Usefulness of an interprofessional work manual for perioperative glucose control of an artificial pancreas.

BACKGROUND: A closed-loop bedside-type artificial pancreas for perioperative glucose control has previously been introduced. However, artificial pancreas therapy was often interrupted due to continuous blood sampling failure. We developed an interprofessional work manual to reduce the interruption time of artificial pancreatic therapy for perioperative blood glucose control due to continuous blood sampling failure. This study aimed to investigate the usefulness of this manual. METHODS: The manual consisted of the following sections: (1) the roles of the professionals in the preparation and management of the artificial pancreas, (2) how to address continuous blood sampling failure, and (3) checkpoints for interprofessional transfer of the artificial pancreas. We compared the results before the introduction of the manual and 2 years after the introduction of the manual. RESULTS: There were 35 and 37 patients in the Before and After groups, respectively. There were no significant differences in patient backgrounds between the two groups, although there was significantly less blood loss in the After group (1164 vs. 366 mL; p < 0.001). The mean artificial pancreas therapy and artificial pancreas therapy interruption times were 847 min and 20 min, respectively. Artificial pancreas therapy interruption time (34 vs. 8 min; p = 0.078) and time per interruption (24 vs. 4 min; p < 0.001) were significantly shorter in the After group than in the Before group. CONCLUSIONS: The interprofessional working manual was useful in reducing the artificial pancreatic therapy interruption time for perioperative glucose control.

Pronação de pacientes com Síndrome do Desconforto Respiratório Agudo: criação e validação de cenário simulado / Pronation of patients with Acute Respiratory Distress Syndrome: creation and validation of a simulated scenario

Resumo: Trata-se de um estudo metodológico para construção e validação de um cenário simulado com abordagem interprofissional, que permitirá a utilização no ensino e na educação permanente de profissionais da saúde por meio da metodologia ativa de simulação clínica. Este estudo foi realizado em uma universidade pública da região Sul do Brasil, objetivando construir e validar um cenário simulado para a pronação de pacientes críticos com Síndrome do Desconforto Respiratório Agudo (SDRA). Para isto, o estudo ocorreu em duas etapas: revisão de conteúdo, construção do cenário e de validação de conteúdo e de aparência por juízes. A revisão da literatura permitiu conhecer melhor sobre o manejo do paciente com SDRA, bem como subsidiar o desenvolvimento do caso clínico para o cenário. Um protocolo de pronação segura de um hospital universitário foi adotado. A partir desta revisão, a construção do cenário foi realizada considerando um roteiro validado. Como parte desta construção, surgiram como resultados: a descrição do cenário; a relação de materiais e equipamentos necessários para o desenvolvimento do cenário; o roteiro para o ator simulado; o guia de apoio ao facilitador; o guia de apoio ao participante; o quadro de apoio para tomada de decisão e o checklist de observação do desenvolvimento de competências e habilidades para cada profissão envolvida no cenário. Onze juízes participaram do estudo. Em relação ao perfil sociodemográfico dos juízes, a amostra foi predominantemente de enfermeiros (63,6%), seguido por fisioterapeutas (18,1%), médico (9%) e docente de enfermagem (9%). Para medir o percentual de concordância entre os juízes, adotou-se o Índice de Validade de Conteúdo (IVC) para os itens, que foram agrupados de acordo com unidades de significância. Após a leitura do cenário, os juízes responderam a um questionário do tipo Likert com 37 itens, que abordaram sobre a "Experiência Prévia do Participante/Briefing", "Conteúdo/Objetivos"; "Recursos Humanos"; "Preparo do Cenário", "Desenvolvimento do Cenário" e "Avaliação". Todos os itens obtiveram IVC superior ao desejável (0,80) e, portanto, foram considerados válidos. Além disso, os juízes realizaram sugestões de melhorias no cenário, aos quais foram acatadas ou rejeitas e discutidas com a literatura disponível. Este estudo permitiu criar e validar um cenário que reflete a prática real, ao mesmo tempo que oportuniza um ambiente seguro para os participantes e responde aos objetivos da aprendizagem.

