Interprofessional education interventions in undergraduate students of musculoskeletal healthcare professions: a scoping review protocol.

INTRODUCTION: Enhancing interprofessional education (IPE) fosters collaborative efforts among healthcare professionals specializing in musculoskeletal (MSK) care. This approach presents a valuable opportunity to address the pressing MSK disease burden in developing countries, with high prevalence rates and limited resources. While an abundance of literature on the various elements of IPE among healthcare students and professionals exists, shared contexts of practice of South African MSK disciplines are not currently developed through IPE at higher education level, establishing a need for South African formalised curricular IPE interventions with an explicit focus on undergraduate students of MSK healthcare professions. METHODS AND ANALYSIS: The intended scoping review protocol is guided by the framework set out by Arksey and O'Malley, where the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide the process of reporting. English sources (qualitative and quantitative methodological studies, conference papers and proceedings, systematic reviews, grey literature, unpublished materials, theses and dissertations) from the electronic databases PubMed, Scopus, ERIC and ProQuest with no date restriction will be included. A researcher, an independent reviewer and research librarian will search and extract data from abstracts and full texts for this scoping review, where any arising disagreements will be resolved by discussion. Reference lists of relevant literature will be scrutinised. Relevant literature will be recorded on a referencing software and deduplicated. The data collection will take place between May and October 2023. The findings will be reported narratively with the use of tables. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval as all literature used already exists in the public domain with no involvement of human participants. The findings from this planned review will be submitted to peer-reviewed journals and will be presented at higher education conferences. This scoping review protocol was registered on Open Science Framework with the registration osf.io/c27n4.

Fluid professional boundaries: ethnographic observations of co-located chiropractors, osteopaths and physiotherapists.

BACKGROUND: Chiropractors, osteopaths and physiotherapists (COPs) can assess and manage musculoskeletal conditions with similar manual or physical therapy techniques. This overlap in scope of practice raises questions about the boundaries between the three professions. Clinical settings where they are co-located are one of several possible influences on professional boundaries and may provide insight into the nature of these boundaries and how they are managed by clinicians themselves. OBJECTIVES: To understand the nature of professional boundaries between COPs within a co-located clinical environment and describe the ways in which professional boundaries may be reinforced, weakened, or navigated in this environment. METHODS: Drawing from an interpretivist paradigm, we used ethnographic observations to observe interactions between 15 COPs across two clinics. Data were analysed using reflexive thematic analysis principles. RESULTS: We identified various physical and non-physical 'boundary objects' that influenced the nature of the professional boundaries between the COPs that participated in the study. These boundary objects overall seemed to increase the fluidity of the professional boundaries, at times simultaneously reinforcing and weakening them. The boundary objects were categorised into three themes: physical, including the clinic's floor plan, large and small objects; social, including identities and discourse; and organisational, including appointment durations and fees, remuneration policies and insurance benefits. CONCLUSIONS: Physical, social, organisational related factors made the nature of professional boundaries between COPs in these settings fluid; meaning that they were largely not rigid or fixed but rather flexible, responsive and subject to change. These findings may challenge patients, clinicians and administrators to appreciate that traditional beliefs of distinct boundaries between COPs may not be so in co-located clinical environments. Both clinical practice and future research on professional boundaries between COPs may need to further consider some of these broader factors.

Exploring factors associated with healthcare professionals' subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence, satisfaction and burden levels.

OBJECTIVE: The aim of this study was to explore factors associated with healthcare professionals' subjective perceptions of complex issues in primary care settings in Japan. DESIGN: Cross-sectional survey conducted through a self-administered web-based questionnaire. SETTING: Japan, from June to October 2020. PARTICIPANTS: Healthcare professionals recruited via an email list from the Japan Primary Care Association. MEASURES: The questionnaire assessed subjective perception of satisfaction, confidence and burden regarding complex issues using a 100 mm Visual Analogue Scale (VAS). Explanatory variables included the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), basic demographic information, administrative experience and an organisational climate scale. This scale comprised the 'Plan, Do, See' (PDS) factor for management and the 'Do' factor in a leader-centred direction for those working under compulsion. Factors associated with subjective perceptions were analysed using binomial logistic regression analysis and Bonferroni analysis (p<0.017). RESULTS: Data from 593 participants (average age of 41.2 years, including 133 nurses, 128 physicians and 120 social workers) were analysed. Median (quartile) VAS scores for satisfaction, confidence and burden were 50 (36-70), 52 (40-70) and 50 (30-66), respectively. Higher satisfaction group was significantly associated with PDS factor, Do factor and JASSIC Score. Greater confidence group associated with older age, male, Do factor, administrative experience and JASSIC Score. No factors were significantly associated with the higher perceived burden. CONCLUSION: These findings reveal that interprofessional competency self-assessment influence perceptions of complex issues among healthcare professionals. Moreover, satisfaction with complex issues might be enhanced by a manageable organisational climate, while confidence might be influenced by personal attributes.

