Perceptions of parents and healthcare professionals on family centred care in Australian neonatal units

The experiences of families receiving family centred care and of healthcare professionals providing family centred care in Australian neonatal units were evaluated by online surveys, distributed to families and healthcare professionals across Australia. Parents rated experience of partnerships, information sharing, coordinated care and respectful care in the moderate range. Healthcare professionals rated capacity to provide family centred care as moderate for interpersonal sensitivity, information sharing and treating people respectfully. Neonatal units providing moderate acuity care showed greater capacity to provide family centred care than intensive care or low acuity care units. These data provide a baseline and indicate room for improvement. Reasons for varying levels of family centred care provided by healthcare professionals in different neonatal settings require further investigation. Education of all staff on family centred care is required and targeted collection of data from parents at intervals will indicate progress in providing a higher level of family centred care.     

Communication skills and cultural awareness courses for healthcare professionals who care for patients with sickle cell disease

AIMS: This paper reports a project evaluating the efficacy and impact of a pilot communication skills and cultural awareness course for healthcare professionals who care for patients with sickle cell disease. BACKGROUND: Poor communication between patients with sickle cell disease and healthcare professionals causes suspicion and mistrust. Many patients feel that they are negatively labelled by the healthcare system and are sceptical of opening themselves to an unsympathetic system. They may therefore appear hostile and aggressive when interacting with healthcare professionals, which in turn leads to distortions and misunderstandings between both groups. The use of good communication skills by healthcare professionals is therefore vital for good healthcare practice. METHODS: Forty-seven healthcare professionals took part in a series of three pilot courses each lasting 3 days. Healthcare professionals were taught a repertoire of communication skills and cultural awareness strategies to use in challenging situations that arise in their care of sickle cell patients. Expert facilitators used a variety of teaching techniques, such as professionally-made videos, role-play, and group exercises. Participants' confidence in dealing with challenging situations was assessed at baseline, immediately after the intervention, and at 3- and 6-month postintervention. FINDINGS: A repeated measures anova revealed a statistically significant increase in confidence from pre- to postcourse scores. Confidence scores further increased from immediately postcourse and 3 months postcourse follow-up. These were then maintained at 6 months postcourse. CONCLUSION: The overall findings of this local study demonstrated that this type of communication skills and cultural awareness training had a positive and enduring impact on professionals' perceived ability and confidence in communicating with patients with sickle cell disease. Participants attributed this to the learner-centred approach of the course that provided them with the opportunity to transfer and apply the taught skills in their daily practice. This type of training might be helpful in reducing mistrust and increasing empathetic responses in healthcare professional.     

Developing interprofessional collaborative practice competencies in rural primary health care teams

BackgroundLeaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs.PurposeDescribe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture.MethodsThe implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP.FindingsSignificant improvement (p < .035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership.DiscussionPartnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice.     

An interprofessional collaborative practice approach to transform heart failure care: An overview

Interprofessional collaborative practice (IPCP) approaches to health care are increasingly recognized as necessary to achieve the Triple Aim—improved health of the population, improved patient care experience, and improved affordability of care. This paper introduces and provides an overview of an interprofessional intervention to improve a healthcare team, healthcare system, and patient outcomes for hospitalized patients with heart failure. In this paper, we describe the overall project resulting from a workforce training grant and the proposed series of future papers resulting from the interprofessional intervention. Collectively, these papers will describe the results of a unique IPCP approach on team, system, and patient outcomes as well as describe and compare organizational and leadership traits that affect collaborative practice. Our hope is that the intervention approaches, evaluation results, and lessons learned described in these papers will help further the efforts to spread IPCP approaches to transforming health care.     

