Paid Caregivers in the Community-based Dementia Care Team: Do Family Caregivers Benefit?

PurposeOlder adults with dementia often rely on both paid caregivers (ie, home health aides, personal care attendants, other direct care workers) and family caregivers (ie, spouses, children, other unpaid individuals) to remain in the community. This study conceptualizes paid caregivers as part of the collaborative dementia care team and examines the association between receipt of paid care and primary family caregiver experience.MethodsUsing data from 3 waves (2011, 2015, and 2017) of the National Health and Aging Trends Study linked to the National Study of Caregiving, community-dwelling Medicare beneficiaries aged ≥67 years with advanced dementia (n = 338 observations) were identified. Primary family caregiver experiences were compared among those with zero, part-time (<40 hours/week), and full-time (≥40 hours/week) paid care, and multivariable models were used to evaluate the associations between full-time paid care and family caregiver strain (eg, being overwhelmed due to caregiving) and activity restriction (eg, being unable to work for pay due to caregiving).FindingsAbout one half of the community-dwelling older adults with advanced dementia received paid care: 30% had part-time paid care and 18% had full-time paid care. The experiences of family caregivers of those receiving part-time and no paid care were not significantly different. After adjusting for family caregiver and care recipient characteristics, receipt of full-time paid care was associated with a nearly 70% reduced odds of having activity restrictions due to caregiving (odds ratio, 0.31; P = 0.01) and a reduction in mean caregiver strain score (–0.73; P = 0.04). There was no statistically significantly association between the odds of high caregiver strain (score ≥5) and receipt of paid care (odds ratio, 0.65; P = 0.33).ImplicationsThe provision of paid care for individuals with dementia in the community may benefit family caregivers. Future work should acknowledge the important ways that paid caregivers contribute to outcomes for all members of the collaborative dementia care team.     

Primary health care team workshop: team members'perspectives

This study explored members 'perceptions of team work in two primary health care teams (PHCTs) It also examined the effect of a team-building intervention on members' perceptions centred around five topics the PHCT, role perception, communication, leadership and conflict The study used a qualitative approach with semistructured interviews before and after the intervention It was found that members perceived each other's roles only in the light of their interactions with each other Issues of hierarchy in leadership and interpersonal conflicts were raised It is concluded that the team-building intervention had some positive effects on team members' perceptions and behaviour However, further research is needed into management structures and conflict resolution in the PHCT     

Does time matter? Exploring the relationship between interdependent teamwork and time allocation in Swedish interprofessional teams

This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration – development of team climate and communication and more opportunity for both manager coordination and self-regulation.     

Does time matter? Exploring the relationship between interdependent teamwork and time allocation in Swedish interprofessional teams

This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration - development of team climate and communication and more opportunity for both manager coordination and self-regulation.     

The role of teams in resolving moral distress in intensive care unit decision-making

Conflicts arise within teams and with family members in end-of-life decision-making in critical care. This creates unnecessary discomfort for all involved, including the patient. Treatment plans driven by crisis open the team up to conflict, fragmented care and a lack of focus on the patient's wishes and realistic medical outcomes. Methods to resolve these issues involve planned ethical reviews and team meetings where open communication, clear plans and involvement in decision-making for all stakeholders occur. In spite of available literature supporting the value of these techniques, patient care teams and families continue to find themselves involved in spiraling conflict, pitting one team against another, placing blame on family members for not accepting decisions made by the team and creating moral conflict for interdisciplinary team members. Through a case presentation, we review processes available to help resolve conflict and to improve outcome.     

The role of teams in resolving moral distress in intensive care unit decision-making

Conflicts arise within teams and with family members in end-of-life decision-making in critical care. This creates unnecessary discomfort for all involved, including the patient. Treatment plans driven by crisis open the team up to conflict, fragmented care and a lack of focus on the patient's wishes and realistic medical outcomes. Methods to resolve these issues involve planned ethical reviews and team meetings where open communication, clear plans and involvement in decision-making for all stakeholders occur. In spite of available literature supporting the value of these techniques, patient care teams and families continue to find themselves involved in spiraling conflict, pitting one team against another, placing blame on family members for not accepting decisions made by the team and creating moral conflict for interdisciplinary team members. Through a case presentation, we review processes available to help resolve conflict and to improve outcome.     

