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Luna G, Kim M, Miller R, Parekh P, Kim ES, Park SY, Abdulbaseer U, Gonzalez C, Stiehl E. Interprofessional relationships and their impact on resident hospitalizations in nursing homes: A qualitative study. Appl Nurs Res 2023; 74:151747. [PMID: 38007247 DOI: 10.1016/j.apnr.2023.151747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/27/2023]
Abstract
AIM The aim of this study is to explore experiences and perspectives of nurses and providers (e.g., physicians, medical directors, fellows, and nurse practitioners) on reducing preventable hospitalizations of nursing home (NH) residents in relation to interprofessional relationship and hospitalization decision-making process. BACKGROUND Preventable NH resident hospitalization continues to be a pressing public health issue. Studies show that improved interprofessional relationship may help reduce hospitalization, yet research on communication processes and interactions among different NH staff remains limited. METHODS This is a qualitative descriptive study. Two focus groups were held with fourteen nurses and thirteen in-depth, qualitative interviews were conducted with providers from two Chicagoland NHs. Focus group sessions and interviews were transcribed, coded, and analyzed for common themes based on qualitative description method. RESULTS All study participants agreed that providers have the ultimate responsibility for hospitalization decisions. However, nurses believed they could influence those decisions, depending on provider characteristics, trust, and resident conditions. Nurses and providers differed in the way they experienced and conveyed emotions, and differed in key elements affecting hospitalization decisions such as structural or environmental factors (e.g., lacking staff and equipment at the facility, poor communication between the NH and hospitals) and interpersonal factors (e.g., characteristics of effective nurses or providers and the effective interactions between them). CONCLUSIONS Interpersonal factors, including perceived competence, respect, and trust, may influence NH hospitalization decisions and be targeted for reducing preventable hospitalizations of residents.
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Affiliation(s)
- Geraldine Luna
- Chicago Department of Public Health, 333 S State St #200, Chicago, IL 60604, United States of America.
| | - Mhinjine Kim
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
| | - Richard Miller
- University of Illinois Chicago, 2170 West Bowler Street, Chicago, IL 60612, United States of America.
| | - Pooja Parekh
- University of Illinois Chicago, 1355 S. Halsted St., Chicago, IL 60607, United States of America.
| | - Esther S Kim
- University of Illinois Chicago, 625 W Madison St., Chicago, IL 60661, United States of America.
| | - Sophia Yaejin Park
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Ummesalmah Abdulbaseer
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Cristina Gonzalez
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Emily Stiehl
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
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Tsunematsu K, Asai A, Kadooka Y. Moral conflicts from the justice and care perspectives of japanese nurses: a qualitative content analysis. BMC Med Ethics 2023; 24:79. [PMID: 37794440 PMCID: PMC10552434 DOI: 10.1186/s12910-023-00960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals' moral conflicts through the lens of justice and care to obtain suggestions for conflict resolutions. METHOD Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person's thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally's taxonomy. RESULTS Among 31 responses, 2 that did not mention moral conflict were excluded, leaving 29 responses that were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The "rules" category of justice and the "welfare of others" category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective. CONCLUSIONS The nurses in this study suggest that they make moral judgments based on moral values that are intertwined with justice and care perspectives complex manner.Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider's responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care is recommended.
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Affiliation(s)
- Kayoko Tsunematsu
- Department of Bioethics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 8608556, Japan.
| | - Atsushi Asai
- Department of Medical Ethics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yasuhiro Kadooka
- Department of Bioethics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 8608556, Japan
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Bilgen A, Elçi M. The mediating role of organizational intelligence in the relationship between quantum leadership and innovative behavior. Front Psychol 2022; 13:1051028. [PMID: 36389490 PMCID: PMC9643169 DOI: 10.3389/fpsyg.2022.1051028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022] Open
Abstract
The present study aims to examine the mediator effect of organizational intelligence between quantum leadership and innovative behavior of employees in health organizations. It is aimed to examine the mediator effect of organizational intelligence between quantum leadership and innovative behavior of employees in health organizations. The data of the study were collected from 626 healthcare professionals working in hospitals and health centers in Istanbul, Turkey, by survey method. After the analysis of normality, validity and reliability, the hypotheses of the research were tested on the LISREL program using the structural equal modelling. The findings have showed that the three hypotheses of the research were confirmed: quantum leadership and organizational intelligence affect the innovative behaviors of employees positively and significantly, and organizational intelligence has a mediator effect between quantum leadership and the innovative behavior of employees. It is imperative that healthcare organizations, which are likely to encounter chaos and crisis risks such as the Covid-19 pandemic, follow innovation in order to provide better quality services. Quantum leadership and organizational intelligence are necessities in terms of revealing innovative behavior for healthcare organizations operating in a dynamic and chaotic environment. Since the effects of quantum leadership have not been studied in health organizations adequately, this study makes a contribution to fill this gap. In addition, it is predicted that the findings of this research will be illuminating in terms of innovative behaviors and leadership styles for health organizations that have a vital importance in all societies and have recently experienced a fact like COVID-19.
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Colón-Emeric CS, Hecker EJ, McConnell E, Herndon L, Little M, Xue T, Berry S. Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis. Arch Osteoporos 2022; 17:11. [PMID: 34981246 PMCID: PMC9479090 DOI: 10.1007/s11657-021-01050-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023]
Abstract
Decisions on whether to use pharmacologic osteoporosis therapy in skilled nursing facility residents are complex and require shared decision-making. Residents, proxies, and staff desire individualized fracture risk estimates that consider advanced age, dementia, and mobility. They want options for reducing administration burden, monitoring instructions, and periodic reassessment of risk vs. benefit. PURPOSE Decisions about pharmacologic osteoporosis treatment in nursing home (NH) residents with advanced age and multimorbidity are complex and should occur using shared decision-making. Our objective was to identify processes and tools to improve shared decision-making about pharmacologic osteoporosis treatment in NHs. METHODS Qualitative analysis of data collected in three NHs from residents at high fracture risk, their proxies, nursing assistants, nurses, and one nurse practitioner (n = 28). Interviews explored participants' stories, attitudes, and experiences with oral osteoporosis medication management. Framework analysis was used to identify barriers to shared decision-making regarding osteoporosis treatment in this setting. RESULTS Participants wanted individualized fracture risk estimates that consider immobility, advanced age, and comorbid dementia. Residents and proxies expected nursing staff to be involved in the decision-making; nursing staff wished to be informed on the relative risks vs. benefits of medications and given monitoring instructions. Two important competing demands to address during the shared decision-making process were burdensome administration requirements and polypharmacy. Participants wanted to reassess pharmacologic treatment appropriateness over time as clinical status or goals of care change. CONCLUSIONS Shared decision-making using strategies and tools identified in this analysis may move osteoporosis pharmacologic treatment in NHs and for other older adults with multimorbidity from inappropriate inertia to appropriate prescribing or appropriate inaction.
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Affiliation(s)
- Cathleen S Colón-Emeric
- Duke University, Box 3003 DUMC, Durham, NC, 27710, USA. .,Durham VA Geriatric Research Education and Clinical Center, Durham, NC, 27705, USA.
| | | | - Eleanor McConnell
- Duke University, Box 3003 DUMC, Durham, NC, 27710, USA.,Durham VA Geriatric Research Education and Clinical Center, Durham, NC, 27705, USA
| | | | - Milta Little
- Duke University, Box 3003 DUMC, Durham, NC, 27710, USA
| | - Tingzhong Xue
- Duke University, Box 3003 DUMC, Durham, NC, 27710, USA
| | - Sarah Berry
- Hebrew Center for Senior Life, Boston, MA, USA
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Xue T(M, Colón-Emeric CS, Herndon L, Hecker EJ, Berry SD, Little MO, McConnell ES. Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities. Gerontologist 2021; 62:1112-1123. [PMID: 34971374 PMCID: PMC9451018 DOI: 10.1093/geront/gnab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. RESEARCH DESIGN AND METHODS Descriptive qualitative study using framework analysis applied to open-ended semistructured interviews (n = 28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from 3 SNFs in the Eastern United States (Massachusetts and North Carolina). RESULTS Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. DISCUSSION AND IMPLICATIONS Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.
