Kathryn A. Pfaff

An integrative review of the factors influencing new graduate nurse engagement in interprofessional collaboration

AIM To analyse critically the barriers and facilitators to new graduate nurse engagement in interprofessional collaboration. BACKGROUND The acculturation of new graduate nurses must be considered in strategies that address the global nursing shortage. Interprofessional collaboration may support the transition and retention of new graduate nurses. DESIGN Whittemore and Knafls revised framework for integrative reviews guided the analysis. DATA SOURCES A comprehensive multi-step search (published 2000-2012) of the North American interprofessional collaboration and new graduate literature indexed in the CINAHL, Proquest, Pubmed, PsychINFO and Cochrane databases was performed. A sample of 26 research and non-research reports met the inclusion criteria. REVIEW METHODS All 26 articles were included in the review. A systematic and iterative approach was used to extract and reduce the data to draw conclusions. RESULTS The analysis revealed several barriers and facilitators to new graduate engagement in interprofessional collaboration. These factors exist at the individual, team and organizational levels and are largely consistent with conceptual and empirical analyses of interprofessional collaboration conducted in other populations. However, knowledge and critical thinking emerged as factors not identified in previous analyses. CONCLUSION Despite a weak-to-moderate literature sample, this review suggests implications for team and organizational development, education and research that may support new graduate nurse engagement in IPC.

Exploring new graduate nurse confidence in interprofessional collaboration: A mixed methods study

BACKGROUND Confidence is required for effective engagement in interprofessional collaboration. New graduate nurses often lack confidence in interprofessional interactions, and this may compromise the delivery of safe and effective healthcare. OBJECTIVES The overall objective of this study was to explore new graduate nurse confidence in interprofessional collaboration. DESIGN An explanatory sequential mixed methods design was used. METHODS New graduate nurses from Ontario, Canada (N=514) completed a cross-sectional descriptive survey in 2012. The survey measured perceived confidence in interprofessional collaboration, and it included items that were proposed to have a relationship with new graduate nurse confidence in interprofessional collaboration. Follow-up qualitative telephone interviews were conducted with 16 new graduate nurses. RESULTS The quantitative findings suggested that several factors have a positive relationship with new graduate nurse confidence in interprofessional collaboration: availability and accessibility of manager, availability and accessibility of educator, number of different disciplines worked with daily, number of team strategies, and satisfaction with team. The qualitative phase supported the quantitative findings and also provided new information about factors that facilitated and challenged new graduate nurse confidence when engaging in interprofessional collaboration. The facilitators were: experience, knowledge, respect, supportive relationships, and opportunities to collaborate. Challenges included: lack of experience, lack of knowledge, communication challenges, and balancing practice expectations. The overall findings relate to team and organizational support, and new graduate nurse development. CONCLUSION Interventions that provide support for interprofessional collaboration at the team and organizational levels, and develop new graduate nurse knowledge and experiences regarding collaborative practice, are essential for enhancing new graduate nurse confidence in interprofessional collaboration.

Leaders’ experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review

INTRODUCTION Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. PURPOSE The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. METHODS We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. RESULTS Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. CONCLUSIONS Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care.

A mixed methods exploration of the team and organizational factors that may predict new graduate nurse engagement in collaborative practice

Abstract Although engagement in collaborative practice is reported to support the role transition and retention of new graduate (NG) nurses, it is not known how to promote collaborative practice among these nurses. This mixed methods study explored the team and organizational factors that may predict NG nurse engagement in collaborative practice. A total of 514 NG nurses from Ontario, Canada completed the Collaborative Practice Assessment Tool. Sixteen NG nurses participated in follow-up interviews. The team and organizational predictors of NG engagement in collaborative practice were as follows: satisfaction with the team (β = 0.278; p = 0.000), number of team strategies (β = 0.338; p = 0.000), participation in a mentorship or preceptorship experience (β = 0.137; p = 0.000), accessibility of manager (β = 0.123; p = 0.001), and accessibility and proximity of educator or professional practice leader (β = 0.126; p = 0.001 and β = 0.121; p = 0.002, respectively). Qualitative analysis revealed the team facilitators to be respect, team support and face-to-face interprofessional interactions. Organizational facilitators included supportive leadership, participation in a preceptorship or mentorship experience and time. Interventions designed to facilitate NG engagement in collaborative practice should consider these factors.

Reducing the “cost of caring” in cancer care: Evaluation of a pilot interprofessional compassion fatigue resiliency programme

ABSTRACT Compassion fatigue (CF) is a combination of secondary traumatic stress and burnout. Empathy becomes depleted among professional caregivers due to repeated exposure to emotional pain. Negative effects include decreased general wellbeing, impaired caregiver health and diminished team functioning. Intervention is needed to support caregiver quality of life and team relationships in high-stress work environments. This pilot study evaluated the impact of a pilot CF resiliency (CFR) programme on interprofessional staff at a regional cancer centre. An embedded experimental mixed-methods design was employed to evaluate a 6-week formalised CFR intervention. We measured CF satisfaction, burnout, clinical stress and silencing responses pre- and post-intervention. Focus group and individual interviews were conducted mid-programme and at end-programme completion to understand participants’ views about how the programme affected their experiences of CF. Qualitative and quantitative data were analysed separately and merged to produce the overall findings. Participants reported reduced clinical stress at programme completion (t = 3.5; p = .005). This finding may be explained by participants’ ability to identify signs and symptoms of CF and engage in self-care and mindfulness activities. Further larger studies are needed to evaluate the long-term effects of CFR programmes on caregiver and organisational wellbeing.

