Examining interprofessional learning perceptions among students in a simulation-based operating room team training experience

High-fidelity simulation (HFS) operating room (OR) inter-professional team training improves healthcare students’ team-based attitudes and behaviours. Such improvements can diminish tribalism among the professions in the OR by overcoming entrenched perceptions of team members. We investigated whether simulation-based interprofessional student OR team training impacts students differently based on their professional background. From 2010 to 2013, HFS OR interprofessional student team training sessions were conducted involving senior medical students, senior undergraduate nursing students, and nurse anaesthesia students. The training involved a two-scenario format, each followed by a structured debriefing focusing on team-based competencies. Before and after each session, students completed a 15-item teamwork competencies self-efficacy survey as well as, from 2012–2013, the Readiness for Interprofessional Learning Scale (RIPLS). At the end of each session, they also completed a 6-item rating scale assessing overall team function during the session. Mean scores were calculated for each student professional group, post/pre mean differences were determined, and student t-test and ANOVA analyses were employed to compare within and between-group differences, respectively. Response rates were over 80% for each scale used. Medical students and undergraduate nursing students had significant improvements in team-based attitudes post- to pre-session. Medical students and nurse anaesthesia students had significant improvements in RIPLS scores. Statistically significant improvements from post- to pre-session were seen overall for both team-based attitudes (effect size = 0.83) and RIPLS (effect size = 0.37). The difference between the team-based scores between professions was significant; RIPLS differences were not. No significant difference existed between professions related to overall teamwork scores. HFS OR team training of healthcare students has beneficial but variable benefits for each professional group.     

整体论在手术室人力资源管理中的应用及效果

目的探讨整体论在手术室人力资源管理中的应用,寻求人力资源管理的最优化方案。方法从人力资源管理的整体着手,对人力资源进行甄选、培训、分配、激励、考核,实施整体管理方案。结果提高了手术室工作效率,以有限的人力完成了逐年递增的手术量,提高了护理质量,提升了护理队伍的整体素质。结论运用整体论对手术室人力资源进行管理,可提高手术室护理队伍的整体水平,提升工作效率和护理质量,优化手术室人力资源管理。     

Implementation of interprofessional learning activities in a professional practicum: The emerging role of technology

Abstract

To prepare future healthcare professionals to collaborate effectively, many universities have developed interprofessional education programs (IPE). Till date, these programs have been mostly courses or clinical simulation experiences. Few attempts have been made to pursue IPE in healthcare clinical settings. This article presents the results of a pilot project in which interprofessional learning activities (ILAs) were implemented during students' professional practicum and discusses the actual and potential use of informatics in the ILA implementation. We conducted a pilot study in four healthcare settings. Our analysis is based on focus group interviews with trainees, clinical supervisors, ILA coordinators, and education managers. Overall, ILAs led to better clarification of roles and understanding of each professional's specific expertise. Informatics was helpful for developing a common language about IPE between trainees and healthcare professionals; opportunities for future application of informatics were noted. Our results support the relevance of ILAs and the value of promoting professional exchanges between students of different professions, both in academia and in the clinical setting. Informatics appears to offer opportunities for networking among students from different professions and for team members' professional development. The use of technology facilitated communication among the participants.     

Aligning interprofessional education collaborative sub-competencies to a progression of learning

In the United States, the Interprofessional Education Collaborative (IPEC) developed four core competencies for interprofessional collaborative practice. Even though the IPEC competencies and respective sub-competencies were not created in a hierarchal manner, one might reflect upon a logical progression of learning as well as learners accruing skills allowing them to master one level of learning and building on the aggregate of skills before advancing to the next level. The Louisiana State University Health-New Orleans Center for Interprofessional Education and Collaborative Practice (CIPECP) determined the need to align the sub-competencies with the level of behavioural expectations in order to simplify the process of developing an interprofessional education experience targeted to specific learning levels. In order to determine the most effective alignment, CIPECP discussions revolved around current programmatic expectations across the institution. Faculty recognised the need to align sub-competencies with student learning objectives. Simultaneously, a progression of learning existing within each of the four IPEC domains was noted. Ultimately, the faculty and staff team agreed upon categorising the sub-competencies in a hierarchical manner for the four domains into either a “basic, intermediate, or advanced” level of competency.     

