Interprofessional communication in the care of adults with cancer: exploring clinicians' perceptions of team rounding.

Interprofessional communication (IPC) is important for the inpatient oncology team due to the complexity and acuity of oncology patients. One intervention used to improve IPC is team rounding, yet few researchers have explored experiences of team members with team rounding. In this study, 12 interviews were conducted with providers from five different professions: Nursing Assistant, Registered Nurse, Pharmacist, Advanced Practice Provider, and Physician. We aimed to identify communication barriers and explore providers' perceptions of team rounding and IPC through semi-structured interviews on the adult inpatient oncology unit. Interviews were coded and conventional content analysis used. Facilitators identified were: effective team communication: (a) including interprofessional stakeholders in rounding and communication; (b) the importance of "real-time" communication; and (c) team dynamics. Barriers identified were: effective team communication: (a) workflow-related issues and (b) team dynamics. Findings from this study indicate each profession had unique perceptions, but all had a positive outlook on the necessity of IPC in the delivery of optimal cancer care.

A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience.

BACKGROUND: Systems thinking (ST) is the ability to recognize, understand, and synthesize interactions and interdependencies in a set of components designed for a purpose. Systems thinking has been shown to improve systems and decrease error. Despite these benefits, ST has not yet been consistently integrated into all health care education programs. PURPOSE: This study examined the impact of Friday Night at the ER (FNER), a table-top simulation designed to teach ST to a variety of prelicensure and postlicensure health care students. METHODS: A multisite study was conducted in 5 academic institutions targeting both graduate and prelicensure students enrolled in nursing, medicine, physical therapy, public health, psychology, and pharmacy programs. RESULTS: The FNER simulation was followed by statistically significant improvements in ST scores. CONCLUSIONS: The FNER table-top simulation was found to improve ST in a wide variety of health-related majors.

Coproducing Health Professions Education: A Prerequisite to Coproducing Health Care Services?

In 2016, Batalden et al proposed a coproduction model for health care services. Starting from the argument that health care services should demonstrate service-dominant rather than goods-dominant logic, they argued that health care outcomes are the result of the intricate interaction of the provider and patient in concert with the system, community, and, ultimately, society. The key notion is that the patient is as much an expert in determining outcomes as the provider, but with different expertise. Patients come to the table with expertise in their lived experiences and the context of their lives.The authors posit that education, like health care services, should follow a service-dominant logic. Like the relationship between patients and providers, the relationship between learner and teacher requires the integrated expertise of each nested in the context of their system, community, and society to optimize outcomes. The authors then argue that health professions learners cannot be educated in a traditional, paternalistic model of education and then expected to practice in a manner that prioritizes coproductive partnerships with colleagues, patients, and families. They stress the necessity of adapting the health care services coproduction model to health professions education. Instead of asking whether the coproduction model is possible in the current system, they argue that the current system is not sustainable and not producing the desired kind of clinicians.A current example from a longitudinal integrated clerkship highlights some possibilities with coproduced education. Finally, the authors offer some practical ways to begin changing from the traditional model. They thus provide a conceptual framework and ideas for practical implementation to move the educational model closer to the coproduction health care services model that many strive for and, through that alignment, to set the stage for improved health outcomes for all.

Designing and implementing asynchronous online deliberate practice to develop interprofessional communication competency.

Communicating with healthcare providers is a core tenant in the Quality and Safety Education for Nurses and Institute of Medicine teamwork and collaboration competency but remains a major concern for pre-licensure nursing students and novice nurses. Pre-licensure nursing students rarely have opportunities to practice interprofessional communication skills with other healthcare providers even though lack of this skill competency may lead to patient harm. This article explores the feasibility of using story-guided online deliberate practice sessions as an educational strategy to improve students' interprofessional critical communication competency. The design and testing of asynchronous online deliberate practice session prototypes is described and the implementation and evaluation of two online deliberate practice sessions into a nursing course is reported. The online format provided students with convenient opportunities to develop competency in critical communication skills using SBAR in a safe environment. Results from the prototype testing and student evaluation indicated that students had an overall positive experience. The online deliberate practice sessions provided a low-cost, flexible practice experience to develop critical communication skills and were evaluated as highly satisfactory and easy to navigate. The optimal number of practice sessions needed to attain competency, retain skills, and impact patient outcomes require further longitudinal study.

Using clinical simulations in geriatric nursing continuing education.

Accompanying an increased number of older adults in the population is the need for knowledgeable and clinically competent nurses to provide care for this group, especially those experiencing sudden changes in health status. A continuing education program was designed to improve geriatric nursing competencies through the use of clinical simulations. Three-day nurse educator institutes and one-day workshops for registered and licensed practical nurses were offered to 312 nurses. The clinical simulations that were developed specifically focused on acute health events or conditions. Specific geriatric clinical competencies were also emphasized. Different types of clinical simulations included unfolding cases, use of a human patient simulator, and online case studies. Geriatric nursing knowledge significantly increased and clinical simulations were well-received. Clinical simulations involving the human patient simulator were highly rated. Clinical simulations are an excellent teaching strategy to help nurses increase knowledge and skill in caring for older adults.

Education to bridge the quality gap: a case study approach.

Educators are challenged to integrate quality and safety concepts into nursing curricula, staff development, and continuing education. This article presents an unfolding case study simulation for urinary tract infection highlighting Quality and Safety Education for Nurses (QSEN) competencies.

Developing an Innovative Statewide Infrastructure and Model for Delivering Continuing Interprofessional Education: The North Carolina AHEC Initiative.

