Members Of Health Care Team Research Articles

Veteran and healthcare team perspectives on the TeleWound Practice Program within the Veterans Health Administration.

The Veterans Health Administration (VHA) recently piloted the implementation of the TeleWound Practice Program (TWP), which provides interprofessional wound care to Veterans remotely. We assessed the perceptions of Veterans and healthcare team members (HCTMs), and their experiences with the TWP. We surveyed Veterans from four VHA medical centres who had received at least one TWP visit between 1 May 2020 and 31 May 2021, and HCTMs associated with any TWP encounter between 1 September 2019 and 31 March 2021. Survey data were summarised using descriptive statistics and open-ended question responses were analysed using thematic coding. Out of 534 Veterans approached, 194 completed the survey (a 36% response rate). Most were interested in continuing to use TeleWound care (66%), felt more motivated to participate in their wound care due to the TWP (70%), and reported reductions in travel distance (81%) and cost (81%) related to wound care. Of the 32 HCTMs approached, 19 completed the TWP survey (a 59% response rate). Respondents indicated that the TWP improved their own professional decision-making skills (82%) and supported Veterans to take a more active role in their health (100%). Challenges included insufficient training for HTCMs, lack of stakeholder buy-in, and logistical and technical issues. Suggestions for improvement related to equipment, additional training and dedicated TWP staff. In this study, the Veterans were satisfied with the TWP and were more motivated to engage in wound self-management after receiving care through the TWP. HCTMs also perceived the TWP as beneficial to Veterans. However, additional efforts are needed to address barriers to TWP implementation across the VHA system of care.

Pediatric Fever in the Emergency Department: Triage to Caregiver Education.

The number 1 reason children 15 years of age and younger present to the emergency department is fever. To successfully address this common chief complaint, a consistent message must be sent by all health care team members. This consistent message must demonstrate a solid knowledge of the physiology of fever, which includes the benefits of fever and the pattern of fever during an illness. In addition, treatment of fever must be evidence based with a goal of comfort rather than normothermia. Nurses must address caregivers' concerns and consider the age, medical history, and clinical presentation of the child with fever when determining the appropriate triage level and management.

Long-Term Follow-Up After Bariatric Surgery: Key to Successful Outcomes in Obesity Management.

Background/Objectives: Bariatric surgery (BS) is considered one of the most effective interventions for the treatment of obesity. To achieve optimal long-term results, continuous follow-up (FU) within a multidisciplinary treatment team is essential to ensure patient compliance and maximize the benefits of BS. However, many patients find it difficult to maintain regular FU, which can affect the quality of care and lead to postoperative complications. This review aims to highlight factors that may hinder compliance with FU after BS, examine potential causes and consequences of inadequate FU, and identify strategies to improve patient participation in long-term FU. Methods: The literature search was conducted between October 2023 and June 2024 in Medline (PubMed) and the Cochrane Library datasets. Studies were selected for their relevance to adherence to FU, multidisciplinary approaches, and long-term bariatric outcomes. Results: The pre- and postoperative period is critical for educating patients and healthcare team members about the importance of FU, addressing potential barriers (e.g., logistical, psychological, and social challenges), and highlighting the risk of relapse to obesity after surgery. The lack of a standardized FU protocol leads to differences between medical centers, further impacting patient adherence. Conclusions: Tailored and regularly updated strategies are essential to address individual patient needs and improve adherence to FU. Further research is needed to identify the specific factors that influence variability in long-term BS outcomes, highlighting the need for a patient-centered approach to obesity treatment.

Interprofessional collaboration in primary care for patients with chronic illness: a scoping review mapping leadership and followership

BackgroundEffective interprofessional collaboration (IPC) in primary care is essential in providing high-quality care for patients with chronic illness. However, the traditional role-based leadership approach may hinder IPC. Instead, physicians should...

