Lack Of Role Clarity Research Articles

Development and Implementation of a Medical Respite Program for People Experiencing Homelessness: An Analysis of a Cross-sectoral Partnership.

People with lived experience of homelessness (PWLEH) undergo worse health outcomes despite frequent acute care use, often because their functional and social needs remain unmet. In response, a homeless shelter and the provincial health authority formed a partnership to implement a medical respite program. We describe this collaboration by conducting a qualitative study, interviewing people involved in planning and implementing the program (n=25). Thematic analysis was performed. Stakeholders were motivated by a common desire to address the health inequities experienced by PWLEH, and frontline service providers felt a sense of teamwork. However, due to logistical limitations, an evolution of partnerships, and lack of role clarity, there was no singular program vision, resulting in lack of stakeholder support and conflicts between partner organizations. Health care for PWLEH must be multidisciplinary and cross-sectoral. The synergies and challenges described shed light on how future partnerships can be navigated.

Knowledge and Attitudes of Allied Health Professionals Towards End-Of-Life and Advance Care Planning Discussions With People With COPD: A Cross-Sectional Survey Study.

Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting condition. End-of-life (EOL) and Advance Care Planning (ACP) discussions are essential, yet access and support remain inadequate. Allied health professionals (AHPs) commonly have ongoing relationships with patients and opportunities to discuss care outside acute crises as is considered best practice. Australian and New Zealand AHPs were invited to complete an anonymous, online, cross-sectional survey that aimed to explore knowledge, attitudes and practices, and associated perceived triggers and barriers to EOL and ACP discussions with patients with COPD. Closed survey responses were summarized descriptively and free-text thematically analysed. One hundred and one AHPs (physiotherapists, social workers and occupational therapists) participated. Many held positive attitudes towards ACP but lacked procedural knowledge. Half (50%) of participants routinely discussed EOL care with patients when perceiving this to be appropriate but only 21% actually discussed ACP with the majority of their patients. Many cited lack of training to engage in sensitive EOL discussions, with barriers including: 1) clinician lack of confidence/fear of distressing patients (75%); 2) perceived patient and family reluctance (51%); 3) organizational challenges (28%); and 4) lack of role clarity (39%). AHPs commonly have ongoing relationships with patients with chronic conditions but lack the confidence and role clarity to utilise this position to engage ongoing EOL and ACP discussions. While AHPs may not traditionally consider EOL and ACP discussions as part of their role, it is crucial that they feel prepared to respond if patients broach the topic.

Early childhood development practices in a remote Aboriginal Community Controlled Health Services setting.

Supporting Early Childhood Development (ECD) is an Australian national priority. Aboriginal children in Western Australia's Kimberley region have much higher rates of developmental concerns at school entry than non-Aboriginal children. We aimed to describe ECD practices in the participating service; document follow-up of identified developmental concerns; and identify barriers and enablers to incorporating ECD practices into clinic activity. Mixed-method design incorporating clinical audit and staff interviews. An Aboriginal Community Controlled Health Service (ACCHS) in the Kimberley region. A total of 176 children receiving primary health care through the participating ACCHS; interviews with five ACCHS staff members. Frequency of developmental enquiry by age and domain; follow-up of identified developmental concerns; and barriers and enablers to ECD practices. Developmental enquiry was documented for 114 of 176 eligible children (65%), including in 80% of ACCHS child health assessments. Standardised ECD assessments were less common. Staff were aware of the importance of developmental enquiry, however, barriers to increasing ECD practices included a lack of resources and structured staff education, time pressures and a lack of role clarity between the ACCHS and government community health clinic. This study provides insight into ECD practices in an ACCHS setting, highlighting the potential of primary health care to have an enhanced role in ECD if appropriate systems, training and tools are provided. A lack of role clarity across services, combined with poor communication between services, creates a potential risk for missed opportunities to support ECD.

Cancer care clinicians' provision of smoking cessation support: A mixed methods study in New South Wales, Australia.

