Introdução: Nas organizações de saúde, a Prática Interprofissional Colaborativa (PIC) e Clima do Trabalho em Equipe (CTE) são essenciais para promoção do cuidado integrado e melhoria na qualidade da assistência em saúde. Entretanto, a implementação da PIC tem se mostrado um desafio, com lacuna de conhecimentos relacionados a sua operacionalização no âmbito do Sistema Único de Saúde (SUS). Assim como a PIC, o CTE preocupa-se com aspectos relacionais e organizacionais do trabalho interprofissional. Poucas investigações têm explorado a relação entre PIC e CTE. Este estudo considera as implicações do CTE para a PIC, destaca as ligações teóricas e empíricas entre os dois, e sugere como o CTE pode ter um papel na compreensão e operacionalização da PIC. Objetivo geral: Analisar a PIC em equipes de Atenção Primária à Saúde (APS) com diferentes perfis de CTE. Método: estudo de método misto sequencial explanatório (quantitativo-qualitativo) realizado em 18 equipes da Estratégia Saúde da Família (ESF), em município da região metropolitana de São Paulo. Na fase 1 (quantitativa), o CTE foi avaliado com a aplicação da Escala de Clima do Trabalho em equipe (ECTE) em 18 equipes da ESF (N=144). Para análise dos dados utilizou-se estatística descritiva, análise de agrupamentos (método Ward) e análise bivariada (t student). Na fase 2 (qualitativa), realizou-se estudo de caso múltiplo com entrevistas em profundidade com membros das equipes (N=24) que apresentaram escores contrastantes na ECTE. Na coleta e análise dos achados qualitativos foram utilizadas técnicas da teoria fundamentada em dados. Os resultados das fases 1 e 2 foram integrados. Resultados: Na fase 1 foram identificados dois agrupamentos de equipes: (A) com maiores e (B) de menores escores na ECTE. As diferenças entre os grupos foram estatisticamente significativas em todos os fatores da escala: participação na equipe (p<0,001), apoio para ideias novas (p=0,002), objetivos da equipe (p=0,001) e orientação para as tarefas (p=0,015). Achados da fase 2 corroboram os achados da fase 1, sendo as equipes do agrupamento A aquelas que apresentaram características relacionais e processuais mais favoráveis ao CTE e também à PIC. A análise interpretativa permitiu a identificação de duas modalidades contingenciais e dinâmicas de colaboração: 1) colaboração em equipe e 2) colaboração intersetorial, em rede e com a comunidade. Em torno das modalidades identificadas foi proposto um modelo da PIC. O modelo descreve as condições em que a PIC ocorre, as formas como se apresenta e suas consequências na organização da assistência à saúde. Conclusões: A análise do CTE mostrou-se capaz de prover insights sobre a PIC nas equipes. O modelo proposto apresenta conhecimentos que contribuem para compreensão e operacionalização da PIC. Os resultados sugerem que embora o clima de equipe tenha um papel importante na construção da colaboração, a compreensão da PIC no âmbito do SUS requer a consideração de elementos pertinentes à inovação no trabalho interprofissional e da própria forma de organização da APS e das Redes de Atenção à Saúde. / Background: In health care organizations, Interprofessional Collaborative Practice (ICP) and Team Climate (TC) are essential means to promote integrated care and improve health care quality. However, implementing ICP presents a series of challenges, and there is a lack of knowledge of how to operationalize this approach within the Brazilian Health Care System (SUS). Like Interprofessional Collaborative Practice, Team Climate is concerned with the effectiveness of relational and organisational aspects of interprofessional work. Few studies have explored the relationship between these two concepts or the role that Team Climate might play in establishing the operational conditions needed for Interprofessional Collaborative Practice. This study considers the implications of Team Climate for Interprofessional Practice, highlights the theoretical and empirical links between the two, and suggests how Team Climate may have a role in understanding and operationalising Interprofessional Collaborative Practice more effectively. Aim: To analyse ICP in Primary Health Care (PHC) teams with different TC. Methods: This is a mixed methods sequential explanatory study (quantitative-qualitative) conducted with 18 primary care teams from the Family Health Strategy (FHS), in the metropolitan region of São Paulo. In Stage 1 (quantitative), Team Climate was assessed using the Team Climate Inventory (TCI) in all 18 teams (144 participants in total). Data from the TCI were analysed using descriptive statistics, cluster analysis (Wards method) and bivariate analysis (Student t). In Stage 2, which used a multiple qualitative case study approach, data were collected through in-depth interviews with members (N=24) from teams with contrasting scores on the TCI. Grounded theory techniques were employed to analyse the qualitative data. Findings from both stages of the research were then compared and considered together. Results: Two different clusters of teams were identified in Stage 1: (A) teams with the highest mean scores; and (B), teams with the lowest mean scores on the TCI. Differences between cluster A and B were statistically significant for all TCI factors: participative safety (p <0.001), support for new ideas (p = 0.002), team goals (p = 0.001) and task orientation (p=0.015). Findings from Stage 2 reinforced quantitative findings from Stage 1. Teams from cluster A demonstrated more positive relational and processual characteristics to support TC and ICP. Interpretative analysis revealed two dynamic and contingent modalities of collaboration: 1) team collaboration; and 2) collaboration between different health and social sectors, within a healthcare network, and with the community. A framework for Interprofessional Collaborative Practice in primary health care was developed, based on these modalities of collaboration, and describing the conditions, modalities and health care consequences of ICP. Conclusions: Analysis of Team Climate provided insights into ICP in healthcare teams. The proposed framework provides fresh insights into the understanding and operationalization of ICP, and suggests that although Team Climate is important in establishing collaboration, the understanding of ICP within SUS also requires consideration of a range of other factors, including innovation in interprofessional work and the organizational structure of PHC and Health Care Networks.

