Members Of Interprofessional Health Care Teams Research Articles

Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies

Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

Interprofessional mock code simulation promotes collaboration and competency in Parkinson's medication safety during transition in care

An interprofessional mock code simulation was designed to educate students from four healthcare disciplines on the care of a patient with Parkinson's disease (PD) during a care transition. This interprofessional education initiative facilitated students learning about, from, and with each other. The simulation consisted of an unfolding patient with Parkinson's disease (PD) that involved an incomplete medication reconciliation and an omission of time-sensitive PD medication, resulting in a full code. The simulation explored quality improvement strategies for safe and timely medication administration and reconciliation during a care transition for a patient with PD. The simulation was conducted in the Learning Resource Simulation Center with small groups of students from two separate institutions and four separate schools or college programs rotating throughout the semester. The student participants consisted of the following: Baccalaureate Degree Senior Nursing Students; Master's level Senior Nurse Anesthesia Students; Fourth-Year Doctor of Osteopathic Medicine Students; and Fourth-Year Doctor of Psychology Students. The objectives of the interprofessional mock code simulation were as follows: 1) learners shall understand the roles and responsibilities of members of a healthcare team by participating in an interprofessional simulation of a patient with Parkinson's disease during a mock code scenario; 2) learners shall recognize the harm that occurs from incomplete medication reconciliation specific to Parkinson's disease during care transitions such as disorientation, garbled speech, severely limited breathing capacity and even death; and 3) learners from four different healthcare disciplines will evaluate their comfort and competence specific to working as part of an interprofessional healthcare team during a mock code simulation. The simulation demonstrated an increase in knowledge among all the interprofessional healthcare team members regarding PD medication safety. This PD unfolding case study simulation training also helped students and future professionals feel comfortable and competent while working together during a patient code situation in the acute care setting. This simulation holds great potential for dissemination among all faculty disciplines to improve the quality and safety of the PD population during care transitions. A complete copy of the IPE simulation is available upon request from the primary author.

Role of Occupational Therapy in Primary Care.

The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners' distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy's focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners' holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy's evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).

Perceptions of Palliative Care: Voices From Rural South Dakota.

This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

Building trust and facilitating goals of care conversations: A qualitative study in people with heart failure receiving home hospice care

Background: Despite a majority of persons receiving hospice care in their homes, there are gaps in understanding how to facilitate goals of care conversations between persons with heart failure and healthcare providers. Aim: To identify barriers and facilitators which shape goals of care conversations for persons with heart failure in the context of home hospice. Design: A qualitative descriptive study design was used with semi-structured interviews. Setting/participants: We conducted qualitative interviews with persons with heart failure, family caregivers, and interprofessional healthcare team members at a large not-for-profit hospice agency in New York City between March 2018 and February 2019. Results: A total of 39 qualitative interviews were conducted, including with healthcare team members (e.g. nurses, physicians, social workers, spiritual counselors), persons with heart failure, and family caregivers. Three themes emerged from the qualitative interviews regarding facilitators and barriers in goals of care conversations for better decision-making: (1) trust is key to building and maintaining goals of care conversations; (2) lack of understanding and acceptance of hospice inhibits goals of care conversations; and (3) family support and engagement promote goals of care conversations. Conclusion: Findings from this study suggest that interventions designed to improve goals of care conversations in the home hospice setting should focus on promoting understanding and acceptance of hospice, family support and engagement, and building trusting relationships with interprofessional healthcare teams.

Using shared mental models to conceptualize patients as professionals, decision-makers, collaborators, and members of interprofessional healthcare teams

Using shared mental models to conceptualize patients as professionals, decision-makers, collaborators, and members of interprofessional healthcare teams

Community health worker perspectives of an academic community medication therapy management collaboration

