Perceived influence of power distance, psychological safety, and team cohesion on team effectiveness.

Interprofessional education needs a stronger theoretical basis informed by the challenges facing collaboration across professions. This study explores the impact of power distance (perception of role hierarchy), on team effectiveness as mediated by team cohesion and psychological safety (believe one can speak up without the fear of negative consequences). Furthermore, it tests for differences between medical and nursing students in these concepts. Final-year medical and nursing students completed a paper survey on study constructs at the end of a three-session, 6-h interprofessional critical care simulation activity. Two hundred and forty-three (76% response rate) retrospective surveys found the relationship between power distance and perceived team effectiveness was mediated by perceptions of team cohesion and psychological safety, suggesting these concepts influence desired interprofessional collaboration. There were no differences between medical and nursing students on study variables. While interprofessional training typically focuses on general attitudes toward interprofessional collaboration and on the acquisition and demonstration of knowledge and skills, these findings suggest important team concepts underlying effective collaboration may include perceptions of psychological safety and power distance. These concepts can be key drivers of cohesion and effectiveness during interprofessional simulation exercises and may be targets for future interventions.

ICU Clinicians' Experiences of Terminal Weaning and Extubation.

CONTEXT: Aside from spontaneous death, a majority of ICU deaths occur after a decision to either withhold or withdraw life-sustaining measures, including withdrawal of ventilatory support. While terminal weaning or terminal extubation are both used, the lack of evidence on the superiority of one method over the other can create challenges for ICU clinicians. There is a need to explore clinicians' experiences related to terminal weaning/extubation to understand their decision-making processes as well as the context and mechanisms that guide this process. OBJECTIVES: This study aimed to explore ICU clinicians'experiences of Terminal Weaning of Mechanical Ventilation (TWMV) in order to better understand the process, and clinicians' feelings about the process. METHODS: This study used an exploratory descriptive qualitative design. Data were collected via semi-structured, face-to-face interviews with 20 ICU clinicians. An inductive, data driven thematic analysis approach was used for data analysis. RESULTS: Analysis of the data resulted in four themes: Fine-tuning the Process of TWMV; Focusing on the Family; Ensuring Patient-Centered Care; and Impact on Health care Clinicians and Support Needs. CONCLUSION: The identified themes provide insight into the complexity of the withdrawal of mechanical ventilation within the context of end-of-life care in the ICU. The themes highlight the need for clear communication of a TWMV plan between clinicians to avoid conflict during the process, ensuring medication is in place for potential distressing symptoms, incorporating patient and family wishes in planning, supporting the family during the process, and training and support for clinicians.

Stemming the tide of distrust: A mixed-methods study of vaccine hesitancy.

Public distrust in the US pandemic response has significantly hindered its effectiveness. In this community-based participatory research mixed-methods study, based on two datasets, we examined how distrust in COVID-19 vaccines relates to institutional distrust. We found that the Johnson & Johnson vaccine pause undermined trust in COVID-19 vaccines in general. Findings also suggest that vaccine distrust developed after participating in a study on COVID-19 testing. Increased distrust may be an unintended consequence of how healthcare and public health activities are presented and delivered, and research participation is structured. Both will continue without proactively addressing the root causes of distrust.

Facing the Inevitable: Preparing Nurses to Deliver End-of-Life Care.

Health care providers have an ethical obligation to reduce suffering during a patient's end of life (EOL), but few receive formal education on EOL care principles. The objective of this project was to determine the feasibility and potential benefits of an education initiative in which the principles of EOL care were taught to senior-level nursing students and practicing nurses. To assess feasibility, data regarding recruitment rates, retention rates, and implementation issues were collected. Workshop effectiveness was evaluated through use of the End-of-Life Nursing Education Consortium-Knowledge Assessment Test survey, which evaluates knowledge levels regarding EOL care principles. A mixed-effects linear model was used to test for changes from the preworkshop to postworkshop scores. Demographic information and satisfaction data were also collected. Nineteen students and 24 nurses participated (total N = 43). There was a statistically significant time difference (P = .0001), with the postworkshop scores being higher (43.5 ± 0.93) versus the preworkshop scores (41.2 ± 0.93). However, no statistically significant workshop date difference (P = .3146) emerged. Satisfaction data were positive. Retention for the second workshop was negatively affected by COVID-19. The unique needs of patients nearing their EOL are significant. This project describes the implementation and outcomes of an education initiative, focused on EOL care principles, that was both feasible and beneficial.

