Team Perspective Research Articles

Endoscopy anesthesia, team perspective

Endoscopy anesthesia, team perspective

Reconceptualizing Care Transitions Research From the Patient Perspective.

Reconceptualizing Care Transitions Research From the Patient Perspective.

Decision Support System Applications for Scheduling in Professional Team Sport. The Team's Perspective.

Background: Periodization implies the systematic planning of training and competition with the goal of reaching the best possible performance in the most important competition. In team sports, this consists of finding a flight-and-practice schedule that maximizes the opportunities to perform the periodized contents (e.g., trips, practices, games, and days off). This process is conducted whilst considering known constraints (e.g., competitive schedule, roster availability, weather, especial events, holidays, or emotional effect of days away). The way a scheduling decision support system (DSS) leads users to make a decision should allow for flexibility, whilst minimizing users' confusion and facilitating the understanding of the recommendation given by the scheduling decision support system. Traditional approaches to solving scheduling problems use either simulation models, analytical models, heuristic approaches or a combination of these methods. When it comes to evaluate how the scheduling DSS is performing, three overarching aspects need to be reviewed: context satisfaction, process efficiency, and output quality. Appropriate training periodization and scheduling of trips and training sessions are critical for teams to optimize training and recovery processes in order to maximize health and performance. This article presents a methodological framework for designing decision-support systems for scheduling in professional team sports.

Strategies for Successful Clinical Trial Recruitment of People Living with HIV in Low- and Middle-Income Countries: Lessons Learned and Implementation Implications from the Nigeria Renal Risk Reduction (R3) Trial.

Clinical trials represent a bedrock for measuring efficacy of interventions in biomedical research, but recruitment into clinical trials remains a challenge. Few data have focused on recruitment strategies from the perspective of clinical trial teams, especially in low- and middle-income countries (LMIC), where HIV is most prevalent. We summarized data from the literature and our experience with recruitment for the Renal Risk Reduction trial, aimed at reducing risk of kidney complications among people living with HIV in Nigeria. Using an implementation science framework, we identified strategies that contributed to successful clinical trial recruitment. For strategies that could not be categorized by this framework, we summarized key features according to selected action, actor, target, context, and time. We identified how these identified strategies could map to subsequent implementation outcomes at the patient and provider/health system level, as well as capacity-building efforts to meet needs identified by LMIC partners, which is a priority for success. Our experience highlights the importance of considering implementation outcomes, and the strategies necessary to achieve those outcomes early, in the planning and execution of clinical trials. Clinical trial recruitment can be optimized via methodologies grounded in implementation science.

Study and promotion of safety culture using mixed methods research

Abstract Objective With a positive safety culture, institutions offer the best quality and safe care to their patients. The objective of this study was to analyze patient safety culture from the perspective of the multidisciplinary team, to identify factors that influence patient safety culture, and to create/promote—jointly with the study participants—strategies for improving processes of change. Methods The study design represented a mixed methods research approach, with a sequential explanatory design. A multidisciplinary team of workers at a general hospital was eligible for the study. To collect quantitative data, we administered the Safety Attitudes Questionnaire (SAQ). The qualitative phase was accomplished via focus groups (FGs), with participants from the first phase of the study using the principles of deliberative dialogue (DD) as a knowledge-translation strategy. The STROBE guideline was used to develop the study. Results The overall SAQ score was positive (75.1 ± 10.4). Negative scores were found in the fields of Safety Climate, Working Conditions, and Stress Recognition. Focus group discussions identified the aspects that create a negative impact on safety culture, such as ineffective communication, punitive approach in the event of errors, the lack of commitment and adherence to the protocols, and the non-recognition of the stress and the mistakes. Actions for the promotion of safety culture were developed and implemented during the study. Conclusions The use of the principles of DD as a strategy for knowledge translation (KT) made it possible to identify and plan for joint actions to generate improvements in safety culture.