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Affiliation(s)
- Tingzhong (Michelle) Xue
- Address correspondence to: Tingzhong (Michelle) Xue, MS, RN, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA. E-mail:
| | - Cathleen S Colón-Emeric
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA,Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laurie Herndon
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Emily J Hecker
- Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Milta O Little
- Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eleanor S McConnell
- Duke University School of Nursing, Durham, North Carolina, USA,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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Abusalem S, Polivka B, Coty MB, Crawford TN, Furman CD, Alaradi M. The Relationship Between Culture of Safety and Rate of Adverse Events in Long-Term Care Facilities. J Patient Saf 2021; 17:299-304. [PMID: 30889049 DOI: 10.1097/pts.0000000000000587] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the relationship of culture of safety dimensions and the rate of unanticipated care outcomes in long-term care facilities (LTCFs) using the Agency for Healthcare Research and Quality framework of resident safety culture. METHODS Cross-sectional survey data were collected on 13 dimensions of culture of safety in five LTCFs from registered nurses, licensed practical nurses (LPNs), nursing assistants, administrators/managers, administrative support, and rehabilitation staff. Secondary data on falls in the five LTCFs from quarters 1 to 3 of 2014 were obtained from the Centers for Medicare and Medicaid Services in February 2015. Spearman's ρ and the Generalized Estimating Equations using a log link (Poisson distribution) were used. RESULTS Communication and feedback about incidences reported the highest mean scores (M = 4.35, SD =0.71). Higher rate of falls was associated with a lower level of team work, lower degree of handoffs, and lower levels of organizational learning. The risk for falls increased as the number of residents per facility increased (rate ratio [RR] = 1.02; 95% confidence interval [CI] = 1.01-1.02) and as the number of LPN hours per resident increased (RR = 37.7, 95% CI = 18.5-76.50). Risk for long stay urinary tract infections increased as number of residents increased (RR =1.01, 95% CI =1.01-1.01). Increase in culture of safety score was associated with decrease in risk of falls, long stay urinary tract infections, and short stay ulcers. CONCLUSIONS With the shortage of registered nurses in LTCFs and new reimbursement regulations, many LTCFs are hiring LPNs to have full staffing and save money. Licensed practical nurses may lack essential knowledge to decrease the rate of falls.
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Affiliation(s)
- Said Abusalem
- From the School of Nursing, University of Louisville, Louisville, Kentucky
| | - Barbara Polivka
- From the School of Nursing, University of Louisville, Louisville, Kentucky
| | - Mary-Beth Coty
- From the School of Nursing, University of Louisville, Louisville, Kentucky
| | | | | | - Maryam Alaradi
- Royal College of Surgeons in Ireland-Bahrain, Al Sayh, Bahrain
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Abstract
Transitions from one level of care to another are complex processes that pose medical and organizational risks and depend on care integration between different providers. This qualitative study investigated user experiences with an existing digital system for care integration between hospitals and nursing homes, and the potential of artificial intelligence to contribute to its optimization. The findings reveal challenges regarding (a) untimely information, (b) irrelevant information, (c) confusing information, (d) missing information, (e) information overload, and (f) information multiplicity. Artificial intelligence could address these by (i) identifying and verifying low-quality information, (ii) targeting information for different user groups, (iii) visually summarizing relevant information, and (iv) jointly presenting multiple versions. The implications of these findings extend beyond the context of care integration, presenting empirical evidence for the importance of qualitative health research in, and a model for, determining the scope and design of future artificial intelligence solutions to optimize (health)care processes.
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Al-Surimi K, Al Omar M, Alahmary K, Salam M. Prevalence of Workplace Bullying and Its Associated Factors at a Multi-Regional Saudi Arabian Hospital: A Cross-Sectional Study. Risk Manag Healthc Policy 2020; 13:1905-1914. [PMID: 33061722 PMCID: PMC7537811 DOI: 10.2147/rmhp.s265127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Workplace bullying (WPB) refers to any form of repeated and unreasonable verbal, physical or sexual harassment that an employee endures by a person or a group. In healthcare settings, practitioners are occasionally victims of WPB incidents. The aim of this study was to survey victims of WPB and determine factors associated with being a victim of WPB at a multiregional health care facility in Saudi Arabia. Methods This cross-sectional study was conducted in 2018, by distributing a self-administered questionnaire via a private electronic mail to all fulltime healthcare practitioners within a multi-regional hospital in Saudi Arabia. Healthcare practitioners included physicians, nurses, allied healthcare professionals and pharmacists who reported being exposed to WPB in the past year. Study outcomes were the prevalence rate ratio of WPB and its associated factors, such as victim, perpetrator and incident characteristics. Results WPB has been reported by 684 participants. Perpetrators were mainly patients (36.1%), their families/relatives (29.5%), and hospital staff (27.2%) or managers/supervisors (7.2%). The type of WPB incident was mostly verbal abuse (98.1%) followed by physical harassment (11.8%) and sexual connotations (5.8%). WPB was 30% more prevalent among younger nurses and 24% less prevalent among higher educated nurses compared to their counter groups, P<0.001 each. Among technicians and administrative employees, WPB was 54% more prevalent among females, 36% more prevalent among the younger group, and 25% more prevalent among expatriate workers compared to their counter groups P<0.014, P<0.001 and P=0.017, respectively. WPB was 20% less prevalent among higher educated allied health professionals, P=0.002. Among physicians, WPB was 33% more prevalent among females, P=0.041 and was 47% more prevalent among higher educated physicians compared to their counter groups, P=0.018. Conclusion WPB might occur any time, anywhere and by any person within health care facilities. The prevalence of WPB varies within health occupational groups. Gender, age, educational level, and nationality were significantly associated factors with WPB.
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Affiliation(s)
- Khaled Al-Surimi
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Munirah Al Omar
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khalid Alahmary
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Salam
- Department of Health System Management, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
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Kerr D, Ostaszkiewicz J, Dunning T, Martin P. The effectiveness of training interventions on nurses' communication skills: A systematic review. Nurse Educ Today 2020; 89:104405. [PMID: 32244125 DOI: 10.1016/j.nedt.2020.104405] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/03/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The objective of this systematic review was to identify, critically appraise and synthesise evidence for the effectiveness of communication skills training interventions in nursing practice. DESIGN A systematic review of literature. DATA SOURCES Randomised controlled trials published in English from 1998 to 2018, identified in five computerised databases (Medline, Cinahl, Embase, Psychinfo and Cochrane Database). Studies were included if they reported an educational intervention to enhance nurses' communication with patients and contained an objective measure of communication skills and/or patient outcome measures. REVIEW METHODS The Preferred reporting Items for Systematic reviews and Meta-Analyses guided the review. Data were extracted regarding study design and effectiveness on nurses' communication skills. Trial quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The heterogeneity of the included studies prohibited meta-analysis. RESULTS Of the 7811 papers identified, seven trials met the eligibility criteria. The quality was modest. Training programs varied significantly in duration, structure, location and use of outcome measurement tools. Five trials focused on communication with cancer patients using simulated patients. All trials found at least one statistically significant improvement for nurses' communication skills. CONCLUSIONS Educational interventions to enhance nurses' capacity to communicate with patients show promise. The paper reports the first systematic review of randomised controlled trials concerning the effect of communication skills training on nurses' abilities to communicate with patients, inclusive of non-cancer settings. The direct impact of educational interventions on nurses' communication skills is difficult to measure arising from non-standardised outcome measurement tools. Further research is particularly needed in acute, chronic illness, aged care and community settings.
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Affiliation(s)
- Debra Kerr
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Centre for Organisational Change in Person-Centred Healthcare, Deakin University, Australia.
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Barwon Health Partnership, Bellerine Street, Geelong, Victoria, Australia
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research (QPS), School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Barwon Health Partnership, Bellerine Street, Geelong, Victoria, Australia
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Deakin University, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
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Olsson A, Thunborg C, Björkman A, Blom A, Sjöberg F, Salzmann-Erikson M. A scoping review of complexity science in nursing. J Adv Nurs 2020. [PMID: 32281684 DOI: 10.1111/jan.14382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
Abstract
AIM To describe how complexity science has been integrated into nursing. DESIGN A scoping review. DATA SOURCE/REVIEW METHOD Academic Search Elite, Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science were searched November 2016, updated in October 2017 and January 2020. The working process included: problem identification, literature search, data evaluation, synthesizing and presentation. RESULTS Four categories were found in the included 89 articles: (a) how complexity science is integrated into the nursing literature in relation to nursing education and teaching; (b) patients' symptoms, illness outcome and safety as characteristics of complexity science in nursing; (c) that leaders and managers should see organizations as complex and adaptive systems, rather than as linear machines; and (d) the need for a novel approach to studying complex phenomena such as healthcare organizations. Lastly, the literature explains how complexity science has been incorporated into the discourse in nursing and its development. CONCLUSION The review provided strong support for use in complexity science in the contemporary nursing literature. Complexity science is also highly applicable and relevant to clinical nursing practice and nursing management from an organizational perspective. The application of complexity science as a tool in the analysis of complex nursing systems could improve our understanding of effective interactions among patients, families, physicians and hospital and skilled nursing facility staff as well as of education. IMPACT Understanding complexity science in relation to the key role of nurses in the healthcare environment can improve nursing work and nursing theory development. The use of complexity science provides nurses with a language that liberates them from the reductionist view on nursing education, practice and management.
