Multiprofessional Teamwork Research Articles

Advanced practice nurses’ scope of practice: a qualitative study of advanced clinical competencies

To describe and explore Advanced Practice Nurses' clinical competencies and how these are expressed in clinical practice. Discussion concerning advanced clinical practice has been ongoing in the USA since the 1960s and in the UK since the late 1980s. Approximately 24 countries, excluding the USA, have implemented the role of Advance Practice Nurse (APN). In the Nordic countries, especially Sweden and Finland, APNs have been introduced in some organizations but their competency domains have not yet been clearly defined. The study's theoretical framework emanates from Aristotle's three-dimensional view of knowledge that is epistêmê, technê, and phronesis. Between October 2005 and January 2006, focus group interviews of Clinical Nurse Specialists who provide expert functions in pediatric, internal medicine, and surgical units (n = 26) and APN students (n = 8) were conducted. The data material was analyzed using inductive content analysis. Grouped into five main themes, the study results indicate that APNs possess advanced level clinical competencies in: (A) assessment of patients' caring needs and nursing care activities, (B) the caring relationship, (C) multi-professional teamwork, (D) development of competence and nursing care, and (E) leadership in a learning and caring culture. Clinical competencies consist of advanced skills, which typify an expanding role that offers new possibilities for holistic patient care practice. APNs' scope of practice is characterized by responsibility and competence in making autonomous judgments based on expanded clinical competence. On an advanced level, clinical competence consists not merely of advanced skills for assessing and meeting the needs of patients but also the creation of safe and trustful relationships with patients and collaboration with colleagues. APNs can realize advanced skills in their actions through their manner of knowing, doing, and being.

The management of a simulated emergency: Better teamwork, better performance

Objectives To determine whether team performance in a simulated emergency is related to generic teamwork skills and behaviours. Methods Design – Cross-sectional analysis of data from the Simulation and Fire-drill Evaluation (SaFE) randomised controlled trial. Setting – Six secondary and tertiary Maternity Units in Southwest England. Participants – 140 healthcare professionals, in 24 teams. Assessment – Blinded analysis of recorded simulations. Main outcome measures – Correlation of team performance (efficiency conducting key clinical actions, including the administration of an essential drug, magnesium), and generic teamwork scores (using a validated tool that assesses skills and behaviours, by Weller et al.). Results There was significant positive correlation between clinical efficiency and teamwork scores across all three dimensions; skills (Kendall's tau b = 0.54, p < 0.001), behaviours (tau b = 0.41, p = 0.001), and overall score (tau b = 0.51, p < 0.001). Better teams administered the essential drug 2½ min more quickly (Mann–Whitney U, p < 0.001). Conclusions The clinical conduct of a simulated emergency was strongly linked to generic measures of teamwork. Further studies are needed to elucidate which aspects of team working are critical for team performance, to better inform training programs for multi-professional team working.

Práticas cuidadoras que favorecem a integralidade do cuidado ao recém-nascido de alto risco: revisão sistemática

doi: 10.5216/ree.v12i3.7509A busca de um cuidado que contemple as dimensões biopsicossociais do recém-nascido, não limitadas às que garantem a sua sobrevida, tem sido promovida através de diferentes práticas que consideramos serem favorecedoras da integralidade. Neste estudo realizou-se uma revisão bibliográfica sistemática com o objetivo de identificar práticas cuidadoras que favorecem a integralidade do cuidado ao recém-nascido de alto risco. A busca foi realizada nas bases de dados BDENF, LILACS, MEDLINE, PAHO, WHOLIS e BVS INTEGRALIDADE, utilizando-se os indexadores Cuidados Integrais de Saúde, Neonatologia, Recém-nascido e Unidades de terapia intensiva neonatal, no período de 1988 a 2009. Foram selecionadas 17 publicações, em inglês, português e espanhol. Os resultados foram agrupados nas categorias: cuidado centrado no recém-nascido e na família, trabalho em equipe multiprofissional, participação da mãe e dos familiares no cuidado ao recém-nascido e continuidade da assistência. Concluiu-se que iniciativas são tomadas para possibilitar um cuidado integral mas que, para construção da integralidade da assistência ao neonato de risco, ainda existem dificuldades a serem superadas, principalmente em relação à ampliação do foco do cuidado e à reorganização do processo de trabalho em Unidade de Terapia Intensiva Neonatal.Descritores: Cuidados Integrais de Saúde; Neonatologia; Recém-nascido; Unidades de terapia intensiva neonatal.

