Advanced nurse and midwife practitioners' experience of interprofessional collaboration when implementing evidence-based practice into routine care: An interpretative phenomenological analysis.

AIM: To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care. DESIGN: A qualitative interpretative phenomenological analysis. METHODS: A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis. RESULTS: Six superordinate themes emerged: Understanding of advanced practice; 'Treated as an equal and as a "nurse"'; Nursing management support; 'A voice to implement anything new'; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice. CONCLUSION: There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care. IMPACT AND IMPLICATIONS: The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients. CONTRIBUTION TO THE WIDER GLOBAL CLINICAL COMMUNITY: As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice. Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care. REPORTING METHOD: Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Impact of oral health management by nurses and dental professionals on oral health status in inpatients eligible for the Nutrition Support Team: A longitudinal study.

OBJECTIVE: As the participation of dental professionals in multidisciplinary care is often limited, instructions on oral health management provided by dental professionals to other professionals are important to achieve transdisciplinary oral health management; however, the effectiveness of such instructions remains unclear. In this longitudinal study, we aimed to determine the impact of oral health management provided by dental professionals and nurses instructed on oral health management by dental professionals on the oral health of inpatients eligible for a Nurition Support Team (NST). METHODS: The study participants were 117 patients (66 men and 51 women, mean age: 71.9 ± 12.5 years) who received oral health management during the NST intervention period. The participants received oral health management from nurses (Ns group) or dental professionals (D group). The nurses who conducted the oral health management received instructions from dental professionals. Oral health was assessed at the beginning and end of the NST intervention using the Oral Health Assessment Tool (OHAT). RESULT: The Ns and D groups showed significant improvements in the total OHAT scores at the end of the NST intervention. Both groups showed significant improvements in the OHAT subitems of lip, tongue, gums and tissues, saliva, oral cleanliness and dental pain, while only the D group showed a significant improvement in the denture subitem. CONCLUSION: Effective oral health management provided by dental professionals or by nurses trained by them improved the oral health status of inpatients eligible for NST at an acute-care hospital.

'Our Voices Aren't Being Heard': A qualitative descriptive study of nurses' perceptions of interprofessional collaboration in care supporting older people's functioning during a hospital stay.

INTRODUCTION: Older people admitted to hospital are highly susceptible to functional decline and related complications. Care supporting their functioning is complex and requires healthcare professionals working in concert, with nurses playing a central role. Yet, little is known about nurses' perceptions of interprofessional collaboration (IPC) in care supporting functioning in acutely admitted older people. To fill this knowledge gap, we elucidate the perspectives of nurses in Ontario, Canada, on IPC in care supporting older people's functioning during a hospital stay. METHODS: We employed a qualitative methodology in conjunction with a qualitative descriptive design. Thirteen focus groups were held with a purposeful, criterion-based sample of 57 acute care nurses practising in a range of acute care settings (e.g. Emergency, General Medicine, General Surgery, Intensive Care, Coronary Care). Data were thematically analysed. RESULTS: We identified two overarching themes: (1) IPC is improving, but nurses are excluded from decision-making and (2) nurse advocacy causes friction with other professionals. The first theme captures nurses' perception that IPC in older people's care is improving, but nurses are marginalised in interprofessional decision-making. As a result, nurses perceive that their knowledge is devalued, and their contributions to care supporting older people's functioning are undermined. The second theme underlines a tension between interprofessional team practices and patient- and family-centred care, while also demonstrating nurses' increasing willingness to act as patient and family advocates. CONCLUSIONS: Findings can be used to enhance IPC in care supporting the functioning of acutely hospitalised older people. To improve IPC, clinical and administrative leaders should cultivate more egalitarian team relationships that encourage nurses to contribute to decision-making and advocate on behalf of older patients and their families.

What matters in low-threshold collaboration? Perceptions of interprofessional collaboration between education and social and healthcare professionals in Finnish primary schools.