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Affiliation(s)
- Annakarin Olsson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
| | - Charlotta Thunborg
- Department of Neurobiology, Care Sciences and Society, Division of Clinical geriatrics, Karolinska Institutet, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annica Björkman
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden.,Health Services Research, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anneli Blom
- Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden
| | - Fredric Sjöberg
- Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Martin Salzmann-Erikson
- Faculty of Health and Occupational Studies, Department of Caring Science, University of Gävle, Gävle, Sweden
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11
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Bird M, Strachan PH. Complexity science education for clinical nurse researchers. J Prof Nurs 2020; 36:50-55. [DOI: 10.1016/j.profnurs.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 12/26/2022]
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Omori M, Baker C, Jayasuriya J, Savvas S, Gardner A, Dow B, Scherer S. Maintenance of Professional Boundaries and Family Involvement in Residential Aged Care. Qual Health Res 2019; 29:1611-1622. [PMID: 30931823 DOI: 10.1177/1049732319839363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The importance of family's involvement in care planning has been stressed to cater individualized, person-centered care in residential aged care. However, in reality, there are numerous structural obstacles and barriers that limit opportunities for their involvement. The aim of this article is to explore what they are. The findings based on the 12 focus groups, six groups of care professionals and six groups of family/relatives, reveal that the narrow pathway of communication between staff and families, which is hierarchically structured, one-directional, and clinically driven, enables the former to maintain and control professional boundaries between formal and informal care-giving. Such communication style delimits an opportunity for families to engage in quality discussion about care planning for their loved ones with care staff. Communication within residential aged care facilities embodies complex dynamics of care expectations and responsibilities held by care staff and families.
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Affiliation(s)
- Maho Omori
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Courtney Baker
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Jude Jayasuriya
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Steven Savvas
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
- 2 Royal Freemasons Ltd, Melbourne, Victoria, Australia
- 3 The University of Melbourne, Parkville, Victoria, Australia
| | - Anastasia Gardner
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Briony Dow
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
- 3 The University of Melbourne, Parkville, Victoria, Australia
| | - Sam Scherer
- 2 Royal Freemasons Ltd, Melbourne, Victoria, Australia
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Affiliation(s)
- Courtney H. Van Houtven
- Courtney H. Van Houtven is a research scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs (VA) Health Care System, and a professor in the Department of Population Health Sciences at the Duke University School of Medicine, in Durham, North Carolina
| | - S. Nicole Hastings
- S. Nicole Hastings is center director and a research scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, and an associate professor of medicine and population health sciences and a senior fellow in the Center for the Study of Aging and Human Development at the Duke University School of Medicine
| | - Cathleen Colón-Emeric
- Cathleen Colón-Emeric is a research scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, and in the Durham VA Geriatrics Research, Education, and Clinical Center; a professor of medicine and chief of the Division of Geriatrics in the Department of Medicine, Duke University; and a senior fellow in the Center for the Study of Aging and Human Development, Duke University School of Medicine
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Wentlandt K, Toupin P, Novosedlik N, Le LW, Zimmermann C, Kaya E. Language Used by Health Care Professionals to Describe Dying at an Acute Care Hospital. J Pain Symptom Manage 2018; 56:337-343. [PMID: 29792980 DOI: 10.1016/j.jpainsymman.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 11/27/2022]
Abstract
CONTEXT Clinicians often rely on documentation to relay information, and this remains the mainstay of interprofessional communication regarding patient care. However, there has been scant research focused on clinicians' documentation of dying in hospital and how this is communicated to other team members in patient charting. OBJECTIVES To understand the language used to describe the deterioration and death of patients in an acute academic tertiary care center and to identify whether patient diagnoses or palliative care (PC) involvement was associated with clearer descriptions of this process. METHODS We conducted a retrospective chart review of the final admission of 150 patients who died on an inpatient internal medicine unit. Conventional and summative content analysis was performed of the language used to describe, either directly or indirectly, that the patient's death was imminent. RESULTS Of the 150 deaths, the median age was 79.5 (range 22-101), 58% were males, and 69% spoke English. A total of 45% of deaths were from cancer, and 66% occurred with prior PC team involvement. There was no documentation of the dying process in 18 (12%) charts. In the remainder, clinicians' documentation of imminent death fell into three categories: 1) identification of the current state using specific labels; for example, dying (24.7%) or end of life (15.3%), or less specific language, unwell or doing poorly (6.0%); 2) predicting the future state using specific or more vague predictions; for example, hours to days (7.3%) or poor or guarded prognosis (26.0%); and 3) using care provided to the patient to imply patient status; for example, PC (49.3%) or comfort care (28.7%). PC involvement, but not a malignant diagnosis, was associated with more frequent use of specific language to describe the current state (P = 0.004) or future state (P = 0.02). CONCLUSION Death and dying in hospital is inadequately documented and often described using unclear and vague language. PC involvement is associated with clearer language to describe this process.
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Affiliation(s)
- Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Philippe Toupin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalia Novosedlik
- Hospice Palliative Care and Caregiver Wellness, Scarborough Centre for Healthy Communities, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Research Institute, Toronto, Ontario, Canada
| | - Ebru Kaya
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Pype P, Mertens F, Helewaut F, Krystallidou D. Healthcare teams as complex adaptive systems: understanding team behaviour through team members' perception of interpersonal interaction. BMC Health Serv Res 2018; 18:570. [PMID: 30029638 PMCID: PMC6053823 DOI: 10.1186/s12913-018-3392-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/15/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Complexity science has been introduced in healthcare as a theoretical framework to better understand complex situations. Interdisciplinary healthcare teams can be viewed as Complex Adaptive Systems (CAS) by focusing more on the team members' interaction with each other than on the characteristics of individual team members. Viewing teams in this way can provide us with insights into the origins of team behaviour. The aim of this study is to describe the functioning of a healthcare team as it originates from the members' interactions using the CAS principles as a framework and to explore factors influencing workplace learning as emergent behaviour. METHODS An interview study was done with 21 palliative home-care nurses, 20 community nurses and 18 general practitioners in Flanders, Belgium. A two-step analysis consisted of a deductive approach, which uses the CAS principles as coding framework for interview transcripts, followed by an inductive approach, which identifies patterns in the codes for each CAS principle. RESULTS All CAS principles were identified in the interview transcripts of the three groups. The most prevalent principles in our study were principles with a structuring effect on team functioning: team members act autonomously guided by internalized basic rules; attractors shape the team functioning; a team has a history and is sensitive to initial conditions; and a team is an open system, interacting with its environment. The other principles, focusing on the result of the structuring principles, were present in the data, albeit to a lesser extent: team members' interactions are non-linear; interactions between team members can produce unpredictable behaviour; and interactions between team members can generate new behaviour. Patterns, reflecting team behaviour, were recognized in the coding of each CAS principle. Patterns of team behaviour, identified in this way, were linked to interprofessional competencies of the Interprofessional Collaboration Collaborative. Factors influencing workplace learning were identified. CONCLUSIONS This study provides us with insights into the origin of team functioning by explaining how patterns of interactions between team members define team behaviour. Viewing healthcare teams as Complex Adaptive Systems may offer explanations of different aspects of team behaviour with implications for education, practice and research.
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Affiliation(s)
- Peter Pype
- Department of Family Medicine and Primary Health Care, University Hospital – 6K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Fien Mertens
- Department of Family Medicine and Primary Health Care, University Hospital – 6K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Fleur Helewaut
- Clinical Skills Training Centre, Faculty of Medicine and Health Sciences, University Hospital 2K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Demi Krystallidou
- Faculty of Arts (Sint Andries Campus), University of Leuven, Sint Andriesstraat 2, B-2000 Antwerp, Belgium
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Banerjee A, James R, Mcgregor M, Lexchin J. Nursing Home Physicians Discuss Caring for Elderly Residents: An Exploratory Study. Can J Aging 2018; 37:133-44. [PMID: 29618397 DOI: 10.1017/s0714980818000089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RÉSUMÉMalgré la complexité croissante des soins en foyers de soins de longue durée, le rôle des médecins dans la prestation des soins aux résidents a été peu étudié. Cette étude exploratoire internationale visait à mieux comprendre les rôles des médecins, leurs responsabilités et leurs tâches, ainsi qu’à explorer les caractéristiques uniques de la pratique médicale dans les foyers de soins de longue durée. Des entrevues ont été menées avec 18 médecins. Ces médecins ont mentionné qu’ils contribuaient fortement à la qualité des soins pour les résidents, en clarifiant les objectifs des soins, en prenant des mesures pour réduire les hospitalisations et les prescriptions de médicaments non nécessaires, et en contribuant à la formation du personnel. Les pratiques en foyers de soins de longue durée impliquaient les médecins au centre de réseaux de relations qui assuraient non seulement une meilleure qualité des soins médicaux, mais aussi une satisfaction professionnelle chez les médecins. L’importance de ces relations est telle qu’elle permettait d’aller au-delà des démarcations traditionnelles entre le domaine médical et le domaine social, et mettait en évidence qu’une bonne pratique médicale implique de bonnes pratiques sociales. Considérant la nature exploratoire de l’étude, les auteurs recommandent que de futures recherches soient menées pour mieux comprendre les dimensions relationnelles associées à la pratique de la médecine en foyers de soins de longue durée.