Relación clínica y problemas éticos en atención primaria, São Paulo, Brasil

Objectives Main Objective: to identify ethical problems in primary care according to nurses’ and doctors’ perceptions. Secondary Objective: to know ethical issues of patient-professional relationships in primary care. Design Synthesis to integrate and reinterpret primary results of qualitative studies. Setting Primary healthcare centers, Sao Paulo, SP, Brazil. Participants and/or context Incidental sample of 34 nurses and 36 medical doctors working in primary healthcare centers selected by convenience. Methods Individual, semi-structured interviews to identity situations considered as sources of ethical problems. The sample is socially representative of primary care health centers and professionals. Data collection assured discourse saturation. Hermeneutic-dialectical discourse analysis was used to study the results. Results Patient-professional relationships and team work were the main sources of ethical problems. The most important problems were patient information, privacy, confidentiality, interpersonal relationship, linkage and patient autonomy. These issues reflect the recent changes in clinical relation ships and show the peculiarities of primary care with its continuous care which lasts a long time. Healthcare involves multiprofessional team work in the midst of the patient claims for autonomy. Good care of patients needs requires a relationship based on communication and cooperation, and includes feelings and values, with communication skills. Conclusions Ethical problems in primary care are common situations. For quality and humane primary care the relationship should consist of dialogue, trust and cooperation.

Editorial

‘So why do you want to do Acute Medicine?’ – it’s a common interview question, and one for which most prospective trainees will have a well-prepared answer. Sometimes the candidate will focus on the opportunities for multi-professional working and teamwork, as well as interactions with critical care and other specialities; however almost all will mention the wide variety of conditions with which acute physicians are faced in their daily practice. What may appear a simple problem at the time of presentation may have a twist in the tail which will catch out the unwary. The need to maintain a broad differential diagnosis is a key skill for the acute physician: I frequently need to remind trainees that ‘Query ACS – measure 12 hour troponin’ is not an acceptable management plan. It is crucial to remember that even when a condition like acute coronary syndrome has been ‘excluded’, a serious cause may still be lurking. Several of the articles in this edition illustrate such caveats. In the review of the diagnosis and management of aortic dissection, the variability of presentation is illustrated with a case where the onset of symptoms preceded the hospital admission by several weeks and was initially labelled as ‘musculoskeletal’. In this case it was the chest x-ray which raised the clinical suspicion when a change in the mediastinal contour was identified. However, serious spinal causes of chest pain, such as the spontaneous extradural haematoma on p76, will only be diagnosed by more complex imaging; this will be hard to arrange without a clear clinical indication. The rarity of this condition means that most will not have come across a case and will therefore be unaware of the need to consider this diagnosis. The importance of a careful history, refreshingly emphasised in the recent NICE guidance on chest pain of possible cardiac origin as summarised by Charlotte Cannon in this edition, cannot be understated. Many readers will have come across patients with erythema nodosum, referred as ‘unresolving cellulitis’ – often these turn out to have sarcoidosis as described in Dr Chakraborty’s case series, although other underlying causes need also to be considered. Cellulitis may also be a manifestation of a subcutaneous source of infection, particularly when it appears in an unusual site; Denzil May’s case illustrates the need to image the abdomen when presented with abdominal wall cellulites – on this occasion an underlying psoas abscess was the cause although appendix abscesses, inflammatory bowel disease, diverticular abscesses and pelvic collections also need to be considered. The opportunity to learn a practical procedure has been a subject of considerable debate amongst acute medical trainees over recent years, and has been highlighted in this journal in the past. Much of the focus in previous editions has been on echocardiography. Ultrasound is another practical procedure which is listed in the training curriculum for Acute Medicine, although the feasibility of training acute medical trainees in this area has not been fully evaluated. Dr Ismaeel’s study comparing the outcome of ultrasound undertaken at the bedside by an acute medical trainee and that undertaken in the radiology department may stimulate some debate on the value of this. This study looked specifically at diagnostic ultrasound of the abdomen and demonstrated that some conditions could be identified at the bedside, though probably not with enough reliability to prevent the need for a subsequent departmental ultrasound. The key is whether the specific questions can be answered by the ‘occasional’ sonographer using portable equipment: ‘are the bile ducts dilated?’, ‘are the kidneys obstructed?’, ‘are there metastases in the liver?’, ‘is there ascites or is it just fat?’ – knowing the answers to such questions can inf luence management out of hours, although currently most patients will have to wait until the morning for a scan. A formal training programme in acute medical ultrasound will need to focus clearly on these specific areas, rather than generic diagnostic ultrasound skills. Many readers will be familiar with the rapid turnover of AMU nursing staff, particularly at a junior level, which can undermine the ability to develop a stable workforce. In a questionnaire study in Birmingham and Dundee, consultant nurses Liz Lees and Liz Myers have produced some interesting data which may help to improve recruitment and retention of nurses on Acute Medical Units. It seems that, as with junior doctors, it is the variety which is the main attraction, as well as the being the main factor which keeps nurses interested in working on the AMU. Correspondence relating to this and any other issues relating to articles in this journal would be most welcome.

