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

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

The Experiences of Nurse Educators in Developing and Implementing Concurrent Enrollment Associate Degree in Nursing–Bachelor of Science in Nursing Programs

There is a critical shortage of bachelor of science-prepared nurses. Efficient pathways for bachelor of science completion, such as concurrent enrollment associate degree-to-bachelor of science programs, are needed to meet workforce demands. This article shares findings from a study of the experiences of nurse educators in developing and implementing concurrent enrollment in associate degree-to-bachelor of science programs. Detailed accounts of their experiences may facilitate an understanding of the process and assist educators in implementing similar programs.     

Pharmacy students’ attitudes towards physician–pharmacist collaboration: Intervention effect of integrating cooperative learning into an interprofessional team-based community service

The aim of this study was to evaluate the attitudes towards physician–pharmacist collaboration among pharmacy students in order to develop an interprofessional education (IPE) opportunity through integrating cooperative learning (CL) into a team-based student-supported community service event. The study also aimed to assess the change in students’ attitudes towards interprofessional collaboration after participation in the event. A bilingual version of the Scale of Attitudes Toward Physician–Pharmacist Collaboration (SATP²C) in English and Chinese was completed by pharmacy students enrolled in Wuhan University of Science and Technology, China. Sixty-four students (32 pharmacy students and 32 medical students) in the third year of their degree volunteered to participate in the IPE opportunity for community-based diabetes and hypertension self-management education. We found the mean score of SATP²C among 235 Chinese pharmacy students was 51.44. Cronbach’s alpha coefficient was 0.90. Our key finding was a significant increase in positive attitudes towards interprofessional collaboration after participation in the IPE activity. These data suggest that there is an opportunity to deliver IPE in Chinese pharmacy education. It appears that the integration of CL into an interprofessional team-based community service offers a useful approach for IPE.     

Participation in age-related activities and influence of cultural factors–comments from youth and parents of children with postnatal post infectious hemiplegia in Stockholm,Sweden

Purpose. To investigate whether children with postnatal post-infectious hemiplegic cerebral palsy, and their parents, felt that participation in activities typical for the child's age and gender was affected. To identify factors, intra- and extra-personal that influenced disability with emphasis on factors related to immigration.

Method. Interviews with six youths and 15 caregivers regarding the child's ability to participate in age-related activities, the consequences of disability in their home country compared to Sweden, and whether immigration influenced being a parent to a disabled child.

Results. All reported large difficulties participating in age-related activities. Positive and negative differences in participation in different cultures were described. War, culture, eating habits, hygiene habits, and school could differ and create difficulties when in Sweden. Language skills and intra personal factors influenced information gathering and participation in parental activities.

Conclusions. Surprisingly large difficulties in participation may separate those with a postnatal post-infectious aetiology from hemiplegia of other aetiologies. High degrees of additional impairments may influence participation more than the physical disability. Language skills and cultural factors influence ability to seek and gain information. A mutual process where both Swedes and immigrants know traditions of care for disabled in both places may create understanding and improved dialogue.     

Nurse–surgeon object transfer: Video analysis of communication and situation awareness in the operating theatre

Background

One of the most central collaborative tasks during surgical operations is the passing of objects, including instruments. Little is known about how nurses and surgeons achieve this. The aim of the present study was to explore what factors affect this routine-like task, resulting in fast or slow transfer of objects.

Methods

A qualitative video study, informed by an observational ethnographic approach, was conducted in a major teaching hospital in the UK. A total of 20 general surgical operations were observed. In total, approximately 68 h of video data have been reviewed. A subsample of 225 min has been analysed in detail using interactional video-analysis developed within the social sciences.

Results

Two factors affecting object transfer were observed: (1) relative instrument trolley position and (2) alignment. The scrub nurse's instrument trolley position (close to vs. further back from the surgeon) and alignment (gaze direction) impacts on the communication with the surgeon, and consequently, on the speed of object transfer. When the scrub nurse was standing close to the surgeon, and “converged” to follow the surgeon's movements, the transfer occurred more seamlessly and faster (<1.0 s) than when the scrub nurse was standing further back from the surgeon and did not follow the surgeon's movements (>1.0 s).

Conclusions

The smoothness of object transfer can be improved by adjusting the scrub nurse's instrument trolley position, enabling a better monitoring of surgeon's bodily conduct and affording early orientation (awareness) to an upcoming request (changing situation). Object transfer is facilitated by the surgeon's embodied practices, which can elicit the nurse's attention to the request and, as a response, maximise a faster object transfer. A simple intervention to highlight the significance of these factors could improve communication in the operating theatre.     

