Factors Related To Implementation of An Interprofessional Communication Concept In Thoracic Oncology: A Mixed-Methods Study

Background: An innovative patient-centred interprofessional communication concept with advanced lung cancer patients (Heidelberg Milestone Communication Approach, MCA) has been developed and implemented. Role changes and interprofessional communication are challenging in a busy outpatient oncology service. The aim of the study was to assess team-related factors associated with its implementation and thoracic oncology teams’ attitudes towards interprofessional collaboration.Methods: Interviews and focus groups on implementation and interprofessional collaboration in the context of MCA were conducted with healthcare staff. The topics were analysed deductively, guided by the Professional Interactions factor of the Tailored Implementation for Chronic Diseases (TICD) framework. In addition, 3 of the 4 subscales of the validated German translation of the University of the West of England Interprofessional Questionnaire (UWE-IP-D) were collected prior to implementation of MCA (t0) with follow-up data collections at 4 months (t1), 10 months (t2) and 17 months (t3). Descriptive analysis included calculating subscale sum scores and categorizing each subscale into positive, neutral and negative attitudes. Results: Fifteen staff members participated in the interviews and focus groups. The main interprofessional interaction factors associated with implementation concerned the knowledge of the MCA and the impact of the intervention on team roles, on information sharing and on transfer processes between wards. The survey with 87 staff (44 nurses, 13 physicians, 12 psycho-social staff, 7 therapists, and 11 others) participating at least once (t0: n=20, t1: n=48, t2: n=33, t3: n=25) found heterogeneous attitudes. A positive attitude to ‘Communication and Teamwork’ was indicated by individual sum scores between 10 and 23 (M=17.7, SD=3.0). The majority of the respondents (n=48) had neutral attitudes to ‘Interprofessional Interaction’ with individual sum scores varying between 13 and 45 (positive attitude n=14, negative attitude n=22; M=28.5, SD=5.6). ‘Interprofessional Relationships’ were characterized by primarily positive attitudes (n=80) (neutral: n=6, negative attitude n=1; M=16.0, SD=3.6). There were no differences between collection times.Conclusions: Positive experiences and potential shortfalls in the implementation were observed. Future introductions of interprofessional communication concepts require further activities which should address the attitudes of healthcare professionals towards interprofessional care.Trial registration: DRKS00013469 / Date of registration: 22/12/2017.

Role-Play versus Standardised Patient Simulation for Teaching Interprofessional Communication in Care of the Elderly for Nursing Students

This study aims to describe and compare the effects of standardised patient simulation and role-play in the acquisition and retention of interprofessional communication in elderly care competence amongst nursing students. In this controlled clustered randomised trial, 121 nursing students attended a workshop on interprofessional communication in elderly care using role-play or standardised patient simulation. The study was conducted between September 2017 and February 2018. Participants’ knowledge, self-efficacy and communication skills were assessed using a simulated scenario at pre-test, post-test and 6-week follow-up points. Between-subject and within-subject differences were measured using counts and proportions of participants who achieved competence. Regardless of the strategy applied, a significant improvement in knowledge, skills, self-efficacy and overall interprofessional communication competence was found between pre-test and post-test. Moreover, there were significant differences between pre-test and follow-up for all the studied variables, but no differences were found between post-test and follow-up. Lastly, when comparing the success rates of both strategies, no significant differences were observed (p > 0.05). In conclusion, standardised patient simulation and role-play have been shown to promote an improvement on knowledge, self-efficacy and interprofessional communication skills in nursing students, although it is not possible to state which strategy is the most adequate for teaching this competency.

Promoting positive interactions between midwives and obstetricians at the primary/secondary interface

Background: Interprofessional communication is a critical component of safe maternity care. The literature reports circumstances in Aotearoa New Zealand and overseas when interprofessional collaboration works well between midwives and obstetricians, as well as descriptions of unsatisfactory communication between the two professions. Aim: To explore and define effective collaboration between midwives and obstetricians at the primary/secondary interface in maternity care, in order to generate suggestions to foster positive collaboration. Method: Eight primary care midwives, three obstetricians and two obstetric registrars from a single District Health Board in Aotearoa New Zealand were interviewed about their interactions at the primary/secondary interface and their understanding, and use, of the Referral Guidelines. The theoretical perspective was Appreciative Inquiry. Data were analysed using thematic analysis. Findings: Results indicate usually positive interprofessional interactions. Dominant emergent themes are the need to negotiate differing philosophies, to clarify blurred boundaries that sometimes lead to lack of clear lines of responsibility, and the importance of three-way conversations. Of the three themes, this article focuses on three-way communication between midwife, obstetrician/registrar and woman. Participants reported that, when effective three-way communication between woman, midwife and obstetrician occurred, philosophical difference could be negotiated, blurred boundaries clarified and understanding of the respective roles of the LMC midwife and the obstetric team promoted. Participants value the Referral Guidelines but report some limitations to their applicability. Conclusion: Effective three-way communication promotes good maternity care. This study has identified ways to support optimal communication.

