From uniprofessionality to interprofessionality: dual vs dueling identities in healthcare.

Healthcare systems are at times still viewed as siloed performances of single professions, wherein some groups hold hierarchical positions based on their expertise and prestige, rather than a collective functioning of interprofessional teams. Current policies, procedures, and regulations in healthcare education and practice seem to contribute to this context in which the various health and social care professions are set in opposition to one another. The historical, and still prominent, uniprofessional education and socialization practices position health and social care professions to view each as rivals and threats toward achieving their profession/al advancement and growth. The transformation from uniprofessionality to interprofessionality in healthcare requires the application of interprofessional socialization not just at the individual level, but also at the professional and system levels. In this process of interprofessional socialization, we need to embrace the uniqueness of each profession while cultivating an interprofessional collaboration culture in the system (dual identity). In so doing, we can facilitate a shifting mind-set, culture, operations, and policies in healthcare to recognize and foster the contribution and accountability of each profession toward achieving the quadruple aim of better care, better health, better value, and better work experience.

A longitudinal, narrative study of professional socialisation among health students.

PURPOSE: Interprofessional collaboration (IPC) among health professionals is well-recognised to enhance care delivery and patient outcomes. Emerging evidence suggests that the early socialisation of students in health professional programmes to teamwork may have a positive impact on their future as collaborative practitioners. With a purpose of contributing to growing evidence on the processes of professional identity construction, and to explore how early expectations and perceptions of IPC develop during professional socialisation and pre-licensure education, our study examined the early professional socialisation experiences among five groups of health professional students. METHOD: A qualitative, narrative approach was used to examine early professional socialisation among five programmes of health professional students (dentistry, medicine, nursing, pharmacy, physiotherapy) at an Atlantic Canadian University. In March and October 2016, students participated in interviews after first term (n = 44) and first year of study (n = 39). Interviews focused on participants' professional identify formation, as well as their perceptions and experiences of IPC. The authors analysed interview transcripts using narrative analysis. RESULTS: Findings identify that despite the espoused importance of IPC within health professional training, students have a limited understanding of their professional roles and are largely focused on developing a uniprofessional, vs. interprofessional identity. Clinical experiences, role models and exposure to teamwork are critical to contextualise collaborative practice and enhance the development of an interprofessional identity. CONCLUSIONS: Findings can be used to guide the development of curricula that promote interprofessional identity development and IPC during early professional socialisation.

Pre-entry perceptions of students entering five health professions: implications for interprofessional education and collaboration.

Dysfunctional interprofessional teams are a threat to health system performance and the delivery of quality patient outcomes. Implementing strategies that prepare future health professionals to be effective collaborators requires a comprehensive understanding of how early professional socialization and professional identity formation occur. We present findings from a qualitative study, grounded in narrative methodology, examining early professional socialization among students across five health professional programs (dentistry, medicine, nursing, pharmacy, physiotherapy) in the first year of health professional training. Between April and September 2015, students (n = 49) entering programs at an Atlantic Canadian University participated in one-on-one, audiotaped interviews starting before formal program orientation. Pre-entry interviews focused on factors influencing students' career choice and expectations of future profession and interprofessional collaboration (IPC). Findings revealed that many different experiences influenced participants' career choice and framed the social positioning of their future career (e.g., leadership, prestige, autonomy). Participant narratives revealed the existence of stereotypes pertaining to their chosen and other health professions. Study findings provided insights that may help strengthen initiatives to promote positive professional identity formation within the context of IPC. Implications of this research highlight the need for the early introduction of IPC including pre-entry recruitment messaging for prospective health professionals.

Mapping the peer-reviewed literature on accommodating nurses' return to work after leaves of absence for mental health issues: a scoping review.

