Multi-professional Staff Research Articles

The effect of sex, age, work experience, education, shift, and ward on nursing autonomy perceptions.

In Italy, cultural and professional nursing improvements are reached thanks to the university-based education which marks the clinical competency and the professional autonomy in nursing decision-making. To highlight how Italian nurses perceived their nursing autonomy level in the main action-points highlighted in the Italian regulation law according to sex, age, work experience, education, shift and ward. A cohort explorative study was carried out from September 2022 to January 2023 to highlight how Italian nurses perceived their nursing autonomy levels in the main action-points highlighted in the Italian regulation law for the nursing profession according to demographic characteristics, like: gender, age, work of experience, education, shift, ward employment. A total of 403 nurses were enrolled. Significant differences were recorded in: decision-making authority in patient care and shift (p≤0.001) and ward employment (p = 0.045); ability to initiate nursing interventions and education (p < 0.001) and ward employment (p = 0.011); collaboration and communication with healthcare team members and education (p < 0.001) and ward employment (p = 0.010); independence in clinical judgment and critical thinking and shift (p < 0.001); responsibility for the planning and evaluation of nursing care and education (p = 0.005) and shift (p = 0.002) and ward employment (p = 0.013); autonomy in professional development and continuing education and shift (p < 0.001) and ward employment (p < 0.001). The results highlighted the intricate world both of the healthcare surrounding and the abilities to act autonomously within the multiprofessional staff. Future studies will develop qualitative and phenomenological designs in order to better define in which fields nurses will act their professional autonomy.

An evaluation of a quality improvement initiative examining benefits and enablers and challenges and barriers of implementing and embedding core clinical supervision in primary care

Background Core Clinical Supervision has become a valued activity that impacts on the culture and organisational delivery of healthcare. It embeds good practice to ensure that staff have a high skill set, desirable professional attitudes, and provide high quality evidence-based care. It also helps to support good clinical governance and enhances staff retention (CQC 2013). A supervision framework has been adopted and adapted from the ‘General Practice – Developing confidence, capability, and capacity. A Ten Point Action Plan for General Practice Nursing’ ( NHS England 2018 ) and applied at scale across Yorkshire and the Humber, with minimal impact on clinical capacity, quality, and safety. This initiative coincides with general practice (and the wider health service) being under enormous pressure managing the effects of the COVID-19 pandemic, with impact on staff wellbeing and retention. The main aims are to evaluate the impact of embedding the Core Supervision training across primary care practice and strengthen course content for future delivery. Methodology and Methods A quantitative approach using an online survey, was completed by multi-professional primary care staff who had completed the Core Supervision Training. Findings Practitioners indicated that they required protected time due to competing demands and visible senior buy in to undertake core supervision. Additionally, practitioners who had participated or supervised sessions felt the benefits on staff wellbeing and indicated that it improved patient care delivery. Conclusion and Implications Survey findings suggest further research on embedding core supervision within primary care and a focus on national and local strategies are required. Standardised learning outcomes across the regions to ensure transferability of supervision practice and review training in supervision processes, particularly around conducting a supervision session.

#3144 Improving care for patients on maintenance haemodialysis effectiveness: a novel multidisciplinary approach

