How theories of complexity and resilience affect interprofessional simulation-based education: a qualitative analysis of facilitators' perspectives

Background Quality of care and patient safety rely on the ability of interprofessional teams to collaborate effectively. This can be trained through interprofessional simulation-based education (IPSE). Patient safety also relies on the ability to adapt to the complexity of such situations, an ability termed resilience. Since these needs are not explicitly addressed in IPSE, the aim of this study was to explore how central concepts from complexity-theory and resilience affect IPSE, from facilitators’ perspective, when applied in debriefings. Methods A set of central concepts in complexity-theory and resilience were introduced to facilitators on an IPSE course for nursing and medical students. In five iterations of focus groups interviews the facilitators discussed their application of these concepts by reviewing video recordings of their own debriefings. Video recordings of the interviews were subjected to coding and thematic analysis. Results Three themes were identified. The first, Concepts of complexity and resilience are relevant for IPSE, points to the applicability of these concepts and to the fact that students often need to deviate from prescribed guidelines/algorithms in order to solve cases. The second theme, Exploring complexity, shows how uncertainty could be used as a cue to explore complexity. Further, that individual performance needs to account for the context of actions and how this may lead to certain outcomes. Moreover, it was suggested that several ways to approach a challenge can contribute to important insight in the conditions for teamwork. The third theme, Unpacking how solutions are achieved, turns to needs for handling the aforementioned complexity. It illustrates the importance of addressing self-criticism by highlighting how students were often able to overcome challenges and find solutions. Finally, this theme highlights how pre-defined guidelines and algorithms still work as important resources to help students in transforming perceived messiness into clarity. Conclusions This study suggests that IPSE provides the possibility to explore complexity and highlight resilience so that such capability can be trained and improved. Further studies are needed to develop more concrete ways of using IPSE to account for complexity and developing resilience capacity and to evaluate to what extent IPSE can provide such an effect.publishedVersio

Patients prefer clinical handover at the bedside; Nurses do not: Evidence from a Discrete Choice Experiment

Background: Shift-to-shift bedside handover is advocated as a patient-centred approach, yet its enactment is challenging. Objectives: To describe and compare the preferences of both patients and nurses in the implementation of bedside handover in a Swedish University Hospital. Design: A discrete choice experiment (DCE) survey. Settings: University setting, four medical wards in two hospitals. Participants: Adult medical patients (n = 218) and registered nurses (n = 101) Methods: The survey was administered by an electronic tablet-assisted face-to-face survey. Respondents made repeated choices between two hypothetical bedside handover alternatives and a third alternative of ‘handover away from the bedside’. Handover alternatives were described according to six attributes: invitation to participate, number of nurses present at the handover, family member, carer or trusted friend (of the patient) allowed to be present, level of (patient) involvement, what information related to your (patient) care is discussed. Choice data were analyzed using a mixed logit model. Results: A total of 1308 (patients) and 909 (nurses) choice observations were included in the preference models. Patients showed a strong preference for handover at the bedside compared to nurses. Nurses generally preferred handover away from the bedside. Patients perceived their level of involvement in handover as highly important, being able to speak, hear what was said being the most important characteristic, closely followed by being invited to participate and asked questions as well as being heard. Nurses considered patients being invited to participate most important, followed by level of involvement. Different options for handing over sensitive information were not perceived of importance by patients or nurses. There was substantial variation at the individual level across both patients and nurses for where and how handover is delivered. Conclusions: In this study, patients strongly preferred handover at the bedside, while the nurses considered patients to be invited to participate to be the most important preference but generally preferred handover to take place away from the bedside, all else equal. When implementing bedside handover in a Swedish context this must be considered, although participation is a prerequisite for bedside handover. Differences between patients and nurses’ preferences could jeopardize future introduction of bedside handover in Swedish health care, and might explain why bedside handover is still not very common in hospital wards

Patient preferences for participation in patient care and safety activities in hospitals

BackgroundActive patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. The aim of the study was to explore hospitalised patients&rsquo; preferences on participation in their care and safety activities in Sweden.MethodsExploratory qualitative study. Data were collected over a four-month period in 2013 and 2014. Semi-structured interviews were conducted with 20 patients who were admitted to one of four medical wards at a university hospital in Sweden. Data were analysed using thematic analysis.ResultsNine men and eleven women, whose median age was 72 years (range 22&ndash;89), were included in the study. Five themes emerged with the thematic analysis: endorsing participation; understanding enables participation; enacting patient safety by participation; impediments to participation; and the significance of participation. This study demonstrated that patients wanted to be active participants in their care and safety activities by having a voice and being a part of the decision-making process, sharing information and possessing knowledge about their conditions. These factors were all enablers for patient participation. However, a number of barriers hampered participation, such as power imbalances, lack of patient acuity and patient uncertainty. Patients&rsquo; participation in care and patient safety activities seemed to determine whether patients were feeling safe or ignored.ConclusionThis study contributes to the existing literature with fundamental evidence of patients&rsquo; willingness to participate in care and safety activities. Promoting patient participation begins by understanding the patients&rsquo; unique preferences and needs for care, establishing a good relationship and paying attention to each patient&rsquo;s ability to participate despite their illness.<br /

