Interprofessional Team Conflict Resolution: A Critical Literature Review.

INTRODUCTION: Although concern related to conflicts within health care teams has been discussed in the literature, most studies have focused on individuals' personal conflict management style identification or on managers resolving workplace conflicts between parties. The purpose of this review was to identify significant components in the field of conflict with particular attention to conceptual findings that may be integrated into understanding interprofessional health care team conflict and its resolution. METHODS: A critical review of the conflict literature across many fields was undertaken using the method identified by Grant and Booth, incorporating literature-search, appraisal, synthesis, and analysis. RESULTS: This critical review explored existing models and schools of thought to provide an overview of how conflict is conceptualized, its focus on interpersonal and workplace issues, team conflict application and training in team conflict resolution, and finally a summary of this review's contribution to interprofessional health care team conflict and its resolution. CONCLUSIONS: Team conflict is comprised of three forms-relationship, task, and process. When team building occurs that incorporates training in the use of an adapted constructive controversy approach, there is a greater opportunity to enhance the quality of a cooperative approach to patients' care planning. Training in team conflict resolution is needed as a key ingredient to ensure all team members can enhance the effectiveness and quality of interprofessional client-centered collaborative practice. This benefits not only the health providers in the team, but also their clients/patients who are recipients of their shared teamwork.

Translation and psychometric properties of the German version of the "Interprofessional Socialization and Valuing Scale" (ISVS-21-D).

Understanding of the processes associated with socialization into collaborative work plays an important role in interprofessional education and collaborative practice. In order to evaluate changes in socialization toward interprofessional collaborative practice a measure is needed that captures professional beliefs, attitudes and behaviors of individuals in learning activities and in workplace practice. This article presents the translation and psychometric properties of the German Version of the Interprofessional Socialization and Valuing Scale (ISVS-21). Following translation from English to German, data of the German version of the questionnaire (ISVS-21-D) was collected in six different interprofessional education and practice settings amongst undergraduate students and health professionals. In total, 494 responses were analyzed. Results showed high reliability with Cronbach's alpha .90. Although not all fit indices are in the desired range, results give preliminary indication of the underlying single factor of the ISVS-21-D and suggest that the German version of the ISVS-21-D is a reliable instrument that can be used to measure interprofessional socialization in German health professionals and health care students as well as within other disciplines.

Patient roles in primary care interprofessional teams: a constructivist grounded theory of patient and health care provider perspectives.

Health care providers are increasingly asked to work in interprofessional teams to enhance the care provided to and health outcomes of their patients. However, there is little evidence on how to include patients in meaningful roles on these teams to support their health monitoring and management. The purpose of this study was to gain insight into roles that patients can assume within their health care teams and to understand the conditions and processes required for patient roles to be enacted. Ten patients and 10 health care providers from two Family Health Teams in Southwestern Ontario, Canada, participated in individual interviews to learn about their perspectives on patient roles in teams. Data collection and analysis strategies generated theoretical concepts, and member-checking interviews provided final feedback on the framework. This study resulted in a comprehensive framework of two roles and the conditions and processes required for patient-health care provider interactions within primary care interprofessional teams. Further researchers could use this framework to build knowledge of patient roles in interprofessional teams across varying health care settings and patient populations.

Primary health care clinics as catalyst to community building and health among residents in low income housing units.

BACKGROUND: This paper focuses on the identified value of a community-based project (CBP), including residents' living within low income housing units and their reported experiences of receiving health and social services within two communities by nurse practitioners (NPs) and its impact on their communities. OBJECTIVE: To gain insight into the lived experience of residents in the housing units from a collaborative interprofessional care approach provided in a clinic situated within each housing unit, in integrating health and social services within the residents' own 'community' and its outcomes. DESIGN: A qualitative descriptive study to gain insight into the shared views of care informants. SETTINGS: Two low income housing units in xxxxxxxxxxxxxxxxxxxx. PARTICIPANTS: Twenty-two residents representing all genders who lived in the housing units. METHODS: A purposive sampling of willing residents participated in a focus group interview. Each group comprised from 4 to 6 persons. Two focus group interviews occurred in each of the two housing units. RESULTS: Their voices resulted in identification of two themes - clinic as a catalyst to creating a sense of community and clinic as assisting them in managing their overall health. Two subthemes were also identified within each theme. CONCLUSION: Findings provide insight into the value of CBP, that a strengths-based and interprofessional care approach can serve as a catalyst for an evolving community.

