A Swiss Health Care Professionals’ Perspective on the Meaning of Interprofessional Collaboration in Health Care of People with MS—A Focus Group Study

Multiple sclerosis (MS) is a chronic, inflammatory autoimmune disease of the central nervous system mainly of adults ranging from 20 to 45 years of age. The risk of developing MS is 50% higher in women than in men. Most people with MS (PwMS) experience a spectrum of symptoms such as spasticity, continence dysfunctions, fatigue, or neurobehavioral manifestations. Due to the complexity of MS and the variety of patient-centered needs, a comprehensive approach of interprofessional collaboration (IPC) of multiple health care professionals (HCP) is necessary. The aim of this qualitative study was to explore the meaning of IPC in the comprehensive care of PwMS from a HCP perspective. Focus groups (FG) with HCP were conducted, recorded, and transcribed verbatim. The sample contained HCP from three MS clinics in different phases of care and rehabilitation. Four main categories emerged: (a) experience with IPC, (b) relevant aspects for IPC in patients’ treatment, (c) differences in in- and outpatient settings, and (d) influence of patient perspective. IPC plays a crucial role in HCP perspective when treating PwMS, which can benefit from an IPC therapeutic approach because HCP work together in a patient-centered way. The inpatient setting of HCP strongly supports the implementation of IPC. This prerequisite does not exist in outpatient settings

First Insights into Barriers and Facilitators from the Perspective of Persons with Multiple Sclerosis: A Multiple Case Study

Multiple Sclerosis (MS) is a complex, lifelong disease. Its effects span across different areas of life and vary strongly. In Switzerland, there is an intense discussion on how to optimize quality of care and patient safety. Patients should be more involved in the management of health care to improve the quality of care from the patient's perspective and form a more comprehensive perspective. This multiple-case study explores the question of how persons with MS experience and describe functioning related barriers, facilitating factors, and ethically relevant conflicts. To address this from a comprehensive perspective, the MS core set of the International Classification for Functioning, Disability, and Health (ICF) is used as theoretical framework. To explore barriers, facilitators, and relevant ethical issues, different narrative sources were used for thematic analysis and ICF coding: (a) MS transcripts from DIPEx interviews and (b) an autobiographical book of persons living with MS. Insights that were meaningful for daily practice and education were identified: (a) understanding the importance of environmental circumstances based on narrative sources; (b) understanding the importance of a person's individual life situation, and the ability to switch perspectives in the medical field; (c) respect for PwMS' individuality in health care settings; (d) creating meaningful relationships for disease management and treatment, as well as building trust. Keywords: DIPEx; ICF; ethics; multiple case study; multiple sclerosis; narration; patient experience; patient perspective; qualitative research methods; source analysis; thematic analysi

An International Expert Survey on Functioning in Vocational Rehabilitation Using the International Classification of Functioning, Disability and Health

Background Vocational rehabilitation (VR) is a key process in work disability (WD) management which aims to engage or re-engage individuals to work and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO) can be interfaced with VR but there is a lack of evidence of what ICF contents experts in the field consider. The objective of this study is to survey the experts in the VR field with regard to what factors are considered important to patients participating in VR using the ICF as the language to summarize the results. Methods An internet-based survey was conducted with experts from six WHO Regions (Africa, the Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). Experts were asked six open-ended questions on factors that are important in VR. Each question was related to a component of the ICF (body functions, body structures, activities and, environmental factors, and personal factors). Responses were linked to the ICF. Results Using a modified stratified randomized sampling, 201 experts were sent the survey and 151 experts responded (75% response rate). We identified 101 ICF categories: 22 (21.8%) for body functions, 13 (12.9%) for body structures, 36 (35.6%) for activities and participation, and 30 (29.7%) for environmental factors. Conclusions There was a multitude of ICF functioning domains according to the respondents which indicates the complexity of VR. This expert survey has provided a list of ICF categories which could be considered in V

Professional Identity Formation in Health Promotion Practitioners: Students’ Perspectives during an Undergraduate Program in Switzerland

The health promotion (HP) community advocates for capacity building, quality assurance and political awareness of HP. Professional identity (PI) is of great relevance to these goals as persons who strongly identify with their profession better adopt their professional role, raising the quality, competence and common values within a professional group. However, investigations on the HP workforce are missing. In order to investigate PI formation in HP professionals, a longitudinal study was conducted with two student cohorts of a Swiss HP and prevention undergraduate program. Using a qualitative approach, focus groups were conducted at the beginning and end of the undergraduate program. Data were transcribed verbatim and condensed using thematic analysis. The results highlight the complexity of the HP’s professional profile. While students experienced difficulties to capture the profile at the beginning of the program, at the end they developed an understanding of it. The practical experience within work placements helped students to grasp the profile and specify their future professional role. Several behavioral, cognitive and motivational aspects were identified that influence HP students’ PI formation and can be fostered. For instance, universities can commit to public relations for HP practitioners and support the PI formation throughout the study program

Motor Imagery Experiences and Use: Asking Patients after Stroke Where, When, What, Why, and How They Use Imagery: A Qualitative Investigation

Background. A framework on where, when, what, why, and how to use imagery from sports psychology was explored whether it can be applied in patients after stroke in their chronic stage. Methods. Eleven patients (ages 31–85, 3 females, 1.3–6.4 years after stroke) were interviewed. Semistructured interviews were conducted before and after a two-week MI intervention period with six MI sessions. Information was obtained regarding experiences and knowledge of MI, and the evaluation of an MI practical example. The coding scheme was based on the framework and a hierarchical categorisation. Results. Information regarding domains where, when, what, why, and how to use imagery was addressed. Patients imagined themselves as healthy individuals, did not focus on surroundings during MI practice,and reported to use positive imagery only. After MI training, patients became more flexible regarding their location and position during MI practice. Conclusions. MI became an automatic process, and patients did not need specific concentration and quietness as mentioned in the first interview. Patients recommended daily MI training and began to transfer MI to practice movements that were affected by the stroke. In contrast to sports, patients did not talk about how MI was triggered rather than how MI was designed