An ecological investigation into multi-professional team working

An ecological investigation into multi-professional team working

Moving and handling rehabilitation patients: A survey of nurses' views

Aims This article reports on a UK national questionnaire survey to explore nurses' views in relation to the handling of rehabilitation patients. Methods 3205 questionnaires were distributed via the Royal College of Nursing Rehabilitation and Intermediate Care Nurses Forum and the UK Stroke Nurses Network national conference. Findings Questionnaires were returned by 501 nurses (a response rate of 15.6%); 83.6% of respondents were confident in their patient handling skills. Respondents valued physiotherapy knowledge and were committed to teamwork in relation to patient handling. ‘No lifting’ policies were reported to be in use in the workplaces of 77.6% of respondents, and 33.4% of these respondents felt the policies interfered with rehabilitation. There was an equal number of respondents who agreed that manually helping patients to stand or transfer helps them to regain more mobility than if an aid were used (40.2%), and who disagreed (40.2%). The majority of nurses (64.9%) stated that manual handling was more physically tiring than using a mechanical aid, and 60.9% of nurses reported that they had put themselves at risk to promote rehabilitation. Conclusions Nurses in this study valued their role in supporting patients with mobility and movement problems and were positive about teamworking as a way to facilitate this. However, further observational research is needed to explore the actual nature of multiprofessional teamworking in relation to patient handling. Nurses should view all patient handling activities as a rehabilitation opportunity and managers should ensure that nurses have access to the full range of patient handling equipment needed to facilitate rehabilitation.

Resultados da implementação de modelo organizacional de um serviço de cirurgia cardiovascular

Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes. From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra- and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis. After establishment of such model, there was reduction of hospital mortality (from 12% to 3.6%, relative risk= 0.3; P=0.003) and combined events (from 22% to 15%, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Other predictors of mortality were age > 65 years (OR=6.36; 95%CI 2.57 - 17.21; P<0.0001) and cardiopulmonary bypass time > 145 minutes (OR=8.57; 95%CI 3.55 - 21.99; P<0.0001). Marked improvements in surgical outcomes depend on development of cardiac surgery centers based on organizational models similar to the model proposed in this study.