Examining the Feasibility of Early Mobilization With Virtual Reality Gaming Using Head-Mounted Display and Adaptive Software With Adolescents in the Pediatric Intensive Care Unit: Case Report.

BackgroundEarly rehabilitative mobilization for adolescents is safe and feasible. However, there is a lack of published rehabilitation strategies and treatments that can maximize engagement and outcomes among adolescents in the pediatric intensive care unit (PICU). Virtual reality (VR) gaming using a head-mounted display (HMD) and adaptive software can allow active and nonactive gameplay at the bedside for people with limited arm mobility, making it a potentially inclusive and enjoyable treatment modality for adolescents in the PICU.ObjectiveThe purpose of this brief case study is to report on the preliminary feasibility of incorporating adaptive VR gaming using an HMD with 2 adolescents who received early mobility treatment within the PICU.MethodsThis study was a mini-ethnographic investigation of 2 adolescents (a 15-year-old male and a 13-year old male) in the PICU who underwent VR gaming sessions as part of their early mobilization care, using an Oculus Rift HMD and adaptive software (WalkinVR) that promoted full gameplay in bed. The Rift was plugged into a gaming laptop that was set up on a table within the patient’s room before each session. The intervention was delivered by an adapted exercise professional and supervised by a physical therapist. Patients had access to a variety of active games (eg, boxing, rhythmic movement to music, and exploratory adventure) and nonactive games (eg, racing and narrative adventure). Gaming sessions were scheduled between usual care, when tolerable and requested by the participant. The interventionist and therapists took audio-recorded and written notes after completing each gaming session. These data were analyzed and presented in a narrative format from the perspective of the research team.ResultsCase 1 participated in 4 gaming sessions, with an average of 18 minutes (SD 11) per session. Case 2 participated in 2 sessions, with an average of 35 minutes (SD 7) per session. Both cases were capable of performing active gaming at a moderate level of exercise intensity, as indicated by their heart rate. However, their health and symptoms fluctuated on a daily basis, which prompted the gameplay of adventure or nonactive games. Gameplay appeared to improve participants’ affect and alertness and motivate them to be more engaged in early mobilization therapy. Gameplay without the WalkinVR software caused several usability issues. There were no serious adverse events, but both cases experienced symptoms based on their condition.ConclusionsThe findings of this study suggest that VR gaming with HMDs and adaptive software is likely a feasible supplement to usual care for adolescents within the PICU, and these findings warrant further investigation. Recommendations for future studies aimed at incorporating VR gaming during early mobilization are presented herein.

Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study

BackgroundEvidence-based practices (EBPs) have been shown to improve behavioral and mental health outcomes for children diagnosed with autism spectrum disorder (ASD). Research suggests that the use of these practices in community-based organizations is varied; however, the utilization of implementation guides may bridge the gap between research and practice. The Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART) Implementation Toolkit is a web-based implementation toolkit developed to guide organization-based implementation teams through EBP identification, adoption, implementation, and sustainment in ASD community-based organizations.MethodsThis study examined the facilitators and barriers (collectively termed “determinants”) to the utilization of this toolkit, based on the perspectives of implementation teams at six ASD community-based organizations. Two independent coders utilized the adapted EPIS framework and the Technology Acceptance Model 3 to guide qualitative thematic analyses of semi-structured interviews with implementation teams.ResultsSalient facilitators (e.g., facilitation teams, facilitation meetings, phase-specific activities) and barriers (e.g., website issues, perceived lack of ease of use of the website, perceived lack of resources, inner context factors) were identified, highlighting key determinants to the utilization of this toolkit. Additionally, frequent determinants and determinants that differed across adapted EPIS phases of the toolkit were noted. Finally, analyses highlighted two themes: (a) Inner Context Determinants to use of the toolkit (e.g., funding) and (b) Innovation Determinants (e.g., all website-related factors), indicating an interaction between the two models utilized to guide study analyses.ConclusionsFindings highlighted several factors that facilitated the utilization of this implementation guide. Additionally, findings identified key areas for improvement for future iterations of the ACT SMART Implementation Toolkit. Importantly, these results may inform the development, refinement, and utilization of implementation guides with the aim of increasing the uptake of EBPs in community-based organizations providing services to children with ASD and their families. Finally, these findings contribute to the implementation science literature by illustrating the joint use of the EPIS framework and Technology Acceptance Model 3 to evaluate the implementation of a web-based toolkit within community-based organizations.

