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Perceptions of Effective and Ineffective Nurse-Physician Communication in Hospitals
Nursing Forum
Abstract
Nurse-physician communication affects patient safety. Such communication has been well studied using a variety of survey and observational methods; however, missing from the literature is an investigation of what constitutes effective and ineffective interprofessional communication from the perspective of the professionals involved. The purpose of this study was to explore nurse and physician perceptions of effective and ineffective communication between the two professions.
Using focus group methodology, we asked nurses and physicians with at least 5 years' acute care hospital experience to reflect on effective and ineffective interprofessional communication and to provide examples. Three focus groups were held with 6 participants each (total sample 18). Sessions were audio recorded and transcribed verbatim. Transcripts were coded into categories of effective and ineffective communication.
The following themes were found. For effective communication: clarity and precision of message that relies on verification, collaborative problem solving, calm and supportive demeanor under stress, maintenance of mutual respect, and authentic understanding of the unique role. For ineffective communication: making someone less than, dependence on electronic systems, and linguistic and cultural barriers.
These themes may be useful in designing learning activities to promote effective interprofessional communication.
... Only three studies included midwives (Hastie & Fahy, 2011;Miers & Pollard, 2009;Watson et al., 2016). Ten of the 55 included studies focused on the physician-nurse relationship (e.g Collette et al., 2017;Karam et al., 2022;Robinson et al., 2010). Other included participants were pharmacists, social workers, dietitians, speech therapists, occupational therapists, physical therapists, and psychologists (e.g Adamson et al., 2018;Mertens et al., 2021;Sheehan et al., 2007). ...
... Despite this, it allowed us to cover the full scope of IP communication sub-competencies. Some behaviors like "active listening" (n = 13) Adamson et al., 2018;Adler-Milstein et al., 2011;Clark & Greenawald, 2013;Collins & Currie, 2009;Dúason et al., 2021;Dudley et al., 2019;Garth et al., 2018;Hastie & Fahy, 2011;Manias & Street, 2001;Ntinga, 2020;Tang et al., 2018;Weller & Janssen, 2008), "respect" (n = 12), and "empathy" (n = 3) (Adamson et al., 2018;André et al., 2017;Apker et al., 2006;Clark & Greenawald, 2013;Costa et al., 2014;Ennis et al., 2013;Garth et al., 2018;Kim et al., 2019;Lancaster et al., 2015;Müller et al., 2018;Robinson et al., 2010) were frequently mentioned, highlighting their importance in IP communication (Adler-Milstein et al., 2011;Collette et al., 2017;Collins & Currie, 2009;Costa et al., 2014;Karam et al., 2022;Kim et al., 2019;Mertens et al., 2021;Ntinga & Van Aswegen, 2020). "Open communication" was also a key aspect (n = 8), while issues of hierarchy, especially between physicians and nurses, were common (n = 6) Digby et al., 2018;Garth et al., 2018;Hartung & Miller, 2013;Robinson et al., 2010;Tang et al., 2018). ...
... Some behaviors like "active listening" (n = 13) Adamson et al., 2018;Adler-Milstein et al., 2011;Clark & Greenawald, 2013;Collins & Currie, 2009;Dúason et al., 2021;Dudley et al., 2019;Garth et al., 2018;Hastie & Fahy, 2011;Manias & Street, 2001;Ntinga, 2020;Tang et al., 2018;Weller & Janssen, 2008), "respect" (n = 12), and "empathy" (n = 3) (Adamson et al., 2018;André et al., 2017;Apker et al., 2006;Clark & Greenawald, 2013;Costa et al., 2014;Ennis et al., 2013;Garth et al., 2018;Kim et al., 2019;Lancaster et al., 2015;Müller et al., 2018;Robinson et al., 2010) were frequently mentioned, highlighting their importance in IP communication (Adler-Milstein et al., 2011;Collette et al., 2017;Collins & Currie, 2009;Costa et al., 2014;Karam et al., 2022;Kim et al., 2019;Mertens et al., 2021;Ntinga & Van Aswegen, 2020). "Open communication" was also a key aspect (n = 8), while issues of hierarchy, especially between physicians and nurses, were common (n = 6) Digby et al., 2018;Garth et al., 2018;Hartung & Miller, 2013;Robinson et al., 2010;Tang et al., 2018). ...
Interprofessional communication is crucial for patient care, yet there is a dearth of comprehensive assessment tools essential to train and assess healthcare students. While the Interprofessional Educational Collaborative framework (IPEC) outlines eight sub-competencies, it lacks detailed behavioral indicators. This study aimed to create a repository of interprofessional communication behaviors to complement the IPEC sub-competencies. From 12,448 articles, 55 were selected and thematically analyzed with NVivo18®. We identified 230 interprofessional communication behaviors, organized into 10 themes and 61 sub-themes, aligning with the IPEC sub-competencies. This comprehensive repository could be foundational for developing interprofessional communication assessment tools in healthcare education and aiding healthcare institutions in improving interprofessional communication practices. ARTICLE HISTORY
... Significant commonalities were found between our findings and past studies. Our main themes -the presence of direct communication, collegiality and respect, attentiveness and responsiveness, consistency, and support -include the notions of trust, collaborative attitudes, teamwork, and lack of communication opportunities reported by similar studies [24,25]. Partnership and relationship between nurses and physicians have been repeatedly found as key facilitators of NPC [26,27]. ...
... Partnership and relationship between nurses and physicians have been repeatedly found as key facilitators of NPC [26,27]. Language and cultural barriers reported by Robinson et al. [25] did not strongly emerge in our study between nurses and physicians specifically, although physician-patient language barriers did emerge. Tan et al. summarized these reported themes of NPC, including common understanding, trust and respect, collaborative attitudes, lack of communication opportunities, modes of communication, objectionable communications, insufficient information, selective communication, language, and culture [6]. ...
... Second, we did not collect our participants' demographic data to ensure confidentiality. This limits our interpretations of the reason why the cultural and language barrier between physicians and nurses [25] did not emerge in our study. Last, we conducted only three focus groups with a total of 19 nurse participants. ...
Background
There is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions.
Methods
We conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes and associated quotes.
Results
The presence of direct communication between physicians and nurses was identified as the first theme and perceived by nurses as very important. Additional themes related to physician communication and attributes emerged including collegiality and respect (e.g., engaging nurses as partners in patient care), attentiveness and responsiveness (e.g., listening carefully and addressing concerns), and directness and support (e.g., backing nurses up in difficult situations). Effective NPC is further facilitated by organizational structure, relationship development separate from patient care, and consistent/timely use of technology.
Conclusions
Hospital bedside nurses provided valuable insight into improved physician communication and what attributes contribute to more effective NPC. Most importantly, they emphasized the significance of physicians in supporting them with difficult patients.
... Currently health research and evidence-informed practices related to intercultural, transcultural and cross-cultural communication put the patient first. Here, he or she is of a different linguistic, ethnic or cultural background than the standard or mainstream (Purnell, 2014;Carnevale et al., 2009;Jacobs et al., 2005) The health professions in general have begun to appreciate what the evidence shows: that when there is a mix of languages or a discrepancy in levels of proficiency in the language being spoken in the health-based interaction, the possibility for misunderstanding and the occurrence of errors are not beyond expectation (Siemsen et al., 2012;Robinson et al., 2010). Divi et al. (2007) identified that this language barrier inhibits the care provider's ability to determine signs and symptoms. ...
... Strong accents from non-native speakers can be obstacles to clear communication. According to Robinson et al. (2010), accents can confuse the listener and errors in interpretation can occur when words are misheard. For example, there could be serious outcomes if a physician or nurse with a strong foreign accent wanted to give verbal orders and the care provider receiving them misunderstood or misinterpreted (or vice-versa). ...
... Cohen et al. (2005) are of a like opinion, believing that language barriers such as discordance impede communication between patient and care provider thereby increasing the risk for medication errors. Robinson et al. (2010) studied the perceptions of nursephysician communication within a cohort of multi-ethnic, multi-linguistic health providers in a large urban medical facility in the United States. They found common themes voiced by staff of miscommunication, misunderstanding and adverse events when care providers involved were of a non-English speaking backgrounds. ...
In increasingly multilingual healthcare environments worldwide, ensuring accurate, effective communication is requisite. Language proficiency is essential, particularly medical language proficiency. Medical language is a universal construct in healthcare, the shared language of health and allied health professions. It is highly evolved, career-specific, technical and cultural-bound-a language for specific purposes. Its function differs significantly from that of a standard language. Proficiency requires at minimum, a common understanding of discipline-specific jargon, abstracts, euphemisms, abbreviations; acronyms. An optimal medical language situation demands a level of competency beyond the superficial wherein one can convey or interpret deeper meanings, distinguish themes, voice opinion, and follow directions precisely. It necessitates the use of clarity, and the ability to understand both lay and formal language-characteristics not essential to standard language. Proficiency influences professional discourse and can have the potential to positively or negatively affect patient outcomes. While risks have been identified when there is language discordance between care provider and patient, almost nothing has been said about this within care teams themselves. This article will do so in anticipation that care providers, regulators, employers, and researchers will acknowledge potential language-based communication barriers and work towards resolutions. This is predicated on the fact that the growing interest in language and communication in healthcare today appears to be rested in globalization and increasingly linguistically diverse patient populations. Consideration of the linguistically diverse healthcare workforce is absent. An argument will be posited that if potential risks to patient safety exist and there are potentials for disengagement from care by patients when health providers do not speak their languages then logically these language-based issues can also be true for a care team of mixed linguistic backgrounds. Members may disengage from each other or adverse events may occur as a result of misunderstanding or other language-based confounds. While the greater goal of the article is to address the issues of medical language across languages, English and medical English are used to illustrate points. Questions will be posed to stimulate thought and identify a need for research. Recommendations include collaboration between the health and language disciplines.
Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
... There is a rapid proliferation of electronic communications allowing almost everyone to be reached at anytime, anywhere, by anyone. There is an increasing development of specialization at all levels of healthcare organizations for a wide variety of tasks with a corresponding increase in the required degree of coordination needed between these specialists which is not always being realized [7]. ...
... This is despite the proliferation of personal communication technology (e.g. cellphones, tablet computers, and electronic medical records (EMR)) which should, in theory, have the opposite effect of enhancing lateral interactions [7,8]. In one study at a "contemporary state-of-the-art" hospital in the United States, a survey of users identified the EMR as introducing barriers to communication between specialties, reduced confidence that notes were being shared appropriately, and that there was inhibition of effective and timely communication between practitioners [9]. ...
... EMRs, as has been discussed, have largely taken the role of official communication. EMRs, if relied upon for data transfer and communication, however, have been demonstrated to reduce in-person communication, increase the likelihood of incomplete or piece-meal information flow, and reduce shared problem-solving opportunities [7,20]. This is similar to the previously discussed limitations of relying on official pathways in the military experience. ...
Healthcare is fully embracing the promise of Big Data for improving performance and efficiency. Such a paradigm shift, however, brings many unforeseen impacts both positive and negative. Healthcare has largely looked at business models for inspiration to guide model development and practical implementation of Big Data. Business models, however, are limited in their application to healthcare as the two represent a complicated system versus a complex system respectively. Healthcare must, therefore, look toward other examples of complex systems to better gauge the potential impacts of Big Data. Military systems have many similarities with healthcare with a wealth of systems research, as well as practical field experience, from which healthcare can draw. The experience of the United States Military with Big Data during the Vietnam War is a case study with striking parallels to issues described in modern healthcare literature. Core principles can be extracted from this analysis that will need to be considered as healthcare seeks to integrate Big Data into its active operations.
... 9, 10 Ambas profesiones reconocieron que la colaboración efectiva es esencial para lograr una mejor calidad de atención al paciente, lo que finalmente conduce a mejores resultados de salud para los pacientes. [9][10][11] Dos estudios respaldaron que los médicos y ______________________________________________________________________________________________________________________________ __________________________________________________________________________ PARANINFO DIGITAL 2018, XII(28): e156 2 enfermeras reconocieron la importancia de la colaboración para garantizar la seguridad, satisfacción, recuperación más rápida y menores tasas de mortalidad del paciente. 11,12 Algunos de los estudios revisados informaron que los médicos consideraron la colaboración como menos importante en comparación con las enfermeras. ...
