Intraprofessional Collaboration Research Articles

Clinical Nurse Specialist Collaboration to Recognize, Prevent, and Treat Pediatric Pressure Ulcers.

The purpose of this quality improvement project was to reduce the incidence of pressure ulcers in a 232-bed, freestanding children's hospital in Western United States. Pressure ulcers have been an underappreciated hospital-acquired condition in children. Children have distinct anatomic, physiologic, and developmental factors that alter how pressure ulcers occur, but nurses may not recognize the pediatric patient as at risk because of lack of knowledge and tools to assess skin, identify risk factors, and recognize or stage pressure ulcers. Our initial efforts to develop organizational tools to reduce pediatric pressure ulcers were not sufficient, despite improvements in care. Interprofessional and intraprofessional collaboration, led by clinical nurse specialists, focused on documentation, tracheostomies, respiratory devices, and hemodynamically unstable or extracorporeal life support patients. Stage 3 and 4 and unstageable pressure ulcers are also "never events" in children. The unique factors involved with infant and pediatric pressure ulcers demand unique solutions. Our collaborative efforts led to a significant and sustained reduction in pressure ulcer incidence, from 3.3 per 1000 patient days in the first quarter of 2010 to 1.7 per 1000 patient days in the second quarter of 2014. Reportable pressure ulcers were reduced by 60%. Improved awareness and prevention strategies also led to significant reductions in extracorporeal life support patient pressure ulcers and respiratory device-related pressure ulcers. Through intraprofessional and interprofessional collaboration, the clinical nurse specialists were able to implement sustained organizational change and improve care for infants and children. Reduction in pressure ulcers is achievable but requires collaboration and creative solutions that involve multiple disciplines.

The experiences of pre-licensure or pre-registration health professional students and their educators in working with intra-professional teams: a systematic review of qualitative evidence protocol

The experiences of pre-licensure or pre-registration health professional students and their educators in working with intra-professional teams: a systematic review of qualitative evidence protocol

The experiences of pre-licensure or pre-registration health professional students and their educators in working with intra-professional teams: a systematic review of qualitative evidence protocol.

REVIEW QUESTION / OBJECTIVE The aim of this review is to identify the experiences of pre-licensure or pre-registration health professional students and their educators of intra-professional teams. The objectives of this review are: 1. To identify the experiences of pre-licensure or pre-registration health professional students about learning how to work in intra-professional teams. 2. To identify the experiences of health professional educators about teaching intra-professional collaboration across categorical and/or regulatory boundaries of professional groups. The specific question for this review is: What are the experiences of health professional students and educators learning to work in intra-professional teams? INCLUSION CRITERIA Types of participants This review will consider studies that investigate pre-licensure health professional students' and educators’ experiences of intra-professional teams. We will define pre-licensure health professional students as those students enrolled in a health-related diploma or degree program leading to the writing of a licensure or registration exam prior to engaging in practice (i.e. regulated health care provider programs). Health related programs that will be included are those that have multiple points of entry-to-practice under one disciplinary domain. This could include (but will not be limited to) disciplines such as dentistry, nursing, medicine, occupational therapy, pharmacy, physiotherapy or social work. Thus, we will consider studies that include experiences of students and educators working in various disciplinary domains (such as dentistry, medicine, nursing, occupational therapy pharmacy or physiotherapy) focusing on regulated health professions which have more than one point of entry into practice for their students (e.g. baccalaureate degree or diploma). TRUNCATED AT 250 WORDS

Nursing roles and responsibilities in general practice: three case studies

Primary care nursing teams may now comprise registered nurses (usually termed practice nurses), nurse practitioners, physician assistants, enrolled nurses, and primary care practice assistants, clinical assistants, or nursing assistants. There is a need to understand how practitioners in the different roles work with patients in the changed environment. The aim of this study was to describe the different configurations of health professionals' skill-mix in three dissimilar primary care practices, their inter- and intra-professional collaboration and communication, and to explore the potential of expanded nursing scopes and roles to improve patient access. Document review, observation and interviews with key stakeholders were used to explore how health practitioners in three practice settings work together, including their delegation, substitution, enhancement and innovation in roles and interdisciplinary interactions in providing patient care. A multiphase integrative, qualitative and skill-mix framework analysis was used to compare findings related to nursing skill-mix across case studies. Three models of primary care provision, utilising different nursing skill-mix and innovations were apparent. These illustrate considerable flexibility and responsiveness to local need and circumstances. Enabling nurses to work to the full extent of their scope, along with some adjustments to the models of care, greater multidisciplinary cooperation and coordination could mitigate future workforce shortages and improve patient access to care.