Learning to teach with patients and caregivers: a focused ethnography.

BACKGROUND: Little is known about what happens when patients and caregivers are involved in an academic setting as co-teachers and how healthcare professionals approach a new model of partnership-based teaching. This study aimed to explore the learning and behavioural patterns of a group of healthcare professionals who were learning to teach with patients and caregivers as co-teachers in a post-graduate course. METHODS: A focused ethnographic study involving 11 health professionals was conducted. Data were collected through participatory observation during the course, individual semi-structured interviews, and a follow-up focus group. Taxonomic analysis was performed. RESULTS: Three categories were identified: 'group', 'role of narration' and 'applying co-teaching with patients and caregivers '. Specifically, heterogeneity, absence of hierarchies, and balanced relationships characterised the group dynamic and promoted partnership. Narration played a key role both in learning and in healthcare professionals' relationship with patients and caregivers and promoted emotional skills and self-awareness. Project planning and lessons simulations were essential aspects of the implementation process. CONCLUSIONS: This focused ethnography helped further understanding of the context of a specific project involving patients and caregivers as co-teachers in healthcare professional education. The development of emotional skills and self-awareness are the main learning patterns of co-teaching, and interprofessionalism and balanced relationships are the basis of the behavioural patterns. These patterns facilitated the involvement of patients and caregivers in health education.

[Assessments in the initial nursing consultation-starting point for interprofessional cooperation in oncology]. / Assessments im pflegerischen Erstgespräch ­ Ausgangspunkt für interprofessionelle Zusammenarbeit in der Onkologie.

BACKGROUND: Most oncology patients are not adequately screened for symptoms during the admission process. As a result, their needs are not properly assessed and included in their treatment. OBJECTIVE: To investigate which assessments are already used by different nursing, medical, and social services at oncology centers and how these could be centralized in order to include the different services involved in the care of patients in a bundled way. MATERIALS AND METHODS: Interviews were conducted with nursing, medical, and social services of an oncology center. Hereby, a main focus was put on their individual screenings. Furthermore, the special features of the services for oncological patients were elaborated. RESULTS AND CONCLUSION: Symptom assessments are currently only performed if the nursing, medical, or social service concerned is actively involved in the care of the patient. This usually happens only once a problem arises. This could be counteracted by a needs and requirements analysis integrated into the admission process, in which the assessments are used in a bundled manner. In this way, a comprehensive picture of the individual could be created even before a problem arises. Based on the analysis by nursing experts, the various nursing, medical, and social services could then be involved in the care of the patient right at the start of treatment. This would significantly improve the quality of care for patients.

Effects of interprofessional practice on nursing workload in hospitals: A systematic review.

OBJECTIVE: To synthesise scientific evidence on interprofessional practice in hospital care and the effects on nursing workload. METHODS: Systematic mixed method review, registered in PROSPERO (CRD42021225627) and conducted in the following databases: CINAHL, Medline, Web of Science and Scopus, with no restrictions on the publication period of the studies. Primary studies were recruited on nurses' interprofessional practice (actions and interactions with other professional categories) in hospitals and the effects on one or more dimensions of nursing workload (quantitative, qualitative, physical, cognitive, emotional, time and variation). Scientific articles available in open access, in English, Spanish or Portuguese, were included. The searches were carried out in January 2021. The studies were evaluated by pairs of independent researchers to verify methodological quality, through the Mixed Method Appraisal Tool, and data extraction. To summarise the studies, thematic analysis was adopted. RESULTS: A total of 1774 publications were assessed for eligibility and 17 studies were included. Of these, two were mixed methods, four were qualitative, and 11 were quantitative, published between 2011 and 2020. The main scenarios investigated were Intensive Care Units and/or Inpatient Units. During data analysis, three thematic categories emerged: Interprofessional practice in coping with emotional overload; Time dedicated by nurses to professional communication; and Working conditions and patient care. The third category consisted of three subthemes: Conflict and flexibility in the context of practice; Working conditions and interprofessional practice; and Effects on patient care. CONCLUSIONS: The evidence points to the emotional overload of nurses in the face of uncooperative practices. Interprofessional actions, especially communicative ones, demand nurses' time and impact the care provided. The results contribute to political decisions and health work management.