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Colón-Emeric CS, Corazzini KN, McConnell ES, Pan W, Toles MP, Hall R, Batchelor-Murphy M, Yap TL, Anderson AL, Burd A, Amarasekara S, Anderson RA. Resident Vignettes for Assessing Care Quality in Nursing Homes. J Am Med Dir Assoc 2018; 19:405-10. [PMID: 29174560 DOI: 10.1016/j.jamda.2017.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Validated process measures that correlate with patient outcomes are needed for research and quality improvement. DESIGN Cross-sectional analysis within a cluster-randomized fall prevention study. SETTING Nursing homes in North Carolina (n = 16). PARTICIPANTS Nursing home staff (n = 541) and residents with 1 or more falls in 6 months (n = 597). MEASUREMENTS Fall-prevention process measures in 4 categories derived from Assessing Care of Vulnerable Elders quality indicators were measured in 2 ways: (1) chart abstraction; and (2) staff responses to clinical vignettes of hypothetical residents at risk for falls. Recurrent fall rates (falls/resident/year) were measured. The proportion of the total variation in falls rates explained by the scores for each method (chart abstraction or vignette) was calculated using multilevel adjusted models. RESULTS Chart and vignette measures of comorbidity management were moderately correlated (Pearson correlation coefficient 0.43), whereas other process measure categories had low or negative correlation between the 2 methods (psychoactive medication reduction 0.13, environmental modification -0.42, and exercise/rehabilitation -0.08). Measures of environmental modification and comorbidity management explained a moderate amount of the total variation in recurrent fall fates, vignettes (7%-10% variation explained) were superior to chart abstraction (2%-6% variation explained). Vignette responses from unlicensed staff (nurse aides and rehabilitation aides) explained more variance than registered nurses, licensed practical nurses, or other licensed staff in these categories. Process measures for psychoactive medication reduction and exercise/rehabilitation did not explain any of the variation in fall outcomes. Overall, vignette process measures explained 3.9% and chart abstraction measures explained 0% of the variation in fall outcomes. CONCLUSIONS Clinical vignettes completed by nursing home staff had greater association with resident recurrent fall rates than traditional chart abstraction process measures.
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Colón-Emeric CS, Corazzini K, McConnell ES, Pan W, Toles M, Hall R, Cary MP, Batchelor-Murphy M, Yap T, Anderson AL, Burd A, Amarasekara S, Anderson RA. Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes: A Cluster-Randomized Trial. JAMA Intern Med 2017; 177:1634-1641. [PMID: 28973516 PMCID: PMC5710274 DOI: 10.1001/jamainternmed.2017.5073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
IMPORTANCE New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls. OBJECTIVE To test whether a complexity science-based staff training intervention (CONNECT) promoting high-quality staff interactions improves the impact of an evidence-based falls quality improvement program (FALLS). DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized trial in 24 nursing homes receiving either CONNECT followed by FALLS (intervention), or FALLS alone (control). Nursing home staff in all positions were asked to complete surveys at baseline, 3, 6, and 9 months. Medical records of residents with at least 1 fall in the 6-month pre- and postintervention windows (n = 1794) were abstracted for fall risk reduction measures, falls, and injurious falls. INTERVENTIONS CONNECT taught staff to improve their connections with coworkers, increase information flow, and use cognitive diversity in problem solving. Intervention components included 2 classroom sessions, relationship mapping, and self-monitoring. FALLS provided instruction in the Agency for Healthcare Research and Quality's Falls Management Program. MAIN OUTCOMES AND MEASURES Primary outcomes were (1) mean number of fall risk reduction activities documented within 30 days of falls and (2) median fall rates among residents with at least 1 fall during the study period. In addition, validated scales measured staff communication quality, frequency, timeliness, and safety climate. RESULTS Surveys were completed by 1545 staff members, representing 734 (37%) and 811 (44%) of eligible staff in intervention and control facilities, respectively; 511 (33%) respondents were hands-on care workers. Neither the CONNECT nor the FALLS-only facilities improved the mean count of fall risk reduction activities following FALLS (3.3 [1.6] vs 3.2 [1.5] of 10); furthermore, adjusted median recurrent fall rates did not differ between the groups (4.06 [interquartile range {IQR}, 2.03-8.11] vs 4.06 [IQR, 2.04-8.11] falls/resident/y). A modest improvement in staff communication measures was observed overall (mean, 0.03 [SE, 0.01] points on a 5-point scale; P = .03) and for communication timeliness (mean, 0.8 [SE, 0.03] points on a 5-point scale; P = .02). There was wide variation across facilities in intervention penetration. CONCLUSIONS AND RELEVANCE An intervention targeting gaps in staff communication and coordination did not improve the impact of a falls quality improvement program. New approaches to implementing evidence-based care for complex conditions in the nursing home are urgently needed. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00636675.
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Affiliation(s)
- Cathleen S Colón-Emeric
- Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina
| | | | - Eleanor S McConnell
- Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina.,Duke University School of Nursing, Durham, North Carolina
| | - Wei Pan
- Duke University School of Nursing, Durham, North Carolina
| | - Mark Toles
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill
| | - Rasheeda Hall
- Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina.,Durham VA Geriatric Research Education and Clinical Center, Durham, North Carolina
| | - Michael P Cary
- Duke University School of Nursing, Durham, North Carolina
| | | | - Tracey Yap
- Duke University School of Nursing, Durham, North Carolina
| | | | - Andrew Burd
- Duke University School of Nursing, Durham, North Carolina
| | | | - Ruth A Anderson
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill
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Pype P, Krystallidou D, Deveugele M, Mertens F, Rubinelli S, Devisch I. Healthcare teams as complex adaptive systems: Focus on interpersonal interaction. Patient Educ Couns 2017; 100:2028-2034. [PMID: 28687278 DOI: 10.1016/j.pec.2017.06.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/11/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study is to test the feasibility of a tool to objectify the functioning of healthcare teams operating in the complexity zone, and to evaluate its usefulness in identifying areas for team quality improvement. METHODS We distributed The Complex Adaptive Leadership (CAL™) Organisational Capability Questionnaire (OCQ) to all members of one palliative care team (n=15) and to palliative care physicians in Flanders, Belgium (n=15). Group discussions were held on feasibility aspects and on the low scoring topics. Data was analysed calculating descriptive statistics (sum score, mean and standard deviation). The one sample T-Test was used to detect differences within each group. RESULTS Both groups of participants reached mean scores ranging from good to excellent. The one sample T test showed statistically significant differences between participants' sum scores within each group (p<0,001). Group discussion led to suggestions for quality improvement e.g. enhanced feedback strategies between team members. CONCLUSION The questionnaire used in our study shows to be a feasible and useful instrument for the evaluation of the palliative care teams' day-to-day operations and to identify areas for quality improvement. PRACTICAL IMPLICATIONS The CAL™OCQ is a promising instrument to evaluate any healthcare team functioning. A group discussion on the questionnaire scores can serve as a starting point to identify targets for quality improvement initiatives.
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Affiliation(s)
- Peter Pype
- Department of Family Medicine and Primary Health Care, University Hospital - 6K3, Ghent University, De Pintelaan 185, B-9000 Gent, End-of-Life Care Research Group, VUB & Ghent University, Belgium.
| | - Demi Krystallidou
- Faculty of Arts (Sint Andries Campus), Sint Andriesstraat 2, B-2000 Antwerp, Belgium.
| | - Myriam Deveugele
- Department of Family Medicine and Primary Health Care, University Hospital - 6K3, Ghent University, De Pintelaan 185, B-9000 Gent, Belgium.
| | - Fien Mertens
- Department of Family Medicine and Primary Health Care, University Hospital - 6K3, Ghent University, De Pintelaan 185, B-9000 Gent, Belgium.
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne\and Swiss Paraplegic Research, Nottwil, Guido Zäch Strasse 4, 6207 Nottwil, Switzerland.
| | - Ignaas Devisch
- Department of Family Medicine and Primary Health Care, University Hospital - 6K3, Ghent University-Artevelde University College, De Pintelaan 185, B-9000 Gent, Belgium.