BACKGROUND: The complexity of nursing practice increases the risk of nurses suffering from mental health issues, such as substance use disorders, anxiety, burnout, depression, and posttraumatic stress disorder (PTSD). These mental health issues can potentially lead to nurses taking leaves of absence and may require accommodations for their return to work. The purpose of this review was to map key themes in the peer-reviewed literature about accommodations for nurses' return to work following leaves of absence for mental health issues. METHODS: A six-step methodological framework for scoping reviews was used to summarize the amount, types, sources, and distribution of the literature. The academic literature was searched through nine electronic databases. Electronic charts were used to extract code and collate the data. Findings were derived inductively and summarized thematically and numerically. RESULTS: Academic literature is scarce regarding interventions for nurses' return to work following leaves of absence for mental health issues, and most focused on substance use concerns. Search of the peer-reviewed literature yielded only six records. The records were primarily quantitative studies (n = 4, 68%), published between 1997 and 2018, and originated in the United States (n = 6, 100%). The qualitative thematic findings addressed three major themes: alternative to discipline programs (ADPs), peer support, and return to work policies, procedures, and practices. CONCLUSIONS: While the literature supports alternative to discipline programs as a primary accommodation supporting return to work of nurses, more on the effectiveness of such programs is required. Empirical evidence is necessary to develop, maintain, and refine much needed return to work accommodations for nurses after leaves of absence for mental health issues.

Exploring postpartum sexual health: A feminist poststructural analysis.

Postpartum sexual health has historically been viewed and discussed in specific ways, often dominated by biomedical discourse. There is a need to expand understandings of sexual health for postpartum women in the context of interdisciplinary health care. Research surrounding postpartum sexual health is largely focused on physical measures, such as vaginal lubrication or initiation of intercourse, without accounting for the diverse and subjective ways that sexuality and sexual health are experienced during the postpartum period. This critical analysis uses feminist post-structuralism to critique and analyze current health research and practice surrounding postpartum sexual health. Agency, subjectivity, gender and sex considerations, relations of power, and discourse are essential to understanding postpartum sexual health in a more holistic, woman-centered way. This includes awareness of dominant discourses that have shaped how health researchers, practitioners, postpartum women, and health institutions care for, support, and promote postpartum sexual health. There is a need to move beyond physically focused, reductionist, heteronormative understandings of sexual health to better promote overall postpartum health and wellbeing.

Experiences With Managing the Workplace Social Environment: A Qualitative Study.

OBJECTIVE: This study aims to examine 1st-line managers' (FLMs') experiences in managing the workplace social environment (WSE). BACKGROUND: FLMs are responsible for the establishment and maintenance of supportive WSE essential for effective teamwork. Poorly managed WSE and dysfunctional teams hold negative implications for patients, teams, and organizations. METHODS: This was a qualitative descriptive study, using content analysis of individual and focus group interviews with FLMs and directors. RESULTS: FLMs play a critical role in the management of the WSE; however, the task is fraught with constraints and challenges including competing demands, lack of support, and insufficient training. Findings explicate how competing demands and communication challenges impede the successful management of the WSE. CONCLUSIONS: Given the importance of a healthy WSE to patient, professional, and organizational outcomes, FLMs need support, training, and resources to assist them in managing the social environment alongside other competing priorities.

The Intergenerational Impact of Management Relations on Nurse Career Satisfaction and Patient Care.

OBJECTIVE: This article provides insights into the role of management relations on nurses' career satisfaction across different career stages. BACKGROUND: Managers and positive relations with staff are critical to improving job satisfaction, career development, and retention for new graduates to mid- to late-career nurses. METHODS: Using a descriptive qualitative approach, we conducted a thematic analysis of 18 focus groups held in 8 Canadian provinces with 185 student, early-career, and mid- to late-career nurse participants. RESULTS: Student participants expressed the need for a supportive environment to enable successful transition to practice. Early-career nurses expected effective leadership at the unit level, effective communication, and positive working relationships to enable best care outcomes. Mid- to late-career nurses were most dissatisfied with management interactions and relationships. CONCLUSIONS: Management relations are important across all career stages, affecting patient care and job satisfaction. Findings provide insight into how nurse-manager relations can be enhanced from new graduate support to guidance in career development and ongoing recognition and respect for nurses throughout their careers.

The history of nurse imagery and the implications for recruitment: a discussion paper.