Visioner och Sätt att Verkställa Dem: Nyckelaktörers Åsikter om Lokal Alkoholpolitik

This study is based on an analysis of discussions of local experts on the prevention of alcohol-related harms. Dismantling of the centralized and hierarchical alcohol control system in Finland has shifted responsibilities from the state to the local level, and restructured the system of alcohol policy and prevention. At the state level greater emphasis is now placed on supporting and enabling local work, and the local level is expected to co-ordinate multiprofessional team work on a broad basis. In this process the roles and responsibilities of different actors are being reconfigured. The substudy is a part of the Local Alcohol Policy (PAKKA) demonstration and evaluation project. This particular sub-study focuses on the possibilities and factors influencing sustainability of local interventions. The data were gathered in four group discussions. The discussion groups consisted of various actors influential in the professional fields of alcohol retail and the restaurant business, liquor licensing and surveillance, the police, and municipal harm prevention. The thematic discussion was facilitated by a researcher. The discussions were videotaped and transcribed and analysed by using the group as the unit of analyses. The participants explored ways of resolving the pressures caused by the decentralizing of alcohol prevention to the local level, and conceptualized the role and position of preventive work amid the changes in the alcohol administration. The different groups had similar views on the difficulties and obstacles faced by local prevention of alcohol-related harms. All of them also discussed the balance between public and private responsibility. The groups differed from one another in terms of how they saw the relationship between alcohol markets, civil society and the public sector. They also differed in how optimistic they were about the future of local work in the prevention of alcohol-related harms. The analysis reveals a kind of an empowerment story about the future possibilities of local alcohol policy.

Book Review: Developing Multiprofessional Teamwork for Integrated Children's Services

Book Review: Developing Multiprofessional Teamwork for Integrated Children's Services

Implementing and using care pathways in mental health: Developing an approach for practice

AbstractCare pathways have been widely used in physical healthcare since the 1980s. Their use provides a range of benefits including more efficient treatment planning, increased use of research evidence, clinical audit, multi-professional teamwork and cost-effectiveness. Their introduction and use in mental health has been less widespread, due to the perceived lack of predictability often associated with mental disorders. However, a number of local, national and international initiatives have promoted their use, integrating either disorder (predictive) or process (benchmark) oriented approaches. Evidence from these indicates that contemporary and future mental health developments can benefit from the wider adoption of care pathways. The involvement of patients, relatives and carers, in addition to a range of emerging technologies and enhanced therapeutics, provides many opportunities to place pathways at the heart of mental health strategies. This paper describes an overview of the approach, highlights a ...

Patient Care: Past, Present, and Future

The 40 years since St Christopher's Hospice opened has witnessed a burgeoning international interest in palliative care. Its key characteristics comprise a focus on the whole-person (physical, psychological, social, and spiritual), patient-centeredness (partnership with and empowerment of the patient and family), openness and honesty in communication, an acceptance of the inevitability of death coupled with improvement in the quality of life, multi-professional teamwork integrated with community (volunteer) involvement. Although much has been achieved, much remains to be done. Both in resource-poor countries and in more wealthy ones, the scope of palliative care has changed. Initially in the United Kingdom, palliative care was mostly limited to cancer patients but now strenuous efforts are being made to extend coverage to other patient groups, e.g., those with end-stage heart disease or renal failure. In India, with a dearth of chronic care facilities, palliative care services increasingly embrace those with chronic disability as well as progressive end-stage disease. In Sub-Saharan Africa, the devastating impact of AIDS is having a major impact on the development and delivery of palliative care. To maximize the benefits of limited financial and other resources, a strategic approach is necessary. The World Health Organization emphasizes three essential foundation measures: health service policy, public awareness and professional education, and drug availability. However, at the end of the day, if we are truly to honor Cicely Saunders, palliative care must remain a movement with momentum, combining creative charisma with inevitable bureaucratic routinization.

