This thesis is concerned with communication in interprofessional practice, an issue which is identified as a ‘difficulty’ but ‘essential’ in the literature. The research is based on a case study focusing on the communication between professionals in a series of planning meetings held to support the transition of a child with additional support needs from playgroup into the nursery class of a primary school in Scotland. The study explores the dynamics and complexities of communication through the theoretical frameworks of ethnography of communication and Dewey’s concept of communication as participative action. This joint analysis illustrates the way in which the group worked together to make something in common and the extent of commonality that was needed for them to work actively together. The findings show the interprofessional group functioning as a speech community with a bounding feature of working with the child. The soft-shell of this community illustrates a flexibility of practice and the ability of the group to expand or contract to meet the needs of the child and family. The way in which the participants worked together to agree the outcomes they were working towards is an illustration of Deweyan communication, making something in common between them. This process included the recognition of the competence and responsibility of individual professions. The study demonstrates that the doctors who were members of the interprofessional group were recognised as holding more power than the other members of the group and were bound by the outcomes and procedures of their own profession. This difference affected the dynamics of communication within the interprofessional team. The findings add to our understanding of the complexities of communication in an interprofessional team and show that communication in a Deweyan sense can strengthen the work of an interprofessional group and develop their support for the child or family they are working with.

The prevailing approach to managing persons with criminal histories involves community supervision professionals like probation and parole officers partnering with other mental health providers to address clients’ needs. The relationships between individual professionals are seldom researched, though, and the current study aims to address this deficit in the empirical literature. This study utilized interviews about professionals’ perceptions of their work experiences, analyzed open-endedly to identify major themes. Mental health providers’ themes included appreciation and process of collaboration, individual characteristics and roles, characteristics of collaboration, elements of interprofessional relationships, and involvement of the courts. Community supervision professionals discussed issues pertaining to appreciation and process of collaboration, individual characteristics and roles, when conflict occurs, and the lack of basic knowledge about other professionals. Second, these partnerships were examined in light of interprofessional healthcare competencies. Themes identified here resembled healthcare values and ethics competencies and roles and responsibilities competencies; healthcare competencies regarding interprofessional communication and teamwork showed partial congruence with the current themes. Overall, interprofessional collaboration is valued. This research highlights the strengths of this type of interprofessional collaboration and offers suggestions for improving the efficacy of collaboration.

Objectives: To assess and compare interprofessional and interpersonal communication self-efficacy beliefs of medical, nursing and pharmacy students before and after participation in a communication skills course. Method: Using self-efficacy as a theoretical framework, a 37-item survey instrument was developed based on Interprofessional Education Collaborative (IPEC) Core Competencies and course learning objectives. Medical, nursing, and pharmacy students voluntarily completed the survey instrument before and after the required course. Nonparametric tests were employed to examine matched pre- and post-assessments within colleges and to explore differences in self-efficacy beliefs across college. Results: A response rate of 87% (168/193) was achieved. Overall, nursing students entered the course with higher self-efficacy beliefs as compared to medical and pharmacy students. Pharmacy students indicated particularly low self-efficacy beliefs regarding their ability to communicate with other health professionals (p=0.009) and contribute to healthcare teams (p=0.002). Matched pre/post analyses indicated statically significant increases in student self-efficacy beliefs across all colleges. After the course, pharmacy students continued to perceive a relative lack of confidence in their ability to develop positive relationships with other health care providers as compared to medical and nursing students (p=0.02). Implications: Our findings suggest that completion of an interprofessional communications course was associated with a positive effect on self-efficacy beliefs aligned with IPEC competencies across all colleges. Pharmacy students, in particular, noted significant improvements in self-efficacy beliefs across multiple domains. Research is being conducted to examine relationships between validated observational assessments and student self-perceptions.

