The willingness and barriers to collaborate in the care of frail older adults: perspectives of primary care professionals

Holistic framing for improving care provision for older people with chronic diseases in Jordan: a phenomenological study

There is a sharp increase in the number of older people globally. Thus, it is important to adopt strategies to improve the care provided for older people, especially due to the increased prevalence of chronic conditions. However, very little evidence is available on what should be done, especially from the perspective of healthcare professionals responsible for providing care for older people in nursing homes. Thus, this study aimed to explore the opinions of healthcare professionals including nurses and physicians in nursing homes on adopting holistic framing for improving care provision for older people with chronic conditions in Jordan. The study employed a descriptive phenomenological design using semi-structured interviews with 13 nurses and two physicians in Amman governorate in Jordan during the period from June to September 2024. Inductive content analysis was used to analyze data. The findings revealed three overarching themes including: (1) offering dedicated courses and postgraduate programs; (2) improving facilities and resources; and (3) raising awareness and enhancing collaborations. The findings provide a holistic framing for improving healthcare provision for older people with chronic diseases in Jordan.

Health professionals' willingness to share responsibility and strengthen interprofessional collaboration: a cross-sectional survey

BACKGROUND

Doctors' unwillingness to share responsibility acts as a major barrier to interprofessional collaboration (IPC). Educating both doctors and allied health professionals in taking on or relinquishing responsibility could enhance IPC. Yet there is no evidence that these educational efforts increase IPC willingness. This study aims to (1) compare the willingness to take on or relinquish responsibility for decision-making in patient care and their willingness to strengthen IPC between members of five main health professions, and (2) investigate associations between the willingness to take on or relinquish responsibility and the willingness to strengthen IPC.

METHODS

We conducted a cross-sectional survey targeting pharmacists, doctors, medical practice assistants, nurses, and physiotherapists in Switzerland. Group differences were assessed, and associations were examined using multivariable logistic regression analyses.

RESULTS

Overall, 3670 health professionals participated. Members of all allied health professions were highly willing to take on more responsibility for decision-making for patient care (ranging from 74.3% to 86.5%). Medical practice assistants (52.3%) and nurses (46.8%) were highly willing to relinquish responsibility, less so pharmacists (34.2%) and physiotherapists (37.8%); doctors were torn between high (49.2%) and neither high nor low willingness (38%). Members of all professions were highly willing to strengthen IPC (ranging from 76.4 to 91.2%). We found a strong, statistically significant relationship between willingness to take on more responsibility and willingness to strengthen IPC (OR = 5.30, p < .001). The relationship between willingness to relinquish responsibility and willingness to strengthen IPC was smaller (OR = 3.30, p < .001).

CONCLUSION

Increasing the health professionals' willingness to take on responsibility is crucial to strengthen IPC. Increasing the willingness to relinquish responsibility would likely be less effective. Actions required include educational and political efforts to transfer responsibility to allied health professionals and to enable health professionals to decide when it is appropriate to take on or relinquish responsibility. Given the willingness of many health professionals to strengthen IPC, substantial potential in practice is evident.

Interprofessional Collaboration amongst Healthcare Workers of a Tertiary Hospital in North-Eastern Nigeria

BACKGROUND

Interprofessional collaboration in healthcare is important to optimise healthcare delivery. However, relatively few studies have been conducted on the topic in Nigeria, especially in the North.

OBJECTIVE

The objective of this study was to determine the levels of interprofessional collaboration, enablers and barriers amongst healthcare workers.

MATERIALS AND METHODS

Data were collected using a five-domain modified Assessment of Interprofessional Team Collaboration Scale questionnaire, with a Likert scale of 1-5. The ideal mean score was ≤2 for the barriers domain and ≥4 for the other domains. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 23.

RESULTS

Two hundred and sixty-six participants responded to the questionnaire. Male and female respondents were 131 (49.2%) each. Half of the respondents were 31 to 40 years old. One hundred and thirty-six (51.1%) of the respondents were nurses, and 48 (18.0%) were doctors. The modal working experience was 6-11 years (41.4%), and 117 (44.0%) respondents had at least a bachelor's degree. The mean scores for the domains were 4.1032 for partnership, 3.2383 for cooperation, 3.6309 for coordination, 4.2844 for enablers and 3.7902 for barriers.

CONCLUSION

There was adequate level of partnership and enablers amongst the healthcare workers but insufficient cooperation and coordination and high level of barriers. Staff training on cooperation, coordination and identified barriers is necessary to improve interprofessional collaboration in the hospital.

Promoting meaningful activities by occupational therapy in elderly care in Belgium: the ProMOTE intervention

BACKGROUND

Older people want to age in place. Despite advancing functional limitations and their desire of aging in place, they are not always faithful to therapy that maintains independence and promotes safety. Occupational therapists can facilitate aging in place. Occupational therapy is defined as the therapeutic use of everyday life occupations with persons, groups, or populations for the purpose of enhancing or enabling participation.

AIM

To describe the content a high-adherence-to-therapy and evidence-based occupational therapy intervention to optimize functional performance and social participation of home-based physically frail older adults and wellbeing of their informal caregiver, and the research activities undertaken to design this intervention.

METHODS

A roadmap was created to develop the occupational therapy intervention. This roadmap is based on the Medical Research Council (MRC) framework and is supplemented with elements of the Intervention Mapping approach. The TIDieR checklist is applied to describe the intervention in detail. A systematic review and two qualitative studies substantiated the content of the intervention scientifically.

RESULTS

The application of the first two phases of the MRC framework resulted in the ProMOTE intervention (Promoting Meaningful activities by Occupational Therapy in Elderly). The ProMOTE intervention is a high-adherence-to-therapy occupational therapy intervention that consists of six steps and describes in detail the evidence-based components that are required to obtain an operational intervention for occupational therapy practice.

CONCLUSION

This study transparently reflects on the process of a high-quality occupational therapy intervention to optimize the functional performance and social participation of the home-based physically frail older adult and describes the ProMOTE intervention in detail. The ProMOTE intervention contributes to safely aging in place and to maintaining social participation. The designed intervention goes beyond a description of the 'what'. The added value lies in the interweaving of the 'why' and 'how'. By describing the 'how', our study makes the concept of 'therapeutic use-of-self' operational throughout the six steps of the occupational therapy intervention. A further rigorous study of the effect of the ProMOTE intervention on adherence, functional performance and social participation is recommended based to facilitate the implementation of this intervention on a national level in Belgium.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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