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.     

Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected,disempowered and devalued?

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals’ roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses’ interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in‐depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty‐five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses’ absence from morning rounds, one‐way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision‐making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse–physician interactions and the current context of nursing care.     

Healthcare Team Vitality Instrument (HTVI): developing a tool assessing healthcare team functioning

Title.  Healthcare Team Vitality Instrument (HTVI): developing a tool assessing healthcare team functioning.
Aim.  This paper is a report of a study conducted to refine, shorten and validate the Healthcare Team Vitality Instrument.
Background.  The Healthcare Team Vitality Instrument was developed to assess team vitality of nurses as well as other licensed and unlicensed personnel working as part of healthcare teams in inpatient hospital units. This instrument was necessary for two reasons. First, other commonly used instruments assess characteristics of Registered Nurses or perceptions about and characteristics of the organizations in which they work, but not these factors in combination with critical factors of interdisciplinary team functioning and collaboration. Second, a short tool for repeated, regular measurement of team vitality was needed to track the impact of changes to improve work environments.
Method.  Revisions to the Healthcare Team Vitality Instrument occurred in two phases. Phase 1 entailed collecting preliminary data and conducting cognitive interviews to refine the initial items. During Phase 2, the factor structure of the Healthcare Team Vitality Instrument was identified and a brief form developed and validated. Data were collected in 2006 and 2007.
Findings.  Exploratory factor analyses suggested a four-factor solution with the following dimensions: (1) support structures, (2) engagement and empowerment, (3) patient care transitions and (4) team communication.
Conclusion.  The Healthcare Team Vitality Instrument can contribute both to better management practices and advancing knowledge to promote retention of nurses, and to some extent other healthcare professionals, as well as efforts to transform the acute healthcare work environment.     

Nursing emotion work and interprofessional collaboration in general internal medicine wards: a qualitative study

Title. Nursing emotion work and interprofessional collaboration in general internal medicine wards: a qualitative study Aim. This paper is a report of a study to examine nursing emotion work and interprofessional collaboration in order to understand and improve collaborative nursing practice. Background. Nursing standards identify collaborative practice as necessary for quality patient care yet many nurses are often reluctant to participate in interprofessional teams. Strategies intended to improve participation often fail which suggests that the factors underpinning nurses’ disinclination towards interprofessional collaboration have yet to be understood. The concept of emotion work has not been applied to nursing interprofessionalism, and holds the potential to improve collaborative practice. Nursing emotion work is defined as the management of the emotions of self and others in order to improve patient care. Methods. Qualitative data were collected in 2006 using non‐participant observation, shadowing and semi‐structured interviews with nursing, medical and allied professionals in the general internal medicine wards of three hospitals in urban Canada. Findings. Nurses’ collaborations with other professionals are influenced by emotion work considerations. The establishment and maintenance of a nursing esprit de corps, corridor conflicts with physicians, and the failure of the interdisciplinary team to acknowledge the importance of nursing’s core caring values are important factors underpinning nurses’ interprofessional disengagement. Conclusion. Longstanding emotion work issues must be addressed before nurses will engage collaboratively. We suggest improving nursing collaboration through the refining of holistic nursing information, and reflections on practice by all interprofessional team members.     

Utilising Medicare annual wellness visits to implement interprofessional education in the primary care setting

Interprofessional education (IPE) is an important component of healthcare professional curriculum in order to optimally prepare students for their roles as part of the healthcare team. Integrating IPE activities into direct patient care in the primary care clinic setting can help improve perceptions and student understanding of other healthcare professionals’ responsibilities in this ever-evolving practice setting. This report describes the implementation of an interprofessional clinic including a variety of healthcare professionals and students in the context of the Medicare Annual Wellness Visits (AWV). Design of the clinic and general roles of the professionals in optimising preventive care are described. Student perceptions of IPE and their knowledge of other healthcare professionals were also surveyed. Student knowledge of other professionals mildly improved. Student perception of actual cooperation and interprofessional interaction statistically improved, while perception of interprofessional learning slightly worsened. Utilising Medicare AWVs can be a way for various professionals to improve IPE in the primary care setting.     