Interprofessional care team practices and perspectives on immuno-oncology (IO) therapies for metastatic non-small cell lung cancer (mNSCLC): Insights from a nationwide survey.

e21147 Background: Appropriate molecular testing, biomarker-directed treatment selection, and management of immune-related adverse events (irAEs) are essential best practices for managing patients with mNSCLC who are eligible for IO therapies. Identifying real-world challenges among mNSCLC care teams is necessary to inform educational interventions that support optimal care. Methods: From 10/2020 to 01/2021, 75 health care professionals (HCPs) who treat mNSCLC completed surveys assessing practice patterns, challenges, and confidence related to the use of IO therapies. To reflect current real-world practice across treatment settings, surveys were administered at 10 clinics nationwide and through a large oncology practice network. Results: Participants represented the interprofessional mNSCLC care team: oncologists (50%), primary care physicians (23%), advanced practice professionals (13%), and nurses (13%). Nearly one-third reported that PD-L1+ mNSCLC presented greater management challenges than other mNSCLC sub-types. Regarding patients who are eligible for IO therapies, the most commonly reported challenges were applying pathology results to treatment decisions (29%), differentiating IO therapies (19%), and managing irAEs (19%). Case-based questions revealed gaps in care relative to guidelines: 65% incorrectly identified which patients should be tested for PD-L1; 49% failed to identify the most appropriate IO regimen based on case details; and 65% failed to identify an inappropriate strategy for managing mild irAEs (Table). Further, HCPs reported inappropriate reasons to exclude patients from IO therapy and suboptimal use of supportive care measures. Confidence gaps echoed these challenges; most HCPs reported less-than-high confidence in their ability to apply molecular test results to treatment decisions (80%), differentiate IO therapies based on PD-L1 expression (65%), or coordinate irAE care (85%). Conclusions: In current real-world practice, mNSCLC care teams report challenges in biomarker testing and interpretation; differentiation of IO therapies based on patient, disease, and treatment factors; and irAE management. These identified gaps represent key opportunities for future interventions to improve mNSCLC care. [Table: see text]

Conceptualising interventions to enhance spread in complex systems: a multisite comprehensive medication review case study

BackgroundAdvancing the description and conceptualisation of interventions in complex systems is necessary to support spread, evaluation, attribution and reproducibility. Improvement teams can provide unique insight into how interventions are operationalised...

Initiative in Work Teams: Lever between Authentic Leadership and Results.

Background: The central point of this study is team initiative, and we analyzed how the theoretical model of antecedents and consequents of personal initiative contribute to explaining the relationship between team initiative and its antecedents and consequents. Authentic leadership is proposed as the antecedent, and the consequent leads to two types of outcomes, one of which is related to employee well-being, and the other is related to performance. However, little is known about what occurs in this relationship once the focus shifts to the team level. From a team perspective, with the label team initiative, we propose a collective construct defined similarly to personal initiative. This study shows the relationship between team initiative and its two consequences, team work engagement and performance, which are measured in terms of team productivity by the leader. Methods: Our model was tested in a field study with 344 employees of 79 work teams belonging to 55 organizations. Results: The analysis of the results using SEM and a regression analysis supported our main hypotheses. Conclusions: The finding that initiative is related to performance establishes the importance of initiative at the team level. It also emphasizes its impact on employee well-being through team work engagement and suggests the importance of authentic leadership.

