“What is Found There”1: Qualitative Analysis of Physician–Nurse Collaboration Stories

Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 02/2009; 24(2):198-204. DOI: 10.1007/s11606-008-0869-5
Source: PubMed


Effective physician-nurse collaboration is an important, but incompletely understood determinant of patient and nurse satisfaction, and patient safety. Its impact on physicians has not been described. This study was undertaken to develop a fuller understanding of the collaboration experience and its outcomes.
Twenty-five medical residents, 32 staff nurses, 5 physician and 5 nurse faculty wrote narratives about successful collaboration; the narratives were then qualitatively analyzed. Narrative analysis was the initial qualitative method iteratively employed to identify themes. A phenomenological approach was subsequently used to develop a framework for collaborative competence.
Collaboration triggers, facilitative behaviors, outcomes and collaborative competence were the themes identified. Affect was identified in the triggers leading to collaboration and in its outcomes. Practioners typically entered a care episode feeling worried, uncertain or inadequate and finished the interaction feeling satisfied, understood and grateful to their colleagues. The frequency of affective experience was not altered by gender, profession, or ethnicity. These experiences were particularly powerful for novice practioners of both disciplines and appear to have both formative and transformative potential. Collaborative competence was characterized by a series of graduated skills in clinical and relational domains. Many stories took place in the ICU and afterhours settings.
Despite the prevailing wisdom that nursing and medicine are qualitatively different, the stories from this study illuminate surprising commonalities in the collaboration experience, regardless of gender, age, experience, or profession. Collaborative competence can be defined and its component skills identified. Contexts of care can be identified that offer particularly rich opportunities to foster interprofessional collaboration.

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Available from: Diane Morse, Sep 10, 2015
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    • "Weobservedthatteamworkwillnotbeginjustbyprovidingthe propermilieu(consolidatedsettinginwhichbothnursesand residentshavereceivedpatient-centeredtrainingandareencouragedtoworkasateam ).Rather,improvedteamworkrequired dailyfacilitationbywardleadersandfaculty.Suchlonger-term concertedeffortsarenecessarytobreakprior,deeplyingrained patternsthathavecementednursesanddoctorsintoseparate, parallelworktracks.Progresshasbeenslow,dependingonnot onlythebehaviorsoftheimmediateresidentandnurse,butalsoon thoseoftheirsupervisors.Welearnedfrommanydiscussionsthat therewerenegativepriorexperiences,withfacultyaswellas residents,innurse–doctorinteractionsthatmustbeovercome, oftentakingmultiplecorrectiveinteractionsovermonthsto achieveamodicumofcomfort.Further,nurseandresident administrativestructuresposedproblems;e.g.,nurseshaveother dutiesthatcanprecludejoiningattendingrounds;resident morningreportinterfereswithattendingnursesign-offreports. Theexcitingthingwehaveobserved,though,isthatchangeis possiblewithongoingfacilitation:interactionshavebecome progressivelymorefrequentandmeaningfulastheresidents andnursessimplygettoknow–andtrust–oneanother.The caveatisthatteachingaddressaffectiveandrelationalissues,aswe havehere[14] [15]. Further,weshouldnotexpectawardteamtoformthewayit maywherefewerprovidersareinvolvedandproblemsareless diverseandmoreacute;e.g.,intensivecareunitteam,trauma team.Rather,weenvisionalong-termprocesswhereinresidents andnursesbecomeintegratedascareteamsbyongoingattention toteambuilding.Theinherentlyhighturnoverrateofresidents andnursesononewardbespeaksthekeyroleofmedicaland nursingfacultyinprovidingnotonlyongoingtrainingbutalsoin bridgingprogressfromonerotationtothenextandoneyeartothe next. "
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    ABSTRACT: To train medical residents and nurses to work together as a patient-centered care (PCC) team on a medical ward and test its feasibility, nurses' learning, and patient outcomes. Working with administrative leadership, we consolidated residents' patients on one 32-bed ward. Already training residents in an evidence-based patient-centered method, we now trained 5 nurse leaders similarly, and they then trained all staff nurses. A national consultant visited twice. Specific team-building activities for nurses and residents fostered ward interactions. We used a retrospective pre/post/6-month post-design to evaluate nurses' knowledge and self-efficacy of patient-centered skills. Patients were assigned non-randomly to our unit or comparison units from our emergency room; using a post-test only design, the primary endpoint was patient satisfaction. 28 trained nurses showed improvement in knowledge (p=0.02) and self-efficacy (p=0.001). 81 treatment patients showed no improvement in satisfaction (p=0.44). Training nurses in patient-centered practices were effective. Unique in this country, we also trained nurses and residents together as a PCC team on a medical ward and showed it was feasible and well accepted. We provide a template for team training and urge that others explore this important new area and contribute to its further development.
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    • "Physicians' collaboration with nurses has been discussed in several studies in various care settings: internal medicine wards (Mcgrail et al. 2008), medical-surgical units (Nelson et al. 2008), orthopaedic settings (Rodts 2008), intensive care units (Baggs 2007) and at home for the treatment of cancer (Rodts 2008). Only one study (Kaas et al. 2000) describing collaboration between psychiatrists and psychiatric-mental health clinical nurse specialists with prescriptive privileges was found, and no studies concerning psychiatrists' collaboration with other professionals in the mental healthcare setting were found. "
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    ABSTRACT: The focus was to describe Swedish psychiatrists' experiences of collaboration with healthcare professionals when treating women with postpartum psychosis (PPP). A qualitative design was used, and semi-structured interviews were performed with nine psychiatrists working in psychiatric hospitals in Sweden. Data were analysed using manifest and latent content analysis. The results of these experiences were categorized in this study as: collaboration related to admission, collaboration during inpatient care and collaboration related to discharge. Collaboration with midwives and obstetricians was important in diagnosing the illness, as this often occurred on postnatal wards; and decisions about the form of care for the woman with PPP and for her baby demanded collaboration with various healthcare professionals. Collaboration with nurses was based on expectations and confidence in nurses' competence, and was exceedingly important during inpatient care. When the woman was to be discharged, collaboration with healthcare teams, e.g. outpatient clinic, child health clinic and community services, was required. The conclusions were that psychiatrists collaborate with different professionals in the various phases of the caring process. They rely extensively on nurses' competence when caring for women with PPP, and consider nurses to be their most important collaborators.
    Full-text · Article · Aug 2010 · Journal of Psychiatric and Mental Health Nursing
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