Filipino therapists’ experiences and attitudes of interprofessional education and collaboration: A cross-sectional survey

For the past more than 50 years, the World Health Organisation has acknowledged through empirical findings that health workers that learn together work together effectively to provide the best care for their patients. This study aimed to: (1) describe the perceived extent of interprofessional education (IPE) experience among Filipino occupational therapists (OTs), physical therapists (PTs), and speech-language-pathologists (SLPs); (2) identify their attitudes towards interprofessional collaboration (IPC); and (3) compare their attitudes towards IPC according to: prior IPE experience, classification of IPE experience, profession, years of practice, and practice setting. Using a cross-sectional survey design, a two-part questionnaire was sent to Filipino OTs, PTs, and SLPs working in the Philippines via an online survey application. The first part of the survey contained eight items of demographic information and the second part contained the 14-item Attitudes Towards Health Care Teams Scale (ATHCTS). Findings revealed that among the Filipino OT, PT and SLP respondents (n = 189), 70.9% had prior experience on IPE. Moreover, the three most commonly used IPE teaching-learning strategies were case discussion (clinical setting), small group discussion, didactics, and case discussion (community setting), while the use of didactics and case discussion (community setting) yielded more agreeable attitudes towards IPC. Among the 14 items in the ATHCTS, 11 were rated with agreeability and three items with neutrality. For professional variables, only the practice setting variable yielded a statistically significant finding confirming those working in the academia to be more agreeable towards IPC compared to other settings. However, years of practice and professional background variables both yielded no statistically significant difference implying no association between years of practice and attitude towards IPC and a homogenous composition among respondents, respectively. The results of this research are to springboard IPE initiatives within Philippine higher education institutions to enable evidence-based IPC approaches in clinical practice.     

Physicians' perceptions of physician–nurse collaboration in Japan: Effects of collaborative experience

Studies of physician–nurse relationships have focused mainly on nurses' perceptions. Few studies have explored physicians' perceptions and related factors. This study had two aims: to describe physicians' perceptions of physician–nurse collaboration in Japan by focusing on attitudes toward collaboration and collaborative practice and to examine the effect of physicians' experiences related to collaboration on their perceptions of collaboration. A cross-sectional survey was conducted. Of the 520 physicians from four hospitals, 248 completed the survey. The survey included the Jefferson Scale of attitudes toward physician–nurse collaboration, the collaborative practice scales, learning experiences related to collaboration with nurses and experiences of joint activities with nurses. Multiple regression analysis revealed that learning experiences in undergraduate and out-of-hospital education and experiences of joint committee work were significantly associated with higher collaborative practice scores. Although participants' attitude scores had a strong association with practice scores, there were no variables significantly associated with the attitude score. This study supported the importance of education in undergraduate courses and suggested that it should be ongoing after qualification. Joint activities other than daily practice, such as continuous quality improvement, might also be effective. Factors that improve physicians' attitudes toward collaboration should be further explored.     

Interprofessional education for health science students’ attitudes and readiness to work interprofessionally: a prospective cohort study

BackgroundInterprofessional education of healthcare providers is necessary to foster collaborative practice and improve patient outcomes.ObjectiveTo examine the effectiveness of the single-session interprofessional education in improving interprofessional attitudes, increasing knowledge of healthcare professions, and improving perceived-readiness for working interprofessionally and with older adults in students in occupational therapy, physical therapy, and physician assistant graduate programs.MethodsWe used a prospective, pre–post cohort design. Fall risk evaluation for older adults was selected as the topic of the 4-hour interprofessional education session. Graduate students from three professional programs including occupational therapy (n = 20), physical therapy (n = 26), and physician assistant studies (n = 35) participated in the study, and 17 older adults aged 65 years or older volunteered for the session. Our primary outcome measure was the Interprofessional Attitudes Scale measuring interprofessional attitudes, and our secondary outcome measure was the study-specific questionnaire measuring the direct effect of our interprofessional education session.ResultsGraduate students showed significant improvements in the subscale of teamwork, roles, and responsibilities in the Interprofessional Attitudes Scale. Students also showed significant improvements in “understanding of other professions,” “perceived-readiness to work interprofessionally,” and “perceived-readiness to work with older adults” in the study-specific questionnaire. Ceiling effects were observed in most of the subscales in the Interprofessional Attitudes Scale.ConclusionThis study demonstrates that a single 4-hour interprofessional education session can improve interprofessional attitudes, knowledge of other professions, and perceived-readiness of health science graduate students to work interprofessionally and to work with older adults.     