Anesthesia and the Fetus

Anesthesia and the Fetus

Failure to cope: the hidden curriculum of emergency department wait times and the implications for clinical training.

The study explored optimal intraprofessional collaboration between physicians in the emergency department (ED) and those from general internal medicine (GIM). Prior to the study, a policy was initiated that mandated reductions in ED wait times. The researchers examined the impact of these changes on clinical practice and trainee education. In 2010-2011, an ethnographic study was undertaken to observe consults between GIM and ED at an urban teaching hospital in Ontario, Canada. Additional ad hoc interviews were conducted with residents, nurses, and faculty from both departments as well as formal one-on-one interviews with 12 physicians. Data were coded and analyzed using concepts of institutional ethnography. Participants perceived that efficiency was more important than education and was in fact the new definition of "good" patient care. The informal label "failure to cope" to describe high-needs patients suggested that in many instances, patients were experienced as a barrier to optimal efficiency. This resulted in tension during consults as well as reduced opportunities for education. The authors suggest that the emphasis on wait times resulted in more importance being placed on "getting the patient out" of the ED than on providing safe, compassionate, person-centered medical care. Resource constraints were hidden within a discourse that shifted the problem of overcrowding in the ED to patients with complex chronic conditions. The term "failure to cope" became activated when overworked physicians tried to avoid assuming care for high-needs patients, masking institutionally produced stress and possibly altering the way patients are perceived.

Collaboration amongst clinical nursing leadership teams: a mixed-methods sequential explanatory study.

To explore intra-professional collaboration amongst nursing leadership teams at a tertiary referral hospital in Sydney. Effective working within a wide network of alliances is critical to patient outcomes. An understanding of collaboration amongst nursing leadership teams is essential within this context. A sequential explanatory mixed-methods design was used. The Collaborative Behaviour scale was sent to 106 Nurse Unit Managers, Nurse Educators and Clinical Nurse Consultants to measure pairwise collaborative behaviours; two follow-up focus groups with 15 participants were conducted. Data were collected between May 2012 and May 2013. A thematic analysis of focus group data provided a detailed explanation of the questionnaire findings. The findings identified high collaboration between dyad groups. Two themes emerged from the thematic analysis: (1) professional role and expectations; with sub-themes of transparency and clarity of individual roles; and intra/interpersonal aspects of role functioning; and (2) organisational infrastructure and governance. These leadership teams can be effective and powerful vehicles for change and are central to optimum patient outcomes. Organisational strategic planning and evaluation can benefit from understanding how to promote collaborative behaviours in these nurse leaders. To date, little research has explored collaboration amongst nursing leadership teams. Successful collaboration may contribute to the efficient use of nursing resources; improve patient outcomes, and ultimately, nurse satisfaction and retention.

Graduate Clinical Nurse Preceptors: Implications for Improved Intra-Professional Collaboration

Advanced practice nurses have increased in number and public acceptance. Students preparing for these roles require quality clinical education so they are prepared to assume collaborative roles in healthcare settings. Although graduate clinical preceptors have a vitally important role in the clinical education and professional socialization of advanced practice students, there is a paucity of evidence about factors that influence their role commitment. In this article, the authors review the literature related to graduate-level, clinical-preceptor experiences; describe their study of 91 graduate clinical preceptors that identified factors influencing graduate clinical preceptors’ role commitment; report and discuss their findings; as well as the limitations of this study. They conclude that the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures, and identify the need for intra-professional collaboration among nursing faculty, administrators, and clinicians to facilitate the recruitment, cultivation, and retention of graduate clinical preceptors

“You Scratch My Back, I'll Scratch Yours”: Reciprocal Intraprofessional Collaboration for OB Simulation

Childbearing Poster Presentation Purpose for the Program Simulation is a widely used educational strategy that promotes critical thinking and clinical decision‐making skills. It often is integrated into nursing school curricula, but more recently is used by hospitals to train nursing staff. Though intraprofessional simulation is a “hot topic” in education, there is minimal evidence of collaborative simulation efforts within a profession. This program demonstrates how nursing school faculty can collaborate with medical center nurses to provide enhanced simulation experiences through sharing pedagogic and clinical expertise and resources. Proposed Change In this intraprofessional collaborative endeavor, experienced practicing nurses from UNC Hospitals assisted faculty from the UNC School of Nursing to facilitate six simulation cases for over 100 students per semester for three semesters. In a reciprocal manner, faculty assisted these nurses and their nurse manager to run case scenarios for the nurses who were new to obstetrics. Implementation, Outcomes, and Evaluation The UNC School of Nursing has a high‐fidelity simulation learning lab, which includes birthing and newborn simulators. The labor and delivery unit's nurse manager asked to use this lab to ensure that her staff had quality training in recognizing and responding to obstetric emergencies. After visiting the simulation learning lab and observing nursing students participate in simulations, the manager and several experienced nurses collaborated with faculty to enhance the content and flow of the simulation scenarios. The nurse manager arranged for equipment and supplies to be provided to the UNC School of Nursing so that the simulation setting was more realistic. Implications for Nursing Practice Intraprofessional collaboration is a win–win situation for nurse educators and nursing staff. The sharing of resources and expertise provides opportunities for realistic, simulated learning experiences.