Bakgrund Mobila Intensivvårds Grupper (MIG) är idag etablerade på flera svenska sjukhus. MIG bidrar till att minska antalet hjärtstopp och till att patienter som är på väg att försämras upptäcks tidigare. MIG innebär också en trygghet för avdelningspersonalen. Delaktighet i MIG är en naturlig del i intensivvårdssjuksköterskans arbetsuppgifter. Syfte Att beskriva intensivvårdssjuksköterskors erfarenheter av interaktionen med avdelningspersonalen vid MIG-uppdrag. Metod En kvalitativ studie med semistrukturerade intervjuer har utförts vid två sjukhus. Resultatet har analyserats med kvalitativ innehållsanalys. Resultat Två teman framkom vid analysen, Betydelsen av interaktion för en sammanlänkad och säker vård samt Samspelsbefrämjande faktorer. Respondenterna anser avdelningspersonalens närvaro och engagemang som väsentlig vid MIG-uppdraget för att patienten ska få en sammanlänkad och säker vård. Respondenterna upplever att avdelningspersonalen ibland inte förstår vikten av deras närvaro och att MIG då behöver arbeta aktivt för att få avdelningspersonalen mer engagerad. Det interprofessionella samarbetet gagnar inte enbart patienten utan gynnar även den professionella utvecklingen genom utbyte av kunskap. För att interaktionen ska fungera optimalt krävs att MIG bekräftar avdelningspersonalen och att alla involverade vid MIG-uppdraget har en gemensam bild av situationen och delar samma mål med vården. Resultatet diskuterades utifrån den teoretiska referensramen Relationship Centered Care. Slutsats Interaktionen vid MIG-uppdrag fungerar väl när MIG och avdelningspersonalen samarbetar och kompletterar varandra. Välfungerande samarbete och sammanlänkad vård i samband med MIG-uppdrag leder till ökad patientsäkerhet. Klinisk betydelse Samarbetet vid MIG-uppdrag stärks genom utbildning och praktisk träning i interprofessionellt samarbete. Genom mer utbildning, tydligare kommunikation från MIG och ökad återkoppling kan avdelningspersonalen få en större förståelse för vikten av deras delaktighet vid MIG-uppdragen. / Background Mobile Emergency Teams (MET) are established at several Swedish hospitals. MET helps to reduce the number of cardiac arrest and patients who are about to deteriorate are detected earlier. MET also means security for the staff at general wards. Being involved in the MET is a natural part of the critical care nurse's work assignments. Aim To describe the critical care nurses' experiences of interaction with the staff at general wards during MET- assignments. Method A qualitative study using semi-structured interviews was carried out at two hospitals. The collected data were analyzed by qualitative content analysis. Results Two themes emerged from the analysis, The importance of interaction for an interconnected and safe healthcare and Teamwork promoting factors. Respondents believe attendance and commitment from the staff at general wards as important in MET- assignments for the patient to get interconnected and safe care. Respondents experience that ward staff sometimes don´t understand the importance of their presence and that MET then need to work actively to get the ward staff more committed. The interprofessional collaboration is not only beneficial for the patient but it also promotes the professional development through the exchange of knowledge. For the interaction to work optimally it requires MET to confirm the staff at general wards and that everyone involved in the MET-assignment has a mutual perception of the situation and the goal with the treatment. The results were discussed using the theoretical framework Relationship Centered Care. Conclusion The interaction in MET-assignments works well when MET and the staff at general wards work together and complement each other. Effective collaboration and interconnected healthcare during MET-assignments increases patient safety. Clinical significance The collaboration during MET-assignments can be strengthened through education and practical training in interprofessional collaboration. Through more training, clearer communication from MET and increased feedback can the staff at general wards gain a greater understanding of the importance of their participation in MET-assignments.

