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Facilitating transformation through collaboration.

The philosophical underpinnings of transformative education were utilized to redesign a course taught to special education majors and nursing students at a rural southeastern university. The main goal when restructuring the class was to develop a course that would encourage communication and collaboration between education and nursing majors within the school community. The current course, "Health Care Perspectives of Exceptional Students," focuses on specific health care topics, with nurse faculty presenting the health care aspects and education faculty discussing educational implications for the classroom teacher. Every class includes dialogue and activities that require interaction. The last two classes are devoted to first-aid training and CPR certification. During the evaluation phase of the course, both education and nursing majors responded positively to the question of whether or not medically fragile children belong in the classroom. Furthermore, they saw the need for communication and collaboration between the classroom teacher and the school nurse as essential for effectively serving the medically fragile child in the school setting.

Education, Nursing↗
PubMed2002

The organizational huddle process--optimum results through collaboration.

The St. Joseph's Regional Medical Center in Paterson, New Jersey, initiated a methodology called The Organizational Huddle Process in the fall of 1999. This communication vehicle enhances operational performance through a fast, focused, and highly collaborative process. The results of this initiative have been most impressive. Hundreds of problems have been resolved before escalating to crisis levels, with an increase in stakeholder satisfaction. This process is appropriate for all levels within an organization, is effective for both interdisciplinary and departmental groups, and has minimal associated implementation costs. This article reviews the rationale and benefits of The Organizational Huddle Process, a recommended implementation strategy, and a nurse manager's review on the application of this methodology.

Decision Making, Organizational↗
PubMed2004

Involvement of nurses in physician-assisted dying.

BACKGROUND: Death in modern societies is often preceded by medical end-of-life decisions. Empirical research on these end-of-life decisions focuses predominantly on the physicians' role. Little is known about the role of other health care workers, especially that of nurses. AIM: This paper reports the findings of a study that investigated how often nurses are consulted by physicians in the decision-making process preceding end-of-life decisions and how often nurses participate in administering lethal drugs in end-of-life decisions. METHOD: Data were collected within a nationwide cross-sectional retrospective death certificate study in Flanders, the Dutch-speaking part of Belgium. We selected 3999 deaths, a 20% random sample of all those occurring during the first 4 months of 1998. Anonymous questionnaires were mailed to the physicians who signed the death certificates. Several questions concerned the involvement of nurses in end-of-life decisions. RESULTS: We received 1925 valid questionnaires. For all reported end-of-life decisions (39.3% of all deaths in Flanders), physicians provided information about the involvement of nurses. Physicians consulted at least one nurse in 52% of end-of-life decisions cases occurring in institutions, compared with 21.4% of such cases at home. Nurses administered lethal drugs in 58.8% of euthanasia cases occurring in institutions and in 17.2% at home. For cases in which life was ended without the patient's explicit request because, predominantly, they were too ill to do so, these percentages were respectively 82.7% and 25.2%. In institutions, nurses mostly administered drugs without the attendance of a physician who had prescribed the drugs. CONCLUSIONS: Nurses in Belgium are largely involved in administering lethal drugs in end-of-life decisions, while their participation in the decision-making process is rather limited. To guarantee prudent practice in end-of-life decisions, we need clear guidelines, professionally supported and legally controlled, for the assignment of duties between physicians and nurses regarding the administration of lethal drugs to reflect current working practice. In addition, we need appropriate binding standards governing mutual communication about all end-of-life decisions.

Adolescent↗
PubMed2006

Common ground: the canadian collaborative mental health initiative.

BACKGROUND: As one of 12 participating national health associations, Dietitians of Canada (DC) endorsed the Charter Principles and Commitments created by the Canadian Collaborative Mental Health Initiative (CCMHI). The Chair of the DC Board of Directors signed the Charter, committing DC to work collaboratively to uphold the Principles and actively endorse the Commitments. ACHIEVEMENTS: The Initiative's vision, making mental health care work--new places, new partners, new hope, provided the Steering Committee with a clear direction. The CCMHI Charter Principles cover promotion and prevention, a holistic approach, collaboration, partnership, respect, information exchange, and resources. In addition to the Charter, the CCMHI has produced a series of 12 toolkits and research papers. The toolkits are practical pieces that also contain ideas and other information. Dietitians of Canada has developed a toolkit that examines the dietitian's role in primary health care mental health programs. A set of reviews of the practice of collaborative mental health care in Canada covers a wide range of issues, from the attributes of effective collaborative care to a discussion of the barriers to collaboration. CONCLUSION: Communications between the 12 member organizations are ongoing, and the organizations await the establishment of the Canadian Mental Health Commission, which is expected to be up and running in fall 2006.

