Patient Roles within Interprofessional Collaborative Patient-Centred Care Teams: The Patient and Health Care Provider Perspectives

With current rapid expansions to medical knowledge and technology and rising chronicity of diseases, health care providers are increasingly called upon to work together within interprofessional teams to provide the most comprehensive care to their patients. Interprofessional teams have been depicted as enhancing patient health outcomes and increasing patient satisfaction with care, while decreasing health care spending and wait times for receiving care. However, there is little evidence on how to collaboratively include patients in these teams. The study’s purpose was to construct a framework on the conditions and processes required for patients to assume active participant roles in their care within primary care interprofessional teams. Charmaz’s Constructivist Grounded Theory approach was used. Ten patients and 10 health care providers from two Family Health Teams in Southwestern Ontario, Canada participated in individual semi-structured interviews to learn about their perspectives on patient roles in teams. Data collection and analysis including memoing, coding and constant comparative analysis were used to generate theoretical concepts of the framework. Member-checking interviews occurred to provide final feedback on the framework. The framework entitled: “Patients on Interprofessional Teams in Primary Care: A Framework for Teamwork” presents three main concepts: (1) patient roles; (2) processes; and (3) conditions. The patient roles concept comprises three sub-concepts with each having two categories/descriptors: (1) expert of own health – expressive and advisor; (2) (co)decision-maker – active voice and trusting; and (3) self-manager – advocate and evaluator of care. The processes concept presents five sub-concepts: (1) explain; (2) identify; (3) educate; (4) build; and (5) collaborate. The conditions concept outlines four sub-concepts: (1) flexibility; (2) time; (3) willingness; and (4) readiness. This study presents a comprehensive framework for patient-health care provider interactions within primary care interprofessional teams, including dimensions of and more clarity about three types of roles patients can assume within these teams. This study also offers an understanding of the conditions and processes health care providers adopt in practice towards patient inclusion on these teams. Further research should utilize this framework to continue to build knowledge of patient roles on interprofessional teams within a multitude of health care settings and populations

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Poem written for special issue called "Learning from one another in medical encounters."</p

Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals

The transfer of accountability (TOA) for a patient from one nurse to another at change of shift is an important opportunity to exchange essential patient care information, as well as to enhance the safety and quality of patient care. This study was undertaken to explore nurses’, patients’ and family members’ perceptions associated with the implementation of bedside nurse to nurse TOA. Focus groups were conducted pre-implementation (two with nurses and two with patients and family members) and post-implementation (six with nurses and two with patients and family members). The focus groups were audio-recorded, transcribed and analysed using directed content analysis. Findings were divided into positive outcomes and challenges to bedside nurse to nurse TOA. Positive outcomes included increased patient safety, more informed patients more consistent use of whiteboards in the patient rooms, better engagement with family via the whiteboard and increased family involvement, confirmation of information between nurses, increased accountability between nurses, and personal introduction/icebreaker of the new nurse. The inclusion of the Patient Partners on the project team was a key success factor for the project. Challenges included a perception of lengthened time required for TOA and increased workload, lack of privacy and potential breaches of confidentiality, patient fear and lack of comprehension, lack of clarity in TOA processes, and inconsistent application of the procedures. Hospital administrators and nurse leaders can use these findings to anticipate and understand change associated with bedside TOA as seen by both nurses and patients/families

Improving a Culture of Knowledge Transfer in a School of Nursing

Introduction: A series of 19 unfunded knowledge transfer hands-on workshops were implemented (2017–2019) and delivered by 22 facilitators from disciplines of nursing, business, communication, plastic arts, engineering, and community studies. The purpose of this paper is to report on the post-appraisal of the workshops’ implementation; uncovering the attendees’ new ideas and reflections on the content; and the process of expanding knowledge for practice. Methods: The qualitative program evaluation approach, using the standards of utility, feasibility, accuracy, and propriety of a given program, inspired the design of the immediate appraisal of the workshops delivered within a Canadian school of nursing located in a major urban center. Workshop participants (n = 267) included undergraduate and graduate nursing students, contract instructors, and nurses holding administrative positions. Results: Workshops with high attendance included: (a) Structuring Effective Teaching-Learning Encounters in Healthcare Education and Practice; (b) Cancer Pain; (c) Fetal Health Surveillance; and (d) Nurses as Educators in the Clinical Setting. Concerns were raised by the attendees’ low attendance to the following workshops: (a) Mindfulness for Students; (b) Horizontal Violence; and (d) Self-Care for Nursing Students: Alleviating Anxiety. Workshops offered opportunities for attendees to reflect on content and process as related to their future incorporation of learned knowledge in their own education and practice. Conclusions: High engagement in hands-on exercises, spontaneous construction of context, and relaxed moments shared by the attendees indicate a promising culture of sharing and receiving knowledge. A culture of collective, pleasurable learning among attendees was effective in mobilizing powerful forms of nursing knowledge

A scoping review to inform the development of dementia care competencies

Health professionals and care partners of persons living with dementia have expressed that learning needs related to dementia care are a priority. There are currently a variety of training programs available in Ontario (Canada) to address aspects of dementia care, but no commonly accepted description of the core knowledge, skills, and abilities, (i.e., competencies) that should underpin dementia-related training and education in the province. The aim of this study was to review current evidence to inform the later development of competency statements describing the knowledge, skills and actions required for dementia care among care providers ranging from laypersons to health professionals. We also sought to validate dementia care principles adapted from Bardsley (2011), and align new concepts to provide a useful organizing framework for future competency development. We distinguished between micro-, meso- and macro-level concepts to clarify the competencies required by individuals situated in different locations across the healthcare system, linking competency development in dementia care to broader system transformation. This review precedes the co-development of a holistic competency framework to guide approaches to dementia care training in Ontario