Healthcare is continuously changing through means of project work. Small projects in healthcare settings are of particular interest since they are usually not adequately supported by the health institution, and present many challenges of their own. However, collective successful completion of small projects has the potential to significantly impact and improve health service delivery. This thesis examined the common and successful project management practices in small projects in Canadian hospital settings to acquire new knowledge on this understudied kind of project and propose basic project management practice guidelines for future small projects conducted within these settings. Data collection was conducted in two hospitals in the form of 23 semi-structured interviews with five interprofessional project teams composed of 4-10 healthcare professionals. Each project was considered as the unit of analysis. Qualitative within-case and cross-case inferential processes were applied and a consolidated list of 43 project management practices deemed important by the majority of participants from all cases was revealed and could serve as basic project management practice guidelines for future small projects conducted in hospitals. Findings also shed light on the beneficial value of adapting principles of project management to small projects in hospital settings. Given the bottom-up nature of small projects, results suggest it is of significant importance to clearly define and understand the small project, as well as perform a thorough stakeholder analysis to be able to gain the right approvals. Insufficient time dedicated to small project management governed these shortcomings, thus team members need to regularly allot time to managing their small project. Lastly, the presence of a team leader was a significant factor influencing continuous project execution. Future studies should take into consideration allied disciplines’ contributions such as organizational behaviour to help explain the interplay between group dynamics and small project outcome.

Many students in primary and secondary schools are impacted by a chronic health condition. Researchers have postulated that interprofessional collaboration between medical and mental health providers can be beneficial in improving the academic, behavioral, and social-emotional outcomes of students with chronic health conditions (Drotar, Palermo, & Barry, 2003; Shapiro & Manz, 2003). An emerging area of focus is on the school-based collaboration between school nurses and school psychologists regarding supporting students with chronic health conditions. This study investigated school nurses’ perceptions of the benefit of collaborating with school psychologists, school nurses’ awareness of the roles of school psychologists, the frequency of collaborative practices, the relationship between the awareness of roles and frequency of collaborative practices, and the barriers and facilitators to the collaborative process. A total of 1,054 school nurses were recruited from National Board for Certification of School Nurses to participate in the study, and 240 surveys were completed (23% response rate). Findings indicate that school nurses perceive the collaborative practice as being beneficial for supporting students with chronic health conditions. Additionally, school nurses were able to accurately identify many roles of school psychologists. Despite school nurses perceiving collaboration with school psychologists as beneficial, and being aware of the roles of school psychologists, the frequency of collaboration between school nurses and school psychologists was low. Further analysis found a significant and positive relationship between awareness of the roles and collaborative practices. Benefits of the collaborative process included cross-disciplinary problem solving and the opportunity to share resources.