SBAR improves nurse–physician communication and reduces unexpected death: A pre and post intervention study

Background

The Joint Commission International Patient Safety Goal 2 states that effective communication between health care workers needs to improve. The aim of this study was to determine the effect of SBAR (situation, background, assessment, recommendation) on the incidence of serious adverse events (SAE's) in hospital wards.

Method

In 16 hospital wards nurses were trained to use SBAR to communicate with physicians in cases of deteriorating patients. A pre (July 2010 and April 2011) and post (June 2011 and March 2012) intervention study was performed. Patient records were checked for SBAR items up to 48 h before a SAE. A questionnaire was used to measure nurse–physician communication and collaboration.

Results

During 37,239 admissions 207 SAE's occurred and were checked for SBAR items, 425 nurses were questioned. Post intervention all four SBAR elements were notated more frequently in patient records in case of a SAE (from 4% to 35%; p < 0.001), total score on the questionnaire increased in nurses (from 58 (range 31–97) to 64 (range 25–97); p < 0.001), the number of unplanned intensive care unit (ICU) admissions increased (from 13.1/1000 to 14.8/1000 admissions; relative risk ratio (RRR) = 50%; 95% CI 30–64; p = 0.001) and unexpected deaths decreased (from 0.99/1000 to 0.34/1000 admissions; RRR = −227%; 95% CI −793 to −20; NNT 1656; p < 0.001). There was no difference in the number of cardiac arrest team calls.

Conclusion

After introducing SBAR we found increased perception of effective communication and collaboration in nurses, an increase in unplanned ICU admissions and a decrease in unexpected deaths.     

Australian and Indian nursing students’ skills and attitudes surrounding mental illness: Preparing for a transnational nursing education collaboration

Cultural competence is a viewed as a necessary set of skills within nursing, and there is a need for student support in this area. This is particularly important in mental health care, with two skills considered crucial for providing quality care: therapeutic relationship skills and positive attitudes. With the objective of initiating an educational collaboration between two educational institutions, this study examined Australian and Indian undergraduate nursing student's perceived therapeutic relationship skills and stigma attitudes associated with mental illness. Participants were five hundred and fifty-five (n = 555) undergraduate nursing students from two different universities in Indian and Australia. The modified version of the Scale To Assess Therapeutic Relationship (STAR-C) and the Social Distance Scale (SDS) were both used to examine student's perceived therapeutic relationship skills and stigma attitudes. Australian nursing students indicated lower levels of stigma with lower levels of self-reported therapeutic relationships skills, as compared with the Indian nursing student cohort. However, Indian nursing students indicated higher levels of stigma with higher self-reported therapeutic relationship skills. The results of this study may reflect cultural differences and meanings attached to mental illness.     

Developing and testing transferability and feasibility of a model for educators using simulation-based learning — A European collaboration

BackgroundThere is a pragmatic and often inconsistent approach of embedding simulation-based learning into nursing programmes. This paper details a European collaboration that designed a model for educator facilitation for educators utilizing simulation-based education.ObjectivesThe objectives of the study were to develop a model to educate the educators who deliver simulation-based learning and to test to which extent this model could be transferred to education providers in different national settings.MethodsThis model, its transferability and feasibility, was tested across three European countries. Educators from three Schools of Nursing participated in the study. Design-based Research was used as an overall methodology. Data were collected by the use of pre- and post-programme questionnaires and focus groups.ResultsThe content of the NESTLED model is consistent with the needs of the participants. The testing also demonstrated that the model is transferable across-countries. Additionally, the participants' preferences regarding amount of time and pre-reading for the different sessions vary depending on the background and level of seniority of the individual participant.ConclusionThe testing of the NESTLED model demonstrated that participants gained confidence and knowledge from undertaking the programme. Delivering the NESTLED model across-countries was found to be feasible, but flexibility is required in terms of logistical delivery of the programme.     