Comparison of language used and patterns of communication in interprofessional and multidisciplinary teams

Can the language used and the patterns of communication differentiate a multidisciplinary team from an interprofessional team? This research question arose from an unexpected outcome of a study that investigated clinical reasoning of health professional team members in the elder care wards of two different hospitals. The issue at stake was the apparent disparity in the way in which the two teams communicated. To further explore this, the original transcribed interview data was analysed from a symbolic interactionist perspective in order that the language and communication patterns between the two teams could be identified and compared. Differences appeared to parallel the distinctions between multidisciplinary and interprofessional teams as reported in the literature. Our observations were that an interprofessional team was characterized by its use of inclusive language, continual sharing of information between team members and a collaborative working approach. In the multidisciplinary team, the members worked in parallel, drawing information from one another but did not have a common understanding of issues that could influence intervention. The implications of these communication differences for team members, team leaders and future research are then discussed.     

Are interprofessional healthcare teams meeting patient expectations? An exploration of the perceptions of patients and informal caregivers

Poor teamwork skills in healthcare have been found to be a contributing cause of negative incidents in patient care, whilst effective teamwork has been linked to more positive patient outcomes. The aim of this research is to explore views of patients and informal caregivers on the key characteristics of effective healthcare teams and their experiences of healthcare teams using a qualitative approach. A focus group schedule was developed from existing literature to explore this. Topics included the purpose and value of teams in patient care, key attributes and their impact on patient care. Patients and informal caregivers were recruited via convenience sampling. Three focus groups were conducted. Thematic analysis identified a number of themes associated with effective teams. These themes included the perceived purpose of teams, perceptions about the structure of a team, team-based communication, the role of patients, delivery of care. Research participants noted the importance of key characteristics in effective teams, but felt that these were not always consistently present. Communication was considered to be the most important attribute in team working and also appeared to be the area in which the patient experience can be significantly improved. It is clear from the findings of this research that further improvements in teamwork skills in healthcare are needed to achieve effective collaborative practice, sustainable service delivery models and optimal patient care.     

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.     

Barriers to pain management: caregiver perceptions and pain talk by hospice interdisciplinary teams

As patients are cared for in their homes by family caregivers, several challenges arise in effective pain and symptom management. Despite hospice's reputation as the gold standard for terminal care, there is still a need to improve pain management practices, including challenges that caregivers face, related to pain assessment, reluctance and fear of administering medication, noncompliance with pain medicine regimens, and hesitance to report pain. The hospice philosophy of care promotes service for both patients and their family by an interdisciplinary team, and total pain management is a goal of this care. The aim of this control phase of a larger National Cancer Institute-funded mixed methods study was to understand the current practice of hospice assessment and collaboration on informal caregiver issues related to pain management. This study of 30 hospice caregiver--patient dyads from one rural hospice found that 87% of caregivers indicated concern with at least one question on the Caregiver Pain Medicine Questionnaire. Interdisciplinary team discussions for 23 of the dyads were recorded over nine months for a total of 86 sessions. Although caregiver concerns were identified with the Caregiver Pain Medicine Questionnaire by the research team, there was only one discussion of caregiver pain-related concerns during the hospice team meeting. This despite the finding that 38% of the time involved in a patient discussion is spent on pain-related talk. These findings indicate an opportunity for improvement by hospice teams through focusing on caregiver assessment and intervention.     