AIM: This paper presents a discussion of the history of nurse imagery in the context of recent career choice research and the need for contemporary images for nursing recruitment. BACKGROUND: The critical and growing shortage of nurses is a global concern. Understanding how individuals come to know nursing as a career choice is of critical importance. Stereotypical imaging and messaging of the nursing profession have been shown to shape nurses' expectations and perceptions of nursing as a career, which has implications for both recruitment and retention. DATA SOURCES: Relevant research and literature on nurse imagery in relation to career choice and recruitment were identified through a search of the CINAHL, PsychINFO, Sociological Abstracts, PubMed; Medline and Embase databases from 1970-2012. DISCUSSION: Historical images of nurses and nursing remain prevalent in society today and continue to influence the choice of nursing as a career among the upcoming generation of nurses. Students interested in nursing may be dissuaded from choosing it as a career based on negative, stereotypical images, especially those that position the profession as inferior to medicine. IMPLICATIONS FOR NURSING: Understanding the evolution and perpetuation of popular images and messages in relation to the profession has implications for not only how we recruit and retain future generations of professional nurses but also holds implications for interprofessional collaboration between nursing and other health disciplines. CONCLUSION: Strategies for future recruitment and socialization within the nursing and the health professions need to include contemporary and realistic imaging of both health professional roles and practice settings.

Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management.

In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for granted. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse. Our findings add to a growing body of literature that challenges a number of widely held assumptions about obesity within a health care system that is currently unsupportive of individuals living with obesity. Our identification of these three themes is an important finding in obesity management given the diversity of perspectives across the three groups and the tensions arising among them.

The state of obesity management for women giving birth in Atlantic Canada.

OBJECTIVES: The purpose of this survey was to gain insight into the status of birthing facilities across Atlantic Canada regarding obesity management. Specifically, we were interested in learning about the reported number of obese women entering birthing facilities, if body mass index (BMI) was determined from weight and height, and whether this was used to diagnose maternal obesity or not. Clinical, delivery, or equipment-related challenges and the state of existing or planned policies or guidelines specific to this high-risk population were also sought. METHODS: An online, cross-sectional survey (audit), distributed via email to key staff members at birthing facilities in Atlantic Canada, including nurse managers, nurse practitioners, registered staff nurses and obstetrician-gynecologists. RESULTS AND CONCLUSIONS: Twenty-two responses were received from 38 invitees (57% response rate), representing half the birthing facilities in Atlantic Canada. Despite the fact that the majority of facilities recorded maternal height and pre-pregnancy weight upon admission, these measurements were not used to calculate and document maternal BMI, nor to make a diagnosis of maternal obesity. More troubling, no birthing facilities in our survey had guidelines or care plans in place to deal with this high-risk population, and two-thirds of those surveyed had no plans for their creation in the near future. While maternal obesity was considered a problem, a third of respondents reported no direct access to properly sized lifts or transfer devices in their units. This study provides a useful baseline for monitoring improvements in the care of obese women giving birth in Atlantic Canada.

Generational differences in distress, attitudes and incivility among nurses.

AIMS: The first research objective was to replicate the finding of Leiter et al. [(2008)Journal of Nursing Management, 16, 100-109.] of Generation X nurses (n=338) reporting higher levels of distress than Baby Boomer nurses (n=139). The second objective was to test whether Generation X nurses reported more negative social environments at work than did Baby Boomer nurses. BACKGROUND: Negative social environments can influence the quality of work and the experience of distress for nurses. Generational differences in the experience of distress and collegiality have implications for the establishment of healthy workplaces, recruitment and retention. METHODS: A questionnaire survey of nurses was organized by generation. Analyses of variance contrasted the scores on burnout, turnover intention, physical symptoms, supervisor incivility, coworker incivility and team civility. RESULTS: The results confirmed the hypotheses of Generation X nurses reporting more negative experiences than did Baby Boomer nurses on all measures. CONCLUSIONS: The negative quality of social encounters at work contributes to nurses' experience of distress and suggest conflicts of values with the dominant culture of their workplaces. IMPLICATIONS FOR NURSING MANAGEMENT: Proactive initiatives to enhance the quality of collegiality can contribute to retention strategies. Building collegiality across generations can be especially useful.

When respect deteriorates: incivility as a moderator of the stressor-strain relationship among hospital workers.

