Professional Team Members Research Articles

Points of tension: a qualitative descriptive study of significant events that influence undergraduate nursing students' sense of belonging

Soon-to-be graduate nurses who choose to begin their career in rural hospital settings face not only the challenge of learning to do rural nursing, but also how to navigate the complex personal and professional relationships that characterize the close knit community of rural hospital teams. Since every encounter with registered nurses and other members of the team is contextually mediated, the challenge for students, preceptors, other professional staff members, and nurse educators is to develop a supportive clinical environment that fosters students' sense of belonging. The objective of this study was to describe events that influence undergraduate nursing students' sense of belonging during a rural hospital preceptorship, and to explore their meaning. Using the clinical incident technique, a purposive sample of fourth year nursing students completing a rural hospital-based preceptorship in southern Alberta and British Columbia, Canada was used. Individual in-person and telephone interviews as well as written accounts were analyzed. Inductive and comparative analysis was used to uncover the themes 'points of tension' and 'minimizing the differences'. The clinical environment that includes everyone who interacts with the student has the potential to positively or negatively influence students' sense of belonging. Tension developed when students' expectations of their preceptor, nurses, and other professional team members did not coincide with the reality of the everyday clinical environment. Only when the differences between themselves and the registered nurses they worked with on daily basis were minimized did the participants in this study feel as if they belonged to the community of professional nurses. Nurse Educators need to carefully assess not only students' knowledge of rural nursing practice, but also students' expectations of themselves, their preceptor, other professional staff members, and the overall clinical environment. As such, students need to develop social awareness and facility. Preparation also extends to everyone in the clinical setting who is involved in the students' experience so that they learn not only what students know but how to interact with them. In this way the clinical environment is supportive of students' learning and transition to the graduate nurse role.

An interdisciplinary symposium on dementia care improves student attitudes toward health care teams

Interdisciplinary teams are sometimes used in the provision of health care to populations who present with complicated needs, such as older adults experiencing dementia. Moreover, there is an international consensus that health care students should receive training in interdisciplinary care. 157 health care students from Xavier University's College of Social Sciences, Health, and Education in Cincinnati, U.S.A. participated in a five-hour symposium on an interdisciplinary approach to treating older adults with dementia. The Attitudes Toward Health Care Teams Scale (ATHCTS; Heinemann et al., 1999) was used to assess student attitudes before and after the symposium. A paired-sample t-test was conducted to compare pre and post-test ATHCTS overall and subscale scores. There was a statistically significant increase in the overall pre-post ATHCTS scores and Quality of Care/Process Subscale scores. There was a significant decrease in the Physician Centrality Subscale scores. The findings suggest that, after the symposium, participants reported more positive overall attitudes about health care teams, and about the quality of care provided by such teams and the teamwork to achieve good patient care. Participants also displayed a decrease in their beliefs about how essential physicians are as leaders of health care teams. These results affirm the use of a brief interdisciplinary educational approach in changing student attitudes about the use of health care teams. Students who develop more positive attitudes about working on an interdisciplinary health care team recognize the team's value and therefore may be more receptive to and effective in working as professional team members in the future.

Achieving Interprofessional Practice in Cardiac Rehabilitation

Cardiac rehabilitation staff members consider interprofessional practice to be the standard for delivering effective care. However, it is not known how interprofessional teams collaborate or what they consider to be important elements of collaboration. Thus, it is important to investigate how healthcare professionals plan and communicate care, work together, and define their roles as members of the cardiac rehabilitation teams. The purpose of this report was to provide an analysis of current literature related to interprofessional practice in cardiac rehabilitation, with a particular focus on examining the terms interprofessional practice and collaboration. For this review, published articles in peer-reviewed journals for the preceding 20-year period were included from online databases (CINAHL, MEDLINE, EBM Reviews, PubMed, and Google Scholar). Key words used in the search included "cardiac rehabilitation," "cardiac recovery," and "interprofessional and interdisciplinary practice and collaboration." Of the 67 articles reviewed, 7 met inclusion criteria specifically addressing interprofessional practice in cardiac rehabilitation. Analysis revealed that (1) the terms interprofessional and multidisciplinary are commonly used interchangeably in healthcare, revealing a lack of clarity regarding interprofessional practices and approaches, and (2) there are few articles that clearly describe, define, or discuss interprofessional practice or collaboration in cardiac rehabilitation settings, rendering it difficult for practitioners to adhere to published practice guidelines. It is unclear why and how professional team members practice in specific ways to form cardiac teams. Further research is required to increase an understanding of these issues and to develop possibilities for the enhancement of cardiac rehabilitation practice.

