Intraprofessional Collaboration Research Articles

Nursing during the COVID-19 pandemic: A reflective thematic analysis of how the hamster wheel shifted personal and professional control.

The aim of this national study was to examine the experience of nurses 9-12 months after the onset of the pandemic. This article reports the reflective thematic analysis of the qualitative portion of a mixed methods study of the experiences of 1319 Canadian nurses between February to May 2021. Data gathering occurred through open-text box questions in an online survey. Three overarching themes were found: (1) the hamster wheel, (2) the shifting sense of control, and (3) the inability to leave the pandemic at work. This research presents a national perspective of nurses which contributes to the wider global narrative. The experience of redeployment, nurses as decision-makers, communication and leadership challenges were all factors impacting mental health and intraprofessional collaboration. The findings revealed the immense pressure, mental health concerns, and professional implications for nurses in all domains. No public or patient contributions.

Psychiatric consultation in general practitioners’ daily practice: a qualitative study on the experience of consultation-liaison psychiatry interventions in primary care settings in French-speaking Switzerland

BackgroundMental disorders are frequent in primary care settings, which is challenging for primary care physicians. In Neuchâtel (Switzerland), a Consultation-Liaison psychiatrist integrated three primary care group practices, proposing both clinical interventions and supervisions/psychiatric training. Primary care physicians’ experience regarding this collaboration was investigated.MethodsA qualitative study was conducted. Three focus groups were organized in each primary care group practice involved in the project (10 primary care physicians participated in focus groups). Data were analysed with thematic content analysis.ResultsSix major themes emerged from our analysis, describing primary care physicians’ collaboration with psychiatrists: 1) Impact on a difficult to reach and “reluctant to consult” population; 2) Fluidity of the intraprofessional collaboration; 3) Influence on the doctor-patient relationship; 4) Positive emotional experiences; 5) Psychiatric counselling and training; 6) Long-term prospects for the project.ConclusionsConsultation-Liaison psychiatrist’s presence came as a relief for participating primary care physicians, facilitating accessibility to mental healthcare, introducing a common culture of care, and offering “in-situ” psychiatric training. Primary care physicians felt that their relationships with patients benefited from such interventions, being better able to deal with complex emotional experiences and found patients more confident regarding proposed care. Models of psychiatric intervention provided in primary care must establish settings of collaboration that reinforce relationships between primary care physicians, psychiatrists, and patients.

Adaptability and learning Intraprofessional collaboration of residents during the COVID-19 pandemic

ContextThe COVID-19 pandemic created a worldwide public health emergency, in which hospitals created new COVID departments and doctors from different disciplines had to work together. In the Netherlands, a large proportion of doctors in these departments were residents. With knowledge of the disease developing only gradually, the influx of COVID-19 patients called for adaptability, innovative work behavior, and intraprofessional collaboration (intraPC) between residents and between residents and medical specialists.Research goalThis study investigates how the delivery of COVID-19 care in hospital settings altered the way residents develop their sense of adaptability and intraPC during their training.MethodsSixteen semi-structured interviews were conducted with residents and medical specialists from various disciplines who worked at a COVID department or Intensive Care Unit (ICU) during the COVID pandemic in the Netherlands, focusing on adaptability and intraPC learning. Transcripts were analyzed using (thematic) template analysis.ResultsFour themes that influenced learning during COVID care were identified: collective uncertainty, social cohesion and a sense of safety, the need for adaptive performance and intraPC learning. During the first wave, collective uncertainty about the unknown disease and the continuation of the crisis urged residents to adapt in order to take care of patients with a disease that was as yet unknown. The combination of collective uncertainty, social cohesion and a sense of safety, and the presence of different disciplines in one department promoted residents’ intraPC learning. However, intraPC learning was not always the matter of course due to the scope of the crisis and the huge numbers of new patients.ConclusionCollective uncertainty affected the residents’ adaptability. The combination of collective uncertainty, social cohesion, and the presence of different disciplines in one department promoted the residents’ intraPC learning. An important facilitating factor for both adaptability and intraPC learning is a high level of social cohesion and safety. The physical and psychological proximity of supervisors is an important factor contributing to a safe learning environment. This study provides implications for practice for learning during postgraduate training in non-crisis settings.