Interprofessional pharmacotherapy workshop: intervention to improve health professionals’ and students’ attitudes towards collaboration between physicians and pharmacists

ABSTRACT

Collaboration between physicians and pharmacists is recognized as an important factor for reducing medication errors and improving patient outcomes. Therefore, two pharmacotherapy workshops were delivered in Croatia - one for pre-registration medical (n=42, 4th-6th year) and pharmacy (n=38, 4th-5th year) students, and the other one for physicians (n=18) and pharmacists (n=23). The purpose of this study was to determine whether participation in common pharmacotherapy workshop could improve attitudes among participants towards interprofessional collaboration between pharmacists and physicians. Attitudes were measured by validated questionnaire “Scale of Attitudes Towards Collaboration Between Pharmacists and Physicians” at the beginning and at the end of the workshops. Three complex clinical scenarios were presented during the workshops. Participants were given general information about cases (all participants) and 2 groups of specific information (only for medical students/physicians and only for pharmacy students/pharmacists). For the first scenario, medical and pharmacy students/professionals were not allowed to exchange their specific information. However, participants collaborated for the 2nd and 3rd scenarios in order to achieve the hypothesized therapeutic goals. Before the workshops, pharmacists and pharmacy students showed more positive attitudes than physicians and medical students. However, the workshop contributed in closing the gap by equating health care professionals’ attitudes. Additionally, students’ attitudes were more positive after the workshop with an increase of 10% for medical and 2.2% for pharmacy students. This study indicates that interprofessional pharmacotherapy workshops could significantly improve attitudes toward collaboration between physicians and pharmacists for both students and practicing professionals.     

IN-2-THEORY – Interprofessional theory,scholarship and collaboration: A community of practice

Theoretical awareness is essential in the development and delivery of effective interprofessional education and collaborative practice (PECP). The objective of this paper was to explain the origins and purpose of an international network, IN-2-THEORY – interprofessional theory, scholarship and collaboration: a community of practice (CoP) that aims to build theoretical rigor in IPECP. It explains why the network is viewed as a CoP and lays out the way forward for the community based on the principles for developing a CoP outlined by Wenger, McDermott, and Snyder (2002).     

A call for better doctor–nurse collaboration: A qualitative study of the experiences of junior doctors and nurses in escalating care for deteriorating ward patients

BackgroundDespite the widespread implementation of medical emergency teams (METs) in hospitals to provide immediate interventions to deteriorating ward patients, little is known about how junior doctors and nurses escalate care for deteriorating ward patients in hospitals with established MET services.ObjectivesThe objective of this research study was to explore the experiences of junior doctors and nurses in escalating care for clinically deteriorating patients in general wards.MethodsTwenty-four individual interviews were conducted with 10 junior doctors and 14 registered nurses of a 1000-bed acute general hospital with the most established MET service in Singapore. Interviews were transcribed verbatim and analysed using an interpretive thematic analysis approach.FindingsThree salient themes emerged from thematic analysis: (1) MET activations versus the primary team doctors' reviews, (2) challenges in obtaining medical reviews, and (3) unspoken rules of the escalation of care. Participants' decisions to call the MET or to escalate to the primary team doctors not only depended on the severity of a patient's deterioration and their perceptions of the primary team doctors' capacity to manage the patient but also were largely influenced by sociocultural factors that were shaped by the hierarchy of medical professions. Key challenges faced by nurses in obtaining medical reviews from junior doctors for patients with early deterioration included presenting “convincing” evidence of patient deterioration and “packaging” information about patient deterioration.ConclusionsThe decision to call a MET or the primary team doctors is a complex judgement that is greatly influenced by the dynamics of perceived hierarchy between the medicine and nursing professions and within the medicine profession. Educational and organisational changes that enhance doctor–nurse interprofessional and intraprofessional collaboration among all levels of doctors may improve the process of the escalation of care for deteriorating patients and thus improve patient safety for hospitalised patients.     

