTS

We found that a workplace's history, clinicians´ workload, responsibilities and hierarchies influence interprofessional communication. The results showed that the prerequisites for interprofessional communication were created through the unit's code of conduct, clear and engaging leadership, and trust in the ability of the various clinicians to perform new tasks.

CONCLUSION

Our results indicate that leadership, an involving working style, and an environment where speaking up is encouraged and valued can foster interprofessional communication and respect for each other´s professional roles is key to achieving this. Interprofessional communication between different clinicians is an important part of psychiatric outpatient work, where efficiency, insufficient staffing and long patient queues are commonplace. Research can help shed light on these parts by highlighting aspects influencing communication.

Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes

BACKGROUND

Collaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes.

METHODS

DBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles.

RESULTS

Eight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment.

CONCLUSION

This article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.

Exploring healthcare staff narratives to gain an in-depth understanding of changing multidisciplinary team power dynamics during the COVID-19 pandemic

BACKGROUND

Multidisciplinary teams (MDTs) are integral to healthcare provision. However, healthcare has historically adopted a hierarchical power structure meaning some voices within the MDT have more influence than others. While power dynamics can influence interprofessional communication and care coordination, the field's understanding of these power structures during the COVID-19 pandemic is limited.

METHODS

Adopting a narrative inquiry methodology, this research addresses this knowledge gap and provides an in-depth understanding of MDT power dynamics during COVID-19. Using semi-structured interviews (n = 35) and inductive thematic analysis, this research explores staff perspectives of changing power dynamics in MDTs during the pandemic response.

RESULTS

An in-depth analysis generated three overarching themes: (1) Healthcare: a deeply embedded hierarchy reveals that while a hierarchical culture prevails within the Irish health system, staff perceptions of influence in MDTs and 'real' experiences of autonomy differ significantly. (2) Team characteristics: the influence of team structure on MDT power dynamics highlights the impact of organisational structures (e.g., staff rotations) and local processes (e.g., MDT meeting structure) on collaborative practice. (3) Ongoing effort to stimulate true collaboration underscores the importance of ongoing interprofessional education to support collaborative care.

CONCLUSION

By offering a greater understanding of MDT power dynamics throughout the COVID-19 pandemic, this research supports the development of more appropriate strategies to promote the provision of interprofessional care in practice.

Realist review of interprofessional education for health care students: What works for whom and why

Interprofessional education (IPE) programs, are complex, logistically challenging, and can be expensive to deliver, but these matters are offset by the perceived benefits of IPE. There is little clarity regarding how IPE contributes to the desirable development of collaborative practitioners. To guide educators in the design of IPE programs there is a need to understand the elements that promote optimal learning. A realist review was conducted to identify the mechanisms and resources that contribute to IPE outcomes. Four databases were searched until April 2020 for empirical studies describing mandatory IPE for pre-registration medical, nursing and other health professional students. Twelve articles met the inclusion criteria. Two novel learning design elements were identified; interdependence, where there is a need for genuine contribution of skills and knowledge from the professions learning together to successfully complete tasks, and embodiment, where through being immersed in an authentic scenario, learners feel what it is like to work in their professions. Other observations supported previous research findings such as the importance of skilled facilitators to promote interaction and reflection. Interprofessional interventions incorporating these specific learning design features seem likely to enhance the impact of IPE, thus making the best use of limited institutional resources and student time.

Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers

Interprofessional simulation-based education (IP-SBE) supports the acquisition of interprofessional collaborative competencies. Psychologically safe environments are necessary to address socio-historical hierarchies and coercive practices that may occur in IP-SBE, facilitating fuller student participation. A scoping review was conducted to understand the barriers and enablers of psychological safety within IP-SBE. Research papers were eligible if they included two or more undergraduate and/or post-graduate students in health/social care qualifications/degrees and discussed barriers and/or enablers of psychological safety within simulation-based education. Sources of evidence included experimental, quasi-experimental, analytical observational, descriptive observational, qualitative, and mixed-methodological peer-reviewed studies. English or English-translated articles, published after January 1, 1990, were included. Data were extracted by two members of the research team. Extraction conflicts were resolved by the principal investigators. In total, 1,653 studies were screened; 1,527 did not meet inclusion criteria. After a full-text review, 99 additional articles were excluded; 27 studies were analyzed. Psychological safety enablers include prebriefing-debriefing by trained facilitators, no-blame culture, and structured evidenced-based simulation designs. Hierarchy among/between professions, fear of making mistakes, and uncertainty were considered barriers. Recognition of barriers and enablers of psychological safety in IP-SBE is an important first step towards creating strategies that support the full participation of students in their acquisition of IPC competencies.