Informal interprofessional learning: an untapped opportunity for learning and change within the workplace

Abstract

In this paper, we explore the educational and workplace learning literature to identify the potential and significance for informal interprofessional learning within the workplace. We also examine theoretical perspectives informing informal workplace interprofessional learning. Despite numerous studies focusing on formal interprofessional education programs, we suggest that informal interprofessional learning opportunities are currently unrealized. We highlight reasons for a focus on learning within the workplace and the potential benefits within an interprofessional context.     

Looking beyond the checklist: An ethnography of interprofessional operating room safety cultures

The Surgical Safety Checklist (SSC) has been adopted in operating rooms (OR) worldwide to reduce medical errors, increase patient safety and improve interprofessional communication. Despite often high compliance rates, recent studies suggested the SSC has not been associated with significant reductions in operative mortality or complications. This ethnographic study sought to understand this disconnection through approximately 50 hours of observation in the OR and 10 in-depth semi-structured interviews with surgeons, nurses, and anaesthesiologists in orthopaedic surgery. Inductive thematic analysis was used to analyse the data. By spending time in the OR and listening to the staff, this study was able to look beyond what “ought” to be happening in the OR and garner a deep understanding of the realities of OR work that acknowledges the complexities of surgical culture in which the SSC is being implemented. This study found SSC compliance was influenced by the perceived (un)importance of individual checklist items within the orthopaedic setting. Additionally, there remains a need to further explore patients’ involvement in their operative experience.     

手术室背景音乐的应用及效果评价

目的:评价背景音乐对患者和医护人员的影响,探讨提供舒适环境的方法。方法:采用调查问卷法收集资料,患者与手术人员使用的调查问卷相同。结果:手术室播放背景音乐得到认可,背景音乐有利于稳定患者情绪,提高医护人员的工作效率,但应避免曲目重复,不同的时间应播放不同的音乐,使之成为人性化护理的重要组成部分。结论:手术室背景音乐播放系统应由专人管理,在不同时间选择适宜的音乐,创造一个舒适的手术环境。     

手术室节假日人力资源管理与效果

目的 探索节假日手术室人力资源的有效管理方法,以满足患者和手术科室的需要,保障节假日手术工作的安全和质量。方法通过弹性排班、增加副班等方法应对节假日突发事件和较多手术量等情况,制订节假日工作流程,合理安排人力和物力。结果增加了手术量,提高了患者及护理人员的满意度,减少了护理缺陷。结论有效的节假日人力资源管理,是保障手术患者安全的必要前提和赢得抢救时间的关键,是提高手术室工作满意度的有力保证。     

Case-based interprofessional learning for undergraduate healthcare professionals in the clinical setting

Interprofessional learning (IPL) within the healthcare setting has well documented positive outcomes for patients, yet it is not widely offered at the undergraduate level, particularly in a clinical setting. We set up case-based teaching scenarios involving a real patient, aimed at small groups of four students representing two or more healthcare professions. The aim of the sessions was to give students a greater awareness of the roles of all the different healthcare professions involved in patient care in a hospital setting. Weekly sessions were offered on six wards covering different clinical specialties. Three hundred and twenty-nine undergraduate students from different healthcare professions (nursing, medicine, pharmacy, midwifery, physician associate, physiotherapy, occupational therapy, speech, and language therapy) each attended one IPL session during the current academic year. Students were given an evaluation sheet at the end of each session to be filled out anonymously. Forty per cent of the students reported experiencing interprofessional case-based learning for the first time. Over 90% of students agreed or strongly agreed with a list of statements promoting the advantages and benefits of case-based IPL for undergraduate students and many of them requested more sessions. Seventy per cent of all respondents stated they would alter their future professional behaviour as a result of this session. We propose to introduce the sessions into the undergraduate curriculum across all healthcare related professions.     