Given the importance of supporting cancer patients to quit smoking, we sought to ascertain cancer care clinicians' beliefs and practices regarding providing smoking cessation brief interventions. We used a cross-sectional sequential explanatory mixed method design, including a survey of multidisciplinary cancer care clinicians and semistructured interviews. One hundred and sixty-five cancer care clinicians completed the survey and 21 participated in interviews. Over half of survey respondents (53%) said they do not regularly undertake smoking cessation brief interventions and 40% rarely or never advise quitting. Nonmetropolitan clinicians were more likely to discuss medication options and refer to the Quitline. Physicians were more likely to do brief interventions with patients and radiation therapists were least likely. Barriers were lack of training and experience, lack of knowledge of the Quitline referral process, lack of role clarity, lack of resources and systems, and perceived psychological ramifications of cancer for patients. There is a need to upskill cancer clinicians and improve systems to provide smoking cessation brief interventions as part of routine clinical practice. All cancer care clinicians should complete brief intervention smoking cessation training relevant to the cancer context, including making referrals to Quitline, and be supported by systems to record and follow-up care.

Barriers and facilitators of following perioperative internal medicine recommendations by surgical teams: a sequential, explanatory mixed-methods study

BackgroundPreoperative medical consultations add expense and burden for patients and the impact of these consults on patient outcomes is conflicting. Previous work suggests that 10–40% of preoperative medical consult recommendations are not followed. This limits measurement of the effect of perioperative medical consultation on patient outcomes and represents a quality gap, given the patient time and healthcare cost associated with consultation. We aimed to measure, characterize, and understand reasons for missed recommendations from preoperative medical consultation.MethodsThis explanatory, sequential mixed-methods study used chart audits followed by semi-structured interviews. Chart audit of consecutive patients seen in preoperative medical clinic were reviewed to measure the proportion and characterize the type of recommendations that were not completed (“missed”). This phase informed the interview participants and questions. The interview guide was developed using the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Template analysis was used to understand drivers and barriers of missed recommendationsResultsChart audit included 255 patients (n=161, 63.1% female) seen in preadmission clinic between April 1 and April 30, 2019. 55.7% of patients had all recommendations followed (n=142). Postoperative anticoagulation management and postoperative cardiac biomarker surveillance recommendations were least commonly followed (50.0%, n=28, and 68.9%, n=82, respectively).Eighteen surgical team members were interviewed. Missed recommendations were both unintentional and intentional, and the key drivers differed by these categories. Unintentionally missed recommendations occurred due to individual-level factors (drivers: knowledge of the consultation note, lack of routine for reviewing the consultation note, and competing demands on time) and systems-level factors (driver: lack of role clarity). Intentionally missed recommendations occurred due to user error due (drivers: lack of knowledge of guidelines or evidence) and appropriate modifications (driver: need to adapt a preoperative plan for a complicated postoperative course).ConclusionsOnly 55.7% of consult notes had all recommendations followed, suggesting a quality gap in perioperative medical care. Qualitative data suggests multiple drivers of missed recommendations that should be targeted to improve the efficiency of care for these patients.

Determining the Impact of COVID-19 on End-of-Life Experiences of Family Caregivers for People Living With Dementia

COVID-19 has impacted all of our lives, but the population most at risk are older adults. Family caregivers (FCGs) for people living with dementia (PLWD) face challenges in providing care, which are compounded with the introduction of COVID-19 public health policies. The purpose of this study was to examine the experiences of FCGs where the PLWD died during the COVID-19 pandemic. FCGs were invited to participate in an online survey to examine their caregiving experiences during the COVID-19 pandemic, with the option of participating in a follow-up focus group. Sixteen FCGs whose family members with dementia died during the pandemic participated in the survey. A follow-up focus group was conducted to further examine how COVID-19 policies impacted their role as a caregiver in long-term care (LTC) and affected their ability to grieve. The results of the survey and focus group suggest that a lack of role clarity and inadequate communication channels between the FCG and LTC due to COVID-19 increased the strain FCGs faced during end-of-life care. At the end of life, public policies, such as reduced or no visitation, led to feelings of inadequacy and regret. Several participants also expressed appreciation for completing Advanced Care Planning documentation prior to COVID-19. Based on these results, policymakers can help ease the increased turmoil faced by FCGs during end-of-life care in future public health emergencies by involving FCGs of PLWD in the decision-making process. The completion of Advanced Care Planning documentation can also ease the burden FCGs may experience during end-of-life care.