Canada↗
PubMed2003

Improving communication between hospitals and care homes: the development of a daily living plan for older people.

The present study describes a practice development project that produced a user-led daily living plan (DLP), which was developed in partnership with older people, and staff from health and social care settings. The DLP was designed to facilitate communication of the daily living preferences of older people, ensuring that continuity of care and support could be maintained and that their future care can be planned on an individualised basis when they move from hospital to a care home. In the process of developing and implementing the DLP, more effective person-centred communication between hospitals and care homes was achieved, and some of the hospital staff's ideas about care homes changed.

Activities of Daily Living↗
PubMed1992

Measuring quality of life in theory and in practice: a dialogue between philosophical and psychological approaches.

Measuring quality of life is of concern to both philosophers and psychologists, yet the two disciplines typically approach the question in very different ways, ways so diverse that it may look as if they are engaged in such disparate activities that no dialogue between them is possible. In this paper we aim to construct the beginnings of a dialogue between the two disciplines which will show how they could serve each other and yet also show how, from the dialogue, difficult and previously unconsidered issues emerge for both sides.

Bioethical Issues↗
PubMed2005

Joined-up working' between early years professionals and speech and language therapists: moving beyond 'normal' roles.

This paper draws on research conducted for the Nuffield Foundation (Mroz et at, 2002) which looked at the knowledge, skills and confidence of early years professionals in relation to young children's speech and language development. Key findings from the project are reported in relation to the efficacy of initial and post-qualification training in preparing professionals for the identification and support of children with communication problems. The discussion centres around early years practitioners' experiences of working with speech and language therapists and the needs which they expressed, both for inter-professional training and for modes of working together.

Child↗
PubMed2005

Part II. General practitioner-specialist referral process.

This is the second of two articles that explore the general practitioner (GP)-specialist relationship. In this article, we explore the nature of the referral process, beginning with referrals frequently made by GPs in Australia and reasons for referral to specialists. In Australia, GPs commonly refer patients to specialists, particularly orthopaedic surgeons, ophthalmologists, surgeons and gynaecologists for a variety of reasons, including diagnosis or investigation, treatment and reassurance (reassurance for themselves as well as reassurance for the patient). GPs will choose a specialist after considering a variety of factors, such as the specialist's medical skill, their previous experience with the specialist, the quality of communication between them, office location and patient preferences. The referral is generally made by telephone or by letter, the latter of which is known to vary significantly in content and quality. The specialist, GP and patient expectations of the referral and the consultation process are also described. Specialists expect the GP to provide information about the problem to be addressed and adequate patient history, GPs expect a clear response regarding diagnosis and management as well as justification for the course of action, and patients expect clear communication and explanation of the diagnosis, treatment and follow-up requirements. When these expectations remain unmet, GPs, specialists and patients end up dissatisfied with the referral process.

Attitude of Health Personnel↗
PubMed2005

Shared maternity care: all care--not enough responsibility? An audit of patient care communications pre- and post- a multi-faceted intervention.

BACKGROUND: Shared maternity care is an important model of care in Australia and overseas, but Victorian studies have shown patient dissatisfaction and widespread communication problems. AIMS: This study aimed to implement and evaluate initiatives to improve communication between three maternity hospitals and general practitioners involved in shared maternity care in Melbourne. METHODS: A pre- and post-design with audit of 150 hospital records at each of three hospitals plus audit of 20 general practitioner files for evidence of key communications on shared care patients, before and after a multifaceted intervention. RESULTS: Significant improvements at individual hospitals were seen if one person was made responsible for a communication outcome. Other initiatives did not lead to improvements if they did not include individual accountability. CONCLUSION: The standard of integration of shared maternity care is unacceptable low. Improvements to communication are achievable but depend on the allocation of individual time and responsibility, plus a commitment by hospitals to ongoing audit of their performance.

Family Practice↗
PubMed1987

The humanities, humanistic behavior, and the humane physician: a cautionary note.

