Postoperative recovery: a concept analysis

AIM: This paper presents a concept analysis of the phenomenon of postoperative recovery. BACKGROUND: Each year, millions of patients throughout the world undergo surgical procedures. Although postoperative recovery is commonly used as an outcome of surgery, it is difficult to identify a standard definition. METHOD: Walker and Avant's concept analysis approach was used. Literature retrieved from MEDLINE and CINAHL databases for English language papers published from 1982 to 2005 was used for the analysis. FINDINGS: The theoretical definition developed points out that postoperative recovery is an energy-requiring process of returning to normality and wholeness. It is defined by comparative standards, achieved by regaining control over physical, psychological, social and habitual functions, and results in a return to preoperative level of independence/dependency in activities of daily living and optimum level of psychological well-being. CONCLUSION: The concept of postoperative recovery lacks clarity, both in its meaning in relation to postoperative recovery to healthcare professionals in their care for surgical patients, and in the understanding of what researchers in this area really intend to investigate. The theoretical definition we have developed may be useful but needs to be further explored.     

Intimidation: A Concept Analysis

PROBLEM.  Patient safety is being compromised by intimidating communication and ineffective teamwork among healthcare providers. The Joint Commission Update indicates that ineffective communication has been the leading root cause of the majority of sentinel events since 1996. Furthermore, the organizational implementation of policies and procedures for addressing this dangerous situation is now mandated by The Joint Commission Sentinel Event Alert. However, in order to consistently identify and address this problem, there must be a clear and universal definition of intimidation.
METHODS.  The purpose of this article is to clarify the definition of intimidation in healthcare settings. Without this clarity, the role of intimidation as a precursor to the occurrence of medical errors will inevitably be obscured. The framework for concept analysis proposed by Walker and Avant is used to explicate the definition, attributes, antecedents, consequences, and cases of intimidation.
FINDINGS.  Analyzing the extent of the relationship between intimidation and medical errors will provide healthcare organizations and professionals with a foundation for the development of strategies to combat the effects of intimidation on medical errors and patient safety.
CONCLUSIONS.  The necessity to create a culture of safety in healthcare settings is paramount.     

Interprofessional empathy: A four-stage model for a new understanding of teamwork

ABSTRACT

Collaboration in healthcare implies that health providers share responsibility and partner with each other in order to provide comprehensive patient care. A review of the empirical literature on teamwork in healthcare settings suggests that the relationships between service providers remain conflictual and variable in commitment to interprofessional collaboration. Recently, social psychologists have given considerable attention to the possibility that empathy could be used to improve intergroup attitudes and relations. Although empathy may be referred to as a means to humanize healthcare practices, few published studies from the healthcare literature focus on the nature of interprofessional empathy. Understanding frameworks different from your own and empathizing with other members of the team is fundamental to collaborative practice. The aim of this study was to understand the nature of empathy among members of interprofessional teams within a hospital environment. This study followed the lived experience of 24 health professionals with their perspective of empathy on interprofessional teams. A two-step procedure was used consisting of semi-structured interviews and depth interviews. Phenomenological data analysis was used to identify common themes and meanings across interviews. From the findings, a four-stage developmental model of interprofessional empathy emerged: Stage 1 is engaging in conscious interactions; Stage 2 requires using dialogical communication; Stage 3 is obtained when healthcare professionals consolidate understanding through negotiating differences between each other; and Stage 4 shows mastery of nurturing the collective spirit. Knowledge of this stage model will provide clinicians with the information necessary to develop awareness of how day-to-day activities within their interprofessional teams influence the development of interprofessional empathy.     

Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication,teamwork, and patient-centred care

Abstract

Achieving safe, quality health care is highly dependent on effective communication between all members of the healthcare team. This study explored the attitudes and experiences of recent healthcare graduates regarding interprofessional teamwork and communication within a clinical setting. A total of 68 pharmacy, nursing, and medicine graduates participated in 12 semi-structured focus group discussions in clinical workplaces across three Australian states. Discussion focussed on graduates’ experiences of interprofessional education and its impact on their capacity for interprofessional teamwork and communication. The Social Identity and Realistic Conflict theories were used as a framework for qualitative data analysis. A consistent pattern of profession-focussed, rather than patient- or team-focussed goals was revealed along with reports of negative stereotyping, hierarchical communication, and competition for time with the patient. Graduates acknowledged the importance of communication, teamwork, and patient-centred care and felt a better understanding of the roles of other health professionals would assist them to work together for patients’ wellbeing. Identifying workplace identities and differential goals has uncovered possible motivations underlying health professionals’ behaviour. These insights may help improve interprofessional collaboration by focusing attention on common team goals, increasing feelings of worth and being valued among different professionals, and decreasing the need for competition.     

Do multidisciplinary integrated care pathways improve interprofessional collaboration?

This paper reports on the evaluation stage of an action research project on interprofessional collaboration in discharge planning. Findings from interviews with health care professionals working in the acute sector had revealed concerns about discharge planning and multidisciplinary teamwork. In the United Kingdom the National Health Service (NHS) Plan has reinforced the need for an integrated approach to health care. Effective health care integration requires effective communication, teamwork and the commitment to deliver integrated care. Integrated documentation is a key strategy for enhancing interprofessional collaboration and reducing the isolation of professionals, and has been successfully implemented in a range of health care settings. Presented with the concerns about the collaborative process in discharge planning, an action research strategy was chosen to bring about change in an orthopaedic ward in one London teaching hospital. This paper will evaluate the implementation of an integrated care pathway with fractured neck of femurs in one London teaching hospital. Care pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The emphasis will be on understanding whether integrated care pathways enhance and develop interprofessional collaboration and enable effective information access and flow across the professions and the organization. The criteria for evaluation, forming the hypotheses of the study, were that interprofessional nonverbal and verbal communication would be enhanced and that interprofesisonal collaboration would increase. Methods of evaluation used were: (i) stakeholder interviews, (ii) interprofessional audit and (iii) analysis of the variances from the integrated care pathway. The evaluation revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were enhanced. Furthermore, key factors in discharge delays appeared to be organizational rather than professional.     

'One flew over the psychiatric unit': mental illness and the media

Media representation of mental illness has received growing research attention within a variety of academic disciplines. Cultural and media studies have often dominated in this research and discussion. More recently healthcare professionals have become interested in this debate, yet despite the importance of this subject only a selection of papers have been published in professional journals relating to nursing and healthcare. This paper examines the way in which mental illness in the United Kingdom is portrayed in public life. Literature from the field of media studies is explored alongside the available material from the field of mental healthcare. Three main areas are used to put forward an alternative approach: film representation and newspaper reporting of mental illness; the nature of the audience; and finally the concept of myth. The paper concludes by considering this approach in the context of current mental health policy on mental health promotion.     

Interprofessional education about shared decision making for patients in primary care settings

With an increasingly complex array of interventions facing healthcare professionals and patients, coupled with a potentially diverse number of professionals operating within the primary care team, the adoption of shared decision making (SDM) ? with or without patients’ decision aids ? in an interprofessional manner is essential to ensure the highest quality of care for patients. In this article, we propose a framework for interprofessional education about SDM targeted to primary care settings. Five areas of knowledge and skills were agreed to be essential for all relevant stakeholders for interprofessional education in SDM to be successful: understanding the concept of SDM; acquiring relevant communication skills to facilitate SDM; understanding interprofessional sensitivities; understanding the roles of different professions within the relevant primary care group; and acquiring relevant skills to implement SDM. We suggest a series of teaching methods for the aforementioned areas, using principles from adult learning.     