Syfte: Syftet med studien var att undersöka kunskapen om vilka insatser som hör till arbetsterapi i primärvården enligt andra professioner. Idag saknas studier som belyser de andra professionernas kunskaper om vilka insatser som arbetsterapin inom primärvården bidrar till i patientarbetet. Metod: Studien genomfördes med en kvantitativ ansats som baserades på en enkätundersökning med 52 deltagare ifrån regionerna: Södermanland, Jönköping, Skåne, Halland och Västerbotten. Populationen bestod av: fysioterapeuter, läkare, psykologer, sjuksköterskor, undersköterskor, verksamhetschefer och vårdadministratörer. Ett obundet slumpmässigt urval användes i studien. Resultat: Studiens resultat visade att majoriteten av deltagarna hade kunskap om insatser inom arbetsterapi i primärvården. Dock ansåg majoriteten deltagare i studien inte/eller var tveksamma inför insatser såsom: ”Körkortsbedömning vid utredning och beslut kring fortsatt bilkörande efter skada eller sjukdom”, ”Arbetsplatskartläggning” och ”Kognitiv bedömning vid neuropsykiatriska funktionsnedsättningar” till att vara insatser i utrednings- och bedömningsarbetet inom arbetsterapi i primärvården. Majoriteten deltagare ansåg även inte/eller var tveksamma inför insatsen: ”Träning av arbetsförmåga” inom interventionsarbetet till att vara en insats inom arbetsterapi i primärvården. Slutsats: Författaren anser att det är viktigt att andra professioner inom primärvården har insikt i vilka insatser arbetsterapeuten har för att patienten ska få vård i god tid. Slutsatserna ur denna studie kan bidra till nya insikter inom hälso- och sjukvården, och förbundet ”Sveriges Arbetsterapeuter” varpå kvalitetsarbete och riktlinjer för vilka insatser som borde ingå i arbetsterapeutyrket inom primärvården kan göras. / Aim: The aim of this study was to examine occupational therapy work efforts that belong to occupational therapy in primary care according to other professions. There are no studies today that shed light on the knowledge of other professionals concerning the contributions that occupational therapy in primary care contributes to in work with patients. Method: The study was conducted with a quantitative approach, which was based on a survey of 52 participants from the regions of: Södermanland, Jönköping, Skåne, Halland and Västerbotten. The population consisted of: physiotherapists, doctors, psychologists, nursing assistants, heads of departments and care administrators. An unbound random sample was used in this study. Result: The result of the study showed that the majority of the contributions in the survey coming from the brochure ”Arbetsterapi i primärvården” ("Occupational Therapy in Primary Care") (Sveriges arbetsterapeuter, 2014) was confirmed as occupational therapy work efforts in primary care according to the other professions. However, the majority of participants in this study did not consider or were hesitant about work efforts such as: ”Körkortsbedömning vid utredning och beslut kring fortsatt bilkörande efter skada eller sjukdom” ("Driving license assessment in investigations and decisions regarding continued driving after injury or illness"), ”Arbetsplatskartläggning” ("Workplace mapping") and ”Kognitiv bedömning vid neuropsykiatriska funktionsnedsättningar” ("Cognitive assessment in neuropsychiatric disabilities") to be investigative assessment and assessment procedures within occupational therapy in primary care. The majority of participants also did not consider or were hesitant about the intervention: ”Träning av arbetsförmåga” ("Training of work ability") as an intervention in occupational therapy in primary care. Conclusion: The author believes that it is important that other professions in primary care have an insight into the efforts of the occupational therapist to ensure that the patient is getting proper care in an earlier stage. The conclusions of this study could contribute to new insights in the health care system, and the association "Sweden's Occupational Therapists" whereupon quality work and guidelines for which interventions should be included in the occupational therapy profession in primary care can be made.

Syftet med denna uppsats är att undersöka skolkuratorers upplevelse av att arbeta inom skolan som tvärprofessionell verksamhet samt deras upplevda möjlighet att utföra sitt arbete. Skolkuratorn är en minoritet i verksamheten samt har ett annat perspektiv än de andra professionerna vilket gör det intressant att studera. Syftet undersöks genom att titta på kuratorns relationer till andra yrkesgrupper i skolan samt vad de anser är kännetecknande för yrkesrollen. Analysen utgår från en fenomenologisk ansats och Bourdieus teoretiska begrepp fält, habitus och kapital. Studien har utförts genom kvalitativa intervjuer med skolkuratorer och sedan analyserats genom en tematisk analys. Resultatet visar på att kuratorn är i underläge i skolans fält på grund av ett annat habitus än pedagogerna, samtidigt som de ses som experter inom sitt perspektiv och ofta rådfrågas. Det som är betydande för kuratorns position i fältet är relationen till ledningen och lärarna samt att få förtroende från dessa genom att ha ett högt värderat kunskapskapital. Skolkuratorerna lyfter även elevhälsoteamet som väldigt viktig för dem då de har en grupp de känner starkare tillhörighet till och blir mindre ensamma. Nätverk med andra kuratorer framstår också som betydande då det ger möjlighet att diskutera med andra socionomer samt ger en känsla av delaktighet. Kuratorsrollen beskrivs i övrigt som mångfacetterad, ensam, splittrad, otydlig och värdefull. Kuratorernas möjlighet att utföra sitt arbete påverkas till stor del av vilka förutsättningar som finns, exempelvis hur mycket tid de har till sitt befogande i relation till arbetsbördan.