Developing Multiprofessional Teamwork for Integrated Children's Services

By Anning, Angela, Cottrell, David, Frost, Nick, Green, Josephine and Robinson, Mark Maidenhead : Open University Press , 2006 ISBN 9780335219780 , 147 pp, £17.99 (pb) Despite the strong current emphasis on the value of multi-agency working, there is still little research evidence on the impact of joined up services and multi-professional practice on outcomes for service users. It was within this context — and before the publication of Every Child Matters or the 2004 Children Act — that the research project which informs this book was begun. Funded by the Economic and Social Research Council and based at Leeds University, the Multi-Agency Teamwork for Children's Services (MATCh) project was set up to explore, over a 2-year period, the daily realities of delivering public and voluntary sector services by multi-agency teamwork. The project worked with five well-established teams, exemplifying the type of multi-professional teams operating across the statutory and voluntary sectors — a youth offending team, a young people's Child and Adolescent Mental Health team, a nursery for children with learning difficulties, a head injury team and a child development team. Using two theoretical frameworks —‘communities of practice’ and activity theory — the study examines how the teams developed and functioned, how they were organised and managed, and the experiences of the individuals working in them. The issues that are raised will be familiar to anyone who has worked with colleagues with different training, beliefs, value systems and language and who are likely to hold different constructs of family and childhood. Working in inter-agency teams challenges professional identities and status and leads to a new sense of ‘who I am’. The authors also point to the way in which the nature of professional knowledge is challenged —‘what I know’ and ‘what I do’ draws on a combination of formal and informal, and theoretical and experiential knowledge, and whilst much of this knowledge is tacit within the workplace, in multi-agency teams it has to be made more explicit and drawn from across the team. The point is also made that it remains important to respect and deploy distinctive specialisms within teams, as well as general understanding, if professionals are to gain job satisfaction. The main value of this book for managers and practitioners is its discussion of some of the key dilemmas faced by multi-professional teams. The researchers introduced a series of scenarios to the members of their teams, illustrating specific incidents that arose during the course of the project and the dilemmas they presented — for example about sharing and acknowledging specialist expertise, reshaping working practices, negotiating new ways of working, resolving difference of values, transferring skills, sharing information, etc. They draw on the response to these scenarios, and on other research in the field, to explore strategies for resolving these dilemmas, focusing in particular on strategies for making decisions and delivering services for children. A number of themes are examined, amongst them shared procedures, clear lines of accountability, clarity on employment conditions, effective leadership, agreed strategic objectives and shared aims, transparent communication structures and ongoing support for professional development. This is a timely book and one that will be of value to all those who work across agencies to plan, commission, deliver and review services for children and families. But we should not forget that the main purpose of multi-professional and across-agency working is to deliver services that are more effective in meeting the needs of children and improving their well-being. Multi-professional working is a means to an end, and an important means, but not an end in itself.

In response to: Bond P., Kingston P. &amp; Nevill A. Operational efficiency of healthcare in police custody suites: comparison of nursing and medical provision. Journal of Advanced Nursing 60 (2) 127–134.