Combined interprofessional and intraprofessional clinical collaboration reduces length of stay and consultations: a retrospective cohort study on an intensive collaboration ward (ICW)

ABSTRACT Patients with multiple health problems are a growing population at high risk of receiving fragmented care, resulting in a poorer quality of care, preventable hospitalisations, and higher costs. Health agencies such as the World Health Organization (WHO) advocate the implementation of interprofessional care, which should lead to better patient care. This retrospective cohort study investigated the effect of combined interprofessional and intraprofessional collaboration on the management of mainly elderly patients with multiple health problems on an Intensive Collaboration Ward (ICW). Patient health outcomes, patient experience, and the cost and value of care were assessed. In total, 200 patients admitted to the ICW were compared with 51 control patients with an indication for the ICW who were admitted to a regular ward because of a shortage of ICW beds. Patients admitted to the ICW had a shorter length of hospital stay than control patients (median 5 vs 7 days, p = .004) and had fewer in-hospital consultations (p = .003). Patient satisfaction did not differ between the ICW and control patients (mean rating (1–10) 8.22 vs 8.75, p = .060). This study indicates that interprofessional and intraprofessional clinical collaboration reduces the length of hospital stay and the number of in-hospital consultations, without affecting patient satisfaction.

Go Big on Your Way Home!

Abstract We are entering an environment in which health care and public health are integrating more than ever, and discipline-specific lines are transforming into large encroaching waves of gray. We must take charge of our own story so that we do not become obsolete, so that our distinct value remains the distinct value of occupational therapy. Occupational therapy is narrative. Our own narrative grows as we experience others’ narratives. To future-proof occupational therapy and continue our momentum forward, we must be intentional about intraprofessional collaboration. The American Occupational Therapy Association (AOTA) has also committed not only to discussing JEDI (justice, equity, diversity, inclusion) in principle, but to taking actions to realize it, placing the Allied Health Workforce Diversity Act as a high priority and advocating for its passage with Congress. From guiding academic programs toward more diverse and inclusive missions, to addressing the burnout and current mass exodus of occupational therapy practitioners, to engaging more with both AOTA members and nonmembers in open conversation within their practice settings, this Inaugural Presidential Address offers a message of the need to honor our past so that we can embrace our present to empower our future.

A case study: Promoting interprofessional community-based learning opportunities for health sciences students at the University of KwaZulu-Natal, Durban, South Africa


 
 
 
 Background. Preventing disease and promoting health call for interprofessional collaboration of health professionals working in a team, making it important for student health professionals to experience collaborative teamwork while in training, rather than learning and working in silos. Objectives. To describe the opinions of participating students and supervising staff in an intraprofessional community-based initiative involving the disciplines of physiotherapy and dentistry at the University of KwaZulu-Natal (UKZN), Durban, South Africa.
 Methods. This was a qualitative descriptive study demonstrating teamwork of students from two health sciences disciplines, giving a joint health education talk to patients at a local community health centre. Data were collected from focus group discussions. Three such discussions were held with purposively selected samples: (i) 5 physiotherapy students; (ii) 6 dental therapy students; and (iii) 6 staff members from both disciplines who supervised the students. These data were analysed using thematic analysis. Ethical approval was obtained from UKZN.
 Results. By working collaboratively, the students believed that they learnt more about the other health professionals and obtained a deeper understanding of their roles within the healthcare team. Staff believed that the collaborative project could break down professional barriers to work cohesively in the work environment. The main difficulties encountered were the language barrier and rigid timetables.
 Conclusion. This case study provides an example of intraprofessional collaboration and teamwork, capable of positively influencing participating students, emphasising the need for interprofessional learning opportunities for students across all health sciences disciplines while in training.
 
 
 

Designing the learning of intraprofessional collaboration among medical residents

BackgroundTo preserve quality and continuity of care, collaboration between primary‐care and secondary‐care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design‐Principles guide the design and development of educational activities when theory‐driven Design‐Principles are tailored into context‐sensitive Design‐Principles. The aim of this study was to develop and substantiate a set of theory‐driven and context‐sensitive Design‐Principles for intraPC learning during hospital placements.MethodsBased on our earlier research, we formulated nine theory‐driven Design‐Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design‐Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design‐Principles.ResultsThe theoretical Design‐Principles were discussed and modified iteratively. Two new Design‐Principles were added during focus group 1, and one more Design‐Principle was added during focus group 2. The Design‐Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design‐Principles in the Culture cluster were prerequisites to facilitate intraPC learning.ConclusionThis study led to the development of 12 theory‐driven and context‐sensitive Design‐Principles that may guide the design of educational activities to support intraPC learning during hospital placements.