An agent model to support social network-based palliative care

A social health care system, and palliative care in particular, can be viewed as a social network of interacting patients and care providers. Each patient in the network has a set of capabilities to perform his or her intended daily tasks. However, some patients may not have the required capabilities to carry out their desired tasks. Consequently, different groups of care providers offer the patients support by providing them with a variety of needed services. Assuming there is a cost and resource limitations for providing care within the system, where each care provider can support a limited number of patients, the problem is to find a set of suitable care providers to match the needs of the maximum number of patients. In this paper, we propose a novel agent-based model to address this problem by extending the agents capabilities using the benefit of the social network. Our assumption is that each agent, or patient, can cover its disabilities and perform its desired tasks through collaboration with other agents, or care providers, in the network. The goal of this work is to improve the quality of services in the network at both individual and system levels. On one hand, an individual patient wants to maximize his/her goals, while at the system level we want to achieve quality care for as many patients as possible with minimum cost. The performance and functionality of this proposed model have been evaluated based on various synthetic networks. The results demonstrate a significant reduction in the operational costs and enhancement of the service quality.

Using social network analysis to model palliative care

Abstract Palliative and end-of-life care are special types of healthcare that focus on improving the quality of life of patients who are living with life-threatening illness or nearing their end of life. The primary goal here is to provide various support services to help the patients to maintain an active life and dignity. Assuming there are cost and resource limitations for delivering care within the system, where each care provider can support a limited number of patients, the problem can be defined as finding a set of suitable care providers with a minimum overall cost to match the needs of the maximum number of patients. In the grand scheme, the whole care system can be seen as a social network consisting of patients and care providers. This representation provides an opportunity to apply social network analysis techniques to enhance the topology of the system and improve its efficiency. In this paper, we propose a novel computational agent-based model to address this problem by extending the agents capabilities using the benefits of the social network. We assume that each patient agent can cover its disabilities and perform its desired tasks through collaboration with other agents. The primary objective is to optimize a dynamic, personalized care pathway system that will support palliative care within a community eco-system. Testing the ability of the system to match social support agents with personal preferences, needs, and capabilities is the second goal of this research work. In addition, we are going to measure the impact of the system on perceived quality of life, social connectedness, caregiver burden, and care satisfaction. The performance and functionality of our proposed model have been evaluated using various synthetic and a real palliative networks. The results demonstrate a significant reduction in the operational costs and enhancement of the service quality.

Compassionate collaborative care: an integrative review of quality indicators in end-of-life care

BackgroundCompassion and collaborative practice are individually associated with high quality healthcare. When combined in a compassionate collaborative care (CCC) practice framework, they are reported to improve health, strengthen care provision, and control health costs. Little is known about how to integrate and measure CCC, yet it is fundamentally applied in palliative and end-of-life care settings. This study aimed to identify quality indicators of CCC by systematically reviewing and synthesizing the current state of the palliative and end-of-life care literature.MethodsAn integrative review of the palliative and end-of-life care literature was conducted using Whittemore and Knafl’s method. Donabedian’s healthcare quality framework was applied in the data analysis phase to organize and display the data. The analysis involved an iterative process that applied a constant comparative method.ResultsThe final literature sample included 25 articles. Patient and family-centered care emerged as a primary structure for CCC, with overarching values including empathy, sharing, respect, and partnership. The analysis revealed communication, shared decision-making, and goal setting as overarching processes for achieving CCC at end-of-life. Patient and family satisfaction, enhanced teamwork, decreased staff burnout, and organizational satisfaction are exemplars of outcomes that suggest high quality CCC. Specific quality indicators at the individual, team and organizational levels are reported with supporting exemplar data.ConclusionsCCC is inextricably linked to the inherent values, needs and expectations of patients, families and healthcare providers. Compassion and collaboration must be enacted and harmonized to fully operationalize and sustain patient and family-centered care in palliative and end-of-life practice settings. Towards that direction, the quality indicators that emerged from this integrative review provide a two-fold application in palliative and end-of-life care. First, to evaluate the existing structures, processes, and outcomes at the patient-family, provider, team, and organizational levels. Second, to guide the planning and implementation of team and organizational changes that improve the quality delivery of CCC.

Sharing the burden: Schwartz rounds® as a compassionate collaborative practice and education model in long-term care

Background: Caregivers in long-term care often struggle to manage the holistic care for residents who have complex health needs, and are nearing end-of-life. Schwartz Rounds® promote compassionate inter-professional education and practice, thus have potential to improve team relationships, resident care, and retention of long-term care caregivers. These Rounds promote open and honest dialogue about feelings that emerge as a result of caregiving. Through sharing this burden, the Rounds can improve how inter-professional teams care for self and others. Objectives: In this paper, we report the results of a literature review that was used to develop a protocol for Schwartz Round implementation in long-term care settings. Methods: We conducted a literature review to understand the nature and implementation of Schwartz Rounds. Following a keyword search of various databases, we retrieved, reviewed and integrated evidence about protocols and processes for conducting Rounds. Experts in long-term care reviewed and contributed to the protocol development. Results: Rounds are structured monthly opportunities through which professional and non-professional caregivers can share feelings and responses to specific resident care issues. A team member frames the topic and encourages discussion. A panel of caregivers participate in roundtable dialogue regarding a real resident case. The discussion generates awareness of emotional care responses, and support for team members. Conclusions: Implementing Schwartz Rounds in long-term care has potential to improve compassionate collaborative practice and education, combat compassion fatigue, improve resident care, and retain the long-term care workforce. Leadership at the point-of-care and administrative levels are essential for overcoming implementation challenges. Correspondence to: Kathryn Pfaff, RN, PhD, Assistant Professor, Faculty of Nursing, University of Windsor, 401 Sunset, Windsor, Ontario N9B 3P4, Tel: 519-253-3000; 519-253-4977; E-mail: kpfaff@uwindsor.ca