Team functioning in hospice interprofessional meetings: An exploratory study of providers’ perspectives

Interprofessional collaboration is the foundation of hospice service delivery. In the United States, hospice agencies are required to regularly convene interprofessional meetings during which teams review plans of care for the patients and families they serve. A small body of research suggests that team functioning could be significantly enhanced in hospice interprofessional meetings; however, systematic investigation of this possibility has been limited to date. The purpose of this qualitative study was to better understand the experiences and perspectives of hospice providers who regularly participate in interprofessional meetings as a first step toward improving teamwork in this setting. We interviewed 24 hospice providers and conducted a template analysis of qualitative data to identify barriers and facilitators to effective team functioning in interprofessional meetings. Participants recognised the ways meetings supported high-quality, holistic patient and family care but voiced frustrations over meeting inefficiencies, particularly in light of caseloads they perceived as overly demanding. Time constraints were often viewed as prohibiting the inclusion of interprofessional content and full participation of all team members. Findings suggest that modifications to interprofessional meetings such as standardising processes may enhance meeting efficiency and team functioning.     

The role of oncologists in multidisciplinary cancer teams in the UK: an untapped resource for team leadership?

Background and aims In the UK, cancer care is managed via multidisciplinary teams (MDT). Core members of these teams are typically surgeons, oncologists, radiologists, pathologists and clinical nurse specialists (with other health care professionals potentially present). Good teamwork, including team communication and leadership, has been shown to be a prerequisite for safe care delivery in other health care contexts, but cancer MDT team working processes are yet to be fully explored. This study aimed to assess the self‐perceived contribution of oncologists to MDTs, with emphasis on their potential role as team leaders. Methods Data were collected at the British Uro‐oncology Group 6th Annual Meeting (Sep 11–12 2009, York, UK). Respondents completed various items related to their perceived contribution to MDTs, aspects of current and potential MDT leadership, team decision making in these meetings, and also demographic information. Results Seventy‐seven oncologists attended the meeting, of whom 61 fully completed the survey (response rate 79%). Oncologists reported that their contribution to the MDT discussion carries equal weight to those of surgeons, radiologists and pathologists. Whereas 83% of respondents reported that MDT chairmanship could rotate, only 39% reported that it does in their own MDTs. More than 90% of respondents thought that oncologists (clinical or medical) could chair these meetings, but only 25% of them had ever chaired their own MDT. Conclusions Despite a high level of contribution to MDTs and the respect of their colleagues, oncologists are not taking leadership roles within MDTs at the level that they expect. This study raises the question of whether a re‐evaluation the leadership of MDTs is required with clinicians from a variety of specialities being given opportunities to develop skills necessary to lead cancer MDTs and improve team performance and ultimately cancer care.     

The impact of team processes on psychiatric case management

Title. The impact of team processes on psychiatric case management Aim. This paper is a report of a study to identify the structures and interactions within community mental health teams that facilitate or impede effective teamwork and psychiatric case management. Background. Effective case management requires close collaboration between case managers or care co‐ordinators and other members of the multidisciplinary mental health team, yet there has been little research into this relationship. Method. A multiple case study of seven United Kingdom community mental health teams was conducted between 1999 and 2001, using qualitative methods of participant observation, semi‐structured interviews and document review. Findings. Factors were identified that impacted on the ability of care co‐ordinators to act effectively: ‘structure and procedures’; ‘disrespect and withdrawal’; ‘humour and undermining’; ‘safety and disclosure’. Care co‐ordination was enhanced when team structures and policies were in place and where team interactions were respectful. Where members felt disrespected or undermined, communication, information sharing and collaboration were impaired, with a negative impact on the care provided to service users. Conclusions. Teams require clear operating procedures alongside interprofessional trust and respect to ensure that there is open, safe and reflective participation. Further research is required to identify how best to bring about collaborative, effective teamwork in mental healthcare.     

Difficulties in collaboration: a critical incident study of interprofessional healthcare teamwork

The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.     

