Evolving global responses to the pandemic: sustaining interprofessional education and collaborative practice.

The COVID-19 pandemic created global disruption in health professions education and healthcare practice, necessitating an abrupt move to digital delivery. A longitudinal survey was conducted to track the evolution of global responses to the pandemic. During the initial stages, educational and health institutions were forced to adapt quickly without careful consideration of optimal pedagogy, practices, and effectiveness of implemented approaches. In this paper, we report the results of Phase 3 of the global survey that was distributed between November 2021 and February 2022 through InterprofessionalResearch.Global (IPR.Global). The Phase 3 qualitative survey received 27 responses, representing 25 institutions from 13 countries in 6 regions. Using inductive thematic analysis, the data analysis resulted in three emerging themes: Impact of the pandemic on the delivery of interprofessional education and collaborative practice (IPECP); Impact of the pandemic on the healthcare system (team, population/client health, clients); and Sustainability and innovation. This study highlights the evolving nature of health education and collaborative practices in response to the COVID-19 pandemic. IPECP educators need to be resilient and deal with the complexities of face-to-face and digital learning delivery. Preparing for emerging forms of teamwork is essential for new work contexts and optimal health services.

Advanced practice nursing in Europe-Results from a pan-European survey of 35 countries.

AIM: To report the results of a mapping exercise by the European Federation of Nurses on current advanced practice nursing frameworks and developments across Europe. DESIGN: Online, cross-sectional, questionnaire study. METHODS: An online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. The questionnaire solicited input on 60 items concerning key features of advanced practice nursing, intending to map existing developments and better understand the current state of advanced practice nursing in Europe. Data analysis used descriptive statistics, including counts and percentages, tabulation; open-text responses were handled with thematic synthesis techniques. RESULTS: The definition, sense-making and operationalization of advanced practice nursing vary across Europe. Important variations were noted in the definition and requirements of advanced practice nursing, resulting in different views on the competencies and scope of practice associated with this role. Importantly, the level of education and training required to qualify and practice as an advanced practice nurse varies across European countries. Furthermore, only 11 countries reported the existence of a national legislation establishing minimum educational requirements. CONCLUSION: Significant variation exists in how countries define advanced practice nursing and how it is regulated at academic and practice levels. More research is needed to clarify whether this variation results from designing models of advanced practice nursing that work in different contexts; and what impact a standardized regulatory framework could have to grow the volume of advanced practice nurses across Europe. IMPACT: The current paper exposes the lack of clarity on the development and implementation of advanced practice nursing across Europe. We found significant variation in the definition, recognition, regulation and education of advanced practice nurses. Our data are essential to policymakers, professional associations and employers to ensure a coordinated and systematic effort in the consistency and ongoing development of advanced practice nurses across Europe. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution applied; the participants were national nurses' associations.

How is Integration Defined and Measured, and what Factors Drive Success in Brazil? An Integrative Review.

Introduction: Integration in health and care can improve quality and outcomes, but it is challenged by expansion of medical knowledge, social pressures on patient needs, and demands to deliver critical information. In Latin American and in other lower and middle-income countries integrated care remains in development. This paper examined the available literature on integrated care to understand how Latin American countries identify and measure integration, and what factors influence success. Methods: This integrative literature review included systematic searches in Global Health, PubMed, SciELO and BVSPsi databases for articles on integrated care in Spanish, Portuguese, and English in the period from January of 1999 to December 2020. The articles were screened for selection and assessed independently by five reviewers that used the inclusion criteria of papers about integration in health care systems. The sample excluded articles that did not deal with the integration of health care, which addressed issues related to public health campaigns, programs to control endemics and epidemics, reports on the experience of implementing health services, health promotion guidelines, food safety, oral health, and books evaluation. Results: 24 articles were included: qualitative (75%), quantitative (12,5%), and mixed-method research (4%) published between 2000 and 2017. All studies were undertaken in Brazil, and two of them were also conducted in Latin American countries. In 15 articles there was an interchangeable use between concepts of integration of services and integrated care, while nine studies did not define integration. Barriers to integration included absence of shared understanding of knowledge among members of interprofessional teams, lack of clarity on professional roles, missing consensus on a definition and measurement of integrated care, power struggles between professionals, poor institutional support, insufficient team preparation and training and unequal valuation of professions by society. Conclusion: Several types of integration and factors contributing to the success of implementation of integrated care in various contexts in Brazil were identified. The concept of integration reflected the varied local and regional realities including different health settings and levels of health and care, suggesting a need for further clarifications on its objective and components especially in LMIC contexts.

Sociomaterial perspective as applied in interprofessional education and collaborative practice: a scoping review.