Equity in clinical practice requires organisational and system-level change – The role of nurse leaders

BackgroundIn the International Year of the Nurse and Midwife 2020, nurses in Australia and around the world are being encouraged to lend their voices to lead change. The COVID-19 global health crisis has highlighted the critical role of nurses in our community in ensuring that the challenges to our health care system are being met and overcome. It has also brought attention to existing health inequities in our community, in particular the poorer health of refugees, some culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander peoples.AimTo call on nurses and nurse leaders to take greater action to improve health equity.MethodsThis paper presents a discussion with regard to the importance of equitable and safe clinical practice and the urgent need to address organisational and system-level barriers to the provision of equitable health care.FindingsClinicians’ abilities and capacities to provide equitable care is ultimately shaped by health care organisations and the broader historical, political, social and economic context of our community.DiscussionEquity should not only be reflected in clinical practice, but also in organisational policies and procedures, embedded in key performance indicators and supported by adequate funding and resources.ConclusionSystemic inadequacies are likely to be further amplified during times when the health system is under additional pressure. Nurses and nurse leaders should take this opportunity to reflect upon the integral role they play in addressing organisational and system-level change to ensure equity in health care delivery. We call on nurse leaders and the nursing profession to lead us all to a more equitable health care system and society.     

Spheres of influence or autonomy? A discourse analysis of the introduction of Nurse Practitioners in rural and remote Australia

AIM: This paper is a report of a study to examine the social discourses of nursing within health care as these produce understandings about autonomy for Nurse Practitioners, where autonomy refers to the ability of Nurse Practitioners to practise as professionals in their own right. BACKGROUND: Nurse Practitioners were recently introduced to the nursing career pathways in Australia. Despite a plethora of international information, the role implementation in rural and remote Australia is slow with a number of influences emerging to hinder progress. METHOD: Critical discourse analysis was used to examine the differences between policy and the reality of implementation. The notion of autonomy was used to explore texts in policy documents relating to Nurse Practitioner authorization and published between 1995 and 2006, and these were compared with the experiences of nurses working in Nurse Practitioner positions. FINDINGS: Policy texts indicate support for advanced practice and the autonomy of Nurse Practitioners. The process for authorization; however, has constraints which support nurses' progress but also hinder it. Subsequent acceptance of Nurse Practitioners has also been problematic as colleagues struggle to understand the role within the current healthcare system. CONCLUSIONS: There is a significant gap between the rhetoric of policy and the implementation of Nurse Practitioner roles in rural and remote Australia. Whilst policy supports the notion of autonomy, the experiences of nurses indicate a mere shift in the traditionally-accepted boundaries of nurses' roles. Evidence from the United Kingdom and United States of America suggests that the findings in this study are relevant internationally as well as nationally.     

Attitudes towards physician–nurse collaboration in a primary care team-based setting: Survey-based research conducted in the chronic care units of the Tuscany region of Italy

Across the world, multidisciplinary teamwork has become an essential component in the care of patients with chronic conditions—the Chronic Care Units (CCUs) in the Italian region of Tuscany are no exception to this new era of collaboration. We sought to explore the attitudes towards collaboration of general practitioners (GPs) and nurses within the CCUs using the Jefferson Scale of Attitudes towards Physician–Nurse Collaboration (JSAPNC). The survey was sent electronically to 218 GPs and 46 nurses of 23 CCUs in two Local Health Authorities of Tuscany. A higher JSAPNC score is indicative of a more positive attitude towards physician–nurse collaboration. JSAPNC scores were calculated for both totals and by three factors: “shared education and collaboration,” “caring versus curing,” and “physician authority.” A total of 133 healthcare professionals (94 GPs and 39 nurses) responded (response rate = 51.5%). Nurses reported significantly more positive attitudes towards collaboration than GPs (52.5 vs. 44.0, p < 0.01). This trend was also found in each of the three factors. This information adds to the scarce literature on nurse–physician collaboration in the primary care setting and highlights the need for considerable improvement given the rise of team-based outpatient care models.     

Identifying incidents of suboptimal care during paediatric emergencies–an observational study utilising in situ and simulation centre scenarios

Aim

Life threatening paediatric emergencies are relatively uncommon events. When they do occur staff caring for these children must have the ability to recognise the deterioration, evaluate and simultaneously treat these patients. The aim of this study was to identify suboptimal care during standardised simulated scenarios and to identify the potential causation factors.

Methods

Participants were emergency department and operating theatre staff in Sydney, Australia. Incidents of suboptimal care were identified during scenarios and were analysed by thematic qualitative assessment methods. Potential causation factors were elicited both during and immediately after the scenarios and during facilitated debriefings. Causation factors were attributed to any of seven pre-defined categories.