Examining the impact of rhythmic breathing and progressive muscle relaxation on acute pain following inguinal hernia repair: a parallel randomized clinical trial

BackgroundAcute postoperative pain is often reported after repair of inguinal hernia and can negatively impact patient satisfaction and clinical outcomes. This includes delayed wound healing, longer hospitalization, and increased health care costs. Non-pharmacological techniques like Progressive Muscle Relaxation (PMR) and Rhythmic Breathing (RB) have been suggested as possible interventions for managing this type of pain. The purpose of this study was to examine the effects of PMR and RB on postoperative pain following repair of inguinal hernia.MethodsThis parallel randomized controlled trial was conducted to examine 120 patients in the age range of 18 to 75 years with inclusion criteria: Repair of Inguinal Hernia under general anesthesia and no addiction to drugs and narcotics. These patients were randomly assigned to one of three groups: the RB group, PMR group, or the control group (which received standard care). The RB and PMR interventions were administered at 3, 6, 12, and 24 h after surgery. The primary outcome measure was the intensity of pain at the surgical site, assessed using the Visual Analog Scale (VAS). The secondary outcome measure was the amount of rescue analgesic (Pethidine). The one-way analysis of variance, Chi-square, post-hoc test, and repeated measures ANOVA were used for data analysis.ResultsFollowing the interventions, participants in both the RB and PMR groups exhibited significantly lower levels of acute pain after inguinal hernia repair compared to the control group across all four time periods, except at 12 h postoperatively in the RB group. However, there was no statistically significant difference between the RB and PMR groups. Additionally, the amount of pethidine consumed in the control group was significantly higher compared to the two experimental groups.ConclusionsBased on the results, both RB and PMR were found to be effective techniques in reducing patients’ pain. Therefore, it is recommended that healthcare team members, particularly nurses, actively learn and teach both RB and PMR.Trial registrationRegistered in the Iranian registry of clinical trials (www.irct.ir) in 31/01/2023 with the following code: IRCT20200206046395N2.

Birthing parent and companion verbal reactions following interactions with inpatient postpartum health care team members: an observational study using naturalistic filming

BackgroundRespectful, equitable, and supportive health care team interactions with patients and their companions are a key part of quality health care services. Despite the importance of communication and other aspects of engagement during inpatient postpartum care, little is known about how care is experienced during this period from families’ perspectives.MethodsThis study collected video and audio data with 15 birthing families (n = 9 English-speaking and n = 6 Spanish-speaking) and their health care team members during inpatient postpartum care in a southeastern United States academic medical center. This analysis quantifies health care team member presence in family hospital rooms, assesses linguistic appropriateness of health care team member verbal communication, and describes birthing parent and companion verbal reactions to health care team member interactions. A behavioral taxonomy was applied to identify these codes in the 12 h prior to hospital discharge. Additionally, we transcribed the birthing parent and companion verbal reactions for 10-minutes each time the health care team member departed their room. This content was inductively coded to identify topics and develop themes.ResultsA total of 160 h of video and audio data were coded across 15 participating families for this analysis. There were 19.9 h of missing data in the 12 h prior to hospital discharge due to equipment being turned off across five participants. At least one health care team member was present in the postnatal unit rooms within the observation period in 200 instances (median 13 times, range 5 to 19 times per participating family). Communication with Spanish-speaking birthing parents was linguistically appropriate for between 20.0% and 75.0% of interactions. Following health care team member presence, birthing parent and companion reactions were indeterminate 1 time, no verbal reaction 107 times, positive 25 times, confused 38 times, and negative 52 times. Many parents expressed more than one reaction. Reaction topics included clarity of information provided, postpartum pain management, hospital discharge coordination, health care team member conduct, and access to supplies.ConclusionThere are strengths in postpartum patient engagement as well as areas for health care team improvement. More appropriate communication including setting of clearer expectations surrounding various aspects of services on the postnatal unit may improve patient experiences. As a part of this improved quality of inpatient postpartum care, consistent utilization of interpretation services could decrease patient confusion, enable shared decision-making, and promote positive patient-provider relationships.

C.E. Credit Practice Quiz for “Sustainability in Dentistry: An Overview for Oral Healthcare Team Members”

C.E. Credit Practice Quiz for “Sustainability in Dentistry: An Overview for Oral Healthcare Team Members”

Qualitative Study of Health Care Team Perception of the Benefits and Limitations of Remote Symptom Monitoring.

Remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROS) connects patients and health care teams between appointments. Patient-perceived benefits and drawbacks of RSM are well-known, but health care team members' perceptions are less clear. Health care team members from the University of Alabama at Birmingham and the University of South Alabama Health Mitchell Cancer Institute participated in semi-structured qualitative interviews to explore their experiences and perspectives on RSM benefits and limitations. Interviews were audio-recorded, transcribed, and analyzed inductively using NVivo software to identify recurring themes and exemplary quotes. Thirty oncology health care team members, including physicians (n = 9), nurse practitioners (n = 2), nurses (n = 8), nonclinical navigators (n = 7), and administrators (n = 4), were interviewed. Findings were organized into five major themes: three benefits (Proactive, Improved Patient-Health Care Team Relationship, and Patient Engagement and Symptom Reporting) and two limitations (Health Care Team-Perceived Limited Patient Buy-In or Awareness and Workload and Workflow Issues). Health care team members perceived that RSM improved their ability to support patients and the quality of care delivered to patients by promoting proactive management, strengthening the patient-health care team relationship, and engaging patients in symptom reporting. Despite positive perceptions, health care team members also voiced drawbacks of RSM related to the lack of patient buy-in or awareness and increased workload and disrupted workflow. Although health care team members recognized the benefits of RSM as a standard of care, future work is necessary to address identified limitations to support wide-scale implementation of RSM in oncology practices.

Birthing parent perspectives on measuring the quality of perinatal care: metrics, timing, and process.

Centering birthing parents is critical for improving reproductive health policies and practices. This study investigates patient perspectives on measuring the quality of perinatal care. A cross-sectional qualitative research study was conducted at an academic medical center in the Southeastern United States. Individuals who had recently given birth participated in audio-recorded interviews between May 2020 and September 2020. This analysis addresses the research question, "If we were providing quality healthcare for families, how would we know?" Transcribed and translated responses were inductively coded to develop categories and identify themes. Forty birthing parents participated in the study. Metrics, timing, and process were identified as important components of meaningfully measuring the quality of perinatal care. Recommended metrics included asking patients whether their health priorities were addressed. Additional metrics of importance were whether coping strategies were provided, the clarity of information provided, patient comprehension of health information, the extent to which care planning was collaborative among patients and their healthcare team members, whether clinicians alleviated patient doubts, patient feelings of being taken care of, healthcare team mannerisms, clinician demonstrations of respect for patient autonomy, and postpartum visit attendance. With regard to timing, patients desired that their healthcare team members "check-in" with them as part of an ongoing, direct dialog. Birthing parents also wanted opportunities to provide feedback soon after encounters. As part of a robust measurement process, they wanted to share their insights with someone who was not a part of their healthcare team, for maintaining confidentiality. The patients desired a "serious platform" with accessible methods for all birthing parents to be able to convey nuanced accounts of their care. They also wanted to hear from the healthcare institutions about their feedback. Birthing parents sought assurances for their perinatal care feedback to be de-identified to protect them from potential retaliation. The participants recognized that they might need to utilize healthcare services from the same institution and individuals in the future. Birthing parents expressed desire for their perinatal healthcare experiences to be understood. Meaningful quality measurement may be promoted through transparent and multimethod opportunities for patients to securely share insights. In addition to healthcare systems communicating assurances of patient confidentiality, institutional feedback in response to patient-reported experiences is recommended.

Patient perspectives on dietitians’ role in nutrition management among cancer patients: Implications for proactive care and communication

Objective: This study aimed to determine patients’ perspectives regarding the role of dietitians in nutrition management. Methods: This study was conducted at our hospital’s oncology outpatient clinics. It used a questionnaire previously reported in the literature. One hundred sixty-two adult volunteers were included in this study. Patients’ knowledge of nutritional information, preferences for nutrition care, and perspectives on the dietitian’s role were measured. Descriptive statistics were used to describe the continuous variables. The degree of agreement was assessed using a 5-point Likert scale. Results: Nutritional care was a high priority for most volunteers (74.7%). Almost half of the patients expressed a need for dietitians to address their dietary challenges proactively. Most patients (64.2%) first met with a dietitian during ongoing treatment. They emphasized the need for frequent meetings and were willing to be referred to a dietitian earlier in their treatment. Conclusions: Most patients are referred to a dietitian after malnutrition, indicating the need for earlier intervention. Patients strongly desire improved communication among the healthcare team members regarding their nutritional concerns. Proactive nutritional management can reduce the incidence of malnutrition and enhance patient outcomes.