Pharmacist-social worker interprofessional relations and education in mental health: a scoping review.

Background: One in eight patients is affected by a mental health condition, and interprofessional mental health teams collaborate to improve patient care. While pharmacists and social workers are recognized as mental health team members, there is a lack of literature describing interprofessional relations and education between these professions, especially as it pertains to mental health. The purpose of this review was to identify and characterize reports describing pharmacist-social worker interprofessional relations and education within mental health. Methodology: To address this knowledge gap, this scoping review was conducted to collect and characterize reports published between January 1, 1960 and August 18, 2023 describing pharmacist-social worker interprofessional relations and education within the field of mental health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Ovid MEDLINE, CINAHL, and Social Work Abstracts were searched using keywords "pharmacy student," "pharmacist," "social work student," "social worker," and "social work." Reports were included if they were published in English and interprofessional relations or education occurred directly between (student) pharmacists and social workers. Results: Three hundred twenty records were identified and three records were included: one cross sectional study, one qualitative educational project, and one case report. Each record suggested positive patient and/or educational outcomes developing from pharmacist-social worker interprofessional relations and education. In clinical practice, pharmacist-social work teams identified mental health risk factors, reduced 30-day readmissions, and improved post-discharge telehealth care. In the classroom, a social worker improved pharmacy students' confidence assessing patient suicidal ideations. Conclusions: This scoping review identified needs and areas for future research: pharmacist interprofessional education with Master of Social Work and Doctor of Social Work degree students, transitional care and mental health outcome measure reporting using evidence-based outcomes, and development of scholarly teaching projects utilizing higher-level educational frameworks beyond learner reactions.

Interprofessional clinical decision-making process in health: A scoping review.

AIMS: To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. DESIGN: Scoping review of the literature. DATA SOURCES: MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. REVIEW METHODS: References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. CONCLUSION: Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. IMPACT: The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. IMPACT STATEMENT: Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.

Interpersonal relationships of the nursing team in the work environment according to nursing students: A qualitative study.

AIM: To explore the perceptions of nursing students from Brazilian universities about the interpersonal relationship of the nursing team in the work environment. BACKGROUND: Healthcare institutions are complex entities where diverse professionals from different educational backgrounds work together to provide high-quality care to the population. The effective coordination of services within these institutions is closely linked to the interpersonal relationships among these different healthcare professionals. Nurses play a crucial role as members of the multidisciplinary healthcare team, acting as fundamental links between other professionals and patients. DESIGN: This is a descriptive study with a qualitative approach. METHODS: An online, open-ended questionnaire was used. A total of 30 nursing students participated in the study. RESULTS: Data were organized in two themes: (1) Interpersonal relationships of the nursing team and (2) Improving interpersonal relationships of the nursing team. Also, eight sub-themes were identified: Conflict dynamics within the nursing team, Hierarchical issues, Lack of communication, Impact of workplace interpersonal relationships on nursing students, Valuing the profession, Understanding role boundaries, Training in effective communication and conflict management, and Curricular reform. CONCLUSIONS: Blurred boundaries between professional roles, lack of respect, ineffective communication, hierarchical issues, and conflicts, were identified. Of particular concern was the limited interaction observed between the nursing team and multidisciplinary/support teams. Inadequate interpersonal relationships between members of the health team reflect negatively on nursing students during their clinical placements. These findings underscore the urgent need for interventions aimed at improving interpersonal relationships within nursing teams.