Abstract Background and Aims Care for patients receiving maintenance haemodialysis (MH) is critically dependent on multi-professional coordination of care for multimorbidity and complex care needs. Design and coordination of care models is an important clinical concern (Kharbanda et al., 2020). We developed the Biannual Comprehensive Haemodialysis Multidisciplinary Team meeting (BCHMDT), a weekly meeting in which patients receiving MH are reviewed biannually. This study aimed to assess the efficacy of the BCHMDT in improving the provision of care for patients receiving MH. Method This single-centre retrospective study collected data from documentation from 146 patient encounters with the BCHMDT during from two separate time periods: August-December 2020, when the meeting had just been introduced (63 patient encounters) and February to July 2022 (83 patient encounters). Meetings involved a renal physician, haemodialysis specialist nurse, renal dietician, dialysis access nurse specialist, renal transplant coordinator, renal counsellor, and palliative care physician. Meetings were structured around a specially designed proforma Fig. 1. Results Actions generated by the MDT included investigations planned (41%), referrals made to other specialists (33%), changes to dialysis prescriptions (37%), medication changes (39%), dialysis access issues picked up (26%) and new RESPECT discussions (25%).The breakdown of data by time period (2020 group and 2022 group) is shown in Fig. 2 (option 1) OR “the data collected is summarized inFigure 2”(option 2). The proportion of patients achieving their prescribed Kt/V was 63% (2020 group) and 77% (2022 group). The proportion of patients who were eligible for transplant referral but had not yet been referred was 13% (2020 group) and 10% (2022 group). Conclusion The BCH MDT is an worthwhile method to improve coordination of dialysis care, and multi-professional staff in our centre use it as an opportunity to review and improve care. The meeting results in high numbers of actions and adjustments to patient care. Furthermore, in this uncontrolled observational study, there was improvement over time in the proportions of patients achieving adequate Kt/V, and in referral rates for transplant assessment, suggesting a positive impact on MH care.

Status quo and influencing factors of multiprofessional and multidisciplinary teamwork for early mobilization in mechanically ventilated patients in ICUs: A multi-centre survey study.

To understand the status quo of multiprofessional and multidisciplinary collaboration for early mobilization of mechanically ventilated patients in Chinese ICUs and identify any factors that may influence this practice. A multi-centre cross-sectional survey. From October to November 2022, the convenience sampling method was used to select ICU multiprofessional and multidisciplinary early mobility members (including physicians, nurses and physiotherapists) from 27 tertiary general hospitals in 14 provinces, cities and autonomous regions of China. They were asked to complete an author-developed questionnaire on the status of collaboration and the Assessment of Inter-professional Team Collaboration Scale. A multiple linear regression model was used to analyse the factors associated with the level of collaboration. Physicians, nurses and physiotherapists mostly suffered from the lack of normative protocols, unclear division of responsibilities and unclear multiprofessional and multidisciplinary teams when using a collaborative approach to early activities. Multiple linear regression analysis showed that the number of ICU patients managed, the existence of norms and processes, the attitude of colleagues around them, the establishment of a team, communication methods and activity leaders were significant influences on the level of collaboration among members of the multiprofessional and multidisciplinary early activities. The collaboration of multiprofessional and multidisciplinary early activity members for mechanically ventilated patients in the ICU remains unclear, and the collaboration strategy needs to be constructed and improved, taking into account China's human resources and each region's economic development level. This study investigates the collaboration status of multiprofessional and multidisciplinary activity members from the perspective of teamwork, analyses the reasons affecting the level of collaboration and helps to develop better teamwork strategies to facilitate the implementation of early activities. The participants in this study were multiprofessional and multidisciplinary medical staff who performed early activities for ICU patients.

Exploring the gender gap in end-of-life care: ethical considerations for dementia patients

Abstract Background Dementia is a common, terminal disease that significantly reduces the quality of life. Home hospice services face ethical challenges when caring for patients in the final stages of the disease. While gender differences are known to exist in various aspects of care, limited research has explored gender variation in end-of-life care perceptions. This study aims to explore how home hospice staff consider gender, particularly regarding ethical issues. Methods The study used a phenomenological qualitative approach, conducting semi-structured interviews with 30 multi-professional home hospice staff members caring for dementia patients. Findings Caregivers tend to ignore gender when caring for elderly patients at the end of their lives. This non-gender-related approach is evident in their attitudes towards ethical issues, such as respecting patients, considering their welfare and dealing with communication difficulties. However, disregarding gender when caring for dementia patients within the home hospice framework raises questions regarding the dying person's perception of human dignity, their wishes, and their overall welfare. Conclusions Given that gender is a crucial component of a person's identity, the staff's non-gender-related approach towards end-of-life care reflects the non-gender-related social construction of the elderly. This raises concerns about the quality of care provided to end-of-life patients. To ensure that patients’ dignity is preserved in the final stages of their lives, it is necessary to provide training for caregiving staff on the importance of considering gender in end-of-life palliative care. Key messages • Home hospice staff tend to ignore gender when caring for dementia patients. Neglecting gender raises ethical concerns and questions about patient dignity and welfare. • Considering gender in end-of-life palliative care is crucial to ensure high-quality care for patients with dementia in the final stages of their lives.

