A mixed methods exploration of the team and organizational factors that may predict new graduate nurse engagement in collaborative practice

Abstract

Although engagement in collaborative practice is reported to support the role transition and retention of new graduate (NG) nurses, it is not known how to promote collaborative practice among these nurses. This mixed methods study explored the team and organizational factors that may predict NG nurse engagement in collaborative practice. A total of 514 NG nurses from Ontario, Canada completed the Collaborative Practice Assessment Tool. Sixteen NG nurses participated in follow-up interviews. The team and organizational predictors of NG engagement in collaborative practice were as follows: satisfaction with the team (β?=?0.278; p?=?0.000), number of team strategies (β?=?0.338; p?=?0.000), participation in a mentorship or preceptorship experience (β?=?0.137; p?=?0.000), accessibility of manager (β?=?0.123; p?=?0.001), and accessibility and proximity of educator or professional practice leader (β?=?0.126; p?=?0.001 and β?=?0.121; p?=?0.002, respectively). Qualitative analysis revealed the team facilitators to be respect, team support and face-to-face interprofessional interactions. Organizational facilitators included supportive leadership, participation in a preceptorship or mentorship experience and time. Interventions designed to facilitate NG engagement in collaborative practice should consider these factors.     

General practitioners’ experiences using cognitive behavioural therapy in general practice: A qualitative study

Abstract

Objective. To explore GPs’ experiences using cognitive behavioural therapy (CBT), with a focus on factors that promote or limit the use of CBT in general practice. Design. Qualitative study using data from written evaluation reports and focus-group interviews. Setting. Norwegian general practice. Subjects. GPs who participated in a longitudinal CBT course in the continuous medical education (CME) programme for GPs in Norway, of whom 19 filled in evaluation forms and 15 participated in focus-group interviews. Main outcome measures. Experiences with the use of CBT in general practice. Results. GPs used CBT mainly in the treatment of patients with anxiety disorders and depression. Factors that promoted the use of CBT in general practice were structured supervision and group counselling, receiving feedback on individual video-recorded consultations, and experiencing that one mastered the therapeutic techniques. Limiting factors were that it took some time before one mastered the techniques, lack of eligible patients, constraints related to attending group supervision during office hours, and the lack of financial incentives to use CBT in general practice. Conclusion. Tailored training programmes in CBT for GPs may contribute to more frequent use of CBT in general practice. A formal recognition of CBT in the reimbursement scheme for GPs might counter limiting factors to an increased use of CBT in general practice.     

Evaluation of a knowledge translation initiative for physical therapists treating patients with work disability

Purpose. We evaluated a knowledge translation and exchange (KTE) initiative aimed at providing physical therapists with best practice information regarding work disability prevention.

Method. The KTE initiative involved dissemination of a best practice resource guide for work disability prevention, creation of a network of peer-selected educationally influential clinicians, province-wide seminars for practicing clinicians, and use of the resources in an academic training curriculum. Evaluation included email surveys of clinician practice patterns and exposure to the KTE initiative. We also evaluated the impact of the KTE on community physical therapy workers' compensation outcomes.

Results. 241 and 164 clinicians responded to the baseline and follow-up email surveys, respectively. Clinicians reported a wide range of years in practice (0–30+ years) and practice settings although the majority worked in private clinics (～61%). Approximately 80% of the follow-up sample reported some exposure to the KTE initiative. Few differences were observed in reported practice patterns between survey periods. Compensation outcomes improved slightly after KTE (68 versus 70% off benefits) however, this effect was confounded by proportion of claimants with sprain/strain injury.

Conclusions. Implementation of a KTE initiative appears to have had little impact on the clinical practice or outcomes. Future interventions for rehabilitation professionals should consider the organisational culture of the settings in which they practice, which may be a barrier or facilitator of research uptake.     

Effects of 4-weeks of asynchronous hand-rim wheelchair practice on mechanical efficiency and timing

Purpose.?To investigate the consequence on gross mechanical efficiency (GE), arm frequency and sub-maximal performance, of paced and unpaced practice during asynchronous hand-rim wheelchair propulsion.