Provider beliefs about the ideal design of an opioid deprescribing and substitution intervention for older adults

PURPOSE

Opportunities exist to meaningfully reduce suboptimal prescription opioid use among older adults. Deprescribing is one possible approach to reducing suboptimal use. Appropriate interventions should outline how to carefully taper opioids, closely monitor adverse events, substitute viable alternative and affordable nonopioid pain treatments, and initiate medications for opioid use disorder to properly manage use disorders, as needed. We sought to document and understand provider perceptions to begin developing effective and safe opioid deprescribing interventions.

METHODS

We conducted 3 semistructured focus groups that covered topics such as participant perspectives on opioid deprescribing in older adults, how to design an ideal intervention, and how to identify potential barriers or facilitators in implementing an intervention. Focus group transcripts were double coded and qualitatively analyzed to identify overarching themes.

RESULTS

Healthcare providers (n = 17), including physicians, pharmacists, nurses, social workers, and administrative staff, participated in 3 focus groups. We identified 4 key themes: (1) involve pharmacists in deprescribing and empower them as leaders of an opioid deprescribing service; (2) ensure tight integration and close collaboration throughout the deprescribing process from the inpatient to outpatient settings; (3) more expansive inclusion criteria than age alone; and (4) provision of access to alternative pharmacological and nonpharmacological pain management modalities to patients.

CONCLUSION

Our findings, which highlight various healthcare provider beliefs about opioid deprescribing interventions, are expected to serve as a framework for other organizations to develop and implement interventions. Future studies should incorporate patients' and family caregivers' perspectives.

Exploring interprofessional communication during nursing home emergencies using the SBAR framework

Communication breakdowns during emergencies threaten patient safety. In nursing homes (NHs) vulnerable residents may experience emergencies at any time. Concerns over clinical complexity and diverse communication styles among interprofessional practitioners heighten the need for standardized methods to improve practitioners' communication skills. This study explores communication structures among 32 practitioners in four NHs using in-depth interviews following a formalized Situation-Background-Assessment-Recommendation (SBAR) framework. Network analysis, a deductive approach to qualitative data analysis, and case analysis were performed for a comprehensive understanding of interprofessional communication in 48 emergency cases identified during interviews. Findings identified the flow of information, messaging, and management strategies that were expected of receivers during interprofessional communication. These results could help develop training regimens or guidelines to improve cooperative interprofessional communication, allowing practitioners to provide appropriate emergency care for NH residents.

Elucidating the Ruling Relations of Nurses' Work in Labor and Delivery: An Institutional Ethnography

Obstetrics is a well-known area for malpractice and medical-legal claims, specifically as they relate to injuries the baby suffers during the intrapartum period. There is a direct implication for nurses' work in labor and delivery because the law recognizes that monitoring fetal well-being during labor is a nursing responsibility. Using institutional ethnography, we uncovered how two powerful ruling discourses, namely biomedical and medical-legal risk discourses, socially organize nurses' fetal surveillance work in labor and delivery through the use of an intertextual hierarchy and an ideological circle.

Effects of Inclusive Leadership on Quality of Care: The Mediating Role of Psychological Safety Climate and Perceived Workgroup Inclusion

Purpose: The aim of the study is to investigate the multilevel effects of the inclusiveness of workgroup leaders on quality of care by intervening through a “psychological safety climate” at the group level and “perceived workgroup inclusion” at the individual level within professionally diverse workgroups of healthcare professionals. Material and Methods: Data are collected from 305 healthcare professionals nested in 61 workgroups and 305 patients treated by the same workgroups working in public-sector hospitals in Pakistan. Hypothesized relationships are tested through multilevel analyses using Mplus 7. Results: The results of the study show that inclusive leadership can enhance the quality of care delivered by multiprofessional workgroups of healthcare professionals through perceived workgroup inclusion. Further, the psychological safety climate does not mediate the relationship between inclusive leadership and quality of care individually, but it transmits the effects of inclusive leadership through perceived workgroup inclusion on quality of care. Conclusion: The results of the study suggest that the inclusiveness of workgroup leaders, the psychological safety climate, and perceived workgroup inclusion can create safe and inclusive interpersonal mechanisms that play a key role in transmitting the positive effects of inclusive leadership on quality of care.