Reports

The challenge for members of interprofessional teams is to manage the team processes that occur in all teamwork while simultaneously managing their individual professional identities. The aim of this study was to identify and describe difficulties perceived by health professionals in interprofessional teamwork. Utterances on verbal actions and resolutions were also explored to enable a discussion of the implications for interprofessional learning. Individual interviews using a Critical Incident Technique were performed with 18 Swedish professionals working in healthcare teams, and examined with qualitative content analysis. The main findings show difficulties related to the team dynamic that arose when team members acted towards one another as representatives of their professions, difficulties that occurred when the members' various knowledge contributions interacted in the team, and difficulties related to the influence of the surrounding organization. The perceived consequences of the difficulties, beyond individual consequences, were restrictions on the use of collaborative resources to arrive at a holistic view of the patient's problem, and barriers to providing patient care and service in the desired manner. This paper also discusses how experiences of managing difficulties entailed various forms of interprofessional learning situations.     

Significant event analysis: a comparative study of knowledge,process and attitudes in primary care

Introduction Significant event analysis (SEA) is now well established in UK primary care. Previously, considerable variation has been reported in the knowledge, skills and attitudes of general practitioners undertaking SEA. Little is known about the wider team's understanding, participation or perceptions. We therefore aimed to determine the awareness, degree of analysis and perceived risk of recurrence of a recent significant event, types of discussion forums, staff groups' participation and perceived barriers. Comparisons were made with a 2003 survey and significant changes described. Method A postal questionnaire survey was undertaken of a random selection of general practice team members in National Health Service Greater Glasgow in 2008/9. Results In total, 375/711 respondents (53%) from 111 practices participated. The vast majority was aware of a recent significant event, 29% reported not implementing a change and 23% perceived the risk of recurrence as moderate to high. Administrative and community‐based staff were infrequently involved in meetings. Dedicated significant event meetings remain uncommon (P = 0.06). Perceptions improved since 2003, but lack of time remained a concern. Discussion This survey was the first known attempt to include all members of the primary care team while studying SEA. Awareness and analysis levels were high, but only lead to sustainable improvement of care quality and clinical safety if teams implement change. Greater use should be made of dedicated SEA meetings and participation of all staff groups increased to gain full benefits. Lack of time can be managed pragmatically by prioritizing events based on their perceived severity, potential for change and potential team involvement.     

Developing a Healing Environment for Broken Souls of Patients With Life-Threatening Illnesses and Their Caregivers

What a privilege it is to be able to touch those sacred spaces in the soul of each person that we encounter everyday. Patients with life-threatening illnesses can struggle with physical, emotional, and existential and spiritual concerns and the suffering of caregivers. A key goal of our supportive and palliative care teams is to alleviate patient and caregiver suffering. When caring for patients with advanced and terminal illness, the spirituality of each member of the palliative care team becomes a single collective spirituality or soul with common goals, values, and belonging, with a main goal of providing the best care for patients and caregivers in the alleviation of suffering. Embracing the spiritual care into our daily practice is a common effort and a service provided by each member of the team. Our role as members of the collective soul is to preserve human dignity and raise up the broken souls of patients living with life-threatening illness by creating healing environments.     

Interprofessional health care teams: attitudes and environmental factors associated with participation by community pharmacists

The purpose of this study was to determine whether community pharmacists are prepared to assume a more active role as members of the primary health care team. A secondary objective was to develop multi-items scales for future studies involving pharmacists, as well as other health professions. This paper reports on rates of participation by community pharmacists as members of interprofessional health care teams, the extent to which this participation was related to pharmacists' attitudes about their preparedness for this role, their relationship with physicians, and their assessment of potential barriers to interprofessional teamwork within their practice setting. A mail questionnaire was sent to community pharmacists across Canada between February and April, 2004. The overall response rate was 35.2% (470/1337) with the highest response rate in the Prairie Provinces (40.6%) and the lowest in Quebec (24.4%). Pharmacists on teams were more likely to agree their training and skills were sufficient to participate, and to report good relations with physicians. Pharmacists on teams were more likely to agree there was more opportunity to meet and get to know other health disciplines, and to see teamwork as part of their role. They were also more likely to agree physicians wanted their input, and less likely to see other disciplines as being too protective of their professional "turf". Pharmacists on teams did not differ from those not on teams in rating lack of time, bad past experiences with teamwork, financial reimbursement or proximity to other health care workers as barriers to being a member of a community-based primary care team.