Results

Seventy-three simulations occurred over 9 month period in 2011. 270 doctors, 235 nurses and 11 students participated. 194 incidents of suboptimal care were observed and attributed to 325 causation factors. There were 76 knowledge deficits, 39 clinical skill deficits, 36 leadership problems, 84 communication failures, 20 poor resource utilisations, 23 preparation and planning failures and 47 incidents of a loss of situational awareness. Clinically important themes were: paediatric life support, drug choice and doses, advanced airway and ventilation, intravenous fluids and recognition of the deteriorating patient. Recurring incidents included the failure to recognise a cardiac arrest, inadequate fluid resuscitation and incorrect medication dose administration.

Conclusions

During standardised paediatric simulations multiple incidents of suboptimal care have been identified and multiple causation factors attributed to these. Educators should use this information to adapt current training programs to encompass these factors.     

Hospital organizational factors influence work–family conflict in registered nurses: Multilevel modeling of a nation-wide cross-sectional survey in Sweden

Background

The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work–family conflict is a known risk factor for turnover and sickness absence.

Objective

This paper empirically examines whether the nurse practice environment is associated with experienced work–family conflict.

Design

A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments.

Results

We found that 6% of the variability in work–family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work–family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part.

Conclusion

These results suggest that higher level organizational factors in health care have a significant impact on the risk of work–family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling.     

Interprofessional simulation-based education program: A promising approach for changing stereotypes and improving attitudes toward nurse–physician collaboration

An effective working relationship between physicians and nurses is enhanced by fostering positive perceptions and collaborative attitudes between the two professions. This brief paper examines the effect of an interprofessional simulation-based communication education program in enhancing medical and nursing students' perceptions of each other's profession and their attitudes toward nurse–physician collaboration. Pretest–Posttest design was conducted on 96 medical and nursing students who demonstrated the existence of professional stereotypes in the baseline data. This study showed that by promoting open communication, shared information and decision-making, mutual respect, and trust during the interprofessional simulation training, a positive transformation on the stereotypes and attitudes toward nurse–physician collaboration can be achieved.     

Patients’ Perceptions of What Makes a Good Doctor and Nurse in an Israeli Mental Health Hospital

The aim of this study was to identify inpatients’ expectations of their doctors and nurses in a mental health hospital setting. Individual interviews were conducted with 72 inpatients of a large mental health hospital in northern Israel. Our study produced three major results. First, most patients, whatever their emotional status, share similar expectations of staff, of which the most conspicuous is that they be respected as whole persons and that staff not treat them merely as cases of illness. Second, they expect to be involved in making decisions about their treatment, including being informed of reports and records referring to them. Third, patients expect all hospital staff, particularly nurses, to provide them with emotional support. The findings of this study can be used to facilitate improved care of mental health inpatients by both doctors and nurses. Structured and methodical examinations of inpatients’ expectations at the time they are hospitalized can help adjust not only the professional aspect of health care but also the therapeutic communication approach to patients’ individual needs.     

The survey of the relationship between osteoporosis and relative effective factors in old men

AIM：To measure the bone mineral density and the relative effective factors of osteoporosis in the different age groups,so as to study the relationship between both,and will offer the theoretical foundation on the prevention and treatment of osteoporosis in the old men.METHODS:Forearm bone mineral density were measured by dual energy X-ray absorptiometry (DEXA);By using full-automatic biochemical analytic instrument to measure serum calcium (Ca),phosphorus (P);By using radio-immunoassay to measure serum parathormone(PTH),Calcitonin(CT),1,25(OH2D3,25(OH)D3,interleukin-6(IL-6).Ninety-seven old men were divided into osteoporosis group and non-osteoporosis group,were compared with normal group of men under sixty years old.RESULTS:Some results such as bone mineral density,CT,1,25(OH)2O3 and 25(OH)D3 showed decrease,while some results such as serum PTH and IL-6 showed increase with aging.The former in osteoporosis proup were also significantly lower than those in non-osteoporosis group(P&;lt;0.05).The latter in osteoporosis group were also significantly higher than those in non-osteoporosis group(P&;lt;0.05-0.001).CONCLUSION;The change of the above relative effective factors lead to the following result.Bone resorption is increasing and bone formation is decreasing.These cause bone loss,at last,osteoporosis comes up.     

The analysis of depression in aged patients with myocardial infarction and its elative factors

Depression occurrs in most aged patients with myocardial infarction,and the patients with longer disease courses,more severe disease,higher self estimation,lower education degree and fewer social support are often in more severe depression.OBJECTIVE:To study the depression in aged patients with myocardial infarction and its relative factors.