... 9,11 Muchos de los estudios revisados han identificado los principales factores que afectaron la colaboración, como la comunicación, el respeto y el estatus desigual entre médicos y enfermeras. 10,13 Otro de los hallazgos es la falta de comprensión de los roles profesionales de cada uno y la priorización de las tareas. 10 La mayoría de los estudios revisados propusieron fuertemente la implementación de estrategias para mejorar la colaboración entre médicos y enfermeras. ...
... 10,13 Otro de los hallazgos es la falta de comprensión de los roles profesionales de cada uno y la priorización de las tareas. 10 La mayoría de los estudios revisados propusieron fuertemente la implementación de estrategias para mejorar la colaboración entre médicos y enfermeras. Las estrategias implementadas por estudios de intervención incluyen programas interprofesionales. ...
Introducción La colaboración enfermera-médico se define como el pro-ceso de decisión conjunta en el que comparten los objetivos y la responsabilidad de los resultados del paciente. Las carac-terísticas de esta relación son la confianza mutua, la comuni-cación abierta, el respeto y el conocimiento sobre el rol de cada uno. 1 Las enfermeras y los médicos deben trabajar juntos de manera no jerárquica y contribuir por igual a las decisio-nes sobre la atención al paciente. 2 Esta colaboración ha sido recomendada por el Instituto de Medicina para mejorar tanto la entrega de atención clínica como los resultados organizacionales. 3 Se ha demostrado que las relaciones positivas entre ellos mejora la calidad de la atención del paciente y pueden disminuir la tasa de mortali-dad, reducir complicaciones y eventos adversos. Por el con-trario, una colaboración deficiente afecta negativamente los resultados del paciente y la calidad de la atención prestada, 4,5 lo que lleva a un alto nivel de insatisfacción entre los profe-sionales 6 y a un aumento de la intención de abandonar el trabajo, lo que dificulta la retención y el reclutamiento de enfermeras. 7 También se han realizado estudios en los hospitales con reconocimiento Magnético-aquellos que han sido acreditados por la American Nurses Credentialing Center (ACCC)-basándose en el cumplimiento de los valores o fuerzas del magnetismo para conseguir la excelencia del cuidado para los pacientes y la satisfacción de sus profesionales. Uno de estos valores es una mejor calidad en la relación entre enfermeras y médicos. 8 En resumen, a pesar de que en algunos aspectos ha mejo-rado la colaboración entre enfermeras y médicos, sus diferen-cias resultan obvias y requieren de un esfuerzo para mejorar esta relación. Por lo tanto, las preguntas de investigación son: ¿Cuáles son las percepciones de las enfermeras y los médi-cos sobre la colaboración enfermera-médico? ¿Qué factores influyen en sus percepciones sobre esta colaboración? El objetivo de esta investigación es examinar las percep-ciones de estos dos grupos profesionales sobre la colaboración enfermera-médico en la literatura e identificar cómo estas percepciones pueden influir en las interacciones colaborativas entre ellos. Este estudio sigue la declaración PRISMA para informar revisiones sistemáticas.
... Previous studies on interprofessional communication have mostly been restricted to the relationship between physicians and nurses [12,[19][20][21][22], indicating that further research involving other clinicians within healthcare is needed. The present study aims to investigate the importance of interprofessional communication in an occupational group of different healthcare professionals (clinicians). ...
... In previous research, hierarchies, conflicts, and power struggles between nurses and physicians, in general, have been pointed out showing that communication between them can be seen as a work performance obstacle [12,21,22,29]. At the same time, clinicians value each other's perspectives in maintaining a healthy and good organizational and social work environment [9,23]. ...
Background
Communication in healthcare has been extensively studied, but most research has focused on miscommunication and the importance of communication for patient safety. Previous research on interprofessional communication has mainly focused on relationships between physicians and nurses in non-psychiatric settings. Since communication is one of the core competencies in psychiatric care, more research on interprofessional communication between other clinicians is needed, and should be explored from a broader perspective. This study aimed to explore and describe interprofessional communication in a psychiatric outpatient unit.
Method
During spring 2022, data consisting of over 100 h of fieldwork were collected from observations, formal semi-structured interviews and informal conversations inspired by the focused ethnography method. Data was collected at an outpatient unit in central Sweden, and various clinicians participated in the study. The data analysis was a back-and-forth process between initial codes and emerging themes, but also cyclical as the data analysis process was ongoing and repeated and took place simultaneously with the data collection.
Results
We found that a workplace’s history, clinicians´ workload, responsibilities and hierarchies influence interprofessional communication. The results showed that the prerequisites for interprofessional communication were created through the unit’s code of conduct, clear and engaging leadership, and trust in the ability of the various clinicians to perform new tasks.
Conclusion
Our results indicate that leadership, an involving working style, and an environment where speaking up is encouraged and valued can foster interprofessional communication and respect for each other´s professional roles is key to achieving this. Interprofessional communication between different clinicians is an important part of psychiatric outpatient work, where efficiency, insufficient staffing and long patient queues are commonplace. Research can help shed light on these parts by highlighting aspects influencing communication.
... Extant literature suggests EN-patient communication and EN communication with other healthcare workers is integral to the provision of patient care (Bramhall, 2014;Robinson et al., 2010). The steady increase of ED visit rates in the U.S. (NCHS, 2019) and the impacts of nurse-patient and healthcare worker communication on patient outcomes (Crawford et al., 2012;Robinson et al., 2010;Tan et al., 2017) indicate a need to better understand how ENs interact with patients and other healthcare workers. ...
... Extant literature suggests EN-patient communication and EN communication with other healthcare workers is integral to the provision of patient care (Bramhall, 2014;Robinson et al., 2010). The steady increase of ED visit rates in the U.S. (NCHS, 2019) and the impacts of nurse-patient and healthcare worker communication on patient outcomes (Crawford et al., 2012;Robinson et al., 2010;Tan et al., 2017) indicate a need to better understand how ENs interact with patients and other healthcare workers. Ellingson (2005) front and backstage communication framework is a valuable tool to guide this inquiry. ...
Effective emergency nurse-patient (EN) communication and ENs' communication with other healthcare workers have implications for patient outcomes. Effective EN-patient communication informs and empowers patients. This study sought to better understand ENs frontstage and backstage interactions in a metropolitan emergency department (ED). The researcher engaged in participant observation of 15 different ENs' healthcare interactions with patients and other healthcare workers in the ED for a total of 47 hours and 30 minutes. Iterative analysis of field notes builds reveal two key observations. First, frontstage and backstage spaces are fluid in nature, where healthcare workers simultaneously engage in backstage and frontstage communication regardless of physical space or audience. Second, frontstage communication processes can be categorized into three groups: information seeking and sharing, informally attending to patients and rapport building, and acting out of character. Further, a novel type of front stage interaction, "acting out of character" is conceptualized as when ENs act in ways that are inconsistent with their typical role when communicating with a patient. Implications for health communication practice and theorizing are discussed.
... Effective collaboration is associated with improved quality of care, safety and improved patient outcomes, increased physician and nurse satisfaction, reduced work-related stress, and reduced care costs (Bowles et al., 2016), while low collaboration is associated with high job dissatisfaction (Zhou et al., 2019). On the other hand, it is stated that ineffective collaboration between nurses and physicians may cause a lack of autonomy and a higher probability of turnover (Nelson et al., 2008;Robinson et al., 2010;Thomson, 2007;Van Bogaert et al., 2013). ...
... Thirty-nine questionnaires were discarded physicians (19 for nurses and 20 for physicians) as they had less than a year of experience. This was suggested by Robinson et al. (2010) who stated that more experience is needed to identify effective and ineffective interprofessional communication practices. Thus, questionnaires were analyzed for those participants with at least one year of experience (Zhang et al., 2016). ...
Despite extensive research having been carried out on nurse-physician collaboration, there remains a paucity of evidence on how collaboration interacts with organizational commitment and its effect on turnover intention. This study aims to determine the mediating role of nurse-physician collaboration on the effect of organizational commitment on turnover intention. We used a cross-sectional design based on voluntary paper surveys from the inpatient clinics of six public hospitals in the north of Turkey. Data including measures of nurse-physician collaboration, organizational commitment, and turnover intention were collected from a convenience sample of the nurses (n = 212) and physicians (n = 109). Pearson’s correlation analysis was used to determine the relationships between variables, and the mediating effect was analyzed with PROCESS Macro “Model 4” for IBM SPSS. Statistical significance was specified at 95% confidence intervals and two-tailed P values of <0.05 for all tests. While most of the participants were nurses (66%), 34% were physicians. For both nurses and physicians, organizational commitment and nurse-physician collaboration negatively affected the turnover intention. However, the mediating role of nurse-physician collaboration was only significant for nurses (b = −0.025). The results demonstrate the importance of harmony, joint decision-making, and responsibility-sharing between nurses and physicians concerning dedication, engagement, and job satisfaction, especially for nurses.
... Multiple studies have echoed the necessity of engagement, highlighting that when engaged, nurses and physicians can collaborate to make sense of their knowledge and the environment and thus develop shared meaning and value. [27][28][29] In 1 study on the benefit of using interdisciplinary rounding versus traditional physician-only rounding, 100% of the participants in the interdisciplinary rounding group reported that they had a clear understanding of the patient's goal for the day and the hospital stay, and 96% of the respondents stated that they felt like active participants in the conversation in which the plan of care was developed. 30 These results suggest that a form of interdisciplinary round promoted engagement in patient care discussions. ...
... Similarly, other studies have found that nurses and physicians must work together to achieve shared understanding through mutual listening and responding, asking and confirming, and clarifying and negotiating. [27][28][29]40,41 In the classic communication literature, confirmation has been described as a relational concept that provides more information about the relationship than about the ...
Background:
Effective communication between physicians and nurses is crucial to the safety of patients, especially for those with cancer, which is a complex disease requiring multidisciplinary treatment. However, little is known about the factors that contribute to effective communication, which is defined as the development of shared understanding between two or more people.
Objective:
This qualitative secondary analysis was conducted to identify factors that contribute to shared understanding between physicians and nurses from video-recorded conversations that occurred between them during inpatient rounds on oncology units.
Methods:
We used inductive grounded theory to identify videos depicting moments of shared understanding. We then searched for preceding events to develop a preliminary conceptual model that described the factors contributing to shared understanding.
Results:
Four factors emerged as contributors to shared understanding: engagement, clarification, confirmation, and resolution. These factors occurred in sequence with engagement occurring first and resolution occurring last, as the closure of a communication exchange.
Conclusions:
Existing interventions to improve communication include some of the factors identified as contributing to shared understanding (eg, closed-loop communications require clarification and confirmation). However, nurses may need to pay attention to all four factors to develop shared understanding that will promote effective communication with physicians and thereby enhance cancer care.
Implications for practice:
Nurses achieve effective communication when they are assertive and avoid indirect communication. A greater awareness of body language and positioning in relation to a physician at the start of a communication exchange may increase the effectiveness of nurse-physician communication.
... Wider research from critical care has shown that nurses score low on self-assessment in relation to the responsibility for nutrition assessment (Persenius et al, 2006), yet they can directly influence the success of NST (Marshall and West, 2006). Medical dominance and the lack of consideration of nursing input into decision making is described as a barrier to the delivery of high-quality patient care (Bryon et al 2008;Robinson et al, 2010;Matziou et al, 2014;Walton et al, 2016;Tang et al, 2018). Traditional perceptions of the different healthcare roles are frequently attributed to medical dominance over decision-making (Thomas et al, 2003;Hansson et al, 2010). ...
... Unnecessary variations in care and the failure to implement guidelines have been associated with health professionals' preferences for a particular practice (Hoffmann et al, 2014;Joseph-Williams et al, 2014), as well as the way clinical judgement is used in decision making (Baker and Thompson, 2012). Developing a collaborative approach requires effective communication and task prioritising, respect and trust, as well as an understanding of the different professional and individual roles (Robinson et al, 2010). Targeting interventions to identified barriers have been shown to be an effective way to improve the delivery of EN (Cahill et al, 2016). ...