A case study exploring the ethical and policy dimensions of allocating acute care resources to a dying patient

Aims. We aimed to identify policy, process and ethical issues related to allocation of National Health Service resources when patients with end‐of‐life illness are referred to acute care services. Background. Sharing healthcare decisions denotes a different partnership between professionals and patients when patients are empowered to define their needs. Implementation of a transition from professional to patient decision‐making appears to be dependent upon its interpretation by personnel delivering care using the local trust policy. The outcome of this is a reformation of responsibility for budget allocation, choice of acute care provider and selecting services, currently in the realm of primary care; be it the general practitioner, community practitioners, or the patient. Design. We used a ‘lens’ approach to case study analysis in which the lens is constructed of a model of policy analysis and four principles of biomedical ethics. A patient's decision to decline care proposed by an Accident and Emergency department nurse and the nurse's response to that decision expose a policy that restricts the use of ambulance transport and with that, flexibility in responses to patients’ decisions. Findings. End‐of‐life care partnership decisions require sensitivity and flexibility from all healthcare practitioners. We found that policy‐based systems currently used to deliver care across the primary care – hospital care border are far from seamless and can lead to foreseeable problems. Conclusions. Health professionals responsible for the care of a patient at the end of life should consider the holistic outcomes of resource allocation decisions for patients. Relevance to clinical practice. Government and health professional agenda suggest that patients should be given a greater element of control over their healthcare than has historically been the case. When patients take responsibility for their decisions, healthcare personnel should recognize that this signals a shift in the nature of the professional–patient relationship to one of partnership.     

International educational partnership for practice: Brazil and the United Kingdom

BACKGROUND: To enhance healthcare globally, successful academic partnerships between institutes of higher education are crucial to strengthen collaboration between countries and identify new ways of working. The desire to reduce maternal mortality and morbidity among childbearing women in north-east Brazil urged professional nurses to seek new ways of working through such a partnership. Reflections on the success of the link identify the key qualities uniting the partnership. AIMS. This paper explores the key qualities of a higher education partnership between the United Kingdom and north-east Brazil. These qualities can act as a guide to other faculties engaged in such links to facilitate successful collaborative working for gains on both sides. RESULTS. Critical reflections from both partners revealed that the key qualities identified are effective communication, deep commitment and the need for both partners to understand each other's context of care. CONCLUSIONS. Examination of each of these qualities illustrates that the shared perspectives, mutual respect and enriched educational experience are valuable and essential to successful partnership working. This critical reflection illustrates the process of success and how others can benefit from the lessons learned, whatever the nature of partnership. Understanding the nature of collaborative working has strengthened each education and practice community, encouraged them to take risks, and remain committed to collective success.     

Continuing professional development for interprofessional teams supporting patients in healthcare decision making

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients’ needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients’ and professionals’ values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives.     

Continuing professional development for interprofessional teams supporting patients in healthcare decision making

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients' needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients' and professionals' values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives.     

Healthcare professionals’ experiences with highly qualified nurses working in acute care teams in primary healthcare settings

ObjectiveStrengthening primary healthcare with highly qualified nurses in acute care units or teams is a new Danish initiative intended to detect acute diseases and the deterioration of chronic diseases and to develop treatment for outpatients. This study explores healthcare professionals’ experiences with this initiative.DesignQualitative semi-structured interviews conducted in 2019–2020. Analysis was conducted with a systematic text condensation.SettingThis study is based on an acute care team in one Danish municipality called Acute Team Odense (ATO). ATO delivers acute nursing in patients’ own homes (including nursing homes) in collaboration with different healthcare professionals.SubjectsIndividual interviews with general practitioners (GPs) (n = 15), five focus-group interviews with nurses and nursing assistants from the municipality (n = 19) and one focus-group interview with staff from the emergency department (ED) (n = 10).Main outcomesExperiences of different healthcare professionals’ experiences with ATO.ResultsIn general, all of the participants were very satisfied with the new acute care team and the cross-sectorial possibilities. The GPs usually referred ATO to assessments in which paraclinical equipment, competencies, accessibility, response time and communication were important. The municipal nurses and nursing assistants tended to use ATO if they needed second opinions or acute nurse assistance. The ED most often used ATO to assist with intravenous therapy after an ED visit. All participants reported that ATO increased what could be assessed and treated in patients’ homes, which is central to preventing unnecessary hospitalisations.ConclusionsATO created new possibilities in patient’s homes which potentially might prevent unnecessary hospitalisations.