Assessment of the Interprofessional Team Collaboration Scale for Students-AITCS-II (Student): Development and Testing.

The challenge of measuring collaborative teamwork among interprofessional students has been reported in the literature. Emphasis in evaluating teamwork has been on socialization and attitudes towards wanting to work with others and not on other aspects of teamwork such as collaboration in teamwork. To date, while the Assessment of the Interprofessional Team Collaboration Scale (AITCS) has been used generically to measure collaboration in both practitioner and student 'teams,' it has been suggested that there may be a need for a student-specific version of this measure. The purpose of this paper is to report on the psychometric properties of the AITCS-II for students. Data sets from 316 student respondents completing pretest assessments of team collaboration were used for a descriptive analysis of the ATICS. Both exploratory (EFA) and confirmatory factor analyses (CFA) were carried out. Factors from the EFA were then used in the CFA to obtain a good model fit. The result was a 16-item AITCS-II for students that demonstrated a reasonable model fit related to four latent variables: partnership (3 items), cooperation (6 items), team working (4 items) and coordination (3 items). In conclusion, the student version of the AITCS-II provides some evidence for its validity and reliability that can be used to assess collaboration in interprofessional student groups.

The effects of an IPS-based IPE program on interprofessional socialization and dual identity development.

The purpose of this study was to assess the effect of an interprofessional socialization (IPS) based interprofessional education (IPE) program intervention on health professions students' IPS process and dual identity development. Despite the growing acknowledgment of IPS in recent literature, there is a paucity of research investigating socialization processes learners move through in order to develop dual identity - professional and interprofessional. A concurrent embedded mixed-method design was used. One hundred and eight pre-licensure students from seven different health professions completed the IPS program intervention. Latent Growth Curve (LGC) modeling and thematic content analysis were used to analyze the quantitative and qualitative data, respectively. A significant and consistent growth rate in dual identity was found among the participants. The thematic analysis resulted in four emerging themes (uniprofessional education as a barrier, IPS program as an eye-opener, learning to collaborate, and collective unified team). The integrated findings provide support for the use of the interprofessional socialization framework.

The circles of care game © - using gaming to teach interprofessional teamwork in clerkship.

The aim of this study was to gain insight into how online gaming can teach medical students about interprofessional collaborative practice and promote their development of interprofessional competencies prior to clerkship. This prospective cohort study involved third year medical students from the Schulich School of Medicine and Dentistry in London, Ontario, Canada who participated in the 'Circles of Care'© online board game. A total of 97 student reflections were obtained and subjected to conventional qualitative descriptive content analysis. The transcribed data were analyzed question by question and line by line. Themes evolved from four questions: (1) What surprised you the most about teamwork from this learning activity, (2) What did you learn about collaborative teamwork, (3) What will you take away from this learning event to use in your practice, and (4) Please comment on the value of using a game such as this one to develop your collaborative team practice. A total of seven themes emerged including: "Gaining insights", "What worked and what did not", "Openness to learning", "Comfort in sharing with others", "Commitment and skepticism", "Being a seeker", and "Continuum of value to learning and practice". Analysis of the student reflections illustrated the potential of using an online-based game to effectively introduce and teach interprofessional competencies to medical students.

Italian version of the Assessment of Interprofessional Team Collaboration Scale II (I-AITCS II): a multiphase study of validity and reliability amongst healthcare providers.