Bildungschancen verbessern – Familien unterstützen

Abstract The deteriorating competencies of pupils in recent years and the increasing inequality of educational opportunities threaten to reduce the supply of skilled labour and innovative strength in Germany. The diminishing educational opportunities begin with the fact that parents from educationally disadvantaged households are less able to support their children by reading to them. Children from educationally disadvantaged households attend early childhood education less often; their parents have greater difficulty finding a place in a day-care centre, have less contact with teachers at schools and are often unable to assist with homework. There are also disadvantages in the choice of educational paths and professions. In order to increase educational equity, parents in particular should receive more language support in early childhood education; all-day facilities should be expanded (as well as the quality in the direction of family centres), more multi-professional staff could be available at schools to support teachers and parents, and STEM subjects and vocational orientation at schools could be strengthened to help improve equal opportunities and better utilise the potential of children from educationally disadvantaged households for securing skilled labour.

Staff perception of the implementation, enablers and barriers to pediatric intensive care unit diary writing: A qualitative study

ObjectivesTo explore how the multi-professional pediatric intensive care unit staff experienced the implementation of the diary. Research Methodology/DesignQualitative study using the implementation research approach.Setting: a six-bed pediatric intensive care unit at a large Italian tertiary care pediatric hospital, treating patients with acute conditions from the Emergency Department or hospital wards. Main outcome measuresHealthcare providers’ experiences of the implementation of the diaries. Data was collected by focus groups and interviews and thematic analysis was performed. FindingsThree focus groups and four interviews with staff were conducted after the implementation of thediaries from August 2020 to June 2021. Staff describe an initial disbelief towards the effectiveness of diaries followed by an increasing perception of their relevance for parents’ emotional expression through shared narration. Diaries are reported as a beneficial communication tool between the family, the child, and health care providers, increasing staff understanding of parents’ experiences of their child’s admission and parents’ sense of the care received by their child. For staff, barriers for diary writing were logistics, lack of time, limited sense of ownership, fear of legal retaliation and fear of emotional labor. ConclusionHealth care providers perceived diaries as beneficial for parents and the healthcare team, potentially supporting their partnership as recommended by Family Centered Care models. The enablers and barriers that emerged for diary writing can support the development of implementation strategies to prevent the reported challenges to diary writing in the healthcare team, enhancing their uptake in the pediatric intensive care unit setting.

Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM.

Zirpe KG, Tiwari AM, Pandit RA, Govil D, Mishra RC, Samavedam S, et al. Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM. Indian J Crit Care Med 2022;26(S2):S43-S50.

Development of the Interdisciplinary and Interprofessional Course Concept "Advanced Critical Illness Life Support".

The Advanced Critical Illness Life Support (ACiLS) course was developed on behalf of the German Society for Interdisciplinary Emergency and Acute Medicine (DGINA). The goal of the ACiLS course is to provide a nationally recognized and certified life support course that teaches medical professionals the key principles of initial care of critically ill patients in the emergency department, including the (PR_E-)AUD2IT-algorithm. It is designed for interdisciplinary and multi-professional staff in the resuscitation room to optimize patient safety and outcome. ACiLS includes a new blended learning concept with a theoretical part as comprehensive e-learning and a two-day practical part with strong focus on team training in scenarios and workshops. The course format was conceived to balance best teaching practices within the limited instructional time and resources available. This article describes the development of the ACiLS course and provides an overview of its future implementation.

Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research.