ObjectiveTo qualitatively assess community health workers’ (CHWs’) perceptions of the challenges and benefits associated with participating in a collaborative, interprofessional medication therapy management (MTM) program for rural, underserved, predominantly Latinx, patients with diabetes and hypertension. MethodsNine CHWs participated in a 1-hour, semistructured focus group that explored their experiences while assisting in the delivery of MTM services through an academic community partnership between an MTM provider and participating rural clinics. Audio recordings of the focus group were transcribed and thematically analyzed by 2 independent reviewers. ResultsAll program-involved CHWs participated in the focus group. Qualitative analysis identified 2 overarching themes: (1) opportunities and (2) challenges. Opportunities were further subcategorized as benefits to (1) CHWs, (2) patients, or (3) academic community MTM research. The CHWs perceived that they served as a liaison among the medical provider (prescriber), patient, and MTM pharmacist. Benefits to the patients focused on the integration of CHWs as essential to patient recruitment, especially for those who were reluctant to participate or receive a phone call from a stranger. The major challenges identified were (1) interruptions in workflow and (2) communication between CHWs and the health care practitioners (physicians, nurse practitioners, pharmacists). Specifically, the CHWs universally agreed that they needed more time after receiving patient report, scheduling a visit with the patient, and communicating with the patient’s health care provider to better understand the individual’s circumstances and needs. ConclusionThis study identified perceived opportunities and challenges faced by CHWs and chronically ill, rural Latinx patients in the acceptance of MTM program. These findings may be useful for all interprofessional health care team members to better understand and appreciate the role of CHWs, while simultaneously enhancing and improving respective medication adherence efforts, and to improve collaborative, academic community programs in the future.

Moving on from structured communication to collaboration: a communication schema for interprofessional teams

ABSTRACTObjectives: We describe a conceptual framework for an approach towards an effective and collaborative communication strategy among interprofessional health care team members.Methods: Interprofessional health care team members apply different communication techniques to share healthcare data. They are often not taught how to recognize and respond to the challenges carried by emotions and pressure to conform among team members. Those two factors have the potential to affect the quality and outcome of communication with a resulting suboptimal clinical decision-making. Here, we developed a Communication Schema that addresses the three critical concepts that are embedded in any conversation, namely: 1 – understanding the contribution of social interaction in teamwork, 2 – recognizing and managing triggered emotions, and 3 – effective inquiries and exploration of points of view.Implications: We call on extending the traditional view of teamwork as a collection of skills to include the reality of interprofessional practice where people working together are influenced by social experience and expectations. The learning conversation schema offers a tool that is sensitive to innate threats to effective communication in working environments and allows its users to circumvent obstacles to optimum shared decision-making.

The Negative Behaviors in Healthcare Survey: Instrument Development and Validation.

Examine the psychometric properties and factor structure of the Negative Behaviors in Healthcare (NBHC) Survey. A principal axis factor analysis with varimax rotation was conducted utilizing the 2012 NBHC survey data (n = 1,918) to explore the underlying structure of the NBHC instrument. A confirmatory factor analysis using AMOS 23 (Arbuckle, 2014) was then conducted using the 2014 NBHC survey data (n = 1,479). Internal consistency reliability was supported for four of the five identified factors, while construct validity for a five factor solution was established with acceptable model fit indices (Goodness of Fit Index [GFI] = 0.98; Relative Fit Index [RFI] = 0.98, Normed Fit Index [NFI] = 0.98, Root Mean Square Residual [RMR] = 0.05). The NBHC instrument is a valid reliable instrument to assess negative behaviors among interprofessional healthcare team members, adding to a select few available instruments measuring negative behavior among interprofessional healthcare workers.

An interprofessional approach to promoting autonomous decision-making for clients who are aphasic

Often times interprofessional health care team members presume individuals with aphasia due to stroke lack the capacity to participate in and contribute to decision-making. This belief may hinder the client’s participation in the decision-making process. Two main impairments resulting from stroke, that impede communication and limit capacity for autonomous participation in decision-making, are aphasia and cognitive deficits. Reduced capacity for communication in the client with stroke, combined with complexity in health team dialogue and process, may further diminish the individual’s ability to engage in autonomous decision-making. Health team members need to use reliable methods and devise new methods which can more accurately measure capacity for autonomous decision-making. This review elucidates the necessity for (1) autonomous decision-making in persons with aphasia, (2) assessing the need for capacity, (3) concrete ways to assess cognitive function, and (4) interprofessional team decision-making.

A qualitative analysis of interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement.