Nutritional status has been linked to clinical outcomes in patients with cancer, and those being treated with haematopoietic stem cell transplant (HSCT) have a significant potential for prolonged periods of poor oral nutrition. This article explores factors affecting the provision of timely nasogastric tube feeding. A preliminary literature search identified a growing evidence-base for the choice and timing of nutritional support therapy. However, existing evidence and personal experience suggest that the use of nasogastric tubes to feed patients is often resisted by both health professionals and patients. This is the first systematic review to explore factors affecting attitudes on the decision to commence nasogastric tube feeding. Wide variation in practice already exists. Therefore, a better understanding of factors that affect the attitudes of health professionals and patients towards nutritional support therapy can facilitate the delivery of optimal nutritional care. The results provide a new perspective on how to achieve the best possible outcomes for patients.
... Such discrepancies can be explained by pressure to conform, social identity, and relational motivation. On the other hand, effective communication between professionals requires mutual respect and recognition of each other's exclusive contributions; clear, precise, and validated messages; and calm behavior and a supportive demeanor under stress (Robinson et al., 2010). ...
Universities are offering hybrid interprofessional health sciences collaboration education courses to address the challenges of schedule synchronization, silos, and communication. This article focuses on analyzing the psychometric quality of a questionnaire used in a setting where interprofessional teams collaborated online and face-to-face in a hybrid university health sciences course. This questionnaire was originally designed for people in the working world in order to assess the constructs of collaboration (communication, synchronization and explicit and implicit coordination) mobilized in the face-to-face setting. The results of the second order confirmatory factor analyses support its use in an academic context and support the metric qualities of the original questionnaire. Online and face-to-face collaboration could be measured using this questionnaire in a hybrid university pedagogical context. The study mobilizes knowledge about the evaluation of collaboration, an avenue that little research has taken to date.
... With EMR, legible clinical notes and prompts, rapid information exchange, instant viewing, and access to the data needed will increase the visibility of diagnoses, procedures, and test results, and facilitate knowledge transfer [41]. The use of EMRs is becoming more widespread even though it is argued that EMRs increase the time physicians spend on recording and decrease the time they spend with patients and nurses [42,43], may reduce face-to-face communication between physicians and nurses [44], may increase the likelihood of incomplete and fragmented communication by reducing the likelihood of verification, collaborative problem solving, and clarification phenomena created by simultaneous communication, which is needed for effective communication [45], and could undermine "patient ownership" [46]. Despite these risks, the use of EMR is rapidly increasing due to the advantages it offers. ...
It is important for the future of electronic health services to determine the attitudes of physicians and nurses towards electronic medical records (EMR) in communication and sharing information (CSI), the type of medical record they prefer and the main problems, they experience. For this purpose, the study was carried out in a university hospital with a 963-bed capacity in Türkiye in 2022 to collect data from the field. The survey method was used in the research and the data were collected by means of a printed questionnaire. The frequency of use of EMRs (3.82 ± 1.07) and CSI behaviors (3.76 ± 0.082) of physicians and nurses in the performance of daily tasks in the hospital were also determined. There was a moderate positive correlation between the use of EMRs and CSI behavior (r = 0.442; p < .05) and that the use of EMRs explained 20 % of the variability in CSI behavior. Paper forms continue to be used due to legal requirements and distrust of electronic records. There is a positive and significant relationship between the use of EMR and CSI behavior. The use of EMRs is effective in increasing CSI behaviors, but there is a need to identify and remove barriers to EMR use to increase the effectiveness of CSI among healthcare professionals.
... Additional elements affecting physician-nurse collaboration is job prioritization, comprehension of professional responsibility, respect, and equal power [10]. Providing high-quality patient care that improves outcomes requires effective cooperation and positive connections [11][12][13]. As a result, there are fewer deaths, as it ensures patient security, satisfaction, and speedy recovery [14,15]. ...
Collaboration between physicians and nurses is essential to healthcare delivery and is associated with high-quality patient care, greater patient satisfaction, and better health outcomes. Hence, it is imperative that doctors and nurses have a particular set of interprofessional collaboration skills. This descriptive cross-sectional study assessed how medical students in the pre-clinical and clinical years perceived attitudes toward collaboration between physicians and nurses in a hospital setting. The Jefferson Scale of Attitude toward Physician–nurse Collaboration (JSAPNC) was reverse-translated into Arabic for the current study. The results showed a total JSAPNC mean score of 46.55, lower than other medical students in other universities. In general, the results of the study showed no significant difference in the total JSAPNC score among medical students when analyzed according to age, clinical exposure, and year level, except in the two factors of JSAPNC: shared education and teamwork (p = 0.038) and caring as opposed to curing (p = 0.043). The findings of this study suggest the necessity of integrating interprofessional education (IPE) across the medical school curriculum because, as future physicians, medical students would be well equipped to treat their patients in partnership with their nursing colleagues.
... This is especially important to investigate as the lexicons that patients use typically differ from the ones in the clinical setting [62,63]. Moreover, different clinical roles-physicians (general practitioners and specialists) and nurses-may use different lexicons as well [64,65], and the notes they produce have different purposes in the overall care of the patient [66,67]. Similarly, it should be further conceptualized what role may clinical notes play in raising the alerts as our current approach only considered structured EHR data. ...
Background
Electronic health record (EHR) data from multiple providers often exhibit important but convoluted and complex patterns that patients find hard and time-consuming to identify and interpret. However, existing patient-facing applications lack the capability to incorporate automatic pattern detection robustly and toward supporting making sense of the patient’s EHR data. In addition, there is no means to organize EHR data in an efficient way that suits the patient’s needs and makes them more actionable in real-life settings. These shortcomings often result in a skewed and incomplete picture of the patient’s health status, which may lead to suboptimal decision-making and actions that put the patient at risk.
Objective
Our main goal was to investigate patients’ attitudes, needs, and use scenarios with respect to automatic support for surfacing important patterns in their EHR data and providing means for organizing them that best suit patients’ needs.
Methods
We conducted an inquisitive research-through-design study with 14 participants. Presented in the context of a cutting-edge application with strong emphasis on independent EHR data sensemaking, called Discovery, we used high-level mock-ups for the new features that were supposed to support automatic identification of important data patterns and offer recommendations—Alerts—and means for organizing the medical records based on patients’ needs, much like photos in albums—Collections. The combined audio recording transcripts and in-study notes were analyzed using the reflexive thematic analysis approach.
ResultsThe Alerts and Collections can be used for raising awareness, reflection, planning, and especially evidence-based patient-provider communication. Moreover, patients desired carefully designed automatic pattern detection with safe and actionable recommendations, which produced a well-tailored and scoped landscape of alerts for both potential threats and positive progress. Furthermore, patients wanted to contribute their own data (eg, progress notes) and log feelings, daily observations, and measurements to enrich the meaning and enable easier sensemaking of the alerts and collections. On the basis of the findings, we renamed Alerts to Reports for a more neutral tone and offered design implications for contextualizing the reports more deeply for increased actionability; automatically generating the collections for more expedited and exhaustive organization of the EHR data; enabling patient-generated data input in various formats to support coarser organization, richer pattern detection, and learning from experience; and using the reports and collections for efficient, reliable, and common-ground patient-provider communication.
Conclusions
Patients need to have a flexible and rich way to organize and annotate their EHR data; be introduced to insights from these data—both positive and negative; and share these artifacts with their physicians in clinical visits or via messaging for establishing shared mental models for clear goals, agreed-upon priorities, and feasible actions.
... La pression de conformité, l'identité sociale et la motivation relationnelle sont des causes qui expliquent ces divergences. En revanche, la communication efficace entre différents professionnels repose sur le respect mutuel et sur la reconnaissance des contributions exclusives à chacun, sur la clarté, la précision et la validation des messages, sur un comportement calme et sur une attitude de soutien en situation de stress(Robinson et al., 2010). ...
Des universités offrent des cours d’éducation à la collaboration interprofessionnelle en sciences de la santé et, pour faire face aux défis de synchronisation des horaires, de cloisonnement et de communication, plusieurs sont dispensés en mode hybride. Cet article s’intéresse à l’analyse de la qualité métrique d’un questionnaire utilisé en contexte où des équipes interprofessionnelles ont collaboré en ligne et en présentiel dans le cadre d’un cours universitaire hybride en sciences de la santé. Initialement, ce questionnaire a été conçu pour des personnes du monde du travail dans le but d’évaluer les composantes de la collaboration (communication, synchronisation et coordinations explicite et implicite) mobilisées en présentiel. Les résultats des analyses factorielles confirmatoires de second ordre appuient les qualités métriques du questionnaire original. La collaboration en ligne et en présentiel pourraient être mesurées à l’aide de ce questionnaire dans un cours universitaire hybride. L’étude mobilise des connaissances sur l’évaluation de la collaboration, une voie scientifique peu connue à ce jour.
... De la investigación cualitativa se puede extraer, como característica de la comunicación ineficaz por parte de la enfermera/o, el uso de lenguaje indirecto (Borrott et al., 2016). Por el contrario, la seguridad del paciente se ve favorecida por una comunicación clara y precisa entre profesionales (Robinson et al., 2010). Destacar que existen instrumentos usados para la comunicación en el ámbito sanitario que pueden ser una barrera para la misma (Brady et al., 2017). ...
Resumen: Introducción: La comunicación posibilita el establecimiento de vínculos profesionales, facilitando la colaboración interdisciplinar, así como la elaboración de planes conjuntos. Los problemas de comunicación interprofesional durante la actividad asistencial habitual, pueden transformarse en errores de información que afecten a la seguridad del paciente. Objetivo: Analizar las variables, temas y categorías que caracterizan la comunicación entre profesionales de enfermería y medicina para una atención sanitaria segura. Metodología: Se realizó una revisión sistemática de los estudios primarios publicados en bases de datos electrónicas en inglés y español sobre la comunicación entre profesionales de enfermería y medicina. Resultados: Diecisiete estudios cumplieron los criterios de la revisión. Tanto en estudios cuantitativos como cualitativos se puso de manifiesto que hablar de forma clara y precisa favorecía la seguridad del paciente. Por el contrario, el uso de lenguaje indirecto o su inhibición dificultó una comunicación interprofesional eficaz. En estudios cualitativos, los profesionales de enfermería recomendaron el mantenimiento de una actitud profesional respetuosa, de colaboración, reconocimiento profesional y mayor escucha. Conclusiones: Hay una ausencia generalizada de adaptación transcultural y validación de los cuestionarios en los estudios cuantitativos. La mayoría de los estudios están circunscritos a entornos de atención en servicios especiales. Se necesitan más estudios en hospitalización.Palabras clave: comunicación; comunicación interprofesional; relaciones enfermeros-médicos; seguridad del paciente.Abstract: Introduction: Communication enables the establishment of professional links, facilitating interdisciplinary collaboration, as well as the elaboration of joint plans. Interprofessional communication problems during usual care activity can be transformed into information errors that affect patient safety. Objective: To analyze the variables, themes and categories that characterize the communication between nursing and medical professionals for safe health care. Methodology: A systematic review of the primary studies published in electronic databases in English and Spanish on communication between nursing and medical professionals was carried out. Results: Seventeen studies met the criteria of the review. Both quantitative and qualitative studies showed that speaking clearly and precisely favored patient safety. On the contrary, the use of indirect language or its inhibition hindered effective interprofessional communication. In qualitative studies, nursing professionals recommended the maintenance of a respectful professional attitude, collaboration, professional recognition and greater listening. Conclusions: There is a general absence of cross-cultural adaptation and validation of questionnaires in quantitative studies. Most of the studies are limited to special services care settings. More studies in hospitalization are needed.Keywords: communication; interprofessional communication; nurses-physician relations; patient safety.
... Extensive research has shown that the full decision-making autonomy of the team leaders results in significant practice variation (Corallo et al. 2014, Davis et al. 2000, Grytten and Sørensen 2003, Valtchinov et al. 2019). Different team leaders will make different decisions, even when facing similar situations, and will have different preferences and styles for whether and how they narrate their decisions to trainees and other team members (Manojlovich 2005, Nembhard and Edmondson 2006, Robinson et al. 2010). These differences in practice and communication style may complicate trainee and cross-discipline partners' ability to generalize lessons from the variation they encounter across team leaders. ...