A concept analysis of simulation as a learning strategy in the education of undergraduate nursing students

Simulation is increasingly referred to in the nursing literature and its use in healthcare has developed dramatically over the past decade. Whilst the concept of simulation is not new, there is now a greater emphasis on its use in nurse education (Murray et al., 2008). The purpose of this article is to develop understanding and define the concept of simulated learning as a strategy used in the education of undergraduate nursing students. The analysis outlined in this paper was guided by a systematic process of studying a concept presented by Walker and Avant (2005). The analysis sought to identify how the concept of simulation is interpreted in the existing literature printed in English and retrieved from databases (Medline, CINAHL, PubMed, and Cochrane Library), internet search engines (GoogleScholar) and hand searches. The definition offered is a work in progress and presents a theoretically grounded understanding of what simulated learning currently represents. The identified antecedents, critical attributes and consequences are presented as a basis to stimulate further research, development and understanding.     

Breaking traditions: sexual health and ethnicity in nursing research: a literature review

AIM: The aim of this paper is to explore some reasons for the lack of focus on ethnicity and sexual health in nursing research, and suggest ways to advance the nursing evidence-base required for practice development. BACKGROUND: The United Kingdom National Strategy for Sexual Health and human immunodeficiency virus published in July 2001 highlighted the continued rise in sexual ill health amongst minority ethnic groups. In order to improve sexual health, research evidence is needed explain why particular ethnic groups appear to be at greater risk of sexual ill health. The Strategy identified nurses as key to bringing about improvements in sexual health. Nursing research includes many studies exploring links between ethnicity and health. However, with the exception of extensive work on human immunodeficiency virus/acquired immunodeficiency syndrome as a specific disease, nursing research into ethnicity has not systematically included sexual health. METHODS: Literature searches were conducted using the BIDS database, World Wide Web and United Kingdom Department of health website between June 2000 and August 2003. Papers written in English incorporating the keywords 'sexual health', 'sexually transmitted infection' and 'health and ethnicity' in the title or abstract were selected for review. FINDINGS: Nursing research into the association between sexual health and ethnicity is rare. It has been hampered by a variety of political and social constraints concerning the nature of sexual health practice in nursing, researching sexual health, and researching ethnicity and health. The result is a dearth of research evidence to support the development of sexual health practice and the education of healthcare professionals to underpin care of minority ethnic clients. CONCLUSIONS: Barriers to researching ethnicity and sexual health by nurses must be addressed through nursing education and practice. Without this, a detailed evidence base will fail to materialize and healthcare practices to implement the priorities to improve sexual health in minority ethnic communities will remain undeveloped.     

Conceptualizing collaboration in nursing

Nurses practicing at every level need a clear definition of collaboration before applying the concept in daily practice. Additionally, a conceptual definition of collaboration in nursing assists nurse researchers in finding or developing instruments for measuring collaboration and attributes of collaboration, which will enhance research findings. Collaboration extends beyond communication and includes sharing, teamwork, and respect. Multiple databases including CINAHL, PubMed, and ERIC were searched using the keywords collaboration, nursing, concept analysis, sharing, respect, and teamwork. For this analysis, using Walker and Avant’s method, the conceptual definition of collaboration in nursing is an intraprofessional or interprofessional process by which nurses come together and form a team to solve a patient care or healthcare system problem with members of the team respectfully sharing knowledge and resources. Two instruments consistent with the conceptual definition of collaboration are The Mayo High Performance Teamwork Scale (MHPTS) and Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS) and these instruments are summarized in this study. Finally, case scenarios are given to illustrate exemplars of collaboration in clinical practice.     

Principle‐based analysis of the concept of telecare

Aim. To report a concept analysis of telecare. Background. Lately telecare has become a worldwide, modern way of giving care over distance by means of technology. Other concepts, like telemedicine, e‐health, and telehealth, focus on the same topic though the boundaries between them seem to be blurred. Data sources. Sources comprise 44 English language research articles retrieved from the database of Medline and Cinahl (1995–October 2011). Design. Literature Review. Method. A principle‐based analysis was undertaken through content analysis of the definitions, attributes, preconditions, and outcomes of the concept. Results. The attributes are well described according to the use of technology, caring activity, persons involved, and accessibility. Preconditions and outcomes are well described concerning individual and health political needs and benefits. The concept did not hold its boundaries through theoretical integration with the concept of telemedicine and telehealth. The definition of telecare competes with concepts like home‐based e‐health, telehomecare, telephonecare, telephone‐based psychosocial services, telehealth, and telemedicine. Assessment of the definitions resulted in a suggestion of a new definition: Telecare is the use of information, communication, and monitoring technologies which allow healthcare providers to remotely evaluate health status, give educational intervention, or deliver health and social care to patients in their homes. Conclusion. The logical principle was assessed to be partly immature, whereas the pragmatical and linguistical principles were found to be mature. A new definition is suggested and this has moved the epistemological principle forward to maturity.     

