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 review to characterise and map the growth mindset theory in health professions education.

INTRODUCTION: Growth mindset is a motivation theory proposed by Carol Dweck that posits our beliefs about intelligence, and the ability to change mindsets can have impacts on how we approach challenges, respond to criticism challenges and orient our goals. This study characterised articles on growth mindset theory in health professions education to: summarise the aspects of growth mindset being researched, describe the discussed benefits of growth mindset theory and outline strategies discussed that may promote a growth mindset. METHODS: A systematic review of the literature yielded 4927 articles-articles were reviewed and excluded if they were outside of health professions education and did not discuss Dweck's growth mindset theory. The final review yielded 14 research articles and 13 commentaries, which were characterised and analysed using content analysis. RESULTS: The included articles were published in 2016 and beyond; the articles represented a diverse context, participant type and approach. Most research studies measured participant mindsets and evaluated the correlation with other variables (eg grit, well-being, anxiety). Articles often highlighted benefits and strategies to promote a growth mindset at the learner, educator and organisation level. The most common learner benefits were to help them be more receptive to feedback as well as increased resiliency and perseverance, educator benefits focused on supporting collaborative relationships and safe learning environments. The most prevalent strategies discussed were teaching learners about growth mindset theory, shifting faculty feedback to emphasise effort and to prioritise feedback across the organisation. CONCLUSION: The growth mindset framework has been shown in other fields to help others manage educational challenges and enhance learning environments. Researchers are encouraged to explore how interventions such as teaching about and prioritising a growth mindset can support learners, health care professionals, educators and organisations.

An Appraisal of School Nurse Health Services and Programs in North Carolina Public Schools, 2006-2016.

School nurses are instrumental in delivering health services to children in schools. This study addresses the gap in school nurse health services data, examining patterns in health services and programs provided by school nurses between 2006 and 2016 for students in North Carolina public schools. This study focused on services and programs related to asthma and diabetes, two health conditions that affect millions of children in the United States. Over 1.46 million children attend North Carolina public schools. In 2006, the average school nurse-to-student ratio was 1:1,340. By 2016, the average school nurse-to-student ratio decreased to 1:1,086, a 19% improvement. Over the 10-year study time period, there were statistically significant increases in the rate of occurrence of all health conditions that students received health services for (p < .001), asthma (p < .001), type I diabetes (p = .0003), orders for all health-care procedures (p = .01), all school nurse-led health counseling (p = .004), and diabetes health counseling (p < .01).

Interprofessional collaboration between health sciences librarians and health professions faculty to implement a book club discussion for incoming students.

BACKGROUND: The following case example provides an overview of one innovative way to engage health professions faculty with health sciences librarians in the development of an interprofessional book discussion and identifies strategies to address implementation challenges. Academic health sciences librarians worked with the Interprofessional Education (IPE) Steering Committee to organize interprofessional book discussion groups for incoming health professions students. This inaugural book discussion brought together students and faculty of different disciplines to engage students in "learning from, with, and about" other professions. CASE PRESENTATION: When Breath Becomes Air, by Paul Kalanithi, allowed involved discussions on important health sciences issues. The project included outreach, designing pre- and post-surveys, scheduling participants, and communicating with all participants before, during, and after the event. A total of seventy-nine students and thirty-six faculty, representing all health professions schools, participated in the small group IPE book discussions over two weeks. CONCLUSIONS: Small group book discussions have been shown to be an effective tool to engage students and faculty in IPE. The results of the participant surveys were positive, and the IPE Steering Committee found value in including health sciences librarians throughout the process. Lessons learned from the pilot project include needing an efficient scheduling system, strongly communicating at all stages of the project, and starting the planning process months ahead of time. The IPE Steering Committee plans to conduct similar book discussions every fall semester moving forward and explore options for other IPE events.

Call for ACTion: Transforming Dental Education at the University of North Carolina at Chapel Hill.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.

Exploring New Paradigms for Team-Based Care.

In this issue of the North Carolina Medical Journal we have focused on team-based care and recognized some of the innovative models of true collaboration aiming to improve patient and population health outcomes. This issue offers examples for integrating care in behavioral health, hospice, and primary care as well as strategies for creating unique partnerships with churches, legal services, and public health workers. We will also explore the role technology plays as a team member and the financial implications of team-based care.

