La conciencia y la esencia del médico en dos películas / The Physician’s Conscience and Essence through Two Films

Dos películas -una española ambientada en Colombia, la otra belga- que tienen un denominador común, y provocan un cuestionamiento vocacional: ¿Cuál es el sentido de ser médico? ¿Por qué elegir esta profesión? Y, a continuación, la pregunta lógica: ¿Cómo formar médicos hoy en día, cuando parece que el sistema no ayuda? La construcción del profesionalismo médico enfrenta desafíos únicos que ven de dentro del sistema sanitario. La atención está centrada en procesos y resultados, y el paciente es, con mucha frecuencia, olvidado. El enfermo se transforma en un detalle o, peor, en un elemento que problematiza el sistema, diseñado para situaciones teóricas, sin contemplar la necesaria imprevisibilidad del ser humano. La solución posible sugiere la necesidad de formar una cultura en grupo, trabajar en conjunto con profesionales que son felices, y tiene orgullo de ser médicos y dedicarse vocacionalmente a cuidar de los pacientes. El médico es una conciencia frente a una confianza que el paciente le otorga. Por eso, reflexionar sobre la práctica médica es fundamental para el aprendizaje y el despertar de esta conciencia profesional. Sólo cuando pensamos en nuestro desempeño, en cómo aprendemos de cada encuentro con el paciente, podemos mejorar y adquirir nuevas actitudes. Postura que es integridad y al mismo tiempo dedicación y cuidado amoroso, donde se injerta la verdadera competencia y sabiduría, como la demostrada por los médicos ejemplares de todas las épocas. Aprender, que la sabiduría no es sólo saber las cosas, sino también amarlas. (AU)

Two films -one Spanish set in Colombia, the other Belgian- that have a common denominator, and provoke a vocational questioning: What is the meaning of being a doctor? Why we choose this profession? And then, the logical question: how to train doctors today, when it seems that the system does not help? Building medical professionalism faces unique challenges that come from within the healthcare system. Attention is focused on processes and results, and the patient is very often forgotten. The patient becomes a detail or, worse, an element that problematizes the system, designed for theoretical situations, without contemplating the necessary unpredictability of the human being. The possible solution suggests the need to form a culture-group, able to work together with professionals who are happy and proud to be doctors and dedicate themselves to caring for patients. The doctor is a conscience in the face of a trust that the patient gives him. For this reason, reflecting on medical practice is essential for learning and awakening this professional awareness. Only when we think about our performance, about how we learn from each encounter with the patient, we can improve and acquire new attitudes. Posture that is integrity and at the same time dedication and loving care, where true competence and wisdom are grafted, as demonstrated by exemplary doctors of all times. And at the bottom, to learn that wisdom is not only knowing things, but also loving them. (AU)

Interprofessional collaboration in telemedicine for long-term care: An exploratory qualitative study.

BACKGROUND: Widespread and sustained adoption of telemedicine in long-term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations. AIMS: To explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations. METHODS: A qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi-structured online interviews were conducted, and data were thematically analyzed. RESULTS: Three themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision-making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse-physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians. CONCLUSION: Interprofessional collaboration in teleconsultations is challenging because of lack of in-person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international-dominated healthcare workforce in long-term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse-physician collaborative practice. CLINICAL RELEVANCE: Telemedicine is increasingly adopted in long-term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.

Inter-professional collaboration and associated factors among nurses and physicians in specialized public hospitals, the northwest, Ethiopia: mixed method multi-centered cross-sectional study.

OBJECTIVE: The study aimed to investigate inter-professional collaboration and associated factors among nurses and physicians working in referral and teaching hospitals in the Northwest and Ethiopia in 2022. METHOD: This study used a concurrent (quantitative cross-sectional and phenomenological qualitative) design from September to October 2022. A structured, self-administered nurse-physician collaborative scale questionnaire was used to collect quantitative data from 279 nurses and 87 physicians. A simple random sampling technique was used to select participants. The magnitude of the association was measured using the odds ratio at a 95% confidence interval and was statistically significant at a p-value less than 0.05 using binary logistic regression analysis. Qualitative data were collected from nine key informants via focused interviews or semi-structured in-depth interviews and analyzed using ATLAS.ti version 7.0.7 software via narratives using the thematic analysis method. RESULT: According to the study's findings, a greater number (43.4%) of the respondents had ineffective collaboration during their professional activities. In the final model of multivariable analysis, unsatisfactory organizational support, poor professional support, and poor interpersonal support were all independently associated with ineffective collaboration. The qualitative findings identified poor communication, a lack of professionalism, and failure to adhere to professional duties as barriers to nurse-physician collaboration. CONCLUSION: In this study, nurse-physician collaboration was less than expected; thus, the large number of participants had ineffective collaborations. Potential predictors of decreased effective nurse-physician collaboration included dissatisfaction with organizational support, poor professional support, and poor interpersonal support. This outcome emphasizes the importance of improving nurse-physician collaboration by enhancing organizational, professional, and interpersonal factors to form effective collaborative practice. The qualitative finding supports the quantitative study, which showed ineffective collaboration. The authors recommended that there is a need to empower interprofessional collaboration among nurses and physicians through the creation of a conducive and safe working environment.

La colaboración interdisciplinar en las unidades de cuidados intensivos / Interdisciplinary collaboration in intensive care units from the experience of nurses

Objetivo: Comprender la experiencia vivida por las enfermeras que trabajan en las UCI polivalentes de un hospital de tercer nivel de la ciudad de Barcelona en relación con la colaboración interprofesional. Metodología: Diseño cualitativo exploratorio, multicéntrico de tipo descripción interpretativa. El ámbito de estudio fue cuatro UCI polivalentes de cuatro hospitales públicos y universitarios de tercer nivel. La muestra estuvo formada por 8 enfermeras. El muestreo teórico de variación máxima. La técnica de obtención de información fue el grupo de discusión con grabación de audio. Se realizó un análisis temático de contenido. Se siguieron los criterios de confiabilidad y autenticidad, así como el proceso de reflexividad durante todo el estudio. El estudio fue aprobado por el Comité de Ética de Investigación Clínica (CEIC). Resultados: Emergieron 2 grandes temas: la definición de colaboración interprofesional y propuestas de futuro. Las enfermeras consideran que la confianza y el respeto son la base de la colaboración interprofesional y aseguran la continuidad de los objetivos planificados. La comunicación y la relación entre iguales son dos de los factores que intervienen en la colaboración interprofesional. Es necesario cambiar de una jerarquía convencional a una visión compartida que mejoraría la participación de las enfermeras. Conclusiones: Los grandes pilares de la colaboración interdisciplinar son la comunicación efectiva y el trabajo en equipo, basado en la confianza y el respeto. Las líneas futuras de trabajo van enfocadas a la formación interdisciplinar de los futuros profesionales, la implantación real del pase conjunto y la mejora del clima laboral. (AU)

Purpose: Understanding the nurses experience who work in the ICUs of a high complexity hospital in Barcelona in relation to interprofessional collaboration. Methodology: Interpretative description by a qualitative exploratory and multicenter design. The study area was four ICUs from four high complexity, public and universitary hospitals. The sample consisted of 8 nurses. Theoretical sampling of maximum variation was used. The information gathering technique was the discussion group with audio recording. A thematic content analysis was carried out. The criteria of reliability and authenticity, as well as the process of reflexivity, were followed throughout the study. The study was approved by the Clinical Research Ethics Committee (CEIC). Results: Two major themes emerged: the definition of interprofessional collaboration and proposals for the future. Nurses consider that trust and respect are the basis of interprofessional collaboration and ensure the continuity of planned objectives. Communication and the relationship between equals are two of the factors involved in interprofessional collaboration. It is necessary to change from a conventional hierarchy to a shared vision that would improve the participation of nurses. Conclusions: The great pillars of interdisciplinary collaboration are effective communication and teamwork, based on trust and respect. Future lines of work are focused on the interdisciplinary training of future professionals, the actual implementation of the clinical sessions and the improvement of the work environment. (AU)

Interprofessional team-based collaboration between designated GPs and care home staff: a qualitative study in an urban Danish setting.

BACKGROUND: Being a general practitioner for residents in many care homes may challenge communication with residents, relatives, and care home staff, and potentially lead to lower quality of care. Several countries have therefore introduced different solutions to reduce the number of general practitioners at each care home. In 2017, the designated general practitioner model was introduced at many Danish care homes. This study aimed to evaluate experiences from the interprofessional team-based collaboration between designated general practitioners and care home staff with regular contact with the designated general practitioners in an urban Danish setting. METHODS: A qualitative design was applied using semi-structured interviews. Eight interviews (three group interviews and five individual interviews) were conducted with four designated general practitioners and seven care home staff members at four care homes in an urban setting of Central Denmark Region, Denmark. The interviews were transcribed verbatim, and data were analysed using content analysis with inspiration from the theory of relational coordination. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework. RESULTS: The initiation of the designated general practitioner model was experienced to contribute to more clear, precise, and timely communication between care homes and the general practitioner. An improved mutual acknowledgement of roles and competencies was experienced between designated general practitioners, care home nurses, and sometimes also social and health care assistants. The more frequent visits by the general practitioners at the care homes, as a result of the designated general practitioner model, resulted in more face-to-face communication between care home staff and designated general practitioners. Professional differences in the interpretation of the patient's needs were still present, which at times caused a frustrating compromise of own professional competencies. An important reason for the overall perception of improved collaboration was attributed to the more frequent dialogue in which the care homes staff and the designated general practitioners exchanged knowledge that could be applied in future patient encounters. CONCLUSION: The designated general practitioner model implied an improved collaboration between general practitioners and care homes staff. Clear, precise, and timely communication between care homes and the general practitioners, as well as mutual trust and acknowledgement was experienced to be essential for the collaboration. An important reason for the overall perception of an improved collaboration was attributed to the more frequent dialogue (more frequent general practitioner visits at the care homes) in which the care homes staff and the designated general practitioners exchange knowledge which again could be applied in future patient encounters.

Physician-Nurse and Nurse-Nurse Collaboration From the Perspective of Nurses: A Cross-Sectional Study.

The study aims to determine the physician-nurse and nurse-nurse collaboration levels of nurses and effective factors. A cross-sectional study was conducted with a sample of 477 nurses from five hospitals using a questionnaire. It was determined that the characteristics of working life explained 10% of the Nurse-Nurse Collaboration Scale and the regression model between variables and the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was not statistically significant. Physician-nurse and nurse-nurse collaboration are affected by a variety of factors.

Organizational support and Nurse-Physician collaboration during SARS-CoV-2 pandemic: A qualitative study.

Health care professionals experienced multiple uncertainties during the pandemic. Exploring health care professionals' views about collaboration and organizational support can offer insights into organizational processes and issues during the pandemic. This research explored the perspectives of nurses and physicians about organizational support and nurse-physician collaboration during the SARS-CoV-2 pandemic. Using a qualitative descriptive design, interviews were conducted with nurses and physicians working in hospital settings. The interviews lasted for 24-61 min. Reflexive thematic analysis was used for data analysis. Nurses and physicians were disappointed with the organizational support, but they were satisfied with nurse-physician collaboration. The theme "Management Abusing Authority and Blaming the Victimized Workforce" included organizational nepotism, unethical managerial actions, and neglecting frontline workforce. Nurses and physicians supported each other in tackling the intensive and complex demands of the pandemic. The theme "Demonstrating Professional Humility and Overcoming Patient Care Issues at Hand" entailed subthemes - negotiating conflicts and prioritizing patient care, practicing kindness, and jointly managing conflicts with patients' families. Nurses and physicians reported frustrations with limited organizational support and abusive practices of managers. Still, they prioritized patient care needs and family-related conflicts over interprofessional tensions.

The contribution of professional autonomy in advancing ethical behaviour: A narrative review of studies in nursing.

AIM: This article explores moral disagreements between nurses and physicians; specifically, we aim to analyse professional nurses' practice in navigating these conflicts. BACKGROUND: Nurses face morally challenging situations while caring for patients when their views on treatments and care may contradict those of physicians. It is important that nurses represent patients' perspectives and are partners in the care decision-making process. EVALUATION: A narrative review was conducted by including peer-reviewed articles in English. A literature search was conducted using the Web of Science database and Google Scholar search engine from 1 December 2021 to 10 February 2022. KEY ISSUES: A total of 27 articles published between 2009 and 2021 were included in the analysis. The following themes were explored in this article: areas in which moral disagreements occur and how these disagreements shape physician-nurse relationships, differences in the status of professional autonomy in nursing in the Baltic states and Nordic countries, and potential directions for nurses' involvement in the decision-making process regarding moral disagreements in nursing practice. CONCLUSIONS: Moral disagreements between nurses and physicians most often occur in situations related to treatment and/or care strategies as well as end-of-life decisions. Nurses' participation in the decision-making process and physicians' willingness to consider nurses' perspectives play a fundamental role in navigating moral conflicts because nurses possess a body of knowledge about their patients that differs from that of physicians. This knowledge is just as worthy as physician knowledge. Considering the level of professional autonomy in specific regions, nurses' involvement in decision-making regarding particular patients' care in the Baltic states seems to be relatively low compared to that in the Scandinavian countries, where nurses have a much wider space for independent decision-making. IMPLICATIONS FOR NURSING MANAGEMENT: Complex moral situations that require the input of both physicians and nurses must be examined and addressed. Several processes may assist in fostering nurses' contributions to decision-making, among which training to effectively deal with morally complex situations and creating an atmosphere conducive to collaboration between physicians and nurses are particularly important.

Interprofessional Precepting: A Nursing-Medicine Partnership.

Interprofessional precepting can advance team-based collaboration. We evaluated the impact of nurse-led precepting of medical students on perceptions of nurse-physician relationships. Forty-six frontline nurses precepted 73 third year medical students in New York for a three-part clinical and classroom experience. Nurse preceptor and medical student attitudes toward healthcare teams and medical student attitudes toward nurse-physician collaboration improved after participation using validated scales. This pilot study suggests nurse-led interprofessional precepting can improve attitudes toward interprofessional collaboration.

State-level scope of practice regulations for nurse practitioners impact work environments: Six state investigation.

Nurse practitioner (NP) scope of practice (SOP) policies are different across the United States. Little is known about their impact on NP work environment in healthcare organizations. We investigated the association between SOP policies and organizational-level work environment of NPs. Through a cross-sectional survey design, data were collected from 1244 NPs in six states with variable SOP regulations (Arizona, New Jersey, Washington, Pennsylvania, Texas, and California) in 2018-2019. Arizona and Washington had full SOP-NPs had full authority to deliver care. New Jersey and Pennsylvania had reduced SOP with physician collaboration requirement; California and Texas had restricted SOP with physician supervision requirement. NPs completed mail or online surveys containing the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has these subscales: NP-Administration Relations (NP-AR), NP-Physician Relations (NP-PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models assessed the relationship between state-level SOP and practice-level NP work environment. NP-AR scores were higher in full SOP states compared to reduced (ß = 0.22, p < 0.01) and restricted (ß = 0.15, p < 0.01) SOP states. Similarly, IPS scores were higher in full SOP states. The PV scores were also higher in full SOP states compared to reduced (ß = 0.16, p < 0.001) and restricted (ß = 0.12, p < 0.05) SOP states. There was no relationship between SOP and NP-PR score. State-level policies affect NP work environment. In states with more favorable policies, NPs have better relationships with administration and report more role visibility and support. Efforts should be made to remove unnecessary SOP restrictions.

A qualitative exploration of nurse-physician collaboration in intensive care units.

BACKGROUND: Effective nurse-physician collaboration is associated with superior patient outcomes and improved job satisfaction for both nurses and physicians. OBJECTIVES: This qualitative study explored factors that contribute to nurse-physician collaboration in critical care. Using a qualitative descriptive design, in-depth interviews were conducted with intensive care unit physicians and nurses. Four physicians and six nurses were interviewed between November 2018 and February 2019. Using an iterative process, data analysis occurred after each interview and Lincoln & Guba's Trustworthiness criteria was used to establish validity. FINDINGS: The importance of effective collaboration was emphasized by all nurses and physicians who participated in this study. All participants emphasized the importance of communication and linked effective collaboration to better patient outcomes. Nurses valued respect while physicians stressed the importance of relationships. Both nurses and physicians identified multidisciplinary rounds as the best mechanism for collaboration. Collaboration was also linked to both nurse and physician job satisfaction. CONCLUSION: Effective nurse-physician collaboration is essential to a healthy work environment and optimal patient outcomes. Collaboration improves with the implementation of multidisciplinary rounds. This is the first study to examine this relationship using a qualitative approach. Regardless of health system, both nurses and physicians value effective collaboration. Efforts should be made to invest in activities to improve this relationship. IMPACT: Intenisve care units with effective collaboration are associated with superior patient outcomes. This study used an intimate approach to examine nurses' and physicians' perceptions on collaboration which provided candid and provoking opinions.

Expanding nurses' authority - Physicians' and nurses' attitudes.

AIM: To examine and compare the attitudes of physicians and registered nurses regarding extending nurses' authority. DESIGN: This was a comparative quantitative study, which used a questionnaire that examined the attitudes of nurses and physicians regarding expanding nurses' authority. METHODS: The study comprised a sample of 134 nurses (62.7%) and physicians (37.3%), who filled out the self-report questionnaire that included sociodemographic data and questions designed to examine the participants' attitudes and perceptions on expanding nurses' authority. The general reliability of the questionnaire was Cronbach's α = 0.931. Participants were sampled through the convenience-snowball method. RESULTS: Differences were found between the attitudes of physicians and nurses to expanding nurses' authority. Nurses tended to be in favor, whereas physicians tended to be against (t(86.29) = 7.713; p < 0.05). Nurses' attitudes are also more positive specifically to procedures related to drug administration (t(132) = 6.894; p < 0.05) and resuscitation (t(132) = 2.974; p < 0.05), compared to physicians. CONCLUSIONS: Nurses have more positive attitudes toward expanding nurses' authority than physicians do, specifically toward drug administration and resuscitation. Further study is proposed to identify factors which affect the physician-nurse relationship and attitudes on a large scale through a qualitative study.

Stakeholders' perceptions of how nurse-physician communication may impact patient care: protocol for a concept mapping study.

Effective nurse-physician interprofessional communication is important to ensure that patients receive evidence-based care and treatment. There is a gap in knowledge about how nurse-physician communication impacts patient care. We propose using concept mapping to develop an in-depth understanding of patients, nurses, and physicians' perspectives on how physician-nurse communication affects patient care. There are six phases to concept mapping: determining the focus, generating statements, structuring statements, producing the map, interpretating the map, and map utilization. We will use 'Ariadne', a concept mapping software package for data collection and analysis. The study outcome will be a two-dimensional concept map providing a visual representation of how nurse-physician communication influences patient care. We will report similarity and differences among three stakeholder groups. Our research will inform the development of testable hypotheses about nurse-physician communication and patient care.

Disruptive behavior in a high-power distance culture and a three-dimensional framework for curbing it.

BACKGROUND: Disruptive behavior can harm high-quality care and is prevalent in many Western public health systems despite increasing spotlight on it. Comparatively less knowledge about it is available in Asia, a region commonly associated with high-power distance, which may limit its effectiveness in addressing disruptive behavior. PURPOSE: The aim of this study was to develop a comprehensive framework for tackling disruptive behavior among health care professionals in a public health system. METHODOLOGY: A nationwide cross-sectional study relying on the Nurse-Physician Relationship Survey was conducted in Singapore. Four hundred eighty-six public health care professionals responded. RESULTS: Two hundred ninety-eight doctors (95.5%) and 163 nurses (93.7%) had witnessed a form of disruptive behavior. Doctors observed disruptive behavior committed by other doctors and nurses much more frequently than did nurses. Doctors made stronger associations between disruptive behavior and negative employee outcomes and between disruptive behavior and negative patient outcomes. Qualitative analyses of participants' open-ended answers produced a multipronged three-dimensional approach for tackling disruptive behavior: (a) deterrent measures, (b) development of knowledge and skills, and (c) demonstration of organizational commitment through proper norms, empathizing with staff, and structural reforms. PRACTICE IMPLICATIONS: Disruptive behavior is a multifaceted problem requiring a multipronged approach. Our three-dimensional framework is a comprehensive approach for giving health care professionals the capability, opportunity, and motivation to address disruptive behavior effectively.

La presencia: el poder terapéutico de habitar el presente en la práctica clínica / Presence: the therapeutic power of inhabiting the present in clinical practice

Como agentes de salud discípulos de una cosmovisión eminentemente materialista y con escasa atención a nuestro mundo interior, los profesionales sanitarios, a menudo desconocemos del potencial de nuestra presencia en el marco del encuentro terapéutico. Este artículo pretende profundizar sobre nuestra capacidad de estar presentes frente al desconocido que sufre, entendida como una condición inherente a todo ser humano y como una facultad que todos podemos reconocer, explorar y cultivar para ponerla al servicio de nosotros mismos y de aquellos a quienes acompañamos. Desde el reconocimiento del profesional como su propia herramienta terapéutica, se introducen los riesgos y oportunidades de la relación de ayuda, el rol de las emociones en el encuentro, el concepto de presencia terapéutica y el papel de la autoconciencia del profesional. Se recogen algunas referencias expertas sobre la presencia terapéutica. Se describen las bases neurofisiológicas y las características de la presencia y su papel en la co-regulación con el paciente. Y finalmente se hacen algunas propuestas para el cultivo de la presencia (AU)

As health agents, disciples of an eminently materialistic worldview, and with little attention to our inner world, health professionals are often unaware of their presence’s potential in the framework of the therapeutic encounter. This paper aims to deepen in their ability to be present in front of an unknown suffering person, understanding this ability as an inherent condition of every human being and as a faculty that we can all recognize, explore and cultivate in order to serve ourselves and those we care for. The risks and opportunities of the helping relationship, the role of emotions in the encounter, the concept of the therapeutic presence and the role of the professional’s self-awareness are introduced from the recognition of the professional as their own therapeutic tool. Some expert references on the therapeutic presence are also collected. The neurophysiological bases and the characteristics of the presence and their role on the co-regulation with the patient are described. Finally, some proposals are given for the presence cultivation (AU)

Practice environment, independence, and roles among DNP- and MSN-prepared primary care nurse practitioners.

BACKGROUND: Many nursing schools are adopting the Doctor of Nursing Practice (DNP) as the preferred model of nurse practitioner (NP) education and eliminating Master of Science in Nursing (MSN) programs. To date, no studies have explored the relationship between DNP preparation and NP practice environment, independence, and roles. PURPOSE: The purpos of this study is to compare practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs. METHODS: This study used a cross-sectional design and observational regression analysis of survey data. FINDINGS: DNP-prepared NPs reported: 1) more favorable NP-Physician Relationships, 2) fewer clinical hours, and 3) more practice leadership. These differences were, however, small and not significant at 0.05 level. DISCUSSION: We found no major differences in practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs. As more nursing schools establish DNP programs and more DNP-prepared NPs enter the field, it is especially important to continue to study the impact of DNP preparation on the NP workforce.