“I’m just a TA”; From mixing paints to managing safeguarding and class teaching: An exploration of teaching assistant's perceptions and roles in school

This small-scale piece of research listened to the stories, experiences and perceptions of teaching assistants to hear their lived experiences of the role of teaching assistant. To hear how expectations have altered with/without legislative and framework guidance and consideration of the individuals who take up teaching assistant roles, in a climate where there is a succinct lack of legal requirement for any training or qualifications to be undertaken prior to or during the job role. The findings indicated that there appears to be an ethos within primary educational settings that teaching assistants can ‘do it all’ at ‘all times’, that there is a lack of clarity in role and responsibilities across the ‘unqualified staff’, and furthermore that they self-position as “Just a TA”.

Challenges to Employing Shared Decision Making With Adults Under Community Supervision Who Have a Mental Illness.

Adults under community corrections supervision and who have a mental illness (MI) are expected to comply with conditions of release which often include involvement with supportive social services. The rates of technical violation, arrest, and incarceration that result from failure to comply with these mandates are exceedingly high. Shared decision making among officer-supervisors and client-supervisees is a promising approach to promote engagement in community corrections services among supervisees who have MI. This paper reviews recent research on shared decision making and identifies three barriers to its implementation in this context: (1) a lack of role clarity, (2) a predilection for risk avoidance, and (3) stigma toward supervisees. Empirically supported recommendations are suggested to aid in overcoming these obstacles, facilitate shared decision making, and promote recovery among this population: (1) unification of supervisor rehabilitative and public safety roles, (2) maximizing opportunities for self-determination through low-stakes events and/or enhancement of supervisee strengths and capabilities, and (3) supervisor training in principles of mental health recovery.

Cancer survivorship care and general practice: A qualitative study of roles of general practice team members in Australia.

Primary care providers, including general practice teams (GPTs), are well positioned within the community to integrate cancer survivorship care into ongoing health management. However, roles of GPT members in delivery of cancer survivorship care have not been explored. The purpose of this study is to explore these roles from the perspectives of General Practitioners (GPs), Practice Nurses (PNs) and Practice Managers (PMs). An interpretive qualitative study using semi-structured in-depth telephone interviews with ten GPs, nine PNs and five PMs was conducted. Interviews were recorded, transcribed and analysed using grounded theory methods. Perspectives of roles in delivery of cancer survivorship care were highly variable. Variation was evident among perceptions of needs of cancer survivors, individual team members' scopes of practice, and individual professional knowledge and skills. A lack of clarity in roles and responsibilities of GPT members was thought to contribute to a lack of consistency in survivorship care. Reducing variations in perceptions of survivorship care in the primary care setting should be a priority. Such efforts may include development of practical guidance to support GPT members to clarify scopes of practice within the team. In addition to accessible comprehensive education programs, other innovative, tailored individualised education approaches may be helpful. System-level support in clarifying and supporting the roles of the primary care team is needed to facilitate a survivorship delivery system at general practice level where those within GPT can ensure that individual patients' needs are met in a timely and effective manner.