The Faculty of Forensic and Legal Medicine is committed to raising the standards of healthcare to detainees in police custody and fully supports the introduction of a multi-professional approach in order to achieve this aim. Bond and colleagues have undertaken research ‘to examine the operational impact of a police custody nursing service on healthcare delivery in one police service in the north of England’ and their findings are potentially important. The study raises a number of specific and more general issues. The authors found that ‘in comparison to the traditional service, nurses demonstrated faster response times, comparable consultation times, and were perceived by custody staff as more approachable than their medical colleagues in providing handover information’. Yet we note that they state ‘for legal and security reasons it was not possible to analyse clinical consultation times. However, it was possible to analyse the duration of time taken by a clinician at the police station to complete a single consultation’. This is somewhat confusing, as if ‘clinical consultation times’ could not be analysed how can a conclusion about ‘comparable consultation times’ be achieved? The study compared a doctor-only service with one provided by a combination of nurses and doctors. The only significant improvement in performance indicators was an apparent reduction in the response time provided by nurses but this was rendered meaningless by the lack of any comparison between the manpower resources available under the two different systems and their comparative cost. Response times, in themselves, provide no information about the quality or appropriateness of healthcare provided and, given that 34·5% of detainees seen by nurses were referred on to doctors, the actual time to achieve the desired healthcare intervention may have been much longer under this system. It should be recognised that, although response times and consultation times are easily measurable (which is no doubt why they have become important to policy makers), these times in isolation have little or no relevance to the crucially important issues of whether a longer average response time has any adverse effect on the healthcare of detainees or results in any delays to police procedures. These are matters that were not addressed in the study. Likewise it is a pity (although we recognise not a part of the study design or aims) that the authors did not seek to address in anyway the type of consultation undertaken; the clinical findings; the outcome of the consultation; and the opinion of the examinee. These problems relate in part to the retrospective nature of the study design and in part to the researchers’ lack of access to the clinically relevant data which is the essence of healthcare in police custody. The Faculty is working with partners to develop key performance indicators that can reliably assess the quality of healthcare provided to detainees and hopes that such indicators will provide the evidence base to properly support an expansion of multi-professional clinical team working in police custody. We believe that the authors are correct in their assertion that ‘nurses can assist FMEs by screening the need for a doctor to be called out to a police station and could help prioritise the clinical needs of detainees’. Prospective studies which explore the actual healthcare needs of those in police custody and relate those to service provision by multi-professional teams (as in any other area of medicine and nursing) are the most appropriate ways of determining the best options for an extremely vulnerable patient group.

Facilitating as a guidelines implementation tool to target resources for high risk patients – The Helsinki Prevention Programme (HPP)

Interprofessional care may provide some answers to the challenge of scarce healthcare resources, through the utilization of the expertise of various professionals to improve evidence-based care. This was a two-year programme in primary care, where doctor and nurse pairs acted as intrinsic facilitators creating and implementing local guidelines and encouraging multiprofessional teamwork. The effect of implementation was studied by auditing professional opinion change, blood pressure, serum lipid and HbA1C levels. After one year, 20 health stations reported improvement in treatment practices of hypertension and the division of tasks across team members, and seven and eight health stations reported improvement in treatment of diabetes and dyslipidemia. After two years, the corresponding figures were 29, 25 and 22, respectively. Active guidance to home measurements increased from 90% to 100% and every health station identified a dedicated area for patient self-measurement. At baseline, in poor control were 17% of blood pressure measurements, and 31% of diabetic and 71% of dyslipidemic patients. At follow-up, the corresponding figures were 22%, 34% and 64%, respectively. Multiprofessional facilitation and learning proved to be effective in implementing guidelines, improving multiprofessional collaboration and sharing duties and responsibilities, as well as targeting preventative activities and resources adequately.

O Programa Integrador: uma experiência na formação profissional

O Programa Integrador (PI), eixo pedagógico estruturante da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, busca inserir o aluno precocemente na realidade através das ações em áreas de atuação das unidades básicas de saúde, numa parceria ensino-serviço, trabalho realizado em grupos multiprofissionais e que é desenvolvido do segundo até o sexto período de cada curso. O desenvolvimento desta ação acontece de forma progressiva começando com o levantamento do território, das famílias, fazendo um diagnóstico de saúde que serve de base para o planejamento das ações executadas no último período. Este texto é relato de uma aluna que, vivendo nesse cotidiano pôde perceber a importância desse processo na formação profissional, e essa prática permitiu vencer algumas ansiedades sentidas no primeiro contato com o paciente, bem como modificar o olhar, geralmente focado na doença para um mais abrangente que pensa e trabalha em prol da saúde. A descrição dessa experiência pretende contribuir para que outras instituições possam se beneficiar transformando suas práticas em parcerias exitosas como a nossa