Abstract: This is a methodological study for the construction and validation of a simulated scenario with an interprofessional approach, which will allow the use in the teaching and continuing education of health professionals through the active methodology of clinical simulation. This study was carried out in a public university in the South region of Brazil, aiming to build and validate a simulated scenario for the pronation of critically ill patients with Acute Respiratory Distress Syndrome (ARDS). To this end, the study occurred in two stages: content review, scenario construction, and content and appearance validation by judges. The literature review provided a better understanding of the management of the ARDS patient, as well as a basis for developing the clinical case for the scenario. A safe pronation protocol from a university hospital was adopted. Based on this review, the scenario was built using a validated script. As part of this process, the following results emerged: the description of the scenario; the list of materials and equipment needed for the development of the scenario; the script for the simulated actor; the facilitator support guide; the participant support guide; the decision support framework; and the checklist for observing the development of competencies and skills for each profession involved in the scenario. Eleven judges participated in the study. Regarding the sociodemographic profile of the judges, the sample was predominantly nurses (63.6%), followed by physical therapists (18.1%), physicians (9%), and nursing professors (9%). To measure the percentage of agreement between the judges, the Content Validity Index (CVI) was adopted for the items, which were grouped according to significance units. After reading the scenario, the judges answered a Likert-type questionnaire with 37 items, which addressed "Prior Participant Experience/Briefing", "Content/Objectives"; "Human Resources"; "Scenario Preparation", "Scenario Development", and "Evaluation". All items scored higher than desirable CVI (0.80) and were therefore considered valid. In addition, the judges made suggestions for improvements in the scenario, which were accepted or rejected and discussed with the available literature. This study made it possible to create and validate a scenario that reflects actual practice, while providing a safe environment for participants and meeting the learning objectives.

Nursing Students' Experiences in Consecutive Clinical Interprofessional Education in Japan: Application of the IPE in Nursing Colleges.

AIM: To document nursing students' experiences of continuous participation in a clinical interprofessional education (IPE) program with the Faculty of Pharmacy of other universities in Japan, which had been incorporated into the existing practicum program, and consider how to develop a one-shot clinical IPE program. METHODS: The study participants were two nursing students from a single-department college; they were participating in a clinical IPE program-the first IPE program they had ever participated in-during an area-based practicum in Year 3. Subsequently, in Year 4, a semi-structured interview was conducted, and these interview data were qualitatively and inductively analyzed. RESULTS: Seven categories were identified, and it was found that through continuous participation in the IPE program, there was a change from "clinical IPE is stuck at the back of their mind as a bitter experience" to "the process of clinical IPE stimulates their maturity as a nursing student" and "cultivates attitudes necessary for cooperation". CONCLUSION: Consecutive years of continuous clinical IPE helps students deepen their understanding of learning content by reducing the physical and mental burden of multidisciplinary cooperation and collaboration. For difficulties with regard to step-by-step IPE, it is suggested that one-shot clinical IPE can be conducted for the upper grades along with continuous reflection activities for teams and individuals.

Students' perception of a hybrid interprofessional education course in a clinical diabetes setting: a qualitative study.

OBJECTIVES: To explore what the student participants learned and how they felt about the use of three educational settings, namely, face-to-face workshop setting, asynchronous and synchronous online learning environments and interactions with outpatients in a real-world clinical setting in a hybrid interprofessional education course. METHODS: This qualitative study used semi-structured in-depth interviews with healthcare undergraduate student participants in a course comprising workshops in three educational settings. A total of 15 healthcare undergraduate students, which included four medical, three pharmacy, five nursing and three nutrition students, completed this IPE course. All students agreed to participate in the study. We conducted four focus groups selected using convenient sampling. Focus group transcripts were analysed using the 'Steps for Coding and Theorization' qualitative data analysis method. We investigated the students' perception through the experience of three educational settings in the hybrid interprofessional education course. RESULTS: The students recognised that this course had three types of educational spaces, namely, real, semi-real and unreal. Then, the positive changes in the awareness of students are trained in recognition of the patient perspective, the recognition of the roles discharged by the other professions and the recognition of the functions of their own profession after experiencing the educational spaces designated for this course. CONCLUSIONS: The repeated experience of participants to real, semi-real and unreal educational spaces promoted changes over time in the students' awareness of interprofessional competencies with respect to patient-centred care and ameliorated their readiness to undertake interprofessional tasks.