Defining and Implementing Value-Based Healthcare for Older People from a Geriatric and Gerontological Perspective

The world's population is ageing at a faster rate than ever before; it is estimated that there are currently over 1 billion people aged 60 years or older, mostly living in low- and middle-income countries [...].

Exploring implicit influences on interprofessional collaboration: a scoping review

Interprofessional collaboration (IPC) is fraught with multiple tensions. This is partly due to implicit biases within teams, which can reflect larger social, physical, organizational, and historical contexts. Such biases may influence communication, trust, and how collaboration is enacted within larger contexts. Despite the impact it has on teams, the influence of bias on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within interprofessional teams. Using scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, selecting 159 articles for full-text eligibility. From these, reviewers extracted, coded, and iteratively analyzed key data using a framework derived from socio-material theories. Authors found that many studies demonstrated how biases regarding dominance and expertise were internalized by team members, influencing collaboration in predominantly negative ways. Articles also described how team members dynamically adapted to such biases. Overall, there was a paucity of research that described material influences, often focusing on a single material element instead of the dynamic ways that humans and materials are known to interact and influence each other. In conclusion, implicit biases are relatively under-explored within IPC. The lack of research on material influences and the relationship among racial, age-related, and gender biases are critical gaps in the literature. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings.

"We Are All Just Walking Each Other Home": Exploring the Lived Experiences of Rural Hospice Social Workers in "Companioning" the Dying

Social workers play a critical role on the hospice team including assessing risk and safety, advocacy, grief counseling, referral and connection to resources and providing guidance through advance care planning and advance directives. However, the voice of the rural hospice social worker is often absent from research. To address this gap in the literature, this study aimed to explore lived experiences of rural hospice social workers to better understand their role and challenges. Non-experimental qualitative research design was used for this study. Data was collected through in-depth qualitative interviews. A total of 19 rural hospice social workers participated in the study. We used a phenomenological approach focusing on the common lived experiences of rural hospice social workers and thus interviews were unstructured. Field notes and data were collected until data saturation was achieved. Five main themes were identified: (1) meaning of hospice social work, (2) role of hospice social workers, (3) vulnerability and realness, (4) self-care, and (5) rural culture. Based on these findings, we identified recommendations for hospice social work practice, research and policy, in general, as well as for rural hospice social work specifically. Future research could explore lived experiences of hospice professionals or of the dying and could also explore social worker experience of resource barriers.

For the interprofessional management of the discomfort of long-term care facility residents with dementia

Educating interprofessional practitioners in long-term care facilities (LTCFs) is critical for managing discomfort of residents with dementia, which is often unnoticed and undertreated. A framework of education on discomfort management that is applicable in various environments in different facilities is necessary. We developed a preliminary framework to educate interprofessional practitioners on discomfort management of dementia residents in LTCFs. We conducted a three-step research process: a literature review using topic modeling, in-depth interviews, and Delphi surveys. We derived four categories for an interprofessional approach toward discomfort management education in LTCFs: identifying visual and nonvisual signs to communicate among professionals, close observation using comparison and contrast to share information for discomfort care, harmony in interprofessional roles, and applying common and specific professional knowledge for discomfort management. The findings provide the first outline for an educational framework for interprofessional discomfort management in LTCFs for residents with dementia. We recommend interventions across different cultures to verify the framework in future research.

Striving for high reliability in healthcare: a qualitative study of the implementation of a hospital safety programme

BACKGROUND

Healthcare leaders look to high-reliability organisations (HROs) for strategies to improve safety, despite questions about how to translate these strategies into practice. Weick and Sutcliffe describe five principles exhibited by HROs. Interventions aiming to foster these principles are common in healthcare; however, there have been few examinations of the perceptions of those who have planned or experienced these efforts.

OBJECTIVE

This single-site qualitative study explores how healthcare professionals understand and enact the HRO principles in response to an HRO-inspired hospital-wide safety programme.

METHODS

We interviewed 71 participants representing hospital executives, programme leadership, and staff and physicians from three clinical services. We observed and collected data from unit and hospital-wide quality and safety meetings and activities. We used thematic analysis to code and analyse the data.