AIM: To test whether incivility at work exacerbates the relationship between stressors and strain for hospital workers. BACKGROUND: A climate of incivility and disrespect among colleagues was expected to heighten the impact of work stressors on the mental and physical health of care providers. METHODS: Members of 17 care-providing units from five hospital systems in Canada completed surveys, before and after a civility intervention (eight intervention vs. nine comparison units). Analyses tested whether (1) incivility moderated the stressor-strain relationship at baseline (n=478), and (2) the stressor-strain relationship decreased for the intervention units relative to comparison units 6 months later (n=361). RESULTS: (1) Pre-intervention, individuals reporting more incivility on their unit showed a stronger stressor-strain relationship. (2) The negative relationship between work overload and mental health was mitigated among intervention group staff 6 months after the introduction of a colleague-based civility programme. CONCLUSIONS: Besides being a stressor itself, incivility exacerbates the relationship between existing job role stressors and strain among health care workers. IMPLICATIONS FOR NURSING MANAGEMENT: Colleague civility and respect have an important ripple effect of buffering inevitable work stressors, helping health care providers respond to stress with greater health and resiliency.

Becoming a nurse: a meta-study of early professional socialization and career choice in nursing.

AIM: This paper is a report of a meta-study of early professional socialization and career choice in nursing. BACKGROUND: The current and growing shortage of nurses is a global issue, and nursing recruitment and retention are recognized priorities internationally. The future of nursing will lie in the ability to recruit and retain the next generation to the profession. DATA SOURCES: Studies were identified through a search of the CINAHL, PsycInfo, Sociological Abstracts, PubMed; Medline and Embase databases from 1990 to 2007. REVIEW METHODS: Studies were included if they gave insight into the experience of choosing nursing as a career, used qualitative methodology and methods, and were published in English. Analysis was undertaken using Paterson et al.'s framework for qualitative meta-synthesis. RESULTS: Ten primary studies were included in the review. Their methodologies included: ethnography (4); descriptive qualitative (3); grounded theory (2); and phenomenology (1). The location of the research was Canada (3), United Kingdom (2), United States of America (2), Australia (1), Japan (1) and Sweden (1). Three main themes were identified: influence of ideals; paradox of caring and role of others. CONCLUSION: Career choice and early professional socialization are influenced by multiple factors. In future recruitment and retention strategies to address the critical nursing shortage, it is important to consider the role of mentors, peers and role models in the formulation of career expectations, and career choice decisions. It is also necessary to consider the role of mentors, peers and role models in the formulation of career expectations, and career choice decisions.

BMI: a vital sign for patients and health professionals.

Body mass index (BMI) is a significant indicator of health and well-being.The notion of considering BMI as a vital sign was first put forward over a decade ago; however, many health-care professionals do not routinely measure height and weight, or calculate BMI. Given the current obesity epidemic, this oversight has implications for the diagnosis and management of obesity and for appropriate healthcare delivery for obese patients. The authors propose that BMI should be considered a vital sign.They suggest that protocols be put in place to encourage health-care providers to record BMI routinely and to take action to address a BMI that is outside the normal range. Promoting the routine calculation of BMI on admission or initial assessment may encourage health-care professionals to become more aware of obesity and its impact on the patient and the health system.

Menopause experiences of women in rural areas.

AIM: This paper is a report of a study to explore the menopause experiences of women living in rural areas. BACKGROUND: The menopausal phase can be physically and emotionally unsettling in a woman's life. Evidence has shown that a woman's ability to cope with the stresses of menopause can be enhanced through education and social support, yet there is a paucity of research in relation to the experiences of menopausal women in rural areas, where access to supportive services is often limited. METHOD: Naturalistic inquiry was used to explore the experiences of 25 menopausal women who were living in rural areas in Nova Scotia, Canada. Participants were interviewed in focus group and individual sessions, conducted during 2006. Verbatim transcripts of the interviews were analysed using thematic analysis. FINDINGS: Women living in rural communities described a need to understand fully the intensity of menopause-related symptoms, including changes to their physical and mental wellbeing. Participants described struggling to sift through excessive and conflicting information from a variety of venues and identified a need to receive reliable information from sources they trusted. They described the menopause experience as having a significant impact on their personal relationships and identified social support and humour as their primary coping strategies. CONCLUSION: Menopause is a significant life event affecting millions of women globally. Nurses are uniquely situated to provide comprehensive women's health care and must employ innovative strategies to provide support to women living in rural communities to enhance both health and wellbeing as they transition through menopause and as they age.