Interprofessional education involving didactic TeamSTEPPS® and interactive healthcare simulation: A systematic review

ABSTRACT

The didactic portion of TeamSTEPPS®, which focuses on teaching teamwork and communication, coupled with interactive simulation methods provides a unique interprofessional education (IPE) learning environment. Across the literature there are a wide variety of such programs described, but there is not a consensus on the most effective methodology. A systematic review was therefore undertaken to synthesize, critically appraise, and evaluate existing literature on IPE programs that utilize didactic TeamSTEPPS in conjunction with interactive healthcare simulation. EBSCO and PubMed databases were searched from inception through March 2017 using predetermined inclusion and exclusion criteria. The initial search yielded 66 articles which was reduced to 42 peer-reviewed publications after duplicates were removed. An additional 2 articles were identified via hand search. Therefore, 44 articles were identified and reviewed and 11 studies met all inclusion criteria. Critical appraisal was performed using The Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. The outcome measures associated with each program as well as specifics of the didactic portion and interactive healthcare simulation are further explored in this review. It is anticipated that the findings from this systematic review will aid in the development of future evidence-based interprofessional programs.     

Practice educators’ attitudes and perspectives of interprofessional collaboration and interprofessional practice learning for students: A mixed-methods case study

ABSTRACT

Interprofessional collaboration (IPC) is important for the delivery of effective integrated health and social care systems. Interprofessional practice learning (IPPL) enables students to learn to work together within a relevant context and prepare for future IPC. While there is some evidence that negative attitudes impact on IPC and interprofessional education, there is a dearth of research on health and social work professionals’ attitudes and perspectives of IPC and IPPL opportunities for students. A mixed-methods case study was used to investigate practice educators’ attitudes and perspectives of IPC and IPPL for their students. Results showed that attitudes were positive and that mainly meso- and macro-level factors, as opposed to the micro level, impacted on the implementation of IPC and IPPL for students’ learning in practice settings. IPC was perceived to be best enabled by effective communication, established teams, IPPL for staff, and shared processes and policies. Close working proximity to other professionals encouraged informal communication and positive interprofessional relationships. Motivation and resources were perceived as enablers of IPPL, but there were often missed opportunities for IPPL. These findings suggest that further work is required to identify systems for improving IPC and to enhance IPPL opportunities for students learning within practice settings.     

Canada and the Caribbean–a bilateral program of continuing education for physical therapists

Postgraduate education for health professionals in Third World regions is affected by limited resources, financial constraints, and limited access to programs in countries with advanced health and education systems. A program linking a Canadian health science centre and physical therapy services in the Caribbean region has been developed. This program enables Canadian clinical specialists to offer short-term clinical continuing education programs in the Carribean directly in the health care and clinical teaching setting, on topics identified by Caribbean clinicians. The program, funded by the Canadian International Development Agency (CIDA), has provided over 30 clinical workshops over a 5 year period. It is suggested that this model of continuing education in Third World regions is applicable to other health science disciplines.     

Undergraduate nursing students' attitudes and preparedness toward caring for dying persons – A longitudinal study

Nursing education needs to prepare students for care of dying patients. The aim of this study was to describe the development of nursing students' attitudes toward caring for dying patients and their perceived preparedness to perform end-of-life care. A longitudinal study was performed with 117 nursing students at six universities in Sweden. The students completed the Frommelt Attitude Toward Care of the Dying Scale (FATCOD) questionnaire at the beginning of first and second year, and at the end of third year of education. After education, the students completed questions about how prepared they felt by to perform end-of-life care. The total FATCOD increased from 126 to 132 during education. Five weeks' theoretical palliative care education significantly predicted positive changes in attitudes toward caring for dying patients. Students with five weeks' theoretical palliative care training felt more prepared and supported by the education to care for a dying patient than students with shorter education. A minority felt prepared to take care of a dead body or meet relatives.     