Working in a pandemic and post-pandemic period – Cultural intelligence is the key

Working environment has been transformed by this pandemic into flexible work arrangements with a swift acclimatization of technology. The post-pandemic working arrangements are expected to be increasingly driven by technology as business models will also evolve to adopt these changes. Virtual working arrangements bring several challenges like reduced trust, disrupted communication, limited collaboration, lack of role clarity and lowered team performance. The research suggests that the future of work is going to be more dynamic and virtual. The normal physical work arrangements that were in place before the pandemic will evolve to include multiple models. Therefore, the challenges and problems associated with virtual working needs to be addressed along with the increasing adoption. Cultural intelligence helps in fostering ‘trust and understanding’ even among virtual teams. The study surveyed people working virtually during this pandemic and analysed, if cultural intelligence and its dimensions i.e. cognitive, metacognitive, motivational and behavioural have effect on the challenges faced by the virtual teams. It is observed that the behavioural cultural intelligence predicts virtual team effectiveness and address the challenges faced by virtual teams.

Developing interprofessional collaborative practice competencies in rural primary health care teams

BackgroundLeaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs. PurposeDescribe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture. MethodsThe implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP. FindingsSignificant improvement (p < .035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership. DiscussionPartnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice.

Current occupational therapy scope of practice in the work-to-retirement transition process: An Australian study

Background Occupational therapists have skills to work with people considering or experiencing the transition from paid work to retirement. Aim The aims were to explore: (1) occupational therapists’ experiences and perceptions in working with people transitioning to retirement; (2) current scope of practice of occupational therapy in the work-to-retirement transition; and (3) factors influencing current scope of practice of occupational therapy in the work-to-retirement transition. Methods Qualitative semi-structured interviews with Australian occupational therapists were thematically analysed. Results Fourteen Australian occupational therapists were interviewed. Three overarching themes (12 sub themes) emerged: (1) occupational therapists’ application of a contemporary occupational paradigm; (2) current approaches adopted by occupational therapists are add on, stylistic and talk based; and (3) contextual challenges and opportunities encountered by occupational therapists. Conclusion/significance Occupational therapists use enablement skills (e.g. coach; collaborate) and consider various professional reasons (e.g. engagement in meaningful occupation; health responsibility) when addressing the transition from work to retirement. Overcoming barriers to service provision (e.g. funding; lack of role clarity) will facilitate a more comprehensive service provision to enable health and well-being of older adults.

Experience of the Irish physician associate role: PA and supervising consultant perspectives

Background: The physician associate/assistant (PA) role was introduced into the Irish healthcare system in 2015 when four PAs from North America were recruited to work in Ireland as part of a two-year pilot program. In parallel, the Royal College Surgeons in Ireland (RCSI) began its own PA program in January of 2016 and has graduated 25 PAs. To date, there is little published on the few Irish-trained PAs. This study seeks to share initial experiences with the PA profession in Ireland.Methods: This descriptive phenomenological study explores the newly implemented PA role in Ireland through semi-structured, one-to-one interviews with five PAs and their supervising consultants in Dublin, Ireland. Questions centered on the PA scope of clinical practice, satisfaction with the role, acceptance by the medical team, and integration into the Irish healthcare system.Results: Six themes were identified from the interviews: continuity of patient care, flexible scope of practice, lack of role clarity, complementary to the medical team, regulation and prescribing challenges, and the emerging role of the PA.Conclusions: The development of the PA role is in its infancy in Ireland, but this study suggests that they fill an important role by providing continuity of care to both patients and the medical team. Currently, there are significant challenges imposed by a lack of regulation of the PA profession and the inability to prescribe. However, PAs in Ireland appear to enjoy their work and have great potential to expand throughout Irish healthcare and are valued by their team members.

Professional development in clinical facilitation: An integrated review

<h2>ABSTRACT</h2><h3>Background</h3> Clinical facilitators have an essential role in the development of safe and committed nurses worldwide, but the approach to provision of professional development to help clinical facilitators reach potential is informal, inconsistent and not always relevant to their learning needs. It is important to examine the reported role tensions to generate solutions to the problems and include these teachings in professional development opportunities for clinical facilitators. <h3>Method</h3> An integrative literature review was undertaken intending to understand and collate the tensions, constraints, as well as supports, and best practice in the role. <h3>Results</h3> The review identified 40 relevant studies. <h3>Conclusion</h3> The identified studies highlighted challenges such as lack of role clarity and lack of evaluation of professional development approaches, which hamper best practice; as well as exemplary practices, such as peer-to-peer learning; which has potential to advance the sub-specialty of clinical facilitation.

