[Show abstract][Hide abstract] ABSTRACT: Interprofessional care ensures high quality healthcare. Effective interprofessional collaboration is required to enable interprofessional care, although within the acute care hospital setting interprofessional collaboration is considered suboptimal. The integration of nurse practitioner roles into the acute and long-term care settings is influencing enhanced care. What remains unknown is how the nurse practitioner role enacts interprofessional collaboration or enables interprofessional care to promote high quality care.
The study aim was to understand how nurse practitioners employed in acute and long-term care settings enable interprofessional collaboration and care.
Nurse practitioner interactions with other healthcare professionals were observed throughout the work day. These interactions were explored within the context of “knotworking” to create an understanding of their social practices and processes supporting interprofessional collaboration. Healthcare professionals who worked with nurse practitioners were invited to share their perceptions of valued role attributes and impacts.
Twenty-four nurse practitioners employed at six hospitals participated. 384 hours of observation provided 1,284 observed interactions for analysis. Two types of observed interactions are comparable to knotworking. Rapid interactions resemble the traditional knotworking described in earlier studies, while brief interactions are a new form of knotworking with enhanced qualities that more consistently result in interprofessional care. Nurse practitioners were the most common initiators of brief interactions.
Brief interactions reveal new qualities of knotworking with more consistent interprofessional care results. A general process used by nurse practitioners, where they practice a combination of both traditional (rapid) knotworking and brief knotworking to enable interprofessional care within acute and long-term care settings, is revealed.
[Show abstract][Hide abstract] ABSTRACT: Interprofessional collaboration is an important aspect of patient discharge from a general internal medicine (GIM) unit. However, there has been minimal empirical or theoretical research that has examined interactions that occur between medical residents and other healthcare professionals in the discharge process. This study provides insight into the social processes that shape and characterize such interactions.
To explore factors that shape interactions between medical residents and other healthcare professionals in relation to patient discharge, and to examine the opportunities for negotiations about discharge between these professional groups.
A qualitative ethnographic approach using observations, interviews and documentary analysis.
Healthcare professionals working in a GIM unit in Canada.
Sixty-five hours of observations were undertaken in a range of settings (e.g. interprofessional rounds, medical and nursing rounds, nursing station) in the unit over a 17-month period. A maximum variation sampling approach was used to identify healthcare professionals working in the unit. Twenty-three interviews were completed, recorded and transcribed verbatim. A directed content approach using theories of medical dominance and negotiated order was used to analyze the data.
The organization of clinical work in combination with clinical teaching influenced interprofessional interactions and the quality of discharge in this GIM unit. While organizational activities (orientation and rounds) and individual activities (e.g. role modeling, teaching) supported negotiations between medical residents and other healthcare professionals around discharge, participants had varied perspectives about their effectiveness.
This study illuminates social factors and processes that require attention in order to address challenges with interprofessional collaboration and discharge in GIM. These findings have implications for medical education, workplace learning, patient safety and quality improvement.
Journal of General Internal Medicine 04/2015; in press(10). DOI:10.1007/s11606-015-3306-6 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PurposeTo describe activities of interprofessional (IP) care, a key aspect of high-quality care, performed by nurse practitioners (NPs) employed in acute and long-term care institutions.Data sourcesWe developed and tested a new theory-driven process tool to quantify NP everyday activities of IP care. We then invited NPs in acute and long-term care to complete the IP self-assessment tool (IPSAT).Conclusions
The IPSAT is a validated tool shown to be reliable for use with NPs. Testing with other healthcare professionals is suggested. More than 50% of NPs engage in all activities of IP care. Many engage in shared decision making, professional relationship, communication, and partnership or collaboration activities on most work days. Less-common activities were interdependence and collective problem solving including efforts to create role clarity.Implications for practiceIt is important to evaluate the everyday use of activities that enhance high-quality care. Awareness and enhanced knowledge of IP care activities such as promoting interdependence, collective problem solving, and ensuring role clarity will improve care quality. The tool results are valuable for practicing NPs and their educators to reflect on practice and advance knowledge to influence purposeful engagement in interprofessional care.