Evaluation of an educational programme in Ege University, Turkey: Medical student's home visits with midwife preceptors

Objective to evaluate the efficiency of the midwife preceptors in teaching comprehensive health care for women and their families through exploring how they perceive their roles as educators and from the perspectives of medical students; to assess the number of educational goals achieved. Design for midwives, a quantitative method was used for pre- and post-evaluation of a ‘Medical Students’ Home Visits with Midwife Preceptors’ course. Focus-group interviews were used to gather qualitative data. Students were evaluated after undertaking home visits with the midwives. Setting urban health centres in Western Turkey and Ege University Faculty of Medicine. Participants a sample of four clusters of second year medical students (130 out of 284) and all midwives ( n=32) linked with the health centres participated in the programme. Findings in general, both the midwives and the medical students found the programme useful. Students declared that they achieved their learning objectives and midwives stated that they had contributed to this achievement. Scores of eight of the 20 learning objectives significantly increased in the midwives’ post-test evaluation. Midwives and students valued the effective communication they had with each other. All midwives participated in focus-group interviews, and reported that the course before the home visits was useful to them. Nearly all of the midwives suggested that the home visits course should be longer, repeated, or both. It was difficult to organise home visits for all of the medical students, and access to some households to enable students to gain training experience was refused. Conclusions this programme encouraged the medical students to adopt broad public health approaches in assessing the health needs of defined communities. It also increased their awareness of the importance of multi-professional teamwork and comprehensive health care for women and their families. At the same time, the programme improved the professional knowledge of midwives, and they were able to appreciate their roles and functions in primary health care, and enhance their self-esteem. The findings also indicated that this programme is an effective way of promoting multi-professional education in medical schools.

Gwilym Penrose Hosking

Gwilym Penrose Hosking was attracted to paediatric neurology partly because of a desire to work in multiprofessional teams. During his first consultant post at the Ryegate Centre in Sheffield he...

Renewing occupational cultures—Bridging boundaries in learning spaces

Professional bureaucracies of the Finnish municipal services are challenged by many modernization pressures manifested currently in the form of New Public Management. Along with efficiency demands the new emphasis is on the provision of client-oriented services by the means of multi-professional teamwork crossing the traditional sector boundaries. This paper analyzes the learning processes needed when representatives of different professional and other occupational cultures start cooperation. The participants of the research are professionals taking care of the elderly: in a small rural municipality the social and health care staff plan joint home care services and in a city, where a joint home care unit is already established, the professional collaboration is extended towards theatre, art exhibitions and other cultural services. In both cases the researchers invited the professionals to have future-oriented discussions on joint dialogue forums. In the analysis of the proceedings the forums were conceptualized as ‘learning spaces’ and the differences in professional cultures as ‘thresholds’. The results of the analysis point out how the professional cultural confrontation between the social and health sector was more severe, the thresholds were higher, than between the home care staff and the cultural sector professionals. The paper suggests that the dialogue method facilitates learning and crossing the professional cultural boundaries if all participants themselves let this happen and secure that the results of the dialogues will be turned into concrete actions.

Programa Saúde da Família: a experiência de equipe multiprofissional

The Family Health Program proposes a new dynamics for the structuring of health service, as well as for its relationship with the community in its different levels of care. The aim of the present study was to analyze the significance of teamwork for professionals working in the Family Health Program. The study was carried out in the city of Conchas, Southeastern Brazil, in 2004. We used a qualitative approach based on phenomenology as an attempt to reveal the essence of the reality experienced by eight professionals from two Family Health Program teams. Themes revealed that teamwork is characterized by dedication to daily activities. Interaction among all members is required for integral action, although there are differences in ideology and conduct between professionals. Close contact with families has allowed for more efficient interventions, and integrated work is essential for efficacious, high-quality care. The phenomenon unveiled gives origin to a new perspective of action for professionals and furthers our understanding of multiprofessional teamwork.