Efforts to teach and evaluate humanistic qualities in physicians in residency training are marred by ambiguous goals. The humane physician can be characterized by four distinct qualities: technical competence, humanistic attitude, knowledge of humanistic concepts, and humanistic behavior. Education in the humanities can foster humanistic attitudes, but it cannot promise to lead to changes in behavior. Likewise, although formal training in communication teaches the skills necessary for humanistic behavior, without an understanding of humanistic concepts these skills may not serve medical or moral ends. Evaluation of the humane physician must also include modalities that test attitude, knowledge, and behavior. Testing one characteristic does not ensure competence in other areas; knowledge of the requirements for informed consent, for example, does not guarantee one's ability to discuss this concept effectively with patients. In this article, we suggest ways to combine the humanities and communication skills in the clinical setting and we emphasize both the training and the evaluation of humane physicians.

Attitude of Health Personnel↗
PubMed1995

Being skeptical about the medical humanities.

In this paper the author challenges the prevailing view that contemporary writing in the medical humanities is serving the needs of the various health care disciplines. The current medical humanities literature assumes that physicians are the appropriate target group. This is most notably the case within health care ethics literature. There appears to be an unexamined assumption that physician-centric approaches to clinical ethical decision-making are the standard by which appropriate ethical practice is judged. The author challenges this assumption and addresses the problems that this approach engenders. The medical humanities literature appears to reinforce hierarchical, patriarchal arrangements which are themselves not morally neutral.

Bioethical Issues↗
PubMed2004

British Columbia Provincial Eating Disorders Program: an organizational description.

The British Columbia Provincial Eating Disorders Program (BCEDP) is a small government funded body that communicates eating disorder treatment needs to the government, helps communication between primary, secondary, and tertiary care givers, gives treatment advice and teaching to primary and secondary care givers, and assists the Provincial Eating Disorders Resource Centre in decision making and communication with government. The program deals with anorexia nervosa and bulimia nervosa, but not obesity, for budgetary reasons.

Adolescent↗
PubMed2005

Connecting health departments and providers: syndromic surveillance's last mile.

INTRODUCTION: A critical need exists for mechanisms to identify and report acute illness clusters to health departments. The Massachusetts Department of Public Health (MDPH) works with partner organizations to conduct syndromic surveillance. This effort is based on CDC's Health Alert Network program and includes automated generation and notification of signals and a mechanism to obtain detailed clinical information when needed. METHODS: Syndromic surveillance partners collect emergency department and ambulatory care data. The principal communications platform between syndromic surveillance partners and MDPH is the Massachusetts Homeland and Health Alert Network (HHAN). This Internet-based application serves as a portal for communication and collaboration and alerts predefined groups of users involved in emergency response. Syndromic surveillance partners' systems report to HHAN by using Public Health Information Network Messaging System events that meet thresholds selected by MDPH. Cluster summaries are automatically posted into a document library. HHAN notifies users by electronic mail, alphanumeric pager, facsimile, or voice communications; users decide how they want to be notified for each level of alert. Discussion threads permit real-time communication among all parties. RESULTS: This automated alert system became operational in July 2004. During July-December 2004, HHAN facilitated communication and streamlined investigation of 15 alerts. CONCLUSION: The system allows rapid, efficient alerting and bidirectional communication among public health and private-sector partners and might be applicable to other public health agencies.

Disaster Planning↗
PubMed2004

Facilitating transdisciplinary teamwork in dietetics education: a case study approach.

Teamwork, emphasized by the transdisciplinary approach, has been strongly linked to the development of a culture of patient safety. However, the vast majority of health care education is one-dimensional, ie, focused on one discipline, taught by practitioners of the same discipline, with students of the same discipline. In an effort to address this one-dimensional view of health care education, a case-study assignment was developed to facilitate professional interaction between graduate physical therapy and graduate nutrition students. The objectives were threefold: (a). to increase student understanding of the role of another discipline, (b). to increase student ability to obtain and analyze information from a consultant relative to a patient case, and (c). to increase student communication skills across disciplines. For the assignment, physical therapy students were assigned one case scenario and one nutrition student to interview individually. The nutrition students acted as consultants in a clinical setting. The interactive assignment was considered an effective learning tool for facilitating interprofessional learning by the faculty based on student comments reporting increased understanding of the role of the other discipline, increased communication skills, and an understanding of the barriers to transdisciplinary interaction. Future studies, both quantitative and qualitative, may further identify effects of instructional activities designed to facilitate transdisciplinary health care.

Adult↗
PubMed2006

Information handling in the nursing discharge note.