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Madden C, Clayton M, Canary HE, Towsley G, Cloyes K, Lund D. Rules of performance in the nursing home: A grounded theory of nurse–CNA communication. Geriatr Nurs 2017; 38:378-384. [DOI: 10.1016/j.gerinurse.2016.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022]
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Thompson DS, Fazio X, Kustra E, Patrick L, Stanley D. Scoping review of complexity theory in health services research. BMC Health Serv Res 2016; 16:87. [PMID: 26968157 PMCID: PMC4788824 DOI: 10.1186/s12913-016-1343-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/09/2016] [Indexed: 11/17/2022] Open
Abstract
Background There are calls for better application of theory in health services research. Research exploring knowledge translation and interprofessional collaboration are two examples, and in both areas, complexity theory has been identified as potentially useful. However, how best to conceptualize and operationalize complexity theory in health services research is uncertain. The purpose of this scoping review was to explore how complexity theory has been incorporated in health services research focused on allied health, medicine, and nursing in order to offer guidance for future application. Given the extensiveness of how complexity theory could be conceptualized and ultimately operationalized within health services research, a scoping review of complexity theory in health services research is warranted. Methods A scoping review of published research in English was conducted using CINAHL, EMBASE, Medline, Cochrane, and Web of Science databases. We searched terms synonymous with complexity theory. Results We included 44 studies in this review: 27 were qualitative, 14 were quantitative, and 3 were mixed methods. Case study was the most common method. Long-term care was the most studied setting. The majority of research was exploratory and focused on relationships between health care workers. Authors most commonly used complexity theory as a conceptual framework for their study. Authors described complexity theory in their research in a variety of ways. The most common attributes of complexity theory used in health services research included relationships, self-organization, and diversity. A common theme across descriptions of complexity theory is that authors incorporate aspects of the theory related to how diverse relationships and communication between individuals in a system can influence change. Conclusion Complexity theory is incorporated in many ways across a variety of research designs to explore a multitude of phenomena.. Although complexity theory shows promise in health services research, particularly related to relationships and interactions, conceptual confusion and inconsistent application hinders the operationalization of this potentially important perspective. Generalizability from studies that incorporate complexity theory is, therefore, difficult. Heterogeneous conceptualization and operationalization of complexity theory in health services research suggests there is no universally agreed upon approach of how to use this theory in health services research. Future research should include clear definitions and descriptions of complexity and how it was used in studies. Clear reporting will aid in determining how best to use complexity theory in health services research.
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Affiliation(s)
- David S Thompson
- School of Nursing, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada.
| | - Xavier Fazio
- Faculty of Education, Brock University, 500 Glenridge Avenue, St. Catharines, ON, L2S 3A1, Canada
| | - Erika Kustra
- Teaching and Learning Development, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Linda Patrick
- Faculty of Nursing, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Darren Stanley
- Faculty of Education, University of Windsor, 401 Sunset, Avenue, Windsor, ON, N9B 3P4, Canada
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Abstract
The growing research literature on cognitive diversity in teams has multidisciplinary and international relevance. However, the varied conceptual and operational definitions restrict theory development and comparisons of empirical results. The purpose of the present article is to provide guidance for the systematic study of cognitive diversity and team functioning. We demonstrate that organization of the literature is necessary and offer an organizing heuristic based on the stability of the cognitive diversity conceptualization. Using this framework, we review the empirical findings for the effects of cognitive diversity on team criteria. Then, we address methodological issues and describe the manners in which cognitive diversity has been composed to the team level. Following each section we offer summary findings, critique the state of the literature, and offer guidance for future research. There are opportunities for researchers to enhance precision in theory and measurement and for integration across disciplines.
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Shetach A, Marcus O. Citizenship-behavior, cooperation and job satisfaction of medical and nursing teams in an Israeli hospital. Team Performance Management: An International Journal 2015. [DOI: 10.1108/tpm-11-2014-0058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to investigate into the relationships among citizenship behavior within medical and nursing teams, cooperation among these teams within hospital units and job satisfaction of members of those teams.
Design/methodology/approach
– Data were gathered via questionnaires, administered to 107 doctors and nurses of a small hospital in Israel, regarding their job satisfaction, their evaluation of the citizenship behavior within their own professional team (medical or nursing) and the extent of cooperation of their own team with the other professional team. Preacher and Hayes’s mediation analyses were carried out on the data.
Findings
– The findings show that medical–nursing cooperation mediates the relationship between citizenship behavior within the professional team (medical or nursing) and job satisfaction. When analyzed separately for doctors and nurses, results show that job satisfaction is predicted by the cooperation between the medical and nursing staff within hospital units, for nurses only. Citizenship behavior is shown to predict job satisfaction for each of the two professional sectors. Although for nurses, both factors affect their levels of job satisfaction, whereas for the doctors, cooperation affects citizenship behavior within the medical team, which, in turn, affects their job satisfaction.
Research limitations/implications
– The research sample is small and culturally specific, thus limiting the generalization potential of this study.
Originality/value
– The unique nature of teamwork within hospital departments is hereby investigated. The findings shed light on a critical issue of hospital human resource management, which has not been previously investigated, and may have practical implications regarding hospitals’ overall management policies.
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Hunter PV, Hadjistavropoulos T, Kaasalainen S. A qualitative study of nursing assistants' awareness of person-centred approaches to dementia care. Ageing and Society 2016; 36:1211-37. [DOI: 10.1017/s0144686x15000276] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTRecently, the number of education programmes addressing person-centred approaches to long-term residential dementia care has increased, and nursing assistants (NAs) are often the target audience. The effectiveness of employee education programmes is actively debated, and our objective is to contribute to this discussion by exploring the knowledge NAs acquire through practice. We examined approaches to person-centred care generated during a series of interviews with NAs, and compared these to the content of five frameworks for person-centred dementia care. Our results suggest that although NAs acquire significant knowledge about person-centred dementia care during the course of their work, application of person-centred care strategies varies across NAs. We propose ways of enhancing NA education in order to address gaps in knowledge. We also recommend sustained attention to organisational factors that contribute to variability in practice.
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Shetach A, Marcus O. The critical managerial capabilities of medical and nursing managers in an Israeli hospital. Evidence-based HRM: a Global Forum for Empirical Scholarship 2015. [DOI: 10.1108/ebhrm-12-2012-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to determine the managerial capabilities that are required of medical and nursing managers, in a Christian-affiliated hospital in Israel, in order to promote the job satisfaction of their subordinates.
Design/methodology/approach
– Data were gathered via questionnaires, administered to 107 doctors and nurses of a small Christian-affiliated hospital in Israel, regarding the job satisfaction of the respondents, and their evaluation of the managerial capabilities of their medical and nursing superiors. Correlations and regressions were carried out on the data.
Findings
– Overall managerial capabilities of medical and nursing managers were shown to be significantly related to how their subordinates felt about their teams and about their work. The results suggest differences between nurses and doctors. When analyzed for the two dimensions of managerial capabilities and the two dimensions of job satisfaction, the results were significant for the nurses, but not significant for the doctors. When tested for Christians vs non-Christians, the results for the nurses were the same as in the sample as a whole; whereas for the doctors, there were differences between the two religious groups.
Research limitations/implications
– The sample is small and culturally specific, thus limiting the generalization potential of this study.
Practical implications
– Findings of this research may have practical implications regarding hospitals’ recruitment, promotion, instruction and follow-up policies.
Originality/value
– This study sheds light on the issue of hospital management and leadership within a specific cultural-religious setting, which has not been previously investigated.
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Eika M, Dale B, Espnes GA, Hvalvik S. Nursing staff interactions during the older residents' transition into long-term care facility in a nursing home in rural Norway: an ethnographic study. BMC Health Serv Res 2015; 15:125. [PMID: 25888843 PMCID: PMC4380253 DOI: 10.1186/s12913-015-0818-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Future challenges in many countries are the recruitment of competent staff in long-term care facilities, and the use of unlicensed staff. Our study describes and explores staff interactions in a long-term care facility, which may facilitate or impede healthy transition processes for older residents in transition. Methods An ethnographic study based on fieldwork following ten older residents admission day and their initial week in the long-term care facility, seventeen individual semi-structured interviews with different nursing staff categories and the leader of the institution, and reading of relevant documents. Results The interaction among all staff categories influenced the new residents’ transition processes in various ways. We identified three main themes: The significance of formal and informal organization; interpersonal relationships and cultures of care; and professional hierarchy and different scopes of practice. Conclusions The continuous and spontaneous staff collaborations were key activities in supporting quality care in the transition period. These interactions maintained the inclusion of all staff present, staff flexibility, information flow to some extent, and cognitive diversity, and the new resident’s emerging needs appeared met. Organizational structures, staff’s formal position, and informal staff alliances were complex and sometimes appeared contradictory. Not all the staff were necessarily included, and the new residents’ needs not always noticed and dealt with. Paying attention to the playing out of power in staff interactions appears vital to secure a healthy transition process for the older residents.
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Affiliation(s)
- Marianne Eika
- Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway. .,Telemark University College, Faculty of Health and Social Studies, Post box 203, , NO-3901, Porsgrunn, Norway. .,Center for Caring Research, Telemark University College, Post box 203, , 3901, Porsgrunn, Norway.
| | - Bjørg Dale
- Department of Health and Nursing Sciences, Agder University, Campus Grimstad, Post box 509, , N-4898, Grimstad, Norway. .,Center for Caring Research - Southern Norway, Campus Grimstad, Post box 509, , N-4898, Grimstad, Norway.
| | - Geir Arild Espnes
- Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.
| | - Sigrun Hvalvik
- Telemark University College, Faculty of Health and Social Studies, Post box 203, , NO-3901, Porsgrunn, Norway. .,Center for Caring Research, Telemark University College, Post box 203, , 3901, Porsgrunn, Norway.