Among elderly persons living in nursing homes in Sweden, 42 percent have poor oral health. Poor oral health is a suffering for the elderly person and can affect the person's ability to speak, chew and smile but can also lead to poor self-esteem and depression and in worst case critical illness. Therefore, oral health is an area of nursing that must be updated and prioritized. Nurses hold a key position to be able to promote good oral health for older people and could identify oral health problems at an early stage. Therefore, nursing staff need to get knowledge about oral health related to general health. The purpose of the literature review is to shed light on how care staff can improve the oral health of people in nursing homes. The method chosen was a literature review, based on four qualitative, four quantitative and two mixed method studies. Two main categories and six subcategories were created. The two main categories were barriers to good oral health and factors for good oral health and the subcategories describe lack of knowledge among care staff, priorities and attitudes, dislike to oral care as well as interprofessional collaboration, progressive strategies and organizational support. Oral health is neglected due to barriers such as lack of time, high workload, and priorities in nursing homes. For oral health to be improved among people in nursing homes, increased knowledge and cooperation between care staff and dental staff is required.

Objectives To evaluate the effectiveness of pharmacist-physician collaboration in the treatment of type 2 diabetes mellitus (DM) with severe insulin resistance, using 500 U/mL concentrated regular insulin (U-500) in a primary care clinic that is not staffed by an endocrinologist. Methods A retrospective chart review was conducted searching for patients who were prescribed U-500 insulin from January 1, 2008 through December 31, 2014. Subjects were included in the analysis if the pharmacist initiated U-500 insulin therapy, received treatment for at least 6 months, and who attended at least one follow-up visit with the pharmacist. Anyone who received U-500 insulin before the initial pharmacist consultation, managed by an endocrinologist, or who was missing follow-up hemoglobin A1c (HbA1c) laboratory values during the follow-up period was excluded. The primary endpoint was the change in HbA1c from U-500 initiation to 6 months later. Secondary endpoints included changes in weight, confirmed hypoglycemia events, changes in other anti-DM medications and the number of pharmacist and primary care physician visits during the follow-up period. Results Eighty-one patients were identified and screened, and 44 patients were included in the analysis. Baseline HbA1c (mean ± standard deviation) was 9.7% ± 1.6% and decreased to 8.6% ± 1.6% after 6 months of follow-up, representing a reduction of 1.1% (95% confidence interval -1.6 to -0.6, P < 0.001). Body weight increased (mean ± standard deviation) by 6.7 ± 15.1 lb from baseline (P = 0.005). The frequency of confirmed hypoglycemia events was low (0.8 events per patient). Treatment with metformin was preserved, whereas most other DM medications were discontinued. A similar number of pharmacist and physician follow-up visits were completed by the end of the study period (2.0 and 2.7 visits, respectively; P = 0.805). Conclusions Initiation of U-500 insulin by clinical pharmacists collaborating with primary care physicians results in improved DM control in patients with severe insulin resistance. Our findings suggest this interprofessional partnership provides an alternative referral approach for primary care physicians when endocrinology services are absent or limited.

No description available.

<p><strong>Background. </strong>Interprofessional collaboration is a cogent strategy to promote retention and safe, quality nursing care among new graduate nurses. This sandwich thesis describes a research project undertaken to understand how new graduate nurses engage in interprofessional collaboration.</p> <p><strong>Objective. </strong>The aim was to comprehensively understand the individual, team, and organizational factors that influence new graduate nurse engagement in interprofessional collaboration.</p> <p><strong>Methods. </strong>An integrative review of the new graduate nurse literature was conducted within the context of interprofessional collaboration. Applying the Structuration Model of Interprofessional Collaboration as a framework, a mixed methods study examined the team and organizational predictors of new graduate nurse engagement in interprofessional collaboration, and explored factors that influenced confidence among new graduate nurses toward interprofessional collaboration. Quantitative data were collected via mailed surveys. Follow-up interviews were conducted to explain the quantitative findings.</p> <p><strong>Results. </strong>The integrative review revealed individual, team, and organizational factors that were reported to influence new graduate nurse engagement in interprofessional collaboration. The review concluded a gap in the current knowledge of the issue, and literature that was weak to moderate in quality. The team and organizational predictors of new graduate nurse engagement in interprofessional collaboration were: satisfaction with the team, number of team strategies, participation in a mentorship or preceptorship experience, accessibility of manager, and accessibility and proximity of educator or professional practice leader. The interviews revealed respect, team support, and face-to-face interprofessional interactions as team facilitators. Supportive leadership and preceptorship or mentorships were organizational facilitators. Several variables had a relationship with new graduate nurse confidence in interprofessional collaboration. A model that explains this confidence was developed from the qualitative findings.</p> <p><strong>Conclusion. </strong>The Structuration Model of Interprofessional Collaboration was a valuable</p> <p>framework for understanding the structural elements of new graduate nurse engagement in interprofessional collaboration. This thesis identifies implications for education, practice and research.</p> / Doctor of Philosophy (PhD)