Quality of life in inflammatory bowel diseases : Aspects on interventions and unconventional treatments

Crohn s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) of unknown aetiology and characterized by periods of remission and exacerbation. Disabling bowel symptoms, untoward effects of treatments and interventions, the risk of developing colorectal cancer in longstanding UC, ignorance of the disease, disappointment in conventional medicine, all these features may influence the patient s health related quality of life (HRQOL) in various ways. The aims of this study were to assess the attitudes to and the use of complementary and alternative medicine (CAM) among patients with IBD, and to evaluate interventions such as a group based educational programme, colonoscopic surveillance, treatment with leukocyte apheresis and its effect on HRQOL, functional health status, general state of health as well as anxiety and coping ability in patients with IBD. Two hundred and eighty-nine IBD patients in four different countries answered a self-administered questionnaire concerning the use of and attitudes to CAM. Fifty-one percent used some form of alternative therapy. The usage was higher in North America than in Europe. The six most commonly used therapies were: exercise (28%), prayer (18%), counselling (13%), massage (11%), chiropractic (11%) and relaxation (10%). Only 7% used acupuncture or homeopathy and 5% used herbal medicine. Forty-one patients with longstanding, extensive/total UC in remission undergoing colonoscopic colorectal cancer (CRC) surveillance were compared with two groups of UC patients not undergoing surveillance. Four self-administered questionnaires were used: Sickness Impact Profile (SIP), Health Index (HI), State Trait Anxiety Inventory (STAI) and Sense of Coherence (SOC). No significant differences between the groups studied were found using any of the questionnaires nor before or after the colonoscopy. Thirty-four UC patients underwent weekly one hour apheresis sessions with a selective leukocyte adsorptive device for five consecutive weeks. HRQOL was measured by the Inflammatory Bowel Disease Questionnaire (IBDQ) before, at week 3, and after treatment. The mean IBDQ increased from 138 (range 97-208) at start to 154 (95-214) at week 3 (p=0.001) and 163 (117-216) after treatment (p=0.0006). When analysed separately, the IBDQ bowel, systemic and emotional dimensions improved significantly during the study. Forty-four IBD patients in remission or with low disease activity were randomized to a group-based medical and psychological/psychosocial intervention or to a control group. The intervention comprised nine weekly sessions with lectures and psychological/psychosocial group treatment. HRQOL was measured by the IBDQ and coping by the SOC before, at 6 and 12 months. The control patients received conventional medical and psychosocial treatment. No significant change was observed for IBDQ before (173.9) and after the intervention at month 6 (175.7), or at month 12 (171.8) or when comparing intervention (171.8) and controls (173.7) at month 12. Similarly, no significant differences in SOC scores were observed. However, the mean values from a visual analogue scale (VAS) and the results from a content analysis showed a positive trend. There is an increased interest in CAM among IBD patients, and this may reflect the patients disappointment of conventional medicine. Complicated and invasive interventions such as colonoscopic surveillance (for detecting CRC), and selective leukocyte apheresis do not seem to impair HRQOL in UC patients. A group based medical and psychological/psychosocial intervention was highly appreciated in IBD patients, but no effect on HRQOL could be demonstrated by using standard HRQOL or coping measurements

Experiences of complementary and alternative medicine in patients with inflammatory bowel disease - a qualitative study

BACKGROUND: The use of Complementary and Alternative Medicine (CAM) in Inflammatory Bowel Disease (IBD) is increasing. Although CAM often improves patients' well-being, it can also lead to side-effects and interactions with conventional medications. Research on patients with IBD in Sweden who have experiences of CAM is sparse. More studies are needed to enhance awareness of and improve communication about CAM. The aim of this study was to describe experiences of CAM in the healthcare context reported by patients with IBD. METHODS: Fifteen patients with IBD, eight with Crohn's disease (CD) and seven with ulcerative colitis (UC), were recruited. Semi-structured qualitative interviews were conducted and qualitative content analysis was performed. RESULTS: The analysis revealed the theme Knowledge and communication lead to participation in the area of CAM based on three categories; CAM use, Communication and Self-care. Patients with IBD wanted to be asked about CAM to be able to start a dialogue, as some perceived being treated in a disparaging manner and not taken seriously when raising the subject. Healthcare professionals (HCPs) need to be aware of this in order to meet and understand patient needs. Patients with IBD found it easier to communicate about CAM with the IBD nurses than physicians and dietary changes was one important CAM treatment. CONCLUSIONS: The finding that it was easier to discuss CAM with nurses than physicians emphasizes the important role of the IBD nurse in communication and monitoring patients' CAM use. Patients wanted to be asked about CAM to be able to start a dialogue, as some perceived not taken seriously when raising the subject. Furthermore, HCPs need to understand that many patients with IBD regard dietary changes as an important part of CAM treatment. Further research in these areas is needed