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Abstract
How can discharge planning (DP) for patients who require care in the home following a period in hospital be understood and developed through the lenses of complexity theory? With the help of complexity theory and practice-based narrative research this study discloses the formal routines and complex dynamic practices that are associated with DP. A study of the literature established that there was an almost total absence of complexity-theoretical perspectives on interpreting and developing DP. The researchers collected narratives about the DP processes using qualitative interviews with the nurses responsible for this in a hospital ward: these were audio-recorded and transcribed verbatim. They also participated in and documented meetings where these nurses, as a group, discussed DP. The findings show that nurses have to continuously deal with uncertainty, surprises and the unknown. They have to make sense and take charge of dynamic complex events and new knowledge, and manage complex relations and information. The researchers argue that looking upon practice from the lenses of complexity theory, and therefore accepting the complexity of practice, could facilitate the development of nurses' skills in order to guarantee good quality in DP.
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Affiliation(s)
- Sören Augustinsson
- Senior Lecturer, School of Health and Society, Kristianstad University, Sweden
| | - Pia Petersson
- Senior Lecturer, School of Health and Society, Kristianstad University, Sweden
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Bennett MK, Ward EC, Scarinci NA. Mealtime management in Australian residential aged care: Comparison of documented, reported and observed care. Int J Speech Lang Pathol 2014; 17:451-459. [PMID: 25541741 DOI: 10.3109/17549507.2014.987816] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Mealtime management in Residential aged care facilities (RACFs) should be holistic and comply with the principles of person-centred care (PCC) to ensure residents' medical, nutritional and psychosocial mealtime needs are met. However, this is not always achieved and multiple issues with mealtime management in RACFs exist. The aim of the current study was to compare documented, reported and observed mealtime management to explore factors influencing optimal mealtime care. METHOD Data were triangulated from: (a) review of 14 resident files; (b) observation of 41 mealtimes; (c) questionnaires with 14 residents; and (d) questionnaires with 29 staff. RESULT Results revealed multiple discrepancies between data sources leading to the delivery of sub-optimal mealtime care. Poor documentation impacted staff knowledge of required mealtime practices resulting in occasions of inconsistent and inappropriate care. Observational and interview data highlighted discrepancies between residents' mealtime preferences and actual practice. In many instances observed care was not holistic nor consistent with PCC. CONCLUSION Given the significant medical, nutritional and psychosocial risks associated with poor mealtime management, systematic changes in policy, staff training and multidisciplinary care are needed.
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Leykum LK, Lanham HJ, Pugh JA, Parchman M, Anderson RA, Crabtree BF, Nutting PA, Miller WL, Stange KC, McDaniel RR. Manifestations and implications of uncertainty for improving healthcare systems: an analysis of observational and interventional studies grounded in complexity science. Implement Sci 2014; 9:165. [PMID: 25407138 PMCID: PMC4239371 DOI: 10.1186/s13012-014-0165-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/27/2014] [Indexed: 12/02/2022] Open
Abstract
Background The application of complexity science to understanding healthcare system improvement highlights the need to consider interdependencies within the system. One important aspect of the interdependencies in healthcare delivery systems is how individuals relate to each other. However, results from our observational and interventional studies focusing on relationships to understand and improve outcomes in a variety of healthcare settings have been inconsistent. We sought to better understand and explain these inconsistencies by analyzing our findings across studies and building new theory. Methods We analyzed eight observational and interventional studies in which our author team was involved as the basis of our analysis, using a set theoretical qualitative comparative analytic approach. Over 16 investigative meetings spanning 11 months, we iteratively analyzed our studies, identifying patterns of characteristics that could explain our set of results. Our initial focus on differences in setting did not explain our mixed results. We then turned to differences in patient care activities and tasks being studied and the attributes of the disease being treated. Finally, we examined the interdependence between task and disease. Results We identified system-level uncertainty as a defining characteristic of complex systems through which we interpreted our results. We identified several characteristics of healthcare tasks and diseases that impact the ways uncertainty is manifest across diverse care delivery activities. These include disease-related uncertainty (pace of evolution of disease and patient control over outcomes) and task-related uncertainty (standardized versus customized, routine versus non-routine, and interdependencies required for task completion). Conclusions Uncertainty is an important aspect of clinical systems that must be considered in designing approaches to improve healthcare system function. The uncertainty inherent in tasks and diseases, and how they come together in specific clinical settings, will influence the type of improvement strategies that are most likely to be successful. Process-based efforts appear best-suited for low-uncertainty contexts, while relationship-based approaches may be most effective for high-uncertainty situations. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0165-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luci K Leykum
- South Texas Veterans Health Care System, San Antonio, TX, USA.
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30
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Frey R, Boyd M, Foster S, Robinson J, Gott M. Burnout matters: The impact on residential aged care staffs’ willingness to undertake formal palliative care training. Progress in Palliative Care 2014. [DOI: 10.1179/1743291x14y.0000000096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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31
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Anderson RA, Toles MP, Corazzini K, McDaniel RR, Colón-Emeric C. Local interaction strategies and capacity for better care in nursing homes: a multiple case study. BMC Health Serv Res 2014; 14:244. [PMID: 24903706 DOI: 10.1186/1472-6963-14-244] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 05/06/2014] [Indexed: 11/29/2022] Open
Abstract
Background To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff. Methods We conducted comparative, multiple-case studies in selected NHs (N = 4). Data were collected over six months from managers and staff (N = 406), using direct observations, interviews, and document reviews. Manifest content analysis was used to identify and explore patterns within and between cases. Results Participants described interaction strategies that they explained could either degrade or enhance their capacity to achieve better outcomes for residents; people in all job categories used these ‘local interaction strategies’. We categorized these two sets of local interaction strategies as the ‘common pattern’ and the ‘positive pattern’ and summarize the results in two models of local interaction. Conclusions The findings suggest the hypothesis that when staff members in NHs use the set of positive local interaction strategies, they promote inter-connections, information exchange, and diversity of cognitive schema in problem solving that, in turn, create the capacity for delivering better resident care. We propose that these positive local interaction strategies are a critical driver of care quality in NHs. Our hypothesis implies that, while staffing levels and skill mix are important factors for care quality, improvement would be difficult to achieve if staff members are not engaged with each other in these ways.
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Karra V, Papathanassoglou ED, Lemonidou C, Sourtzi P, Giannakopoulou M. Exploration and classification of intensive care nurses' clinical decisions: a Greek perspective. Nurs Crit Care 2014; 19:87-97. [PMID: 24400657 DOI: 10.1111/nicc.12018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 01/18/2013] [Accepted: 02/05/2013] [Indexed: 11/27/2022]
Abstract
AIM The recording, identification, coding and classification of clinical decisions by intensive care nurses. BACKGROUND Clinical decision-making is an essential dimension of nursing practice as through this process nurses make choices to meet the goals of patient care. Intensive care nurses' decision-making has received attention because of the complexity and urgency associated with it, however, the types of nurses' clinical decisions have not been described systematically. METHODS Qualitative content analysis of daily diaries of clinical decisions recorded during nursing work by 23 purposefully selected intensive care nurses from three major hospitals of Greece. The process of data collection and analysis continued until the point of theoretical saturation. FINDINGS Eight categories of nursing clinical decisions emerged including decisions related to: (1) evaluation, (2) diagnosis, (3) prevention, (4) intervention, (5) communication with patients, (6) clinical information seeking, (7) setting of clinical priorities and (8) communication with health care professionals. Psychological assessment and support decisions were scarce, whereas patient input in care decisions appeared to be limited. The most frequent types of decisions were regarding intervention (29%), evaluation (25%) and clinical setting of priorities (17%), while clinical information seeking (3%) and communication with patients decisions (2%) were the least frequent. Additionally, recorded decisions were ranked in order of degree of urgency and of dependency on medical order. Non-urgent decisions were 78% of the total and 60% of nurses' intervention decisions were independent of medical order and were related to basic nursing care. CONCLUSIONS Intensive care nurses make multiple decisions that seem to be in line with the nursing process, although the latter is not officially implemented in Greek ICUs. RELEVANCE TO CLINICAL PRACTICE The types and frequency of clinical decisions made by intensive care nurses are related to features of ICU work environment, their professional autonomy and accountability, as well as their perceptions of their clinical role.