Methods.?Twenty-five able-bodied participants performed five, 4-min exercise bouts at 1.7?m/s, at the freely chosen frequency (FCF) and four paced arm frequencies of 60, 80, 120 and 140% FCF. GE, arm frequency and measures of sub-maximal performance were determined. Participants were assigned to an unpaced (FCF, N?=?9), paced (80% FCF, N?=?8) or control (CON, N?=?8) no practice group. The FCF and 80% FCF groups received 4-weeks (unpaced and paced, respectively) propulsion practice (three sessions·per wk, four 4?min/trials; 33–35?W) at 1.7?m/s on a wheelchair ergometer. Following practice, the pre-testing protocol was repeated.

Results.?Mean GE showed a relative increase in both experimental groups (21 and 17%; FCF and 80% FCF respectively; p?=?0.001) compared to no change in CON (?1.5%). The FCF arm frequency decreased in both experimental groups (p?=?0.001), with larger changes evident following FCF practice.

Conclusion.?Four weeks of unpaced or paced practice had a beneficial effect on GE. This improvement seems to be associated with a reduction in arm frequency.     

Practice nurses' sources of clinical support: observations from a citywide survey

Objectives: The survey aimed to identify present sources, and perceived adequacy, of clinical support amongst local practice nurses.Design: Telephone survey and focus group.Setting: Practice Nurses employed in a General Practice setting supported by reimbursement from the Manchester Health Authority.Participants: Telephone survey—75 practice nurses, ten data collectors. Focus group—6 Practice Nurses, Primary Care Nurse Advisor and a Researcher.Main outcome measures: Survey results aimed to identify frequency of and sources of clinical support amongst all local practice nurses and their understanding of the term Clinical Supervision. Focus group explored fine detail and ‘puzzlements’ arising from survey.Findings:General practitioners are the main source of clinical support for practice nurses. The practice nurses preferred an informal approach to clinical support with the nurse remaining in control of the process, seeking support when needed. All respondents expressed strong concerns that the professional autonomy that they associate with practice nursing should be protected. Most practice nurses seemed unaware of the growth and development elements of clinical supervision. One third of respondents were very vociferous and saw clinical supervision as a threat, the word ‘supervision’ being interpreted as introducing hierarchical management by stealth.Conclusions: There is support that Clinical Supervision has the potential to develop nurses' clinical effectiveness and contribute to clinical governance. It also appears that practice nurses, who work in comparative professional isolation from other nurses, have much to gain personally and professionally from the supportive elements of this initiative. However, this study highlights values and organizational issues that must be considered before implementing this initiative in this particular nursing group.     

When East meets Wests: community-based rehabilitation in Chinese communities

Purpose.?Community-based rehabilitation (CBR) has been practiced in mainland China for over three decades. This study reviews the development of CBR and describes its practice in Chinese communities in order to discuss current controversies within CBR practice internationally and in the Chinese context.

Method.?Review of literature. Development of CBR, its principles and controversies internationally and in the Eastern world is reviewed. CBR practice in Chinese communities is examined.

Results.?Shifting ideology and practices mean many different activities are labelled CBR. Variation across contexts has led to many controversies, specifically: the lack of evidence to support practice; ownership of programs; conceptual differences surrounding autonomy and participation and cultural issues. Contemporary Chinese cultural values and Chinese CBR are shaped by traditional peasant culture, traditional Chinese philosophy and socialist ideology.

Conclusion.?The review indicates that Western CBR concepts and philosophy cannot be directly applied to the Chinese context. An appropriate model or framework is needed to fit the unique Chinese cultural context and to guide practice in Chinese communities.     

The Health Professions Education Pathway: Preparing Students,Residents, and Fellows to Become Future Educators

Problem: Training the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner. Intervention: The University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation. Context: Through course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice. Outcome: From 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment). Lessons Learned: Learners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator communities of practice. Also important for learner success was alignment of their projects with the goals of the local educator community of practice. Our community of practice approach to educator career development has shown promising early outcomes by nurturing learners' passion for teaching; expanding their interest in educational leadership, innovation, and scholarship; and focusing on their identity formation as future educators.     