Students’ Engagement in Learning Nursing Pharmacotherapeutics: A Self-reported Volunteer Experience

Hands-on experiential learning within a clinical setting and the integration and translation of theoretical knowledge to practice have been explored as pedagogical methods to enhance nursing education. This study reports nursing students’ self-assessment of volunteer learning experience at hospitals and community pharmacies to enhance nursing pharmacologic knowledge. The study quantitatively evaluated the self-reported assessment of nursing students at hospital and community pharmacies in Belize using a convenient sampling technique. Forty-six nursing students spent 48 hours at assigned community and hospital pharmacies under the supervision of a licensed pharmacist. Self-assessment questionnaires and the grades from preceptors were analysed and reported. Students described a positive experience with high mean scores indicating self-reported learning of new medications, drug side effects, labelling of drugs, dispensing prescriptions, patients’ assessment, communication and experience working alongside interprofessional healthcare team members. This study shows that undergraduate nursing students can benefit from volunteer learning at community and hospital-based pharmacies to enhance hands-on learning of pharmacotherapeutics knowledge. Daily interactions with pharmacists, medications and patients complemented students’ learning of medications and skills acquisition. Nursing educators should explore nonconventional pedagogical approaches, such as pharmacy clinical sites, to complement students’ pharmacologic learning.

The Role of Telemedicine in Transforming Palliative Nursing Care: Challenges and Implications for End-of-Life Care

Telemedicine is undoubtedly a powerful solution to transform nursing practices in palliative care, with a particular focus on improving care for terminally ill patients. This report highlights the value of telemedicine in end-of-life care by examining issues related to compensation, emphasizing communication and ethics, and addressing the social implications of the field. The telemedicine model of palliative services results in universally accessible healthcare that overcomes geographical barriers and provides equitable care. Additionally, it plays a crucial role in establishing better communication among healthcare team members, including doctors, patients, and patients’ families, thus fostering collaboration and coordination in patient treatment and health management. Conversely, the challenges associated with technological obstacles and depersonalization due to digital interactivity require careful consideration. Socially, telemedicine may also exacerbate healthcare disparities, disproportionately impacting under-resourced and ethnic communities. Furthermore, the shift towards telecare may alter caregiver-patient relationships, as advancing technology could affect these dynamics unless the approach incorporates the patience and compassion essential in caregiving. Healthcare providers bear a social responsibility to ensure equitable access to telemedicine while upholding the fundamental principles of end-of-life care.

Training providers to implement heart failure shared medical appointments: A qualitative evaluation.

Shared medical appointments (SMA) help patients learn skills to self-manage chronic medical conditions. While this model of care delivery is thought to improve access to care with an efficient use of healthcare providers' time, many healthcare teams struggle to implement this healthcare model. Guidance and training resources on the implementation of SMAs is expected to improve adoption, implementation and sustainability of SMAs. Our evaluation team collaborated with the HF SMA trainer to complete a developmental formative evaluation of a two-day training program with a goal of adapting the training program and to better suit the needs and resources of healthcare teams interested in implementing HF-SMAs. Our evaluation team interviewed members of healthcare teams participating during each stage of training: pre-training, post-training, and post-implementation. The evaluation team also observed training sessions and reviewed minutes from debrief and training team meetings. Qualitative data collected from interviews, observations and document reviews were analyzed using matrix analysis with a focus on identifying potential adaptations to improve the HF-SMA training program. Data summaries were presented by the evaluation team to the training team for consideration. Training program participants found the training comprehensive, useful, and helpful; they highlighted how the trainers were experienced SMA providers who shared lessons learned. While participants found the training to be useful, opportunities for improvement, success of the virtual format and identified six adaptations: 1) the two-day training was reduced to short online modules, 2) curriculum was adapted to fit local site's needs, 3) added periodic one-on-one coaching, 4) shifted training to focus on skills and knowledge needed for each team member requirements, 5) adapted curriculum provides for more team building during premeeting assignments, and 6) training had more information included. We offer/present an improved model for a HF-SMA training program. Future studies, potentially using comparative designs to measure success and sustainability are needed.