Learning and working together towards better health outcomes today have become more complex requiring an investigation on how interprofessional education (IPE) and interprofessional collaboration (IPC) practices could be sustained and further developed. Through a sociomaterial perspective, we can better understand IPE and IPC practices by foregrounding the material aspect of learning and working together and examining its relationship with humans and their interactions. This article aimed to examine existing literature that discusses the application of sociomaterial perspectives in IPE and IPC. A scoping review was conducted following Arksey and O'Malley's framework to explore the extent within the current body of knowledge that discuss how sociomaterial perspective is applied in IPE and IPC practices. A systematic database search was performed in September 2021 to retrieve literature published from 2007 onwards, with forty-three papers meeting the inclusion criteria. These papers included research articles, book chapters, conference papers and commentaries, with the majority originating from Europe. The thematic analysis revealed the following themes: (1) power as a sociomaterial entity shaping IPE and IPC; (2) inclusion of non-health professionals in reimagining IPE and IPC practices, and (3) the critical understanding of sociomateriality. The findings suggest that a sociomaterial perspective can allow for the reimagination of the contemporary and future practices of interprofessionalism.

Workplace Violence Against Nurses: Challenges and Solutions for Europe.

We report the results of a mapping exercise by the European Federation of Nurses (EFN) on challenges and solutions related to violence against nurses. This is an issue of growing international concern, with the problem accentuated during and following the COVID-19 pandemic. Following a cross-sectional observational design, an online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. Face validity was achieved through an expert panel. Descriptive statistics were used for data analysis, including counts, percentages, and tabulation. Qualitative data analysis followed thematic synthesis techniques. Three main findings are noted. First, violent incidents against nurses are under-reported due to fear of victimization, employer discouragement, and the perception that reporting will not make any difference. Second, perpetrators of violent acts extend beyond patients and families to include health professionals of different ranks. Third, violent incidences have a significant adverse effect on nurses' health and retention, leading to nurses reducing their working hours or opting for part-time work. Violence against nurses is an expression of a broader problem that is rooted in the failure to recognize and manage violence at the level of the healthcare organization, and the absence of appropriate legislation to maintain minimum standards of safe working environments. This is partly the result of inadequate European Union-wide legislation targeting workplace violence in the health professions. Nurses need more institutional support through dedicated funding aimed at targeted interventions, more legislative commitment to ratify policies against discrimination, and an opportunity to voice the needs to the appropriate policymakers with the ability to bring significant change to existing conditions. Given the severity of the situation, inaction could lead to irreplaceable damage to the nursing workforce, compounding pressures resulting from the COVID-19 pandemic. Ultimately, this situation can further drive existing nurses out of the profession, weakening health systems worldwide.

The perceived impact of the COVID-19 pandemic on interprofessional education and collaborative practice: preliminary results from phase I of a global survey.

The COVID-19 pandemic has had a sizable effect on interprofessional education and collaborative practice (IPECP) globally, yet much of the available literature on the topic remains anecdotal and locally bounded. This body of literature reflects celebratory and aspirational reports, with many case studies of successful response and perseverance under conditions of extreme pressure. There is, however, a more worrisome narrative emerging that pointed to differences in pandemic response with concerns raised about the sustainability of IPECP during and after the pandemic. The COVID-19 task force of InterprofessionalResearch.Global (IPRGlobal) set out to capture the successes and challenges of the interprofessional community over the pandemic through a longitudinal survey, with a view to inform global attempts at recovery and resilience. In this article, we report preliminary findings from Phase 1 of the survey. Phase 1 of the survey was sent to institutions/organizations in IPRGlobal (representing over 50 countries from Europe, North and South America, Australia, and Africa). The country-level response rate was over 50%. Key opportunities and challenges include the abrupt digitalization of collaborative learning and practice; de-prioritization of interprofessional education (IPE); and rise in interprofessional collaborative spirit. Implications for IPECP pedagogy, research, and policy post-pandemic are considered.

Impact of and mitigation measures for burnout in frontline healthcare workers during disasters: A mixed-method systematic review.

