Journal of Interprofessional Care最新文献

Structured Interdisciplinary Bedside Rounds (SIBR) is a standardized, team-based intervention for hospitals to deliver high quality interprofessional care. Despite its potential for improving IPC and the workplace environment, relatively little is known about SIBR's effect on these outcomes. Our study aimed to assess the fidelity of SIBR implementation on an inpatient medicine teaching unit and its effects on perceived IPC and workplace efficiency. We conducted a quasi-experimental study with 88 residents and 44 nurses at a large academic medical center and observed 1308 SIBR encounters over 24 weeks. Of these 1308 encounters, the bedside nurse was present for 96.7%, physician for 97.6%, and care manager for 94.7, and 64.7% occurred at the bedside. Following SIBR implementation, perceived IPC improved significantly among residents (93.3% versus 67.9%, p < .024) and nurses (73.7% versus 36.0%, p < .008) compared to before implementation. Moreover, residents perceived greater workplace efficiency operationalized as being paged less frequently with questions by nurses (20.0% versus 49.1%, p = .01). No statistically significant improvements were reported regarding burnout, meaning at work, and workplace satisfaction. Our implementation of SIBR significantly improved perceived IPC and workplace efficiency, which are two important domains of healthcare quality. Future work should examine the impact of SIBR on patient-centered outcomes such as patient experience.

Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varies. An improvement-focused appreciative inquiry (AI) into a large intensive care unit's WR practices identified a pivotal axis of collaboration between the most senior medical role (the consultant) and the bedside nurse (BSN). This paper examines that axis of interprofessional collaboration (IPC) to deepen understanding of its implications. Data included ethnographic observations, interviews, and co-constructed AI with groups of staff. Four key concepts emerged from cyclical interpretive analysis: "need," "presence," "ability" and "willingness." BSNs and consultants needed the interprofessional WR to enable their work; WR effectiveness was affected by whether they were both present, then able and willing to participate in IPC. BSN presence was necessary for effective and efficient IPC between these key roles. Indirect contributions, based on prior exchanges with colleagues or through written notes, reduced the joint problem-solving through discussion and negotiation that characterizes IPC to less efficient asynchronous interprofessional coordination. Factors affecting "presence," "ability" and "willingness" are discussed alongside potential mitigations and acknowledgment of asymmetric power. Appreciative examination of interprofessional WRs identified mechanisms supporting and undermining effective WR IPC and the centrality of consultants' and BSNs' collaboration.

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.

Interprofessional Education (IPE) as a preparatory stage for Interprofessional collaboration (IPC) is overlooked in some low-and middle-income countries, including Indonesia. One of the driving forces behind IPC is the development of Interprofessional Identity (IPI), which has yet to be assessed in the Indonesian context. Our study aims were translating and culturally adapting the Extended Professional Identity Scale (EPIS) and confirming its construct validity. We invited third-year students from three programs (medicine, nursing, and dietetics) without previous IPE experience to participate in the study. Using Confirmatory Factor Analysis (CFA), we examined the construct validity, analyzed internal consistency, and conducted a Kruskal-Wallis test to identify variations across professions. Of 513 students approached, 335 participated (response rate 65.3%). The CFA showed factor loadings ranging between .59 and .86, while correlations among subscales varied from .55 to .86. All five goodness-of-fit indices were sufficient. The internal consistency of subscales interprofessional belonging, commitment, and beliefs was .82, .84 and .87, respectively, and .90 for the overall scale. Interprofessional belonging and commitment were different among various students (p-value = .009 and .004) and the dietetics students had lower scores than other students. The Indonesian EPIS (EPIS-RI) demonstrated reliability and construct validity.

The lack of a proper system for ongoing open interprofessional communication among care providers increases miscommunications and medical errors. Seamless access to patient information is important for care providers to prevent miscommunication and improve patient safety. A shared understanding of the information needs of different care providers in an interprofessional team is lacking. Our purpose is to identify care providers' information needs from the perspective of different professions for communication, shared understanding about the patient, and decision-making. We conducted semi-structured interviews with 10 subject matter experts representing eight professions, including dentistry, dietetics, medicine, nursing, occupational therapy, pharmacy, physical therapy, and social work in a 465-bed academic hospital at a large urban Midwestern city. We used an in-house rounding tool presenting physicians' information needs and a hypothetical patient scenario to collect participants' feedback. Interview notes were coded using direct content analysis. We identified 22 additional essential data elements for an interprofessional rounding tool. We categorized those into six domains: discharge-related, social determinants of health, hospital safety, nutrition, interprofessional situation awareness, and patient history. A well-designed validated rounding tool that includes an interprofessional team of care providers' information needs could improve communication, care planning, and decision-making among them.