Working together: Using a unique approach to evaluate an interactive and clinic-based longitudinal interprofessional education experience with 13 professions

Interprofessional education (IPE) involving an interactive and longitudinal clinic experience at an inner-city charitable clinic from September to May 2013/2014 was evaluated. Pre-, mid-, and post-intervention data were collected from students in 13 different professions including medicine (medical and physician assistant), dentistry (dental and dental hygiene), nursing (undergraduate and clinical nurse specialist), public health, pharmacy, physical therapy, occupational therapy, nutritional sciences, speech and language pathology, and social work. To evaluate their interprofessional attitudes, students completed the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and Readiness for Interprofessional Learning Scale (RIPLS). They also completed a unique measure, healthcare professionals circles diagrams (HPCDs), that indicated student conceptualisation of a healthcare team caring for a complex patient, along with perception of their team’s progress towards meeting patient goals. Results from the T-TAQ and RIPLS scores indicated small but significant increases from pre- to post-intervention (p = 0.005 and 0.012, respectively). Analysis of the HPCDs revealed significant increases in students’ perceptions of the types of interprofessional team members, relationships, and communication between professions to provide medical care to patients (p < 0.01). Most HPCDs included pharmacists, nurses, and physicians as part of the care team at all time points. Students significantly increased their inclusion of dentistry, public health, social work, and physician assistants as members of the healthcare team from pre- to post-intervention. Implications of our data indicated the importance of IPE interventions that include not only classroom-based sessions, but actual patient care experiences within interprofessional teams. It also reinforced the importance of new and unique methods to assess IPE.     

From the nurses' station to the health team hub: how can design promote interprofessional collaboration?

Interprofessional practice implies that health professionals are able to contribute patient care in a collaborative environment. In this paper, it is argued that in a hospital the nurses' station is a form of symbolic power. The term could be reframed as a "health team hub," which fosters a place for communication and interprofessional working. Studies have found that design of the Nurses' Station can impact on the walking distance of hospital staff, privacy for patients and staff, jeopardize patient confidentiality and access to resources. However, no studies have explored the implications of nurses' station design on interprofessional practice. A multi-site collective case study of three rural hospitals in South Australia explored the collaborative working culture of each hospital. Of the cultural concepts being studied, the physical design of nurses' stations and the general physical environment were found to have a major influence on an effective collaborative practice. Communication barriers were related to poor design, lack of space, frequent interruptions and a lack of privacy; the name "nurses' station" denotes the space as the primary domain of nurses rather than a workspace for the healthcare team. Immersive work spaces could encourage all members of the healthcare team to communicate more readily with one another to promote interprofessional collaboration.     

The interprofessional clinical experience: interprofessional education in the nursing home

Abstract

The interprofessional clinical experience (ICE) was designed to introduce trainees to the roles of different healthcare professionals, provide an opportunity to participate in an interprofessional team, and familiarize trainees with caring for older adults in the nursing home setting. Healthcare trainees from seven professions (dentistry, medicine, nursing, nutrition, occupational therapy, optometry and social work) participated in ICE. This program consisted of individual patient interviews followed by a team meeting to develop a comprehensive care plan. To evaluate the impact of ICE on attitudinal change, the UCLA Geriatric Attitudes Scale and a post-experience assessment were used. The post-experience assessment evaluated the trainees’ perception of potential team members’ roles and attitudes about interprofessional team care of the older adult. Attitudes toward interprofessional teamwork and the older adult were generally positive. ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting.     

Prospective health students’ perceptions of the pharmacist role in the interprofessional team

Negative perceptions or underdeveloped understanding of healthcare team member roles can impact the functionality of the team and stunt innovations in interprofessional practice and education. Therefore, the intent of this study was to explore the perception of pharmacists’ role on the healthcare team by future team members: prospective health professional students. The study utilised a survey to examine these perceptions in prospective health professional students (n = 34) nearing the application process to health professional school. A coding process was used to explore open-ended text responses through a line-by-line analysis and identify emerging themes regarding perception of pharmacists’ roles, responsibilities, and practice settings. Quantitative data examined perception of pharmacists by intended prospective profession, healthcare experience, and pharmacy experience. Results indicate that while prospective health professional students find pharmacists to be an important part of the healthcare team, they lack a developed understanding of pharmacists’ roles, responsibilities, and practice settings. Identifying and addressing prospective health professional students’ misperceptions surrounding pharmacists’ roles and responsibilities may encourage them to make informed career decisions and shape them into more knowledgeable future professionals with the ability to better impact patient care on interprofessional teams.     