INTRODUCTION: North Carolina AHEC (NC AHEC) leadership recognized that continuing interprofessional education (CIPE) is vital for improving patient care and outcomes. Rather than train and educate in professional silos, interprofessional education presented an opportunity to reframe continuing education (CE) to improve the integration of care delivery and outcomes. METHODS: In April 2014, two regional AHECs collaborated to design a statewide initiative for AHEC CE leaders, CE professionals, and CE faculty to learn about integrating interprofessional education into CE planning and implementation. The design of this innovative initiative develops a common knowledge base in CIPE, promotes collaboration, avoids duplication, and creates shared definitions and standards to advance CIPE across the NC AHEC program. RESULTS: The NC AHEC CIPE Initiative drew participation from CE leaders, CE professionals, and CE faculty. Immediately after the completion of the Initiative, seven AHECs completed CIPE events. By June 2017, AHECs across the state had offered a total of 36 CIPE events. DISCUSSION: The NC AHEC CIPE Initiative demonstrates that it is possible to implement CIPE programming in a regional CE context. The education model promoted changes in knowledge, competence, and performance of CE professionals and faculty. Critical success factors include leadership support, functioning as a community of practice, engaging experts to train CE professionals and faculty, and using technology to span geographic distance of learners.

Exercise and heart rate recovery.

PURPOSE: This study examines whether heart rate recovery (HRR) improves as a result of exercise training during cardiac rehabilitation (CR). METHODS: A retrospective study was performed that included 100 patients who completed phase II CR and had entry and exit exercise stress tests. HRR was compared for the sample. Improvements in HRR were compared between gender and age groups. Correlation between age and HRR was performed. RESULTS: The total sample improved HRR (P = .020). There was no significant difference in the improvement of HRR based on gender, indicating males and females improve at similar rates (P = .833). Similarly, there was no significant difference in the improvement of HRR based on age, indicating older subjects improve similarly to younger subjects (P = .700). There was no relationship between age and HRR; therefore, as age increases there is no decrease in HRR. CONCLUSION: HRR improves in patients who complete CR.

Implementing the standards of best practice for simulation.

The Standards of Best Practice: Simulation are a resource for quality and consistency of simulation, evaluation of outcomes, and improvement of simulation programs. The Standards provide guidelines for practice and a vital framework for strategic planning, research, and faculty development. This article discusses challenges and shares approaches to enhance implementation of the Standards into practice to improve education, increase patient safety, and reduce variability in simulation experiences.

Interprofessional education: a survey of students' collaborative competency outcomes.

This study examines students' collaborative competencies after participating in an interprofessional education (IPE) course offered to undergraduates in nursing, medicine, and pharmacy. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was foundational to the course. The Interprofessional Collaborative Competency Attainment Survey was administered to 33 students who had successfully completed the interprofessional education course; 17 students completed the survey, for a response rate of 52%. The students' collaborative competencies in the core areas of communication, collaboration, roles and responsibilities, collaborative patient- and family-centered approach, conflict management and resolution, and team functioning significantly improved (n = 17, p < 0.001) after course completion, compared with their collaborative competencies before the course. The findings suggest that students' perceptions of their development of interprofessional and collaborative competencies significantly improved after course completion. This may influence their professional practice at the point of care and enhance patient safety.

Teamwork training with nursing and medical students: does the method matter? Results of an interinstitutional, interdisciplinary collaboration.

OBJECTIVES: The authors conducted a randomised controlled trial of four pedagogical methods commonly used to deliver teamwork training and measured the effects of each method on the acquisition of student teamwork knowledge, skills, and attitudes. METHODS: The authors recruited 203 senior nursing students and 235 fourth-year medical students (total N = 438) from two major universities for a 1-day interdisciplinary teamwork training course. All participants received a didactic lecture and then were randomly assigned to one of four educational methods didactic (control), audience response didactic, role play and human patient simulation. Student performance was assessed for teamwork attitudes, knowledge and skills using: (a) a 36-item teamwork attitudes instrument (CHIRP), (b) a 12-item teamwork knowledge test, (c) a 10-item standardised patient (SP) evaluation of student teamwork skills performance and (d) a 20-item modification of items from the Mayo High Performance Teamwork Scale (MHPTS). RESULTS: All four cohorts demonstrated an improvement in attitudes (F(1,370) = 48.7, p = 0.001) and knowledge (F(1,353) = 87.3, p = 0.001) pre- to post-test. No educational modality appeared superior for attitude (F(3,370) = 0.325, p = 0.808) or knowledge (F(3,353) = 0.382, p = 0.766) acquisition. No modality demonstrated a significant change in teamwork skills (F(3,18) = 2.12, p = 0.134). CONCLUSIONS: Each of the four modalities demonstrated significantly improved teamwork knowledge and attitudes, but no modality was demonstrated to be superior. Institutions should feel free to utilise educational modalities, which are best supported by their resources to deliver interdisciplinary teamwork training.

Effective resuscitation by nurses: perceived barriers and needs.

Nurses work in a variety of clinical settings. Some of these areas involve care of patients with acute illnesses while others do not. No matter in which setting a nurse works, the possibility exists that he or she will participate in the resuscitation of a patient. When patients face a life-threatening event such as cardiopulmonary arrest, they rely on the competence and skills of healthcare professionals. Because nurses are often the healthcare providers closest to the bedside and the first to respond to patients' needs, their knowledge and skills need to be optimal and their performance proficient.