Apartment Purchase Decision Variables in Real Estate Companies: Sales Teams Perspective in Addis Ababa, Ethiopia

This study intended to assess factors affecting apartment purchase decision of consumers with respect to real estate sales team perspective in Addis Ababa using four major factors that would affect the purchase decision of a consumer viz., price, location, quality of apartment and corporate image. Accordingly, the study used both descriptive and explanatory research design. Self-administered structured questionnaires were used to collect primary data from a total sample size of 50 sales experts or sales/marketing manager of real estate companies who are drawn using convenient sampling. The relationships proposed in the framework were tested using Pearson correlation, and the causal relations were analyzed using regression analysis. Accordingly, it is found out that there is a strong significant relationship between purchase decision factors and purchase decision with Pearson correlation coefficient of 0.699 (r=0. 699) . In addition, purchase decision factors have an influence on purchase decision in which 52.20% of the variation in purchase decision is explained by the variation in price, location, quality of apartment and corporate image. Furthermore, corporate image is the most influencing apartment purchase decision factor followed by quality of apartment. Thus, it is recommended that real estate companies may give top priority in building their corporate image and developing quality apartments as these two factors are highly influencing real estate customers purchase decision. Keywords: Real estate, Apartment, Purchase decision, purchase decision factors DOI: 10.7176/JMCR/79-02 Publication date: May 31 st 2021

Exploring the process of information sharing in an adult intensive care unit: an ethnographic study

ABSTRACT Information sharing, a component of patient and family engagement (PFE), is an important process that may contribute to intensive care unit (ICU) quality of care. Yet, virtually no studies explore how the process of information sharing unfolds in the ICU from the interprofessional team and family member perspectives. To better understand the process of information sharing, we conducted ethnographic fieldwork in a 20-bed medical ICU, focusing on behaviors and interactions of the interprofessional team and family members (May 2016 – October 2016). We completed 17.5 observation hours, 6 shadowing sessions, and 12 semi-structured interviews with 17 total participants. We used thematic content analysis and iterative inductive coding to identify three themes about the information sharing process: 1) family factors (health literacy and past experience with the ICU environment) influence information sharing; 2) clinicians strategies can support engagement in the process of information sharing (assessing families’ need for information, understanding a families’ hope, using rounds as an opportunity for information sharing); 3) the process of information sharing allows for trust building between families and the ICU team. Our findings suggest that information sharing is a crucial process that may serve as a catalyst for effective patient and family engagement in the ICU.

Covid-19 e as decisões governamentais no retorno presencial de uma rede privada de ensino do DF: um relato da equipe de psicologia escolar

O artigo problematiza o retorno presencial de alunos da Educação Infantil e Ensino Fundamental I, de uma rede privada de ensino, em meio à pandemia da Covid-19. Analisou-se as ações amparadas pelo governo do Distrito Federal e a realidade das famílias de uma escola particular, buscando identificar os fatores que influenciaram o posicionamento dos responsáveis, no sentido de permitir o retorno de seus filhos à frequência presencial. A investigação metodológica foi por meio do relato de experiência, comparando-se as análises de questionários de satisfação enviados às famílias sobre as aulas on-line e pesquisas diretas, com o único intuito de conhecer o quantitativo das famílias com interesse no retorno presencial, e associando essas análises aos diferentes decretos publicados no DODF. Concomitantemente, há o respaldo bibliográfico em relação ao cenário escolar, apresentando, dessa forma, outras experiências vivenciadas durante a pandemia. Após análise, a discussão seguiu uma linha cronológica de pensamento, em um primeiro momento debatendo sobre a educação a distância, trazendo seus vários desafios, tanto da perspectiva bibliográfica como da perspectiva da Equipe de Psicologia da escola em questão. Em um segundo momento discutiu-se sobre a mudança de perspectiva dos responsáveis, em relação ao retorno presencial, com as decisões governamentais do momento, apesar da ascensão dos casos de Covid-19, na média móvel. Conclui-se que a pandemia da Covid-19 determinou, de algum modo, um momento de resiliência e criatividade dos professores, ao mesmo tempo que provocou desgaste emocional na comunidade escolar, refletindo-se também, sobre as desigualdades sociais entre escolas públicas e particulares.