Prevalence and reasons for non-nursing tasks as perceived by nurses: Findings from a large cross-sectional study.

AIM: The aim of this study is to describe the prevalence and reasons for non-nursing tasks as perceived by nurses. BACKGROUND: Four types of non-nursing tasks have been identified to date: (a) auxiliary; (b) administrative, (c) expected by allied health care professionals; and (d) medical. However, no studies on a large scale have been performed with the aim of identifying the prevalence of all of these non-nursing tasks, and factors promoting or hindering their occurrence, given that they represent a clear waste of nurses' time. METHODS: A cross-sectional study in 2017, following The Strengthening the Reporting of Observational studies. All active nurses registered in an Italian provincial Nursing Board (=1331) willing to participate were involved. A questionnaire survey exploring the nature of the nursing tasks performed in daily practice and the underlying reasons was administered via paper/pencil and e-mail. RESULTS: A total of 733 nurses participated of which 94.5% performed at least one type of non-nursing task, mainly administrative and auxiliary. Auxiliary tasks are less likely among nurses working in a community (odds ratio [OR] 0.43, 95% CI 0.29-0.63, p < .01) or in a residential (OR 0.41, 95% CI 0.23-0.72, p < .01) setting, in critical (OR 0.29, 95% CI 0.16-0.54, p < .01) or surgical (OR 0.37, 95% CI 0.19-0.75, p < .01) hospital settings, and when they deal with unexpected clinical events (OR 0.58, 95% CI 0.44-0.77, p < .01). Greater adequacy of nursing resources decreases the occurrence of auxiliary tasks (OR 0.98, 95% CI 0.97-0.99, p < .01), whereas the need to compensate for a lack of resources (OR 1.44, 95% CI 1.07-1.93, p < .01) increases it. CONCLUSIONS: Around one-third of shift time is devoted to non-nursing tasks; working in a hospital, in medical units, with lack of resources and with patients with predictable clinical conditions might increase the occurrence of auxiliary tasks. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies to increase the time available for nursing care should consider the type of tasks performed by nurses, their antecedents and the value added to care in terms of patient' benefits.

Clarifying differences in viewpoints between multiple healthcare professionals during discharge planning assessments when discharging patients from a long-term care hospital to home.

Comprehensive discharge planning provided by interprofessional collaboration is critical for discharging patients from hospitals to home. For effective interprofessional discharge planning, the evaluation that clarifies the differences in assessment viewpoints between various healthcare professionals is needed. This study aimed to clarify the assessment viewpoints of multiple healthcare professional groups when discharging patients from a long-term care hospital (LTCH) to home. We reviewed 102 medical records from an LTCH in Japan, extracted descriptions of discharge planning assessments written by 3 doctors, 13 nurses, 3 physical therapists, 13 care workers, and 2 social workers, linked these to the International Classification of Functioning, Disability and Health, and conducted the statistical analysis. Doctors and nurses significantly focused on "Body Functions". Physical therapists and care workers significantly focused on "Activities and Participation". Social workers significantly focused on "Environmental Factors". We also identified the factors less or missing from assessments in the clinical field of the LTCH. Our findings could be contributed as a base of knowledge to foster a better understanding of different healthcare professionals' assessment viewpoints. The further development of comprehensive discharge planning assessment tools, service programs, and research on discharge planning methods that could contribute to effective interprofessional discharge planning is needed.

Interprofessional work in early detection of breast cancer: An integrative review.

OBJECTIVES: To identify the roles of health care staff in interprofessional work related to breast cancer detection and diagnosis. KEY FINDINGS: A comprehensive search was performed using PICO to support inclusion and exclusion criteria. A shortened version of the STROBE checklist ensured evaluation of the studies. 21 included studies resulted in three main categories describing the role of health care professionals; (1) Communicating breast cancer awareness; (2) The Professional's tasks; (3) Efficacy of Interprofessional Teamwork relative to the profession and the individuals. CONCLUSIONS: Health care professionals' roles in the breast cancer diagnostic process were described mostly from each professional's viewpoint. Support from leadership and management is needed in order to promote interprofessional work, which will benefit health care professions, professionals, and the patient.

