Distributed expertise: qualitative study of a British network of multidisciplinary teams supporting parents of children with chronic kidney disease

Interprofessional identity in clinicians: A scoping review

Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.

The value that social workers' competencies add to health care: An integrative review

Health and social care professionals' competencies have traditionally been separated because of the different aims of the two professions. These competencies need to be integrated, to make sure that seamless services are provided that meet the often complex needs of patients and clients in a coordinated and timely way. The aim of this integrative review was to identify, describe and synthetise previous studies on integrated competencies in health and social care. Electronic literature searches were carried out on the CINAHL, ProQuest, PsycInfo, PubMed, Scopus and SocIndex databases for peer-reviewed scientific papers that were published in English between 1 January 2007 and 31 December 2019. This identified 3,231 papers, after duplicates were removed, and 18 focused on the integration of social workers' competencies with health care. Other types of integration were not found. The value added by integrating social workers' competencies with health care focused on engaging working orientation, improving communication with family members, increasing understanding of service resources and mastering successful discharge procedures so that they met comprehensive, complex health and well-being needs. Social workers added value when they worked with multi-professional teams, but there were challenges to integrating competencies and these were related to professional collaboration and fragmented leadership. In future, more attention needs to be paid to diversifying and optimising the integration of professional health and social care competencies that meet clients' and patients' care and service needs. It is also vital to focus on developing the professional and leadership strategies that are needed to combine those competencies.

Designing a Supportive Program based on the Real Needs of Mothers with Children Undergoing Hemodialysis: A Qualitative Study

BACKGROUND

Mothers with children undergoing hemodialysis play the role of primary caregivers for their child and fully sacrifice themselves for care, leading to social isolation, suffering, stress, and negative effects on their health. Therefore, this study was conducted to design a supportive program based on the real needs of mothers with children undergoing hemodialysis.

MATERIALS AND METHODS

This qualitative study was conducted in the Hemodialysis Division of Doctor Sheikh Pediatric Hospital in Mashhad City, Iran, from September 2016 to February 2019. The research included phenomenological study, meta-synthesis of qualitative studies, focused group, and nominal group. Participants were selected based on purposive sampling. Eleven mothers with children undergoing hemodialysis and seven key people related to these mothers participated in the study. MaxQDA software was used to facilitate data management.

RESULTS

The six main areas including information needs, how to deal with the child, maintaining the mother's physical and functional health, maintaining family relationships, income earning and maintaining financial resources, and emotional-psychological support were extracted. Based on the needs of mothers, 28 support strategies were presented; then, 19 ideas were presented to screen the needs, and finally, the best idea was selected for each need.

CONCLUSIONS

According to the findings of this study, mothers with children undergoing hemodialysis need support in various physical, psychosocial, informational, economic, and functional dimensions. The supportive program designed provides a systematic framework for screening the needs of these mothers and providing multifaceted support measures with the participation of a multidisciplinary care team.

Palliative Care in Patients with End-Stage Renal Disease: A Meta Synthesis

End-stage renal disease is the last stage of chronic kidney disease and is associated with a decreased quality of life and life expectancy. This study aimed to explore palliative care with end-stage renal disease. Qualitative meta-synthesis was used as the study design. The search was performed for qualitative studies published until June 2021 and uses reciprocal translation and synthesis of in vivo and imported concepts. Five themes were included: Struggling to face the disease, experiencing deterioration, overcoming the challenges of dialysis, leading to a positive outlook, and preparing for the end of life. In facing chronic disease with life-limiting potential, patients experienced some negative feelings and deterioration in their quality of life. Adaptation to the disease then leads patients to a better outlook through increased spirituality and social status. Furthermore, by accepting the present condition, they started to prepare for the future. Increasing awareness of mortality leads them to discuss advance care (ACP) planning with healthcare professionals and families.

Role of Pharmacists in the Interprofessional Care Team for Patients with Chronic Diseases

Chronic diseases are a major health problem and cause of death worldwide. Patients with chronic diseases should be managed by an interprofessional care team consisting of general practitioners, medical specialists, nurses, and pharmacists. However, the roles of pharmacists in this interprofessional care team have not been fully explored. This study, therefore, examined their roles as members of the interprofessional care team in managing patients with chronic diseases. A search in PubMed, Google Scholar, EBSCO, Scopus, and Cochrane Library databases was conducted for research articles that discussed pharmacists, interprofessional healthcare, and chronic diseases. From initial 420 identified articles, a total of 27 articles were included in this study. The interprofessional healthcare team should have a sense of tolerance and belonging among its members, which is reflected in five dimensions: partnership, coordination, cooperation, decision-making, and therapeutic outcomes. The five dimensions are closely related because they support each other in the success of the therapy. The presence of pharmacists in an interprofessional healthcare team has been proven to help facilitate access to primary care and improve patient outcomes. Pharmacists can assist in managing chronic disease conditions by providing drug information to patients and other healthcare providers and by acting as a consultant for treatment-related issues. The pharmacist’s role as part of an interprofessional care team reinforces the importance of a collaborative healthcare team in providing clinical services to patients with chronic diseases.

