Interprofessional/interdisciplinary teamwork during the early COVID-19 pandemic: experience from a children's hospital within an academic health center

Pediatric capacity crisis: A framework and strategies to prepare for a pediatric surge

A pediatric capacity crisis developed across the country in the Fall and Winter of 2022 due to a combination of factors, including a surge in respiratory viruses, staffing shortages, and historical closures of inpatient pediatric units. The COVID-19 pandemic and associated surge in critically ill adult patients demonstrated that health care systems and health care workers can quickly implement creative and collaborative system-wide solutions to deliver the best care possible during a capacity crisis. Similar solutions are needed to respond to future surges in pediatric volume and to maintain a high standard of care during such a surge. This paper aims to build upon insights from the COVID-19 and H1N1 pandemic responses and the 2022 pediatric capacity crisis. We provide specific recommendations addressing governmental/policy, hospital/health care system, and individual clinician strategies that can be implemented to manage future surges in pediatric patient volume.

The perceived impact of the COVID-19 pandemic on interprofessional education and collaborative practice: preliminary results from phase I of a global survey

The COVID-19 pandemic has had a sizable effect on interprofessional education and collaborative practice (IPECP) globally, yet much of the available literature on the topic remains anecdotal and locally bounded. This body of literature reflects celebratory and aspirational reports, with many case studies of successful response and perseverance under conditions of extreme pressure. There is, however, a more worrisome narrative emerging that pointed to differences in pandemic response with concerns raised about the sustainability of IPECP during and after the pandemic. The COVID-19 task force of InterprofessionalResearch.Global (IPRGlobal) set out to capture the successes and challenges of the interprofessional community over the pandemic through a longitudinal survey, with a view to inform global attempts at recovery and resilience. In this article, we report preliminary findings from Phase 1 of the survey. Phase 1 of the survey was sent to institutions/organizations in IPRGlobal (representing over 50 countries from Europe, North and South America, Australia, and Africa). The country-level response rate was over 50%. Key opportunities and challenges include the abrupt digitalization of collaborative learning and practice; de-prioritization of interprofessional education (IPE); and rise in interprofessional collaborative spirit. Implications for IPECP pedagogy, research, and policy post-pandemic are considered.

Frontline healthcare workers' perspectives on interprofessional teamwork during COVID-19

Effective interprofessional teamwork serves an important role in successful crisis response. Responses to past public health crises have relied on interprofessional communication and trust to support healthcare worker (HCW) resiliency. To understand interprofessional interactions and perceptions of teamwork during the COVID-19 response, we conducted in-depth semi-structured interviews with 18 inpatient HCWs (11 bedside nurses, 5 care coordinators, and 2 pharmacists) from one VA Medical Center between March and June 2020. Using thematic analysis, we identified four key themes that describe the strengths and challenges of interprofessional teamwork, communication, patient care, and organizational response during the initial COVID-19 surge. Interprofessional teams were fragmented. HCWs who transitioned to remote work lost their status on inpatient teams and struggled to provide pre-pandemic levels of quality of care. Conversely, interprofessional teamwork improved for HCWs who continued to work on inpatient units, where study participants described a decline in interprofessional hierarchies and an increase in mutual support. Participants described the need for timely, accurate, transparent communication as they faced new patient safety and communication challenges brought on by the pandemic. HCWs expressed a desire for sustained leadership support and inclusion in institutional decision-making. The challenges to teamwork, communication, and patient care reported in this study highlight the need for consistent, transparent communication and organizational response from hospital leadership during times of crisis.

Adaptability and learning Intraprofessional collaboration of residents during the COVID-19 pandemic

CONTEXT

The COVID-19 pandemic created a worldwide public health emergency, in which hospitals created new COVID departments and doctors from different disciplines had to work together. In the Netherlands, a large proportion of doctors in these departments were residents. With knowledge of the disease developing only gradually, the influx of COVID-19 patients called for adaptability, innovative work behavior, and intraprofessional collaboration (intraPC) between residents and between residents and medical specialists.