Correction to: Students’ understanding of teamwork and professional roles after interprofessional simulation—a qualitative analysis

The original article [1] contains an error in the Ethics approval statement of the Declarations regarding approval of the study

Students’ understanding of teamwork and professional roles after interprofessional simulation—a qualitative analysis

Abstract Background This study explores how interprofessional simulation-based education (IPSE) can contribute to a change in students’ understanding of teamwork and professional roles. A series of 1-day training sessions was arranged involving undergraduate nursing and medical students. Scenarios were designed for practicing teamwork principles and interprofessional communication skills by endorsing active participation by all team members. Methods Four focus groups occurred 2–4 weeks after the training. Thematic analysis of the transcribed focus groups was applied, guided by questions on what changes in students’ understanding of teamwork and professional roles were identified and how such changes had been achieved. Results The first question, aiming to identify changes in students’ understanding of teamwork, resulted in three categories: realizing and embracing teamwork fundamentals, reconsidering professional roles, and achieving increased confidence. The second question, regarding how participation in IPSE could support the transformation of students’ understanding of teamwork and of professional roles, embraced another three categories: feeling confident in the learning environment, embodying experiences, and obtaining an outside perspective. Conclusions This study showed the potential of IPSE to transform students’ understanding of others’ professional roles and responsibilities. Students displayed extensive knowledge on fundamental teamwork principles and what these meant in the midst of participating in the scenarios. A critical prerequisite for the development of these new insights was to feel confident in the learning environment. The significance of how the environment was set up calls for further research on the design of IPSE in influencing role understanding and communicative skills in significant ways

Registered nurses\u27 experiences of patient participation in hospital care: supporting and hindering factors patient participation in care

Background: Promoting patient participation in care is an international priority identified by the World Health Organization and various national bodies around the world and an important aspect of person-centred care. Aim: The aim of this study was to describe Registered Nurses’ experiences with patient participation in nursing care including their barriers and facilitators for participation. Method: The study setting was a University Hospital in Sweden. Interviews were conducted with twenty Registered Nurses working at medical wards in 2013. Thematic data analysis was used to analyse the transcribed interview data. Results: Twenty nurses from four wards in two hospitals were included. Five themes emerged from the analysis including listening to the patient, engaging the patient, relinquishing some responsibility, sharing power and partnering with patients. The core theme ‘partnering with patients’ was enacted when nurses listened to and engaged patients and when they relinquished responsibility and shared power with patients. In addition, hindering and facilitating factors to participation were identified, such as patients wanted to take on a passive role, lack of teamwork which participants understood would enhance interprofessional understanding and improve patient safety. Patient participation was hindered by medical jargon during the ward round, there was a risk of staff talking over patients’ heads but sometimes inevitable having conversations at the patient’s bedside. However, nurses preferred important decisions to be made away from bedside. Conclusions: It all came down to partnering with the patient and participants described how they made an effort to respect the patients’ view and accept patient as a part of the care team. Identified hindering factors for participation were lack of teamwork, patients’ taking on passive roles and communication during ward rounds having conversations at the patient’s bedside. Nurses wished for a change but lacked strategies on how. Nurses preferred important decisions to be made away from bedside.Full Tex

How theories of complexity and resilience affect interprofessional simulation-based education: a qualitative analysis of facilitators’ perspectives

Abstract Background Quality of care and patient safety rely on the ability of interprofessional teams to collaborate effectively. This can be trained through interprofessional simulation-based education (IPSE). Patient safety also relies on the ability to adapt to the complexity of such situations, an ability termed resilience. Since these needs are not explicitly addressed in IPSE, the aim of this study was to explore how central concepts from complexity-theory and resilience affect IPSE, from facilitators’ perspective, when applied in debriefings. Methods A set of central concepts in complexity-theory and resilience were introduced to facilitators on an IPSE course for nursing and medical students. In five iterations of focus groups interviews the facilitators discussed their application of these concepts by reviewing video recordings of their own debriefings. Video recordings of the interviews were subjected to coding and thematic analysis. Results Three themes were identified. The first, Concepts of complexity and resilience are relevant for IPSE, points to the applicability of these concepts and to the fact that students often need to deviate from prescribed guidelines/algorithms in order to solve cases. The second theme, Exploring complexity, shows how uncertainty could be used as a cue to explore complexity. Further, that individual performance needs to account for the context of actions and how this may lead to certain outcomes. Moreover, it was suggested that several ways to approach a challenge can contribute to important insight in the conditions for teamwork. The third theme, Unpacking how solutions are achieved, turns to needs for handling the aforementioned complexity. It illustrates the importance of addressing self-criticism by highlighting how students were often able to overcome challenges and find solutions. Finally, this theme highlights how pre-defined guidelines and algorithms still work as important resources to help students in transforming perceived messiness into clarity. Conclusions This study suggests that IPSE provides the possibility to explore complexity and highlight resilience so that such capability can be trained and improved. Further studies are needed to develop more concrete ways of using IPSE to account for complexity and developing resilience capacity and to evaluate to what extent IPSE can provide such an effect