Consensus on the definition and attributes of person-centered teamwork: An e-Delphi study.

BACKGROUND: Effective health care relies on person-centeredness and teamwork, which are known to improve outcomes. These two concepts have been defined individually, but we could not find a definition of the combined concept. A preliminary definition was developed through a concept analysis; however, consensus on the concept has not been reached. AIM: The aim of this study was to reach consensus on the definition and attributes of person-centered teamwork. METHODS: A consensus design allowed experts to collaborate and share their experience and wisdom to refine and reach consensus on the definition and attributes of person-centered teamwork. An e-Delphi was used to engage the experts. RESULTS: Three rounds of online engagement with 12 experts were needed to reach consensus on the definition and attributes of person-centered teamwork. The attributes reached consensus of 82% after the first round. The definition had 82% consensus after the three rounds. The definition had been adjusted and refined according to the expert input. The newly adjusted definition was established. LINKING EVIDENCE TO ACTION: We successfully used the e-Delphi method to obtain consensus on the attributes and definition of person-centered teamwork. The definition of person-centered teamwork can be further developed and included in clinical practice to guide improved clinical outcomes. The consensus definition of person-centered teamwork provides a clear understanding of the meaning thereof, which may in turn enrich the usability thereof in clinical practice. Person-centered teams improve outcomes for persons receiving care in hospitals. Building person-centered teams are now better understood and the foundation of building these teams defined. We engaged with 12 experts in the academic and clinical field of person-centeredness and teamwork. The use and value of the Delphi method to obtain consensus is now better understood and can assist future research development.

Consensus on the content of an instrument to measure person-centred teamwork: An e-Delphi study.

AIMS AND OBJECTIVES: To establish consensus on items to be included in an instrument to measure person-centred teamwork in a hospital setting. The objective was to identify the items through a methodological literature review. Refine the items and obtain consensus on the items. BACKGROUND: A definition and related attributes of person-centred teamwork have been agreed upon. An instrument is needed to measure and monitor person-centred teamwork in hospital settings. DESIGN: Consensus, electronic Delphi design. METHODS: Items were identified through a methodological literature review. These items were included in three electronic Delphi rounds. Using purposive and snowball sampling, 16 international experts on person-centred care, teamwork and/or instrument development were invited to participate in three electronic Delphi rounds via Google Forms. Descriptive statistics were used to demonstrate their agreement on the relevance and clarity of each item. Items were included if consensus was 0.75. Content analysis was used to analyse written feedback from experts. RESULTS: The response rate was 56% (n = 9/16). Nine experts participated over an 8-week period to reach consensus on the items to be included in an instrument to measure person-centred teamwork in hospital settings. The experts' responses and suggestions for rephrasing, removing and adding items were incorporated into each round. CONCLUSION: A Delphi consensus exercise was completed, and experts reached agreement on 38 items to be included in an instrument that can be used to evaluate person-centred teamwork in hospital settings. RELEVANCE TO CLINICAL PRACTICE: We engaged with nine international experts in the academic and clinical field of person-centeredness, teamwork and/or instrument development. An online platform was used to allow the experts to give input into the study. The experts engaged from their own environment with full autonomy and anonymity. Person-centred teamwork, aimed at improving practice is now measurable. Person-centred teams improve outcomes of patients. Person-centred teamwork was specifically developed to assist low compliance areas in hospitals.

The use of the World Health Organization Surgical Safety Checklist in operating theatres.

Background: There is a global concern over intraoperative patient safety, as adverse events are on the rise. When the World Health Organization Surgical Safety Checklist (WHO SSC) is used correctly, it has the potential to prevent such events. Unfortunately, the intraoperative team in the designated hospital lacked the cooperation to successfully use the checklist. Aim: This study, therefore, aimed to explore and describe the factors that affect the use of the checklist in the operating theatres in a designated hospital. Methods: A qualitative research approach together with an implementation science strategy structured according to the Consolidated Framework for Implementation Research was used. Individual interviews with nine surgeons and focus group interviews with six operating theatre professional nurses provided sufficient data for inductive and deductive analysis. Results: A deeper understanding of the contextual and interventional factors that affect the use of the WHO SSC is provided by the findings. A high demand for surgery, the hierarchy in the surgical team, their uncertainty about hospital policies and reluctance to adjust to change contributed to the poor use of the checklist. Conclusion: A sustainable implementation process is crucial and should be embraced and promoted by the intraoperative team. Contribution: The article contributes a description of the factors that address the use of a checklist for intraoperative patient safety. It recommends that the factors that hinder the use of the checklist be timeously addressed.

Challenges nurse educators experience with development of student nurses' clinical reasoning skills.