Effect of performance feedback on tracheal suctioning knowledge and skills: randomized controlled trial

Title. Effect of performance feedback on tracheal suctioning knowledge and skills: randomized controlled trial. Aim. This paper is a report of a study to determine whether individualized performance feedback improved nurses’ and physiotherapists’ knowledge and practice of tracheal suctioning. Background. Nurses’ knowledge and practice of tracheal suctioning is often deficient. Whilst teaching has been shown to improve suctioning knowledge and practice, this is not sustained over time. Method. Ninety‐five qualified healthcare professionals (nurses and physiotherapists) in two acute hospitals were randomly allocated to receive either individualized performance feedback or no additional feedback after a standardized lecture and practical demonstration of tracheal suctioning. Randomization was stratified by profession, seniority and site. Data were collected in 2005 in a clinical setting involving patients and a simulation setting. The outcome measures were knowledge and practice of tracheal suctioning, assessed by self‐completion questionnaire and structured observation. Results. In both settings, intervention groups performed statistically significantly better in terms of knowledge (P = 0·014) and practice (P = 0·037) at final follow‐up. Those who received performance feedback had statistically significantly higher knowledge (P = 0·004) and practice (P < 0·01) scores than the control group. For practice, there was also a relationship between professions (P < 0·01), with physiotherapists performing better than nurses overall, and an interaction between group and setting (P < 0·01), with performance feedback showing a stronger positive effect in the simulation setting. Conclusion. Retention of knowledge and tracheal suctioning practice is improved when training is followed up by tailored feedback on performance. Further research would shed light on how long such improvements are sustained, and whether the improvements seen in a simulated setting can be generalized to clinical settings.     

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey

Abstract

Purpose: We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. Methods: We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Results: Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n?=?335/407) and provided input to a mixed diagnostic group of patients (71%; n?=?312/437). Ninety one percent of services (n?=?358/395) reported setting goals with “all” or “most” stroke survivors. Seventeen percent (n?=?65/380) reported that no methods were used to guide goal setting practice; 47% (n?=?148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n?=?362/369) reported routinely asking patients about goal priorities; 39% (n?=?141/360) reported routinely providing patients with a copy of their goals. Conclusions: Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist.

• Implications for Rehabilitation

• Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients.

• Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal.

• Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

     

Connecting with clinicians: Opportunities to strengthen rehabilitation research

Purpose. This article examines the distinctive opportunities and challenges involved in connecting with clinicians to strengthen rehabilitation research.

Method. The relevant literature on various factors that link researchers and clinicians is summarized and discussed.

Results. Links between researchers and clinicians are demonstrated by evidence-based practice, common conceptual background and the development of research capacity. Sustainable partnerships can evolve throughout the research process by using various enduring strategies such as experts' committee as well as novel approaches like communities of practice.

Conclusion. This paper reflects the conviction that reducing the gap between research and clinical practice will be facilitated by implementing partnerships originating from both researchers and clinicians.     

Public Attitudes Toward Practice by Medical Students: A Nationwide Survey in Japan

Background: It is essential for medical students to interact directly with patients. However, patients may be reluctant to be seen by medical students in settings in which they may also be seen by senior staff. Purposes: To understand patients’ attitudes toward practice by medical students and consider the factors involved in obtaining patients’ cooperation, we conducted a nationwide cross-sectional survey. Methods: We randomly selected 2,400 adult participants from all over Japan. Trained research assistants inquired about participants’ experiences and attitudes toward practice by medical students using a questionnaire. We compared differences in attitudes between participants who were accepting of practice by medical students and those who were not, as well as differences between participants who had experienced practice by a medical student versus those who had not. Results: A total of 1,109 (46%) participants were included in the study. Eleven percent (117/1109) of the participants had experienced practice by a medical student. One fourth of participants were accepting of practice by medical students, and experienced participants were significantly more likely to be accepting of practice by medical students than inexperienced participants (45% vs. 24%, p <.001). Impressions of practice by medical students among accepting participants with previous experiences included “polite,” “kind,” and “hard-working.” Fifty-nine percent (637/1088) of participants indicated that they would request a senior staff member's supervision when being seen by a medical student. Conclusions: The present nationwide survey suggests that education emphasizing bedside manner may be effective in promoting patients’ cooperation of medical students. In addition, providing information to patients about medical students and efforts to increase supervision during clinical clerkship should be emphasized to foster the public's cooperation.     