Healthcare is complex with multi-professional staff and a variety of patient care pathways. Time pressure and minimal margins for errors, as well as tension between hierarchical power and the power of the professions, make it challenging to implement new policies or procedures. This paper explores five improvement cases in healthcare integrating system dynamics (SD) into action research (AR), aiming to identify methodological aspects of how this integration supported multi-professional groups to discover workable solutions to work-related challenges. This re-analysis was conducted by a multi-disciplinary research group using an iterative abductive approach applying qualitative analysis to structure and understand the empirical material. Frameworks for consultancy assignments/client projects were used to identify case project stages (workflow steps) and socio-analytical questions were used to bridge between the AR and SD perspectives. All studied cases began with an extensive AR-inspired inventory of problems/objectives and ended with an SD-facilitated experimental phase where mutually agreed solutions were tested in silico. Time was primarily divided between facilitated group discussions during meetings and modelling work between meetings. Work principles ensured that the voice of each participant was heard, inspired engagement, interaction, and exploratory mutual learning activities. There was an overall pattern of two major divergent and convergent phases, as each group moved towards a mutually developed point of reference for their problem/objective and solution, a case-specific multi-professional knowledge repository. By integrating SD into AR, more favourable outcomes for the client organization may be achieved than when applying either approach in isolation. We found that SD provided a platform that facilitated experiential learning in the AR process. The identified results were calibrated to local needs and circumstances, and compared to traditional top-down implementation for change processes, improved the likelihood of sustained actualisation.

Out-of-the-ICU Mobilization in Critically Ill Patients: The Safety of a New Model of Rehabilitation.

OBJECTIVES:Early mobilization of ICU patients has been reported to be safe and feasible. Recently, our ICU implemented out-of-the-ICU wheelchair excursions as a daily rehabilitation practice. The aim of this study is to investigate the safety of participation in the out-of-the-ICU program for early mobilization.DESIGN:Retrospective cohort study.SETTING:Single general ICU in a tertiary teaching hospital.PATIENTS:Adult patients who were admitted to the ICU and underwent the out-of-the-ICU program as an early mobilization intervention was investigated.INTERVENTIONS:The out-of-the-ICU activities include visiting indoor area, visiting our outdoor garden, and bathing.MEASUREMENTS AND MAIN RESULTS:Medical records of ICU patients who participated in the out-of-the-ICU program were reviewed. The primary outcome was the occurrence rate of physical safety events, defined as unintentional removal of medical devices, patient agitation, a fall, or an injury. The secondary outcome was the occurrence rate of adverse physiologic changes, defined as hypotension, hypertension, bradycardia, tachycardia, desaturation, bradypnea, tachypnea, an increase in Fio2, or an increase in doses of vasoactive drugs. In total, 99 adult patients participated in the program, comprising a total of 423 out-of-the-ICU sessions. Among them, one session resulted in a physical safety event, the dislodgement of a tracheostomy tube. In 23 sessions, one or two adverse physiologic changes occurred. None of these events required additional treatment nor resulted in serious sequelae.CONCLUSIONS:An out-of-the-ICU program can be provided safely to adult ICU patients, provided that it is supervised by a dedicated intensivist with an appropriately trained multiprofessional staff and equipment on-site. It appears to contribute to the promotion of humanizing intensive care.

The development of a local clinical pathway for the management of high-grade lateral ankle ligament injuries

Purpose: High-grade lateral ankle ligament injuries cause significant functional impact with the potential for pathological sequelae and a known socio-economic burden. Clinical guidelines exist but are limited in their translation into local frameworks. The purpose of this clinical pathway was to standardise care for this specific group using current evidence and guidelines. This pathway also formed the main project for service development as part of the lead author's involvement in the Royal College of Nursing Clinical Leadership Programme for multi-professional staff at Mid Yorkshire Hospitals NHS Trust.

A importância do cuidado farmacêutico na prevenção e tratamento de doenças cardiovasculares