Poor interprofessional communication has been linked to decreased quality of patient care and increased numbers of medical errors. Increased occupational stress due to lack of effective interprofessional communication can lead to poor job satisfaction and burnout. The purpose of this study was to identify barriers to interprofessional communication as perceived by radiologic technologists. In particular, how did demographic data influence these perceptions? The research was conducted during June of 2009. The population for this survey consisted of registered radiologic technologists employed at hospitals in Northeast Tennessee. A locally developed survey questionnaire covering the subject of interprofessional communication was distributed to a cluster sample directly involved in patient care. Participants indicated that interprofessional communication effects their occupational stress and job satisfaction in addition to the quality of patient care. This analysis revealed that radiographers experienced the most difficulty communicating with nurses.

Bakgrund: Kommunikation är en nyckelfaktor för att kunna bedriva en säker och tillfredsställande vård. Vårdteamet består av flera olika professioner som behöver kommunicera för att uppnå satta mål. Av alla vårdskador är 70% orsakade på grund av bristande kommunikation. För att öka patientsäkerheten krävs det att vårdteamet har rutiner för att säkerställa att patientinformation överförs på ett säkert sätt. Inte minst mellan läkare och sjuksköterska krävs ett säkert kommunikationssystem eftersom professionerna samarbetar kontinuerligt. Syfte: Att belysa sjuksköterskors erfarenheter av interprofessionell kommunikation med läkare och dess betydelse för patientsäkerheten. Metod: Litteraturstudie baserad på tio vetenskapliga artiklar med kvalitativ ansats som granskats, analyserats och sammanställts till ett resultat. Resultat: Sju teman har framställts i resultatet bestående av “Roller”, “Tidsbrist”, “Förminskning”, “Anpassad kommunikation”, “Brist på information”, “Följder för patienten av bristande kommunikation” och “Teamarbete”. Konklusion: Sjuksköterskor upplever att deras kunskaper inte tas på allvar av läkarna. När läkarna undanhåller information om patienten upplevs frustration. De anser att en god relation till läkaren gynnar kommunikationen. För att förmedla information till läkarna krävs det att sjuksköterskrona anpassar sin kommunikationsstil beroende på specifik läkare och situation. / Background: Communication is a key factor to be able to provide safe and satisfactory care. The healthcare team consists of multiple professions who need to communicate to achieve their goals. 70% of all instances where the patient comes to harm in healthcare is because of communication errors. To increase the patient safety the healthcare team needs routines to ensure that patient information is transferred between the professions in a safe manner. Especially between the nurse and the physician the communication needs to function since the two professions corporate continuously. Aim: To examine nurses experiences of communication with physicians and the impact on patient safety. Methods: A literature review based on ten scientific articles with qualitative data that has been reviewed, analysed and compiled to a result. Results: Seven themes were produced in the results consisting of “Roles”, “Lack of time”, “Diminishing”, “Adapted communication”, “Lack of information”, “Consequences for the patient because of lack in communication” and “Teamwork”. Conclusion: The nurses experience that their knowledge is not taken seriously by the physicians. When the physicians are withholding information, the nurses feel frustration. They believe that a good relation with the physician improves the communication. To mediate information to the physicians the nurses sometimes need to adapt their communication style depending on which physician they are communicating with.