In many workplaces, temporary teams convene to coordinate complex work, despite team members having not worked together before. Most related research has found consistent performance benefits when members of temporary teams work together multiple times (team familiarity). Recent work in this area broke new conceptual ground by instead exploring the learning and performance benefits that team members gain by being exposed to many new partners (partner exposure). In contrast to that new work that examined partner exposure between team members who are peers, in this paper, we extend this research by developing and testing theory about the performance effects of partner exposure for team members whose roles are differentiated by authority and skill. We use visit-level data from a hospital emergency department and leverage the ad hoc assignment of attendings, nurses, and residents to teams and the round-robin assignment of patients to these teams as our identification strategy. We find a negative performance effect of both nurses’ and resident trainees’ partner exposure to more attendings and of attendings’ and nurses’ exposure to more residents. In contrast, both attendings and residents experience a positive impact on performance from working with more nurses. The respective effects of residents working with more attendings and with more nurses is attenuated on patient cases with more structured workflows. Our results suggest that interactions with team members in decision-executing roles, as opposed to decision-initiating roles, is an important but often unrecognized part of disciplinary training and team learning.
Funding: This work was supported by the New Faculty Startup Fund from Seoul National University; Harvard Business School; Stanford Center for Work, Technology, and Organization; and Stanford Center for Designing Organizational Change.
Supplemental Material: The online supplement is available at https://doi.org/10.1287/orsc.2022.1585 .
... Several root causes related to suboptimal interprofessional collaboration have been described in the literature, including factors related to communication, respect, trust, unequal power, professional roles and contributions, task prioritising, care domains, and role expectations. (13,(47)(48)(49)(50)(51) Not all participants who reported issues with IPE in the course were necessarily opposed to it; some were not opposed but offered ideas on how to improve the experience. These included professionspecific breakout sessions or learning activities. ...
Context
Interprofessional collaboration is needed in palliative care and many other areas in health care. Pallium Canada's two-day interprofessional Learning Essential Approaches to Palliative care (LEAP) Core courses aim to equip primary care providers from different professions with core palliative care skills.
Objectives
Explore the learning experience of learners from different professions who participated in LEAP Core courses from April 2015 to March 2017.
Methods
This mixed methods study was designed as a secondary analysis of existing data. Learners had completed a standardized course evaluation survey online immediately post-course. The survey explored the learning experience across several domains and consisted of seven closed-ended (Likert Scales; 1= “Total Disagree”, 5= “Totally Agree”) and three open-ended questions. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis (KW) non-parametric test tests, and qualitative data underwent thematic analysis.
Results
244 courses were delivered during the study period; 3045 of 4636 participants responded (response rate 66%); physicians (662), nurses (1973), pharmacists (74), social workers (80), and other professions (256). Overall, a large majority of learners (96%) selected “Totally Agree” or “Agree” for the statement “the course was relevant to my practice”. A significant difference was noted across profession groups; X² (4) = 138; p<.001. Post-hoc analysis found the differences to exist between physicians and pharmacists (X²= -4.75; p<0.001), and physicians and social workers (X²= -6.63; p<0.001). No significant differences were found between physicians and nurses (X²= 1.31; p=1.00), and pharmacists and social workers (X²= -1.25; p=1.00). Similar results were noted for five of the other statements.
Conclusion
Learners from across profession groups reported this interprofessional course highly across several learning experience parameters, including relevancy for their respective professions. Ongoing curriculum design is needed to fully accommodate the specific learning needs of some of the professions.
... YM and YNHH leadership deliberately chose to deliver the ERCC workshop interprofessionally to nurses, advanced-practice providers (APPs), and physicians. The goal of this design was to simultaneously improve the patient experience while creating shared paradigms among teams (3)(4)(5)(6). To deliver the workshop, 12 staff (6 nurses, 5 physicians, and 1 APP) who were identified as good communicators and committed to improving patient experience were recruited from various service lines throughout the institution to become trainers. ...
In 2018, Yale Medicine (YM)—an academic multispecialty practice—and Yale New Haven Health System (YNHH), partnered with the Academy of Communication in Healthcare to develop a one-day interprofessional workshop to introduce relationship-centered communication skills to all of their nurses and physicians. Relationship-centered communication skills include showing positive regard, listening actively and expressing empathy and have been demonstrated to improve patient outcomes. A professionally diverse group of 12 nurses and physicians, committed to improving patient experiences, were purposefully selected for training to teach the workshop. Individual interviews with trainers 3 months post training revealed themes reflecting the intrapersonal, interpersonal, and organizational impact of participation in the Train-the-Trainer program. At the intrapersonal level, training contributed to personal growth, skillfulness, and confidence. At the interpersonal level, it expanded and strengthened professional networks. As an organizational catalyst, training transformed the work experience among nurse and physician trainers, thereby supporting YM/YNHH’s vision to provide interprofessional relationship-centered care. Results suggest that trainer training had additional benefits beyond learning to deliver the workshop, including improving the quality of trainers’ personal and professional relationships, and enhancing organizational efficiency and interprofessionalism.
... Incident was reported for inappropriate treatment and ineffective communication among health care providers and shared with the relevant department. Concerned staff apologized and promised to be more thorough before prescribing such high alert medicine [1,2]. ...
... Komunikasi kolaborasi sedikit sulit terbentuk ketika dalam tim medis merasa hanya dokter yang memiliki dominasi kuat untuk proses pengobatan pasien. Hal ini terlihat dari hasil penelitian dalam salah satu Publikasi Jurnal Kutipan: (Utami, Hapsari, & Widyana, 2016 (Robinson, Gorman, Slimmer, & Yudkowsky, 2010). Namun, ada beberapa dokter yang tidak ingin berkomunikasi dengan perawat dan memilih dominasi dengan langsung cek serta memberikan diagnosa bertanya kepada perawat yang memang selalu berada ditempat sesuai tugasnya yakni mengontrol pasien dalam keseharian di ruang perawatan (Anggarawati & Wulan Sari, 2016 sehingga perlu terus menerus diupayakan untuk ditingkatkan dan dikembangkan dalam program pelayanan kesehatan profesional untuk menjamin kepuasan keamanan pasien. ...
Abstrak Isu kesehatan menjadi penting untuk dikaji melalui bidang ilmu komunikasi dengan adanya masukan dari banyak penelitian bidang kesehatan yang menekankan perhatian pada aspek psikis maupun sosial yang membantu kesembuhan pasien. Kemampuan komunikasi dan Pemahaman Sosial sangat diperlukan baik dalam komunikasi di bidang kesehatan antar tim medis dengan pasien maupun komunikasi dalam tim medis agar pelayanan rumah sakit berjalan optimal bisa meningkatkan reputasi pelayanan rumah sakit. Tujuan dari penelitian ini adalah menelaah kembali peran komunikasi dalam kolaborasi tim medis kesehatan sebagai upaya peningkatan kualitas rumah sakit dengan metode Literature Review. Berdasarkan hasil penelaah pembahasan penemuan data yang berada didalam jurnal-jurnal tersebut ditemukan bahwa saat ini kolaborasi tim medis sangat erat korelasinya dengan kemampuan komunikasi dan pemahaman sosial terhadap pasien sudah terbentuk. Hanya saja masih ada beberapa dokter yang mengabaikan unsur profesi medis lain dengan mendominasi mengabaikan komunikasi. Hal inilah yang membuat beberapa Fakultas Kedokteran serta Ilmu Kesehatan Membentuk Mata Kuliah Ilmu Komunikasi Kesehatan dan Dasar Sosial Kesehatan agar kemampuan komunikasi pemahaman sosial budaya pasien dan rekan tim dapat terbentuk, sebagai kesimpulan Komunikasi adalah hal penting didalam sebuah Tim Medis pada institusi kesehatan dalam upaya meningkatkan layanan kesehatan Rumah Sakit. Abstract Health issues are important to be examined through the field of communication science with the input of many health studies that emphasize attention to psychological and social aspects that help the patient's recovery. Communication skills and Social Understanding are needed both in communication in the field of health between the medical team with patients and communication in the medical team so that hospital services can run optimally to improve the reputation of hospital services. The purpose of this study is to re-examine the role of communication in the collaboration of health medical teams as an effort to improve hospital quality with the Literature Review method. Based on the review of the discussion of the discovery of data contained in these journals, it is found that currently the collaboration of the medical team is very close in correlation with communication skills and social understanding of patients already formed. It's just that there are still some doctors who ignore other elements of the medical profession by dominating communication. This is what makes several faculties of Medicine and Health Sciences Establish Health Communication Subjects and Basic Social Health so that communication skills can be formed social understanding of patients and teammates, in conclusion Communication is important in a Medical Team at a health institution in an effort to improve services Hospital health.
... 11 Studies have reported that poor physician-nurse cooperation could result in job dissatisfaction, a lack of autonomy, and higher possibility of intention to leave the job and poor health. 12,13 According to Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the construction of collaborative relationships between physicians and nurses is vital to positive patient outcomes. 14 Moreover, other benefits include less fragmented care and less wasting of resources. ...
Introduction: Although nurses and physicians are known to share the common goal of improving the quality of health care, there has traditionally been a relational gap between them. The aim of the present study was to investigate the attitude of Iranian nurses about physician-nurse collaboration and its relationship with their job satisfaction. Methods: In this cross-sectional study, a total of 232 nurses were recruited from three educational hospitals of Zanjan University of medical sciences. Three questionnaires were used in this study; (a) Demographic data questionnaire, (2) Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC), and (3) Minnesota Satisfaction Questionnaire. Results: In this study, the mean age of the participants was 33.22 (6.13) years, 83.8% of nurses were female, 90.8% had a baccalaureate degree in nursing, and 82.5 % had rotational work shifts. The mean score of physician-nurse collaboration was found to be 48.07 (8.95) (ranged from 15 to 60), and the mean score of job satisfaction scale was 57.78 (14.67) (ranged from 20 to 100). There was a significant positive correlation between the attitudes toward physician-nurse collaboration and job satisfaction among the nurses (r=0.59, P≤0.001). Conclusion: The results indicated that the collaboration between nurses and physicians increases the job satisfaction of nurses working in clinical settings. Therefore, nurses and physicians should develop a new culture of collaboration with each other with the mutual goal of high quality patient care. Moreover, health care administrators should implement the strategies that strengthen the development of physician-nurse collaboration.
... In addition, the introduction of SBAR before the practicum could enhance students' interests in nurse-physician communication. Clarity and precision of message are important for effective interprofessional communication (Robinson et al., 2010). The SBAR communication program was implemented in a pediatric nursing practicum. ...
Background
Effective communication by nurses is crucial to ensure patient safety. A structured communication program increases communication clarity, education satisfaction, and positivity during interprofessional collaboration among students. In an effort to facilitate effective communication between nurses and physicians, the well-known structured communication tool SBAR (Situation, Background, Assessment, and Recommendation) has been extensively used in clinical and educational settings.
Objectives
The purpose of the study is to investigate the impact of an SBAR communication program on communication performance, perception, and practicum-related outcomes in senior-year nursing students.
Method
The study employed a non-equivalent control group quasi-experimental design and implemented the tool in the pediatric nursing practicum of a nursing school. The experimental group participated in a SBAR program, where role playing using SBAR techniques for different scenarios was used to improve practical communication among nursing students. The SBAR program was developed based on Kolb's Experiential Learning Theory. Communication performance was assessed via the SBAR communication tool and the communication clarity scale. Communication perception was measured by handover confidence level. Practicum-related outcomes of clinical practice self-efficacy, perceived nurse–physician collaboration, and practicum satisfaction, were also evaluated.
Results
The experimental group demonstrated significantly higher SBAR communication (p < .001), communication clarity (p < .001), and handover confidence (p < .001) than the control group. Clinical practice self-efficacy, perceived nurse–physician collaboration, and practicum satisfaction did not differ.
Conclusions
The SBAR program in a pediatric nursing practicum improves SBAR communication, communication clarity, and perceived handover confidence in senior-year nursing students.