Association of poor psychological well-being with co-exposure to psychosocial factors at work in Korean regular workers.

This study evaluated the association of co-exposure to different psychosocial factors with poor psychological well-being of Korean regular workers. This was a secondary analysis of data from the fifth Korean Working Conditions Survey, conducted in 2017. Multiple logistic regression was used to determine adjusted odd ratios (aORs) and 95% confidence intervals for poor psychological well-being associated with self-reported psychosocial factors. Poor psychological well-being was measured using the Well-Being Index of the World Health Organization. For each question on psychosocial factors (long weekly working hours, lack of decision latitude, work pressure, lack of autonomy, lack of role clarity, organizational injustice, lack of reward, and lack of support from managers), answers of "always" and "most of the time" were classified as affirmative and answers of"sometimes," "rarely," and "never" were classified as negative. Poor psychological well-being was significantly associated with most individual work stressors for both sexes (aORs = 1.22-1.83). Furthermore, poor psychological well-being had a positive association with co-exposure to different psychosocial factors (aORs = 1.71-8.08). Co-exposure to an increasing number of psychosocial factors showed greater association with poor psychological well-being. We found that poor psychological well-being was associated with co-exposure to psychosocial factors in Korean workers in regular employment. Thus, we suggest that employers provide comprehensive measures that will protect workers from simultaneous exposure to adverse psychosocial factors.

How Ineffective Interprofessional Collaboration Affects Delivery of Breast Reconstruction to Breast Cancer Patients: A Qualitative Study

Despite the benefits of breast reconstruction (BR), health care professionals do not consistently integrate it as an option in the treatment of breast cancer patients. Interprofessional collaboration (IPC) amongst professionals may facilitate the elaboration of comprehensive oncological treatment plans. As the application of IPC in the delivery of BR has not yet been studied, we undertook a qualitative study to explore the perceptions of physicians and administrators on IPC in breast cancer care and how these impact BR delivery. Interviews were conducted with 30 participants (22 physicians and 8 administrators). Physician interviews focused on their personal beliefs and values regarding BR, while administrator interviews explored their institutional treatment regimens as well as the availability of a BR program. Our thematic analysis was informed by the Canadian Interprofessional Health Collaborative (CIHC) competency framework. IPC challenges were thought by participants to affect the delivery of BR. At the physician level, a lack of role clarity as well as the absence of an explicitly established leader negatively influence collaboration in BR delivery. In addition, varying views on the usefulness of BR and on the role of plastic surgeons in breast oncological teams discourage positive collaboration, rendering the delivery of BR more difficult. The delivery of BR is overall impaired due to a lack of effective IPC. IPC could be improved through clarifying physician roles, establishing clear leadership, and aligning viewpoints on quality oncological care in collaborative teams; ultimately, this may promote equitable BR delivery for breast cancer patients.

Freelancers as Part-time Employees: Dimensions of FVP and FJS in E-Lancing Platforms

The purpose of this study is to explore the dimensions of Freelancer Value Proposition (FVP) and Freelancer Job Stress (FJS). This study provides insights about the factors which create value for freelancers and also sheds light on the factors which cause stress to freelancers while freelancing with the help of an online platform. Semi-structured interviews were conducted for data collection from freelancers. The grounded theory approach was used and data analysis follows the process of open coding, axial coding and themes formulation. Findings indicate that work-life balance value, developmental value, economic value, autonomy value, hedonistic value and social value are dimensions of FVP. Lack of role clarity, payment issues, time management issue, work availability issue, lack of perks and benefits and work rejections are dimensions of FJS. This study is the first effort to find out the dimensions of FVP and FJS, which will help to construct long-term relationship between freelancers and platform.