BackgroundHealthcare systems increasingly engage interprofessional healthcare team members such as case managers, social workers, and community health workers to work directly with patients and improve population health. This study elicited perspectives of interprofessional healthcare team members regarding patient barriers to health and suggestions to address these barriers.MethodsThis is a qualitative study employing focus groups and semi-structured interviews with 39 interprofessional healthcare team members in Philadelphia to elicit perceptions of patients’ needs and experiences with the health system, and suggestions for positioning health care systems to better serve patients. Themes were identified using a content analysis approach.ResultsThree focus groups and 21 interviews were conducted with 26 hospital-based and 13 ambulatory-based participants. Three domains emerged to characterize barriers to care: social determinants, health system factors, and patient trust in the health system. Social determinants included insurance and financial shortcomings, mental health and substance abuse issues, housing and transportation-related limitations, and unpredictability associated with living in poverty. Suggestions for addressing these barriers included increased financial assistance from the health system, and building a workforce to address these determinants directly. Health care system factors included poor care coordination, inadequate communication of hospital discharge instructions, and difficulty navigating complex systems. Suggestions for addressing these barriers included enhanced communication between care sites, patient-centered scheduling, and improved patient education especially in discharge planning. Finally, factors related to patient trust of the health system emerged. Participants reported that patients are often intimidated by the health system, mistrusting of physicians, and fearful of receiving a serious diagnosis or prognosis. A suggestion for mitigating these issues was increased visibility of the health system within communities to foster trust and help providers gain a better understanding of unique community needs.ConclusionThis work explored interprofessional healthcare team members’ perceptions of patient barriers to healthcare engagement. Participants identified barriers related to social determinants of health, complex system organization, and patient mistrust of the health system. Participants offered concrete suggestions to address these barriers, with suggestions supporting current healthcare reform efforts that aim at addressing social determinants and improving health system coordination and adding new insight into how systems might work to improve patient and community trust.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1751-5) contains supplementary material, which is available to authorized users.

Advance Care Planning: Understanding Clinical Routines and Experiences of Interprofessional Team Members in Diverse Health Care Settings.

Interprofessional health care team members consider advance care planning (ACP) to be important, yet gaps remain in systematic clinical routines to support ACP. A clearer understanding of the interprofessional team members' perspectives on ACP clinical routines in diverse settings is needed. One hundred eighteen health care team members from community-based clinics, long-term care facilities, academic clinics, federally qualified health centers, and hospitals participated in a 35-question, cross-sectional online survey to assess clinical routines, workflow processes, and policies relating to ACP. Respondents were 53% physicians, 18% advanced practice nurses, 11% nurses, and 18% other interprofessional team members including administrators, chaplains, social workers, and others. Regarding clinical routines, respondents reported that several interprofessional team members play a role in facilitating ACP (ie, physician, social worker, nurse, others). Most (62%) settings did not have, or did not know of, policies related to ACP documentation. Only 14% of settings had a patient education program. Two-thirds of the respondents said that addressing ACP is a high priority and 85% felt that nonphysicians could have ACP conversations with appropriate training. The clinical resources needed to improve clinical routines included training for providers and staff, dedicated staff to facilitate ACP, and availability of patient/family educational materials. Although interprofessional health care team members consider ACP a priority and several team members may be involved, clinical settings lack systematic clinical routines to support ACP. Patient educational materials, interprofessional team training, and policies to support ACP clinical workflows that do not rely solely on physicians could improve ACP across diverse clinical settings.

A network model of communication in an interprofessional team of healthcare professionals: A cross-sectional study of a burn unit

ABSTRACTHealthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to between team members from the same profession; and (3) which professions are more likely to form interprofessional ties. Health management and support personnel ties were 94% interprofessional while ties among nurses were 60% interprofessional. Nurses and other health professionals were significantly less likely than physicians to form ties. Nurses were 1.64 times more likely to communicate with nurses than non-nurses (OR = 1.64, 95% CI: 1.01–2.66); there was no significant role homophily for physicians, other health professionals, or health management and support personnel. Understanding communication networks in healthcare teams is an early step in understanding how teams work together to provide care; future work should evaluate the types and quality of interactions between members of interprofessional healthcare teams.