A mixed method approach to clarify the construct validity of interprofessional collaboration: An empirical research illustration

The rapid development of empirical studies in the field of interprofessional collaboration (IPC) calls for a wide array of scientific approaches ranging from recruitment and motivation to measurement and design questions. Regardless of whether researchers choose qualitative or quantitative approaches, they must substantiate their findings. We argue that more attention should be given to reliability and validity issues to improve our understanding of IPC as a phenomenon and practice. A mixed methods approach is presented as a relevant design format for the study of IPC. This paper aims to argue that a combination of methodologies may be a feasible way to enhance our understanding of IPC, with a special focus on reliability and validity issues; illustrate the application of different methodologies in an IPC research project; and emphasize the distinction between validity and validation to mitigate possible obstacles in integrating qualitative and quantitative research in the study of IPC.     

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.     

An intervention to improve interprofessional collaboration and communications: A comparative qualitative study

Interprofessional communication and collaboration are promoted by policymakers as fundamental building blocks for improving patient safety and meeting the demands of increasingly complex care. This paper reports qualitative findings of an interprofessional intervention designed to improve communication and collaboration between different professions in general internal medicine (GIM) hospital wards in Canada. The intervention promoted self-introduction by role and profession to a collaborating colleague in relation to the shared patient, a question or communication regarding the patient, to be followed by an explicit request for feedback from the partner professional. Implementation and uptake of the intervention were evaluated using qualitative methods, including 90 hours of ethnographic observations and interviews collected in both intervention and comparison wards. Documentary data were also collected and analysed. Fieldnotes and interviews were transcribed and analysed thematically. Our findings suggested that the intervention did not produce the anticipated changes in communication and collaboration between health professionals, and allowed us to identify barriers to the implementation of effective collaboration interventions. Despite initially offering verbal support, senior physicians, nurses, and allied health professionals minimally explained the intervention to their junior colleagues and rarely role-modelled or reiterated support for it. Professional resistances as well as the fast paced, interruptive environment reduced opportunities or incentive to enhance restrictive interprofessional relationships. In a healthcare setting where face-to-face spontaneous interprofessional communication is not hostile but is rare and impersonal, the perceived benefits of improvement are insufficient to implement simple and potentially beneficial communication changes, in the face of habit, and absence of continued senior clinician and management support.     

Relating new graduate nurse competence to frequency of use

The healthcare workplace can be a stress-laden environment for new graduates and job performance indicators are an important sign of developing confidence and expertise that will lead to improved patient outcomes. What is not evident from nursing studies is whether new graduate nurse competencies relate to the frequency of their use. This study sought to determine the relationship between perceived nursing competence and self-assessed frequency of use by new graduate nurses. Three cohorts (n = 116) of new graduate nurses undertaking year-long transition to graduate practice programs responded to a questionnaire that utilised the 2001 ANCI competencies and the Nurse Competency Scale and a Visual Analogue scale to self assess their perceived competence and the relative frequency of use for specific competence items. Results indicate that a relationship exists between perceived competence and frequency of use and that research competency scores are substantially lower than all other categories of competency. Implications for education and practice indicate that assessment of nurse competency for the new graduate nurse should focus on the development of generic nursing competencies rather than current expectation of advanced and workplace specific nurse competencies.     

Fitting in: a pervasive new graduate nurse need

Aim

This qualitative study aims to provide insight into how Australian New Graduate Nurses (NGNs) experienced their transition to acute care nursing practice.

Method

Nine NGNs each participated in three in-depth interviews conducted across their first year of practice. Constant comparative analysis was used to identify the emergent themes.

Findings

The desire to fit in (establishment of secure social bonds) with ward staff is an important element of NGN transition experiences. Fitting in was about feeling one's self to be part of a social group, and participants made it clear that their perceptions of their success in establishing secure and meaningful social bonds in each new ward was extremely important for their sense of being as NGNs. Current NGN Transition Programmes (NGNTPs) involve multiple ward rotations, increasing the demand for the NGN to fit in. Thus participants were engaged in a deeply personal transition experience that was not necessarily aligned with multiple ward rotations.

Conclusions

Although NGNTPs have the word “transition” in their title, it may be that current programmes are more focussed on organisations’ desire to “orient” NGNs to working within the acute care setting than facilitating personal transitions to practice. Further investigation of the impact of NGNTPs on NGNs and the associated multiple ward rotations is required.     