This study examined the factors linked to low-threshold interprofessional collaboration in the context of Finnish primary schools. The main purpose of the study was to analyze how education and health and social care professionals perceived their mutual collaboration. The PINCOM-Q scale was used to identify factors related to interprofessional collaboration in professionals' work settings. The results indicate that individual factors such as work motivation and personal power are prominent in low-threshold collaboration. At the group level, communication has an important role to play in interprofessional collaboration. Professionals (n = 204) perceived mutual exchange of information as an important aspect of working together. The aspects that matter in the low-threshold mode of interprofessional collaboration are a complex combination of individual, group and less obvious organizational factors, all of which both reflect and are reflected in an individual's motivation and commitment to cooperation. The establishment of long-term and systematic low-threshold, interprofessional collaboration presupposes that individual interests are realized in good interaction in equal encounters between different organizational domains.

Engaging resident physicians in the design, implementation, and assessment of bedside interdisciplinary rounds.

Bedside interdisciplinary rounds (IDR) improve teamwork, communication, and collaborative culture in inpatient settings. Implementation of bedside IDR in academic settings depends on engagement from resident physicians; however, little is known about their knowledge and preferences related to bedside IDR. The goal of this program was to identify medical resident perceptions about bedside IDR and to engage resident physicians in the design, implementation, and assessment of bedside IDR in an academic setting. This is a pre-post mixed methods survey assessing resident physicians' perceptions surrounding a stakeholder-informed bedside IDR quality improvement project. Resident physicians in the University of Colorado Internal Medicine Residency Program (n = 77 pre-implementation survey responses from 179 eligible participants - response rate 43%) were recruited via e-mail to participate in surveys assessing perceptions surrounding the inclusion of interprofessional team members, timing, and preferred structure of bedside IDR. A bedside IDR structure was created based on input from resident and attending physicians, patients, nurses, care coordinators, pharmacists, social workers, and rehabilitation specialists. This rounding structure was implemented on acute care wards in June 2019 at a large academic regional VA hospital in Aurora, CO. Resident physicians were surveyed post implementation (n = 58 post-implementation responses from 141 eligible participants - response rate 41%) about interprofessional input, timing, and satisfaction with bedside IDR. The pre-implementation survey revealed several important resident needs during bedside IDR. Post-implementation survey results revealed high overall satisfaction with bedside IDR among residents, improved perceived efficiency of rounds, preserved quality of education, and value added by interprofessional input. Results also suggested areas for future improvement including timeliness of rounds and enhanced systems-based teaching. This project successfully engaged residents as stakeholders in system-level interprofessional change by incorporating their values and preferences into a bedside IDR framework.

The Impact of Delivery Reform on Health Information Exchange with Behavioral Health Providers: Results from a National Representative Survey of Ambulatory Physicians.

Health information exchange (HIE) is an effective way to coordinate care, but HIE between health and behavioral health providers is limited. Recent delivery reform models, including the Accountable Care Organization (ACO) and Patient Centered Medical Home (PCMH) prioritize interprofessional collaboration, but little is known about their impact on behavioral health HIE. This study explores whether delivery reform participation affects behavioral health HIE among ambulatory health providers using pooled 2015-2019 data from the National Electronic Health Record Survey, a nationally representative survey of ambulatory physicians' technology use (n = 8,703). The independent variable in this analysis was provider participation in ACO, PCMH, Hybrid ACO-PCMH, or standard care. The dependent variable was HIE with behavioral health providers. Chi square analysis estimated unweighted rates of behavioral health HIE across reform models. Logistic regression estimated the impact of delivery reform participation on rates of behavioral health HIE. Unweighted estimates indicated that Hybrid ACO-PCMH providers had the highest rates of HIE (n = 330, 33%). In the fully adjust model, rates of HIE were higher among ACO (AOR = 2.66, p < .01), PCMH (AOR = 4.73, p < .001) and Hybrid ACO-PCMH participants (AOR = 5.55, p < .001) compared to standard care, but they did not significantly vary between delivery models. Physicians infrequently engage in HIE with behavioral health providers. Compared to standard care, higher rates of HIE were found across all models of delivery reform. More work is needed to identify common elements of delivery reform models that are most effective in supporting this behavior.

Interprofessional Collaboration Between Nurses and Physicians in the Perioperative Period.