Die Rolle der Pflegenden im therapeutischen Team der Stroke Unit

Over the last decade, stroke units have been increasingly established in Germany. Within these units, nurses have been identified as having a crucial role in the coordination of multi-professional team activities. However, currently very little data exists to support this fact; therefore, a questionnaire was developed to assess various aspects of the nurses' role within the multi-professional team, including cooperation with other team members (e.g., communication behaviour and acceptance within the multi-professional team), contribution to team and unit organisation, and impact on patient recovery. A total of 55 multi-disciplinary staff members from three separate stroke units completed the questionnaire. Results showed that staff have comparable estimates concerning the nurses' level of interdisciplinary cooperation. As well, nurses and other non-medical staff rate nurses' contribution to unit organisation comparably high while physicians' ratings of nurses' contribution are lower. The professional groups' ratings of the nurses' contribution to patient recovery vary. The results indicate that German stroke unit nurses contribute significantly to stroke unit care by acting as coordinators of the unit organisation for various multi professional team members.

Radiographer-performed stereotactic needle core biopsy: Making a difference

This case study describes a qualitative investigation of the experiences of 14 experienced mammography radiographers who successfully undertook a formal programme of education and training in stereotactic needle core biopsy (SNCB) of the breast. They now routinely perform SNCB within symptomatic and screening breast services in a variety of NHS hospitals across the country. All 14 radiographers completed a semi-structured postal questionnaire approximately six months after the end of the course. A tentative theory derived from the data suggests that the professional challenge associated with radiographer-performed SNCB builds personal confidence and effects positive change. Three main categories emerging from the data – challenge, confidence and change are underpinned by two main themes – educational, professional and service drivers that promote the realisation of goals and vision; and personal, peer and external motivation sustained by respect, recognition and reward. SNCB role extension as explored in this study is having a positive and transformational impact on patient users of breast diagnostic clinical services and on the professional health carers providing them. The key drivers for this as identified in the study are a formal educational experience, professional role extension opportunities and the NHS modernisation process. The participants experienced positive change as individuals and as professional breast cancer multidisciplinary team members. Academic and financial rewards, respect and recognition from colleagues across professional disciplines and from patients, were key motivators that sustained the process. This study indicates that radiographer-performed SNCB can help deliver the NHS Plan and the NHS Cancer Plan and in doing so has the potential to improve the working lives of health care professionals and ultimately to improve the quality of care for patients.

Comparison of language used and patterns of communication in interprofessional and multidisciplinary teams

Can the language used and the patterns of communication differentiate a multidisciplinary team from an interprofessional team? This research question arose from an unexpected outcome of a study that investigated clinical reasoning of health professional team members in the elder care wards of two different hospitals. The issue at stake was the apparent disparity in the way in which the two teams communicated. To further explore this, the original transcribed interview data was analysed from a symbolic interactionist perspective in order that the language and communication patterns between the two teams could be identified and compared. Differences appeared to parallel the distinctions between multidisciplinary and interprofessional teams as reported in the literature. Our observations were that an interprofessional team was characterized by its use of inclusive language, continual sharing of information between team members and a collaborative working approach. In the multidisciplinary team, the members worked in parallel, drawing information from one another but did not have a common understanding of issues that could influence intervention. The implications of these communication differences for team members, team leaders and future research are then discussed.

Interprofessionalism in health care: Communication with the patient's identified family

Communication with the patient's identified family is one of the most important and ongoing service to be provided by the inter-professional team in health care. Placing this importent service within the context of “attachment, security and trust” should help professional team members to learn how to configure patient's families into the circle of health care collaboration. The communication offered to the patient and patient's family is the most important aspect to inter-professionalism within health care. Breakdowns in this communication of trust can have drastic effects with long standing emotional impact.