Competências comuns para a prática interprofissional no cuidado às pessoas em situação de violência sexual / Common skills for the interprofessional practice in care for people in sexual violence

Resumo Introdução: A violência sexual é um grave problema na sociedade brasileira cujas repercussões no âmbito da saúde pública tornam imperativa a abordagem dessa questão no contexto da formação das suas profissões. Igualmente, a integralidade do cuidado destinado às pessoas em situação de violência sexual requer a atuação conjunta de diversas profissões, além da integração em rede e articulação de diferentes equipamentos sociais. Objetivo: Este estudo teve como objetivo reconhecer quais competências - entendidas como o conjunto de conhecimentos, habilidades e atitudes - são necessárias para o desenvolvimento do cuidado integral destinado às pessoas em situação de violência sexual, segundo os melhores padrões de qualidade e segurança para a saúde delas. Método: Realizou-se um estudo qualitativo de caráter exploratório e descritivo que envolveu a aplicação de um formulário prévio sobre os conhecimentos acerca das competências, seguido da dinâmica da construção da figura humana, que consiste na confecção de um boneco no qual os conhecimentos estariam representados pela cabeça, as habilidades pelos membros e as atitudes pelo corpo, na realização de uma oficina com 76 participantes de diferentes profissões. Adicionalmente, aplicou-se um questionário a 32 profissionais com reconhecida expertise na área de violência sexual e com experiência prática no atendimento às pessoas nessa situação. Foi empregada a análise temática categorial. Resultado: Identificaram-se desafios a serem superados nas três dimensões constituintes das competências, com nítida deficiência de conhecimentos para a atuação em rede visando à efetividade e à integralidade do cuidado. Reconheceram-se 15 competências comuns aos profissionais que lidam com a violência, e o produto final foi representado num infográfico de disposição radial com a organização dos conhecimentos, das habilidades e das atitudes identificados como necessários para o desenvolvimento de tais competências. Conclusão: Reconhecer competências comuns e identificar, separadamente, quais conhecimentos, habilidades e atitudes as constituem representa estratégias promotoras da abordagem transversal desses conteúdos na formação das profissões, sobretudo da saúde. A proposição de uma matriz de competências comuns para prática interprofissional no cuidado destinado às pessoas em situação de violência sexual pode orientar a qualificação desse cuidado e alicerçar a interprofissionalidade em cenários cruciais de atuação coletiva para o enfrentamento da flagrante injustiça social que a violência sexual significa.

Abstract Introduction: Sexual violence is a serious problem in Brazilian society whose repercussions on public health make it imperative to address this issue in the context of training in professions. Likewise, comprehensive care for people in situations of sexual violence requires the joint action of different professions, in addition to network integration and articulation of different social facilities. Objective: This study aimed to reflect which competencies - understood as the set of knowledge, skills and attitudes - are permitted for the development of comprehensive care for people in situations of sexual violence, according to the best standards of quality and health safety they. Method: A qualitative study of an exploratory and descriptive nature was carried out, which involved the application of a preliminary form on knowledge about skills, followed by the dynamics of the construction of the human figure, which consists of manufacturing a doll in which the knowledge would be represented by the head, by the skills of the members and by the attitudes of the body, in the creation of an office with 76 participants from different professions. Furthermore, a questionnaire was administered to 32 professionals with experience in the area of sexual violence and with practical experience in caring for people in this situation. Categorical thematic analysis was used. Result: Result: Challenges were identified to be overcome in the three dimensions that constitute competencies, with a clear lack of knowledge for working in a network aiming at the effectiveness and comprehensiveness of care. 15 competencies common to professionals who deal with violence were recognized, and the final product was represented in a radially arranged infographic with the organization of knowledge, skills and attitudes identified as necessary for the development of such competencies. Conclusion: Recognizing common competencies and identifying, separately, which knowledge, skills and attitudes constitute them represent strategies that promote a transversal approach to these contents in the training of professions, especially in health. Proposing a matrix of common competencies for interprofessional practice in care for people in situations of sexual violence can guide the qualification of this care and support interprofessionality in crucial scenarios of collective action to combat the blatant social injustice that sexual violence means.

Approved or disregarded? Exploring arenas for narrative relations in geriatric care.