The Impact of Caring: Teaching Students Empathy Through the Patient Voice.

The purpose of this educational brief is to describe an innovative learning experience focused on teaching students empathy for chronic illness, using patient voices. Panel members of individuals who had experienced acute and chronic illness from either the perspective of the patient or caregiver participated in a one-time session for undergraduate baccalaureate nursing students. Panel members presented their narrative to the students, engaging them in a question-and-answer session about the impact of nursing care on their experience. Both the panelists and the students found the experience meaningful. Over time the panel has varied in format, but has consistently humanized the patient experience, highlighted the importance of empathy, and conveyed the impact that nurses have on their patients and families. This innovative strategy proved to be very beneficial for students transitioning into their first clinical experience.

A new mindset for quality and safety: the QSEN competencies redefine nurses' roles in practice.

Preventable errors are a major issue in health care. The complexity of health care requires interactions among numerous providers for any patient multiple times a day. Nurses are the constant presence with patients and have an important role in coordinating the contributions of the myriad of caregivers. Nurses are also the last line of defense. Increasingly, it is recognized that nurses need to be better prepared with quality and safety competencies to have a leading role in making our healthcare system safer.This article presents evidence related to quality and safety, describes the six core competencies from the Quality and Safety Education for Nurses (QSEN) project for integration in nursing practice, describes a practice based on inquiry and engagement, and presents a toolkit for developing a new mindset based on new quality and safety science.

Exploring the impact of augmenting sedation assessment with physiologic monitors.

BACKGROUND: Pharmacological sedation is a necessary tool in the management of critically ill, mechanically ventilated patients. The intensive care unit (ICU) sedation strategy is to use the least amount of medication to meet safety and comfort goals. Titration of pharmacological agents is currently guided by clinical assessment tools. The purpose of this study was to determine whether the addition of a neurophysiological monitor, bispectral index (BIS), aided the ICU nurse in reducing the amount of drug used, compared to a clinical tool alone, in a general critical care population. METHODS: In this prospective clinical trial, mechanically ventilated adults (N=300) were randomised to sedation assessment using only the observational assessment tool (RASS) or a combination of observational and physiologic measures (RASS+BIS). Subjects were enrolled from a medical ICU (N=154), a trauma ICU (N=72) and a general mixed-use ICU (N=74). RESULTS: BIS-augmented sedation was only associated with the reduction of drug use when patients were sedated with propofol or narcotic agents (propofol [1.61 mg/kg/h vs. 1.77 mg/kg/h; p<0.0001], fentanyl [54.73 mcg/h vs. 66.81 mcg/h; p<0.0001], and hydromorphone [0.97 mg/h vs. 4.00 mg/h: p<0.0001] compared to RASS alone. In contrast, patients sedated with dexmedetomidine or benzodiazepines were given higher doses under the BIS-augmented dexmedetomidine [0.46 mcg/kg/h vs. 0.33 mcg/kg/h; p<0.0001], lorazepam [4.13 mg/h vs. 3.29 mg/h p<0.0001], and midazolam [3.73 mg/h vs 2.86 mg/h; p<0.0001]) protocol compared to clinical assessment alone. CONCLUSION: The clinical evaluation of depth of sedation remains the most reliable method for the titration of pharmacological sedation in the critical care unit. However, BIS-augmented assessment is helpful in reducing the amount of propofol and narcotic medication used and may be considered an adjunct when these agents are utilised.

A new mindset for quality and safety: the QSEN competencies redefine nurses' roles in practice.

Preventable errors are a major issue in health care. The complexity of health care requires interactions among numerous providers for any patient multiple times a day. Nurses are the constant presence with patients and have an important role in coordinating the contributions of the myriad of caregivers. Nurses are also the last line of defense. Increasingly, it is recognized that nurses need to be better prepared with quality and safety competencies to have a leading role in making our healthcare system safer. This article presents evidence related to quality and safety, describes the six core competencies from the Quality and Safety Education for Nurses (QSEN) project for integration in nursing practice, describes a practice based on inquiry and engagement, and presents a toolkit for developing a new mindset based on new quality and safety science.