Journal of the American Association of Nurse Practitioners 02/2015; 27(9). DOI:10.1002/2327-6924.12213
[Show abstract][Hide abstract] ABSTRACT: Background
Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes its consistent and precise operationalization. A conceptualization of PCC was derived from the literature and guided the development of an instrument to assess implementation of PCC by healthcare providers. The items of the instrument capture specific activities that reflect three components of PCC: holistic, collaborative, and responsive care. This paper reports on the measure's content and construct validity and reliability.Methods
Content validity was evaluated in a sample of 11 nurse practitioners who rated the relevance of each items’ content in reflecting the respective component of PCC. The content validity index (CVI) was estimated. Construct validity and internal consistency reliability were examined in a survey of 149 nurse practitioners employed in acute care institutions, using factor analysis and the KR-20 coefficient, respectively.ResultsThe CVIs were 100% for the three subscales assessing the holistic, collaborative, and responsive care components of PCC. The items in each subscale loaded on one factor. The KR-20 coefficients were .66, .70, and .42, respectively. Overall, the majority (>70%) of respondents indicated performance of the activities comprising the three components of PCC.Linking Evidence to ActionThe PCC measure demonstrated acceptable psychometric properties. The low variance in responses, which is anticipated for instruments assessing fidelity of intervention implementation, accounts for the low reliability coefficients. Additional testing of the measure's psychometric properties in different groups of healthcare providers is warranted. The measure can be used to monitor healthcare providers’ implementation of PCC in their usual practice.
[Show abstract][Hide abstract] ABSTRACT: The goal of implementing true interprofessional collaboration within the health care system seems to be elusive. The historical role of medicine as primary clinical leader and decision maker is particularly entrenched in the Western health care system. Florence Nightingale, the acknowledged founder of modern, Western nursing, is often blamed for the subservient role of nursing and other female-dominated health and social care professions. Is it fair to lay the blame on Nightingale? This paper seeks to place Nightingale in context and to revisit her own words to explore the Victorian world in which she worked as a social reformer. It argues that Nightingale made pragmatic compromises to gain acceptance for the new profession of nursing; that these compromises had unanticipated consequences that persist - but are not unchangeable.
Journal of Interprofessional Care 06/2012; 26(5):410-5. DOI:10.3109/13561820.2012.699480 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students' understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students' perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allport's (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allport's theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs.
Journal of Interprofessional Care 04/2012; 26(5):370-5. DOI:10.3109/13561820.2012.673512 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Simulated learning activities are increasingly being used in health professions and interprofessional education (IPE). Specifically, IPE programs are frequently adopting role-play simulations as a key learning approach. Despite this widespread adoption, there is little empirical evidence exploring the teaching and learning processes embedded within this type of simulation. This exploratory study provides insight into the nature of these processes through the use of qualitative methods. A total of 152 clinicians, 101 students and 9 facilitators representing a range of health professions, participated in video-recorded role-plays and debrief sessions. Videotapes were analyzed to explore emerging issues and themes related to teaching and learning processes related to this type of interprofessional simulated learning experience. In addition, three focus groups were conducted with a subset of participants to explore perceptions of their educational experiences. Five key themes emerged from the data analysis: enthusiasm and motivation, professional role assignment, scenario realism, facilitator style and background and team facilitation. Our findings suggest that program developers need to be mindful of these five themes when using role-plays in an interprofessional context and point to the importance of deliberate and skilled facilitation in meeting desired learning outcomes.
Journal of Interprofessional Care 09/2011; 25(6):434-40. DOI:10.3109/13561820.2011.592229 · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Health professions education programs use simulation for teaching and maintaining clinical procedural skills. Simulated learning activities are also becoming useful methods of instruction for interprofessional education. The simulation environment for interprofessional training allows participants to explore collaborative ways of improving communicative aspects of clinical care. Simulation has shown communication improvement within and between health care professions, but the impacts of teamwork simulation on perceptions of others' interprofessional practices and one's own attitudes toward teamwork are largely unknown.
A single-arm intervention study tested the association between simulated team practice and measures of interprofessional collaboration, nurse-physician relationships, and attitudes toward health care teams. Participants were 154 post-licensure nurses, allied health professionals, and physicians. Self- and proxy-report survey measurements were taken before simulation training and two and six weeks after.
Multilevel modeling revealed little change over the study period. Variation in interprofessional collaboration and attitudes was largely attributable to between-person characteristics. A constructed categorical variable indexing 'leadership capacity' found that participants with highest and lowest values were more likely to endorse shared team leadership over physician centrality.
Results from this study indicate that focusing interprofessional simulation education on shared leadership may provide the most leverage to improve interprofessional care.
BMC Medicine 03/2011; 9(1):29. DOI:10.1186/1741-7015-9-29 · 7.25 Impact Factor