Attitudes towards patient gender among psychiatric hospital staff: Results of a case study with focus groups

There is an increasing awareness of gender-related issues in psychiatry. However, empirical findings on attitudes of psychiatric staff towards patient gender are limited. Gender-related issues are particularly relevant in the debate about mixed versus segregated sex wards, yet while the appropriateness of mixed-sex wards is questioned in Great Britain this is not the case in Germany. To investigate attitudes of psychiatric staff towards both patient gender and mixed versus segregated sex wards, we conducted a case study using focus groups with members of professional teams. We evaluated the transition process from two single-sex wards to two mixed-sex wards in a 330-bed psychiatric hospital in a rural area in south Germany. Staff described female patients as more externally oriented, motivating of others, demanding, and even sexually aggressive. Male patients, on the other hand, were described as more quiet, modest, or lazy. Furthermore, participants described the mixing process as a positive development whereas they did not see a need for gender-separated wards in order to protect vulnerable female patients. Some gender descriptions by professionals are “reversed” in comparison with gender stereotypes supposed to be present in wider society. The perception of crossed gender norms may affect staff attitudes towards the vulnerability of female patients in psychiatric settings and the provision of single-sex wards in in-patient psychiatric care. Practical implications are discussed against the background of a high rate of female patients with sexual abuse histories.

A 3-Year Study of Middle, Junior High, and High School IEP Meetings

This study examined the perceptions of 1,638 secondary individualized education program (IEP) meeting participants from 393 IEP meetings across 3 consecutive years. Results indicate significant differences between the survey answers and participant roles, when students did or did not attend their IEP meetings, and when different professional team members attended the meetings. Special education teachers talked more than all team members. Students reported the lowest scores for knowing the reasons for the meetings, knowing what to do at the meetings, and five other survey items. General educators rated themselves lowest on three of the survey questions. Student and general educator attendance at the IEP meetings produced value-added benefits for IEP team members, especially parents.

Web-Based Support for Teacher Evaluation and Professional Growth: The Professional Assessment and Comprehensive Evaluation System (PACES)

This article describes the recent development, implementation, and web-based support for a new comprehensive system designed for the annual evaluation and professional growth of all teachers in the Miami-Dade County Public Schools (M-DCPS), Miami, Florida. The Professional Assessment and Comprehensive Evaluation System (PACES) has been designed to meet new legislative mandates in Florida for approval of district teacher evaluation procedures and mandates that require all teachers and school support/resource personnel (e.g., school counselors, library/media specialists, school psychologists) to develop and implement an annual professional development plan that targets student outcomes. The PACES has also been developed to embrace newer philosophies of professional teaching practice and prominent theories of teaching and learning. Included in the article is an overview of the PACES and a description of current and developing web-based supports for the total PACES effort in M-DCPS. These supports were designed to: (a) enhance the learning of teachers, administrators, and other educators; (b) maintain updated information about program policies and procedures; (c) prepare members of PACES Professional Growth Teams (mentor teachers); (d) provide technology-based supports for the ongoing professional development of teachers, administrators, and other educators; (e) increase the efficiency of collecting and processing information from PACES evaluations and professional growth activities; and (f) facilitate the development of a more cohesive learning community among educators and learners in M-DCPS.

Interdisciplinary meetings: investigating the collaboration between persons with brain injury and treatment teams

The purpose of this study was to gain an understanding of the collaboration that occurs in interdisciplinary team meetings (ITMs) at a post-acute brain injury rehabilitation centre. A qualitative descriptive case study was chosen for its interpretative and naturalistic approach. The study included participant observation of 51 meetings, five interviews, document review of charts and memos, and inductive analyses. Four themes emerged: (1) the ITM transformation ritual (the meetings themselves); (2) the ITM shapers (the case managers); (3) the ITM collaborators (the professional interdisciplinary team members); and (4) the ritual ghosts (surprisingly, the clients). Several patterns of interactions were documented, including subservient clients, lengthy meetings, and client transformation. These findings are discussed within the context of client-centred practice. The results indicate that inclusion of the client in interdisciplinary meetings does not necessarily lead to collaboration. Clinical implications and future research are discussed.

An international survey on information needs of patients with schizophrenia and their carers and management issues most frequently encountered by professional care team members

An international survey on information needs of patients with schizophrenia and their carers and management issues most frequently encountered by professional care team members

Conflict on collaborative design teams: understanding the role of social identities

Social identity theory provides an appropriate framework for analyzing social collaborative design, in which design team members have different design identities, that is, sets of beliefs, attitudes, and values about design. Observations of novice and professional design teams support the notion that collaboration is influenced by designers' adherence to, and reaction against, idealized technology-centered and socially-centered categorizations of themselves and users. Both case studies demonstrated the challenges to developing a superordinate team identity when polarized ideals about design and collaboration exist. However, approximately half of the professional design team members attempted to synthesize multiple viewpoints in response to the polarized identities, suggesting that design identities serve not only to differentiate design team members from other team members, but also as anchoring points for discussions about design. In theoretical terms, social identity assists researchers in modeling how social considerations influence technology design. In practice, encouraging designers to reflect on design identities can improve collaboration.