Understanding nursing practice in stroke units: a Q-methodological study

Abstract

Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses’ involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses’ practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills.

• Implications for Rehabilitation

• Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.

• Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.

• Nurses can routinely incorporate rehabilitation principles in their care.

• Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

     

Beyond profession: nursing leadership in contemporary healthcare

Aim(s)  To examine nursing leadership in contemporary health care and its potential contribution to health service organization and management.
Background  As the nursing profession repositions itself as an equal partner in health care beside medicine and management, its enhanced nursing standards and clinical knowledge are not leading to a commensurate extension of nursing's power and authority in the organization.
Method(s)  An ethnographic study of an ICU in Sydney, Australia, comprising: interviews with unit nursing managers (4); focus groups (3) with less experienced, intermediate and experienced nurses (29 in total); and interviews with senior nurse manager (1).
Results  Inter- and intra-professional barriers in the workplace, fragmentation of multidisciplinary clinical systems that collectively deliver care, and clinical and administrative disconnection in resolving organizational problems, prevented nurses articulating a model of intensive and end-of-life care.
Conclusion(s)  Professional advocacy skills are needed to overcome barriers and to articulate and operationalize new nursing knowledge and standards if nurses are to enact and embed a leadership role.
Implications for nursing management  The profession will need to move beyond a reliance on professional clinical models to become skilled multidisciplinary team members and professional advocates for nurses to take their place as equal partners in health care.     

Ineffective participation: reactions to absentee and incompetent nurse leadership in an intensive care unit

Aim  The aim of the present study was to analyse reactions to ineffective leader participation in an intensive care unit (ICU).
Background  Critical examination of leadership failures helps identify nurse manager behaviours to avoid.
Method  An online survey collected data from 51 interacting healthcare providers who work in an intensive care unit.
Results  Participants reported dissatisfaction with nurse leaders who were perceived as absent or ill prepared. Participants categorized intensive care unit productivity and morale as moderate to low. Multiple regression suggested the best predictor of perceived unit productivity was supervisor communication; the best predictor of employee morale was perceived leader mentoring.
Conclusions  Intensive care unit nurses reported wanting active participation from their leaders and expressed dissatisfaction when supervisors were perceived as absent or incompetent. Ineffective leader participation significantly correlated with lower employee perceptions of productivity and morale.
Implications for nursing management  Senior managers should recruit and develop supervisors with effective participation skills. Organizations primarily concerned about productivity should focus on developing the communication skills of nurse leaders. Units mainly concerned with employee morale should emphasize mentorship and role modelling. Formal assessment of nurse leaders by all intensive care unit team members should also be used to proactively identify opportunities for improvement.     

Nurse practitioners' perceptions and participation in pharmaceutical marketing

Title.  Nurse practitioners' perceptions and participation in pharmaceutical marketing.
Aim.  This paper reports on a study conducted to describe family nurse practitioners' perceptions towards and participation in pharmaceutical marketing and to explore the relationships among related variables.
Background.  The pharmaceutical industry's intense global marketing strategies have resulted in widespread concern in healthcare professionals and professional groups, sectors of the public in many countries, and in the World Health Organization. Research on healthcare providers' participation in pharmaceutical marketing indicates that these relationships are conflicts of interests and compromise healthcare providers' prescribing practices and trust. Nursing, as a discipline, appears to be slow to address the impact of pharmaceutical marketing on nursing practice.
Method.  Questionnaires about perceptions and participation in pharmaceutical marketing were completed by a random sample of 84 licensed family nurse practitioners in the United States of America in 2007.
Findings.  Family nurse practitioners viewed pharmaceutical company marketing uncritically as educational and beneficial. They also perceived other providers but not themselves as influenced by pharmaceutical marketing. The findings supported those found in previous research with nurses and physicians.
Conclusion.  Lack of education, participation in marketing and psychological and social responses may impede family nurse practitioners' ability to respond critically and appropriately to marketing strategies and the conflict of interest it creates.     