Literature regarding simulation for learning interprofessional collaborative practice (IPCP) indicates a need to include a range of health professions and to focus on students' development of team communication and conflict resolution skills in day-to-day healthcare delivery. This study evaluated the impact of interprofessional simulation for occupational therapy, physiotherapy, dietetics, and nursing students on interprofessional collaboration competencies, specifically collaborative communication and conflict resolution during day-to-day interactions, and their intention for IPCP during placement. A series of simulations featuring the potential for interprofessional conflict and involving explicit coaching on communication and conflict resolution were conducted. A single cohort pre-test post-test design included the Students' Perceptions of Interprofessional Clinical Education Revised (SPICE-R), the Interprofessional Collaborative Competencies Attainment Survey (ICCAS), and an open response survey question on future intended practice. A total of 237 students participated in the simulation experience. Overall scores and scores on all IPCP competencies in the ICASS (n = 193) and SPICE-R (n = 226) improved for all professions post-simulation. The mean score of the ICCAS increased for 98% of the respondents and similarly the mean score of the SPICE-R increased for 71% of the respondents. Open-ended responses indicated students' intentions to pursue self-leadership in IPCP. Students who participated in an interprofessional simulation reported perceived improvements in IPCP competencies and were encouraged to initiate IPCP when on placement in the practice setting.

We aimed to investigate whether using a shared electronic patient record (EPR-Youth) strengthened interprofessional teamwork among professionals in youth care and child healthcare. Using a mixed-methods design, we compared two partly overlapping samples of professionals, who completed questionnaires before the introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interprofessional teamwork (interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed for this study. Midway through the study period, focus groups were held with 12 professionals to examine how EPR-Youth contributed to interprofessional teamwork. Professionals reported significantly more flexibility after the introduction of EPR-Youth than before. Professionals scored slightly -but not significantly- more positively on the other components of teamwork. Focus group participants reported that using EPR-Youth strengthened their sense of interdependence and collective ownership of goals, and contributed to newly created professional activities. At baseline, levels of interprofessional teamwork differed between organizations. Focus group participants confirmed these differences and attributed them to differences in facilitation of interprofessional teamwork. Our findings suggest that using EPR-Youth can foster interprofessional teamwork. Organizational differences underline that implementing an EPR alone is inadequate: shared definitions of teamwork and organizational facilities are needed to strengthen interprofessional teamwork.

The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management.

This study examined the factors linked to low-threshold interprofessional collaboration in the context of Finnish primary schools. The main purpose of the study was to analyze how education and health and social care professionals perceived their mutual collaboration. The PINCOM-Q scale was used to identify factors related to interprofessional collaboration in professionals' work settings. The results indicate that individual factors such as work motivation and personal power are prominent in low-threshold collaboration. At the group level, communication has an important role to play in interprofessional collaboration. Professionals (n = 204) perceived mutual exchange of information as an important aspect of working together. The aspects that matter in the low-threshold mode of interprofessional collaboration are a complex combination of individual, group and less obvious organizational factors, all of which both reflect and are reflected in an individual's motivation and commitment to cooperation. The establishment of long-term and systematic low-threshold, interprofessional collaboration presupposes that individual interests are realized in good interaction in equal encounters between different organizational domains.

Educating health care professionals for working in interprofessional teams is a key preparation for roles in modern healthcare. Interprofessional teams require members who are competent in their roles. Self-assessment instruments measuring interprofessional competence (IPC) are widely used in educational preparation, but their ability to accurately and reliably measure competence is unknown. We conducted a systematic review to identify variations in the characteristics and use of self-report instruments measuring IPC. Following a systematic search of electronic databases and after applying eligibility criteria, 38 articles were included that describe 8 IPC self-report instruments. A large variation was found in the extent of coverage of IPC core competencies as articulated by the Interprofessional Education Collaborative. Each instrument's strength of evidence, psychometric performance and uses varied. Rather than measuring competency as "behaviours", they measured indirect proxies for competence, such as attitudes towards core interprofessional competencies. Educators and researchers should identify the most appropriate and highest-performing IPC instruments according to the context in which they will be used.Systematic review registration: Open Science Framework (https://archive.org/details/osf-registrations-vrfjn-v1).