If nurse educators do not teach students to function in interprofessional teams, students may lack communication and teamwork skills, which can result in patient harm; however, nurse educators do not always understand the concept of interprofessional collaboration (IPC) and may, therefore, fail to teach it to students. The purpose of this multiple case study was to understand how undergraduate nurse educators prepared to teach IPC and how their preparation informed their teaching. The theory of transformative learning and the Interprofessional Education Collaborative core competencies of IPC framed this study. Data included semistructured interviews and associated documents from 9 nurse educators representing 3 different schools of nursing. Transcribed interviews and associated documents were coded for emergent themes. The 5 key themes that emerged related to nurse educator preparation to teach IPC were academic IPC preparation was limited, lack of formal preparation and an incomplete understanding, interprofessional communication: positive perceptions and perceived barriers, previous IPC exposure influenced instruction, and educators taught IPC informally. The results of this study may influence positive social change by inspiring educational leaders to consider the possibility that nurse educators may need IPC-specific faculty development. Research suggests that when educators know how to teach IPC, they can prepare students to practice in interprofessional teams. Most importantly, when new nurses know how to work in interprofessional teams, this may result in a decrease in the incidence of unintentional patient injuries.

In some rural and remote locations in New South Wales and elsewhere in Australia, a limited range of radiographic examinations may be performed by nurses and general practitioners if there is no radiographer available. These so called remote x-ray operators are licensed under the New South Wales Radiation Control Act 1990. This study aimed to investigate the experiences and perceptions of remote x-ray operator radiography and examine the role of remote operators in New South Wales from the perspective of a cohort of rural radiographers and nurse and GP remote x-ray operators involved in frontline delivery of rural radiographic services. Methodology Semi-structured in-depth interviews were performed with twenty rural radiographers, ten rural nurses and seven rural general practitioners from various rural communities in New South Wales. Interview questions explored the informants’ knowledge, opinions and values, experience and behaviour, and attitudes and feelings in relation to remote x-ray operator radiography. Interviews were tape-recorded and transcribed. Data analysis was subsequently performed using an iterative process based on a modified grounded theory methodology. Data labelling and comparative analysis were carried out in parallel with data collection, allowing progressive modification of the interview theme list to ensure that theoretical saturation was achieved. Results Data analysis led to the emergence of three key concepts, together with their relevant themes and sub-themes. The primary key concept, ‘Dimensions of Practice’, was inclusive of the central precepts of remote x-ray operator radiography. It includes themes titled ‘Licence Conditions and Limitations’, ‘Competency Requirements’ and ‘Image Quality and Practice Standards’. The key concept of ‘Service Provision and Equity of Access’, represents the realities of clinical practice in the rural and remote health care setting. It includes themes of ‘Clinical Management and Decision Making’, ‘Access and Availability’, ‘Patient Expectations’ and ‘Commitment to Service’. The third key concept is ‘Professional Roles and Relationships’, which deals with the interactions that take place between individual practitioners and the factors that influence them. It encompasses the xii themes of ‘Boundary Delineation’, ‘Professional Status and Esteem’ and ‘Interprofessional Conflict and Collaboration’. Relationships between the key concepts, via their themes and sub-themes were also explored. Conclusions Analysis of the data led to the development of a conceptual model and a single story line that represent the perspectives of the study informants. Remote x-ray operator radiography takes place at the intersection of the occupational worlds of rural radiographers, nurses and general practitioners. Remote operators provide a valuable service that prevents rural residents having to travel to access minor radiographic examinations. However, the quality of the radiography they perform is below the standard expected of radiographers. Improvements in collaborative teamwork could improve the quality of service, although interprofessional communication is stifled by status and hierarchical relationships. The remote x-ray operator experience may inform the development of future models of health care. / PhD Doctorate

Background: The process of shared decision making (SDM), a key component of interprofessional (IP) practice, provides an opportunity for the separate and shared knowledge and skills of care providers to synergistically influence the client / patient care provided. The aim of this study was to understand how different professional groups perceive IPSDM, their role as effective participants in the process and how they ensure their voices are heard. Methods: A sequential explanatory mixed methods design was used consisting of a realist review of the literature about IPSDM in intensive care, a survey of the IP team (n=96; RR-81.4%) about collaboration and satisfaction with the decision making process in NICU, semi-structured interviews with a sample of team members (n=22) working in NICU, and observation of team decision making interactions during morning rounds over a two week period. A tertiary care NICU in Canada was the study setting. Findings: The study revealed a number of key findings that are important to our increased understanding of IPSDM. Healthcare professionals’ (HCP) views differ about what constitutes IPSDM. The nature of the decision (triage, chronic condition, values sensitive) is an important influencing factor for IPSDM. Four key roles were identified as essential to the IPSDM process: professional expert, leader, synthesizer and parent. IPSDM involves collaboration, sharing, weighing and building consensus to overcome diversity. HCPs use persuasive knowledge exchange strategies to ensure their voices are heard during IPSDM. Buffering power differentials and increasing agreement about best options lead to well-informed decisions. A model was developed to illustrate the relationships among these concepts. Conclusions: Findings from this study improve understanding of how different members of the team participate in the IPSDM process, and highlight effective strategies to ensure professional voices are heard, understood and considered during deliberations.