Physician experiences of team-based clinical microsystems: implications for the future of inpatient interprofessional communication

ABSTRACT Healthcare clinical microsystems are small, goal-oriented groups of healthcare professionals that work together on a regular basis to provide care to discrete patient populations. They often include team-based frameworks such as bedside interprofessional rounds, geographic colocation of healthcare team members, interprofessional staff leadership, and unit-level data sharing. In inpatient settings, microsystems improve interprofessional communication and collaboration. In this qualitative study, we examined physician experiences of clinical microsystems and the mechanisms underpinning interprofessional communication in this environment. We interviewed 51 resident and hospitalist physicians. Thematic analysis of physician experiences revealed three key themes: (a) Clinical microsystem effect on workflow, (b) Open forum and work relationships, and (c) Face-to-face vs technology-based communication. Physicians described strong interprofessional relationships based on frequent face-to-face communication. Familiarity with healthcare team members, often resulting from being co-located to the same units, created a comfortable work environment, advanced patient care, and accelerated workflow. Physicians preferred in-person communication with interprofessional colleagues over technology-based communicationand described how in-person interactions enriched subsequent technology-led interactions. As the use of technology-based communication grows in inpatient settings, decreasing face-to-face interactions and facilitating dispersed care, understanding and implementing optimal conditions for effective interprofessional communication is essential.

Abstract 4139192: Remote monitoring platform improves communication and clinical decision making for pediatric interstage healthcare team members

Background: Asynchronous remote patient monitoring (RPM) is increasingly common in healthcare models for infants with congenital heart disease (CHD). Using a downloadable mobile application with a software platform like CHAMP App ® allows parents to proactively engage in data entry, providing pediatric healthcare teams (HCT) timely information without relying solely on parent messaging or calls. Research Question: How does the use of RPM impact family communication and clinical decision-making experiences for HCTs? Goals: To identify the HCT’s experience through a secondary review of the CHAMP Cardiac Repository, using parent-entered interstage data from home for infants with CHD. Methods: This retrospective multi-institution cohort (Table 1) spanned from 5/2019-8/2023, collecting HCTs feedback via Likert responses (Table 2) about experiences with infant monitoring endpoint, which were analyzed in SPSS. Results: Response rates of 75.8% (493/650) were achieved across 10 pediatric cardiac care centers. HCTs reported improved communication (4.5 + .77) and clinical decision-making with video reviews (4.47 + .79). Parents' data engagement averaged 268 + 195.3 total points (oxygen saturation, weights, and/or videos) per infant. Higher engagement correlated with better HCT communication (p <.001) and decision-making (p <.0001), both with small effect sizes. Improved clinical decision-making was noted in families who used study-provided iPads for video recordings (mean score 4.63 ± 0.84) compared to those using personal devices (mean score 4.42 ± 0.734, p = .03), with 69.2% using personal devices. Conclusions: In this modern cohort, families engaged well with data entry through a remote monitoring platform, and HCTs reported significant improvements in communication with families for their child’s data from home and clinical decision-making after reviewing videos. Future research should explore barriers to mobile data engagement and assess HCT preferences for video review.

Navigating Voluntarily Stopping Eating and Drinking in Hospice Settings: A Multidisciplinary Approach.

This article explores current global research on voluntarily stopping eating and drinking (VSED) and presents a detailed, deidentified case study of a patient who elected VSED in a hospice setting in the Southeastern United States. It highlights the collaborative efforts of health care professionals in effectively supporting the patient and family, sharing multiple perspectives from various health care team members who cared for the patient and family. It offers evidence-based recommendations to guide health care teams through the ethical, medical, and emotional challenges of VSED, ensuring compassionate and competent care. The article emphasizes the importance of structured protocols and empathetic care in hospice settings, advocating for the education and preparation of health care teams and families to address the complex challenges associated with VSED. By promoting open communication, interdisciplinary collaboration, and comprehensive support, hospices can respect the autonomy of patients and families choosing VSED, ensuring a compassionate and dignified end-of-life experience.

Measuring Patient Well-Being During Whole-Person Clinical Care: Lessons From the Veterans Health Administration Well-Beings Signs Implementation Pilot.