Physiotherapy new graduate self-efficacy and readiness for interprofessional collaboration: a mixed methods study

ABSTRACT

Effective interprofessional collaboration is a required competency for all health professionals including physiotherapists. Little is known about new graduate physiotherapists’ self-efficacy and readiness for interprofessional collaboration. A sequential mixed-methods design was used to examine and explore (a) new graduate self-efficacy and (b) new graduate perception of the role and influence of curricular activities on their readiness for interprofessional collaboration. New graduate physiotherapists completed a self-efficacy measure based on the Interprofessional Care Core Competencies Global Rating Scales, and semi-structured interviews were undertaken and subjected to framework analysis. 150 surveys were completed (response rate 91%). Less than one quarter of all participants agreed or strongly agreed that they were confident in relation to all interprofessional competencies. New graduates attributed their self-efficacy to being directly exposed to interprofessional collaboration in a clinical setting during their placement year. The results demonstrate that new graduate physiotherapists have high self-efficacy communicating with other professionals and understanding their roles, however they have low self-efficacy with interprofessional conflict resolution and providing feedback to others. This study has implications for supporting new graduates in practice, and for preparing physiotherapy students for interprofessional collaboration.     

Essential features influencing collaboration in team-based non-specific back pain rehabilitation: Findings from a mixed methods study

The aim of the study presented in this article was to explore how professionals, without guidelines for implementing interprofessional teamwork, experience the collaboration within team-based rehabilitation for people with back pain and how this collaboration influences their clinical practice. This study employed a mixed methods design. A questionnaire was answered by 383 participants and 17 participants were interviewed. The interviews were analysed using content analysis. The quantitative results showed that the participants were satisfied with their team-based collaboration. Thirty percent reported that staff changes in the past year had influenced their clinical practice, of which 57% reported that these changes had had negative consequences. The qualitative findings revealed that essential features for an effective collaboration were shared basic values and supporting each other. Furthermore, aspects such as having enough time for reflection, staff continuity, and a shared view of the team members’ roles were identified as aspects which influenced the clinical practice. Important clinical implications for nurturing and developing a collaboration in team-based rehabilitation are to create shared basic values and a unified view of all team members’ roles and their contributions to the team. These aspects need to be emphasised on an ongoing basis and not only when the team is formed.     

Perspectives of pharmacy students in Qatar toward interprofessional education and collaborative practice: a mixed methods study

ABSTRACT

In an IPE environment, students are expected to have better understanding of the roles, responsibilities, and contribution of other health care professions to enhance interprofessional working and collaboration with an end result of improving patient-centred and team-based care. Although many studies have investigated students’ attitudes, very few employ a mixed methods design and hardly are from Middle Eastern countries. A two-staged sequential explanatory mixed method design was used to comprehensively capture the perspectives of pharmacy students toward IPE and collaborative practice. A quantitative survey was conducted as the first stage of the study, followed by an in-depth discussion of these perspectives through a qualitative phase by conducting two focus groups. For the quantitative surveys, the overall response rate was 102/132 (77%) for pharmacy students in Qatar. This was followed by two focus groups with a total of 27 participants from senior and junior students. In exploring the qualitative data, three main themes were identified in relation to the pharmacy students’ perspectives. These were on the pharmacy students’ perception on the enablers (professional related benefits, patient-related benefits and current positive influences), barriers (previous IPE experiences, educational related issues and current working practices and processes), and recommendations to implementing IPE and collaborative practice (future IPE and pharmacy profession).

Overall, the results demonstrate a strong readiness and positive perception by pharmacy students toward IPE and collaborative practice. This study has highlighted different dimensions in pharmacy students’ perceptions. It also provided a useful insight into the readiness of pharmacy students in a Middle Eastern university. Students are seeking more IPE experiences formally incorporated into their curriculum and hence educators should capitalise on these positive and enthusiastic attitudes to identify the most effective means for delivering IPE and inform curricula planning. Collaborative practice-ready graduates will produce better-educated professionals delivering higher quality care.     

