Physician Practices Promoting Effective Communication with Nurses: A Qualitative Study.

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals' roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses' interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in-depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty-five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses' absence from morning rounds, one-way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision-making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse-physician interactions and the current context of nursing care.

Effective communication between midwives and mothers is an essential part of positive birth outcomes. Mothers and midwives are both important for building a communication environment during childbirth. This study was conducted to explore midwives' and mothers' perspectives on effective communication in the maternity ward. This study is a part of a mixed-methods study. A qualitative inductive content analysis study using in-depth interviews with 10 midwives and 11 mothers was performed in Ahvaz, southwestern Iran, between July and October 2023. The data were analyzed via inductive content analysis techniques. The qualitative content analysis identified a core concept: mothers' self-entrustment to midwives, reflecting their growing confidence and reliance on midwives through effective communication in maternity care. This concept is underpinned by three main categories: (1) Creating a safe space; midwives ensure physical and emotional security through empathy, privacy, and non-judgmental communication; (2) Establishing spiritual oneness; a deep emotional connection fostering unity and holistic support; and (3) Building trust; rooted in midwives' competence, honesty, and reliability. These main categories, further elaborated through eight categories, outline specific behaviors and interactions that enhance midwife-mother communication. This study demonstrated that effective midwife-mother communication, achieved by ensuring a safe environment, fostering emotional connection, and demonstrating reliability, facilitates maternal self-entrustment; a process where mothers progressively develop confidence in and reliance on their midwives. These key components form a practical framework for enhancing maternity care interactions and strengthening therapeutic relationships.

Interprofessional corporation between registered community nurses and general practitioner: A qualitative study Abstract. Background: The quality and effectiveness of the work of certified nurses and physicians in the inpatient setting is significantly influenced by interprofessional collaboration (IPC). There is a lack of knowledge about IPC in outpatient primary care at home. Aim: In highlighting the differences between inpatient and outpatient settings, the challenges of IPC for the outpatient setting should become clear. Method: The data for this study was collected in interprofessional group discussions. The data were methodically extracted by knowledge mapping and structuring content analysis according to Kuckartz (2018). The results were compared with the meta-matrix for interprofessional collaboration in inpatient settings by Schärli et al. (2017). Results: The qualitative analysis showed that the outpatient IPC of qualified nurses and general practitioners is challenged by structural conditions, which are given in the inpatient area by the form of organization. Lack of agreements and coordination of processes complicate IPC in outpatient health care, as there is no recognized common management structure. Conclusions: In order to ensure that IPC in the outpatient setting is not dependent on the individual commitment of individuals, nurses and GPs must jointly define criteria for their IPC, define processes and communication channels, and develop a common approach and team spirit.

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.

The authors report on the managerial and logistical details of deploying a computerized adverse drug event surveillance system that was at first a grant-funded research project and ultimately was changed to a sustained safety-monitoring application serving 3 different hospitals. Surveillance was deployed in 3 phases to 2 community-based hospitals and an academic medical center. A logic-based rules engine surveyed electronic records for laboratory, medication, and demographic information indicative of safety concerns. Potential adverse events triggered manual chart review by pharmacists to verify patient harm. During Phase 1, the research team created trigger rules for each hospital. In Phase 2, the trigger review was transitioned to hospital personnel and rule sets were reshaped for specific hospital needs. In Phase 3, surveillance was integrated into daily work flows and organizational balanced scorecards where it was accepted as a quantitative measure of medication safety performance. Computerized surveillance helps detect potentially harmful events regardless of hospital size. Active leadership, change-tolerant culture, and hospital pharmacy practice models significantly impact successful adoption. Entrenched cultural issues impeded sustainability at the academic center but not at the 2 community hospitals. Tailoring surveillance to the needs of different inpatient settings is crucial to developing a sustainable model.