Framework development for the assessment of interprofessional teamwork in mental health settings

In mental health settings, interprofessional practice is regarded as a comprehensive approach to prevent relapse and manage chronic conditions with practice of various teamwork interventions. To reinforce the potential of interprofessional teamwork, it is recommended that theories or conceptual frameworks be employed. There continues, however, to be a limited use of such approaches that assess the quality of interprofessional teamwork in mental health settings. This article aimed to present a new conceptual framework for the assessment of interprofessional teamwork based on the findings of a scoping review of the literature. This review was undertaken to identify conceptual frameworks utilised in interprofessional teamwork in mental health settings. After reviewing 952 articles, the methodological characteristics extracted from 12 articles were considered. The included studies were synthesised into the Donabedian structure-process-outcome model. The findings revealed that structural issues comprised three elements: professional characteristics, client-care characteristics, and contextual characteristics in organisations. Process issues comprised two elements: team mechanisms and community-oriented services. Finally, outcome issues comprised the following elements: clients’ outcomes and professionals’ outcomes. The review findings suggested possibilities for further development of how to assess the quality of interprofessional teamwork and provided information about what specific approach is required to improve interprofessional teamwork. Future research should utilise various areas and cultures to clarify the adaptation potential.     

Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study

This article draws on data from a 5-year project that examined the effectiveness of Comprehensive primary healthcare (CPHC) in local communities. A hallmark of CPHC services is interprofessional teamwork. Drawing from this study, our article presents factors that enabled, or hindered, healthcare teams working interprofessionally in Australian primary healthcare (PHC) services. The article reports on the experiences of teams working in six Australian PHC services (four managed by state governments, one non-government sexual health organisation, and one Aboriginal community-controlled health service) during a time of significant health sector restructure. Findings are drawn from two key methods: an online survey of practitioners and managers (n = 154), and interviews with managers and practitioners (n = 60) from the six study sites. The majority of survey respondents worked with other health professionals in their service to provide interprofessional care to clients. Processes included formal team meetings, case conferencing, referring clients to other health professionals if needed, informal communication with other health professionals about clients, and team-based delivery of care. A range of interrelated factors affected interprofessional work at the services, from contextual, organisational, processual, and relational domains. Funding cuts and policy changes that saw a reorientation and re-medicalisation of South Australian services undermined interprofessional work, while a shared CPHC culture and commitment among some staff was helpful in resisting some of these effects. The co-location of services was a factor in PHC teams working interprofessionally and not only enabled some PHC teams to work more interprofessionally but also created barriers to interprofessional teamwork through disruption resulting from restructuring of services. Our study indicates the importance of decision makers taking into account the potential effects of policy and structural changes on interprofessional teamwork. Decision makers should strive to minimise unintended negative effects of changes on the functioning of interprofessional teams.     