PURPOSE: To explore nurses' and physicians' experiences of the six dimensions of interprofessional (IP) collaboration when using Goal-Directed Therapy (GDT), and to examine how existing protocols on GDT facilitate the six dimensions of IP collaboration. DESIGN: A qualitative design using individual semi-structured interviews and participant observations. METHODS: A secondary analysis of data from participant observation and semi-structured interviews with nurses (n= 23) and physicians (n=12) in three departments of anesthesiology. Observations and interviews were carried out from December 2016 to June 2017. A deductive, qualitative content analysis using the Inter-Professional Activity Classification as a categorization matrix was used to explore interprofessional collaboration as a barrier to implementation. This analysis was supplemented by a text analysis of two protocols. FINDINGS: Four dimensions were identified to influence IP collaboration: commitment, roles and responsibilities, interdependence, and integration of work practices. Negative factors included hierarchical boundaries, traditional nurse-physician relationship, unclear responsibility, and lack of shared knowledge. Positive factors included physician involvement of nurses in decisions and bedside education. The text-analysis showed a lack of clear directions of specific action and responsibility. CONCLUSIONS: Commitment and roles and responsibilities were dominant aspects of interprofessional collaboration in this context, causing problems for enhanced collaboration. Lack of clear guidance in the protocols might detract nurses' feelings of responsibility.

How might enhanced interprofessional collaboration between primary care physicians and registered dietitian nutritionists impact clinical outcomes related to obesity and associated illnesses? A commentary.

The unsettling worldwide prevalence of obesity and obesity-related illnesses seems to be well-understood. What seems to be lacking, however, is a strategy of how best to fix the issue. Meagre nutrition content in medical school curricula may contribute to limited primary care physician (PCP) knowledge of the role nutrition has in health ailments and the understanding of a registered dietitian nutritionist (RDN) scope of practice. In USA, RDN are health care practitioners specialised in nutrition and who are experts in treating obesity and obesity-related illnesses. An increased RDN involvement in patient care has been shown to promote improvements in nutrition-related clinical outcomes. Therefore, enhanced collaboration between PCP and RDN has the potential to ameliorate the obesity epidemic. Tactics to promote collaboration may include enhancing nutrition education in medical school and providing nutrition-focussed continuing education for practicing physicians. The seriousness of the obesity epidemic underscores the need for interprofessional collaboration between PCP and allied health professionals who are uniquely trained to address obesity and obesity-related illnesses.

Collaborators as a key to survival: an ethnographic study on newly graduated doctors' collaboration with colleagues.

BACKGROUND: Newly graduated doctors find their first months of practice challenging and overwhelming. As the newly graduated doctors need help to survive this period, collaborators such as peers, senior doctors, registered nurses and other junior doctors are crucial. However, little is known about what characterise these collaborations, and how much is at stake when newly graduated doctors are striving to establish and maintain them. This study aims to describe and explore the collaborations in depth from the newly graduated doctors' point of view. METHODS: We conducted 135 h of participant observations among newly graduated doctors (n = 11), where the doctors were observed throughout their working hours at various times of the day and the week. Furthermore, six semi-structured interviews (four group interviews and two individual) were carried out. The data was analysed thematically. RESULTS: Newly graduated doctors consulted different collaborators (peers, senior doctors, registered nurses, and other junior doctors) dependent on the challenge at hand, and they used different strategies to get help and secure good relationships with their collaborators: 1) displaying competence; 2) appearing humble; and 3) playing the game. Their use of different strategies shows how they are committed to engage in these collaborations, and how much is at stake. CONCLUSIONS: Newly graduated doctors rely on building relationships with different collaborators in order to survive their first months of practice. We argue that the collaboration with peer NGDs and registered nurses has not received the attention it deserves when working with the transition from medical school. We highlight how it is important to focus on these and other collaborators and discuss different work-agendas, mutual expectations, and interdependence. This could be addressed in the introduction period and be one way to ensure a better learning environment and a respectful interprofessional culture.

An untapped resource? Opportunities for faculty-librarian collaboration to enhance drug information resource utilization in pharmacy education.