OBJECTIVE: To develop and validate an Italian version of the Assessment of Interprofessional Team Collaboration Scale II (I-AITCS II). METHODS: A multiphase validation study was conducted. The first phase was the AITCS-II translation from English into Italian to develop the first version of I-AITCS II for practitioners. The second phase was the study of I-AITCS II face and content validity, and the third phase was a cross-sectional data collection to provide evidence of construct validity using the psychometrics testing and the reliability assessment through the internal consistency study. RESULTS: The agreement for the forward-translation among researchers was high. The face and content validity were satisfactory. The underlying constructs of I-AITCS II were partnership, cooperation and coordination. Internal consistency was good for both scale and domains level. There were significant differences related to partnership in the comparison between settings. CONCLUSIONS: I-AITCS II showed evidence of validity and reliability. It will be useful to gather data to address programs aimed to enhance interprofessional team collaboration within the Italian healthcare contexts, and it could be used for cross-national researches.

Assessment of Interprofessional Team Collaboration Scale (AITCS): Further Testing and Instrument Revision.

INTRODUCTION: The need to be able to assess collaborative practice in health care teams has been recognized in response to the direction for team-based care in a number of policy documents. The purpose of this study is to report on further refinement of such a measurement instrument, the Assessment of Interprofessional Team Collaboration Scale (AITCS) first published in 2012. To support this refinement, two objectives were set: Objective 1: to determine whether the items from the data collected in 2016 load on the same factors as found for the 2012 version of the 37-item AITCS. Objective 2: to determine whether the items in the subscales of the AITCS could be reduced while retaining psychometric properties similar to those from the earlier versions of the AITCS. METHODS: Initially, the overall data sets of 1002 respondents from two hospitals and four community agencies were analyzed for demographics and scale and subscale mean values, SDs, and mean item scores. After deletion of respondents because of missing data, 967 respondents were available for the first analysis. An exploratory factor analysis was then conducted to determine the factor structure. All respondents with any random missing data were further removed to reduce the data set to 676 responses, followed by a confirmatory factor analysis to find a model fit resulting in an item reduction in the scale. RESULTS: The result was a 23-item AITCS-II for practitioners that retained acceptable levels of reliability and validity within 3 subscales-partnership (8 items), cooperation (8 items), and coordination (7 items). DISCUSSION: The shortened version of the AITCS-II is a valid and reliable instrument that can be used to assess collaboration in health care teams in practice settings.

Collaborative Leadership, Part 1: The Nurse Leader's Role within Interprofessional Teams.

The purpose of this paper is to present a perspective advocating for a dual role of nurse leaders as both managers and advocates for nurses to demonstrate their disciplinary knowledge and practice. Further, the paper will demonstrate that nurse leaders have the capacity to influence integration of interprofessional collaborative practice with other health professionals within their leadership areas. Additionally, we present strategies to advocate for changing the meaning of nursing leadership in practice, and creating a shift from task orientation of nurses' care to one that is individualized and comprehensive. Finally, a plea will be made to return the coordinating role of the nurse to its rightful place within patient care.

Collaborative Leadership, Part 2: The Role of the Nurse Leader in Interprofessional Team-Based Practice - Shifting from Task- to Collaborative Patient-/Family-Focused Care.

This paper presents a discussion on the key role that nurses assume with their patients and also with other health providers. We will argue that a change is needed to provide "space" for nurses to re-engage with their patients and to return to their key coordinating role between their patients, their family members and other health providers in interprofessional patient and family-centred collaborative practice. Furthermore, we will discuss the important role of nurse leaders to present the nurses' unique role and importance to health system administrators and policy makers to improve health outcomes of patients and how their role can concomitantly reduce healthcare costs.

An integrative review of the influence of job strain and coping on nurses' work performance: Understanding the gaps in oncology nursing research.