A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application

In the intensive care unit, it can be challenging to determine which interventions align with the patients' preferences since patients are often incapacitated and other sources, such as advance directives and surrogate input, are integral. Managing treatment decisions in this context requires a process of shared decision-making and a keen awareness of the preference-sensitive instances over the course of treatment. The present paper examines the need for the development of preference-sensitive decision timelines, and, taking aneurysmal subarachnoid hemorrhage as a use case, proposes a model of one such timeline to illustrate their potential form and value. First, the paper draws on an overview of relevant literature to demonstrate the need for better guidance to (a) aid clinicians in determining when to elicit patient preference, (b) support the drafting of advance directives, and (c) prepare surrogates for their role representing the will of an incapacitated patient in clinical decision-making. This first section emphasizes that highlighting when patient (or surrogate) input is necessary can contribute valuably to shared decision-making, especially in the context of intensive care, and can support advance care planning. As an illustration, the paper offers a model preference-sensitive decision timeline—whose generation was informed by existing guidelines and a series of interviews with patients, surrogates, and neuro-intensive care clinicians—for a use case of aneurysmal subarachnoid hemorrhage. In the last section, the paper offers reflections on how such timelines could be integrated into digital tools to aid shared decision-making

Interprofessionality in the health professions in the transformation of a modern role and profession development. Report on the results of a world café at the Drei-Länder-Tagung on May 5, 2022 in Bern / Interprofessionalität in den Gesundheitsberufen im Wandel einer modernen Rollen- und Professionsentwicklung. Bericht über die Ergebnisse eines World Cafés auf der Drei-Länder-Tagung am 5. Mai 2022 in Bern

The health professions in the German-speaking region of Germany, Austria and Switzerland, the so-called D-A-CH area, are in dynamic phases of their professionalization due to their shift towards education at universities. In addition, the needs of current and future health care require all health professionals (HPs) to have collaborative competencies and a willingness to work together. This willingness and the challenge of co-creation of health systems by all health professionals is a good starting point for the evolution of the professions. So what must professional profiles, role beliefs - in short, modern professionalization strategies - be like so that, at the beginning of the 21st century, education and professional practice do not remain stuck in old thought structures and templates and in monodisciplinary „silo thinking.” What does it mean in concrete terms for the professionalization of professions that health care professions must (be able to) increasingly work together? Doesn’t professionalization so far tend to mean exclusivity and isn’t a stronger demarcation between the professions then the consequence? Against the background of professionalization through academization, do university studies not tend to aim at a stronger demarcation from other disciplines and professions? Professionalization includes exclusive competencies and specialized methods against the background of one's own profession-related action sciences. At the three-country meeting of the VFWG in Bern on 5–6 May 2022, this area of tension was put up for discussion in a World Café based on four theses. The following article documents the results of the individual discussion rounds and aims to stimulate a critical discours

Interprofessional Collaboration in Fall Prevention: Insights from a Qualitative Study

(1) Background and objective: to explore the experiences of Swiss health care providers involved in a community fall prevention pilot project on barriers and facilitations in interprofessional cooperation between 2016 and 2017 in three regions of Switzerland. (2) Methods: semi-structured interviews with health care providers assessed their perspective on the evaluation of jointly developed tools for reporting fall risk, continuous training of the health care providers, sensitizing media campaigns, and others. (3) Results: One of the project’s strengths is the interprofessional continuous trainings. These trainings allowed the health care providers to extend their network of health care providers, which contributed to an improvement of fall prevention. Challenges of the project were that the standardization of the interprofessional collaboration required additional efforts. These efforts are time consuming and, for some categories of health care providers, not remunerated by the Swiss health care system. (4) Conclusions: On a micro and meso level, the results of the present study indicate that the involved health care providers strongly support interprofessional collaboration in fall prevention. However, time and financial constraints challenge the implementation. On a macro level, potential ways to strengthen interprofessional collaboration are a core element in fall prevention

Aneurysmal Subarachnoid Hemorrhage and Clinical Decision-Making: A Qualitative Pilot Study Exploring Perspectives of Those Directly Affected, Their Next of Kin, and Treating Clinicians

Background: Exploring the experience and impact of aneurysmal subarachnoid hemorrhage (aSAH) from three perspectives, that of those directly affected (AFs), their next of kin (NoK), and treating clinicians, is a way to support and empower others to make informed medical decisions. Methods: In a Swiss neurosurgical intensive care unit (ICU), eleven semi-structured interviews were conducted as part of a Database of Individual Patient Experiences (DIPEx) pilot project and thematically analyzed. Interviews were held with two clinicians, five people experiencing aSAH, and four NoK 14–21 months after the bleeding event. Results: Qualitative analysis revealed five main themes from the perspective of clinicians: emergency care, diagnosis and treatment, outcomes, everyday life in the ICU, and decision-making; seven main themes were identified for AFs and NoK: the experience of the aSAH, diagnosis and treatment, outcomes, impact on loved ones, identity, faith, religion and spirituality, and decision-making. Perspectives on decision-making were compared, and, whereas clinicians tended to focus their attention on determining treatment, AFs and NoK valued participation in shared decision-making processes. Conclusions: Overall, aSAH was perceived as a life-threatening event with various challenges depending on severity. The results suggest the need for tools that aid decision-making and better prepare AFs and NoK using accessible means and at an early stage