Background: Doctor of pharmacy educational accreditation standards state student pharmacists should be able to evaluate the scientific literature as well as critically analyze and apply information in answering drug information questions. Student pharmacists often struggle with identifying and using appropriate resources to answer medication-related questions. To ensure educational needs were met, a college of pharmacy hired a health sciences librarian to support the faculty and students. Case Presentation: The health sciences librarian collaborated with faculty and students throughout the doctor of pharmacy curriculum to identify and address any gaps related to appropriate drug resource utilization. Adding instruction time to the new student pharmacist orientation, coursework throughout the first year of the pharmacy program, and a two-semester evidence-based seminar course provided opportunities for the health sciences librarian to work with student pharmacists in the areas of library resource access, instruction on drug information resources, and evaluation of drug information found on the internet. Conclusion: The deliberate inclusion of a health sciences librarian into the doctor of pharmacy curriculum can benefit faculty and students. Opportunities for collaboration are available throughout the curriculum, such as providing instruction for database utilization and supporting the research activities of both faculty and student pharmacists.

Nutrition education for providers is limited: it is time for increased education to boost interprofessional collaboration!

Nutrition plays a major role in the overall health, longevity, and quality of life of each person, from infancy to elderly. Education and training for most health-care providers to deliver nutrition care to patients have been inadequate and on the decline in the past several decades. This gap needs to be addressed by increasing the knowledge, confidence, and abilities of health-care professionals to deliver nutrition care and work as an interprofessional team for patients. Having a registered dietitian nutritionist as part of the interprofessional team can lead to better-coordinated care, using nutrition at the forefront. We describe the issues with a disparity in online nutrition-focused continuing professional development (CPD) and propose an avenue and strategy to use CPD to deliver nutrition education and training to providers, ultimately to boost interprofessional collaboration.

Interprofessional collaboration among health professionals in cleft lip and palate treatment and care in the public health sector of South Africa.

BACKGROUND: Collaboration among different categories of health professionals is essential for quality patient care, especially for individuals with cleft lip and palate (CLP). This study examined interprofessional collaboration (IPC) among health professionals in all CLP specialised centres in South Africa's public health sector. METHODS: During 2017, a survey was conducted among health professionals at all the specialised CLP centres in South Africa's public health sector. Following informed consent, each member of the CLP team completed a self-administered questionnaire on IPC, using the Interprofessional Competency Framework Self-Assessment Tool. The IPC questionnaire consists of seven domains with 51 items: care expertise (8 items); shared power (4 items); collaborative leadership (10 items); shared decision-making (2 items); optimising professional role and scope (10 items); effective group function (9 items); and competent communication (8 items). STATA®13 was used to analyse the data. Descriptive analysis of participants and overall mean scores were computed for each domain and analysed using ANOVA. All statistical tests were conducted at 5% significance level. RESULTS: We obtained an 87% response rate, and 52 participants completed the questionnaire. The majority of participants were female 52% (n = 27); with a mean age of 41.9 years (range 22-72). Plastic surgeons accounted for 38.5% of all study participants, followed by speech therapists (23.1%), and professional nurses (9.6%). The lowest mean score of 2.55 was obtained for effective group function (SD + -0.50), and the highest mean score of 2.92 for care expertise (SD + -0.37). Explanatory factor analysis showed that gender did not influence IPC, but category of health professional predicted scores on the five categories of shared power (p = 0.01), collaborative leadership (p = 0.04), optimising professional role and scope (p = 0.03), effective group function (p = 0.01) and effective communication (p = 0.04). CONCLUSION: The seven IPC categories could be used as a guide to develop specific strategies to enhance IPC among CLP teams. Institutional support and leadership combined with patient-centred, continuing professional development in multi-disciplinary meetings will also enrich IPC.

Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study.

BACKGROUND: There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice. METHODS: A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes. RESULTS: Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions. CONCLUSION: Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.

Interprofessional ward rounds in an adult intensive care unit: an appreciative inquiry into the central collaboration between the consultant and the bedside nurse.