A safe place with space for learning: Experiences from an interprofessional training ward

Interprofessional learning in a real ward context effectively increases collaborative and professional competence among students. However, less is known on the processes behind this. The aim of this study was to explore medical, nurse, physiotherapy, and occupational therapy students’ perspectives on the process of their own learning at an interprofessional training ward (IPTW). We performed a qualitative content analysis on free-text answers of 333 student questionnaires from the years 2004 to 2011. Two main themes emerged: first, students found that the IPTW provided an enriching learning environment—a safe place with space. It included authentic and relevant patients, well-composed and functioning student teams, competent and supportive supervisors, and adjusted ward structures to support learning. Second, they developed an awareness of their own development with faith in the future—from chaos to clarity. It included personal, professional, and interprofessional development towards a comprehensive view of practice and a faith in their ability to work as professionals in the future. Our findings are discussed with a social constructivist perspective. This study suggests that when an IPTW provides a supportive and permissive learning environment with possibilities to interact with one another—a safe place with space—it enables students to move from insecurity to faith in their abilities—from chaos to clarity. However, if the learning environment is impaired, the students’ development could be halted.     

Cognitive Aids for Role Definition (CARD) to improve interprofessional team crisis resource management: An exploratory study

This study aimed to assess the perceived value of the Cognitive Aids for Role Definition (CARD) protocol for simulated intraoperative cardiac arrests. Sixteen interprofessional operating room teams completed three consecutive simulated intraoperative cardiac arrest scenarios: current standard, no CARD; CARD, no CARD teaching; and CARD, didactic teaching. Each team participated in a focus group interview immediately following the third scenario; data were transcribed verbatim and qualitatively analysed. After 6 months, participants formed eight new teams randomised to two groups (CARD or no CARD) and completed a retention intraoperative cardiac arrest simulation scenario. All simulation sessions were video recorded and expert raters assessed team performance. Qualitative analysis of the 16 focus group interviews revealed 3 thematic dimensions: role definition in crisis management; logistical issues; and the “real life” applicability of CARD. Members of the interprofessional team perceived CARD very positively. Exploratory quantitative analysis found no significant differences in team performance with or without CARD (p > 0.05). In conclusion, qualitative data suggest that the CARD protocol clarifies roles and team coordination during interprofessional crisis management and has the potential to improve the team performance. The concept of a self-organising team with defined roles is promising for patient safety.     

手术室专科护士临床实践能力指标体系的构建

目的：构建科学、全面的手术室专科护士临床实践能力指标体系。方法：采用德尔菲法从全国范围内选取专家40名进行两轮函询。结果：专家函询的群体权威系数为0.87,两轮函询问卷回收率分别为95.00%、92.10%,一级指标和二级指标的协调系数分别为0.38、0.31。最终形成的手术室专科护士临床实践能力指标体系包含6个一级指标及25个二级指标。结论：初步确定手术室专科护士临床实践能力指标体系,为手术室专科护士的培训、评价提供科学依据。     

手术室护生实习压力源的质性研究

目的探讨护生在手术室实习期间压力的来源,给护理临床带教提供信息,促进护生身心健康。方法立意抽样选择15名在手术室实习的护生作为研究对象,采用深入访谈的现象学研究方法探寻其心理压力产生的根源。结果手术室实习护生的心理压力源主要来自以下5个方面：手术室特殊的环境;手术室学习和工作方面的压力;情感方面的压力;社会偏见压力;职业危害压力。结论护理教育者应改革传统教学模式,提高带教老师专科业务水平,注重标准预防和安全防护的教育,加强护生自身应对挫折的承受能力和人际沟通能力的培养。     

巡回护士床边交接班表的设计及应用

<正>临床护理工作中,交接班制度是确保护理工作的整体性和延续性的重要环节[1]。由于手术室工作的特殊性,巡回手术的时间连续性长,术中巡回护士不可避免出现交接班的情况。以往常用口头交班的方式进行,交接班时常出现漏交班、物品不清、贵重耗材丢失、术中器械添加不清等现象。为此,本院手术室于2013年2月根据手术室巡回护士交接班的特点,设计了巡回护士床边交接班表,经实践应用,取得满意效果,现介绍如下。     

手术室护士压力产生的原因分析及对策

笔者报道手术室护士产生压力的主要原因及对策。分析其原因有:工作环境、工作负荷、人际关系冲突、职业危害、媒体不恰当宣传、学习及职称评定等因素。采取相应对策:认识自身价值、处理好各种关系、加强自身防护及普法教育,从而使手术室护士从容面对压力,进一步提高护理质量。     