Background: The integration of Electronic Medical Records (EMRs) in healthcare systems has revolutionized the management of patient information, enhancing efficiency and accessibility. This study explores the impact of EMRs on Clinical Safety Indicator (CSI) behavior among healthcare professionals, focusing on doctors and nurses, who play crucial roles in medical record creation and utilization. Methods: A comprehensive literature review was conducted to assess the prevalence of EMR usage, perceived benefits, concerns, and attitudes toward digital record-keeping. Data was collected to understand the relationship between EMR adoption, professional roles, and perceptions of data security and integrity. Results: Findings revealed a higher inclination of doctors towards EMR adoption compared to nurses, with concerns shared by both groups regarding data accessibility, reliability, and comprehensibility. Nurses tended to prefer traditional paper records, impacting their engagement with EMRs. Security and privacy concerns surrounding EMRs were highlighted, influencing professionals' trust in Health Information Systems (HIS) and data privacy safeguards. Conclusion: The study underscores the importance of addressing healthcare professionals' attitudes and concerns toward EMRs to enhance their integration and utilization. Improved training on digital healthcare systems and addressing data security issues are crucial for promoting EMR adoption and ensuring effective communication and collaboration among healthcare teams.
Amaç: Hemşirelerin bakım kültürü algıları ile iş doyumu, işten ayrılma niyeti ilişkisini ve eğitim programının bakım kültürü algısına etkisini incelemektir.
Gereç ve Yöntem: Bir üniversite hastanesinde yürütülen araştırmanın metodolojik aşaması 240 hemşire örneklemiyle, ikinci aşaması 86 hemşireyle gerçekleştirildi. Veriler; Hemşire Bilgi Formu, Bakım Kültürü Ölçeği (BKÖ), Hemşire İş Doyum Ölçeği (HİDÖ) ile toplandı. Eğitim grubuna bakım kültürüne ilişkin konularda dört haftalık çevrimiçi eğitim verildi. Eğitim ve kontrol grubu ön test son test BKÖ, HİDÖ ve işten ayrılma niyetleri değerlendirildi.
Bulgular: Metodolojik aşamada Bakım Kültürü Ölçeği’nin dil geçerliliği, kapsam geçerliliği, yapı geçerliliği, eş zaman geçerliliği, bilinen gruplar geçerliliği açısından yeterli olduğu belirlendi. Cronbach alfa toplam 0,84 şeklinde ve madde toplam puan korelasyonları iyi düzeyde bulundu. İkinci aşamada program etkililiği açısından hemşirelerin kişisel özen ve bakım kültürü toplam puan ortalamaları eğitim öncesine göre anlamlı düzeyde artış gösterdi. Bakım kültürü ile iş doyumu toplam puan ortalamaları arasında hem ön test hem de son test verileri için orta düzeyde ilişkinin var olduğu; işten ayrılma niyeti ile yönetici özeni, iş arkadaşı özeni ve toplam puan ortalamaları için son test verilerinde negatif yönde anlamlı ilişkilerin olduğu görüldü.
Sonuçlar: Metodolojik aşamada Bakım Kültürü Ölçeği’nin Türkçe versiyonunun hemşirelerin bakım kültürü algılarını değerlendirmek için geçerli ve güvenilir bir araç olduğu tespit edildi. Bakım kültürü ile iş doyumu ve işten ayrılma niyeti arasında zayıf-orta düzeyde ilişki bulundu. Hemşirelerin bakım kültürü algısının iyileştirilmesinde konuyla ilgili hazırlanan eğitim programları katkı sağlayabilmektedir.
Anahtar Kelimeler: Bakım kültürü, eğitim, hemşirelik, kültür, iş doyumu, işten ayrılma niyeti
Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.
Interprofessional collaborative practice is a phenomenon that can be fraught with power dynamics between professions, within professions, and between professionals and patients. In the literature, the dominant notion is that conflicting viewpoints and interests arising from unequal power dynamics can be resolved through negotiation. This study examined COPD patients, health professionals, and physician experiences of negotiation within 10 interprofessional collaborative COPD care teams. Physicians, patients, and healthcare professionals each had strikingly different conceptions and experiences of negotiating their perspective with other team members. Our study suggests that negotiation is an idealized notion rather than a relational process embedded in interprofessional collaborative practice. Importantly, we found that the ability and opportunity to negotiate one's perspective is heavily influenced by one's position in the workplace division of labor and professional hierarchy. We conclude that "negotiation" is only one approach among many in navigating interprofessional relations. Further, the rhetorical and ideological appeal of "negotiation" may overstate its role in interactions in interprofessional care settings, and lead to a misunderstanding of the power dynamics at play. It may be naïve to assume team members can control their situation through the competitive assertion of their individual perspective in a rational debate. Unfortunately, adopting the language of negotiation uncritically may not offer relevant solutions to structural and collective problems within a healthcare workplace.
Aims and objectives:
To describe healthcare professionals' perceptions of person-centred care for patients with colorectal cancer, within the standardised care concept of Enhanced Recovery After Surgery.
Background:
International guidelines for colorectal surgery describe standardised perioperative care. Combining standardised care with person-centred care could be accomplished using the person-centred nursing framework for establishing and maintaining relationships with patients. Despite strong evidence for the standardised care concepts' medical benefits, studies concerning the practice of person-centred care from a nursing point of view are sparse.
Design:
A qualitative descriptive design was used.
Methods:
Four focus groups interviews were performed including 22 healthcare professionals with 1-29 years' experience of caring for patients with colorectal cancer. Data were analysed using qualitative conventional content analysis. The COREQ checklist for reporting qualitative research was used.
Results:
Three themes emerged in the analysis; Framework in the healthcare system, Facing differences in participation and Interacting with the person beyond the illness. Conditions for person-centred care were related to the interactions between patients and healthcare professionals, the structure of care were also considered relevant.
Conclusion:
There is a discrepancy between what is considered important to do and what is done in clinical practice to create conditions for patient participation. Interacting with patients and creating an interprofessional environment are important conditions, the structure of care is also a fundamental key to promoting person-centred care. There is a need for further improvement in care of patients with colorectal cancer to achieve person-centredness within standardised care.
Relevance to clinical practice:
The findings provide valuable insights into what healthcare professionals consider to be important for achieving person-centred care. This knowledge can be useful in clinical practice and education programs.
Patient or public contribution:
At the outset of the study, three patients were interviewed aimed at improving the conditions for the healthcare professionals' focus groups.
Background:
As hospitals shift away from pagers and towards secure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors.
Objective:
This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital.
Design:
This was a qualitative study with focus groups.
Setting and participants:
Participants were pediatric residents and nurses at Lucile Packard Children's Hospital.
Intervention:
Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached.
Main outcome and measures:
Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being.
Results:
Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume.
Conclusion:
Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.
Background
Communication errors contribute to preventable adverse hospital events; however, communication between general surgery residents and nurses remains insufficiently studied. The purpose of our study was to use qualitative methods to characterize communication practices of surgical residents and nurses on inpatient general and intermediate care units to inform best practices and future interprofessional interventions.
Methods
Our study cohort consisted of 14 general surgery residents and 13 inpatient nurses from a tertiary academic medical center. Focus groups were conducted via a secure video platform, recorded, and transcribed. Two authors performed open coding of transcripts for qualitative analysis. Codes were reviewed iteratively with themes generated via abductive analysis, contextualizing results within 3 domains of an established communication space framework: organizational, cognitive, and social complexity.
Results
Communication practices of general surgery residents and inpatient nurses are affected by workflow differences, disruptive communication patterns, and communication technology. Barriers to effective communication, as well as strategies used to mitigate challenges, were characterized, with select communication practices found to negatively affect the well-being of patients, nurses, and residents.
Conclusion
Communication practices of general surgery residents and inpatient nurses are influenced by entrenched and interrelated organizational, technological, and interpersonal factors. Given that current communication practices negatively affect patient and provider well-being, collaboration between surgeons, nurses, systems engineers, health information technology experts, and other stakeholders is critical to (1) establish communication best practices, and (2) design interventions to assess and improve multiple areas (rather than isolated domains) of surgical interprofessional communication.
Communication plays a key role in the provision of safe patient care, and miscommunication in healthcare can lead to avoidable patient harm or mortality. Interprofessional communication (IPCom) can be challenging due to differences in training, education and roles between healthcare professions. The aim of this systematic review was to synthesize the qualitative evidence regarding healthcare providers' perceptions of interprofessional communication in the hospital setting. Four databases (PubMed, CINAHL, Web of Science, and Embase) were searched for studies that met the inclusion criteria. Eighteen studies were identified as suitable for inclusion in the review and were examined using thematic synthesis. Thematic synthesis led to the development of five descriptive themes: 1) 'Hierarchy", 2) "Interprofessional Ethos," 3) "Healthcare Environment," 4) "Personal Factors" and 5) "Methods of Communication," and two overarching analytical themes: "Barriers to Communication" and "Facilitators to Communication." Personal factors, such as strong interprofessional relationships, were found to be important facilitators to IPCom, while organizational factors, such as challenging and hierarchical working environments, were found to pose barriers to IPCom.
Purpose:
Postgraduate training programs are incorporating feedback from registered nurses (RNs) to facilitate holistic assessments of resident performance. RNs are a potentially rich source of feedback because they often observe trainees during clinical encounters when physician supervisors are not present. However, RN perspectives about sharing feedback have not been deeply explored. This study investigated RN perspectives about providing feedback and explored the facilitators and barriers influencing their engagement.
Method:
Constructivist grounded theory methodology was used in interviewing 11 emergency medicine and 8 internal medicine RNs at 2 campuses of a tertiary care academic medical center in Ontario, Canada, between July 2019 and March 2020. Interviews explored RN experiences working with and observing residents in clinical practice. Data collection and analysis were conducted iteratively. Themes were identified using constant comparative analysis.
Results:
RNs felt they could observe authentic day-to-day behaviors of residents often unwitnessed by supervising physicians and offer unique feedback related to patient advocacy, communication, leadership, collaboration, and professionalism. Despite a strong desire to contribute to resident education, RNs were apprehensive about sharing feedback and reported barriers related to hierarchy, power differentials, and a fear of overstepping professional boundaries. Although infrequent, a key stimulus that enabled RNs to feel safe in sharing feedback was an invitation from the supervising physician to provide input.
Conclusions:
Perceived hierarchy in academic medicine is a critical barrier to engaging RNs in feedback for residents. Accessing RN feedback on authentic resident behaviors requires dismantling the negative effects of hierarchy and fostering a collaborative interprofessional working environment. A critical step toward this goal may require supervising physicians to model feedback-seeking behavior by inviting RNs to share feedback. Until a workplace culture is established that validates nurses' input and creates safe opportunities for them to contribute to resident education, the voices of nurses will remain unheard.
Etnosentrizm, iç-dış grup çerçevesinde değerlendirilen kültürel bir olgudur. Kişinin kendi kültürel perspektifine göre kendini ait hissettiği ya da diğer bir ifadeyle kimliğini oluşturan grup (iç grup) ile özdeşleşme eğiliminde olduğu ve haricindeki diğer dış grupların daha bayağı ve aşağıda görüldüğü bir durumu yansıtmaktadır. Bilindiği gibi kültür kişiliğin şekillenmesinde belirleyici bir yapıdadır. Bu yönüyle etnosentrizmin kültüre vurgu yapan yönü kişilikten bağımsız düşünülemez. Aynı zamanda kültür içinde değerlendirilebilecek olan meslek boyutu da etnosentrizmin odak noktalarından birini oluşturmaktadır. Özellikle mesleki öğretilerin sebep olduğu etnosentrizm düşüncesi, mesleğin işleyişine zarar vermektedir. Bu konuda literatürde var olan eksikliğin görülmesi üzerine etnosentrizm ve meslek merkezcilik kavramlarına ilişkin kavramsal bir derleme çalışması yapılması amaçlanmıştır. Yapılan çalışma sonucunda etnosentrizm kavramının sıklıkla tüketici etnosentrizmi üzerine çalışmalarla desteklendiği ve meslek merkezciliğe dair çalışmaların literatürde yer almadığı belirlenmiştir. Aynı zamanda bu kavramın mesleklerin işleyişine katkısının önemli olduğundan hareketle farkına varılmasının önemli olduğu sonucuna ulaşılmıştır.
Objectives:
Poor communication is a major contributor to sentinel events in hospitals. Suboptimal communication between physicians and nurses may be due to poor understanding of team members' roles. We sought to evaluate the impact of a shadowing experience on nurse-resident interprofessional collaboration, bidirectional communication, and role perceptions.