Done well, ward rounds (WRs) promote effective, safe care and collaboration; but WR quality varies. An improvement-focused appreciative inquiry (AI) into a large intensive care unit's WR practices identified a pivotal axis of collaboration between the most senior medical role (the consultant) and the bedside nurse (BSN). This paper examines that axis of interprofessional collaboration (IPC) to deepen understanding of its implications. Data included ethnographic observations, interviews, and co-constructed AI with groups of staff. Four key concepts emerged from cyclical interpretive analysis: "need," "presence," "ability" and "willingness." BSNs and consultants needed the interprofessional WR to enable their work; WR effectiveness was affected by whether they were both present, then able and willing to participate in IPC. BSN presence was necessary for effective and efficient IPC between these key roles. Indirect contributions, based on prior exchanges with colleagues or through written notes, reduced the joint problem-solving through discussion and negotiation that characterizes IPC to less efficient asynchronous interprofessional coordination. Factors affecting "presence," "ability" and "willingness" are discussed alongside potential mitigations and acknowledgment of asymmetric power. Appreciative examination of interprofessional WRs identified mechanisms supporting and undermining effective WR IPC and the centrality of consultants' and BSNs' collaboration.

How are Certified Child Life Specialists perceived by healthcare professionals?: A call for interprofessional collaboration.

Certified child life specialists (CCLS) depend on collaboration with healthcare professionals for awareness of patient needs; however, historically other healthcare professionals misunderstand the CCLS role. The purpose of this study was to examine how healthcare professionals perceived the CCLS role and provide implications on the contribution of the CCLS to interprofessional collaboration (IPC). This study was a partial replication of two previous survey studies. Participants (N = 67) consisted of 26 child life and 42 other healthcare professionals who were employed at one freestanding children's hospital in the southern United States. Qualitative analyses revealed CCLS responsibilities could be explained with seven categories. Child life professionals were more likely to report CCLS responsibilities as providing patient support and family support and documenting psychosocial assessment and interventions in the medical record than other healthcare professionals. Child life and other healthcare professionals are mostly aligned in their perception of the CCLS role, specifically patient education, play, and normalization and development. Previous misconceptions about the CCLS role may be diminishing among other healthcare professionals; however, continued education about the CCLS role and communication with CCLSs would likely promote IPC.

Structured interdisciplinary bedside rounds improve interprofessional communication and workplace efficiency among residents and nurses on an inpatient internal medicine unit.

Structured Interdisciplinary Bedside Rounds (SIBR) is a standardized, team-based intervention for hospitals to deliver high quality interprofessional care. Despite its potential for improving IPC and the workplace environment, relatively little is known about SIBR's effect on these outcomes. Our study aimed to assess the fidelity of SIBR implementation on an inpatient medicine teaching unit and its effects on perceived IPC and workplace efficiency. We conducted a quasi-experimental study with 88 residents and 44 nurses at a large academic medical center and observed 1308 SIBR encounters over 24 weeks. Of these 1308 encounters, the bedside nurse was present for 96.7%, physician for 97.6%, and care manager for 94.7, and 64.7% occurred at the bedside. Following SIBR implementation, perceived IPC improved significantly among residents (93.3% versus 67.9%, p < .024) and nurses (73.7% versus 36.0%, p < .008) compared to before implementation. Moreover, residents perceived greater workplace efficiency operationalized as being paged less frequently with questions by nurses (20.0% versus 49.1%, p = .01). No statistically significant improvements were reported regarding burnout, meaning at work, and workplace satisfaction. Our implementation of SIBR significantly improved perceived IPC and workplace efficiency, which are two important domains of healthcare quality. Future work should examine the impact of SIBR on patient-centered outcomes such as patient experience.

Teaching evidence-based practice piece by PEACE.

Teaching evidence-based practice (EBP) to nurse practitioner (NP) students creates a challenge. Practicing NPs are frequently called upon to develop EBP protocols and therefore, must be proficient in defining clinical problems, retrieving and appraising evidence, implementing protocols to change practice based on evidence, and evaluating the practice changes. A new faculty team integrated the constructivist approach using the PEACE framework to rebuild the EBP course. Course modules corresponded to each letter of the PEACE framework: problem identification, evidence retrieval, appraisal of evidence, changing practice or conducting more research, and evaluation. Students collaborated with a non-nursing professional as part of the college's commitment to interprofessional learning. Following the PEACE framework, students created an evidence-based poster of a proposed clinical practice change. Feedback from faculty and students was positive. Areas for improvement included eliminating redundancy in module content, standardizing all grading rubrics, and adding more virtual sessions for student/faculty interaction.