RESEARCH GOAL

This study investigates how the delivery of COVID-19 care in hospital settings altered the way residents develop their sense of adaptability and intraPC during their training.

METHODS

Sixteen semi-structured interviews were conducted with residents and medical specialists from various disciplines who worked at a COVID department or Intensive Care Unit (ICU) during the COVID pandemic in the Netherlands, focusing on adaptability and intraPC learning. Transcripts were analyzed using (thematic) template analysis.

RESULTS

Four themes that influenced learning during COVID care were identified: collective uncertainty, social cohesion and a sense of safety, the need for adaptive performance and intraPC learning. During the first wave, collective uncertainty about the unknown disease and the continuation of the crisis urged residents to adapt in order to take care of patients with a disease that was as yet unknown. The combination of collective uncertainty, social cohesion and a sense of safety, and the presence of different disciplines in one department promoted residents' intraPC learning. However, intraPC learning was not always the matter of course due to the scope of the crisis and the huge numbers of new patients.

CONCLUSION

Collective uncertainty affected the residents' adaptability. The combination of collective uncertainty, social cohesion, and the presence of different disciplines in one department promoted the residents' intraPC learning. An important facilitating factor for both adaptability and intraPC learning is a high level of social cohesion and safety. The physical and psychological proximity of supervisors is an important factor contributing to a safe learning environment. This study provides implications for practice for learning during postgraduate training in non-crisis settings.

Nurses' perception of solutions proposed by nurse leaders in face of COVID-19 pandemic: A cross-sectional study

AIM

To evaluate the perception of bedside nurses regarding the implementation of solutions proposed by nurse leaders for patient and employee care during the COVID-19 pandemic.

BACKGROUND

Nurse leaders have proposed solutions to better manage the challenges of the pandemic. However, multiple factors influence the transposal of actions from the tactical to the operational levels.

METHOD

This cross-sectional study was carried out in a 620-bed non-profit institution. Participants were bedside nurses who completed an online survey.

RESULTS

One hundred sixty-eight nurses participated in the study. Most of the proposed solutions were very effective and easily identified by the nurses. These solutions included adaptations of the physical structure, availability of medical supplies and adequacy of institutional protocols. The actions that stood out with low perception were adequate integration of new employees and the availability of remote work, hotel accommodations for frontline health care workers and day care for children whose parents worked at the hospital.

CONCLUSION

Bedside nurses were able to recognize most of the solutions proposed by their nurse leaders during the COVID-19 pandemic.

IMPLICATIONS FOR NURSING MANAGEMENT

Tactical-level nurse leaders need constant proximity to bedside nurses and continuous elucidation of the objectives to be achieved by the strategies adopted.

Shaping the Nursing Profession Postpandemic Through Reconstructed Leadership Practices

Responding to and navigating the COVID-19 pandemic were demanding and all-consuming for executive nurse leaders. Long-term pandemic challenges will continue and therefore it is important for nurse leaders to develop their reflective practice to increase role competency, gain wisdom, and advance the profession. The complex postpandemic world requires nurse leaders to show up differently, stop ineffective practices, continue best practices, and implement new ideas to improve performance and outcomes. This article offers a framework for leadership reflection, through role negotiation technique, to identify lessons from the lived nurse executive experience of the COVID-19 pandemic. Specific focus is placed on communication, teamwork, professional governance, posttraumatic growth, gratitude, diversity/equity/inclusion, and social determinants of health. These concepts, along with specific tactics, will help leaders set priorities, aid nursing leadership practice, identify meaningful goals and desired outcomes, and effectively lead to advance the nursing profession postpandemic.