PURPOSE: The use of narration in healthcare has been accentuated as a response to the requested shift towards person-centred care. The notion of narrative relations refers to a process of involving several people in mutual and ongoing narrative exchange. This study aimed to explore how and where narrative relations may be adopted and enacted in everyday healthcare practice. METHODS: The study has a qualitative, explorative design. Seven interprofessional focus group discussions with healthcare staff were prompted by vignettes. A multidisciplinary team of healthcare staff (n = 31) were recruited on a geriatric ward. Data were analysed using a constant comparative method. RESULTS: A core theme shows how narrative relations are adopted and enacted both as part of an approved practice-the work procedures commonly approved as part of healthcare, and as a disregarded practice where covert but important narrative relations take place to support fundamental qualities of healthcare. Moreover, the findings consider arenas of healthcare practice where approved or disregarded practices are enacted in the clinic frontstage and the clinic backstage. CONCLUSIONS: Narrative relations may take place in different arenas of healthcare practice yet simultaneously become a cohesive force interconnecting those arenas and uphold continuity. Impeded narrative relations in one arena may have unintended consequences in another.

What is impacting clinical pharmacists' participation in an interprofessional ward round: a thematic analysis of a national survey.

The ward round (WR) is an important opportunity for interprofessional interaction and communication enabling optimal patient care. Pharmacists' participation in the interprofessional WR can reduce adverse drug events and improve medication appropriateness and communication. WR participation by clinical pharmacists in Australia is currently limited. This study aims to explore what is impacting clinical pharmacists' participation in WRs in Australian hospitals. A self-administered, anonymous national survey of Australian clinical pharmacists was conducted. This study describes the outcomes from qualitative questions which were analyzed thematically in NVivo-2020 according to Braun and Clarke's techniques. Five themes were constructed: "Clinical pharmacy service structure", "Ward round structure", "Pharmacist's capabilities", "Culture" and "Value". A culture supportive of pharmacist's contribution with a consistent WR structure and flexible delivery of clinical pharmacy services enabled pharmacists' participation in WR. Being physically "absent" from the WR due to workload, workflow, and self-perception of the need for extensive clinical knowledge can limit opportunities for pharmacists to proactively contribute to medicines decision-making with physicians to improve patient care outcomes. Bidirectional communication between the interprofessional team and the pharmacist, where there is a co-construction of each individual's role in the WR facilitates consistent and inter-dependent collaborations for effective medication management.

Multidisciplinary perspectives on roles of hospital pharmacists in tertiary settings: a qualitative study.

In today's complex healthcare landscape, exacerbated by resource constraints at various levels, optimization of health professionals' roles is becoming increasingly paramount. Interprofessional collaboration, underpinned by role recognition and teamwork, leads to improved patient and organizational outcomes. Hospital pharmacists play a pivotal role in multidisciplinary teams, and it is imperative to understand multidisciplinary viewpoints on hospital pharmacists' roles to guide role prioritization and organizational efficiency. However, no study extensively investigated multidisciplinary views on values of diverse pharmacist roles in tertiary settings. This study aims to address this gap by examining non-pharmacist health professionals' views on hospital pharmacists' roles, recognizing their specialized niches as a crucial step towards optimizing their roles and services in Australia and internationally. Multiple focus group discussions and interviews were held via a virtual conferencing platform. Study participants were recruited using the study investigators' professional networks who were non-pharmacist health professionals with experience working with pharmacists in hospital settings. Data were collected from transcripts of the focus group recordings, which were later summarized using descriptive statistics and thematic analysis. Overarching themes were categorized and mapped against work system models to conceptualize organizational implications of multidisciplinary feedback, linking them to patient and organizational outcomes. Twenty-seven health professionals participated across focus groups and interviews, with the majority of professions being doctors and nurses. Three major themes were identified as follows: (i) overarching perceptions regarding hospital pharmacists; (ii) professional niches of hospital pharmacists; and (iii) future opportunities to optimize hospital pharmacy services. Valued professional niches included patient and health professional educators, transition-of-care facilitators, and quality use of medicines analysts. The study highlights critical insights into hospital pharmacists' roles in Australia, identifying their niche expertise as vital to healthcare efficiency and success. Based on multidisciplinary feedback, the study advocates for strategic role optimization and targeted research for enhanced clinical, economic, and organizational outcomes.

Do Regulatory and Curriculum Requirements for Interprofessional Practice Align?