The influence of effective communication,perceived respect and willingness to collaborate on nurses' perceptions of nurse–physician collaboration in China

BackgroundNurse-physician collaboration is a critical prerequisite for high-quality care. Previous researchers have addressed multiple factors that influence collaboration. However, little of this research has explored the influence of interactional factors on nurses' perception of nurse-physician collaboration in China.AimsTo examine the influence of interactional factors (effective communication, perceived respect and willingness to collaborate) on nurses' perception of nurse-physician collaboration.MethodsA cross-sectional survey of 971 registered nurses in nine hospitals was conducted. An author-designed interactional factor questionnaire and the Nurse-Physician Collaboration Scale were used to collect data. Multiple regression analysis was used.ResultsNurse-physician collaboration was identified as at a moderate level (mean = 3.93 ± 0.68). Interactional factors (effective communication, perceived respect and willingness to collaborate) were identified as relatively moderate to high (mean = 4.03 ± 0.68, mean = 3.87 ± 0.75, mean = 4.50 ± 0.59, respectively). The results showed that effective communication, perceived respect and willingness to collaborate explained 57.3% of the variance in nurses' perception of nurse-physician collaboration (Adjusted R² = 0.573, F = 435.563, P < 0.001). Perceived respect (β = 0.378) was the strongest factor relevant to nurses' perception of nurse-physician collaboration, second was effective communication (β = 0.315), and the weakest factor among these three factors was willingness to collaborate (β = 0.160).ConclusionNurses' perceptions of collaboration were relatively positive, mainly in Sharing of patient information; however, improvements need to be made regarding Joint participation in the cure/care decision-making process. Effective communication, perceived respect and willingness to collaborate significantly affect nurses' perception of nurse-physician collaboration, with perceived respect having greater explanatory power among the three interactional factors. It is necessary for hospital managers to develop strategies to build professional respect for nurses, facilitate effective nurse-physician communication and improve nurses' willingness to collaborate.     

Aiming for excellence – A simulation-based study on adapting and testing an instrument for developing non-technical skills in Norwegian student nurse anaesthetists

There is increasing focus on building safety into anaesthesia practice, with excellence in anaesthesia as an aspirational goal. Non-technical skills are an important factor in excellence and improved patient safety, though there have been few systematic attempts at integrating them into anaesthesia nursing education. This study aimed to test the reliability of NANTS-no, a specially adapted behavioural marker system for nurse anaesthetists in Norway, and explore the development of non-technical skills in student nurse anaesthetists. The pre-test post-test design incorporated a 10-week simulation-based programme, where non-technical skills in 14 student nurse anaesthetists were rated on three different occasions during high-fidelity simulation, before and after taking part in a training course. NANTS-no demonstrated high overall inter-rater reliability (ICC = 0.91), high test-retest reliability (ICC = 0.94) and good internal consistency (Cronbach's α of 0.85–0.92). A significant improvement was demonstrated across all categories of non-technical skills, with greatest improvements between the first and third and second and third sessions. There was also a significant improvement in two categories between the first and second sessions. NANTS-no is therefore suitable for assessing non-technical skills during simulation training in anaesthesia nursing education. More research is needed to validate its use in clinical practice.     

Nurse–physician collaboration in an academic medical centre: The influence of organisational and individual factors

Ineffective physician–nurse collaboration has been recognised to adversely impact patient and organisational outcomes, and some studies suggest an underlying factor may be that nurses and physicians have different perceptions of interprofessional collaboration (IPC). The objectives of this study were to evaluate for a difference in the perception of IPC between physicians and nurses and to explore potential contributing factors at the individual and organisational levels to any observed difference. Data including measures of perceptions of IPC were collected from a convenience sample of resident physicians (n = 47), attending physicians (n = 18), and nurses (n = 54) providing care for internal medicine patients in a large tertiary care academic medical centre. Regression analysis revealed significantly lower perceptions of IPC scores for nurses in comparison to the scores of both the resident and attending physician groups (p = .0001 for both). Although demographic and workload factors also differed by profession, only profession and workload remained significant in regression analysis. Given the known relationships between effective physician–nurse collaboration and superior patient and organisational outcomes, better defining the individual and organisational predictors of IPC scores may support development of more effective interventions targeting improvements in IPC.