The Acceptability and Feasibility of Using Mortality Prediction Scores for Initiating End-of-Life Goals-of-Care Communication in the Adult Intensive Care Unit.

CONTEXT: Uncertainties in prognosis remain a barrier to end-of-life (EOL) communication in the intensive care unit (ICU), thus strategies are needed for increasing the precision of prognosis and timeliness of EOL goals-of-care communication. Use of mortality prediction scores offers one approach to this issue. OBJECTIVES: This study evaluated the acceptability and feasibility of providers' use of patient mortality prediction scores as part of routine practice to increase prognosis precision and timeliness of EOL communication as well as providers' intentions to change practice related to EOL goals-of-care communication based on awareness of the scores. METHODS: An explanatory mixed-methods approach was used to provide Sequential Organ Failure Assessment (SOFA) patient mortality prediction scores to ICU providers, who then completed an acceptability and feasibility questionnaire and participated in follow-up interviews conducted to further understand questionnaire responses and gain insight into their perceptions based on having SOFA scores. RESULTS: Providers reported that using SOFA scores was acceptable and feasible, although there was some disagreement about effectiveness of SOFA scores for determining mortality risk. Providers with limited ICU experience were eager, and accepting of the scores while those with more experience found the scores to be an adjunct to their own intuition, although all acknowledged the benefit of looking at score trends. An important finding was the need to consider SOFA scores in relation to patient clinical context. CONCLUSION: Use of SOFA scores as a means to potentially increase EOL goals-of-care communication emerged as most beneficial and acceptable to providers with limited ICU experience.

Learning About End-of-Life Care in Nursing-A Global Classroom Educational Innovation.

BACKGROUND: Teaching nursing students how to provide patient-centered end-of-life care is important and challenging. As traditional face-to-face classroom teaching is increasingly supplanted by digital technology, this provides opportunities for developing new forms of end-of-life care education. The aim of this article is to examine how a global classroom was developed using online technology to enhance nursing students' learning of end-of-life care in England and the United States. METHOD: The PDSA (Plan-Do-Study-Act) quality improvement approach was used to guide the design and delivery of this curriculum innovation. RESULTS: The global classroom enhanced the educational experience for students. Teaching needs to be inclusive, focused, and engaging; the virtual platform must be stable and support individual learning, and learning needs to be collaborative and authentic. CONCLUSION: These findings can be used to inform the integration of similar approaches to end-of-life care education in other health care professional preparation programs. [J Nurs Educ. 2017;56(11):688-691.].

The effect of an interprofessional simulation-based education program on perceptions and stereotypes of nursing and medical students: A quasi-experimental study.

BACKGROUND: Interprofessional education is intended to train practitioners to collaboratively address challenges in healthcare delivery, and interprofessional simulation-based education (IPSE) provides realistic, contextual learning experiences in which roles, responsibilities, and professional identity can be learned, developed, and assessed. Reducing negative stereotypes within interprofessional relationships is a prime target for IPSE. OBJECTIVES: We sought to understand whether perceptions of interprofessional education and provider stereotypes change among nursing and medical students after participating in IPSE. We also sought to determine whether changes differed based on the student's discipline. DESIGN: This was a quasi-experimental pretest-posttest study. SETTING: The study took place at a large mid-Atlantic public university with a comprehensive health science campus. PARTICIPANTS: 147 senior Bachelors of Science in Nursing students and 163 fourth-year medical students participated. METHODS: Students were grouped into interprofessional teams for a two-week period and participated in three two-hour simulations focused on collaboration around acutely ill patients. At the beginning of the first session, they completed a pretest survey with demographic items and measures of their perceptions of interprofessional clinical education, stereotypes about doctors, and stereotypes about nurses. They completed a posttest with the same measures after the third session. RESULTS: 251 students completed both the pretest and posttest surveys. On all three measures, students showed an overall increase in scores after the IPSE experience. In comparing the change by student discipline, medical students showed little change from pretest to posttest on stereotypes of doctors, while nursing students had a significant increase in positive perceptions about doctors. No differences were noted between disciplines on changes in stereotypes of nurses. CONCLUSIONS: This study demonstrated that a short series of IPSE experiences resulted in improved perceptions of interprofessional practice and changes in stereotypical views of each profession even when the experience was not directly designed to address these issues. Differences observed between nursing and medical students should be explored further.