RESULTS

Participants reported enactment of the HRO principles 'preoccupation with failure', 'reluctance to simplify interpretations' and 'sensitivity to operations', and described the programme as adding legitimacy, training, and support. However, the programme was more often targeted at, and taken up by, nurses compared with other groups. Participants were less able to identify interventions that supported the HRO principles 'commitment to resilience' and 'deference to expertise' and reported limited examples of changes in practices related to these principles. Moreover, we identified inconsistent, and even conflicting, understanding of concepts related to the HRO principles, often related to social and professional norms and practices. Finally, an individualised rather than systemic approach hindered collective actions underlying high reliability.

CONCLUSION

Our findings demonstrate that the safety programme supported some HRO principles more than others, and was targeted at, and perceived differently across professional groups leading to inconsistent understanding and enactments of the principles across the organisation. Combining HRO-inspired interventions with more targeted attention to each of the HRO principles could produce greater, more consistent high-reliability practices.

Tips for Managing Ethical Challenges in Advance Care Planning: A Qualitative Analysis of Japanese Practical Textbooks for Clinicians

(1) Background: While advance care planning (ACP) provides healthcare professionals with valuable tools to meet patients’ needs in a person-centered manner, several potential ethical challenges are inherent to the process. However, recent studies have largely focused on ACP practicalities such as implementation, execution, and completion rather than on the ethical challenges that clinicians routinely encounter in ACP practices. (2) Research question/aim/objectives: This study aimed to identify tips for clinicians managing ethical challenges in ACP practices. (3) Methods: It performed a brief search for all Japanese published books pertaining to ACP practice available as of January 2021 using the keywords “advance care planning (ACP)” and “autonomy” and analyze the content of nine practical ACP textbooks for clinicians. (4) Results: Two major themes capturing the essential recommendations for managing ethical challenges in ACP were ultimately identified, namely interprofessional ethics and informed consent. (5) Conclusion: The findings suggested tips for managing ethical challenges in ACP: refer to ethical frameworks for interprofessional collaboration and ethical decision making, assess decision-making capacity of family substitute decision makers and one’s eligibility for the role, understand the standard process of informed consent and how to handle situations when the patient are not well informed about the diagnosis and prognosis of non-cancer illness.

The effect of the humanistic care teaching model on nurse patient conflict and nurse turnover intention in a pediatric outpatient department: results of a randomized trial

BACKGROUND

This study was carried out based on the background that sharp nurse-patient conflicts in the pediatric outpatient department lead to a high turnover rate of nurses.

METHODS

A total of 68 nurses working in the pediatric outpatient department of Xiangyang No. 1 People's Hospital were selected as the study subjects, and randomly divided into an experimental group (n=34) and a control group (n=34). Nurses in the control group received a traditional pediatric nursing teaching model, while those in the experimental group received a traditional pediatric nursing teaching model combined with the humanistic care teaching model. The effect of these two nursing teaching models on nurse-patient conflicts in the pediatric outpatient department and the turnover intention of nurses was then compared and analyzed.

RESULTS

There were no significant differences in personal information between the two groups (P>0.05). The strain capacity, operational capacity, nurse-patient communication skills, autonomous learning ability, and teamwork ability of the nurses in the experimental group after training were significantly higher than those in the control group (P<0.05). Both groups after training had significantly higher scores on a professional identity scale than before training, and nurses in the experimental group had significantly higher scores of professional identity than those in the control group (P<0.001). The turnover intention of the nurses in the experimental group were significantly lower than those in the control group (P<0.001). The problem solving ability of nurses in the experimental group was significantly better than that in the control group (P<0.001). Scores in the domains of waiting to see the doctor, the health knowledge education, the ward environment, and nursing quality of nurses in `the experimental group were significantly higher than those in the control group (P<0.001).

CONCLUSIONS

The humanistic care teaching model can significantly improve the professional identity and problem solving ability of nurses in facing different nurse-patient conflicts with significant effect and is worthy of application and popularization in clinical nursing teaching.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100048751.

Interprofessional collaboration between different health care professions in Emilia Romagna

BACKGROUND

Interprofessional collaboration in the healthcare sector contributes to the delivery of high quality and safe services to patients across different subdivisions of the healthcare system which is faced with constant challenges. The international literature offers a plethora of tools for assessing the collaboration between health workers, but only a few of these have been validated in the Italian language. One that has undergone such validation is the interprofessional collaboration (IPC) scale, which measures the perception of collaboration among health professionals. An advantage of this scale is that is addresses all workers within the system, and is not limited to specific professions. The aim of the present study was to apply the validated Italian version of the IPC scale, to a context different to the one used for its validation, to measure the level of collaboration between different health care workers.