Interprofessional Work in Serious Illness Communication in Primary Care: A Qualitative Study.

Background: Evidence demonstrates that discussion between clinicians and seriously ill patients about their goals and preferences, or serious illness communication, is a high-value intervention, resulting in growing demand for improvement in this area. Promising efforts address this demand utilizing interprofessional teams; yet, we lack insight into how different professions work together to deliver better serious illness communication. Objective: To explore the perceptions of primary care clinicians about interprofessional work in serious illness communication. Design: Qualitative analysis of semistructured key informant interviews. Settings/Subjects: Primary care clinicians (physicians, care coordination nurses, and social workers) who have experience implementing a structured primary palliative care program, the Serious Illness Care Program, at a large academic medical center in Boston, Massachusetts. Results: We derived primary themes and subthemes from participant descriptions of program implementation: the importance and value of interprofessional teams, nurses, and individual initiative; the role of preparation and structure in enabling high-quality communication; and the ways in which attempts to improve serious illness communication reveal other problems that can limit program effectiveness or be perceived as program failures. We derived a conceptual model that illustrates the relationships between interprofessional team interactions, workflows, and perceived program outcomes. Conclusions: This study suggests three key areas of focus for design and implementation of programs aimed at improving serious illness conversations by interprofessional primary care teams: establishing clear professional roles and responsibilities, paying special attention to interprofessional and clinician-patient relationships, and clearly structuring interventions aiming to change the way our system drives serious illness communication.

What Capabilities Have Undergraduate Students Acquired for Interprofessional Work? / 医学教育

The purpose of this study is to address what undergraduate students of professional healthcare learned in interprofessional education (IPE), and to explore a way to develop interprofessional work (IPW) competencies effectively in IPE. A qualitative analysis was conducted on the portfolios of 9 medical, 8 dental, 16 pharmaceutical, and 16 nursing and rehabilitation students. 6 elements were identified in the undergraduate IPE; 【Patient/Family-Centered care】, 【Value/Ethics for IPW】, 【Communication Necessary for IPW】, 【Roles/Responsibilities as Healthcare Professionals】, 【Understanding of their own profession】, 【Team/Team work】. In order to acquire these capabilities, undergraduate education programs based on IPE are required.

What Capabilities Have Undergraduate Students Acquired for Interprofessional Work? / 医学教育

The purpose of this study is to address what undergraduate students of professional healthcare learned in interprofessional education (IPE), and to explore a way to develop interprofessional work (IPW) competencies effectively in IPE. A qualitative analysis was conducted on the portfolios of 9 medical, 8 dental, 16 pharmaceutical, and 16 nursing and rehabilitation students. 6 elements were identified in the undergraduate IPE; 【Patient/Family-Centered care】, 【Value/Ethics for IPW】, 【Communication Necessary for IPW】, 【Roles/Responsibilities as Healthcare Professionals】, 【Understanding of their own profession】, 【Team/Team work】. In order to acquire these capabilities, undergraduate education programs based on IPE are required.

Dimensões do trabalho interprofissional e práticas colaborativas desenvolvidas em uma unidade básica de saúde, por equipe de Saúde da Família / Dimensions of interprofessional work and of collaborative practices developed at a primary care unit by a Family Health team

Resumo Este artigo tem como objetivo identificar as dimensões do trabalho interprofissional e das práticas colaborativas desenvolvidas por uma equipe de saúde da família em uma unidade básica de saúde. Trata-se de pesquisa qualitativa realizada mediante observação participante do trabalho desenvolvido por profissionais de saúde. O estudo realizado evidenciou avanços na incorporação de práticas colaborativas no âmbito da atenção primária e na criação de espaços mais favoráveis ao diálogo e ao estabelecimento de consensos que resultam em cuidado integral e segurança do paciente, a despeito dos conflitos e das tensões próprias do processo de trabalho em saúde.(AU)