Perceptions on the Essential Competencies for Intraprofessional Practice

To gather the perspectives of physiotherapists and physiotherapist assistants on essential competencies for intraprofessional (physiotherapist-physiotherapist assistant) collaboration. A survey was developed to gather physiotherapist and physiotherapist assistant perceptions of the essential elements of effective and efficient intraprofessional collaborative practice. Participants were asked to rate the importance of 36 elements in 6 different categories (communication, collaboration, consultation, assignment of tasks, conflict management, and roles/responsibilities) involved in intraprofessional practice. A total of 1049 physiotherapists and 121 physiotherapist assistants responded to the survey. Analysis identified 10 competency elements perceived by participants as essential to effective and efficient intraprofessional collaboration. Comparisons using demographic variables consistently yielded the same top 10 elements. Our results indicated that physiotherapists and physiotherapist assistants working in private and public practice share very similar views on what is essential for effective intraprofessional practice. The consensus is that communication is key; open lines of communication help to determine responsibilities. Physiotherapy pre-licensure and continuing education programmes should include opportunities to work on communication, listening, and the skills needed to interact and collaborate effectively.

Collaboration among nurse practitioners and registered nurses in outpatient oncology settings in Canada

This article is a report on a case study that described and analysed the collaborative process among nurse practitioners and registered nurses in oncology outpatient settings to understand and improve collaborative practice among nurses. Changes in the health system have created new models of care delivery, such as collaborative nursing teams. This has resulted in the increased opportunity for enhanced collaboration among nurse practitioners and registered nurses. The study was guided by Corser's Model of Collaborative Nurse-Physician Interactions (1998). Embedded single case design with multiple units of analysis. Qualitative data were collected in 2010 using direct participant observations and individual and joint (nurse dyads) interviews in four outpatient oncology settings at one hospital in Ontario, Canada. Thematic analysis revealed four themes: (1) Together Time Fosters Collaboration; (2) Basic Skills: The Brickworks of Collaboration; (3) Road Blocks: Obstacles to Collaboration; and (4) Nurses' Attitudes towards their Collaborative Work. Collaboration is a complex process that does not occur spontaneously. Collaboration requires nurses to not only work together but also spend time socially interacting away from the clinical setting. While nurses possess the conceptual knowledge of the meaning of collaboration, findings from this study showed that nurses struggle to understand how to collaborate in the practice setting. Strategies for improving nurse-nurse practitioner collaboration should include: the support and promotion of collaborative practice among nurses by hospital leadership and the development of institutional and organizational education programmes that would focus on creating innovative opportunities for nurses to learn about intraprofessional collaboration in the practice setting.

Collaborative learning among undergraduate students in community health nursing

Teamwork can benefit students, enhancing their ability to think critically, solve problems creatively, and collaborate effectively. We piloted a collaborative learning project with undergraduate community health nursing students (N = 83) that entailed working in teams to explore epidemiologic data, synthesize the literature, and develop an evidence-based plan for nursing intervention and evaluation pertaining to a public health issue. Project evaluation consisted of pre- and post-project surveys by students, peer evaluation, and formative and summative evaluation by faculty. Having students work in teams, while challenging both for faculty and students, may be a viable strategy for preparing the next generation of nurses for inter- and intraprofessional collaboration. Our experience suggests that instituting a collaborative learning experience as part of an undergraduate course in community health nursing can be an effective way to expose students to constructive approaches to teamwork and prepare them for evidence-based nursing practice in the future.

A review of the evidence for the maximization of clinical placement opportunities through interprofessional collaboration

Interprofessional collaboration has been suggested as a potential solution to clinical placement shortages. This review was designed to compile the evidence on the use of interprofessional and nursing intraprofessional collaboration to maximize clinical placement opportunities for undergraduate/pre-licensure health professional students. A worldwide search of the published and grey literature was conducted, supplemented by 28 interviews across Canada. Results revealed only two articles, both in nursing – one that described an intraprofessional nursing collaboration consisting of a clinical placement consortium for finding placements, and one that described a unique program that provided a seamless transition from a practice nurse program to associate degree nursing program and that included collaboration with clinical placements. The interviews revealed various types of collaborations designed to maximize placements and various mechanisms by which these collaborations served to maximize placements including easing the pressure to find preceptors and increasing the number of placements. The authors concluded that while collaborations exist specifically to maximize placements, at least in Canada, it was neither happening within the context of research nor being formally evaluated. More evaluation is needed in order to clarify the evidence by which collaboration works or does not work to maximize placement opportunities.