Traditional teacher-centred teaching strategies do not always facilitate the development of desired clinical reasoning skills required for nursing practice. A multiphase study was conducted to facilitate a process of change towards improving educational practices in order to promote the development of undergraduate student nurses' clinical reasoning skills. The study was conducted at a military nursing education institution. This paper reflects on Phase 1, where a descriptive, qualitative study was conducted to explore the challenges nurse educators experienced in utilizing teaching and learning strategies that could promote the development of clinical reasoning skills in undergraduate student nurses. Unstructured interviews were conducted with 16 nurse educators who were selected purposively. Interviews were recorded, transcribed and data were analysed for content. The findings indicate that the clinical learning environment, the military environment, and various role players in the environment are instrumental in nurse educators not utilizing educational practices that promote the development of clinical reasoning skills in undergraduate student nurses. Addressing nurse educator challenges and empowering them with the means, opportunity and skills to utilize student-centred teaching and learning strategies may contribute to the development of undergraduate student nurses' clinical reasoning skills. Raising awareness of challenges nurse educators experience in implementing student-centred facilitation of learning can assist in developing strategies to ensure nurse educators become more student-centred in their teaching.

Process of development of a contemporary curriculum in advanced midwifery.

BACKGROUND: We identified the need for a contemporary curriculum to enhance education in advanced midwifery. Midwifery education needs to address the changing health needs, meet the requirements of the educational framework in South Africa and align with international trends. AIM: The aim was to describe the development of a contemporary curriculum for advanced midwifery. SETTING: The curriculum development took place at a South African university. METHOD: We used a situational analysis to create a contemporary curriculum based on the Research Development and Diffusion Model. RESULTS: We described the process followed for the situation analysis towards the development of a contemporary curriculum in advanced midwifery which is aligned with global trends. CONCLUSION: A situation analysis of the existing curriculum, the community and country's maternal and neonatal needs, educational framework and global trends should be used to develop the intended contemporary curriculum.

Quality Improvement Initiative for Family-Centered Care in the Neonatal Intensive Care Unit of a Tertiary Hospital in South Africa.

The introduction of family-centered care in the neonatal intensive care unit was identified as a high priority to facilitate bonding and attachment with potential positive outcomes for the parents and infants. The aim of the study was, therefore, to develop and implement a quality improvement initiative to foster family-centered care in a tertiary neonatal intensive care unit from birth onward. A pretest posttest intervention design was used using mixed methods over 3 phases to determine the perceived level of family-centered care according to healthcare professionals and parents using self-administered questionnaires; to develop and implement a quality improvement initiative to enhance family-centered care in a neonatal intensive care unit using a nominal group technique, followed by the quality improvement process; and to evaluate the outcomes of the initiative by repeating the self-administered questionnaires to parents and staff. Various activities were introduced as part of the initiative such as early breastfeeding, early introduction of parents to their infant, open visitation policy, and involvement in caring activities. The perceived level of care according to staff and parents increased. It is expected to enhance bonding and attachment between the infants and their parents, with consequential long-term positive outcomes.

Healthcare needs of displaced women: Osire refugee camp, Namibia.

AIM: The aim of this study was to explore and describe the experiences of healthcare needs of displaced women in the Osire refugee camp in Namibia. BACKGROUND: Namibia is a country where displaced people from other African countries seek refuge as a result of their own country's political instability. All displaced people are hosted in the Osire camp, which is a highly protected area. There are more women than men in the camp and their health is often compromised. METHODS: In this descriptive phenomenological study, the natural dimension of the experiences of the participants of their healthcare needs were explored through in-depth interviews and reflected upon through transcendental processes to formulate the phenomenological dimension thereof. FINDINGS: The essence of displaced women's healthcare needs was "the need for the restoration of hope and human dignity". Their needs refer to measures to enhance their autonomy and freedom; skills training; certainty about their future; security with aid distribution; protection against stigmatization due to human immunodeficiency virus (HIV) infection; protection against abuse; and participation in reproductive health care. DISCUSSION: When displaced women are admitted in a camp they lose their freedom to make decisions about everyday functioning and future. They thus develop feelings of insecurity and vulnerability. CONCLUSION: The participants referred to several factors that were detrimental for their well-being. The essence of their needs was "the need for the restoration of hope and human dignity" that could only be achieved when their needs are addressed. IMPLICATIONS FOR NURSING: As nurses are in close contact with displaced women in refugee camps they should negotiate opportunities for the women to discuss their concerns with the camp officials. IMPLICATIONS FOR HEALTH AND SOCIAL DEVELOPMENT POLICY: Policies should make provision for the involvement of displaced people in all aspects that relate to their everyday and future living arrangements.

Experiences of emotional abuse among women living with HIV and AIDS in Malawi.

Our aim for this study was to describe emotional abuse as it is experienced by women living with HIV and AIDS in Malawi. The study was conducted in the Lilongwe district in Malawi and used a descriptive phenomenological approach. Twelve women from two public health care clinics under the Lilongwe District Health Office were interviewed. Violating experiences that scarred the personhood and inherent value of being human were found to be the essence of their emotional abuse. Their husbands, family, and community members were responsible for the humiliation, abandonment, and blaming that caused them to feel hopeless.