Resumen El objetivo de este artículo es identificar las dimensiones del trabajo interprofesional y de las prácticas colaborativas desarrolladas por un equipo de salud de la familia en una unidad básica de salud. Se trata de investigación cualitativa realizada mediante observación participativa del trabajo desarrollado por profesionales de la salud. El estudio realizado mostró avances en la incorporación de prácticas colaborativas en el ámbito de la atención primaria y en la creación de espacios más favorables al diálogo y al establecimiento de consensos que resultan en cuidado integral y seguridad del paciente, a pesar de los conflictos y de las tensiones propias del proceso del trabajo en salud.(AU)

Abstract This article aims at identifying the dimensions of interprofessional work and of collaborative practices developed by a family health team at a primary care unit. This qualitative research was conducted through participant observation of the work developed by health professionals. The study evidenced advances in the incorporation of collaborative practices in primary healthcare and in the creation of spaces that favor dialogs and the establishment of a consensus that result in comprehensive care and patient safety, despite conflicts and tensions inherent to the health work process.(AU)

Interprofessional work in operating rooms: a qualitative study from Sri Lanka.

BACKGROUND: A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons' perception of teamwork, team members' roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. METHODS: Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. RESULTS: Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. CONCLUSIONS: A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.

Inter-agency work in Open Dialogue: the significance of listening and authenticity.

The article explores what professionals regard as important skills and attitudes for generating inter-agency network meetings involving intra- and interprofessonal work. More specifically, we will examine what they understand as promoting or impeding dialogue and how this is related to their professional backgrounds. The professionals participated in a project using an open dialogue approach in order to increase the use of inter-agency network meetings with young people suffering from mental health problems. In this explorative case study, empirical data was collected through interviews conducted with two focus groups, the first comprising healthcare professionals and the second professionals from the social and educational sectors. Content analysis was used, where the main category that emerged was dialogue. To illustrate the findings achieved in the focus groups, observations of inter-agency network meetings are included. The findings describe the significance and challenges of listening and authenticity in the professionals' reflections. The healthcare workers expressed worries concerning their capacities for open and transparent dialogues, while the other professionals' emphasized the usefulness of particular techniques. Inter-agency network meetings may be improved if more awareness is placed on the significance of meeting atmosphere, dwelling on specific topics, dealing with silence and understanding how authentic self-disclosure in reflections can promote the personal growth of the participants.

Regarding multidisciplinary education: / 医学教育

　Healthcare professionals need to understand the operational mechanisms that drive the team-care model. Although such concepts should be integrated into the education of healthcare students, but current methods of teaching such a model of care are unsatisfactory. In 2007 the Faculty of Medicine and Health Science of Kobe University introduced an early clinical exposure program focusing on team care for first-year students. In 2008, students of the school of pharmacy joined this program. We have developed a collaborative program, the Interprofessional Work tutorial program, for the fourth year of the undergraduate curriculum. As the history of collaborative education for healthcare students is relatively short, we faculty members continuously discuss how to develop this tutorial program. Simulated multidisciplinary team conferences have been introduced into this program to increase students’ understanding of the scenario. During the course of this program, students, as well as faculty members, come to understand the roles of other professionals and to consider collaboration to be fundamental for patient-centered treatment and care. Interprofessional education is essential for human resource development and for preparing future healthcare professionals to participate in interdisciplinary team care. We must integrate the community-based aspects of health and welfare into interprofessional education for health professional students.

Clinical confidence following an interprofessional educational program on eating disorders for health care professionals: a qualitative analysis.

There are an increasing number of educational programs to improve clinical competence and skills to treat mental disorders. For complex disorders there is also a focus on improving the quality of interprofessional work. This paper reports on interprofessional outputs of an educational program on eating disorders. A total of 207 professionals who completed the program were requested to describe up to 12 possible scenarios depicted as realistic prospects for their future work within this field. Analyzing the scenarios resulted in three categories of describing the participants' preferences: (1) interprofessional interventions and treatment; (2) the further development of competence; and (3) organization of the health care system. The findings showed that the participants were considering working across new lines in their current workplaces or crossing borders to new frontiers in the execution of competence. Our findings may be summarized into the concept of "clinical confidence." This concept has so far been understood as some kind of personal trait, disposition, or attitude. The present findings add nuances to this concept in terms of state-dependent encouragement, engagement, and a potential to act and to cross professional borders in order to better treat complex mental disorders.