Nursing is known to be a stressful profession that can lead to physical and psychological health issues and behavioural problems. In oncology, workload among nurses is believed to be increasing in conjunction with rapidly increasing numbers of patients with cancer and staff shortages worldwide, therefore it is essential to sustain a quality oncology nurse workforce. Numerous studies have presented evidence on job strain, effects of coping strategies, and nurses' work performance within healthcare settings, but few have focused on oncology settings and none of these on nurses working in Saudi Arabia. The purpose of this review was to summarize empirical and theoretical evidence concerning job-related stressors in nurses, particularly oncology nurses, and the interrelationships among job strain, coping strategies, and work performance in this population. Search strategies identified studies published on studies in peer-reviewed journals from 2004 to 2016. Twenty-five nursing studies were found examining the relationships among the concepts of interest. Common job-related stressors among oncology nurses were high job demands, dealing with death/dying, lack of job control, and interpersonal conflicts at work. Job strain was found to be significantly linked to coping strategies, and negatively associated with work performance among nurses in general. There is no existing empirical evidence to support the relationship between coping strategies and work performance among oncology nurses. The present evidence is limited, and a considerable amount of research is required in the future to expand the oncology nursing literature. Research is needed to investigate job-related stressors and their effects on oncology nurses.

Refinement of the Interprofessional Socialization and Valuing Scale (ISVS-21) and Development of 9-Item Equivalent Versions.

INTRODUCTION: Measures of interprofessional (IP) socialization are needed to capture the role of interprofessional education in preparing students and health practitioners to function as part of IP health care teams. The aims of this study were to refine a previously published version of the Interprofessional Socialization and Valuing Scale (the ISVS-24) and create two shorter equivalent forms to be used in pre-post studies. METHODS: A graded response model was used to identify ISVS items in a practitioner data set (n = 345), with validation (measure invariance) conducted using a separate student sample (n = 341). RESULTS: Analyses indicated a unidimensional 21-item version with excellent measurement properties, Cronbach alpha of 0.988, 95% confidence interval (CI) 0.985-0.991. There was evidence of measure invariance, as there was excellent agreement of the factor scores for the practitioner and student data, intraclass correlation coefficient = 0.993, 95% CI 0.991-0.994. This indicates that the ISVS-21 measures IP socialization consistently across groups. Two 9-item equivalent versions for pre-post use were developed, with excellent agreement between the two forms. The student score agreement for the two item sets was excellent: intraclass correlation coefficient = 0.970, 95% CI 0.963-0.976. DISCUSSION: The ISVS-21 is a refined measure to assess existing levels of IP socialization in practitioners and students, and relate IP socialization to other important constructs such as IP collaboration and the development of an IP identity. The equivalent versions can be used to assess change in IP socialization as a result of interprofessional education.

Preliminary testing of the Swedish version of the Assessment of Interprofessional Team Collaboration Scale (AITCS-S).

Interprofessional collaboration might improve healthcare processes and outcomes; however, it has been found that most instruments that aim to measure collaboration have undergone limited testing. The assessment of interprofessional team collaboration scale (AITCS) is one questionnaire that aims to evaluate collaboration, but it has not yet been extensively tested. The aim of this study was to translate and to cross-culturally adapt the AITCS for use in Sweden, to describe floor and ceiling values, and to investigate the AITCS in terms of reliability, face, and content validity. The study included a total of 349 participants working in team-based pain rehabilitation. The participants were asked to fill in the Swedish version of the AITCS (AITCS-S) at baseline. Of these, 73 participants also completed the AITCS-S two weeks later. The results showed that the content and face validity were good. Internal consistency varied from 0.79 to 0.96 and judged to be acceptable to excellent. Test-retest stability showed excellent stability with intraclass correlation values above 0.75 for all subscales. This study concludes that the Swedish version of the AITCS is a reliable and valid questionnaire. Further psychometric investigations might be undertaken in order to attempt to develop shorter versions of the AITCS-S.

Understanding healthcare professionals' self-efficacy to resolve interprofessional conflict.