Methods:
This mixed-methods study took place at 2 large academic children's hospitals with pediatric residency programs during the 2018-2019 academic year. First-year residents and nurses participated in a reciprocal, structured 4-hour shadowing experience. Participants were surveyed before, immediately after, and 6 months after their shadowing experience by using an anonymous web-based platform containing the 20-item Interprofessional Collaborative Competency Attainment Survey, as well as open-ended qualitative questions. Quantitative data were analyzed via linear mixed models. Qualitative data were thematically analyzed.
Results:
Participants included 33 nurses and 53 residents from the 2 study sites. The immediate postshadowing survey results revealed statistically significant improvements in 12 Interprofessional Collaborative Competency Attainment Survey question responses for nurses and 19 for residents (P ≤ .01). Subsequently, 6 questions for nurses and 17 for residents revealed sustained improvements 6 months after the intervention. Qualitative analysis identified 5 major themes related to optimal nurse-resident engagement: effective communication, collaboration, role understanding, team process, and patient-centered.
Conclusions:
The reciprocal shadowing experience was associated with an increase in participant understanding of contributions from all interprofessional team members. This improved awareness may improve patient care. Future work may be conducted to assess the impact of spread to different clinical areas and elucidate patient outcomes that may be associated with this intervention.
Background: Inter professional collaboration is necessary to ensure that health care teams are efficient and able to provide collaboration, and joint decision making between the client and the health care teams in all areas of treatment planning and caring clients with the highest quality of care, in order to reach a determined goal, regardless of the health care settings.
Objective: To assess inter-professional collaboration and associated factors among nurses and physicians working in public hospitals at Mekelle town Tigray Northern Ethiopia 2017. Method: Institution based of quantitative cross sectional study design was conducted among 409 study participants were selected by simple random sampling techniques from all public hospitals of Mekelle city. The data were presented in the form of text, frequencies, tables and figures Logistic regression was used to test association between dependent and independent variables. All variables with P value≤0.25 were including in multivariable analysis and magnitude of association measured by using odds ratio at 95% confidence interval and statistically significant at p-value less than 0.05 was considered statically significant.
Result: This study indicates that more than half 222(54.3%) respondents were shows frequent collaborations. The determinants factors showed that unfavorable attitude of shared education and teamwork statistically significant associated 2.53 times higher for infrequent collaboration among those who has favorable attitude (AOR 2.53, 95% CI (1.44-4.45). Poor Communication showed associated 3.73 times higher for infrequent collaboration compared with respondents has good communication (AOR, 3.73, 95% CI (2.30-6.05).Similarly dissatisfied by organizational supports showed significant associated 2.94 times for infrequent collaboration which compared with respondents satisfied by organizational support (AOR 2.94 at 95% CI (1.83-4.73).
Conclusion: The finding of this study was reasonably good and this was caused by jointly collaborated professional activities but still it needs improvements. Organizational supports of professional growth, motivations and recognitions, taking responsibility, early conflict managements were pertinent factors to increase professional satisfaction, mutual understanding and collaborative practice.
Keywords: nurse-physician collaboration, factors, mekelle, ethiopia
Interprofessional collaboration (IPC) is crucial to efficient patient management in the modern healthcare setting. We sought to determine the attitudes of physicians and nurses working in different hospitals in the Islamabad–Rawalpindi region of Pakistan. We employed the Jefferson Scale of Attitudes toward Physician–Nurse Collaboration (JSAPNC), a 15-item questionnaire that quantifies these attitudes in a meaningful way. Higher scores indicate a more positive attitude toward IPC. Four domains (shared education and teamwork, caring vs. curing, nurses’ autonomy, and physicians’ dominance) represent the intricate factors that influence IPC in a hospital setting. A total of 374 healthcare professionals responded. Nurses had significantly better opinions about IPC compared to physicians (mean: 50.81 vs. 47.48, p<.01). Nurses also outscored physicians in all four domains of the JSAPNC (education and collaboration 24.87 vs. 23.72 p<.001, caring vs. curing 10.88 vs. 9.42 p<.001, nurse’s autonomy 10.89 vs. 10.51 p=.004, and physician’s authority 4.17 vs. 3.82 p=.044). The results show that nurses in Pakistan value IPC more than their physician colleagues. Inculcating the importance of IPC through educational methods might help improve these attitudes.
Communication brings about transformation and it serves the mainstream of patient care. Collaborative teamwork has dominated the field of healthcare and a single healthcare provider cannot achieve the continuous and overwhelming surgical care process unaided. Lack of effective communication and teamwork among perioperative team members over the past has culminated into surgical errors. A cross-sectional descriptive design was used to determine the factors affecting communication and teamwork in the operating theatre in Ahmadu Bello University Teaching Hospital, Shika Zaria. A total of 159 (124 doctors and 35 nurses) respondents were proportionately selected from each cluster for this study using a simple random sampling method. Out of 159 questionnaires administered, 116 were completely filled and analyzed, given a response rate of 73%. The main findings of this study established that the lack of joint training among team members (64%) was identified as the perceived problem associated with teamwork and communication. The other factors affecting communication include: lack of information and structural barriers (70%), disruptive behaviours (66%), fragmented communication (65%), misinformation and lack of clarification (63%) and teamwork hospital policies (84%), variance in communication style (79%), multiple responsibilities (78%), failures in monitoring all the team members (77%), different levels of discipline (74%), and work environment (74%). A good number of the respondents rated the overall communication and teamwork experience among the surgical team members as been fair. Years of experience as a surgical team member (p = 0.010) and the participants profession (p = 0.020) had a significant association with communication and teamwork. In conclusion, the study identified several factors affecting communication and teamwork in the operating theatre. This study reiterated the significance of communication, and teamwork in the operating room as it demonstrates a positive relationship with the use of WHO safety checklists as an instrument towards improving the quality of surgical patients care.
The use of email is an internationally recognized and accepted method to communicate information in an asynchronous manner. Yet, despite its ubiquitous use, there is evidence that there are differences in the degree of engagement with and perceived value of email as legitimate work within the healthcare setting. A lack of engagement with email could have consequences on the care of patients if email communication is not read or responded to by the intended recipient. The purpose of this study was to understand the email practices of health professionals within a hospital setting, including their interactions, experiences, and thoughts and ideas for sharing information in the future. Four focus groups (total number of participants, 30) were conducted in 2015 and 2016 using an Appreciative Inquiry model to focus on the use of email. Data were thematically analyzed, with three overarching themes identified: professional practice, workforce self-care, and shaping the future using technology. Overall, email was perceived as a less important function within a health professional's everyday clinical practice; however, this differed depending on their role. The health professionals' use of email ranged from very little engagement to what could be judged as over-engagement, all of which have implications for healthcare organizations who view email as a legitimate work task and a key way to communicate.
Objectives:
Clear and efficient communication between nursing staff and medical providers is an essential component of healthcare delivery. At McLean Hospital, there is an inconsistency in utilization of alphanumeric paging, with many individuals communicating primarily via numeric-only pages that can cause difficulty in triaging importance of pages and lead to disruptions in care. This quality improvement project sought to improve communication between nursing staff and residents by decreasing the number of difficult to triage pages sent to the psychiatrist-on-call at a stand-alone academic psychiatric hospital.
Methods:
Pages were analyzed during two discrete month-long periods before and after the implementation of a standardized paging protocol, which included an updated online template asking the individual sending the page to include specific information (urgency of page, identifying information of patient, contact information, and name of sender) and dissemination of information on its use.
Results:
The implementation of this protocol resulted in a statistically significant decrease in the percentage of pages that were difficult to triage (22.1 to 15.0%; p < 0.05). Examining specific units in the hospital revealed significant variation of change, with as much as 40% reduction to as large as an 11% increase in difficult to triage pages.
Conclusions:
The decrease in the percentage of difficult to triage pages suggests that a standard paging protocol can improve delivery of patient care by minimizing interruptions with low-priority pages and may improve quality of communication between nursing staff and physicians on-call, ultimately improving quality of care provided and bettering the resident learning environment.
Background:
The most common cause of clinical incidents and adverse events in relation to surgery is communication error. There is a shortage of studies on communication between registered nurses and licenced practical nurses as well as of instruments to measure their perception of communication within and between the professional groups. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the adapted ICU Nurse-Physician Questionnaire, designed to also measure communication within and between two professional groups: licensed practical nurses and registered nurses. Specifically, the aim was to examine the instrument's construct validity using confirmatory factor analysis and its internal consistency using Cronbach's Alpha.
Methods:
A cross-sectional and correlational design was used. The setting was anaesthetic clinics in two Swedish hospitals. A total of 316 questionnaires were delivered during spring 2011, of which 195 were analysed to evaluate the psychometric properties of the questionnaire. Construct validity was assessed using confirmatory factor analysis and internal consistency using Cronbach's Alpha. To assess items with missing values, we conducted a sensitivity analysis of two sets of data, and to assess the assumption of normally distributed data, we used Bayesian estimation.
Results:
The results support the construct validity and internal consistency of the adapted ICU Nurse-Physician Questionnaire. Model fit indices for the confirmative factor analysis were acceptable, and estimated factor loadings were reasonable. There were no large differences between the estimated factor loadings when comparing the two samples, suggesting that items with missing values did not alter the findings. The estimated factor loadings from Bayesian estimation were very similar to the maximum likelihood results. This indicates that confirmative factor analysis using maximum likelihood produced reliable factor loadings. Regarding internal consistency, alpha values ranged from 0.72 to 0.82.
Conclusions:
The tests of the adapted ICU Nurse-Physician Questionnaire indicate acceptable construct validity and internal consistency, both of which need to be further tested in new settings and samples.
Trial registration:
Current controlled trials http://www.controlled-trials.com Communication and patient safety in anaesthesia and intensive care. Does implementation of SBAR make any differences? Identifier: ISRCTN37251313, retrospectively registered (assigned 08/11/2012).
This study investigated the conflict transformation pattern and the mediating role of emotions in nurse-physician conflicts. Nurses experience relatively heavier amount of relationship conflict compared to physicians. Relationship conflicts are known to have adverse effects on team satisfaction and team performance. Using a five-day diary study, data was collected from nurses in large hospitals. The respondents selected the physicians with the most frequent interaction, and answered questionnaires regarding that specific interaction while most existing studies used the information elicited from the interaction with the most conflicts. Several HLM analyses on conflicts scales showed that there were conflict transformation from task conflict to relationship conflict and that positive emotion mediated the transformation process. In other words, once task conflict was experienced, positive emotion decreases, and the decrease leads to the increase of relationship conflict the following day. However, the emotion itself did not carry over to the next day. This result suggests that nurses are capable of psychological detachment, which buffers the emotional association for two consecutive days.
The current study sought to obtain pilot data from a Situation, Background, Assessment, Recommendation (SBAR) communication intervention focused on the shared meaning construct of the sensemaking model and explore shared meaning in communication between nursing home (NH) nurses and physicians. The study design was an exploratory sequential mixed method with a pre/post quasi-experiment. Grounded theory was used to collect and analyze nurse and physician interviews and medical records. The Pathway to Shared Meaning model illustrating distinct processes supported use of the sensemaking model for understanding nurse-physician communication. Quantitative changes in communication were not significant. Shared meaning and training in SBAR for communication can be used to strengthen the design and use of structured communication in NHs.
Targets:
Nurses and physicians providing direct care in NHs.
Intervention description:
Stories describing nurse-physician sharing of resident information using SBAR.
Mechanism of action:
Mutual understanding of one another's perspective enhances communication.
Outcome:
Communication openness and satisfaction. [Res Gerontol Nurs. 2019; 12(3):121-132.].
Background:
Mastery learning is an effective educational tool to assess basic procedural skill proficiency and may also be beneficial for more complex skills along the continuum of surgical training. In addition, anxiety and confidence have effects on cognitive and decision-making performance, both in educational and clinical settings. This study evaluates anxiety and confidence in a skills-level-appropriate mastery learning module for chest tube insertion in graduating medical students.
Methods:
A 2-week intern preparatory course was held 2 consecutive years, with 10 and 14 students, respectively. Learners completed a pretest on day 1, didactic session and supervised deliberate practice followed by a Posttest on day 4, and a retention test on day 10. Year one used a traditional educational methodology, and year two provided for remediation as per mastery learning methodology. The chest tube scoring checklist was validated by faculty trauma surgeons to reflect an intern-appropriate skills level. Before and after each test, learners reported state anxiety. Immediately after each test, learners also completed a confidence scale.