Intraprofessional Educational Activities Implemented by OT Programs in the United States

Abstract Date Presented 04/02/2022 The Accreditation Council for Occupational Therapy Education® (ACOTE®) requires OT and OT assistant educational programs to include intraprofessional collaboration activities in their curriculum. We conducted a survey of all the OT and OTA programs in the United States. Results indicate that 21% of OT and OT assistant programs do not include an opportunity for intraprofessional collaboration. This survey also examines the types and length of intraprofessional activities that are offered by OT programs in the United States. Primary Author and Speaker: Patricia Watford Additional Authors and Speakers: Sydney Eller, Emma Morris, Olivia Parker, Charlotte Ruble, Natalie Speciale, Jenna Usry

Intraprofessional collaboration: A qualitative study of registered nurses’ experiences

BackgroundCollaboration and intraprofessional relationships are essential for healthy work environments; they affect everyday practice, quality of care, patient outcomes, and nurses’ welfare. Little is known about how nurses experience nurse—nurse collaboration. AimsTo describe registered nurses’ experiences of nurse—nurse collaboration in one Finnish and one Norwegian university hospital. DesignThis study used a qualitative descriptive approach applying the Consolidated criteria for Reporting Qualitative research guidelines. MethodsInterviews were conducted with 29 nurses in two university hospitals in Finland and Norway in 2015. Interviews were audio-recorded and transcribed, and data were categorised by inductive content analysis. FindingsThe registered nurses described nurse—nurse collaboration as equal and smooth collaboration towards a common goal with the patient in the centre, professional collegiality, a functioning working environment and clear communication. Also essential were empowering relationships, including categories such as sharing of knowledge and skills, and support and sharing of work. DiscussionThere is considerable variation in the ways nurses understand and experience collaboration within the profession. ConclusionsIntraprofessional collaboration profoundly affects nurses’ well-being. Strategies and continuous reinforcement are needed to strengthen and support intraprofessional collaboration, for instance through staff education and training.

Nursing Care Delivery Models and Intraprofessional Collaborative Care: Canadian Nurse Leaders' Perspectives.

IntroductionThere are many different types of nursing care delivery models used to organize and provide care in hospitals. These models are comprised of different organizational structures and staffing skill mixes.ObjectiveThe aim of this study was to explore how nursing care delivery models promote intraprofessional collaborative care in acute care hospitals from the perspectives of nurse leaders.MethodsA qualitative descriptive approach was used for this study. Telephone interviews were conducted between January 2021 and August 2021 using an interview guide comprised of semi-structured and structured questions. Using a purposeful sampling technique, ten leaders from nine hospital systems, representing both urban and rural hospitals in the province of Ontario, Canada, participated in the study. Content analysis was conducted resulting in two overarching themes.ResultsThe first theme, Fluidity of the Model addresses the flexibility of the models and the impact of contextual factors such as changes in nurses’ scope of practice, government funding changes, staffing mix, and organizational policies and rules. The second theme, Tools of the Trade describes the resources that hospitals implement to promote intraprofessional collaboration that indirectly impacts on patient safety.ConclusionNursing care delivery models need to be flexible and adaptable. All nursing care delivery models in this study used various tools to promote intraprofessional collaborative care.

Intraprofessional Collaboration in OT/OTA Academia: Immersive Innovations for Skill Building

Intraprofessional Collaboration in OT/OTA Academia: Immersive Innovations for Skill Building

An international interprofessional tele-mentorship programme: a mixed-methods study

ABSTRACT There is great need for mentorship in low- and middle-income countries (LMICs) in the field of occupational therapy (OT); however, there is little research on the effectiveness of an international tele-mentorship programme. The objectives of this mixed methods research were to examine the effectiveness and perceived benefits of the online, international mentorship programme. The study utilised the Self-Assessment of Clinical Reflection and Reasoning (SACRR) at initiation and completion of the study, 11 months apart, and a focus group. The results found significant changes in self-perceived clinical reflection skills in items 23 and 25 on the SACRR. Qualitative themes were increased confidence in clinical skills and occupational therapy practice, importance of evidence-based practice, significance of mentorship and inter- and intra-professional collaboration, and programme improvements. In conclusion, the tele-mentoring sessions enabled participants to form relationships/contacts, gain knowledge from qualified experts in specialty practice areas, and increase confidence in their clinical skill sets.

Current practices, supports, and challenges in speech-language pathology service provision for autistic preschoolers.