From struggles to resource gains in interprofessional service networks: Key findings from a multiple case study

In interprofessional service networks, employees cross professional boundaries to collaborate with colleagues and clients with expertise and values different from their own. It can be a struggle to adopt shared work practices and deal with “multivoicedness.” At the same time, networks allow members to engage in meaningful service provision, gain a broader understanding of the service provided, and obtain social support. Intertwined network struggles and resource gains have received limited attention in the interprofessional care literature to date. The aim of the study was to investigate the learning potential of the co-existing struggles and resource gains. This article reports findings from two interprofessional networks. Interviews were conducted with 19 employees and thematically analysed. Three types of struggles and six types of resource gains of networking were identified. The struggles relate, first, to the assumptions of networking following similar practices to those in a home organisation; second, to the challenges of dealing with the multivoicedness of networking; and, third, to the experienced gap between the networking ideals and the reality of cooperation. At the same time, the network members experience gains in emotional resources (e.g., stronger sense of meaningfulness at work), cognitive resources (e.g., understanding the customer needs from alternative perspectives), and social resources (e.g., being able to rely on other professionals’ competence). Learning potential emerged from the dynamics between coexisting struggles and resource gains.     

手术室突发事件应急准备现状调查

目的:了解我省三级医院手术室突发事件应急准备现状,以发现运行过程中存在的主要问题,为改进和完善手术室突发事件应急准备提供依据。方法:采用自行设计问卷,对我省20家三级医院的200名手术室医护人员进行手术室突发事件应急准备现状调查。结果:20家三级医院手术室应急预案的编制基本完成,但缺乏对预案的修订;应急组织指挥的权威性尚待加强;应急培训、演练环节薄弱;应急物资储备管理尚待规范;推动突发事件应急工作的专业化人才培训和资金不足以及领导重视不够等。结论:我省三级医院手术室需开展对突发事件应急预案的修订,完善应急组织指挥体系的建设,落实应急培训、演练、考核评价及应急救援的基础保障工作,加大应急资金投入和领导支持力度,不断提高手术室应急能力。     

Getting on the same page: an interprofessional common reading program as foundation for patient-centered care

A primary goal of interprofessional education is to produce clinicians who practice collaboratively to provide patient-centered care. This exploratory study evaluated whether students’ attitudes about a literary account of an illness experience endured after a year of professional and clinical education and if students applied lessons learned from a common reading to the delivery of patient centered care. Six focus groups were completed with health professions students and five main themes emerged from the focus group data. Themes include: Seeing family members as stakeholders; Establishing common ground with peers and the larger reason for graduate school; Applying lessons to clinical practice that see the patient as a person; Experiencing an emotional connection with a story and its characters; and Taking alternative perspectives/stepping into the shoes of the patient. Study results are discussed in relation to the interprofessional education literature, with implications for educators and interprofessional curricula also presented. We conclude that a common reading program may provide an effective means for developing health professions students’ knowledge and attitudes in the tenets of patient-centered collaborative care. It has the potential to build community through shared intellectual experience, facilitating meaningful reflection and perspective-taking in interprofessional learners.     

PBL教学模式在手术室专科护士培训中的应用效果

目的探索PBL教学模式在手术室专科护士培训中的应用效果。方法选取手术室护理人员56名作为研究对象,随机将其分为观察组和对照组,各28例。观察组采用PBL教学模式,对照组采用传统教学模式。比较两组的理论知识、操作技能考试成绩和对教学模式的满意度。结果观察组护理人员的理论知识考核成绩明显高于对照组(P<0.05)。观察组的安全核查及手术物品准备、患者体位摆放、术后手术器械的分类及清洗、突发事件处理得分均显著高于对照组(P<0.05)。观察组对学习主动性、手术操作基本技能、理论知识的掌握和自主解决问题的能力的满意度均明显高于对照组(P<0.05)。结论 PBL教学模式既增强了手术室专科护士学习的主观能动性,又锻炼了其处理解决问题的能力,对于专科护士技能的提高有很大益处,值得进一步推广应用。