Meanings assigned by families about children's chronic disease diagnosis

OBJECTIVES

to understand the meanings assigned by family caregivers about children's chronic disease diagnosis.

METHODS

qualitative study, which used as theoretical framework the Symbolic Interactionism, and methodological, the Grounded Theory. It was held in a pediatric unit in Southern Brazil, in 2016, through interviews submitted to open and axial analysis, with the participation of 20 family caregivers of hospitalized children.

RESULTS

relatives, interacting with the nursing/health staff, perceive children's disease at birth. They are diagnosed with chronic disease by the physician and deny it. Subsequently, they accept and seek information on care.

CONCLUSIONS

the results pointed out the stages that relatives experience by assigning meanings to about children's chronic disease diagnosis. These meanings provide subsidies for nurses' actions, which need to be aware of children's and family's needs in order to offer comprehensive and humanized care.

Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal

BACKGROUND

Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes.

AIM

The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children.

SETTING

The study was conducted in a local district hospital in Ugu, KwaZulu-Natal.

METHODS

An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis.

RESULTS

Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.

CONCLUSION

In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.

Social Networks and Mobile Applications Use in Young Patients With Kidney Disease

Objective: To evaluate the use and benefits of social networking sites (SNS) and mobile applications (MA) in young patients with kidney disease (KD). Background: Pediatric KD is prevalent. The Internet is increasingly being used to communicate rapid healthcare information to children about acute and chronic diseases with greater medical care satisfaction. There is a lack of data on social media (SM) utility in pediatric KD. Materials and Methods: A descriptive, observational, and cross-sectional study was conducted on a national level. Data were collected from 4 different centers through a reviewed questionnaire. Results: 83.9% of the 428 participants were Lebanese. The average age was 11.4 years (±7.1). 69.9% had chronic KD out of which 17.4% had undergone a kidney transplant while 9% were on dialysis. 69.6% of the participants affirmed the need of SM for the health of the sick child while only 9.8% are participating in a scientific forum and 4.7% used SM to find a potential organ donor. Some study variables were statistically associated with the participants' age, nationality, and stage of KD. Conclusions: SM is important for the support and management of pediatric KD. We believe that SNS and MA will play a leading role in the lives of our patients in the upcoming future and will push the physician to be an active participant in the evolution of communication networks. To identify the efficacy of SM in enhancing communication between patients and health professionals, further stratified studies are needed.

Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet

AIM

Dietary modification is integral to the management of end stage kidney disease. However, adherence to the renal diet is poor. Few studies have explored the perspectives of renal dietitians and how they work with patients to facilitate dietary change. The objectives of this study were to explore the experiences of renal dietitians about educating patients with end stage kidney disease; and to describe the strategies perceived to help patients understand the renal diet.

METHODS

Semi-structured interviews based on Sensemaking theory were conducted with renal dietitians (n = 27) working in Australia and New Zealand from a range of metropolitan, regional and remote areas.

RESULTS

Five major themes across two categories were derived from the data. The renal dietitians in this study experienced feelings of frustration, frequently worked in practice environments with limited or inadequate resources and perceived that establishing trust and demonstrating empathy were important to sense making. Renal dietitians helped patients make sense of and understand the diet by clarifying ambiguities and conflicting information; and simplifying complexity by using simple explanations, individualised advice and practical support. These strategies were considered critical to the renal diet sense making process.

CONCLUSIONS

The experience of providing renal diet advice to adults with end stage kidney disease was emotionally and professionally challenging. Alternative approaches to patient education may help dietitians to empower patients to better understand the renal diet. Further research exploring the experiences of learning about the renal diet from the patient and carer perspective would also help to inform future alternative approaches.

Experiences and Perspectives of Dietary Management Among Patients on Hemodialysis: An Interview Study

OBJECTIVES

Diet and fluid management can reduce mortality, serious comorbidities, and debilitating symptoms in patients on hemodialysis, but restrictions may also be a major burden, and nonadherence remains high. We aimed to describe the perspectives and experiences of patients on hemodialysis regarding their dietary management to understand both facilitators and barriers to adherence and to identify strategies to improve care.

DESIGN AND METHODS

Semi-structured interviews were conducted with 35 people on maintenance hemodialysis from six dialysis units in New South Wales, Australia. Transcripts were thematically analyzed using principles of grounded theory.

RESULTS

We identified 5 major themes. Two themes reflect barriers to dietary change: exacerbating disruption (adding to treatment burden, contradicting healthy eating, confused by fragmented advice, conflicting cultural norms, changing appetite and palate, isolation from family and friends) and losing control (crises derailing discipline, frustrated by failure, combating bodily need for hydration). Three themes represent enablers for dietary change: attaining health benefits (avoiding medical catastrophes, enhancing benefits of dialysis, alleviating and managing symptoms, improving health), achieving treatment goals (building familiarity and acceptance, flexibility and moderation, taking personal responsibility), and succeeding withsupport (leaning on family for strength, trusting expert guidance, empowered with flexible and practical advice, relying on reminders and cues, motivation through shared experience).