Speech-language pathology services are among the most frequently accessed services for young autistic children. Therefore, understanding the nature of these services, what challenges these clinicians face, and what supports they value is critical for developing appropriate policies and practices that can maximize positive outcomes for children and families. This study had two primary aims. The first was to examine the self-reported assessment and intervention practices of community-based Speech Language Pathologists (SLPs) and communicative disorders assistants (CDAs; who provide services under the supervision of a SLP) in supporting preschool children with suspected and diagnosed autism. The second aim was to identify barriers and supports (facilitators) to providing services in the community using the Consolidated Framework for Implementation Research (CFIR) as a framework. A cross-sectional online survey was used to collect qualitative and quantitative data from clinicians in Ontario Canada who were providing speech and language services to preschool children with suspected or diagnosed autism. Quantitative data were used to describe clinicians" practices, and qualitative data captured their perspectives on barriers and supports to providing services. A total of 258 clinicians participated in the survey. On average, clinicians reported almost half of the preschoolers on their caseload had either diagnosed or suspected autism. There was consistency across the skill development areas assessed by SLPs, and targeted during therapy sessions, with the top four areas targeted being: foundational social communication, language, play and pragmatics. However, there was wide variation in speech and language assessment and intervention practices reported by this sample of clinicians (i.e., service delivery models, tools or programs used, length and duration of therapy services, level of collaboration with other professionals). Clinicians identified several barriers to providing services: limited funding and time, lack of inter-professional collaboration, difficulty accessing services, community messaging about autism services, family readiness and clinician knowledge. Supports (facilitators) included: access to autism-focused professional development, inter- and intra-professional collaboration, and access to additional supports in the community.

The Association of Work Environments and Nurse-Nurse Collaboration: A Multicenter Cross-Sectional Study

Background: Along with the recent healthcare reform, intraprofessional collaboration in nursing is considered an essential factor for managing the challenges related to diverse roles and tasks of nurses in providing high quality care. There is lack of knowledge on how the nursing work environment could influence nurse-nurse collaboration. Purpose: The study aimed to assess the relationship between nursing work environment and nurses’ intraprofessional collaboration.Methods: A total of 300 nurses working in four teaching hospitals participated in this multicenter cross-sectional study. Data were collected using the Nurse-Nurse Collaboration Scale (NNCS) and the Practice Environment Scale of the Nursing Work Index (PES–NWI). The Pearson correlation test was used to analyze the data.Results: The results showed that the mean score of the PES–NWI was 2.65±0.32 out of 4. The highest and lowest scores belonged to the subscales of the nursing foundations for quality of care (2.86±0.31) and staffing and resource adequacy (2.24±0.49), respectively. The mean total score of nurse-nurse collaboration was 2.94±0.21 out of a score of 4. The results showed a significant positive relationship between nursing work environment and nurses’ intraprofessional collaboration (r=0.49, p<0.05).Conclusion: The nursing practice environment has a positive and significant relationship with nurse-nurse collaboration. Therefore, improving nurses’ practice environment and providing healthy workplaces could improve the intraprofessional nurse’s collaboration. Moreover, nurse managers should improve nurses’ skills in some areas of collaboration such as conflict management.

Nurse-nurse collaboration and performance among nurses in intensive care units.

An essential element for offering high-quality care in the intensive care units (ICUs) is the intraprofessional collaboration among nurses, which facilitates the exchange of knowledge and information and hence improves performance. More research is needed to understand the relationship between the nurse-nurse collaboration and job performance in the ICUs due to the multidimensionality of both concepts, the complexity of the ICU environment, and the lack of studies. To examine the relationship between nurse-nurse collaboration and self-perceived nurse performance among Jordanian nurses in ICUs. Descriptive, correlational cross-sectional design was used. Data were collected through an online survey including the demographic questionnaire, the nurse-nurse collaboration scale, and six-dimensions scale for nursing performance. In total, 155 critical care nurses participated (response rate = 46.97%). Self-perceived job performance was significantly associated with gender (t=-3.189, P=.002), age (r=-0.301, P < .01), workplace (F=28.20, P=.001), the type of ICU (F=17.70, P=.001), and the number of assigned patients (r=0.407, P < .01). Among all nurse-nurse collaboration subscales, only the conflict management subscale was an independent significant predictor of self-perceived nursing performance (t=3.06, B=3.066, P=.003). Effective conflict management is associated with better nurse performance, which could ultimately improve patient care in ICUs. Conflict resolution is an important dimension of optimal nurse-nurse collaboration and has an important effect on nursing performance. Nurses and nurse managers in ICUs need to attend workshops and training programs in conflict management.