Contributions of team climate in the study of interprofessional collaboration: A conceptual analysis

The concept of team climate is widely used to understand and evaluate working environments. It shares some important features with Interprofessional Collaboration (IPC). The four-factor theory of climate for work group innovation, which underpins team climate, could provide a better basis for understanding both teamwork and IPC. This article examines in detail the common ground between team climate and IPC, and assesses the relevance of team climate as a theoretical approach to understanding IPC. There are important potential areas of overlap between team climate and IPC that we have grouped under four headings: (1) interaction and communication between team members; (2) common objectives around which collective work is organised; (3) responsibility for performing work to a high standard; and (4) promoting innovation in working practices. These overlapping areas suggest common characteristics that could provide elements of a framework for considering the contribution of team climate to collaborative working, both from a conceptual perspective and, potentially, in operational terms as, for example, a diagnostic tool.     

Enablers and barriers to the development of interprofessional collaboration between physicians and osteopaths: A mixed methods study

Osteopathy is a complementary and alternative medicine (CAM) that is growing in popularity. Increasing numbers of parents are seeking pediatric osteopathic care in addition to conventional medical care. Information about the development of interprofessional collaboration (IPC) between these practitioners is scarce. This explanatory sequential mixed methods study aimed to explore enablers of and barriers to the development of IPC between physicians and osteopaths involved with pediatric patients in primary care in Quebec, Canada. Postal questionnaires about collaborative practices were first sent to all physicians and osteopaths working with pediatric patients in Quebec. Semi-structured individual interviews were then conducted with a subset of 10 physicians and 11 osteopaths. A total of 274 physicians (14%) and 297 osteopaths (42%) completed the survey. Forty-five percent (n = 122) of physicians reported that they referred at least one pediatric patient per month to an osteopath. Thirty-six percent (n = 96) of physicians and 41% (n = 122) of osteopaths indicated having professional relationships. Personal consultation, professional relationship, perceived utility of osteopathy and community practice were positively associated with osteopathic referrals. According to participants, the strongest enabler of the development of collaboration was positive clinical results reported by parents. Additional enablers included the osteopath having previous health professionals training such as physiotherapist, pediatric experience, mutual respect for professional boundaries and complementarity, perceived safety of osteopathy, and parents’ requests for collaboration. Barriers were the absence of a common language, the organizational and legal context, uncertainty regarding one another’s roles, lack of interprofessional interactions, and limited scientific evidence. These results related to enablers of and barriers to collaboration between physicians and osteopaths and the illustration of their dynamic interaction could be used to guide efforts to promote productive collaboration and safe patient-oriented care.     

The relationship between team climate and interprofessional collaboration: Preliminary results of a mixed methods study

ABSTRACT

Relational and organisational factors are key elements of interprofessional collaboration (IPC) and team climate. Few studies have explored the relationship between IPC and team climate. This article presents a study that aimed to explore IPC in primary healthcare teams and understand how the assessment of team climate may provide insights into IPC. A mixed methods study design was adopted. In Stage 1 of the study, team climate was assessed using the Team Climate Inventory with 159 professionals in 18 interprofessional teams based in São Paulo, Brazil. In Stage 2, data were collected through in-depth interviews with a sample of team members who participated in the first stage of the study. Results from Stage 1 provided an overview of factors relevant to teamwork, which in turn informed our exploration of the relationship between team climate and IPC. Preliminary findings from Stage 2 indicated that teams with a more positive team climate (in particular, greater participative safety) also reported more effective communication and mutual support. In conclusion, team climate provided insights into IPC, especially regarding aspects of communication and interaction in teams. Further research will provide a better understanding of differences and areas of overlap between team climate and IPC. It will potentially contribute for an innovative theoretical approach to explore interprofessional work in primary care settings.     

The experiences of new graduate nurses caring for the deteriorating patient in rural areas: An integrative review