Key Steps Toward a Promotional Communications Strategy: Collaboration Best Practices for Teams Creating Promotional Materials and Regulatory Colleagues.

A promotional communications strategy is considered early in prescription medical product development by commercial disciplines (e.g., commercial/marketing) and informs promotional materials to key stakeholders such as healthcare providers and patients. Health economics and outcomes research (HEOR) is a scientific discipline that is also responsible for the generation of promotional materials to other key stakeholders such as payors. The overarching promotional strategy benefits from consistent partnerships with regulatory affairs colleagues, culminating in cost savings and patient-centric promotional materials. Yet there is a paucity of published content that details effective collaboration between promotional teams and regulatory colleagues prior to medical/legal/regulatory (MLR) review. The following review aims to showcase such organizational innovation from the perspective of teams developing promotional materials (i.e., commercial and HEOR). Behind-the-scenes marketing activities are described in relation to the following key steps that build the strategy's foundation: insight gathering from key stakeholders; sub-strategy development; tactic identification; and promotional message development. Integration of regulatory colleagues with teams developing promotional materials is imperative to accomplish these key steps prior to any MLR review. Finally, four themes in best practices for collaboration with regulatory colleagues are shared from the perspective of commercial disciplines and HEOR, alongside a real-world example for each: (1) Alignment of Strategies; (2) Shared Process & Tools; (3) Creative Problem-Solving; and (4) Culture of Connecting.

Perspectives of Multidisciplinary Professional Teams during Assessment Processes for ATD Selection in the Japanese Public Provision System.

Selection of assistive technology devices (ATDs), which are imperative for persons with disabilities to improve their quality of life, requires collaboration of users and multidisciplinary professionals. However, it is still unknown how to design and implement an adequate collaborative work flow and a professional team. Under Japanese governmental ATD provision system, based on the application by clients, ATDs are mainly selected through collaborative processes with the clients and health professionals in public organizations, rehabilitation counseling centers (RCCs). By employing qualitative study methods in this study, we investigated the ATD selection process in which health professionals in RCCs collaboratively assess clients with physical disabilities so as to support them in selecting the adequate ATDs. To identify the perspectives required for ATD selection completely, the assessment processes were recorded and analyzed with a pseudo setting in two RCCs. Content analysis of the conversations between the client and professionals revealed the characteristics of the information exchanged in the assessment processes. A total of 760 assessment items were identified, thus indicating a broad array of interest. Despite the richness of information collected for the assessment, half of the assessment items did not have corresponding items in the documents that were employed during the prescription process. Thematic analysis of the interviews that followed revealed the common values and collaborative processes in ATD selection, which were shared and elaborated among the staff in daily social interactions. To facilitate implementation of ATD provision in various areas with few resources, it may be effective to convert this tacit-to-tacit knowledge sharing into a more explicit sharing by promoting analyses of good practices.

Symptom management of COVID-19 positive patients in an acute NHS trust: a specialist palliative care team perspective

Despite a 33% mortality rate for hospital admissions with COVID-19, data around end-of-life care needs in the context of the virus remain lacking.[1][1] We present a study of 89 COVID-19 hospital patients who received specialist palliative care team (SPC) input. This study delivers a novel

The multidisciplinary team perspectives on agitation management in critical care: A qualitative study.