CONCLUSIONS

Patients on hemodialysis believe dietary control helps to reduce symptom burden and enhance general health and well-being, but competing medical and social issues coupled with contradictory and/or irrelevant dietary advice prevents them from implementing diet and fluid restrictions. Interventions involving collaborative multidisciplinary care including clinicians with dietetic expertise, and consistent information that addresses cultural and personal circumstances, may support adherence to dietary recommendations and improve outcomes.

Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: an interview study

OBJECTIVE

To describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care.

DESIGN

Face-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory.

SETTING

21 haemodialysis centres across Australia.

PARTICIPANTS

42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences.

RESULTS

Six themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies).

CONCLUSIONS

Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis.

Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration

BACKGROUND

Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed.

OBJECTIVE

To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app.

METHODS

Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories.

RESULTS

Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint-5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is "dry" and "boring," could be "scary," and was either hard to understand or not relevant to individuals' circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a "normal" life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a "normal" life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed.

CONCLUSIONS

Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes.

How do we understand the determinants of health? An exploration of distributed knowledge and interprofessional health sciences education

It is acknowledged that interprofessional communication and teamwork are foundational for high-quality, safe medical practice. The theory of distributed knowledge posits that each person has unique knowledge and experiences that can contribute to a broader group perspective. Patient care can be positively influenced by a robust and interprofessionally shared understanding of the complexities of health and illness. One would expect a variety of perspectives to be evident in all healthcare providers, including incoming health science students from different professional fields. To examine this notion, medical, nursing, and pharmacy students (n = 24) at the start of an interprofessional training experience were asked to write an essay on factors that contribute to health and/or illness. Their essays were thematically coded to generate a list of factors considered key to health/illness and compare responses across fields to better understand how knowledge is distributed across entering learners. Results show that students from different professional backgrounds emphasise some shared and some divergent factors. This distributed knowledge can be a rich source of understanding and shared thinking across professions. It is also a critical source of individual power to contribute to the construction of an ongoing, collaborative discourse about health.

An interactive health communication application for supporting parents managing childhood long-term conditions: outcomes of a randomized controlled feasibility trial

BACKGROUND

Families living with chronic or long-term conditions such as chronic kidney disease (CKD), stages 3-5, face multiple challenges and respond to these challenges in various ways. Some families adapt well while others struggle, and family response to a condition is closely related to outcome. With families and professionals, we developed a novel condition-specific interactive health communication app to improve parents' management ability-the online parent information and support (OPIS) program. OPIS consists of a comprehensive mix of clinical caregiving and psychosocial information and support.

OBJECTIVE

The purpose of this study was to (1) assess feasibility of a future full-scale randomized controlled trial (RCT) of OPIS in terms of recruitment and retention, data collection procedures, and psychometric performance of the study measures in the target population, and (2) investigate trends in change in outcome measures in a small-scale RCT in parents of children with CKD stages 3-5.

METHODS

Parents were recruited from a pediatric nephrology clinic and randomly assigned to one of two treatment groups: usual support for home-based clinical caregiving (control) or usual support plus password-protected access to OPIS for 20 weeks (intervention). Both groups completed study measures at study entry and exit. We assessed feasibility descriptively in terms of recruitment and retention rates overall; assessed recruitment, retention, and uptake of the intervention between groups; and compared family condition management, empowerment to deliver care, and fathers' involvement between groups.

RESULTS

We recruited 55 parents of 39 children (42% of eligible families). Of those, about three-quarters of intervention group parents (19/26, 73%) and control group parents (22/29, 76%) were retained through completion of 20-week data collection. The overall retention rate was 41/55 (75%). The 41 parents completing the trial were asked to respond to the same 10 questionnaire scales at both baseline and 20 weeks later; 10 scores were missing at baseline and nine were missing at 20 weeks. Site user statistics provided evidence that all intervention group parents accessed OPIS. Analysis found that intervention group parents showed a greater improvement in perceived competence to manage their child's condition compared to control group parents: adjusted mean Family Management Measure (FaMM) Condition Management Ability Scale intervention group 44.5 versus control group 41.9, difference 2.6, 95% CI -1.6 to 6.7. Differences between the groups in the FaMM Family Life Difficulty Scale (39.9 vs 36.3, difference 3.7, 95% CI -4.9 to 12.2) appeared to agree with a qualitative observation that OPIS helped parents achieve understanding and maintain awareness of the impact of their child's condition.

CONCLUSIONS

A full-scale RCT of the effectiveness of OPIS is feasible. OPIS has the potential to beneficially affect self-reported outcomes, including parents' perceived competence to manage home-based clinical care for children with CKD stage 3-5. Our design and methodology can be transferred to the management of other childhood conditions.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): 84283190; http://www.controlled-trials.com/ISRCTN84283190 (Archived by WebCite at http://www.webcitation.org/6TuPdrXTF).