METHOD

A questionnaire-based study was conducted on a sample consisting of 329 health professionals working at Azienda USL-IRCCS in Reggio Emilia. The categorical and continuous variables were analysed using descriptive statistics (frequencies, percentages and SD).

RESULTS

The IPC scale showed physicians to express the highest level of collaboration with other professionals, in line with the results of other studies in the literature. The values calculated for the factors "accommodation" and "communication" were higher than for "isolation", depicting a good level collaboration. The only case in which the isolation factor, which describes an absence of collaboration, was equal to the other two factors was in relation to the evaluation of midwives by nursing aides/orderlies.

CONCLUSIONS

In conclusion, the Italian version of the IPC scale provides a useful instrument for measuring interprofessional collaboration between workers in the healthcare sector. In the present study, it revealed a satisfactory level of collaboration between health professionals in an organization located in Emilia Romagna, Italy.

A systematic review exploring the impact of focal leader behaviours on health care team performance

AIM

The aim of this study is to understand how the behaviour of focal leaders impacts health care team performance and effectiveness.

BACKGROUND

Despite recent shifts towards more collectivistic leadership approaches, hierarchical structures that emphasize the role of an individual focal leader (i.e., the formal appointed leader) are still the norm in health care. Our understanding of the effect of focal leader behaviours on health care team performance remains unclear.

EVALUATION

A systematic review was conducted. Five electronic databases were searched using key terms. One thousand forty-seven records were retrieved. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

KEY ISSUES

Fifty papers met the criteria for inclusion, were reviewed and synthesized under the following categories: task-focused leadership, directive leadership, empowering leadership and relational focused leadership.

CONCLUSIONS

Categories are discussed in relation to team performance outcomes, safety specific outcomes, individual-level outcomes and outcomes related to interpersonal dynamics. Emerging themes are explored to examine and reflect on how leadership is enacted in health care, to catalogue best practices and to cascade these leadership practices broadly.

IMPLICATIONS FOR NURSING MANAGEMENT

Empowering and relational leadership styles were associated with positive outcomes for nursing team performance. This underscores the importance of training and encouraging nursing leaders to engage in more collaborative leadership behaviours.

"A real eye opener" - development, implementation and evaluation of a seminar on interprofessional teamwork in GP specialty training

Introduction: The successful treatment of a multitude of chronic diseases is largely dependent on effective interprofessional collaboration. In Germany, many healthcare employees feel unprepared for the challenges of interprofessional teamwork. Can a seminar designed by an interprofessional team for an interprofessional target group improve mutual understanding and provide the basis for successful interprofessional collaboration? Methodological approach: For the development of the seminar, Kern's model for curriculum development was used, which includes the following six steps: problem identification, needs analysis, goal definition (learning objectives and learning content), educational strategies, implementation and evaluation. The all-day event brought together physiotherapists, pharmacists, medical assistants and doctors undergoing specialist training in family medicine. Representatives of the various professions were recruited through multiple channels (associations, pharmacist societies, alumni-networks, etc.). Practical examples and role-play were used to develop a better understanding of each other's professions and to support goal-oriented and appreciative communication among them. The seminar belongs to the curriculum provided by the Hesse Competence Center for Specialist Training in General Practice and has so far taken place three times. The evaluation was carried out by means of a detailed, self-designed questionnaire with five open and 20 closed questions. The statistical analysis was mainly descriptive (mean value, minimum, maximum and SD). Results: Overall, 29 persons have participated in the workshops (eleven doctors undergoing specialist training, six physiotherapists, six pharmacists, six medical assistants). Overall, the seminar was rated very highly. Individual aspects of the seminar's design, such as relevance and practice-orientation, as well as an assessment of whether the seminar contributed towards increasing participants' ability to collaborate with other professionals, were rated positively. In addition, a pre-post comparison of self-assessed ability to collaborate interprofessionally showed significant improvement. Discussion: This highly interactive one-day seminar design contributed towards improving understanding for other professions and communication skills. In order to achieve a broad-based improvement in interprofessional collaboration over the long term, this or similar concepts should be employed more extensively. Conclusions: The results suggest that participants in interprofessional seminars consider them to improve interprofessional collaboration.