The effectiveness of structured multidisciplinary rounding in acute care units on length of hospital stay and satisfaction of patients and staff: a systematic review protocol

Nurse practitioners utilize curbside consultation, an interprofessional collaboration communication process in which one clinician seeks advice from another, in clinical decision-making practices. Nevertheless, this process is not well-understood. A qualitative design with individual open-ended interviews was used to explore the phenomenon of curbside consultation among nurse practitioners for clinical decision-making. Twenty primary care and specialty nurse practitioners participated. Participants were recruited via purposive sampling from in-patient and out-patient settings in order to reach saturation of themes. Using inductive content analyses, the findings revealed that nurse practitioners made multiple decisions in the course of information-seeking and its application during the curbside consultation process. Motivated by the patient’s best interest, nurse practitioners provided advice in the curbside consultation exchange and sought answers to questions encountered in clinical decision-making. Multiple resources were often utilized with curbside consultation frequently evolving into formal consultation. Dynamics of curbside consultation included (a)synchronous approaches including text, e-mail, telephone, or face-to-face processes. Once information was received, nurse practitioners decided whether they (dis)agreed with advice and if validation was necessary. Nurse practitioners utilized curbside consultation for clinical decision-making and means for interprofessional collaboration, thereby increasing clinical competency and promoting quality patient outcomes. Implications of curbside consultation for education and practice require further exploration to enhance outcomes of curbside consultation processes.

The World Health Organization (WHO) emphasizes the need for radical approaches in its Global Patient Safety Action Plan, particularly in terms of interprofessional and multidisciplinary approaches. The plan highlights the importance of providing training on patient safety for all professionals, focusing on team and task-based strategies that include bedside and simulation education. TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) is an educational programme developed to teach health care professionals on specific tools and strategies to enhance basic teamwork skills. Mutual support, one of the teamwork skills described in TeamSTEPPS®, involves team members assisting one another, providing and receiving feedback on performance, and advocating assertively when patient safety is threatened. The aim of this study was to explore the experiences of cardiovascular surgeons and nurses with mutual support through interprofessional collaboration in the intensive care unit (ICU) at Hacettepe University. The study employed a basic qualitative research design. The data were gathered through in-depth interviews and analysed with inductive content analysis in accordance with Elo and Kyngäs. We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to describe and report the components of study design. We interviewed 13 participants: 6 surgeons and 7 nurses. Six themes were identified: mutual support, positiveness of working in a supportive environment, feedback, effective communication, patient safety and conflict resolution. The results of our study revealed that intra/inter-professional collaboration and mutual trust based on the variety of individual and workplace-related factors improved patient safety through individual motivation while monitoring and supporting each other in a positive environment, providing feedback and encouraging effective communication, patient advocacy and conflict resolution. Exploring the experiences, challenges and successes of health care workers in interprofessional collaboration is crucial. Understanding team dynamics, communication barriers and collaboration strategies can help promote more effective teamwork and contribute to the development of plans to improve the quality of patient care.

This process evaluation explored delivery of a complex sedation intervention within the Alpha-2 Agonists for Sedation to Produce Better Outcomes from Critical Illness (A2B) trial, which compared dexmedetomidine- and clonidine-based sedation with propofol (usual care). All groups targeted lighter sedation levels. The objective was to understand bedside nurses' experiences delivering the interventions and identify factors influencing protocol adherence and implementation. A qualitative study using semi-structured interviews was conducted with intensive care unit (ICU) staff (consultants, bedside and research nurses) from A2B trial sites. Thematic analysis explored how participants experienced and delivered trial interventions, with particular focus on bedside nurses' abilities to manage sedation in line with the protocol. Nurses with greater ICU experience described more confidence and adaptability in using alpha-2 agonists, while less experienced staff required support due to limited familiarity with lighter sedation. Hesitancy to up-titrate alpha-2 agonists was common, driven by concerns about bradycardia and hypotension. Reluctance to down-titrate propofol was shaped by fears of agitation and self-extubation. Deep sedation norms, especially amongst nurses trained during the COVID-19 pandemic, further hindered protocol adherence. Research nurses were instrumental in supporting implementation and bridging knowledge gaps. Despite all three trial groups targeting lighter sedation, nurse confidence, safety concerns, and ingrained cultural practices limited adherence to alpha-2 agonist-based protocols. Addressing these barriers through training, support, and cultural change will be essential for future trials and practice shifts involving lighter sedation strategies in ICU. ClinicalTrials.gov NCT03653832 https://clinicaltrials.gov/study/NCT03653832.