Objective: To explore the role of interprofessional collaboration in the delivery of team-based tobacco dependence treatments within primary care. Methods: A narrative review of the literature was completed to examine FHT team functioning in Ontario, followed by a single, multi-site qualitative exploratory case study. Results: Interprofessional collaboration contributed to changes in tobacco dependence treatment through the initiation of system-wide change, cultivation of collective action, and supporting enhanced quality of smoking cessation care. Conclusion: Interprofessional collaboration can enhance the comprehensive delivery of evidence-based treatments for individuals trying to quit smoking. Supportive public policy, education for patients and providers, and evaluation research is needed to advance FHT functioning.

Background: Low back pain (LBP) and low back related disorders are highly prevalent and associated with a considerable burden of pain, disability and work loss. People with a variety of low back-related complaints comprise a large proportion of referrals made to orthopedic surgeons and many of these patients are not considered to be surgical candidates or have not maximized their non-surgical options for managing their low back-related complaints. Objectives: We sought to evaluate the impact of a triage assessment program delivered by physiotherapists using a variety of approaches. Informed by a biopsychosocial model, the objectives of this dissertation were: 1) To determine the short term impact of a physiotherapy triage assessment for people with low back-related disorders on participant self-reported pain, function and quality of life and patient and referring practitioner satisfaction. 2) To determine which demographic, clinical, psychosocial and environmental factors are predictive of improved self-reported pain, function, quality of life and participant and referring practitioner satisfaction. 3) To determine the diagnostic and treatment recommendation concordance between physiotherapists and orthopaedic surgeons, using a newly developed clinical classification tool, for people presenting to a spinal triage assessment service with low back complaints. Methods: Two approaches were used to achieve the aforementioned objectives: a prospective observational study (n=115) to address the first two objectives and a sub-group reliability study (n=45) to address the third objective. Results: There was a mean overall significant improvement in the SF-36 Physical Component Summary at the 4-6 week post-test time point and relatively high satisfaction reported by participants and referring care providers. Qualitative analysis of comments revealed a variety of positive, negative and other contextual factors that may impact outcomes. A variety of different sociodemographic, psychological, clinical and other variables were associated with success or improvement in each respective outcome. There may be a potential mechanism of reassurance that occurs during the spinal triage assessment process as those with higher psychological distress were more likely to improve on certain outcomes. There was high diagnostic concordance between physiotherapists and an orthopaedic surgeon; however, there were more differences in management recommendations between the surgeon and a solo physiotherapist versus physiotherapists working in a collaborative team. Conclusions: A spinal triage assessment program delivered by physiotherapists has the potential to positively impact a variety of patient-related short term outcomes including satisfaction. Further study is needed to examine longer-term outcomes and which biopsychosocial factors may impact these outcomes.

Background: The process of shared decision making (SDM), a key component of interprofessional (IP) practice, provides an opportunity for the separate and shared knowledge and skills of care providers to synergistically influence the client / patient care provided. The aim of this study was to understand how different professional groups perceive IPSDM, their role as effective participants in the process and how they ensure their voices are heard. Methods: A sequential explanatory mixed methods design was used consisting of a realist review of the literature about IPSDM in intensive care, a survey of the IP team (n=96; RR-81.4%) about collaboration and satisfaction with the decision making process in NICU, semi-structured interviews with a sample of team members (n=22) working in NICU, and observation of team decision making interactions during morning rounds over a two week period. A tertiary care NICU in Canada was the study setting. Findings: The study revealed a number of key findings that are important to our increased understanding of IPSDM. Healthcare professionals’ (HCP) views differ about what constitutes IPSDM. The nature of the decision (triage, chronic condition, values sensitive) is an important influencing factor for IPSDM. Four key roles were identified as essential to the IPSDM process: professional expert, leader, synthesizer and parent. IPSDM involves collaboration, sharing, weighing and building consensus to overcome diversity. HCPs use persuasive knowledge exchange strategies to ensure their voices are heard during IPSDM. Buffering power differentials and increasing agreement about best options lead to well-informed decisions. A model was developed to illustrate the relationships among these concepts. Conclusions: Findings from this study improve understanding of how different members of the team participate in the IPSDM process, and highlight effective strategies to ensure professional voices are heard, understood and considered during deliberations.