The impact of intersectionality on nursing leadership, empowerment and culture: A case study exploring nurses and managers' perceptions in an acute care hospital in Aotearoa, New Zealand

AIM

This study determines whether the culture within an acute care hospital empowers 'all' nurses to be leaders by exploring intersectionality and nursing leadership in the context of the social environment.

BACKGROUND

Nurses practice leadership in their day-to-day activities as clinical leaders alongside traditional roles of management and leadership. However, some nurses do not acknowledge nursing work as leadership activity, nor is it seen so by others where hierarchical leadership approaches remain prevalent. Social constructs of gender and race are barriers to accessing formal leadership positions for some, while dominant power structures such as class diminish the value of bedside nursing work. Unexplored is the impact of the intersection of these and other social identities on nurses being leaders.

DESIGN

An embedded case study design.

METHODS

Thirty-one participants participated in semi-structured interviews. Four levels of analysis including inductive and deductive approaches were applied to the data. The research complied with COREQ guidelines for reporting qualitative research.

RESULTS

This study shows nurses do not identify themselves as leaders without an associated title and the pathway to leadership varies depending on intersecting social constructions.

CONCLUSION

The impact of the organisational structures and the experience of navigating intersecting social constructions on nurses being leaders goes unseen, privileging some while disadvantaging others.

RELEVANCE TO CLINICAL PRACTICE

Health organisations need to be aware of intersectionality in the workplace and explore equity in their structures to be genuinely empowering. Nursing leadership must examine strategies that challenge and decolonise the nursing profession. Bedside nurses should be given more power and respected as leaders of the patient experience, achievable through a renewed emphasis on the fundamentals of care and resonant leadership, which can neutralise a culture of managerialism. Intersectionality can inform the development of new nursing leadership roles that enable nurses to remain clinically active, widening opportunities.

Key strategies for improving transitions of care collaboration: lessons from the ECHO-care transitions program

Transitioning the care of a patient from a hospital to a skilled nursing facility (SNF) is critical and often risky. Poor care transitions can result in delays, medication mistakes, incomplete follow-up care, and adverse health outcomes. Ensuring a smooth and effective care transition is the goal for providers at both the hospital and SNF. At its foundation, successful care transitions rely on teamwork, relationship building, and communication among diverse groups of providers. Beth Israel Deaconess Medical Center (BIDMC) developed the ECHO-CT (Extension for Community Healthcare Outcomes-Care Transitions) program to improve transitions of care through structured, bi-directional communication between hospital-based and SNF-based providers. This paper describes key strategies for success in this model including: facilitating teamwork, eliminating hierarchy, and encouraging a bi-directional learning environment. We propose these as strategies that could be implemented in other organizations seeking to improve value during transitions of care.

How interprofessional education could benefit the future of healthcare - medical students' perspective

As British medical students, we believe the impact that interprofessional education can have upon the future of healthcare to be a positive one. This is if it is implemented in health professions' pre-registration curricula worldwide. Our motivations for producing this article stem from our own experiences with IPE or rather our limited experiences during our medical school journey. We have exemplified the UK's NHS to demonstrate how IPE would positively impact a nation's healthcare system. With patient safety, patient experience and the economical functioning of the NHS always pertaining mainstream topics of discussion within the healthcare field, the need for improved interprofessional cohesion is now more important than ever before; especially with an increasingly demanding population. Through this article, we deeply analyse and expand upon the significance IPE has in enhancing interprofessional interactions at a pre-registration stage, in preparation for work within the NHS.

A Literature Review on the Foundations and Potentials of Digital Teaching Scenarios for Interprofessional Health Care Education

The health care system is increasingly complex and specialized, but it presents the actors involved with the challenge of working together in interprofessional teams. One way to meet this challenge is through interprofessional training approaches, where representatives of different professions learn together with learners of other professions. This article contributes to the question of how interprofessional teaching in health care education can be designed with a low threshold by using digital media. We focus on learning with digital learning platforms and learning with videos. Based on existing empirical findings, these approaches are discussed in terms of their potential and limitations for interprofessional teaching. In particular, we examine how these approaches influence the core competence domains of interprofessional collaborative practice. Digital collaborative learning platforms are suitable for teaching interprofessional competences, since they enable social and professional exchange among learners of different professions. Videos are suitable for imparting medical declarative and procedural knowledge. Based on these considerations, the use of videos in combination with interaction possibilities is presented as a didactic approach that can combine the aspect of knowledge transfer with the possibility of interprofessional computer-based collaboration.