BACKGROUND: Burnout is a global concern for the healthcare community, especially following a disaster response. It is a major obstacle to providing safe and quality health care. Avoiding burnout is essential to ensuring adequate healthcare delivery and preventing psychological and physical health problems and errors among healthcare staff. AIMS: This study aimed to determine the impact of burnout on healthcare staff working on the frontline in a disaster context, including pandemics, epidemics, natural disasters, and man-made disasters; and to identify interventions used to mitigate burnout among those healthcare professionals before, during, or after the disaster. METHOD: A mixed methods systematic review was used and included a joint analysis and synthesis of data from qualitative and quantitative studies. The was guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) of qualitative and quantitative evidence. Several databases were searched, for example, Medline, Embase, PsycINFO, Web of Science, Scopus, and CINAHL. The quality of included studies was assessed using the Mixed Method Appraisal Tool (MMAT), version 2018. RESULTS: Twenty-seven studies met the inclusion criteria. Thirteen studies addressed the impact of burnout in relation to disasters and highlighted the association between burnout and the physical or mental well-being of healthcare workers, work performance, and workplace attitude and behavior. Fourteen studies focused on different burnout interventions including psychoeducational interventions, reflection and self-care activities, and administering a pharmacological product. LINKING EVIDENCE TO ACTION: Stakeholders should consider reducing risk of burnout among healthcare staff as an approach to improving quality and optimizing patient care. The evidence points to reflective and self-care interventions having a more positive effect on reducing burnout than other interventions. However, most of these interventions did not report on long-term effects. Further research needs to be undertaken to assess not only the feasibility and effectiveness but also the sustainability of interventions targeted to mitigate burnout in healthcare workers.

The evidence base for interprofessional education within health professions education: A protocol for an update review.

Interprofessional education (IPE) interventions aiming to promote collaborative competence and improve the delivery of health and social care processes and outcomes continue to evolve. This paper reports on a protocol for an update review that we will conduct to identify and describe how the IPE evidence base has evolved in the last 7 years. We will identify literature through a systematic search of the following electronic databases: Medline, Embase, CINAHL, Education Source, ERIC, and BEI. We will consider all IPE interventions delivered to health professions students and accredited professionals. Peer-reviewed empirical research studies published in any language from June 2014 onwards will be eligible for inclusion. The outcomes of interest are changes in the reaction, attitudes/perceptions, knowledge/skills acquisition, behaviors, organizational practice, and/or benefits to patients. We will perform each task of screening, critical appraisal, data abstraction, and synthesis using at least two members of the review team. The review will enable an update and comprehensive understanding of the IPE evidence base to inform future IPE developments, delivery and evaluation across education and clinical settings.

Factors that contributed to burnout among intensive care nurses during the COVID-19 pandemic in Saudi Arabia: A constructivist grounded theory.

BACKGROUND: Intensive care unit (ICU) nurses experience high levels of burnout during the COVID-19 pandemic due to multiple stressors. It has long been known that burnout is negatively associated with patient and staff outcomes. Understanding the triggers for intensive care nurses' burnout during the pandemic can help to develop appropriate mitigation measures. OBJECTIVE: The objective of this study was to examine intensive care nurses' experiences during the COVID-19 pandemic in Saudi Arabia to develop insights into the factors that influenced burnout. METHODS: The study was informed by a constructivist grounded theory design. The study was conducted in an adult ICU in a tertiary hospital in the Makkah province in the Kingdom of Saudi Arabia. All participants were registered nurses with at least 6 months' experience in intensive care and experienced caring for COVID-19 patients. FINDINGS: This paper reports on preliminary findings from interviews with 22 intensive care nurses. A core category 'pandemic pervasiveness' was identified from the interview data, which makes reference to the ever-present nature of the pandemic beyond the ICU context. Family, work, and the wider world context are the three groups of contextual factors that influenced nurses' experience and perception of burnout. CONCLUSION: Many issues identified from the findings in this study can be attributed to shortages in the intensive care nursing workforce. Thus, we join others in calling for healthcare organisations and policymakers to be creative in finding new ways to meet nurses' needs, motivate, and empower them to maintain and sustain the nursing workforce in highly demanding areas, such as ICUs. Nursing managers can play a crucial role in mitigating nurses' burnout by identifying and tackling sources of stress that exist among their staff, specifically team conflict, workplace harassment, and discrimination.

Collective leadership to improve professional practice, healthcare outcomes and staff well-being.

BACKGROUND: Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greater complexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge.  OBJECTIVES: To assess the effects of collective leadership for healthcare providers on professional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language. SELECTION CRITERIA: Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention. DATA COLLECTION AND ANALYSIS: Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants).  AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.

Family perspectives on facilitators and barriers to the set up and conduct of virtual visiting in intensive care during the COVID-19 pandemic: A qualitative interview study.