AIMS: The aim of this paper is twofold. Firstly, it describes hospital nurses' general use of the language function in the nursing discharge notes of patients who will require posthospital home health care. Secondly, it addresses the similarities and differences in completeness, structure and content between paper and electronic nursing discharge notes. BACKGROUND: Previous research has identified gaps in the accuracy and relevance of information communicated between nurses working at different organizational levels. DESIGN AND METHODS: A descriptive design with a text analysis framework was used. RESULTS: The study shows that the text in the nursing discharge notes is information-dense and characterized by technical terms, although the nurses contextualized and individualized the content of the terms to clarify the message. Both similarities and differences were found in range and detail of the information nurses exchanged when they used paper or electronic discharge notes. CONCLUSIONS: The use of structured and standardized templates helped nurses improve the completeness, structure and content of the information in the nursing discharge notes. RELEVANCE TO CLINICAL PRACTICE: Whether paper or electronic documentation is used, the findings in this study highlight the challenges nurses encounter in ensuring continuity of care during patients' trajectory through the health system. The findings may help clarify the appropriateness of the content and language nurses use in the nursing discharge note as a communication medium. This study may also be helpful to nurses planning to use EPRs, as it illustrates some of the issues which should be clarified before this is implemented.

Attitude of Health Personnel↗
PubMed2003

A certain art of uncertainty: case presentation and the development of professional identity.

Healthcare professionals use the genre of case presentation to communicate among themselves the salient patient information during treatment and management. In case presentation, many uncertainties surface, regarding, e.g., the reliability of patient reports, the sensitivity of laboratory tests, and the boundaries of scientific knowledge. The management and portrayal of uncertainty is a critical aspect of professional discourse. This paper documents the rhetorical features of certainty and uncertainty in novice case presentations, considering their pragmatic and problematic implications for students' professional socialization. This study was conducted during the third-year inpatient clerkship at a tertiary care, pediatric hospital in hospital in Canada. Data collection included: (1) non-participant observations of 19 student case presentations involving 11 student and 10 faculty participants, and (2) individual interviews with 11 students and 10 faculty participants. A grounded theory approach informed data collection and analysis. Five thematic categories emerged, two of which this paper considers in detail: "Thinking as a Student" and "Thinking as a Doctor". Within these categories, the management and portrayal of uncertainty was a recurrent issue. Teachers modeled central features of a "professional rhetoric of uncertainty", managing uncertainty of six origins: limits of individual knowledge, limits of evidence, limitless possibility, limits of patient's/parent's account, limits of professional agreement, and limits of scientific knowledge. By contrast, students demonstrated a "novice rhetoric of uncertainty", represented by their focus on responding to personal knowledge deficits through the strategies of acknowledgement, argument, and deflection. Some students moved towards the professional rhetoric of uncertainty, suggesting not only advances in communication, but also shifts in attitude towards patients and colleagues, that were interpreted as indications that this rhetoric shapes professional identity and interactions.

Attitude↗
PubMed2004

Cancer: communicating in the team game.

There is increasing evidence that effective communication is a critical means by which surgeons can assist their patients to achieve the best outcomes. This paper examines the processes and outcomes of effective communication by surgeons in cancer teams, and includes: (i). strategies that promote collaborative relationships with patients and lead to more effective treatment; (ii). strategies to improve multidisciplinary team performance; and (iii). methods to minimize the risk of error and litigation. The experience of a cancer diagnosis involves radical changes in patients' lives, somewhat akin to suddenly finding yourself in the middle of a rugby scrum for the first time. The analogy of rugby throws fresh light on such critical factors in communication as prematch preparation, orientation to the game and the team, a good kick off, sizing up the opposition, creative plays and optimizing teamwork to promote quality of life and survival.

Humans↗
PubMed2006

Role of medical students in preventing patient harm and enhancing patient safety.

BACKGROUND: Substantial efforts are focused on the high prevalence of patient harm due to medical errors and the mechanisms to prevent them. The potential role of the medical student as a valuable member of the team in preventing patient harm has, however, often been overlooked. METHODS: Four cases are presented from two US academic health centers in which medical students prevented or were in a position to prevent patient harm from occurring. The authors directly participated in each case. RESULTS: The types of harm prevented included averting non-sterile conditions, missing medications, mitigating exposure to highly contagious patients, and respecting patients' "do not resuscitate" requests. CONCLUSION: Medical students are often overlooked as valuable participants in ensuring patient safety. These cases show that medical students may be an untapped resource for medical error prevention. Medical students should be trained to recognize errors and to speak up when errors occur. Those supervising students should welcome and encourage students to actively communicate observed errors and near misses and should work to eliminate all intimidation by medical hierarchy that can prevent students from being safety advocates.

Clinical Clerkship↗