Indiana University-Purdue University Indianapolis (IUPUI) / Intraoperative adverse events (IAEs) due to interprofessional miscommunication continue to occur despite implementation of surgical checklists and focused communication trainings. Much of the previous intraoperative communication research has focused on the content and quantity of interprofessional communication instead of its context and quality, and current communication interventions seem to have varying levels of engagement, effectiveness, and persistence. The purpose of this dissertation study was to explore the psychosocial processes involved during the establishment and maintenance of interprofessional communication surrounding IAEs or potential IAEs in the intraoperative environment and to identify the perceived facilitators and barriers to communication. Twenty surgical team members participated in semi-structured interviews and described their experiences with interprofessional communication during IAEs. Grounded theory methodology was used to identify the central process, Testing the Water, and two subprocesses, Reading the Room and Navigating Hierarchy. Testing the Water describes the situational nature of interprofessional communication as surgical team members navigate factors influencing the context and probable trajectories of surgical cases and the perceptions of professional rights and responsibilities within surgical teams. Participants in this study experienced Testing the Water differently based on their professional roles and tenure; findings were organized around three emerging groups identified as inexperienced nurses, experienced nurses, and surgeons. Interprofessional communication surrounding IAEs occurred for study participants in fluid, iterative phases identified as 1) Recognition, 2) Reconnaissance, 3) Rallying, 4) Reaction, and 5) Resolution. Participants recognized IAEs or potential IAEs, gathered information through reconnaissance, rallied other team members, reacted to stabilize patients, and resolved IAEs through individual or surgical team reflection. Study participants reported using strategies during communication to accomplish two psychosocial goals, preserving the flow of surgical cases, and protecting the ‘face’ of themselves and other surgical team members. Supporting these psychosocial goals through increased psychological safety for all surgical team members potentially leads to more effective, timely surgical team communication. More effective interprofessional communication facilitates the improved situational awareness, collective sensemaking, and integrated team mental models that are critical to coordinated responses to IAEs. The findings of this study suggest practical implications to increase the effectiveness of interprofessional communication in the intraoperative environment.

Poor interprofessional communication has been linked to decreased quality of patient care and increased numbers of medical errors. Increased occupational stress due to lack of effective interprofessional communication can lead to poor job satisfaction and burnout. The purpose of this study was to identify barriers to interprofessional communication as perceived by radiologic technologists. In particular, how did demographic data influence these perceptions? The research was conducted during June of 2009. The population for this survey consisted of registered radiologic technologists employed at hospitals in Northeast Tennessee. A survey questionnaire covering the subject of interprofessional communication was distributed to a cluster sample directly involved in patient care. An ANOVA was used to determine which barriers were significantly greater. A TUKEY HSD post hoc analysis was used when influences were significantly different. Participants indicated that interprofessional communication affects their occupational stress and job satisfaction in addition to the quality of patient care. This analysis revealed that radiographers experienced the most difficulty communicating with nurses.

Introduktion: Dagens sjukvård består av olika vårdkedjor där larmcentralen och ambulanssjukvården utgör den första länken för många patienter. Larmcentralen ansvarar för att ta emot, hantera och prioritera nödsamtal som sedan dirigeras ut till ambulansverksamheten. God interprofessionell kommunikation är en förutsättning för att länken ska vara intakt och därmed främja en patientsäker vård. Den forskningsbrist som råder i området motiverar studiens genomförande.   Syfte: Att beskriva förutsättningar för kommunikation mellan ambulansdirigenter och ambulanspersonal utifrån ambulansdirigenters och ambulanssjuksköterskors erfarenheter.   Metod: Studien är en kvalitativ intervjustudie med induktiv ansats. Ett bekvämlighetsurval tillämpades och tolv semistrukturerade intervjuer genomfördes. Analysen utgick ifrån en latent innehållsanalys i enlighet med Lundman och Hällgren Graneheim (2012).   Resultat: Ett tema formades ur den latenta analysen, vilket benämns Mot samma mål trots olika förutsättningar. Resultatet redovisas utifrån två huvudkategorier; teknikens förtjänster och begränsningar samt personliga förmågor. Dessa bygger på sex underkategorier som beskriver informanternas erfarenheter gällande kommunikationen dem emellan. Underkategorierna benämns vara beroende av kommunikationsteknik, behov av samtal, bemötande, hantera stress, ifrågasättande och bristande tillit samt förståelse för varandras uppdrag. Det framkom att fungerande teknik och korrekt hantering av den är centralt för kommunikationen. Oavsett vad rutiner säger så finns det i vissa situationer ett behov av muntlig kommunikation. De personliga egenskaperna påverkar hur kommunikationen fortlöper.   Slutsats: Tekniken måste fungera och personalen måste vara välutbildade inom det tekniska handhavandet. Möjligheten till hospitering inom de båda verksamheterna anses vara av stor vikt för att bidra till en ökad förståelse, vilket på sikt kan förbättra den interprofessionella kommunikationen mellan dem. / Introduction: Today's health care consists of different care chains where SOS Alarm and the ambulance service constitute the first link for many patients. SOS Alarm is responsible for receiving, manage and prioritize emergency calls which are then routed out to the ambulance. Good interprofessional communication is a prerequisite for the link to be intact and thereby achieve a safe care for the patient. The lack of research in the area justifies the implementation of this study.   Aim: To describe the conditions for communication between ambulance conductors and ambulance staff based on the experiences of ambulance conductors and ambulance nurses.   Method: The study is a qualitative interview study with an inductive approach. A convenience sample was applied and twelve semi-structured interviews were conducted. The analysis was based on a latent content analysis in accordance with Lundman and Hällgren Graneheim (2012).   Result: A theme was formed from the latent analysis, which is called Towards the same goals despite different conditions. The result is reported on two main categories: The benefits and limitations of the technology as well as personal abilities. These are based on six subcategories which describes the informants' experiences regarding communication between them. The subcategories are called dependency on communication technology, need for conversation, attitude, dealing with stress, questioning and lack of confidence, and understanding of each other's assignments. It emerged that working technology and proper handling of it are central to communication. Regardless of what routines say, there is a need for oral communication in certain situations. Personal qualities affect how communication progresses.   Conclusion: Is that the technology must be working and the staff must be well-trained in the technical handling. The possibility of visits in each other’s organizations are considered to be of great importance to contribute to a greater understanding, which ultimately can improve communication between them.