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Affiliation(s)
- Vassiliki Karra
- V. Karra, RN, MSN, MHCM, PhD(c), Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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33
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Affiliation(s)
- Yi Liu
- Kaohsiung Medical University; Kaohsiung Taiwan
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34
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Colon-Emeric CS, McConnell E, Pinheiro SO, Corazzini K, Porter K, Earp KM, Landerman L, Beales J, Lipscomb J, Hancock K, Anderson RA. CONNECT for better fall prevention in nursing homes: results from a pilot intervention study. J Am Geriatr Soc 2013; 61:2150-2159. [PMID: 24279686 DOI: 10.1111/jgs.12550] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether an intervention that improves nursing home (NH) staff connections, communication, and problem solving (CONNECT) would improve implementation of a falls reduction education program (FALLS). DESIGN Cluster randomized trial. SETTING Community (n=4) and Veterans Affairs (VA) NHs (n=4). PARTICIPANTS Staff in any role with resident contact (n=497). INTERVENTION NHs received FALLS alone (control) or CONNECT followed by FALLS (intervention), each delivered over 3 months. CONNECT used storytelling, relationship mapping, mentoring, self-monitoring, and feedback to help staff identify communication gaps and practice interaction strategies. FALLS included group training, modules, teleconferences, academic detailing, and audit and feedback. MEASUREMENTS NH staff completed surveys about interactions at baseline, 3 months (immediately after CONNECT or control period), and 6 months (immediately after FALLS). A random sample of resident charts was abstracted for fall risk reduction documentation (n=651). Change in facility fall rates was an exploratory outcome. Focus groups were conducted to explore changes in organizational learning. RESULTS Significant improvements in staff perceptions of communication quality, participation in decision-making, safety climate, caregiving quality, and use of local interaction strategies were observed in intervention community NHs (treatment-by-time effect P=.01) but not in VA NHs, where a ceiling effect was observed. Fall risk reduction documentation did not change significantly, and the direction of change in individual facilities did not relate to observed direction of change in fall rates. Fall rates did not change in control facilities (falls/bed per year: baseline, 2.61; after intervention, 2.64) but decreased by 12% in intervention facilities (falls/bed per year: baseline, 2.34; after intervention, 2.06); the effect of treatment on rate of change was 0.81 (95% confidence interval=0.55-1.20). CONCLUSION CONNECT has the potential to improve care delivery in NHs, but the trend toward improving fall rates requires confirmation in a larger ongoing study.
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Affiliation(s)
- Cathleen S Colon-Emeric
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina
| | - Eleanor McConnell
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
| | - Sandro O Pinheiro
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Kirsten Corazzini
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Kristie Porter
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | | | - Lawrence Landerman
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
| | - Julie Beales
- Richmond Veterans Affairs Medical Center, Richmond, Virginia
| | - Jeffrey Lipscomb
- KayeM, Inc., Durham, North Carolina.,Salem Veterans Affairs Medical Center, Salem, Virginia
| | - Kathryn Hancock
- Asheville Veterans Affairs Medical Center, Asheville, North Carolina
| | - Ruth A Anderson
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,School of Nursing, Duke University, Durham, North Carolina
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Dellefield ME, Magnabosco JL. Pressure ulcer prevention in nursing homes: nurse descriptions of individual and organization level factors. Geriatr Nurs 2014; 35:97-104. [PMID: 24252559 DOI: 10.1016/j.gerinurse.2013.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 09/28/2013] [Accepted: 10/07/2013] [Indexed: 11/23/2022]
Abstract
Sustaining pressure ulcer prevention (PUP) in nursing homes has been difficult to achieve. Implementation science researchers suggest that identification of individual staff and organizational factors influencing current practices is essential to the development of an effective and customized plan to implement practice changes in a specific setting. A mixed methods approach was used to describe nurses' perceptions of individual and organization-level factors influencing performance of PUP in two Veterans Health Administration (VHA) nursing homes prior to implementation of a national VHA initiative on Hospital Acquired Pressure Ulcers (HAPUs). Individual interviews of 16 nursing staff were conducted. Individual factors influencing practice were a personal sense of responsibility to Veterans and belief in the effectiveness and importance of preventive measures. Organizational factors were existence of cooperative practices between nursing assistants and licensed nurses in assessing risk; teamwork, communication, and a commitment to Veterans' well-being. Integration and reinforcement of such factors in the development and maintenance of customized plans of PUP initiatives is recommended.
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Mitchell GJ, Cross N, Wilson M, Biernacki S, Wong W, Adib B, Rush D. Complexity and health coaching: synergies in nursing. Nurs Res Pract 2013; 2013:238620. [PMID: 24102025 PMCID: PMC3786472 DOI: 10.1155/2013/238620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 07/24/2013] [Accepted: 08/07/2013] [Indexed: 11/22/2022] Open
Abstract
Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons' lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.
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Affiliation(s)
- Gail J. Mitchell
- School of Nursing, York-UHN Nursing Academy, York University, HNE 349, 4700 Keele Street, Toronto, ON, Canada M3J 1P3
| | - Nadine Cross
- University Health Network, York-UHN Nursing Academy, York University, Toronto, ON, Canada
| | | | - Shauna Biernacki
- University Health Network, Black Creek Community Health Centre, Toronto, ON, Canada
| | - Winnie Wong
- University Health Network, Black Creek Community Health Centre, Toronto, ON, Canada
| | - Behnam Adib
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Danica Rush
- University Health Network, Dotsa Bitove Wellness Academy, Toronto, ON, Canada M4G 3E8
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Colón-Emeric CS, Pinheiro SO, Anderson RA, Porter K, McConnell E, Corazzini K, Hancock K, Lipscomb J, Beales J, Simpson KM. Connecting the learners: improving uptake of a nursing home educational program by focusing on staff interactions. Gerontologist 2013; 54:446-59. [PMID: 23704219 DOI: 10.1093/geront/gnt043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY The CONNECT intervention is designed to improve staff connections, communication, and use of multiple perspectives for problem solving. This analysis compared staff descriptions of the learning climate, use of social constructivist learning processes, and outcomes in nursing facilities receiving CONNECT with facilities receiving a falls education program alone. DESIGN AND METHODS Qualitative evaluation of a randomized controlled trial was done using a focus group design. Facilities (n = 8) were randomized to a falls education program alone (control) or CONNECT followed by FALLS (intervention). A total of 77 staff participated in 16 focus groups using a structured interview protocol. Transcripts were analyzed using framework analysis, and summaries for each domain were compared between intervention and control facilities. RESULTS Notable differences in descriptions of the learning climate included greater learner empowerment, appreciation of the role of all disciplines, and seeking diverse viewpoints in the intervention group. Greater use of social constructivist learning processes was evidenced by the intervention group as they described greater identification of communication weaknesses, improvement in communication frequency and quality, and use of sense-making by seeking out multiple perspectives to better understand and act on information. Intervention group participants reported outcomes including more creative fall prevention plans, a more respectful work environment, and improved relationships with coworkers. No substantial difference between groups was identified in safety culture, shared responsibility, and self-reported knowledge about falls. IMPLICATIONS CONNECT appears to enhance the use of social constructivist learning processes among nursing home staff. The impact of CONNECT on clinical outcomes requires further study.
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Affiliation(s)
- Cathleen S Colón-Emeric
- *Address correspondence to Cathleen Colón-Emeric, MHS, Durham VA Geriatric Research Education and Clinical Center, MD 508 Fulton St., GRECC 182, Durham, NC 27705. E-mail:
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38
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Corazzini KN, Mueller C, Anderson RA, Day L, Hunt-McKinney S, Porter K. Pain Medication Management in Nursing Homes and Nursing Scope of Practice. J Gerontol Nurs 2013; 39:40-6. [DOI: 10.3928/00989134-20130220-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 01/18/2013] [Indexed: 11/20/2022]
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Anderson RA. Commentary on "Health care organizations as complex systems: new perspectives on design and management" by Reuben R. McDaniel, Dean J. Driebe, and Holly Jordan Lanham. Adv Health Care Manag 2013; 15:27-36. [PMID: 24749212 DOI: 10.1108/s1474-8231(2013)0000015008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this commentary, I highlight a few of the assertions made by McDaniel et al. (2013) about the importance of complexity science guided management practices, and extend these ideas specifically to how we might think about reducing seemingly intractable problems in health care such as patient safety, patient falls, hospital acquired infection, and the rise of chronic illness and obesity. I suggest that such changes will require managers and providers to view health care organizations and patients as complex adaptive systems and include patients as full participants in co-producing their health care.
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Gotlib Conn L, Reeves S, Dainty K, Kenaszchuk C, Zwarenstein M. Interprofessional communication with hospitalist and consultant physicians in general internal medicine: a qualitative study. BMC Health Serv Res 2012. [PMID: 23198855 PMCID: PMC3520700 DOI: 10.1186/1472-6963-12-437] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Studies in General Internal Medicine [GIM] settings have shown that optimizing interprofessional communication is important, yet complex and challenging. While the physician is integral to interprofessional work in GIM there are often communication barriers in place that impact perceptions and experiences with the quality and quantity of their communication with other team members. This study aims to understand how team members’ perceptions and experiences with the communication styles and strategies of either hospitalist or consultant physicians in their units influence the quality and effectiveness of interprofessional relations and work. Methods A multiple case study methodology was used. Thirty-one semi-structured interviews were conducted with physicians, nurses and other health care providers [e.g. physiotherapist, social worker, etc.] working across 5 interprofessional GIM programs. Questions explored participants’ experiences with communication with all other health care providers in their units, probing for barriers and enablers to effective interprofessional work, as well as the use of communication tools or strategies. Observations in GIM wards were also conducted. Results Three main themes emerged from the data: [1] availability for interprofessional communication, [2] relationship-building for effective communication, and [3] physician vs. team-based approaches. Findings suggest a significant contrast in participants’ experiences with the quantity and quality of interprofessional relationships and work when comparing the communication styles and strategies of hospitalist and consultant physicians. Hospitalist staffed GIM units were believed to have more frequent and higher caliber interprofessional communication and collaboration, resulting in more positive experiences among all health care providers in a given unit. Conclusions This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes.
