An activity theory perspective on interprofessional teamwork in long-term care.

Canadian medical education journal Pub Date : 2024-08-30 eCollection Date: 2024-08-01 DOI:10.36834/cmej.77484
Nicolas Fernandez, Nicolas Gulino
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Abstract

Background: Teamwork in healthcare is shaped by reciprocal interactions among individual team members and their clinical context. Cultural Historical Activity Theory (CHAT) provides a framework to study teamwork from a developmental perspective. We observed interactions between members of an Interprofessional Healthcare Team (IHT) to identify practical guidelines for educators.

Method: Three Health Care Providers (HCPs) with more than 22-years' experience in a semi-urban LTC facility participated. We video-recorded two regular IHT meetings and selected excerpts for subsequent video-recall interviews. The excerpts were shown and discussed first with each team member, then with members in pairs and finally with all members reunited. We prompted participants to explain what was happening on the videos. All interviews were recorded, transcribed, and analyzed using CHAT's unit of analysis based on Activity Systems.

Findings: We observed contradictions within the Activity Systems involving diverging views on outcomes of enhancing or maintaining quality of life; using non-traditional tools and spaces to sustain resident mobility; safeguarding community and patient safety despite time constraints and job titles, and unease for being paid to perform unconventional interventions. The contradictions have been grouped into three themes reflecting the Activity Systems: 1) enhancing versus maintaining quality of life; 2) improvising to achieve care goals; and 3) role fluidity.

Discussion: Our findings show that practical goal-oriented and contextual adaptations rely heavily on improvisation and dialogue. Educating HCPs for interprofessional teamwork should focus on developing situational awareness to foster continuous adaptation of disciplinary interventions.

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从活动理论角度看长期护理中的跨专业团队合作。
背景:医疗保健领域的团队合作是由团队成员个人及其临床环境之间的互惠互动形成的。文化历史活动理论(CHAT)提供了一个从发展角度研究团队合作的框架。我们观察了跨专业医疗团队(IHT)成员之间的互动,以确定教育工作者的实用指南:方法:三位在半城市长者照护机构工作超过 22 年的医护人员(HCPs)参与其中。我们录制了两次 IHT 定期会议的视频,并选取了部分节选内容进行随后的视频回放访谈。我们首先向每位小组成员播放并讨论了节选内容,然后让小组成员两人一组进行讨论,最后让所有成员一起讨论。我们提示参与者解释视频中发生的事情。所有访谈都进行了记录、转录,并使用 CHAT 基于活动系统的分析单元进行了分析:我们观察到了活动系统中的矛盾,包括对提高或保持生活质量的结果的不同看法;使用非传统工具和空间来保持居民的流动性;尽管有时间限制和工作头衔,但仍要保障社区和患者的安全,以及对执行非传统干预措施而获得报酬的不安。这些矛盾被归纳为反映活动系统的三个主题:讨论:讨论:我们的研究结果表明,实用的目标导向和环境适应在很大程度上依赖于即兴和对话。对保健专业人员进行跨专业团队合作教育时,应侧重于培养情景意识,以促进对学科干预措施的不断调整。
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A novel IDEA(-R) for a small group teaching format. A phenomenological study of resident and faculty experiences with learner engagement in the normalization of workplace-based assessment. An activity theory perspective on interprofessional teamwork in long-term care. Celebrating inquiry and scholarship: the inaugural Canadian Medical Student Research Competition. Emotional labour in learning to doctor.
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