An analysis of program and family costs of case managed care for technology-dependent infants with bronchopulmonary dysplasia

Caring for technology-dependent infants with bronchopulmonary dysplasia requires a wide range and intense level of services. Case management programs can offer comprehensive services to patients with complex needs. The Neonatal Pulmonary Program at Tulane University Medical Center is a case management program for infants with chronic pulmonary problems. The purpose of this study was to describe the costs of providing care for technology-dependent infants with bronchopulmonary dysplasia and to include the direct and indirect costs to families as well as the Program costs. The study population included 89 infants enrolled in the program from September 1987 through February 1992. Outpatient, inpatient, and professional staff costs were derived from hospital and clinic billing information; all other costs were determined through family interviews. Total costs for outpatient services were $59,627 (89), professional team members time $185,539 (89); inpatient services $1,144,930 (89), professional costs for inpatient services $88,946; direct health costs $32,543 (37) for home health care, equipment, medications, special diets; direct non-health costs $30,670 (37) for transportation, meals, child care, lodging during clinic visits and rehospitalizations and household expenses to accommodate equipment needs; and indirect costs $26,173 (37) for missed work days and employment changes.

Smokeless Tobacco Use and Health Effects Among Baseball Players

The effects of smokeless tobacco (ST) use were studied in 1109 members of major and minor league professional baseball teams during spring training in 1988. The prevalence of current ST use was 39%. The median age at initiation among users was 18 years, and the median duration of use was 5 years. Among users, 75% cited a snuff brand as their usual ST product. Oral leukoplakia was present in 46% (196/423) of current-week ST users and 1.4% (7/493) of nonusers (odds ratio, 60; 95% confidence interval, 28 to 130). Prevalence of oral leukoplakia among ST users increased with hours used per day and decreased with time lapsed since last use, and was higher in snuff users than in chewing tobacco users. Of the subjects with oral leukoplakia who underwent punch biopsy, 91 had benign hyperkeratosis and one had mild dysplasia. Overall prevalence of dental caries, gingivitis, and plaque did not differ between ST users and nonusers. In analyses confined to facial surfaces of mandibular incisor teeth, where ST is most commonly used, there were significant increases among users in both gingival recession and attachment loss. Users of ST did not differ from nonusers in blood pressure, pulse, total or high-density lipoprotein cholesterol level, or white blood cell count, but among users high-density lipoprotein cholesterol levels were inversely associated with serum cotinine levels. The major health effects of ST use among professional baseball players are oral leukoplakia and localized periodontal disease. The study population was young, physically fit, and characterized by relatively moderate short-term ST use.

Psychiatric consultation in professional football.

IN 1980, after a lecture I delivered in Boston on human relationships, a star member of the New England Patriots professional football team, John Hannah, asked if he could speak with me. In my offi...

A Study of the Effectiveness of Certain Occupational Therapy Group Techniques in the Assessment of the Acutely Disturbed Adult Psychiatric Patient

This article is based on research which was undertaken to determine the effectiveness of two types of group work in the assessment of acutely disturbed adult psychiatric patients. The effectiveness of groups for assessment was determined by comparing the occupational therapy assessments of patients after one group session with those assessments made by other professional team members over the period of one week. The study was carried out at two acute psychiatric units in Johannesburg. Thirty patients were assessed by the author and by four members of the team. The five assessments were compared for each patient by statistical analysis. The results indicate that there is no significant difference between the five assessments or between the assessments undertaken in the art groups and those undertaken in the discussion groups. The short-term assessments of patients during these two types of group work is therefore effective.

Feedback and accountability

This article describes a communications system for planning and carrying out guidance and counseling activities. In the proposed model not only professional team members but also consumers of professional services are regarded as active participants in all phases of guidance, from goal identification through outcome evaluation. The article stresses the importance of an adequate feedback system used by all participants and describes its relationship to counselor accountability.