To evaluate the feasibility of the Swiss complex interprofessional intervention, NEODOL© (NEOnato DOLore), for improving the management of procedural pain in neonates in the Finnish context. Interprofessional collaboration is important for all professionals involved in the care of neonates and for neonates' parents, to understand the appropriate use of non-pharmacological and/or pharmacological methods for each pain situation and how to assess pain in real-life situations. Appropriate methods of pain relief for neonates should be preferred as they protect the development of the neonate's brain. A descriptive qualitative design. Data were collected through semi-structured focus group discussions following the Medical Research Council's framework for evaluation of complex interventions, in this case NEODOL© which aims to improve the procedural pain management of neonates. A purposive sample (n = 13) included eleven professionals representing various professions within Finnish Neonatal Intensive Care Units and two parents of infants who have received care in a Neonatal Intensive Care Unit. Data were analysed using inductive content analysis, and the results were reported in accordance with the COREQ guidelines. Professionals' and parents' evaluations suggest that NEODOL© is feasible, because it is consistent and addresses a current need. They assessed its overall content to be relevant and accessible, and its components to be internally coherent. However, they emphasise the need for further evaluation and refinement of the intervention to achieve the desired outcomes and cost-effectiveness. While NEODOL© is considered feasible, it requires further evaluation and refinement in the local context of each hospital before implementation.

BackgroundCoordinated, multidisciplinary care is essential when addressing the complex needs of an aging population, with prehospital emergency care providers often serving as a common point of contact. Addressing complex care needs while maintaining continuity of care necessitates seamless collaboration between diverse healthcare providers. Despite this, there is limited research on interprofessional collaboration in prehospital care of older patients with complex needs. Understanding what influences interprofessional collaboration and identifying areas for improvement are vital for optimizing prehospital care for this vulnerable population. This study aimed to explore ambulance clinicians' perspectives on interprofessional collaboration in prehospital emergency care for older patients with complex care needs and to identify key factors influencing collaboration.MethodsAn explanatory sequential mixed-methods design was employed in this study, conducted in southern Sweden. In Phase 1, quantitative data were collected via an online survey completed by 118 ambulance clinicians (ACs). Descriptive statistics, chi-square tests, and Kruskal–Wallis tests were used to analyze the data. Qualitative responses were analyzed through inductive content analysis, informing the development of an interview guide. In Phase 2, semi-structured interviews were conducted with 20 ACs and analyzed using inductive content analysis. Findings from both phases were integrated using a joint-display matrix, combining quantitative patterns with qualitative insights for a comprehensive interpretation.ResultsQuantitative findings revealed that although collaboration with patients' families and care staff was generally rated as satisfactory by ACs, significant challenges were reported in coordinating care with other healthcare actors, especially home care nurses. About 89% of respondents reported insufficient access to patient information, highlighting difficulties in retrieving such information. Qualitative data underscored the importance of comprehensive patient information for effective decision-making and alignment with patient preferences and care goals. The integrated analysis identified three key factors influencing interprofessional collaboration: defined goals of care, access to information, and clarity in roles and responsibilities. Challenges in maintaining continuity and responsiveness, particularly during night shifts, were emphasized as barriers to effective collaboration.ConclusionAddressing deficiencies in nighttime care coordination, improving access to comprehensive patient information, and strengthening communication pathways between healthcare providers are essential steps in improving interprofessional collaboration to strengthen prehospital care of older patients with complex care needs.