Background: While interprofessional (IP) competency and Interprofessional Education (IPE) has received increasing attention in health, agreement on specific competencies and teaching approaches is frequently limited by profession-specific understandings. As part of a quality improvement initiative focused on improving delivery of IPE offerings, this enquiry maps current regulatory and curricula requirements for IP practice to health professional students from 12 professions trained across Aotearoa New Zealand's national vocational education provider. Methods: Requirements for IP competency in national accreditation documents and in an operative teaching curricula were mapped for 12 professions, namely, clinical exercise physiology, counselling, massage, medical radiology, midwifery, nursing, occupational therapy, osteopathy, paramedicine, physiotherapy, social work, and sport and exercise science. A desk audit was conducted to identify the presence of core IP competencies for each profession. This involved a four-step process 1) Examination of regulatory standards for each profession to confirm IP requirements for each profession; 2) Examination of an operative curricula from each profession to identify the presence and translation of IP regulatory requirements to each of the profession-specific programs of study; 3) Mapping to identify within domains the core (common) IP competencies across the professions, and 4) Consideration of the similarities and differences between accreditation documents and curricula. Results: Of 12 professions, 10 clearly identified IP competency as an expectation. Clinical Exercise Physiology and Counselling were exceptions with explicit requirement for IP competency not evident. Coordination and collaboration were the most identified competency domains in accreditation documents and curricula. In descending order of prevalence, communication, shared values, reflexivity, role-understanding, and teamwork were also identified requirements amongst the 10 professions with IP competency requirements. Conclusion: The IP competencies identified as common across professions can be used to inform development of teaching and assessment. Greater alignment between teaching curricula and required competency standards in this area is recommended.

Defining conditions for effective interdisciplinary care team communication in an open surgical intensive care unit: a qualitative study.

OBJECTIVE: Poor interdisciplinary care team communication has been associated with increased mortality. The study aimed to define conditions for effective interdisciplinary care team communication. DESIGN: An observational cross-sectional qualitative study. SETTING: A surgical intensive care unit in a large, urban, academic referral medical centre. PARTICIPANTS: A total 6 interviews and 10 focus groups from February to June 2021 (N=33) were performed. Interdisciplinary clinicians who cared for critically ill patients were interviewed. Participants included intensivist, transplant, colorectal, vascular, surgical oncology, trauma faculty surgeons (n=10); emergency medicine, surgery, gynaecology, radiology physicians-in-training (n=6), advanced practice providers (n=5), nurses (n=7), fellows (n=1) and subspecialist clinicians such as respiratory therapists, pharmacists and dieticians (n=4). Audiorecorded content of interviews and focus groups were deidentified and transcribed verbatim. The study team iteratively generated the codebook. All transcripts were independently coded by two team members. PRIMARY OUTCOME: Conditions for effective interdisciplinary care team communication. RESULTS: We identified five themes relating to conditions for effective interdisciplinary care team communication in our surgical intensive care unit setting: role definition, formal processes, informal communication pathways, hierarchical influences and psychological safety. Participants reported that clear role definition and standardised formal communication processes empowered clinicians to engage in discussions that mitigated hierarchy and facilitated psychological safety. CONCLUSIONS: Standardising communication and creating defined roles in formal processes can promote effective interdisciplinary care team communication by fostering psychological safety.

Associations between demographics and clinical ideology, beliefs, and practice patterns: a secondary analysis of a survey of randomly sampled United States chiropractors.

BACKGROUND: The chiropractic profession in the United States (US) has a long history of intra-professional discourse surrounding ideology and beliefs. Large-scale efforts have evaluated 3 distinctive subgroups of US chiropractors focused on these areas of practice: spine/neuromusculoskeletal, primary care, and vertebral subluxation. To our knowledge, there have not been any prior studies exploring the factors associated with these ideology and belief characteristics of these subgroups. The purpose of this study was to explore, describe, and characterize the association of US chiropractors' ideology, beliefs, and practice patterns with: 1) chiropractic degree program of graduation, 2) years since completion of chiropractic degree, and 3) US geographic region of primary practice. METHODS: This was a secondary analysis of a cross-sectional survey of a random sample of US licensed chiropractors (n = 8975). A 10% random sample was extracted from each of the 50 states and District of Columbia chiropractic regulatory board lists. The survey was conducted between March 2018-January 2020. The survey instrument consisted of 7 items that were developed to elicit these differentiating ideologies, beliefs, and practice patterns: 1) clinical examination/assessment, 2) health conditions treated, 3) role of chiropractors in the healthcare system, 4) the impact of chiropractic adjustments [spinal manipulation] in treating patients with cancer, 5) vaccination attitudes, 6) detection of subluxation on x-ray, and 7) x-ray utilization rates. Multinomial regression was used to analyze associations between these 7 ideology and practice characteristic items from the survey (dependent variables) and the 3 demographic items listed above (independent variables). RESULTS: Data from 3538 respondents (74.6% male) were collected with an overall response rate of 39.4%. Patterns of responses to the 7 survey items for ideologies, beliefs, and practice characteristics were significantly different based on chiropractic degree program of graduation, years since completion of chiropractic degree, and geographic region of primary practice. CONCLUSIONS: Among US chiropractors, chiropractic program of graduation, years since completion of chiropractic degree, and geographic region of primary practice are associated with variations in clinical ideology, beliefs, and practice patterns. The wide variation and inconsistent beliefs of US chiropractors could result in public confusion and impede interprofessional integration.

Communication between consultants providing advice and referring physicians: a scoping review.

OBJECTIVE: Communication during consultations between referring and consultant physicians is often cited as a source of adverse events, medical error and professional incivility. While existing literature focuses on the role of referring physicians, few studies acknowledge the role of consultant physicians in enhancing communication during consultations. This scoping review aims to identify and synthesise available recommendations to enhance the communication practices of consultants during real-time consultations. DESIGN: A scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. DATA SOURCES: Medline, EMBASE and PsycINFO databases were searched from inception to August 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: English-language publications which describe recommendations, strategies or frameworks to improve the communication practices of consultant physicians during real-time consultations with referring physicians. DATA EXTRACTION AND SYNTHESIS: The search strategy included the following concepts: consultation, physician, communication, interprofessional relations and best practice. Two authors independently performed each phase of title and abstract screening, full-text review and data extraction. Discrepancies were resolved by a third author. Extracted data were iteratively analysed and summarised thematically. RESULTS: Sixteen publications met the inclusion criteria. Synthesis of available recommendations identified organisation, expertise and interpersonal skills as three overarching and interconnected dimensions of communication demonstrated by consultants during effective consultations. Twelve studies identified interpersonal skills as being critical in alleviating the widespread professional incivility that is reported during consultations. Existing recommendations to improve the communication practices of consultants are limited as they lack standardised interventions and fail to comprehensively address all three elements identified in this review. CONCLUSION: This scoping review synthesises available recommendations to improve the communication practices of consultant physicians during real-time consultations. An opportunity exists to develop communication tools or educational interventions based on the findings of this review to enhance interphysician consultation encounters.

Preparing for Death While Investing in Life: A Narrative Inquiry and Case Report of Home-Based Paediatric Palliative, End-of-Life, and After-Death Care.

Paediatric palliative care is pivotal for addressing the complex needs of children with incurable diseases and their families. While home-based care offers a familiar and supportive environment, delivering comprehensive services in this context is challenging. The existing literature on home-based palliative care lacks detailed guidance for its organization and implementation. This qualitative narrative inquiry explores the organization and provision of home-based paediatric palliative care. Data were collected from healthcare practitioners using conversations, storytelling, and reflective journaling. Schwind's Narrative Reflective Process was applied to synthesize the data, resulting in an in-depth case description. The narrative approach illuminates the complexities of home-based paediatric palliative, end-of-life, and after-death care. Key findings encompass the importance of early-care coordination, interprofessional collaboration, effective symptom management, emotional and psychosocial support, and comprehensive end-of-life planning. Through the case study of the child patient, the challenges and strategies for providing holistic, family-centred care within the home environment are described. Practical insights gained from this report can inform the development and improvement of home-based palliative care programs, benefiting researchers, practitioners, and policymakers seeking to optimize care for children and families in similar contexts.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study.

Introduction: Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital. Methods: This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. The questionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled "Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital" and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA. Results: Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (p<0.05) was found in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, p<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, p<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors. Conclusion: This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.