Results:
No learners in either year achieved mastery on the pretest. A total of 40% of the learners achieved the mastery standard on the posttest in year one. All (100%) of the learners achieved the mastery standard after the posttest in year two. Overall, after state anxiety decreased significantly in both years, confidence increased significantly in year two.
Conclusion:
A skills-level-appropriate mastery learning module resulted in higher performance and increased confidence compared with a traditional education model for chest tube placement for incoming surgical interns.
Objective:
The aim of this study was to develop an instrument that measures all healthcare staff's perceptions of a culture of caring.
Background:
Healthcare organizations have increased their focus on cultures of caring within their staff to improve staff satisfaction and patient satisfaction. Nurses and physicians traditionally have been the focus in understanding caring cultures excluding non-direct care staff who do impact organizational culture.
Methods:
An exploratory and partial confirmatory factor analysis was completed on 2 instruments that measure the perception of a caring culture in both direct care and non-direct care staff.
Results:
Results demonstrate that both the direct and non-direct care instruments are valid and reliable measures for assessing a caring culture.
Conclusions:
The new 14-item clinical and new 10-item nonclinical staff caring assessment instruments will provide healthcare and nursing leaders with the ability to assess their culture through a direct and non-direct care perspective.
This study compares quality of care measures for hospitals with fully implemented computerized physician order entry (CPOE) systems with hospitals that have not fully implemented such a system. Using a cross-sectional design, this study linked hospital quality data from the Centers for Medicare and Medicaid Services to the Health Information Management Systems Society Analytics database, which contains hospital CPOE adoption information. Performance on quality measures was assessed using univariate and multivariate methods. In all, 8% of hospitals have fully implemented CPOE systems; CPOE hospitals were more frequently larger, not-for-profit, and teaching hospitals. After controlling for confounders, CPOE hospitals outperformed comparison hospitals on 5 of 11 measures related to ordering medications and on 1 of 9 nonmedication-related quality measures. Using a large sample of hospitals, our study found significant positive associations between specific objective quality indicators and CPOE implementation.
The need to train health professionals who can work across disciplines is essential for effective, competent, and culturally sensitive health care delivery. By its very nature, the provision of health service requires communication and coordination between practitioners. However, preparation for interdisciplinary practice within the health care setting is rare. The authors argue that the primary reason students are not trained across disciplines is related to the diverse cultural structures that guide and moderate health education environments. It is further argued that this profession specific "cultural frame" must be addressed if there is any hope of having interprofessional education accepted as a valued and fully integrated dimension of our curriculum. Each health discipline possess its own professional culture that shapes the educational experience; determines curriculum content, core values, customs, dress, salience of symbols, the meaning, attribution, and etiology of symptoms; as well as defines what constitutes health, wellness and treatment success. Most importantly, professional culture defines the means for distributing power; determines how training should proceed within the clinical setting; and the level and nature of inter-profession communication, resolution of conflicts and management of relationships between team members and constituents. It might be said that one factor limiting interdisciplinary training is profession-centrism. If we are to achieve effective and fully integrated interdisciplinary education, we must decrease profession-centrism by crafting curriculum that promotes interprofessional cultural competence. The article explores how to promote interprofessional cultural competence within the health education setting.
A recent survey was conducted to assess the significance of disruptive behaviors and their effect on communication and collaboration and impact on patient care. SURVEY: VHA West Coast administered a 22-question survey instrument--Nurse-Physician: Impact of Disruptive Behavior on Patient Care--to a convenience sample. Of the 388 member hospitals (in four VHA regions) invited, 102 hospitals participated in the survey (26% response rate). Results from surveys received from January 2004 though March 2007 are represented. Of the 4,530 participants, 2,846 listed their titles as nurses, 944 as physicians, 40 as administrative executives, and 700 as "other."
A total of 77% of the respondents reported that they had witnessed disruptive behavior in physicians--88% of the nurses and 51% of the physicians. Sixty-five percent of the respondents reported witnessing disruptive behavior in nurses at their hospitals--73% of the nurses and 48% of the physicians. Sixty-seven percent of the respondents agreed that disruptive behaviors were linked with adverse events; the result for medical errors was 71%, and patient mortality, 27%.
The results from the survey show that disruptive behaviors lead to potentially preventable adverse events, errors, compromises in safety and quality, and patient mortality. Strategies to address disruptive behaviors should (1) prevent disruptive events from occurring, (2) deal with events in real time to prevent staff or patient harm, and (3) initiate postevent review, actions, and follow-up.
Twelve recommendations--including recognition and awareness, policies and procedures, incident reporting, education and training, communication tools, discussion forums, and intervention strategies--address what hospitals and other organizations can do now to address disruptive behaviors.
Multioperator tasks often require complex cognitive processing at the team level. Many team cognitive processes, such as situation assessment and coordination, are thought to rely on team knowledge. Team knowledge is multifaceted and comprises relatively generic knowledge in the form of team mental models and more specific team situation models. In this methodological review paper, we review recent efforts to measure team knowledge in the context of mapping specific methods onto features of targeted team knowledge. Team knowledge features include type, homogeneity versus heterogeneity, and rate of knowledge change. Measurement features include knowledge elicitation method, team metric, and aggregation method. When available, we highlight analytical conclusions or empirical data that support a connection between team knowledge and measurement method. In addition, we present empirical results concerning the relation between team knowledge and performance for each measurement method and identify research and methodological needs. Addressing issues surrounding the measurement of team knowledge is a prerequisite to understanding team cognition and its relation to team performance and to designing training programs or devices to facilitate team cognition.
Interdisciplinary teams are central to the care of the older patient in long-term care settings. Critical to the success of caring for these patients is the communication between providers about patient care. This study examines professional communication practices in interdisciplinary team meetings, a common forum for discussing patient care. Two teams at a long-term care facility specializing in patients with Alzheimer's participated in this qualitative exploratory study. All team members participated in semi-structured interviews. In addition, seven team meetings in which 31 patients were discussed were audio and video taped. Team members discussed the importance of team meetings to help coordinate care provided to patients, while also expressing concern about the effectiveness of the meetings to reach this goal. Through detailed discourse analyses of transcripts of the meetings, we identified three different communication practices in team meetings: giving report, writing report, and collaborative discussion. Only the latter practice met the goals indicated by the team members to coordinate and make joint decisions about patient care and allowed for team members to collaboratively solve problems. We discuss one case study to exemplify how the use of these communication practices results in the omission of information central to making decisions regarding patient care.
Computerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy to prevent the development of a drug injury defined as an adverse drug event (ADE).
To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure.
PUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies. Reference lists of included studies were also searched.
We searched for original investigations, randomized and nonrandomized clinical trials, and observational studies that evaluated the effect of CPOE with CDS on the rates of ADEs. The studies identified were assessed to determine the type of computer system used, drug categories being evaluated, types of ADEs measured, and clinical outcomes assessed.
Of the 543 citations identified, 10 studies met our inclusion criteria. These studies were grouped into categories based on their setting: hospital or ambulatory; no studies related to the long-term care setting were identified. CPOE with CDS contributed to a statistically significant (P < or = .05) decrease in ADEs in 5 (50.0%) of the 10 studies. Four studies (40.0%) reported a nonstatistically significant reduction in ADE rates, and 1 study (10.0%) demonstrated no change in ADE rates.
Few studies have measured the effect of CPOE with CDS on the rates of ADEs, and none were randomized controlled trials. Further research is needed to evaluate the efficacy of CPOE with CDS across the various clinical settings.
Medical error causes more than 98,000 deaths annually [Kohn, L. T., Corrigan, J. M., and Donaldson, M. S. (1999). To err is human: Building a safer health system. Washington, DC: National Academies Press.] making it a national epidemic during the late 1990s. In reaction, Congress passed the National Defense Authorization Act mandating the Department of Defense (DoD) to establish processes for patient safety in the military health care and veteran affairs. Among the many processes for patient safety identified by the DoD, team training stepped to the forefront in 2001 when the TRICARE Management Activity (TMA) commissioned the development of two programs based upon Crew Resource Management training from the aviation industry. A recent evaluation of these programs identified several limitations including the establishment of two distinct approaches to teamwork and an inability to leverage the larger body of team training available. TeamSTEPPS, or the Team Strategies and Tools to Enhance Performance and Patient Safety, was developed to address the cultural issues facing the military health system and to take advantage of the state-of-the-art evidence-base on team training. Despite success, several challenges remain representing opportunities for human resources professionals and organizational researchers to help improve this program and further research on the impact of team training on patient safety.
A series of changes leads to cultural transformation at a TCAB hospital.
Progress toward understanding the links between interprofessional communication and issues of medical error has been slow. Recent research proposes that this delay may result from overlooking the complexities involved in interprofessional care. Medical education initiatives in this domain tend to simplify the complexities of team membership fluidity, rotation, and use of communication tools. A new theoretically informed research approach is required to take into account these complexities. To generate such an approach, we review two theories from the social sciences: Activity Theory and Knotworking. Using these perspectives, we propose that research into interprofessional communication and medical error can develop better understandings of (1) how and why medical errors are generated and (2) how and why gaps in team defenses occur. Such complexities will have to be investigated if students and practicing clinicians are to be adequately prepared to work safely in interprofessional teams.
The Joint Commission announced this year that rude language and hostile behavior pose serious threats to patient safety and quality of care. The Silence Kills study, conducted by VitalSmarts and the American Association of Critical-Care Nurses, reveals that more than three-fourths of caregivers regularly work with doctors or nurses who are condescending, insulting, or rude. Although such disruptive and disrespectful behavior can be hurtful, what prompted the Joint Commission to address them as a condition of accreditation is the mounting evidence that such behavior is also harmful. The study found that more than 20% of health professionals have seen actual harm come to patients as a result of such behavior. The most powerful force governing human behavior is social influence. People will do most anything to gain acceptance or avoid rejection. If health care leaders want to not only secure the well-being of patients but also increase employee retention and engagement, the most immediate and effective step they can take is change this culture of silence. Health care leaders who want to engage social influence to eliminate disruptive behavior must break the code of silence in 4 critical conversational areas.
The purpose of this article is to increase awareness about and stimulate interest in using focus group interviews, a qualitative research technique, to advance the state-of-the-art of education and learning about health. After a brief discussion of small group process in health education, features of focus group interviews are presented, and a theoretical framework for planning a focus group study is summarized. Then, literature describing traditional and health-related applications of focus group interviews is reviewed and a synthesis of methodological limitations and advantages of this technique is presented. Implications are discussed regarding: need for more inductive qualitative research in health education; utility of focus group interviews for research and for formative and summative evaluation of health education programs; applicability of marketing research to understanding and influencing consumer behavior, despite notable distinctions between educational initiatives and marketing; and need for professional preparation faculty to consider increasing emphasis on qualitative research methods.
In aviation,accidents usually highly visible,and as a result aviation has developed standardised methods of investigating, documenting, and disseminating errors and their lessons. Although operating theatres are not cockpits, medicine could learn from aviation. Observation of flights in operation has identified failures of compliance, communication, procedures, proficiency, and decision making in contributing to errors. Surveys in operating theatres have confirmed that pilots and doctors have common interpersonal problem areas and similarities in professional culture. Accepting the inevitability of error and the importance of reliable data on error and its management will allow systematic efforts to reduce the frequency and severity of adverse events.
Finding time to add to nursing knowledge while solving problems in a fast-paced healthcare environment is the ultimate challenge for nurse executives. At one hospital, use of an action research model to measure collaboration in nurse/physician led interdisciplinary teams improved the intervention and the approach to outcome measurement.
Many hospital nurse executives promote collaborative practice, and yet, innovations introduced to foster collaboration are rarely studied prospectively. The best-known data on collaboration is predominantly from correlational studies. Within the rapidly changing practice setting, action research may be a more legitimate strategy for studying interventions longitudinally.
An action research pretest/posttest design using Baggs' Collaboration and Satisfaction About Care Decisions measured collaboration before and after several interventions to improve nurse/physician collaboration. The sample consisted of 87 pretest and 65 posttest registered nurses working on three medical-surgical units and two intensive care units (ICU).
Collaboration scores in the ICUs were higher than those in previous research, but the posttest indicated no significant difference in either ICU nurse or medical-surgical nurse scores. Higher ICU scores may have been related to the organizational focus on teams. A strong significant correlation between nurse report of level of collaboration and satisfaction with decision making was uncovered.