Effective nurse-patient communication is essential in the development of therapeutic relationships and meeting the cognitive and affective needs of oncology patients. However, the emotional load in cancer nursing has made communication additionally challenging. This review aimed to establish the best available evidence regarding the factors affecting effective communication between registered nurses and adult oncology patients in inpatient setting. Types of participants This review considered studies that included registered nurses and inpatient oncology adults who were more than 21 years of age. This review considered studies carried out in inpatient settings, regardless of ward specialty, whilst active or palliative cancer treatments were administered.Phenomena of interest This review considered the factors affecting effective communication between registered nurses and inpatient oncology adults.Types of studies This review considered both quantitative (randomized controlled trials, non-randomized controlled trials, before and after studies, cohort observational, descriptive survey and mixed method studies) and qualitative (including, but not limited to, phenomenology, grounded theory and ethnography) research studies on the factors affecting effective communication between registered nurses and inpatient oncology adults.Search strategy The search strategy aimed to find studies published in English language and not limited by year of publication. A three-step search strategy was utilized in each component of this review. The grey literature was not included in this review. Quantitative data were extracted using standardized data extraction tools adapted from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Qualitative data were extracted using the standardized data extraction tool from the Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI). Quantitative data were presented in a narrative summary. Qualitative findings were categorised using JBI-QARI tool to generate synthesised findings. One quantitative, two mixed method and four qualitative studies were included in this review. Combined findings of the narrative summary and meta-synthesis identified promoting and inhibiting factors in the characteristics of nurses, patients, and the environment. Promoting factors in nurses included genuineness, competency and supportive facilitation skills. However, the role of post-basic training in improving communication remained inconsistent. In patients, active participation in their own care and information-seeking behaviour promoted nurse-patient communication. Conversely, inhibiting factors in nurses included task orientation, fear of own death and low self-awareness of own verbal behaviours. Nurses also communicated less effectively during psychological assessments and emotionally-charged situations. For patients, their unwillingness to discuss the disease/feelings, their preference to seek emotional support from family and friends and the use of implicit cues inhibited effective communication. Environmentally, a supportive ward environment increased the use of facilitative behaviour in nurses, whereas the existence of conflict among staff increased the use of blocking behaviours. Cultural norms in the Chinese society also inhibited nurse-patient communication. Within the constraints of the study and the few quality papers available, it appears that personal characteristics of patients and nurses are the key influencing factors of effective nurse-patient communication in the oncology setting. Very little evidence exists on the role of environment in effective nurse-patient communication, particularly within an Asian setting. Using evidence from the quantitative component of the review, nurses need to focus on the mental health status of patients admitted with a recurrence of cancer. Education programs can be implemented to inform nurses about the challenges in communication and develop strategies to counter these obstacles. Using evidence from the qualitative component of the review, nurses should build rapport and encourage active patient participation in their care in order to enhance patient disclosure. Nurses should also be mindful of patients' psychological readiness to communicate and respect their preference as to whom they wish to share their thoughts/emotions with. Institutions need to design ward structures (ward culture and nurses' workload) that support and/or encourage nurses to be person-oriented and take responsibility for providing holistic care to patients. Both the quantitative and qualitative components of the review indicated the need to improve nurses' communication skills and their receptivity to patient cues. An explorative descriptive study on the effect of the Asian culture on the effective communication in the oncology setting is required to add to the small amount of knowledge in this area. Descriptive or mixed method studies to ascertain the effect of the patient's age and place within the oncology treatment cycle are also warranted. The lack of evidence on the effectiveness of post-basic communication courses would be best gathered by a descriptive study, followed by a before-and-after randomised controlled trial to test different education programs.

BackgroundThe practice of providing patients with digital access to clinical narrative documentation by health care professionals (HCPs) is known as open notes. In mental health care, this innovation has the potential to increase transparency and foster greater trust in the treatment process. While open notes may improve the quality of care and patient engagement, some HCPs are concerned that they may change the nature of clinical documentation and compromise its quality.ObjectiveThis study aims to examine potential objective and subjective changes in clinical documentation following the implementation of open notes.MethodsClinical notes written before and after the implementation of a patient portal with open notes function in 3 psychiatric outpatient clinics in Germany were collected. A total of 876 notes (453 prenotes and 423 postnotes) were rated on 16 linguistic features using a Likert scale. Differences were analyzed using the Wilcoxon signed rank test. In addition, 10 in-depth qualitative interviews with psychiatric HCPs were conducted and analyzed using reflexive thematic analysis.ResultsPostimplementation significant differences were found in several linguistic features: Monoglossic (P=.002), incomprehensible (P<.001), demeaning (P<.001), stigmatizing (P<.001), factual (P<.001), and controlling (P=.002) language decreased, while comprehensible (P<.001), resource-oriented (P<.001), heteroglossic (P<.001), personal (P<.001), and emotional positive (P=.047) language increased. Interviewed HCPs reported noticeable changes in both their clinical notes and documentation practices. They described reducing the use of medical jargon, providing more detailed explanations, and tailoring documentation to better meet patient needs, resulting in slightly longer notes. However, in the subjective perception of the HCPs, the information they documented in the clinical notes remained mostly the same. HCPs noted an increase in time and workload associated with the new documentation approach, partly due to the workflow adjustments required to adapt to open notes.ConclusionsTo our knowledge, this is the first study to systematically analyze quantitative documentation changes in the field of mental health. The implementation of open notes seems to result in both objective and subjective changes in clinical documentation and documentation practices. Quantitative and qualitative findings from our study suggest that HCPs generally strove to create more patient-friendly notes. In practice, this may benefit both patients and the therapeutic relationship. For open notes to be sustainable in practice, they must be seamlessly and efficiently integrated into HCPs' daily workflows. This requires not only structural changes, but also educating HCPs—both during their training and in clinical practice—on how to write open notes in a way that is both effective and patient-friendly.Trial RegistrationGerman Register of Clinical Studies DRKS00030188; https://tinyurl.com/mum4djbe