Reflective processes of practitioners in head and neck cancer rehabilitation: a grounded theory study

Purpose: This study systematically examined how experienced Speech-Language Pathologists (SLPs) use the processes of reflection to develop knowledge relevant for practice in the context of head and neck cancer (HNC) rehabilitation.

Method: In-depth, semi-structured interviews were conducted with 12 SLPs working in HNC rehabilitation in North America. Grounded theory methodology was adopted for data collection and analysis.

Result: The findings inform a preliminary reflective practice model that depicts the processes of reflection used by practitioners interviewed. Nine categories of reflective processes were identified by participant SLPs in terms of the processes of reflection: ongoing questioning, experimenting through trial and error, integrating knowledge from past cases, embracing surprise, thinking out of the box, being in the moment, consulting with colleagues, putting oneself in the patients’ shoes, and discerning ethical issues. These findings provide empirical evidence that supports Schön’s theory of reflective practice and contribute to knowledge about the ways in which SLPs use processes of reflection in the context of HNC rehabilitation.

Conclusion: The findings of this study have implications for how SLPs perceive and consider their role as knowledge-users and knowledge producers in their day-to-day clinical work, as well as for building capacity for reflective practice.     

Implementing a client-centred approach in rehabilitation: an autoethnography

Purpose: Client-centred practice is widely considered a key element of rehabilitation. However, there is limited discussion of how it should be implemented. This study explored how client-centred practice was operationalized during a clinical trial of innovative goal-setting techniques. Method: This study drew on principles of co-autoethnography. The personal experiences of three clinical researchers were explored to identify insights into client-centred practice, and seek understanding of this within the broader socio-cultural context. Data were collected through group discussions and written reflections. Thematic analysis and coding were used to identify the dominant themes from the data. Results: The primary way that client-centred practice was operationalized was through listening in order to get to know, to uncover and to understand what was meaningful. Four strategies were identified: utilizing mindful listening, allowing time, supporting clients to prioritize what is meaningful and viewing the therapists’ role differently. Conclusion: While technical competence in rehabilitation is important, our study suggested a starting point of ‘being with’ rather than ‘doing to’ may be beneficial for engaging people in their rehabilitation. We have highlighted a number of practical strategies that can be used to facilitate more client-centred practice. These approaches are consistent with what clients report they want and need from rehabilitation services.

Implications for Rehabilitation

• At face value, clinical practice may appear to be client-centred. However, critical reflection of existing practice suggests that in reality, it is not well operationalized.

• Prioritizing getting to know the client, their story and what is meaningful to them appears fundamental to client-centred practice. A number of strategies may facilitate this process, including mindful listening on the part of the clinician and allowing time.

• Structures and processes need to be instituted to support implementation of client-centred practice.

• Autoethnography is an approach that may support clinicians’ to reflect on their practice.

     

Growing a profession: Clinician perspectives on the evolving practice of speech-language pathology in Vietnam

Abstract

Purpose: This paper reports findings from phase two of a multiphase cross-cultural research programme exploring the professional practice of a group of Vietnam’s first university-qualified speech-language pathologists.

Method: Employing qualitative research methodology, this study involved a series of workshops with seven Vietnamese speech-language pathologists in which visual research methods were used to explore the evolution of their work, the challenges they faced, and opportunities to progress their professional practice. Thematic analysis employing a mixed deductive-inductive approach was used to analyse the textual data.

Result: Heightened awareness of the speech-language pathology profession in Vietnam, movement into specialisation and expansion of services into the private sector were described. Dual professional roles, limited access to culturally-relevant resources to support practice and lack of experience in advocating for services posed challenges, whilst community education, the conduct of research, and the training of others in speech-language pathology were progressing the profession.

Conclusion: The professional practice of a group of Vietnam’s first speech-language pathologists is growing. Opportunities to advance their practice will best be informed by knowledge that reflects local context and culture and includes the experiences and preferences of persons living with communication and swallowing disabilities in Vietnam and their families.