This study contributes to the nurse/physician collaboration literature in that it was longitudinal, used a reliable and valid instrument, and surveyed nurses in medical/surgical units as well as the ICU. Some of the difficulties and benefits of research in today's practice setting are illustrated.
The evolution of care delivered by a multidisciplinary burns team is a function of the effectiveness of the professional communication between team members. In this exercise, we have explored concepts and communication between nurses and doctors in a burns team. Loosely structured weekly meetings were held over a 4-month period. The explicit objective was to determine and define the current model of burns care in a regional burn centre. The implicit objective, however, was to develop a mutual appreciation of actual and potential problems in communication. Consensus task identification was achieved at the end of each meeting with full compliance in completing the tasks before the next meeting. Although there was a unanimous commitment to the team concept, traditional, professional, paradigms persist. For nurses, the concept of holistic modelling predominated, whilst the disease centred paradigm remained the focus of medical modelling. Linguistic, cultural and professional barriers to effective communication were identified but did not readily conform to prior expectations. Experience in burns care can transcend these barriers more effectively than a common culture or profession. In conclusion, team work and team building is a complex process that can benefit from an ongoing process of re-evaluation. An obvious yet common error is to assume a level of mutual understanding that does not in fact exist. Stepping aside to re-explore fundamental principles on which team members base their personal and professional practice can help in elucidating and determining new paradigms of care, which can be evaluated and appropriately implemented. The consensus conclusion was that this approach was a very valuable investment in time in pursuing excellence in the field of burns care.
Little is known of the factors that underlie surgical errors. Incident reporting has been proposed as a method of obtaining information about medical errors to help identify such factors.
Between November 1, 2000, and March 15, 2001, we conducted confidential interviews with randomly selected surgeons from three Massachusetts teaching hospitals to elicit detailed reports on surgical adverse events resulting from errors in management ("incidents"). Data on the characteristics of the incidents and the factors that surgeons reported to have contributed to the errors were recorded and analyzed.
Among 45 surgeons approached for interviews, 38 (84%) agreed to participate and provided reports on 146 incidents. Thirty-three percent of incidents resulted in permanent disability and 13% in patient death. Seventy-seven percent involved injuries related to an operation or other invasive intervention (visceral injuries, bleeding, and wound infection/dehiscence were the most common subtypes), 13% involved unnecessary or inappropriate procedures, and 10% involved unnecessary advancement of disease. Two thirds of the incidents involved errors during the intraoperative phase of surgical care, 27% during preoperative management, and 22% during postoperative management. Two or more clinicians were cited as substantially contributing to errors in 70% of the incidents. The most commonly cited systems factors contributing to errors were inexperience/lack of competence in a surgical task (53% of incidents), communication breakdowns among personnel (43%), and fatigue or excessive workload (33%). Surgeons reported significantly more systems failures in incidents involving emergency surgical care than those involving nonemergency care (P <.001).
Subjective incident reports gathered through interviews allow identification of characteristics of surgical errors and their leading contributing factors, which may help target research and interventions to reduce such errors.
To describe how communication failures contribute to many medical mishaps.
In late 1999, a sample of 26 residents stratified by medical specialty, year of residency, and gender was randomly selected from a population of 85 residents at a 600-bed U.S. teaching hospital. The study design involved semistructured face-to-face interviews with the residents about their routine work environments and activities, the medical mishaps in which they recently had been involved, and a description of both the individual and organizational contributory factors. The themes reported here emerged from inductive analyses of the data.
Residents reported a total of 70 mishap incidents. Aspects of "communication" and "patient management" were the two most commonly cited contributing factors. Residents described themselves as embedded in a complex network of relationships, playing a pivotal role in patient management vis-à-vis other medical staff and health care providers from within the hospital and from the community. Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of medical mishaps.
The occurrence of everyday medical mishaps in this study is associated with faulty communication; but, poor communication is not simply the result of poor transmission or exchange of information. Communication failures are far more complex and relate to hierarchical differences, concerns with upward influence, conflicting roles and role ambiguity, and interpersonal power and conflict. A clearer understanding of these dynamics highlights possibilities for appropriate interventions in medical education and in health care organizations aimed at improving patient safety.
Missed follow-up of abnormal test results and resultant delays in diagnosis is a safety issue that is gaining increasing attention. Despite increases in the numbers and types of available diagnostic tests, current systems in health care do not reliably ensure that test results are received and acted upon by ordering physicians. This article examines the case of a patient whose diagnosis of tuberculosis was substantially delayed because of systems problems, including poor continuity (with multiple-provider involvement), lack of communication of test results and other clinical information, and several handoffs. Strategies to ensure adequate communication of critical information and follow-up of test results are discussed, such as explicit criteria for communication of abnormal results, test-tracking systems for ordering providers, and use of information technologies.
Knowledge-translation interventions and interprofessional education and collaboration interventions all aim at improving health care processes and outcomes. Knowledge-translation interventions attempt to increase evidence-based practice by a single professional group and thus may fail to take into account barriers from difficulties in interprofessional relations. Interprofessional education and collaboration interventions aim to improve interprofessional relations, which may in turn facilitate the work of knowledge translation and thus evidence-based practice. We summarize systematic review work on the effects of interventions for interprofessional education and collaboration. The current evidence base contains mainly descriptive studies of these interventions. Knowledge is limited regarding the impact on care and outcomes and the extent to which the interventions increase the practice of evidence-based care. Rigorous multimethod research studies are needed to develop and strengthen the current evidence base in this field. We describe a Health Canada-funded randomized trial in which quantitative and qualitative data will be gathered in 20 general internal medicine units located at 5 Toronto, Ontario, teaching hospitals. The project examines the impact of interprofessional education and collaboration interventions on interprofessional relationships, health care processes (including evidence-based practice), and patient outcomes. Routes are suggested by which interprofessional education and collaboration interventions might affect knowledge translation and evidence-based practice.
To describe communication between nurses and physicians during labor within the context of the nurse-managed labor model in community hospitals and its relationship to teamwork and patient safety.
Multicenter qualitative study involving focus groups and in-depth interviews.
Labor and birth units in 4 Midwestern community hospitals.
54 labor nurses and 38 obstetricians.
Focus groups and in-depth interviews were conducted using open-ended questions. Data were analyzed using inductive coding methods to gain understanding from the perspective of those directly involved.
Description of interdisciplinary interactions during labor.
Nurses and physicians shared the common goal of a healthy mother and baby but did not always agree on methods to achieve that goal. Two clinical situations critical to patient safety (fetal assessment and oxytocin administration) were frequent areas of disagreement and sources of mutual frustration, often leading to less than optimal teamwork. Minimal communication occurred when the mother and fetus are doing well, and this seemed to be purposeful and considered normal. Physicians and nurses had distinct opinions concerning desirable traits of members of the other discipline.
Interdisciplinary communication and teamwork could be improved to promote a safer care environment during labor and birth.
To identify evidence on the role of assertiveness and teamwork and the application of aviation industry techniques to improve patient safety for inpatient obstetric care.
Studies limited to research with humans in English language retrieved from CINAHL, PubMed, Social Science Abstracts, and Social Sciences Citation Index, and references from reviewed articles.
A total of 13 studies were reviewed, including 5 studies of teamwork, communication, and safety attitudes in aviation; 2 studies comparing these factors in aviation and health care; and 6 studies of assertive behavior and decision making by nurses. Studies lacking methodological rigor or focusing on medication errors and deviant behavior were excluded.
Pilot attitudes regarding interpersonal interaction on the flight deck predicted effective performance and were amenable to behavior-based training to improve team performance. Nursing knowledge was inconsistently accessed in decision making. Findings regarding nurse assertiveness were mixed.
Adaptation of training concepts and safety methods from other fields will have limited impact on perinatal safety without an examination of the contextual experiences of nurses and other health care providers in working to prevent patient harm.
"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit confirmation, reminders, or education. "Functional utility" represented direct communication - work connections: many briefings identified problems, prompting decision-making and follow-up actions. The crux of the model is an elaboration of the causal pathway between a specific communication practice (the team briefing), intermediary processes such as enhanced knowledge and purposeful action, and the quality and safety of collaborative care processes. Modeling this pathway is a critical step in promoting change, as it renders visible both the latent dangers present in current team communication systems and the specific ways in which altered communication patterns can impact team awareness and behaviors.
Serious events within healthcare occur daily exposing the failure of the system to safeguard patient and providers. The complex nature of healthcare contributes to myriad ambiguities affecting quality nursing care and patient outcomes. Leaders in healthcare organizations are looking outside the industry for ways to improve care because of the slow rates of improvement in patient safety and insufficient application of evidenced-based research in practice. Military and aviation industry strategies are recognized by clinicians in high-risk care settings such as the operating room, emergency departments, and intensive care units as having great potential to create safe and effective systems of care. Complexity science forms the basis for high reliability teams to recognize even the most minor variances in expected outcomes and take strong action to prevent serious error from occurring. Cultural and system barriers to achieving high reliability performance within healthcare and implications for team training are discussed.
To identify all published studies evaluating computerized physician order entry (CPOE) in the inpatient setting and uniformly classify these studies on outcome measure and study design.
All studies that evaluated the effect of CPOE on outcomes pertaining to the medication process in inpatients were electronically searched in MEDLINE (1966 to August 2006), EMBASE (1980 to August 2006) and the Cochrane library. In addition, the bibliographies of retrieved articles were manually searched. Articles were selected if one of their main objectives was CPOE evaluation in an inpatient setting.
Identified titles and abstracts were independently screened by three reviewers to determine eligibility for further review.
We found 67 articles, which included articles on CPOE evaluation on some outcome at the time of ordering. Most papers evaluated multiple outcome measures. The outcome measures were clustered in the following categories: adherence (n=22); alerts and appropriateness of alerts (n=7); safety (n=21); time (n=7); costs and (organizational) efficiency (n=23); and satisfaction, usage and usability (n=10). Most studies used a before-after design (n=35) followed by observational studies (n=24) and randomized controlled trials (n=8).
The impact of CPOE systems was especially positive in the category adherence to guidelines, but also to some extent in alerts and appropriateness of alerts; costs and organizational efficiency; and satisfaction and usability. Although on average, there seems to be a positive effect of CPOE on safety, studies tended to be non-randomized and were focused on medication error rates, not powered to detect a difference in adverse drug event rates. Some recent studies suggested that errors, adverse drug events (ADEs) and even mortality increased after CPOE implementation. Only in the category time the impact has been shown to be negative, but this only refers to the physician's time, not the net time. Except for safety, on the whole spectrum of outcomes, results of RCT studies were in line with non-RCT study results.
In health care, others' lives depend on the team operating at a level beyond the sum of its individual parts. A framework (a heuristic) represents a three-pronged approach to teamwork in health care that entails communication, coordination, and cooperation. These fundamental requirements of teamwork represent the constant interaction that team members undertake to become an effective team. Guidelines, tips, and examples show how the framework can be applied to establishing and enabling teams to provide safe, reliable care.
The guidelines are as follows: (1) Support precise and accurate communication through a closed-loop communication protocol; (2) diagnose communication errors as you would any illness--Examine the team and look for symptoms, then treat the symptoms through team learning and self-correction; (3) recognize functional expertise by identifying and publicizing topical experts to evenly distribute work load and increase accuracy; (4) institute frequent practice opportunities to keep team skills in good shape because poorly honed skills will limit performance; (5) refine the team's shared mental models (SMMs) by pre-planning to build its implicit coordination skills, adaptability, and flexibility; (6) shape adaptive expertise by fostering a deep understanding of the task to increase team effectiveness; (7) build team orientation by taking steps to increase trust and cohesion to lower stress levels and increase satisfaction, commitment, and collective efficacy; and (8) prepare the team by providing learning opportunities for new competencies that will expose members to feedback and increase the team's overall efficacy.
Although not a comprehensive list, the guidelines and tips represent the most essential requirements for effective teamwork.
Focus groups: A practical guide for applied research
- R A Krueger
Krueger, R. A. (1994). Focus groups: A practical guide for applied research. Thousand Oaks, CA: Sage.
Focus groups interview: An underutilized research technique for improving theory and practice in health education
- Basche