BackgroundWith an ageing population and an increase in chronic conditions, nurses are increasingly providing care for patients with complex healthcare needs who are at risk of deterioration. Although care for the deteriorating patient is expected of nurses, newly graduated registered nurses, being those in their first year of practice since graduation, often feel ill-equipped and unprepared to provide this care and it is unclear as to how working in rural areas may impact the management of care provision.AimThe aim of this review was to identity and explore the literature focused on the experiences of new graduate nurses caring for the deteriorating patient in rural practice areas.MethodsAn integrative review methodology was selected with the aim to review and provide a more comprehensive understanding of New Graduate Registered Nurses (NGRNs) caring for the deteriorating patient by exploring the empirical literature. Literature reviewed was drawn from Australia, the USA, Ireland, Canada, and Sweden. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to present the findings. Literature was critically appraised against the Critical Appraisal Skills Program qualitative studies checklist. Thematic analysis was undertaken to identify relevant themes.FindingsThree major themes were identified within the literature; “preparedness for caring for the deteriorating patient,” “experiencing the deteriorating patient,” and “new graduate support for safe patient care.”DiscussionNGRNs experience stress and anxiety around situations involving the deteriorating patient and are unprepared to manage these. In rural areas NGRNs have additional stressors including increased responsibilities with requirements of everyday care needs and additionally emergent situations, however, the experience of new graduate nurses managing such emergent situations such as deteriorating patients is unknown.ConclusionNo specific studies were found on NGRNs caring for the deteriorating patient in rural areas. Further research is needed to explore the experiences of the newly graduated nurse caring for the deteriorating patient with the added complexities of the rural environment so that appropriate education, orientation, ongoing development and support to ensure safe patient care can be provided.     

儿科新毕业护士存在的安全护理隐患与对策

探讨儿科新毕业护士存在的安全护理隐患与对策。通过对新毕业护士强化护理安全与法制知识教育,加强对医疗护理有关规章制度及操作技术规范、专科知识的学习,加强其沟通能力的培养,从而在临床实际工作中杜绝或减少差错事故的发生。     

Capturing interprofessional collaboration between physicians and nurses in an acute care setting. A validation study of the revised German version of the Collaborative Practice Scales

ABSTRACT

The relevance of interprofessional collaboration (IPC) is widely acknowledged. Given the lack of a fully validated instrument in the German language for measuring the level of IPC, we built upon the current, albeit psychometrically weak, German-language version of the instrument to devise a new version with improved wording and for subsequent psychometric testing. In a tertiary hospital in German-speaking Switzerland, 160 physicians and 374 nurses completed the revised Collaborative Practice Scales in German (CPS-G) and additional scales regarding positive and negative activation at work and regarding job demands and job resources. A confirmatory factor analysis of the CPS-G was performed, and internal consistency estimates were computed. Partial correlations between the CPS-G and the additional scales were examined for criterion validity. The model fit of the CPS-G was good for physicians (χ²/df = 2.38, p?<?.001; CFI = .923; RMSEA = .051, 90%-CI (0.037–0.065)) and moderate for nurses (χ²/df = 5, p?<?.001; CFI = .919; RMSEA = .087, 90%-CI (0.072–0.102)) supporting the two-factor structure of the original English version. Reliability was acceptable in all sub-scales for physicians (inclusion, α = 0.79; consensus, α = 0.80) and nurses (assertiveness, α = 0.77; understanding α = 0.82). As expected, the CPS-G physicians’ subscales correlated positively with positive activation and job resources and negatively with negative activation and job demands, albeit not always statistically significantly. Similar correlations were found with the CPS-G nurses’ subscales other than in one instance. The CPS-G showed good construct and criterion validity and acceptable internal consistency. It consequently represents a valid instrument ready for application to measure the level of interprofessional collaboration between nurses and physicians in acute care settings.     

Physicians’ perceptions of the role of the dental hygienist in interprofessional collaboration: a pilot study

ABSTRACT

Shifts in healthcare models, and greater numbers of patients seeking care, has encouraged professional organizations to recommend collaborative healthcare teams. In the realm of oral health, the American Dental Hygienists’ Association (ADHA) and the Commission on Dental Accreditation (CODA) have set recommendations that interprofessional collaboration (IPC) be emphasized in the profession. The purpose of this study was to determine physicians’ perceptions of the role of the dental hygienist in IPC. A pilot study utilizing a nonprobability sampling method which included a purposive sample of 30 licensed physicians was conducted. The survey addressed: personal experiences with a dental hygienist, dental hygienists’ roles working in collaboration with physicians, experiences with IPC, benefits of working with dental hygienists, barriers, and demographics. The majority (77.7%) supported the concept that dental hygienists have the necessary education and are important in IPC. Over 77.7% indicated dental hygienists would add value to a medical practice. Time and transfer of data were identified as primary obstacles in working collaboratively with dental hygienists. Findings revealed dental hygienists have the necessary education to be valuable members of IPC teams. Future research is needed to broaden the scope of studies among dental hygienists and other members of IPC teams.