Shocks, stress and everyday health system resilience: experiences from the Kenyan coast.

Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses and organizational capacities underpinning those responses, with a view to contributing to the understanding of health system resilience. We drew on learning and experiences gained through working with managers using a learning site approach over the years. We also collected in-depth qualitative data through informal observations, reflective meetings and in-depth interviews with middle-level managers (sub-county and hospital) and peripheral facility managers (n = 29). We analysed the data using a framework approach. Health managers reported a wide range of health system stressors related to resource scarcity, lack of clarity in roles and political interference, reduced autonomy and human resource management. The health managers adopted absorptive, adaptive and transformative strategies but with mixed effects on system functioning. Everyday resilience seemed to emerge from strategies enacted by managers drawing on a varying combination of organizational capacities depending on the stressor and context.

Towards positive institutions: Positive practices and employees’ experiences in higher education institutions

Orientation: Positive organisational functioning is a paradox. Both positive and negative tendencies could enable positive functioning. While an overemphasis on either the positive or the negative aspect is dysfunctional, positive factors must be given extra emphasis for positivity to occur because negativity usually dominates. Research purpose: This study aimed to investigate how positive organisational practices relate to job demands and resources, person–environment fit and well-being. Motivation for the study: Work in organisations and experiences thereof are not always positive. However, focussing on positive practices even when the context and experiences thereof are negative might facilitate positive functioning of individuals and their institutions. Research approach/design and method: A cross-sectional survey design was used with a convenience sample of 339 academic employees from three higher education institutions in South Africa. The Positive Practices Questionnaire, the Job Demands–Resources Scale, two perceived person–environment fit scales and the Flourishing-at-Work Scale – Short Form were administered. Main findings: Results from latent profile analyses provided evidence of four latent profiles. Analysis showed that a perceived lack of positive practices in institutions was associated with perceptions of overload, lack of role clarity, poor supervisor and co-worker relationships, lack of person–environment fit, and reduced emotional, psychological and social well-being. Practical/managerial implications: Interventions should be employed by leaders to address positive practices in higher education institutions. Contribution/value-add: This study contributes to scientific knowledge regarding the relations between positive organisational practices and experiences of job demands and resources, person–environment fit and well-being of academics.

Health TAPESTRY: Exploring the Potential of a Nursing Student Placement Within a Primary Care Intervention for Community-Dwelling Older Adults.

The increasing prevalence of chronic diseases in aging places demands on primary care. Nurses are the major nonphysician primary care workforce. Baccalaureate nursing programs should expose students to primary care and older adults to support these demands and help recruit new graduates to this setting. However, many baccalaureate nursing programs focus on acute care and placements aimed at older adults are viewed negatively. To address these curriculum challenges, third-year Canadian baccalaureate nursing students were placed in an innovative primary care program—Health TAPESTRY—for community-dwelling older adults. Health TAPESTRY involves an interprofessional primary care team, trained lay volunteers conducting home visits, system navigation, and an online software application. The goal of this study was to explore third-year baccalaureate nursing students’ perceptions of this unique clinical primary care placement. This qualitative descriptive study explored students’ perceptions of this placement’s strengths, weaknesses, opportunities, threats (SWOT), and outcomes. Nursing students participated in focus groups (n = 14) or an interview (n = 1) and five completed narrative summaries following visits. Qualitative content analysis was supported by NVivo 10. Strengths of the clinical placement included training for the intervention; new insights about older adults; and experience with home visiting, interprofessional team functions, and community resources. Weaknesses included limited exposure to older adult clients, lack of role clarity, lack of registered nurse role models, and technology challenges. Opportunities included more exposure to primary care, interprofessional teams, and community resources. No threats were described. Nursing students’ clinical experiences can be enhanced through engagement in innovative primary care programs. Adequate exposure to clients, including older adults; interprofessional teams; mentoring by registered nurses or advanced practice nurse preceptors; and role clarity for students in the primary care team should be considered in supporting baccalaureate nursing students in primary care clinical placements.