Nurse turnover: a literature review - an update

BackgroundConcerns related to the complex issue of nursing turnover continue to challenge healthcare leaders in every sector of health care. Voluntary nurse turnover is shown to be influenced by a myriad of inter-related factors, and there is increasing evidence of its negative effects on nurses, patients and health care organizations.ObjectivesThe objectives were to conduct a comprehensive review of the related literature to examine recent findings related to the issue of nursing turnover and its causes and consequences, and to identify on methodological challenges and the implications of new evidence for future studies.DesignA comprehensive search of the recent literature related to nursing turnover was undertaken to summarize findings published in the past six years.Data sourcesElectronic databases: MEDLINE, CINAHL and PubMed, reference lists of journal publications.Review methodsKeyword searches were conducted for publications published 2006 or later that examined turnover or turnover intention in employee populations of registered or practical/enrolled or assistant nurses working in the hospital, long-term or community care areas. Literature findings are presented using an integrative approach and a table format to report individual studies.ResultsFrom about 330 citations or abstracts that were initially scanned for content relevance, 68 studies were included in this summary review. The predominance of studies continues to focus on determinants of nurse turnover in acute care settings. Recent studies offer insight into generational factors that should be considered in strategies to promote stable staffing in healthcare organizations.ConclusionsNursing turnover continues to present serious challenges at all levels of health care. Longitudinal research is needed to produce new evidence of the relationships between nurse turnover and related costs, and the impact on patients and the health care team.     

A network model of communication in an interprofessional team of healthcare professionals: A cross-sectional study of a burn unit

Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to between team members from the same profession; and (3) which professions are more likely to form interprofessional ties. Health management and support personnel ties were 94% interprofessional while ties among nurses were 60% interprofessional. Nurses and other health professionals were significantly less likely than physicians to form ties. Nurses were 1.64 times more likely to communicate with nurses than non-nurses (OR = 1.64, 95% CI: 1.01–2.66); there was no significant role homophily for physicians, other health professionals, or health management and support personnel. Understanding communication networks in healthcare teams is an early step in understanding how teams work together to provide care; future work should evaluate the types and quality of interactions between members of interprofessional healthcare teams.     

What fosters or prevents interprofessional teamworking in primary and community care? A literature review

BACKGROUND: The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved. OBJECTIVES: This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century. DESIGN: A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods. FINDINGS: Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed. CONCLUSIONS: These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.     

Review article: Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient

Clinical communication and recognising and responding to a deteriorating patient are key current patient safety issues in healthcare. The aim of this literature review is to identify themes associated with aspects of the hospital clinical handover between paramedics and ED staff that can be improved, with a specific focus on the transfer of care of a deteriorating patient. Extensive searches of scholarly literature were conducted using the main medical and nursing electronic databases, including Cumulative Index to Nursing and Allied Health Literature, Medline and PubMed, during 2011 and again in July 2012. Seventeen peer‐reviewed English‐language original quantitative and qualitative studies from 2001 to 2012 were selected and critically appraised using an evaluation tool based on published instruments. Relevant themes identified were: professional relationships, respect and barriers to communication; multiple or repeated handovers; identification of staff in the ED; significance of vital signs; need for a structured handover tool; documentation and other communication methods and education and training to improve handovers. The issues raised in the literature included the need to: produce more complete and concise handovers, create respectful and effective communication, and identify staff in the ED. A structured handover tool such as ISBAR (a mnemonic covering Introduction, Situation, Background, Assessment and Recommendations) would appear to provide a solution to many of these issues. The recording of vital signs and transfer of these data might be improved with better observation systems incorporating early warning strategies. More effective teamwork could be achieved with further clinical communications training.     

Analysis of caregiver burden in palliative care: An integrated review

The inclusion of caregivers in a holistic care approach represents a basic principle in palliative care. However, many palliative care professionals have a lack of understanding of difficulties or unmet needs among caregivers. To enhance the quality of life of caregivers and the quality of care for patients, healthcare professionals should be better informed about the constructs of caregiver burden. The aim of this study is to synthesize the concept of caregiver burden in palliative care, providing implications for the caregivers and their support systems. This concept analysis study adopts the integrative review approach and the basic text analysis method (ie, word frequency). The PubMed, CINAHL, Embase, and PsycINFO databases are explored for eligible studies. From this literature search, 66 articles from 1998 to 2018 are located. After data collection is completed, the two authors independently evaluate the quality of studies published before 1 September 2018. The caregiver burden is then redefined with its attributes, antecedents, consequences, empirical referents, and facilitators. It is recommended that the multidimensional concept of caregiver burden in palliative care be measured by considering caregiver characteristics and the caregiving context.