Primary health care reform is currently underway in Ontario with the goals of improving health care access, quality and continuity of care while increasing patient and provider satisfaction and cost effectiveness. Interprofessional collaboration in the provision of primary health care has been widely espoused in the health care literature as a means of achieving the goals of primary health care reform. Primary health care nurse practitioners in collaboration with physicians and other allied health professionals have a fundamental role in enhancing primary health care in Ontario. The purpose of this study was to explore and describe nurse practitioners’ experiences and perceptions of interprofessional collaboration with physicians in the provision of primary health care in Ontario. A qualitative descriptive study design was used and six nurse practitioners working in a variety of primary health care settings in Ontario were purposively sampled and interviewed regarding their experiences and perceptions of interprofessional collaboration with partnering physicians. Interviews were analyzed using qualitative content analysis techniques and themes were identified. Seven themes were identified as key factors influencing collaboration within the nurse practitioner – physician dyad from the nurse practitioner’s perspective. These themes included: quality of communication, complementary vision, physician remuneration methods, establishing and maintaining relationships, investing time and energy, nurse practitioner competency and expertise and mutual trust and respect. A model of nurse practitioner – physician interprofessional collaboration is used to organize the themes identified. The findings of this study support current recommendations for joint education initiatives for health care professionals and practice initiatives aimed at improving collaboration between partnering nurse practitioners and physicians. Areas for future research include incorporating the client’s experiences and perceptions within collaborative practice as well as developing and evaluating interventions that strengthen collaboration within the health care team / Thesis (Master, Nursing) -- Queen's University, 2009-09-22 12:06:31.203

Background: The process of shared decision making (SDM), a key component of interprofessional (IP) practice, provides an opportunity for the separate and shared knowledge and skills of care providers to synergistically influence the client / patient care provided. The aim of this study was to understand how different professional groups perceive IPSDM, their role as effective participants in the process and how they ensure their voices are heard. Methods: A sequential explanatory mixed methods design was used consisting of a realist review of the literature about IPSDM in intensive care, a survey of the IP team (n=96; RR-81.4%) about collaboration and satisfaction with the decision making process in NICU, semi-structured interviews with a sample of team members (n=22) working in NICU, and observation of team decision making interactions during morning rounds over a two week period. A tertiary care NICU in Canada was the study setting. Findings: The study revealed a number of key findings that are important to our increased understanding of IPSDM. Healthcare professionals’ (HCP) views differ about what constitutes IPSDM. The nature of the decision (triage, chronic condition, values sensitive) is an important influencing factor for IPSDM. Four key roles were identified as essential to the IPSDM process: professional expert, leader, synthesizer and parent. IPSDM involves collaboration, sharing, weighing and building consensus to overcome diversity. HCPs use persuasive knowledge exchange strategies to ensure their voices are heard during IPSDM. Buffering power differentials and increasing agreement about best options lead to well-informed decisions. A model was developed to illustrate the relationships among these concepts. Conclusions: Findings from this study improve understanding of how different members of the team participate in the IPSDM process, and highlight effective strategies to ensure professional voices are heard, understood and considered during deliberations.

Lic.-avh. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 2 uppsatser.

The Operating Room (OR) is a clinical context in which interprofessional teams surgically intervene with the intention of improving the health of the patients they care for. Despite this, surgery is high risk, invasive and often volatile. The reality is that some patients die in the OR, an outcome which violates the care intention of the clinicians who work there. Using the narrative paradigm, this study explores the stories interprofessional team members shared about caring for patients who died intraoperatively. To appreciate the cultural climate in which these stories were rooted, a literature review of OR culture and theoretical analysis of master narratives was conducted. Using individual interviews, six perioperative clinicians were invited to share their stories: two Registered Nurses, one Registered Practical Nurse, two Surgeons and one Anesthetist. Two analytic approaches were used to authentically capture participant narratives: a narrative thematic approach and structural analysis. The structural analysis revealed the types of stories told—tragedies, romances, comedies and satires—while the thematic perspective elucidated participants’ experiences of intraoperative death and their interpretation of the impact of these experiences. These findings illustrated unique perspectives of intraoperative death, illuminating features which enhanced or deteriorated the experiences for clinicians and their teams. Examining results in tandem with master narratives highlighted prevalent cultural discourses which are held in tension by the clinicians who perpetuate them. Exploring these intersecting elements provides insight into implications for nursing practice, research, education and policy, with particular attention to interprofessional dynamics, staff support, and promoting a culture of resilience.