BACKGROUND The practice of providing patients with digital access to clinical narrative documentation by healthcare professionals (HCPs) is known as open notes. In mental health care, this innovation has the potential to increase transparency and foster greater trust in the treatment process. While open notes may improve quality of care and patient engagement, some HCPs are concerned that it may change the nature of clinical documentation and compromise its quality. OBJECTIVE This study aims to examine potential objective and subjective changes in clinical documentation following the implementation of open notes. METHODS Clinical notes written before and after the implementation of a patient portal with open notes function in 3 psychiatric outpatient clinics in Germany were collected. A total of 876 notes (453 pre-notes and 423 post-notes) were independently rated by two raters on 16 linguistic features using a Likert scale. Differences were analyzed using the Wilcoxon rank-sum test. In addition, 10 in-depth qualitative interviews with psychiatric HCPs were conducted and analyzed using reflexive thematic analysis. RESULTS Post-implementation significant differences were found in several linguistic features. Notes changed in monoglossic (P = .002) and less heteroglossic (P &lt; .001); comprehensible (P &lt; .001) and incomprehensible (P &lt; .001); demeaning (P &lt; .001) and resource-oriented (P &lt; .001); positive emotional (P = .047); controlling (P = .002); stigmatizing (P &lt; .001); personal (P &lt; .001) and factual (P &lt; .001) language. Interviewed HCPs reported noticeable changes in both their clinical notes and documentation practices. They described reducing the use of medical jargon, providing more detailed explanations, and tailoring documentation to better meet patient needs, resulting in slightly longer notes. However, in the subjective perception of the HCPs, the information they documented in the clinical notes remained mostly the same. HCPs noted an increase in time and workload associated with the new documentation approach, partly due to the workflow adjustments required to adapt to open notes. CONCLUSIONS To our knowledge, this is the first study to systematically analyze objective documentation changes in the field of mental health. The implementation of open notes seems to result in both objective and subjective changes in clinical documentation and documentation practices. Quantitative and qualitative findings from our study suggest that HCPs generally strove to create more patient-friendly notes. In practice this may benefit both patients and the therapeutic relationship. For open notes to be sustainable in practice, they must be seamlessly and efficiently integrated into HCPs' daily workflows. This requires not only structural changes, but also training of HCPs - both during their training and in clinical practice - on how to write open notes in a way that is both effective and patient-friendly. CLINICALTRIAL The study was registered with the German Register of Clinical Studies (No. DRKS00030188).

This qualitative study explores the proactive leadership practices of public school administrators in Cagayan de Oro City, Philippines, through an ethnographic lens, addressing a gap in understanding contextually grounded educational leadership in urban Southeast Asian settings. Drawing from semi- structured interviews with five school heads, the research identifies five key themes: proactive leadership, student-centric prioritization, effective communication strategies, collaborative decision- making, and professional development integration. These themes reveal how administrators navigate complex challenges—such as resource constraints, high student-toteacher ratios, and cultural expectations—by employing adaptive strategies informed by Contingency Theory, the Job Demands– Resources (JD-R) Model, and Transformational Leadership Theory. Proactive leadership manifests through anticipatory planning, institutionalized systems like Standard Operating Procedures (SOPs), and strategic delegation to enhance organizational resilience. Student-centric prioritization guides decision-making, ensuring policies align with learner needs, while effective communication fosters trust through tailored messaging and feedback loops. Collaborative decision-making leverages stakeholder engagement and culturally sensitive consensus-building, reflecting Filipino values like pakikisama (social harmony). Professional development is embedded into daily workflows via individualized plans and peer mentoring, mitigating burnout and fostering teacher growth. The study proposes a conceptual framework illustrating how these practices, shaped by cultural and contextual inputs, lead to improved school performance, stakeholder trust, and administrator resilience. While limited by its small sample size, this research offers actionable insights for school leaders, policy recommendations for culturally responsive frameworks, and a foundation for future mixedmethods studies. It underscores the importance of adaptive, culturally embedded leadership in balancing national mandates with local realities, contributing to both academic discourse and practical leadership strategies in resource-constrained educational contexts.