Measuring patient well-being during clinical care may enhance patient-centered communication and treatment planning. The Veterans Health Administration (VHA) piloted the use of the Well-Being Signs (WBS), a self-report measure of psychosocial well-being, in clinical care. To understand early WBS implementation and health care team member experiences with its use before developing detailed support materials and finalizing the measure. We conducted a mixed-methods evaluation of the WBS implementation pilot at 4 VHA facilities, including surveys of (n=4) Whole Health (WH) leaders/clinical leads, and semi-structured interviews with (n=11) clinical leads and team members. Survey data were characterized using descriptive statistics; interview data were analyzed using rapid qualitative analysis. Facilities supported WBS implementation by disseminating information to clinical team members, primarily during staff meetings (3/4 facilities), individual discussions (3/4), and email (3/4); only half provided training sessions. In interviews, some care team members expressed the need for more training on using the WBS in clinical care. Some interviewees also provided suggestions for changes to the draft measure, including response option format and question look-back period. Although there have been growing calls for attention to patient well-being in clinical care, our results suggest barriers to the implementation of well-being measures in this context. Findings were used to inform the development of enhanced training materials and make modifications to enhance the acceptability of the WBS to providers. Other identified barriers will need to be addressed in future implementation efforts, including bolstering leadership support and easing the added time and burden of administration.

Sustainability in Dentistry: An Overview for Oral Healthcare Team Members

Sustainability in Dentistry: An Overview for Oral Healthcare Team Members

Implementing and Evaluating a Pilot Interprofessional Training Program to Engage Health Care Teams in Cost of Care Conversations.

This study evaluated the impact of Financial and Insurance Navigation Assistance-Training - a pilot interprofessional training program to facilitate cost of care (CoC) conversations and address health-harming social determinants of health in a pediatric hematology-oncology clinic. A pre-post study design was used to evaluate the impact of Financial and Insurance Navigation Assistance-Training on an interprofessional health care team's (clinicians, social workers, financial navigator, and legal advocates) knowledge, attitudes, and behaviors related to CoC conversations and screening, referring, and collaborating with interprofessional team members. Data were collected via surveys administered at baseline/pretraining, immediate post-training, and 12-month post-training. Most health care team members (n= 21) reported improvement in their knowledge of available financial (66.7%) and legal resources (86.7%) and ability to address social needs (93.3%), financial needs (93.3%), and facilitate CoC conversations with patients and caregivers (66.7%). Improvements in attitudes and behaviors toward engaging in CoC conversations, screenings, and referrals were relatively improved as a result of the training. However, there was a lower positive rate for actual behaviors around routine screening and initiating discussions on out-of-pocket costs, suggesting a need to address barriers. Study findings highlight the importance of interprofessional education in helping health care teams address social determinants of health through effective CoC conversations.

A Qualitative Study of Patient and Interprofessional Healthcare Team Member Experiences of Bedside Interdisciplinary Rounds at a VA: Language, Teamwork, and Trust.

Patient and interprofessional healthcare team member experiences of bedside interdisciplinary rounds (BIDR) are generally positive. Overall, there is large heterogeneity in existingBIDR frameworks, and best practices have not been defined. Understand patients' and interprofessional healthcare team members' experiences of BIDR. Academic VA Medical Center (VAMC) with daily structured BIDR. Inpatients, nurses, pharmacists, and care coordinators who participated in BIDR. We conducted semi-structured qualitative interviews with study participants about their experiences with BIDR between January and June 2020. All interviews were recorded and professionally transcribed. We used thematic analysis to identify key themes. We interviewed 14 inpatients and 18 interprofessional healthcare team members, including nurses, pharmacists, and care coordinators. Patients participating in BIDR reported positive perceptions of being included in the discussion of their healthcare plans and increased trust in providers; patient discomfort resulted from physician use of technical language and frombeing presented with unclear, vague careplans. Interdisciplinary healthcare team members participating in BIDR reported an increased understanding, respect, and trust for other team members and improved patient care; challenges were posed by lack of supportive structural elements to interprofessional workflow and prolonged physician presentations. BIDR can build trust between patients andhealthcare providers and within the interprofessional team by creating a setting where teamwork interactions can be observed. Based on our findings, we recommend trust-building practices for BIDR, which include sharing BIDR goals with patients, using patient-centered language, creating structures for interprofessional inclusion, defining team roles, using standardized communication, and addressing interprofessional inputs in real time.