Evolving career choice narratives of new graduate nurses.

This article describes findings from one stage of a longitudinal study of the professional socialization experiences of Millennial nurses as they prepared for graduation and transition to practice. This study employed an interpretive narrative methodology guided by Polkinghorne's theory of narrative identity. Analysis of face-to-face interviews and journal entries by Millennial nursing students uncovered the formal professional socialization experiences over four years of nursing education. Participants include six Millennial nursing student participants (born after 1980) interviewed approximately one-month aftergraduation. These six participants are a voluntary subset of twelve who were interviewed prior to beginning their nursing studies, the analysis of which is captured in Price et al. (2013a) and Price et al. (2013b). Narrative analysis of the post-graduation interviews resulted in three main themes: 'Real Nursing: Making a Difference', 'The Good Nurse: Defined by Practice' and 'Creating Career Life Balance'. Graduate nurses strive to provide excellent nursing care as they transition into the workforce and identify a need for ongoing peer and professional supports to assist their ongoing professional socialization. Ongoing formal socialization and professional development is required to support the transition and retention of new nurse graduates in the workplace and the profession. Millenial generation nurses seek opportunities for career mapping, goal setting and formal mentorship by role models and peers to actualize their professional aspirations.

Effect of cobedding twins on coregulation, infant state, and twin safety.

OBJECTIVE: To evaluate the efficacy of cobedding on twin coregulation and twin safety. DESIGN: Randomized controlled trial (RCT). SETTING: Two university affiliated Level III neonatal intensive care units (NICUs). PARTICIPANTS: One hundred and seventeen sets (N = 234) of stable preterm twins (<37 weeks gestational age at birth) admitted to the NICU. METHODS: Sets of twins were randomly assigned to be cared for in a single cot (cobedded) or in separate cots (standard care). State response was obtained from videotaped and physiologic data measured and recorded for three, 3-hour sessions over a one-week study period. Tapes were coded for infant state by an assessor blind to the purpose of the study. RESULTS: Twins who were cobedded spent more time in the same state (p < .01), less time in opposite states (p < .01), were more often in quiet sleep (p < .01) and cried less (p < .01) than twins who were cared for in separate cots. There was no difference in physiological parameters between groups (p = .85). There was no difference in patient safety between groups (incidence of sepsis, p = .95), incidence of caregiver error (p = .31), and incidence of apnea (p = .70). CONCLUSIONS: Cobedding promotes self-regulation and sleep and decreases crying without apparent increased risk.

Lessons learned from the implementation of a provincial breastfeeding policy in Nova Scotia, Canada and the implications for childhood obesity prevention.

Healthy public policy plays a central role in creating environments that are supportive of health. Breastfeeding, widely supported as the optimal mode for infant feeding, is a critical factor in promoting infant health. In 2005, the Canadian province of Nova Scotia introduced a provincial breastfeeding policy. This paper describes the process and outcomes of an evaluation into the implementation of the policy. This evaluation comprised focus groups held with members of provincial and district level breastfeeding committees who were tasked with promoting, protecting and supporting breastfeeding in their districts. Five key themes were identified, which were an unsupportive culture of breastfeeding; the need for strong leadership; the challenges in engaging physicians in dialogue around breastfeeding; lack of understanding around the International Code of Marketing of Breast-milk Substitutes; and breastfeeding as a way to address childhood obesity. Recommendations for other jurisdictions include the need for a policy, the value of leadership, the need to integrate policy with other initiatives across sectors and the importance of coordination and support at multiple levels. Finally, promotion of breastfeeding offers a population-based strategy for addressing the childhood obesity epidemic and should form a core component of any broader strategies or policies for childhood obesity prevention.