Conflict within interprofessional healthcare teams, when not effectively resolved, has been linked to detrimental consequences; however, effective conflict resolution has been shown to enhance team performance, increase patient safety, and improve patient outcomes. Alarmingly, knowledge of healthcare professionals' ability to resolve conflict has been limited, largely due to the challenges that arise when researchers attempt to observe a conflict occurring in real time. Research literature has identified three central components that seem to influence healthcare professional's perceived ability to resolve conflict: communication competence, problem-solving ability, and conflict resolution education and training. The purpose of this study was to investigate the impact of communication competence, problem-solving ability, and conflict resolution education and training on healthcare professionals' perceived ability to resolve conflicts. This study employed a cross-sectional survey design. Multiple regression analyses demonstrated that two of the three central components-conflict resolution education and training and communication competence-were found to be statistically significant predictors of healthcare professionals' perceived ability to resolve conflict. Implications include a call to action for clinicians and academicians to recognize the importance of communication competence and conflict resolution education and training as a vital area in interprofessional pre- and post-licensure education and collaborative practice.

Educação interprofissional e prática colaborativa na Atenção Primária à Saúde* / Educación interprofesional y la práctica colaborativa en la Atención Primaria de Salud / Interprofessional education and collaborative practice in Primary Health Care*

RESUMO Objetivo Compreender as percepções de docentes, trabalhadores e estudantes sobre a articulação da educação interprofissional com as práticas na Atenção Primária à Saúde. Método Qualitativo compreensivo e interpretativo, cuja coleta de dados foi realizada de 2012 a 2013, por meio de 18 entrevistas semiestruturadas com docentes e quatro sessões de grupos focais homogêneos com estudantes, docentes e trabalhadores da Atenção Primária. Resultados A triangulação dos resultados possibilitou a construção de duas categorias: prática colaborativa centrada no usuário e barreiras para educação interprofissional. A primeira indicou a necessidade de mudança do modelo de atenção e de formação dos profissionais de saúde, e a segunda apontou dificuldades percebidas pelos diferentes atores sociais no que se refere à implementação da educação interprofissional. Conclusão A educação interprofissional é incipiente no Brasil e sinaliza possibilidades de mudança em direção à prática colaborativa, mas requer maiores investimentos na articulação ensino-serviço.

RESUMEN Objetivo Comprender las percepciones de los profesores, trabajadores y estudiantes sobre la articulación de la educación interprofesional con las prácticas en la Atención Primaria de Salud. Método Cualitativo, comprensivo e interpretativo cuya recolección de datos se realizó de 2012 hasta 2013, através de 18 entrevistas semi-estructuradas con profesores y cuatro sesiones de grupos focales homogéneos, con estudiantes, profesores y trabajadores de Atención Primaria. Resultados La triangulación de los resultados llevó a la construcción de dos categorías: práctica (s) colaborativa centrada en el usuario y barreras para la educación interprofesional. La primera indicó la necesidad de cambiar el modelo de atención y formación de los profesionales de la salud y la segunda revela las dificultades percibidas por los distintos actores sociales en relación con la implementación de la educación interprofesional (EIP). Conclusión La educación interprofesional es incipiente en Brasil y apunta las posibilidades de cambio hacia la práctica colaborativa, pero requiere mayores inversiones en la articulación enseñanza-servicios

ABSTRACT Objective To understand the perceptions of professors, health care providers and students about the articulation of interprofessional education with health practices in Primary Health Care. Method To understand and interpret qualitative data collection, carried out between 2012 and 2013, through semi-structured interviews with 18 professors and four sessions of homogeneous focus groups with students, professors and health care providers of Primary Health Care. Results A triangulation of the results led to the construction of two categories: user-centered collaborative practice and barriers to interprofessional education. The first perspective indicates the need to change the model of care and training of health professionals, while the second reveals difficulties perceived by stakeholders regarding the implementation of interprofessional education. Conclusion The interprofessional education is incipient in the Brazil and the results of this analysis point out to possibilities of change toward collaborative practice, but require higher investments primarily in developing teaching-health services relationship.