Commentary: Intraprofessional Collaborative Practice: Strengthening Nursing to Support Health System Transformation.

The complexity of nursing in Canada is evident in the diverse designations and jurisdictional approaches to legislation and regulation of the profession. The ever-evolving scope of practice of each designation of nursing shows the ability of nursing and nurses to adapt to the external environment and evolve to meet the needs of clients, the profession and the healthcare system. This commentary highlights the "made-in-Canada" research regarding intraprofessional collaboration. It also presents recommendations to strengthen intraprofessional collaboration over the next decade.

Exploring power dynamics and their impact on intraprofessional learning

BackgroundDuring postgraduate training, considerable efforts for intraprofessional education are in place to prepare primary care residents (PC residents) and medical specialty residents (MS residents) for intraprofessional collaboration (intraPC). Power dynamics are inherently present in such hierarchical medical contexts. This affects intraPC (learning). Yet little attention has been paid to factors that impact power dynamics. This study aims to explore power dynamics and their impact on intraPC learning between PC residents and MS residents during hospital placements.MethodsThis study expands on previously published ethnographic research investigating opportunities and barriers for intraPC learning among residents in five Dutch hospitals. We analysed transcripts of observations and in‐depth interviews using template analysis. A critical theory paradigm was employed. Discourse analysis additionally informed the data.ResultsWe defined five interrelated themes that describe characteristics of power dynamics in intraPC learning during hospital placements: beliefs; power distribution; interaction style; subjection; and fearless learning. Power dynamics operate both within and between the themes: power distribution between PC residents, MS residents and MS supervisors seemed to be an attribution affected by underlying beliefs about professional norms or about other professions; beliefs influenced the way PC residents, MS residents and MS supervisors interacted; power distribution based on inequity could lead to subjection of PC residents; power distribution based on equity could lead to fearless learning; and open interactions enabled fearless intraPC learning.ConclusionsPower dynamics have an impact on intraPC learning among residents in hospitals. Constructive power dynamics occur when power distribution is based on equity, combined with sincere open interactions, actively inviting each other into discussions and enlisting the support of MS supervisors to foster fearless learning. This can be achieved by creating awareness of implicit beliefs and making them explicit, recognising interaction that encourages intraPC learning and creating policies that support fearless intraPC learning.

Acute care nurses\u2019 perceptions of leadership, teamwork, turnover intention and patient safety \u2013 a mixed methods study

BackgroundThis study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined.MethodsIn this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario.ResultsHierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey).ConclusionsThe results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

Occupational Therapists’ Perceptions of Intraprofessional Collaboration When Working with Young Children Aged Birth to 3 Years

Background: Birth to 3 years of age is a critical period in a child’s development, and occupational therapy intervention during this period can serve many purposes. While pediatric occupational therapists may be working in different settings with different specialties, the foundational knowledge all occupational therapists possess provides a common lens through which they approach treatment. Intraprofessional collaboration is considered best practice, as it is not uncommon for young children to receive occupational therapy services by more than one therapist, and in more than one practice setting at the same time.

Inter- und intraprofessionelle Zusammenarbeit in Krisensituationen auf der Intensivstation am Beispiel von COVID-19.

Interprofessional and intraprofessional collaboration in crises situations in the intensive care unit regarding COVID-19 - a qualitative, retrospective analysis Abstract. Background: Interprofessional collaboration is elementary in the intensive care unit, a success factor in difficult patient situations and complex therapies. The COVID-19-pandemic challenged newly composed treatment teams, however, experience does not exist. Aim: We analyzed personal experiences and views on inter- and intraprofessional collaboration in intensive care units during the COVID-19-pandemic and identified influencing factors. Methods: We used a qualitative, retrospective study design, collected data from physicians, nurses in intensive care, anesthesia and surgery and physiotherapists during group discussions using the story / dialogue method. We analyzed the data according to Mayring's Qualitative content analysis. Results: We identified two main categories, each with three sub-categories: 1. Mastering a exceptional situation actively (Recognizing a common goal; Acting in solidarity; Getting to know each other in inter- / intraprofessional collaboration), 2. Having overcome the exceptional situation in retrospect (Maintaining personal contacts; Gaining new knowledge and perspectives; Taking what has been learned into the future). The participants rated the interprofessional and intraprofessional collaboration as good to very good. Conclusions: Factors promoting collaboration and positive experiences are to be incorporated into everyday work. The intraprofessional management team thereby defines common goals and values for the best possible patient care.