Abstract
Interprofessional collaboration between doctors and nurses is based on team mental models, in particular for each professional’s roles. Our objective was to identify factors influencing concordance on the expectations of doctors’ and nurses’ roles and responsibilities in an Internal Medicine ward. Using a dataset of 196 doctor-nurse pairs (14x14 = 196), we analyzed choices and prioritized management actions of 14 doctors and 14 nurses in six clinical nurse role scenarios, and in five doctor role scenarios (6 options per scenario). In logistic regression models with a non-nested correlation structure, we evaluated concordance among doctors and nurses, and adjusted for potential confounders (including prior experience in Internal Medicine, acuteness of case and gender). Concordance was associated with number of female professionals (adjusted OR 1.32, 95% CI 1.02 to 1.73), for acute situations (adjusted OR 2.02, 95% CI 1.13 to 3.62), and in doctor role scenarios (adjusted OR 2.19, 95% CI 1.32 to 3.65). Prior experience and country of training were not significant predictors of concordance. In conclusion, our concordance-based approach helped us identify areas of lower concordance in expected doctor-nurse roles and responsibilities, particularly in non-acute situations, which can be targeted by future interprofessional, educational interventions.
Highlights
Inpatient hospital care requires close interprofessional collaboration between doctors and nurses
Assessment of mental models is considered through 3 aspects, according to a conceptual framework summarized by DeChurch: [10] a) elicitation methods, or the technique to elicit the content in the model, b) structure representation or the associative networks of knowledge, which can be assessed with similarity ratings and c) the degree of sharedness, or degree of overlap between mental models in a team
We considered the following covariates: prior experience in Internal Medicine was defined as a binary variable with a cut-off at 36 months
Summary
Inpatient hospital care requires close interprofessional collaboration between doctors and nurses. The teamwork model reflects the members’ perception of team member roles, responsibilities and norms, and of team structure, coordination and communication. Our study aimed at rapidly and feasibly assessing the degree of sharedness between the team, using scenarios that require clinical assessment, reasoning and notions of role representation and expectations. Shared expectations and perceptions of professional roles lay the groundwork for communication and collaboration for effective team performance [12]. Lack of a shared underlying mental model of roles can have potential repercussions on quality of care [7, 13] and patient safety [14, 15]. Perception of poor collaboration with physicians is associated with nurse’s intentions to leave their job [18, 19]
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