Persistent isolationist or collaborator? The nurse’s role in interprofessional collaborative practice

orchard ca . (2010) Journal of Nursing Management 18 , 248–257
Persistent isolationist or collaborator? The nurse’s role in interprofessional collaborative practice Aim The present study explores current understanding about interprofessional collaborative client-centred practice and nursing’s role in this form of care delivery. Background A profession-only focus on nursing practice has been challenged at professional, national governmental and World Health Organization levels stressing for more interprofessional patient-centred collaborative teamwork. Evaluation Moving to patient-centred collaborative practice is fraught with barriers. Enablers can result in building trust, power sharing and shared decision-making. Changing current workplace environments requires institutional commitments to support collaborative team development. Key issue(s) Nurses can become collaborative members of teams through: (1) re-socialize; (2) understanding and articulating nurses roles, knowledge and skills to others; (3) other health providers sharing the same to nurses; (4) identifying where shared roles, knowledge and skills exist; and (5) learning to work in collaborative teams. Nurses must address some fundamental issues about practice that negate collaboration and patient-centred care. Conclusions All professionals, including nurses, must move away from a service-oriented delivery to a patient-centred collaborative approach to care. Implications for nursing management The values within health organizations need to be underpinned by collaborative interprofessional patient-centred practice. To accomplish this goal, administrators and managers must support assessment of employees and visiting physicians as to their conformance with agency established expectations for such practice.     

Team effectiveness in academic primary health care teams

Primary health care is undergoing significant organizational change, including the development of interdisciplinary health care teams. Understanding how teams function effectively in primary care will assist training programs in teaching effective interprofessional practices. This study aimed to explore the views of members of primary health care teams regarding what constitutes a team, team effectiveness and the factors that affect team effectiveness in primary care. Focus group consultations from six teams in the Department of Family Medicine at Queen's University were recorded and transcribed and qualitative analysis was used to identify themes. Twelve themes were identified that related to the impact of dual goals/obligations of education and clinical/patient practice on team relationships and learners; the challenges of determining team membership including nonattendance of allied health professionals except nurses; and facilitators and barriers to effective team function. This study provides insight into some of the challenges of developing effective primary care teams in an academic department of family medicine. Clear goals and attention to teamwork at all levels of collaboration is needed if effective interprofessional education is to be achieved. Future research should clarify how best to support the changes required for increasingly effective teamwork.     

Interprofessional simulation training for community mental health teams: Findings from a mixed methods study

ABSTRACT

Community mental health teams (CMHTs) in England face mounting service pressures due to an increased focus on out-of-hospital care. Interprofessional working is essential to providing good mental healthcare in community settings. Simulation training is underused in mental health, despite strong support for its improvement of clinical skills, confidence, teamwork, and interprofessional collaboration in other healthcare settings. This study aims to evaluate the impact of simulation training on community mental health professionals. An interprofessional simulation training course on assessment and team working skills for community mental health professionals was developed and delivered at a time of service reorganisation in South London services, including changes to job roles and responsibilities. In total, 57 course participants completed a survey that measured perceptions of knowledge and confidence, as well as a general view of the course. Eight participants took part in further semi-structured interviews 2–3 months after the course to provide perceptions about this experience’s subsequent impact. There were statistically significant increases in knowledge and confidence scores with large effect sizes. Thematic analyses of open-text survey and interview data identified emergent themes of interprofessional understanding; attitudes in clinical practice; staff well-being; the value of reflection; opportunity for feedback; and fidelity to clinical practice. Simulation training can improve confidence and knowledge in core skills and team working for CMHTs. Participants reported benefits to key areas of community mental healthcare, such as interprofessional collaboration, reflective practice, and staff well-being. Findings represented individual and team learning, as well as subsequent changes to clinical practice, and were related back to the interactive and reflective nature of the simulation. Implications are highlighted concerning the use of interprofessional simulation training in mental health, particularly relating to staff well-being, attitudes, and interprofessional working.     

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.