Neglecting the Importance of the Decision Making and Care Regimes of Personal Support Workers: A Critique of Standardization of Care Planning Through the RAI/MDS

Purpose: The Resident Assessment Instrument–Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the decision making and care practices of personal support workers (PSWs) in relation to the RAI/MDS standardized process. Design and Methods: This qualitative study utilized focus groups and semi-structured interviews with PSWs (n = 26) and supervisors (n = 9) in two nursing homes in central Canada. Results: PSWs evidenced unique occupational contributions to assessment via proximal familiarity and biographical information as well as to individualizing care by empathetically linking their own bodily experiences and forging bonds of fictive kinship with residents. These contributions were neither captured by RAI/MDS categories nor relayed to the interdisciplinary team. Causal factors for PSW exclusion included computerized records, low status, and poor interprofessional collaboration. Intraprofessional collaboration by PSWs aimed to compensate for exclusion and to individualize care. Implications: Exclusive institutional reliance on the RAI/MDS undermines quality care because it fails to capture residents’ preferences and excludes input by PSWs. Recommendations include incorporating PSW knowledge in care planning and documentation and examining PSWs’ nascent occupational identity and their role as interprofessional brokers in long-term care.

Dissemination of research-based knowledge in an intensive care unit—A qualitative study

A gap exists between best evidence and best practice in intensive care units. The aim of this study was to investigate different aspects of intensive care nurses' and physicians' inter- and intraprofessional collaboration, with focus on factors associated with standardised weaning from mechanical ventilation. A qualitative design was used for implementing research-based knowledge into multistage focus group discussions. Data were analysed by means of qualitative content analysis. One main theme emerged: The need for strategies aimed at improving quality control of care, and three sub-themes: 'Interprofessional learning', 'Quality control of care', and 'Teamwork and communication'. The multistage focus groups were perceived as an important interprofessional arena for improving quality of care. Improvement projects and research dissemination must be regarded as vital parts of the organisation's ongoing development work. Management was perceived as crucial for success. Interprofessional research dissemination was perceived as important both in the creation of a common understanding and in knowledge development. Managers should make use of the valuable knowledge possessed by bedside professionals in their strategic planning. There is a need to allocate time for learning and reflection to provide a safe practice environment.

Advanced and Specialist Nursing Practice: Attitudes of Nurses and Physicians in Israel

With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles. Our goal is to evaluate Israeli nurses' and physicians' attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice. Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire. In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients' health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less-tenured physicians. We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change. Inter- and intra-professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase quality of care and patient satisfaction.

Achieving social accountability through interprofessional collaboration: The Canadian medical schools experience

Social accountability in the health professions is increasingly recognized as a necessary foundation for delivering effective healthcare. Inter- and intra-professional collaboration is critical to the process in order to transform intent into action. This article outlines the three-year program undertaken by a national collaboration among all 17 Canadian medical schools and their partners as they engaged in a journey leading to the incorporation of social accountability in an interprofessional context as the cornerstone of healthcare education and practice. An overview of the various dimensions of this project is discussed in order to shed light on how a national initiative in collaboration with local initiatives can synergistically work toward a common goal. Successes and challenges in working on a national level are reviewed with implications for future directions for interprofessional collaboration in healthcare based upon principles and values of social accountability.

Improving care through collaborative working in tissue viability

Collaboration is necessary in order to achieve the government aim of seamless care, but research has tended to focus on inter-professional, rather than intra-professional collaboration. A group of tissue viability nursesfrom across Manchester formed a collaborative group to strengthen their influence across their trusts and to achieve improvements in care through targeting specific objectives. This article discusses the rationale for collaboration, and reports an evaluation of the tissue viability nurse group's first year.

In the Service of Children: Art and Expressive Therapies in Public Schools

This article describes an intraprofessional collaboration between a graduate program in art therapy and expressive therapies, an urban public school system, and a community mental health agency. It addresses the relationship between the state of society, the state of schools, and the need for community involvement within the schools. The authors examine the important role of art and expressive therapies in providing services to underserved, “at-risk” children in public school settings. It also describes the role of off-site art and expressive therapies' supervisors in educational settings and the development of a handbook to guide therapist trainees in the supervision process. The final section consists of case vignettes which illustrate the use of art and expressive therapies in public schools.