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Affiliation(s)
- Lesley Gotlib Conn
- Department of Surgery, St, Michael's Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada.
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Lanham HJ, Leykum LK, Taylor BS, McCannon CJ, Lindberg C, Lester RT. How complexity science can inform scale-up and spread in health care: understanding the role of self-organization in variation across local contexts. Soc Sci Med 2012; 93:194-202. [PMID: 22819737 DOI: 10.1016/j.socscimed.2012.05.040] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 05/22/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
Abstract
Health care systems struggle to scale-up and spread effective practices across diverse settings. Failures in scale-up and spread (SUS) are often attributed to a lack of consideration for variation in local contexts among different health care delivery settings. We argue that SUS occurs within complex systems and that self-organization plays an important role in the success, or failure, of SUS. Self-organization is a process whereby local interactions give rise to patterns of organizing. These patterns may be stable or unstable, and they evolve over time. Self-organization is a major contributor to local variations across health care delivery settings. Thus, better understanding of self-organization in the context of SUS is needed. We re-examine two cases of successful SUS: 1) the application of a mobile phone short message service intervention to improve adherence to medications during HIV treatment scale up in resource-limited settings, and 2) MRSA prevention in hospital inpatient settings in the United States. Based on insights from these cases, we discuss the role of interdependencies and sensemaking in leveraging self-organization in SUS initiatives. We argue that self-organization, while not completely controllable, can be influenced, and that improving interdependencies and sensemaking among SUS stakeholders is a strategy for facilitating self-organization processes that increase the probability of spreading effective practices across diverse settings.
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Affiliation(s)
- Holly Jordan Lanham
- Veterans Evidence Based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, USA.
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Anderson RA, Corazzini K, Porter K, Daily K, McDaniel RR, Colón-Emeric C. CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes. Implement Sci 2012; 7:11. [PMID: 22376375 PMCID: PMC3310735 DOI: 10.1186/1748-5908-7-11] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 02/29/2012] [Indexed: 12/02/2022] Open
Abstract
Background Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures. Methods/design Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model. Discussion By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate. Trial Registration ClinicalTrials.gov: NCT00636675
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Nazir A, Arling G, Katz PR. Incentivizing Nursing Home Quality and Physician Performance. J Am Med Dir Assoc 2012; 13:91-3. [DOI: 10.1016/j.jamda.2011.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 04/13/2011] [Indexed: 11/28/2022]
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Abstract
PurposeThe purpose of this paper is to study patients' attitudes to nurses and investigate what hampering factors occur in the actual nursing situation and what patient features might affect cooperative climates.Design/methodology/approachIn‐depth interviews were conducted with 11 male inpatients suffering prostate cancer. The interviews were personal narrations based on open‐ended questions. The theoretical basis is founded in sense‐making, trust and competence.FindingsExistential issues related to nursing care were interpreted by nurses as a need for (technical) information. However, respondents indicated a need for professional support regarding their whole life. The social climate seems not to be optimal for existential talk owing to hospital routines. Patients' personal traits also affect the propensity to cooperation, and three types were distinguished: cooperating patients; passive patients; and denying patients. Nurses' competence may be regarded as hierarchical levels from optimising single items, over system optimisation and to optimisation from the patient perspective. The study indicates that not even first‐level requirements are met.Research limitations/implicationsOnly patients' views were studied. Nurses' perceptions would add additional insights. Lack of personal relations and cooperation between patient and nurse may decrease service quality. Patient attitudes seem to be a major obstacle. For some patients, passively receiving technical information may be an excuse for not wanting to participate in mutual sense‐making. The supposed need for technical information may also be an excuse for nurses to avoid more sensitive issues.Originality/valueBetter quality of care involves changing patient perceptions and attitudes to what constitutes nursing competence.
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Abstract
BACKGROUND Examining the perception of patient safety culture (PSC) of top managers in health care settings is important because their orientation to PSC can have a large influence on the facility. PURPOSES In this research, the perception of PSC of nursing home administrators (NHAs) and directors of nursing (DONs) is examined. METHODOLOGY/APPROACH Primary data were collected to examine the opinions of NHAs and DONs regarding PSC. Information was collected from a large nationally representative sample of 4,000 nursing homes. The Nursing Home Survey on Patient Safety Culture survey instrument was used as a measure of PSC. This has 12 domains and 38 items. Bias indexes, intraclass correlation coefficients, and Pearson's product-moment correlation coefficients of the differences between NHA and DON item scores were examined. FINDINGS Using a 0-100 scale, most scores fell into the 55-80 range. Higher scores represent a higher (more favorable) PSC. Agreement between the NHAs and DONs was excellent in 10 items, good in 15 items, moderate in 4 items, and poor in 8 items. Of the four largest differences in scores, the NHA scores were higher than the DON scores for 1 item, and DON scores were higher than the NHA scores for 3 items. IMPLICATIONS The overall perception from both NHAs and DONs appear to represent a somewhat "positive" outlook from these top managers on their institution's PSC. However, NHAs in general report higher scores than DONs do. The areas of divergence between these top managers are further discussed, with a view toward directing future patient safety investigations and initiatives in nursing homes.
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Toles M, Anderson RA. State of the science: Relationship-oriented management practices in nursing homes. Nurs Outlook 2011; 59:221-7. [DOI: 10.1016/j.outlook.2011.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 04/25/2011] [Accepted: 05/01/2011] [Indexed: 11/27/2022]
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Abstract
The vast majority of care for end-stage renal disease (ESRD) patients is provided by skilled (but not formally educated) paraprofessional technicians. Using Goffman's (1959) framing of the performance of self in everyday discourse, this study examines discourse from dialysis technicians and technical aides to explore these paraprofessionals' construction and performance of professional identity and professional communication within the context of an outpatient dialysis clinic. Themes of professionalism--individualized care, vigilance, teamwork, and emotion management--are illustrated via poetic transcription of interviews with technicians. I contend that such representation offers validity equal to that of traditional research accounts while embodying alternative representational strengths.
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Affiliation(s)
- Laura L Ellingson
- Department of Communication and Women's & Gender Studies Program, Santa Clara University, CA 95053, USA.
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Colón-Emeric CS, Plowman D, Bailey D, Corazzini K, Utley-Smith Q, Ammarell N, Toles M, Anderson R. Regulation and mindful resident care in nursing homes. Qual Health Res 2010; 20:1283-1294. [PMID: 20479137 PMCID: PMC2918733 DOI: 10.1177/1049732310369337] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple-case study including field notes, interviews, and documents collected in eight nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities.
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Zheng NT, Temkin-Greener H. End-of-life care in nursing homes: the importance of CNA staff communication. J Am Med Dir Assoc 2010; 11:494-9. [PMID: 20816337 DOI: 10.1016/j.jamda.2010.01.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/12/2010] [Accepted: 01/14/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Staff communication has been shown to influence overall nursing home (NH) performance. However, no empirical studies have focused specifically on the impact of CNA communication on end-of-life (EOL) care processes. This study examines the relationship between CNA communication and nursing home performance in EOL care processes. DESIGN Secondary data analysis of 2 NH surveys conducted in 2006-2007. SETTING One hundred seven nursing homes in New York State. PARTICIPANTS Participants were 2636 CNAs and 107 directors of nursing (DON). MEASUREMENTS The measures of EOL care processes-EOL assessment and care delivery (5-point Likert scale scores)-were obtained from survey responses provided by 107 DONs. The measure of CNA communication was derived from survey responses obtained from 2636 CNAs. Other independent variables included staff education, hospice use intensity, staffing ratio, staff-resident ethnic overlap index, facility religious affiliation, and ownership. METHODS The reliability and validity of the measures of EOL care processes and CNA communication were tested in the current study sample. Multivariate linear regression models with probability weights were used. The analysis was conducted at the facility level. RESULTS We found better CNA communication to be significantly associated with better EOL assessment (P = .043) and care delivery (P = .098). Two potentially modifiable factors-staff education and hospice use intensity-were associated with NHs' performance in EOL care processes. Facilities with greater ethnic overlap between staff and residents demonstrated better EOL assessment (P = .051) and care delivery scores (P = .029). CONCLUSION Better CNA communication was associated with better performance in EOL care processes. Our findings provide specific insights for NH leaders striving to improve EOL care processes and ultimately the quality of care for dying residents.
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Affiliation(s)
- Nan Tracy Zheng
- Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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