Objetivo: Apresentar as demandas relativas à atividade clínica do farmacêutico na prevenção e tratamento de doenças cardiovasculares, por meio de uma revisão narrativa que destaca os benefícios da participação deste profissional nas equipes de cuidados de saúde. Revisão Bibliográfica: As doenças cardiovasculares (DCVs) são responsáveis, anualmente, por milhões de óbitos em todo o mundo. A elevação da expectativa de vida e da incidência dos fatores de risco cardiovascular, como diabetes e a hipertensão arterial não controlada, representam os principais motivos do crescente aumento das DCVs nos últimos anos. O farmacêutico, por ser capacitado para identificar e solucionar problemas relacionados ao uso de medicamentos, pode oferecer significativa contribuição à equipe multiprofissional de saúde no que tange aos cuidados e segurança do paciente. Considerações finais: Embora a atuação clínica do farmacêutico na prevenção e tratamento de DCVs ainda seja discreta nos serviços brasileiros de saúde, é possível constatar que a participação do referido profissional nas equipes multiprofissionais de cuidados de saúde pode melhorar a qualidade da assistência aos pacientes, contribuindo para a redução da incidência de erros relacionados à terapia medicamentosa e na melhoria dos resultados terapêuticos relativos à segurança e eficácia dos medicamentos.

Insights gained from a systematic reanalysis of a successful model‐facilitated change process in health care

AbstractHealth care is a complex system with multiprofessional staff and multiple patient care pathways. Time pressure and minimal margins for error make it challenging to implement new policies or procedures, no matter how desirable. Changes in health care also requires the participation of the staff. System dynamics (SD) simulations can lead to shared systems understanding and allows for the development and testing of new scenarios in silico before implementing solutions. However, research shows that the actual implementation rate of simulations is low. This paper presents a reanalysis of a successful change project in health care combining SD principles with basic action research (AR) premises. The analysis was done by a multidisciplinary research group using qualitative methodology and identifies that a fruitful combination of AR inquiry and SD modelling potentially can improve implementation rates.

‘It comes with the territory’ - Staff experience with violation and humiliation in mental health care - A mixed method study

BackgroundThe aim of this study was to investigate staff's experiences with violation and humiliation during work in mental health care (MHC). A total of 1160 multi-professional MHC staff in Norway responded to an online questionnaire about their experiences with different kinds of violation and humiliation in the MHC setting. In addition, a sample of professionals (eight MHC nurses) were recruited for in-depth individual interviews. MethodThe study used an explorative mixed method with a convergent parallel design; this included a web-based questionnaire to MHC staff in combination with individual interviews. The sample is considered to be equivalent to staff groups in MHC in Norway. ResultsBetween 70 and 80% of the staff reported experiencing rejection, being treated with disrespect, condescending behaviour or verbal harassment. Male workers were significantly more often victims of serious physical violence, and women were significantly more often targets for sexual harassment. In interviews, participants said they considered being exposed to violence and humiliation to be part of the job when working in MHC, and that experience, as well as social support from colleagues, helped MHC practitioners to cope better with violent situations and feel less humiliated at work. DiscussionA high amount of MHC staff report experiences of being violated and humiliated during work. The participants' perceptions of the users and their behaviour seem to influence their experience of feeling violated and humiliated. Knowledge about the dynamics of aggression between staff and users in MHC may be used in safeguarding staff and users, prevent coercion and heighten the quality of care.

A Importância do Pensamento Crítico em Inovações Curriculares: interface com a educação sexual emancipatória

A partir de uma pesquisa de doutoramento no campo da Educação em interface com a sexualidade, o presente artigo discorre sobre a importância da promoção do Pensamento Crítico (PC) em mudanças paradigmáticas curriculares no ensino superior. O lócus do estudo foi um Curso de Graduação em Medicina organizado em currículo integrado, orientado por competências, com quadro docente interdisciplinar e multiprofissional, e desenvolvido por metodologias ativas. Objetivamos, neste ensaio, problematizar o desenvolvimento do PC como elemento substancial na materialização de uma proposta curricular que visa uma transformação paradigmática educacional. Norteado pelo paradigma do materialismo histórico dialético, o ensaio configura-se como um estudo de caso que utiliza o método dialético para análise da realidade. Os instrumentos de coleta compreenderam o uso de questionário e, posteriormente, a entrevista semiestruturada áudio gravada. Para análise, foi utilizada a análise de conteúdo, com complementos da análise textual discursiva. Como resultado, registrou-se que o desenvolvimento intencional do PC é fundamental para a busca de uma transformação paradigmática educacional efetiva. Embora hoje sejam defendidos e divulgados vários elementos inovadores no processo de ensino e de aprendizagem, muitos docentes do ensino superior continuam agindo amparados no paradigma convencional acriticamente. Isso sugere que as práticas não promovem naturalmente o PC.

Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre\u2013post study

BackgroundThe quality of family-centered care and parental participation in care in neonatal units differ widely across the world. Appropriate education might be an effective way to support medical staff in neonatal units to collaborate with parents and implement family-centered care. The aim of this study was to evaluate the effects of the educational intervention on the quality of family-centered care in eight Finnish neonatal intensive care units from both the staff and parent perspectives.MethodsA mixed-method pre–post intervention study was conducted in eight neonatal intensive care units in Finland. Data were collected from staff and parents using the Bliss Baby Charter audit tool and semi-structured interviews.ResultsThe quality of family-centered care, as assessed by staff and parents, increased significantly after the intervention in all eight units. The intervention was able to help staff define and apply elements of family-centered care, such as shared decision making and collaboration between parents and staff. In interviews, staff described that they learned to support and trust the parents’ ability to take care of their infant.ConclusionsThe educational intervention increased the quality of family-centered care and enabled mutual partnership between parents and staff.ImpactThis study shows that the educational intervention for the whole multi-professional staff of the neonatal unit improved the quality of family-centered care.The Close Collaboration with Parents intervention enabled mutual partnership between parents and staff.It also provides evidence that during The Close Collaboration with Parents intervention staff learned to trust the parents’ ability to take care of their infant.

Exploring staff experience of economic efficiency requirements in health care: A mixed method study.

Economic resources are limited in health care, and governance strategies are used to push provider organizations to use resources efficiently. Although studies show that hybrid managers are successful in reconciling economic efficiency requirements with professional values to meet patient needs, surprisingly few studies focus on staff. The aim of this study is to explore staff members' experience of economic efficiency requirements. A mixed method design was applied, targeting multi-professional staff in the Department of Rehabilitation Medicine in a Swedish university hospital. Survey data was collected (n=93), followed by focus-group interviews to support the understanding of the quantitative findings. The findings show that health care staff is knowledgeable and intrinsically motivated to consider efficiency requirements, albeit it should not dominate clinical decisions. However, staff experiences little influence over resource allocation and identifies limitations in the system's abilities to meet patient needs. Staff experience incorporates a local unit and a system perspective. Staff members are aware of economic efficiency requirements and will behave accordingly if patients are not at risk. However, their engagement seems to rely on how economic efficiency requirements are handled at multiple system levels and their trust in the system to fairly support patient needs.

Norwegian drug information centres strongly promote person-centred and personalised medicine: a brief report on the achievements and strategy.

The Norwegian network of drug information centres (RELIS) has achievements in person-centred and personalised medicine. RELIS receive questions from physicians, pharmacists, nurses and other health professionals and provide decision support in all aspects of pharmacotherapy. Questions associated with person-centred medicine often include problems with unrealistic risk perception and poor adherence among patients. Questions associated with personalised medicine frequently concern comorbidity, biomarkers and pharmacogenetics. The questions frequently include a mix of problems related to health and disease care. The RELIS staff addresses each question in a problem-oriented approach with expertise in pharmacology and skills in searching and critical evaluation of the literature. A written answer can describe decision support concerning patient empowerment, further diagnostics and preferences in pharmacotherapy including advice with regard to choice of drug and dose to a patient. Links to online resources and attached references for further reading are often included in the answers. The question-answer service is documented in a full-text, searchable question-answer database. Additional drug information activities towards clinicians and patients, and a multi-professional staff with pharmacists and clinical pharmacologists, are important elements in RELIS drug information strategy, and it is essentially relevant to predictive, preventive and personalised medicine (PPPM).

Developing 7-day services – demonstrating effective clinical outcomes using multiprofessional clinical staff

North-west London hospitals were designated as first-wave rollout sites for NHS England's ‘7-day services’ clinical standards. Our aim was to determine clinical outcomes (improved patient flow, reduced length of stay, reduced in-hospital morbidity) and pilot new care models designed to meet those outcomes. Recognising the value of the entire multidisciplinary team to deliver these standards was an important guiding principle.