Technology Guided Assessment for Urinary Tract Infection: Creating a Common Interprofessional Language

The Shared Meaning Model (SMM) is a grounded theory, derived in a previous study. This model demonstrates pathways for communication between nurse and primary care providers (PCPs) in the nursing home (NH), In this study we used the SMM for feasibility testing of a clinical decision support app (CDS app) using a descriptive, structured observational design. This study also provided a forum for initial testing of the SMM. The CDS app algorithm provided a common language to assess a resident with the goal of sharing this information with a PCP. The CDS app guided licensed vocational nurses (LVNs) (N=10) in assessing a standardized nursing home resident in a simulation setting experiencing symptoms of a potential urinary tract infection (UTI). Interviews with LVNs provided details of CDS app usability and concerns about using the CDS app with NH residents. Videos recorded LVNs interacting with the resident while using the CDS app on an iPad®. Time-stamps logged duration of the assessment. Bookmarked segments were used for discussion in LVN interviews. Videos were coded for eye contact, conversation, and touch between LVN and resident and documented personalized interactions. Findings indicated areas (lab values, drug names) for changes to language in the algorithm. In less than 12 minutes the CDS app enabled LVNs to collect information based on language used by PCPs to make decisions about the presence of a UTI. Relationships between initial constructs in the SMM were supported. This CDS app holds promise for building a common language to enhance interprofessional communication.

COMMUNICATION OF PROFESSIONAL CAREGIVERS IN ESTABLISHING INTERPROFESSIONAL COLLABORATION AT MEURAXA HOSPITAL, BANDA ACEH

Background: Interprofessional collaboration for patient care is integrated cooperation between health workers in ensuring optimally consecutive patient care. Interprofessional decisions should be made in two ways between professional caregivers.Aims: This study aimed to analyze communication between professional caregivers in establishing interprofessional collaboration at Meuraxa District General Hospital in Banda Aceh.Method: This study was qualitative research and used a phenomenological approach. In-depth interviews and FGD were conducted with professional caregivers consisting of doctors in charge, nurses, pharmacists, and dietitians. All of the in-depth interviews and FGD were recorded and transcribed. Data obtained were analyzed thematically.Results: Communication between professional caregivers in establishing interprofessional collaboration at the hospital had not been well-performed. Overall, they had not optimally utilized integrated patient progress records as they focused on taking care of their patients individually. They also lacked literacy about the information in the records. Inadequate time in serving patients and the insufficient number of human resources were presumed to hamper interprofessional communication.Conclusion: Promoting interprofessional collaboration and effective communication regularly is required by the hospital management. They also need to evaluate the sufficiency of human resources, especially pharmacist positions. Besides, they can formulate supervision and evaluation systems of interprofessional communication between professional caregivers. Keywords : communication, integrated patient progress record, interprofessional collaboration, professional caregivers

Promoting Interprofessional Communication through Situation, Background, Assessment, and Recommendation (SBAR): An Educational Technique

Context The Board of Certification Standards of Professional Practice and the 2020 Curricular Content Standards indicate athletic trainers should establish working relationships with collaborating medical professionals and be able to communicate effectively. In addition, increased emphasis on interprofessional collaboration (IPC) in practice is apparent throughout health care professions and their educational programs. However, integrating both interprofessional communication and IPC within 1 learning opportunity can be difficult. Objective To share an educational approach aimed to enhance athletic training students' abilities and confidence in delivering patient information to physician assistant students via the situation, background, assessment, and recommendation (SBAR) technique. Background As part of the health care team, athletic trainers need to communicate with various providers while making clinically based decisions. Anecdotally, learners in their final year of health care education are not confident in their ability to make recommendations to other health care professionals. The SBAR communication strategy from the evidence-based framework TeamSTEPPS has become widely adopted in health care disciplines and may help to enhance confidence in communication. Description This learning activity enables athletic training students to use a patient case scenario to develop an SBAR for delivery via phone to a physician assistant studies student. This article describes the content, delivery methods, outcomes to date, and connection to the 2020 Curricular Content Standards. Clinical Advantage(s) This clinically relevant activity provides a low-stakes, real-life opportunity for students to practice communication skills, including the following: condensing the evaluation process, clinical decision-making skills, and the ability to make recommendations for a plan of care. Active participation in the communication process enhances reasoning skills needed for collaborative clinical decision making and the transfer of care, when applicable. Conclusion(s) Developing and implementing an interprofessional SBAR communication experience with 2 health care disciplines is an innovative strategy that bridges the gap between clinical education and actual patient care experiences while addressing curricular content needs.