'Everyone is trying to outcompete each other': A qualitative study of medical student attitudes to a novel peer-assessed undergraduate teamwork module

The centrality of teamwork in ensuring the effective functioning of institutions across all sectors is undeniable. However, embedding teamwork into higher education has been hampered due to a range of deeply entrenched practices associated broadly with the foregrounding of knowledge, beliefs about the place of skill training and routines of assessment. As a result, despite an urgent need to address teamwork, little progress has been made with respect to progressing teamwork education. We have designed and evaluated a novel teamwork module delivered to fourth‐year undergraduate medical students involving placements, a cocreated piece of work, reflection and summative peer assessment. This paper aimed to investigate whether the module increased students’ insight into teamwork, including their own skill development, and whether their perceptions of teamwork changed. Throughout the evaluation, students played a key role, with four final‐year medical students working alongside others in the multidisciplinary project team. Five distinct themes emerged from our in‐depth, semi‐structured interviews: (a) importance and meaning; (b) insight into skill development; (c) transferability; (d) peer assessment; and (e) resistance to teamwork education. Themes had positive and negative components, and student perceptions changed in multiple ways after experiencing a longitudinal educational opportunity to develop their teamwork skills. Before practice, students focused on superficial explanations and on where they might improve. In contrast, after practice, students conveyed deeper insights, contextualisation, focus on how they might improve, and shared structured reflection.

Keeping it going: the importance of delivering interprofessional education during the COVID-19 pandemic

BACKGROUND AND CONTEXT Globally, the coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for better interprofessional collaboration and teamwork. When disciplines have worked together to undertake testing, deliver care and administer vaccines, progress against COVID-19 has been made. Yet, teamwork has often not happened, wasting precious resources and stretching health-care workforces. Continuing to train health professionals during the pandemic is challenging, particularly delivering interprofessional education that often uses face-to-face delivery methods to optimise interactional learning. Yet, continuing to offer interprofessional education throughout the pandemic is critical to ensure a collaboration-ready health workforce. One example is continuing the established INVOLVE (Interprofessional Visits to Learn Interprofessional Values through Patient Experience) interprofessional education initiative. ASSESSMENT OF PROBLEM Educators have not always prioritised interprofessional education during the pandemic, despite its immediate and long-term benefits. The INVOLVE interprofessional education initiative, usually delivered face-to-face, was at risk of cancellation. RESULTS A quality improvement analysis of the strategies used to continue INVOLVE demonstrated that it is possible to deliver interprofessional education within the constraints of a pandemic by using innovative online and hybrid educational strategies. Educators and students demonstrated flexibility in responding to the sudden changes in teaching and learning modalities. STRATEGIES When pandemic alert levels change, interprofessional educators and administrators can now choose from a repertoire of teaching approaches. LESSONS Four key lessons have improved the performance and resilience of INVOLVE: hold the vision to continue interprofessional education; be nimble; use technology appropriately; and there will be silver linings and unexpected benefits to the changes.

Interprofessional work in health in the context of the COVID-19 pandemic: a scoping review

OBJECTIVE

to map the scientific production on interprofessional relationships in health in the first year of the COVID-19 pandemic.

METHOD

this is a scoping review performed in PubMed, Scopus, LILACS, CINAHL, Web of Science, Google Scholar and Science Direct databases, covering the period of publication in 2020, using the acronym PCC (Population = health professionals; Concept = interprofessional relationships; Context = health services) and respective search strategies.

RESULTS

fourteen scientific articles were selected and the content discussed in the manuscripts was standardized, analyzed and organized into categories of affinities and similarities of their results: 1 - Interprofessional collaboration; 2 - Collaborative practice; 3 - Interprofessional work; 4 - Interactive and interprofessional learning.

CONCLUSION

the pandemic demanded quick and effective responses that were only possible through collaboration and interprofessionalism dimensions. Interprofessional work in health during the first year of the COVID-19 pandemic confirms the importance of interprofessional work and its dimensions for the provision of more comprehensive, resolute and safer health services.

