It's all about presence: Health professionals' experience of interprofessional collaboration when mobilizing patients with hip fractures.

Mobilization is an interprofessional task in the evidence-based care pathway 'Enhanced Recovery After Surgery'; multiple health professionals collaborate when mobilizing patients with hip fractures. Drawing on the theory of relational coordination, and focusing on relationships and communication, we set out to explore how health professionals experience and describe interprofessional collaboration when mobilizing patients with hip fractures treated according to Enhanced Recovery After Surgery. Two rounds of interviews were conducted with 27 participants from 11 different professional groups, and the data were analyzed thematically. The main findings were that functional goals characterize the collaboration on mobilization due to undefined roles and responsibilities, and that specialized knowledge leads to a need for physical presence and formalization of work procedures in the collaboration. We argue that the hospital as a workplace can be characterized by logics of production and belonging. These logics create care work managed by quality, efficacy and scales of fairness that install power relations that must be recognized when engaging in interprofessional collaboration. We conclude that a primary focus on relationships and communication, as suggested by relational coordination, cannot solve the challenges of interprofessional collaboration, as the context in which health professionals work must also be considered.

Understandings of and experiences with evidence-based practice in practice among nurses in a surgical department: A constructivist approach.

AIM AND OBJECTIVES: To explore nurses' constructions of the concept of evidence-based practice through their understandings of and experiences with evidence-based practice in a clinical care setting. BACKGROUND: The primary purpose of evidence-based practice is high-quality patient outcomes. However, the adoption of evidence-based practice is described as a complex process, and research shows that evidence-based practice is not translated into practice. Research often explores facilitators and barriers of implementing and adopting evidence-based practice. Yet there is limited knowledge on how nurses construct the concept in practice. DESIGN: This study has a constructivist approach and follows COREQ guidelines. METHOD: Ten semi-structured interviews with 26 nurses were conducted in 2019. Data were analysed with an emic and inductive approach. RESULTS: Three key constructions emerged. Understandings of evidence-based practice were based on the original concept of evidence-based medicine. This included the hierarchy of evidence which was perceived as an inflexible concept not encompassing the nursing care. However, while not using the term evidence-based practice, the nurses were doing evidence-based practice portrayed through outcomes from management-supported nursing-based projects and incorporated reflections and discussions into weekly meetings. A discrepancy between a theoretical understanding and a practical doing of evidence-based practice appeared and was especially evident when the nurses' primary evidence sources consisted of the immediate options, for example asking colleagues or following accessible guidelines. Searching for evidence was central in their theoretical understanding but not an incorporated part of their daily work tasks. CONCLUSION: The nurses' constructions of evidence-based practice indicate a discrepancy between the theoretical understanding of evidence-based practice and the practical doing of evidence-based practice, which hinders the basis of working according to the concept. RELEVANCE TO CLINICAL PRACTICE: Theoretical discussions of evidence-based practice within the nursing field remain academic, as nurses in practice construct the concept on standards from evidence-based medicine.

"Wow I had no idea"-How job rotation is experienced by nurses caring for elective orthopaedic patients: A qualitative study.

AIMS AND OBJECTIVES: To explore gains and impacts of job rotation through the experiences of involved nursing personnel responsible for different parts of care during the elective orthopaedic patient's pathway. BACKGROUND: When patients undergo elective orthopaedic surgery, they encounter nurses from different wards. So far, job rotation has only been described through the experiences of the job rotating nurses. This study includes all involved nursing personnel and bases the job rotation on the pathway of the elective orthopaedic patient. DESIGN: This study has an exploratory-descriptive and qualitative approach and follows the Consolidated Criteria for Reporting Qualitative Research guidelines. METHOD: A total of nine focus groups including 16 informants were conducted before, during and after a 5-month trial period. The data were analysed using thematic analysis. RESULTS: The findings show that existing work structures and work content combined with a lack of a common understanding of the job rotation impacted the expectations of the nursing personnel regarding (in)dependence, individual and collegial involvement and investment, as well as the collegial belongingness expressed through terminologies of "home" and "culture." The personal gains among the job rotating nurses showed increased knowledge, skills and influence. When knowledge was shared and exchanged, the job rotating nurses became "cultural translators" of the care to the elective orthopaedic patient. CONCLUSIONS: This study shows personal gains among the job rotating nurses through increased knowledge, skills and influence as well as collegial gains by sharing and exchanging knowledge. When this exchange was utilised, the job rotation was evaluated positively, and contrary, when not utilised the job rotation had a negative impact on the work environment. RELEVANCE TO CLINICAL PRACTICE: Job rotation among nurses following the care of the patient's pathway can be a way of promoting patient safety and quality through increased knowledge across wards by including every aspect and element of the patient's pathway.