The problem exists that there are no education initiatives focused on teaching and taking into practice the skills of effective interprofessional discourse in this online, asynchronous, professional environment. The purpose of this study was to examine whether it is possible for students in the health professions to learn to practice effective interprofesssional online discourse in an electronic health record. This was a mixed methods study that included both quantitative ad qualitative inquiry underpinned by post positivism and used a method triangulation research design model. Both quantitative and qualitative data were collected and analyzed from an educational intervention and simulated electronic health record exercise. The students' perceptions of their practice in an electronic health record did not necessarily match their knowledge and skills in this group of students. Emergent themes from the study pointed in the possible direction of perceived value of the exercise, prior experience in an electronic health record, and logistical barriers to the activity. Perceived time constraints was a particularly strong concern of the students. The emergent themes might be valuable considerations for other interprofessional programs looking to implement similar activities concerning the electronic health record.

While the body of evidence supporting the use of simulation-based learning in the education of health professionals is growing, howor why simulation-based learning works is not yet understood. There is a clear need for evidence, grounded in contemporary educational theory, to clarify the features of simulation instructional design that optimize learning outcomes and efficiency in health care professional students. Cognitive Load Theory (CLT) is a theoretical framework focused on a learner’s working memory capacity. One principle of CLT is example based learning. While this principle has been applied in both traditional classroom and laboratory settings, and has shown positive performance and learning outcomes, example based learning has not yet been applied to the simulation setting. This study had two main objectives: to explore if the example-based learning principle could successfully be applied to the simulation learning environment, and to establish response process validation evidence for a tool designed to measure types of cognitive load. Fifty-eight novice students from nursing, podiatric medicine, physician assistant, physical and occupational therapy programs participated in a blinded randomized control study. The dependent variable was the simulation brief. Participants were randomly assigned to either a traditional brief or a facilitated tutored problem brief. Performance outcomes were measured with verbal communications skill presented in the Introduction, Situation, Background, Assessment, Recommendation (I-SBAR) format. Response process evidence was collected from cognitive interviews of 11 students. Results indicate participation in a tutored problem brief led to statistically significant differences at t(52)=-3.259, p=.002 in verbal communication performance compared to students who participated in a traditional brief. Effect size for this comparison was d=(6.06-4.61)/1.63 = .89 (95% CI 0.32-1.44). Response process evidence demonstrated that additional factors unique to the simulationlearning environment should be accounted for when measuring cognitive load in simulation based learning (SBL). This study suggests that example based learning principles can be successfully applied to SBL and result in positive performance outcomes for health professions students. Additionally, measures of cognitive load do not appear to capture all contribution toload imposed by the simulation environment.