Evaluation of the elements of interprofessional education for end-of-life care among homecare nurses, care managers, and head care workers: A cluster-randomized controlled trial.

Our group developed an interprofessional education (IPE) program for home-based end-of-life (EOL) care among health and welfare professionals, with the purpose of understanding professional roles in EOL care and promoting mutual respect among team members. This study aimed to verify the understanding and awareness of the elements of IPE. Seven districts in a city in Japan were cluster-randomized into an education group or a control group. A questionnaire survey using original items to evaluate two purposes of the IPE program was conducted before the IPE workshop and seven months later. In total, 291 professionals participated in the study: 64 homecare nurses, 129 care managers, and 98 head care workers. Care managers and care workers in the education group significantly understood their own and other professional roles in EOL care (p= .01, p < .0001, respectively) and gained confidence in collaboration among health and welfare professionals (p = .02, p < .0001, respectively). Care workers in the education group felt respect for team members (p = .02). For homecare nurses, no significant effects were observed. The IPE was more effective for welfare professionals who had difficulty cooperating in end-of-life care.

Through the resident lens: examining knowledge and attitudes about midwifery among physician trainees.

Interprofessional collaboration optimizes maternal-newborn outcomes and satisfaction with care. Since 2002, midwives have provided an increasing proportion of maternity care in British Columbia (BC). Midwives often collaborate with and/or refer to physicians; but no study to date has explored Canadian medical trainees' exposure to, knowledge of, and attitudes towards midwifery practice. We designed an online cross-sectional questionnaire that included a scale to measure attitudes towards midwifery (13 items) and residents' knowledge of midwifery (94 items across 5 domains). A multi-disciplinary expert panel rated each item for importance, relevance, and clarity. The survey was distributed to family medicine (n = 338) and obstetric (n = 40) residents in BC. We analyzed responses from 114 residents. Residents with more favourable exposures to midwifery during their education had significantly more positive attitudes towards midwives (rs = 0.32, p = 0.007). We also found a significant positive correlation between residents' attitudes towards midwifery and four of five knowledge domains: scope of practice (rs = 0.41, p < 0.001); content of education (rs = 0.30, p = 0.002), equipment midwives carry to home births (rs = 0.30, p = 0.004) and tests that midwives can order (rs = 0.39, p < 0.001). The most unfavourable exposures were observing interprofessional conversations (66.2%), and providing inpatient consultations for midwives (61.4%). Findings suggest increased interprofessional education may foster improved midwife-physician collaboration. Abbreviations: BC - British Columbia; UBC - University of British Columbia.

Comparison of nurse and resident physician paging frequency by sex in the emergency department.

Objectives: The role of biological sex in interprofessional relationships is an important factor in collaborative health care settings such as the emergency department (ED) but one that has been sparsely studied. While there is anecdotal evidence on gender-based differences in communication, little research has focused on this topic. The goal of this study was to determine whether there are differences in paging frequency between nurses and male and female residents. Methods: We conducted a retrospective review of patient visits to our urban, tertiary care academic ED between January 1 and April 1, 2021. Only pages from nurses to emergency medicine (EM) residents were included. Outcome variables included number of pages received by sex, number of unique ED visits, and mean number of pages per unique visit. Pearson's chi-square tests were used to analyze differences between observed and expected results. Results: A total of 15,617 pages from nurses to residents over 6843 unique patient visits to the ED were analyzed. This included 187 nurses, 162 (87%) of whom were female and 25 (13%) were male. Of the 39 residents, 12 (31%) were female and 27 (69%) were male. Female residents received 4500 pages over 2228 unique patient ED visits, or a mean of two pages per patient with a mean of 186 unique ED visits per female resident. Male residents received 11,117 pages over 4615 unique patient ED visits, or a mean of 2.4 pages per patient, with a mean of 171 unique ED visits per male resident. This difference in pages per patient was statistically significant (χ2(1) = 369, p < 0.001). Conclusions: We found that male residents received significantly more pages per patient than their female colleagues. Overall, further research is required to understand the factors, such as characteristics of patients or preferred communication methods of providers, that drive this disparity and what the implications are for patient outcomes.