People who are experiencing a period of critical illness frequently experience severe agitation. The presence of agitation can pose risks to the patient, family, and clinical team. To capture the views and opinions of critical care multidisciplinary teams concerning the approaches in the management of agitation, and to understand and identify the perceived risks and benefits of current management strategies. A descriptive qualitative design. Data were gathered using semi-structured interviews with multidisciplinary teams from adult critical care units from one region in the United Kingdom. A total of 19 participants participated between February to September 2017. There were two group interviews (GIs) (n=12, GI 1 n= 8, GI 2 n=4) and seven one-to-one interviews, across four hospital organisations with one participant working via an agency. The mean length (± SD) of each interview, one to one or group, was 58.86 minutes (5.81 minutes). Three major themes were generated about the complex clinical decision-making required to manage an agitated patient. These themes represented: the burden of care, continuity of clinical decision-making, and uncertainty and indecision experienced by participants. Participants described caring for an agitated patient as challenging and stressful. Staff sought clarification on what level of restrictive practice is allowed. Feelings of anxiety and stress generated by the decisions made may have an impact on staff, particularly those who are more inexperienced, which in the longer term could lead to fatigue or moral distress. The study has emphasised the challenges faced by multidisciplinary teams and how decision-making may impact on individuals within the team.

Factors That Influence Use of a Patient Portal by Health Professionals.

Patient portals are websites or apps that provide patients with tools to manage healthcare appointments, access their health records, and communicate with clinicians. Patient portals have been demonstrated to be beneficial for improving communication between patients/carers and their healthcare team in a range of health settings. However, there is limited research on the barriers and enablers for implementing patient portals from the perspective of health professionals and healthcare teams, particularly in a paediatric setting. This study aimed to understand healthcare teams’ experiences of using a patient portal and, using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework, explore the barriers and enablers to ongoing use. Participants were 11 health professionals participating in the pilot of a patient portal for patients/carers in paediatric care. Data were collected using semi-structured interviews. Analysis of the interview data identified nine themes about implementing a patient portal in paediatric care, all of which aligned with the four constructs of the UTAUT. This study identified that barriers and enablers of the uptake of a patient portal by health professionals in a paediatric context aligned with the UTAUT framework. Value for the patient, improved workflow, and adequate technical and implementation support were highlighted by participants.

Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

Productive Ward: Releasing Time to Care™. A qualitative, ward-based team perspective.

Initiating and integrating a personalized end of life care project in a community hospital intensive care unit: A qualitative study of clinician and implementation team perspectives.

The end of life (EOL) experience in the intensive care unit (ICU) can be psychologically distressing for patients, families, and clinicians. The 3 Wishes Project (3WP) personalizes the EOL experience by carrying out wishes for dying patients and their families. While the 3WP has been integrated in academic, tertiary care ICUs, implementing this project in a community ICU has yet to be described. To examine facilitators of, and barriers to, implementing the 3WP in a community ICU from the clinician and implementation team perspective. This qualitative descriptive study evaluated the implementation of the 3WP in a 20-bed community ICU in Southern Ontario, Canada. Patients were considered for the 3WP if they had a high likelihood of imminent death or planned withdrawal of life-sustaining therapy. Following the qualitative descriptive approach, semi-structured interviews were conducted with purposively sampled clinicians and implementation team. Data from transcribed interviews were analyzed in triplicate through qualitative content analysis. Interviews with 12 participants indicated that the 3WP personalized and enriched the EOL experience. Interviewees indicated higher intensity education strategies were needed to enable spread as the project grew. Clinicians described many physical resources for the project but suggested more non-clinical project support for orientation, continuing education, and data collection. A majority of wishes focused on physical resources including keepsakes, which helped facilitate project spread when clinician capacity was attenuated by competing duties. In this community hospital, ICU clinicians and implementation team members report perceived improved EOL care for patients, families, and clinicians following 3WP initiation and integration. Implementing individualized and meaningful wishes at EOL for dying patients in a community ICU requires adequate planning and time dedicated to optimizing clinician education. Adapting key features of an intervention to local expertise and capacity may facilitate spread during project initiation and integration.