Legislating interprofessional collaboration: A policy analysis of health professions regulatory legislation in Ontario, Canada.

Changes to Ontario's health professions regulatory system were initiated through various legislative amendments. These amendments introduced a legislative obligation for health regulatory colleges to support interprofessional collaboration (IPC), collaborate where they share controlled acts, and incorporate IPC into their quality assurance programs. The purpose of this policy analysis was to identify activities, strategies, and collaborations taking place within health professions regulatory colleges pertaining to legislative changes related to IPC. A qualitative content analysis of (1) college documents pertaining to IPC (n = 355) and (2) interviews with representatives from 14 colleges. Three themes were identified: ideal versus reality; barriers to the ideal; and legislating IPC. Commitment to the ideal of IPC was evident in college documents and interviews. Colleges expressed concern about the lack of clarity regarding the intent of legislation. In addition, barriers stemming from long-standing issues in practice including scope of practice protection, conflicting legislation, and lack of knowledge about the roles of other health professionals impede IPC. Government legislation and health professional regulation have important roles in supporting IPC; however, broader collaboration may be required to achieve policy objectives.

Interprofessional education and collaborative practice in Primary Health Care. / Educação interprofissional e prática colaborativa na Atenção Primária à Saúde.

Objective To understand the perceptions of professors, health care providers and students about the articulation of interprofessional education with health practices in Primary Health Care. Method To understand and interpret qualitative data collection, carried out between 2012 and 2013, through semi-structured interviews with 18 professors and four sessions of homogeneous focus groups with students, professors and health care providers of Primary Health Care. Results A triangulation of the results led to the construction of two categories: user-centered collaborative practice and barriers to interprofessional education. The first perspective indicates the need to change the model of care and training of health professionals, while the second reveals difficulties perceived by stakeholders regarding the implementation of interprofessional education. Conclusion The interprofessional education is incipient in the Brazil and the results of this analysis point out to possibilities of change toward collaborative practice, but require higher investments primarily in developing teaching-health services relationship.

The metamorphosis of a collaborative team: from creation to operation.

This paper reports on the process of developing a community-based interprofessional team to provide diabetes related foot ulcer care. A new interprofessional team was formed in a local community, and the process of building a successful team was examined by the adoption of an exploratory qualitative case study approach that gathered a series of one-on-one interviews with participants at three points in time - prior to the team's formation, two months into the team's operation, and finally seven months later - shortly before the team and its clinic closed. Interviews were also conducted with a small sample of the team's patients. The factors linked to the successes and challenges of building a care team in a community setting are explored. Informants highlighted the value of regular team meetings, role clarity, and a commitment to patient-centered care. However effective collaboration was not sufficient to maintain the team in the face of poor institutional and government support.

Hospital-based nurse practitioner roles and interprofessional practice: a scoping review.

This scoping review provides current global understanding of the rapidly evolving nurse practitioner role within hospital settings, and considers the level of understanding of its enactment within interprofessional teamwork. Arksey and O'Malley's framework was used to explore recent primary research, reviews, and gray literature in two ways. First, hospital-based nurse practitioner literature was mapped to country of origin, and thematically summarized. Second, clearly developed and consistently defined key interprofessional concepts were identified in the interprofessional literature then conceptually mapped to the nurse practitioner studies by their operationalization. The nurse practitioner review located 103 abstracts. Twenty-nine, originating from four countries, met the inclusion criteria. The interprofessional concept review identified a total of 137 relevant abstracts, however, only ten met the inclusion criteria. Understanding the nurse practitioner role within hospital teams remains limited due to a small number of countries producing evidence, the lack of nurse practitioner role title standardization hindering consistent knowledgebase development, and limited application and inconsistent operationalization of concepts within nurse practitioner research. Research focused on role enactment is needed to understand the uniqueness of the hospital-based nurse practitioner role.