OBJECTIVE: To gain perspectives from family members about barriers and facilitators to virtual visit set up and conduct across intensive care unit settings in the United Kingdom to inform understanding of best practices. METHODS: We conducted a qualitative descriptive study recruiting a purposive sample of family members of adult intensive care unit patients experiencing virtual visiting during Jan to May 2021 of the COVID-19 pandemic. We used semi-structured qualitative interviews and a standard Thematic Analysis approach. RESULTS: We recruited 41 family-member participants from 16 hospitals in the United Kingdom. Facilitators to successful virtual visit set-up were preparation of the family, negotiating a preferred time, and easy-to-use technology. Facilitators to successful conduct were intensive care unit team member presence; enabling family involvement in care; inclusivity, accessibility, and flexibility; and having a sense of control. Barriers that created distress or conflict included restrictive virtual visiting practices; raising expectations then failing to meet them; lack of virtual visit pre-planning; and failing to prepare the patient. Barriers to visit conduct were incorrect camera positioning, insufficient technical and staff resources, issues with three-way connectivity, and lack of call closure. Recommendations included emotional self-preparation, increased technology availability, and preparing conversation topics. CONCLUSION: These data may guide virtual visiting practices during the ongoing pandemic but also to continue virtual visiting outside of pandemic conditions. This will benefit family members suffering from ill health, living at a distance, unable to afford travel, and those with work and care commitments, thereby reducing inequities of access and promoting family-centered care.

Virtual visiting in intensive care during the COVID-19 pandemic: a qualitative descriptive study with ICU clinicians and non-ICU family team liaison members.

OBJECTIVE: To understand the experiences and perceived benefits of virtual visiting from the perspectives of intensive care unit (ICU)-experienced clinicians and non-ICU-experienced family liaison team members. DESIGN: Qualitative descriptive study. SETTING: Adult intensive care setting across 14 hospitals within the UK National Health Service. PARTICIPANTS: ICU-experienced clinicians and non-ICU-experienced family liaison team members deployed during the first wave of the COVID-19 pandemic. METHODS: Semistructured telephone/video interviews were conducted with ICU clinicians. Analytical themes were developed inductively following a standard thematic approach, using 'family-centred care' and 'sensemaking' as sensitising concepts. RESULTS: We completed 36 interviews, with 17 ICU-experienced clinicians and 19 non-ICU-experienced family liaison team members. In the context of inperson visiting restrictions, virtual visiting offered an alternative conduit to (1) restoring the family unit, (2) facilitating family involvement, and (3) enabling sensemaking for the family. Virtual visits with multiple family members concurrently and with those living in distant geographical locations restored a sense of family unit. Family involvement in rehabilitation, communication and orientation activities, as well as presence at the end of life, highlighted how virtual visiting could contribute to family-centred care. Virtual visits were emotionally challenging for many family members, but also cathartic in helping make sense of their own emotions and experience by visualising their relatives in the ICU. Being able to see and interact with loved ones and their immediate care providers afforded important cues to enable family sensemaking of the ICU experience. CONCLUSIONS: In this UK qualitative study of clinicians using virtual ICU visiting, in the absence of inperson visiting, virtual visiting was perceived positively as an alternative that promoted family-centred care through virtual presence. We anticipate the perceived benefits of virtual visiting may extend to non-pandemic conditions through improved equity and timeliness of family access to the ICU by offering an alternative option alongside inperson visiting.

Interprofessional educators' competencies, assessment, and training - IPEcat: protocol of a global consensus study.

Contemporary practice in interprofessional education (IPE) has evolved predominantly focusing on the competencies for interprofessional collaboration (IPC) that learners must acquire. Competencies that educators need to successfully deliver IPC have been overlooked. This lack of attention is further confounded by a field replete with inconsistent terminology and standards and no global consensus on the core competencies needed for IPE facilitation. There are no globally accepted tools to assess interprofessional educators' competencies nor are there established training programmes that might be used as the basis for a collective global approach to these issues. The International Working Group for Interprofessional Educators Competencies, Assessment, and Training (IWG_IPEcat) seeks to address this gap using a sequential mixed-method approach, to deliver globally developed, empirically derived tools to foster IPE educator competencies. This article presents the protocol of the research project.

The processes of hospital discharge and recovery after blunt thoracic injuries: The patient's perspective.

AIMS: The aim of this study was to explore hospital discharge processes and the self-management of recovery in the early post-discharge period after blunt thoracic injury from a patient perspective. DESIGN: Qualitative interview study. METHODS: Interviews were conducted with participants recruited from 8 sites across England and Wales between November 2019-May 2020. Semi-structured interviews were conducted between 5-8 weeks after hospital discharge, and in total, 14 interviews were undertaken. These interviews were recorded, transcribed and analysed using thematic coding. RESULTS: Three main themes were identified from the analysis: (a) challenges in the discharge process, (b) coping at home after discharge and (c) managing medications at home. Pain was a dominant thread running throughout all themes which represented an important quality and safety concern for all participants. Associated concerns included insufficient preparation and education for hospital discharge, ineffective communication and subsequent unsafe use of opioids at home highlighting unmet patient care needs.