A Virtual Approach to Promote Inter-Professional Learning (IPL) Between Biomedical Science and Medicine in Higher Education for the Benefit of Patient Care

In the clinical setting, collaboration between multidisciplinary teams is core to providing effective patient care. The delivery of traditional interprofessional education is associated with a number of logistical challenges, which were heightened by the Covid-19 pandemic. This workshop was developed to bring together Biomedical Science and Medical students using an online platform. The workshop consisted of (1) defining interprofessional education, (2) introducing the role of the Pathology laboratory, (3) Professional registration with regulatory bodies and (4) an insight into Covid-19 laboratory diagnosis. The session was supported by mixed group breakout rooms and interactive polling. Thirty four percent of students completed a post-workshop online survey which included open and closed questions. Thematic analysis revealed a better understanding the role of the pathology laboratory in diagnosing disease, an increased awareness of the similarities and differences in the roles of a Biomedical Scientist and a Medic and the importance of a multi-disciplinary team in achieving effective patient care. Quantitative analysis of survey data revealed that the majority of students reported positive experiences of interprofessional education online. Approximately 90% of students agreed that the workshop enabled them to increase their understanding of their own roles within healthcare, in addition to increasing their understanding of the roles of other healthcare professionals. 74.3% of participants reported that working with students from a different programme provided an alternative perspective. Seventy nine percent of students agreed that the online format enabled interactivity and discussion of the tasks. Of the 204 students, 85% engaged with the four polls during the workshop. This online workshop enabled discussion between degree programmes, enabled interactivity and allowed the learning outcomes to be met. Universities should embrace online platforms to provide a novel, engaging and effective interprofessional educational experience.

Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study

Background

The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children’s and community hospitals.

Methods

We purposefully sampled participants from both community and children’s hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2–3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes.

Results

We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians’ mental health, and they stressed the importance of mental health resources and wellness activities/spaces.

Conclusions

We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians’ expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians’ mental health and well-being, re-evaluating trainees’ skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06947-7.

Covid-19 Impacts on Florida's Healthcare Professionals

This study described how COVID-19 impacted employment, telehealth usage, and interprofessional collaboration. A cross-sectional survey was deployed in June 2020 to healthcare professionals in Florida. Job status was uniquely separated by profession, with more nurses and medical doctors reported having no effect, and more mental health counselors transitioned to telehealth. Over a third of rehabilitation providers reported being furloughed. Over forty percent of providers had no training in telehealth, yet 33.1% reported an increase in usage. Interprofessional interactions are lower across professions during the pandemic, compared with before. This study shows the need for additional training on telehealth and interprofessional collaboration.

Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians

OBJECTIVE

The COVID-19 pandemic has transformed healthcare delivery in the USA, but there has been little empirical work describing the impact of these changes on clinicians. We conducted a study to address the following question: how has the pandemic impacted US clinicians' professional roles and relationships?

DESIGN

Inductive thematic analysis of semi-structured interviews.

SETTING

Clinical settings across the USA in April and May of 2020.

PARTICIPANTS

Clinicians with leadership and/or clinical roles during the COVID-19 pandemic.

MEASURES

Emergent themes related to professional roles and relationships.

RESULTS

Sixty-one clinicians participated in semi-structured interviews. Study participants were practising in 15 states across the USA, and the majority were White physicians from large academic centres. Three overlapping and inter-related themes emerged from qualitative analysis of interview transcripts: (1) disruption: boundaries between work and home life became blurred and professional identity and usual clinical roles were upended; (2) constructive adaptation: some clinicians were able to find new meaning in their work and described a spirit of collaboration, shared goals, open communication and mutual respect among colleagues; and (3) discord and estrangement: other clinicians felt alienated from their clinical roles and experienced demoralising work environments marked by division, value conflicts and mistrust.

CONCLUSIONS

Clinicians encountered marked disruption of their professional roles, identities and relationships during the pandemic to which they and their colleagues responded in a range of different ways. Some described a spirit of collaboration and camaraderie, while others felt alienated by their new roles and experienced work environments marked by division, value conflicts and mistrust. Our findings highlight the importance of effective teamwork and efforts to support clinician well-being during the COVID-19 pandemic.

New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.