KEY POINTS

• Acute care units or teams are mandatory in Danish health care, but limited knowledge in the area is found.
• Healthcare professionals found that the acute care teams provided new possibilities to assess and treat patients in their own homes.
• Healthcare professionals experienced that the acute care team potentially prevented hospitalisations by fast clinical nurse assessments with paraclinical tests.

     

Productive interdisciplinary team relationships: the hospitalist and the case manager

Since the introduction of the National Patient Safety Goals (Joint Commission International Center for Patient Safety, 2005) into the Joint Commission on Accreditation of Healthcare Organizations standards, there appears to be a positive movement toward improvement in patient care outcomes and safety. Case management has been an integral part of the care team, and has emphasized standards of performance in quality of care, collaboration and resource utilization since 1995. When Leapfrog defined hospitalist intensivists as one of the three requirements necessary to be a safe hospital, an opportunity was borne to create a professional partnership. With the patient and the safety as the central focus of care, case managers and hospitalists are beginning to exponentially change the face of healthcare. This article will demonstrate the value of this partnership.     

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.     

Educating healthcare professionals to act on the physical health needs of people with serious mental illness: a systematic search for evidence

Healthcare professionals in primary and secondary care should monitor the physical health of people with serious mental illness, yet in practice this does not appear to be a routine intervention. Our objective is to develop evidence-based training for healthcare professionals to enable them all to offer better physical care to this population. We performed a systematic search with the aim of evaluating the current evidence of the efficacy of education interventions. Search terms covered Severe Mental Illness, Physical Health and Education. The search yielded 147 papers, of which none were eligible for inclusion. A number of studies were excluded from this review as although there was an implicit education package provided to healthcare professionals, no information was reported on the outcomes of this education with regard to healthcare professionals' knowledge, attitudes and behaviours. The only information that these studies provided was patient-specific outcomes. It is vital that researchers start to publish details of healthcare professional education and their outcomes in physical health and serious mental illness research.     

Defining antimicrobial stewardship competencies for undergraduate health professional education in the United Kingdom: A study protocol

Multi-drug resistant infections have been identified as one of the greatest threats to human health. Healthcare professionals are involved in an array of patient care activities for which an understanding of antimicrobial stewardship is important. Although antimicrobial prescribing and stewardship competencies have been developed for healthcare professionals who adopt the role of a prescriber, competencies do not exist for other medicine-related stewardship activities. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities. This report presents a protocol for a study designed to provide national consensus on antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education. A modified Delphi process will be used in which a panel of Experts, comprising members from across the United Kingdom, with expertise in prescribing and medicines management with regard to the education and practice of healthcare professionals, and antimicrobial prescribing and stewardship, will be invited to take part in two survey rounds. The competencies developed will be applicable to all undergraduate healthcare professional education programmes. They will help to standardise curricula content and enhance the impact of antimicrobial stewardship education.     

Empowerment: healthcare professionals' and community members' contributions

Healthcare disparities for minorities are well reported and related to individual, provider and system characteristics. This paper reports a meta-synthesis of "empowerment with Hispanic and Latino people. This meta-synthesis utilized Noblit and Hare's meta-ethnographic method (1988) examining seven qualitative studies to discover strategies of empowerment by healthcare professionals for Hispanic/Latino people. Three themes were disclosed: strategies for empowerment, sharing power, and growth of the Hispanic/Latino culture in the United States. These themes expand existing conceptualizations of ways in which health care professionals and community members can work in a participatory research approach to improve healthcare outcomes as well as empowering the community.     

Integrated care models in Swiss primary care: An embedded multiple case study

Rationale, Aimsand Objectives

Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient-centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face.

Method

We used an embedded multiple case study design to describe in-depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within-case analysis followed by a cross-case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted.

Results

Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging.

Conclusion

The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice.