Collaboration among nurses when transitioning older adults between hospital and community settings: a scoping review.

BACKGROUND: The transitioning of older patients between healthcare sectors requires the provision of high-quality nursing care. Collaboration among nurses is identified as an essential element of transitional care, yet nurse-nurse collaboration has received little attention. AIM: The aim of this study was to examine the extent, range and nature of nurse-nurse collaboration when transitioning older patients between hospital and community settings, and to identify gaps in the literature. METHODS: Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) framework was used to undertake a scoping review to answer the research questions: how do nurses collaborate together when transitioning older patients from hospital to community settings and what are the facilitators, barriers and outcomes of nurse-nurse collaboration when transitioning older patients between sectors? The Nurse-Nurse Collaboration Scale (NNCS) subdomains informed the identification of selected studies. RESULTS: Twelve papers were included with most coming from Scandinavian countries and the majority using qualitative methodologies. Communication, coordination and professionalism were found to be both facilitators and barriers of nurse-nurse collaboration. Gaps in the literature included conflict management, and the outcomes of collaboration which was only reported in one study. CONCLUSIONS: The findings indicate there is limited study of collaboration among nurses when transitioning older patients between hospital and community settings. Future research should address the impact of conflict on nurses working in collaborative practice as well as conducting intervention studies to examine the outcomes of nurse-nurse collaboration.

Staff perceptions of collaboration on a new interprofessional unit using the Assessment of Interprofessional Team Collaboration Scale (AITCS).

The aim of this study was to obtain baseline information on staff attitudes and perceptions of interprofessional collaboration on a newly formed interprofessional education unit. The Assessment of Interprofessional Team Collaboration Scale (AITCS) was administered to 54 interprofessional team members on a 30-bed medical interprofessional education (IPE) unit. We found that the team members respected each other but felt they needed more organisational support to further develop team skills. Additionally, team members noted that they did not have enough time for team reflection or to make changes to the team processes. The results obtained from this study will help to develop and refine educational strategies to assist the staff working on the IPE unit.

Relational ethics in everyday practice.

Oncology nurses frequently encounter ethical issues in their everyday practice because of the complex needs of patients, which require the expertise of many health care providers. The involvement of various health care providers, as well as of the patient and family means there is the potential for differing views about what is best for the patient. The focus of this paper is to share a case history describing the ethical issues experienced by nurses and to illustrate how relational ethics can offer guidance for nurses caring for patients with cancer.

Collaboration among nurse practitioners and registered nurses in outpatient oncology settings in Canada.

AIM: This article is a report on a case study that described and analysed the collaborative process among nurse practitioners and registered nurses in oncology outpatient settings to understand and improve collaborative practice among nurses. BACKGROUND: Changes in the health system have created new models of care delivery, such as collaborative nursing teams. This has resulted in the increased opportunity for enhanced collaboration among nurse practitioners and registered nurses. The study was guided by Corser's Model of Collaborative Nurse-Physician Interactions (1998). DESIGN: Embedded single case design with multiple units of analysis. METHODS: Qualitative data were collected in 2010 using direct participant observations and individual and joint (nurse dyads) interviews in four outpatient oncology settings at one hospital in Ontario, Canada. FINDINGS: Thematic analysis revealed four themes: (1) Together Time Fosters Collaboration; (2) Basic Skills: The Brickworks of Collaboration; (3) Road Blocks: Obstacles to Collaboration; and (4) Nurses' Attitudes towards their Collaborative Work. CONCLUSION: Collaboration is a complex process that does not occur spontaneously. Collaboration requires nurses to not only work together but also spend time socially interacting away from the clinical setting. While nurses possess the conceptual knowledge of the meaning of collaboration, findings from this study showed that nurses struggle to understand how to collaborate in the practice setting. Strategies for improving nurse-nurse practitioner collaboration should include: the support and promotion of collaborative practice among nurses by hospital leadership and the development of institutional and organizational education programmes that would focus on creating innovative opportunities for nurses to learn about intraprofessional collaboration in the practice setting.

The ethics of interprofessional collaboration.

Interprofessional collaboration has become accepted as an important component in today's health care and has been guided by concerns with patient safety, quality health-care outcomes, and economics. It is widely accepted that interprofessional collaboration improves patient outcomes through enhanced communication among health-care providers and increased accessibility to services. Although there is a paucity of research that provides confirmatory evidence, interprofessional competencies continue to be incorporated into the curricula of health-care students. This article examines the ethics of interprofessional collaboration and ethical issues that arise from the mainstream adoption of interprofessional competencies and the potential for moral distress in nursing.

Nursing Care Delivery Models and Intraprofessional Collaborative Care: Canadian Nurse Leaders' Perspectives.

Introduction: There are many different types of nursing care delivery models used to organize and provide care in hospitals. These models are comprised of different organizational structures and staffing skill mixes. Objective: The aim of this study was to explore how nursing care delivery models promote intraprofessional collaborative care in acute care hospitals from the perspectives of nurse leaders. Methods: A qualitative descriptive approach was used for this study. Telephone interviews were conducted between January 2021 and August 2021 using an interview guide comprised of semi-structured and structured questions. Using a purposeful sampling technique, ten leaders from nine hospital systems, representing both urban and rural hospitals in the province of Ontario, Canada, participated in the study. Content analysis was conducted resulting in two overarching themes. Results: The first theme, Fluidity of the Model addresses the flexibility of the models and the impact of contextual factors such as changes in nurses' scope of practice, government funding changes, staffing mix, and organizational policies and rules. The second theme, Tools of the Trade describes the resources that hospitals implement to promote intraprofessional collaboration that indirectly impacts on patient safety. Conclusion: Nursing care delivery models need to be flexible and adaptable. All nursing care delivery models in this study used various tools to promote intraprofessional collaborative care.

An exploration of nurses' perceptions regarding the implementation of a best practice guideline on the assessment and management of foot ulcers for people with diabetes.

The aim of this qualitative study was to explore nurses' perceptions regarding the implementation of a best practice guideline (BPG) on the assessment and management of foot ulcers for people with diabetes. Fourteen nurses from a community care setting and three hemodialysis units participated in five focus groups and one individual interview. The findings focus on key points regarding the impact of BPG implementation in the areas of patient outcomes, nursing practice, and interdisciplinary teamwork.

A case management experience: implementing best practice guidelines in the community.

This article discusses the implementation of a best practice guideline (BPG) in a community setting using a case management model The role of the case manager is presented as well as the process of evaluation. Challenges to implementing a BPG in a community setting are also addressed.

Nursing care delivery models and outcomes: A literature review.

OBJECTIVE: The purpose of this literature review was to determine the types of nursing care delivery models currently being used in acute care hospitals to determine the effectiveness of the model and the outcomes being measured. METHOD: A literature search was conducted, and databases searched included CINAHL, Nursing and Allied Health, Medline, EMBASE, ProQuest Theses, and Dissertations for the years 2000-2020. Sixteen studies were retrieved. Patient outcomes measured included falls, adverse events, and infections. Nursing outcomes measured included satisfaction, communication, and perceived quality of care. RESULTS: Findings from this review showed there was no single model of nursing care delivery that resulted in positive patient or nurse outcomes, thus a "one size fits all" approach to selecting or utilizing a model of care is not realistic. CONCLUSION: Given the number of nursing care delivery models that were hybrids, clearer descriptions of each model and further research on patient and nursing outcomes is warranted.

Population trends toward increasing cardiovascular risk factors in Canadian adolescents.

OBJECTIVE: To determine prevalence and cross-sectional trends over time for cardiovascular risk factors in Canadian adolescents. STUDY DESIGN: Cross-sectional trends in cardiovascular risk and lifestyle factors were gathered annually in 14- to 15-year-old students in the Niagara region, Ontario, Canada. RESULTS: A total of 20 719 adolescents were screened between 2002 and 2008. The proportion of obese adolescents (>95th percentile for body mass index [BMI]) increased significantly, by +0.34%/year (P = .002). The proportions of adolescents with borderline high cholesterol (4.4-5.1 mmol/L) (+0.57%/year; P <.001) and with high cholesterol (≥5.2 mmol/L) (+0.43%/year; P <.001) both increased significantly over time. The proportion of adolescents with prehypertension decreased by -0.23%/year (P = .02), whereas the proportion of those with stage I hypertension (5%-6%) or stage II hypertension (2%-4%) remained constant. The proportion of adolescents classified as being at high cardiovascular risk increased by +0.67%/year (P <.001). Family history, low levels of physical activity, sedentary behaviors, poor nutrition, and lower socioeconomic status were all independently and negatively associated with all aspects of cardiovascular risk. CONCLUSIONS: A significant proportion of 14- to 15-year-old Canadian adolescents have at least one cardiovascular risk factor, and the cross-sectional trends worsened during the period 2002-2008.

Does it make a difference? Evaluation of a Canadian poverty reduction initiative.

Program evaluation is an important aspect of any organization. The ability to reflect on past performance and plan for the future is essential to an organization's health and future growth. This exploratory study is part of a larger program evaluation initiative that examined the efficacy of a regionally based organization that provided funding to community groups to alleviate poverty. The purpose of the study was to explore testimonials provided by participants of the organization's funded programs, to determine if the participants were satisfied with the programs and the extent to which participants' perceptions are congruent with the goals of the organization. Content analysis was used to examine 3494 testimonials from 77 different agencies. Three overall themes were determined from the analysis: 1 Developing Social Networks, 2 Learning Comes in Various Forms, and 3 Developing Self-Efficacy. Findings from the testimonials suggest that the benefits of the programs are highly social and that connections with others are important, but also provide rich opportunities for learning new skills and knowledge, as well as gaining confidence and a sense of control. The findings from this analysis support one goal of the organization which is to engage people living in poverty in meaningful ways.

Collaboration among Registered Nurses and Licensed Practical Nurses: A Scoping Review of Practice Guidelines.

Professional associations, nurse scholars, and practicing nurses suggest that intraprofessional collaboration between nurses is essential for the provision of quality patient care. However, there is a paucity of evidence describing collaboration among nurses, including the outcomes of collaboration to support these claims. The aim of this scoping review was to examine nursing practice guidelines that inform the registered nurse (RN) and registered/licensed practical nurse (R/LPN) collaborative practice in acute care, summarize and disseminate the findings, and identify gaps in the literature. Ten practice guidelines, all published in Canada, were included in the final scoping review. The findings indicate that many of the guidelines were not evidence informed, which was a major gap. Although the guidelines discussed the structures needed to support intraprofessional collaboration, and most of the guidelines mention that quality patient care is the desired outcome of intraprofessional collaboration, outcome indicators for measuring successful collaborative practice were missing in many of the guidelines. Conflict resolution is an important process component of collaborative practice; yet, it was only mentioned in a few of the guidelines. Future guidelines should be evidence informed and provide outcome indicators in order to measure if the collaborative practice is occurring in the practice setting.

Implementation of a diabetic foot management best practice guideline (BPG) in hemodialysis units.

The aim ofthis study was to examine the impact of introducing the Registered Nurses' Association of Ontario Best Practice Guideline (BPG), Assessment and management of foot ulcers for people with diabetes (2005), on foot ulcer incidence, recurrence, and amputation rate in adult diabetic clients who are undergoing chronic hemodialysis treatments. Fifty-seven individuals from three hemodialysis units participated in the study. Data were collected at three points in time over a 15-month period. A significant reduction in the number of wounds was noted (p < 0.05) from time one to time three, and the grade of wounds (p < 0.01). However, five new amputations were reported Although implementation of the BPG showed a positive patient outcome, further research needs to be conducted with a larger sample size.

Where Does the Patient Fit? An Analysis of Word Use Within the Context of Interprofessional Collaborative Care.

Patient-centeredness is considered central to interprofessional collaborative patient care as a participatory, partnered approach between health care professionals and patients. Content analysis of 501 articles from the 1986, 1987, 1988, 1996, 2006, 2013, 2014, and 2018 volumes of a selected journal was undertaken. The purposes were to identify contexts in which the term patient was used in articles with a primary focus on interprofessional care and to identify trends in its usage. With Dilthey's ideas on language as a framework, patient and its variations in the articles were coded under five categories. Findings suggest that the term patient appears predominantly as a modifier for activities enacted by experts and a platform for the discussion of relationships among professionals. There is limited evidence that use of the term patient fits within the context of partnership, suggesting that the language in published interprofessional collaborative research and discussion is currently largely expert, not patient-centered.

Collaboration among registered nurses and practical nurses in acute care hospitals: A scoping review.

AIM: This study examined the extent, range, and nature of registered nurse (RN) and practical nurse (PN) collaboration in acute care hospitals and identified research gaps in the existing literature. BACKGROUND: Optimal patient care requires collaboration between RNs and PNs. A lack of unity and unresolved tension among different types of nurses influences collaboration and has significant implications on practice and the organizations where nurses work. METHODS: Using Arksey and O'Malley's (2005) framework, a scoping review was undertaken to answer the research question: what is known from the existing literature about the structures, processes, and outcomes of RN-PN collaboration in hospitals? RESULTS: Twenty-nine studies were included with the majority coming from North America. Donabedian's model assisted with the identification of three themes: scope of practice, interpersonal skills, and nurse and patient-related outcomes. CONCLUSION: The findings demonstrate there is a paucity of research specific to RN-PN collaboration. Nurse administrators/managers play an important role in addressing the interpersonal skills of nurses and providing an ongoing education on collaboration in the practice setting. Additional studies should focus on the development of nursing collaborative practice models of patient care, the examination of interventions to improve RN-PN collaborative practice, and the assessment of outcomes relating to collaboration among nurses.

Practice readiness of new nursing graduates: A concept analysis.

Practice readiness is not well defined in the literature and its conceptualization fluctuates from one practice setting to the next. The lack of common perception of what it means to be "practice ready" across sectors (academia, practice, regulatory) creates difficulty in identifying the boundaries of the concept and promotes varying expectations. This paper reports a concept analysis on practice readiness using Rodgers' evolutionary method of concept analysis. Through searching CINAHL, PubMed, EBM Systematic Reviews, and ProQuest Dissertations and Theses, fifteen records were found and included in the analysis. Prominent surrogate terms included job readiness and readiness for practice while related terms included transition to practice and entry into the workplace. Attributes of practice readiness focused on cognitive, professional, and clinical capabilities, as well as self-efficacy. While antecedents comprised of maturity, clinical practice experience, and socialization to the discipline; consequences encompassed provision of safe care, performance confidence, and transitioning into the nursing role. This analysis highlights the technicalities of the nursing role pertaining to practice readiness, but overlooks the humanistic characteristics essential for providing quality care. There is a need for further development of the concept through intersectoral collaboration and exploration of humanistic characteristics as they relate to practice readiness.

Prevalence of cardiovascular risk factors in grade nine students.

BACKGROUND: The Niagara Schools' Healthy Heart Program (NSHHP) is a health education and intervention program offered to students enrolled in a grade nine physical education course. The program involves completion of a family history and a self-report lifestyle survey, measurements of height, weight, blood pressure, and random total cholesterol levels, a heart education class, and CPR training. PURPOSE: The purpose of this study was to report the prevalence of cardiovascular risk for adolescents enrolled in the program. METHODS: A secondary analysis was conducted using data collected by the NSHHP staff to determine the prevalence of cardiovascular risk factors in grade nine students for the school year 2006. Specific risk factors studied were smoking, body mass index, total cholesterol level and blood pressure. RESULTS: A total of 3,639 students from 30 schools participated. Almost 14% of students had at least one cardiovascular risk factor. Body mass index was found to be the highest risk factor (13.7%) and total random cholesterol level (5%) was found to be the lowest risk factor in this sample. There were differences in prevalence rates between male and female students for all risk factors except elevated blood pressure. Five per cent of the students were referred to a family physician for follow-up, mostly for high cholesterol readings. CONCLUSIONS: The findings suggest that adolescents do have cardiovascular risk factors and prevention could be targeted to this population. These risk factors were already established by the time the students reached adolescence. The findings support conducting early prevention with younger children and adolescents.

A Power Experience: A Phenomenological Study of Interprofessional Education.

The purpose of this supplementary analysis of a hermeneutic phenomenological study of the experience of interprofessional collaboration for nursing and medical students was to explore the experience of power that was threaded throughout the original study. Seventeen students participated in guided, face-to-face conversations in the original study (Prentice, Engel, Taplay, & Stobbe, 2014). Through the processes of deductive analysis and inductive reasoning, 2 themes of power emerged from these research conversations: (a) complicated knowledge is power and (b) the power and silence of intimidation. These themes suggest that power and power differentials are significant factors in student interactions in interprofessional learning and have the potential to adversely affect these interactions. Students' perceptions of power need to be taken into account and addressed when planning and implementing interprofessional education events.