Madeline H. Schmitt

Development of an Attitudes toward Health Care Teams Scale

The authors describe the development and psychometric testing across three study phases of an Attitudes Toward Health Care Teams Scale. The measure contains two subscales: Quality of Care/Process (14 items) and Physician Centrality (6 items). The Quality of Care/Process subscale measures team members’ perceptions of the quality of care delivered by health care teams and the quality of teamwork to accomplish this. The Physician Centrality subscale measures team members’attitudes toward physicians’authority in teams and their control over information about patients. Tests of reliability and validity demonstrate that each subscale is a strong measure of its respective underlying concept. The measure has potential for use as a research tool and as a pre-and posttest tool for educational interventions with teams and for evaluating clinically based team training programs for medical and health professions students and residents.

Nurses' and resident physicians' perceptions of the process of collaboration in an MICU.

Ten intensive care unit nurses and 10 medical resident physicians were interviewed to compare their perceptions of the process of nurse-physician collaboration. The grounded theory method for concept development recommended by Strauss and Corbin (1990) was used. The core of the process of collaboration for both groups was working together. Two major antecedent conditions were found: being available, which included being in the right place, having time, and having appropriate knowledge; and being receptive, which included being interested in collaboration and having respect and trust for the other profession. The major outcomes of working together were described as improving patient care, feeling better in the job, and controlling costs. The findings of the study pull together disparate concepts associated with collaborative practice and provide direction for future research.

Collaboration improves the quality of care: methodological challenges and evidence from US health care research

At the present time when interprofessional collaboration in practice is reaching new levels of interest related to health care system changes in both the UK and the US, a key question being raised is: What are the outcomes and costs of interprofessional collaborative models of care? The purposes of this paper are to: (a) summarize past research efforts, primarily in the US, to examine whether interprofessional collaboration improves the outcomes of care, (b) articulate the continuing conceptual and methodological challenges associated with efforts to examine this relationship, (c) present more recent research in the US in which investigators have overcome some of the conceptual and methodological barriers to this type of research, and (d) identify gaps in knowledge and areas for future research on the relationship between collaborative models of care and care outcomes.

A survey of psychotropic drug prescriptions in an oncology population

The present study examined the prescription practices concerning psychotropic drugs in 5 major oncology centers over a 6 month period. During the survey period 1579 patients were admitted to the collaborating institutions, and 51% of them were prescribed at least one psychotropic medication. Hypnotics were the most frequently prescribed drugs, accounting for 48% of total prescriptions, followed by anti‐psychotics at 26% and anti‐anxiety agents at 25%. Anti‐depressant drugs accounted for only 1% of psychotropic prescriptions. Analysis of prescription rationales revealed that 44% of the psychotropic prescriptions were written for sleep, while 25% were given for nausea and vomiting; approximately 17% were attributed to psychological distress, and 12% were associated with diagnostic medical procedures. The overall rate of prescription was approximately 2 psychotropic drugs per patient per admission, with only 2% of prescriptions resulting in chart‐documented side effects. At the level of individual compounds, 3 distinct drugs accounted for 72% of total prescriptions—flurazepam (33%), prochlorperazine (21%), and diazepam (17%).

Informal roles and the stages of interdisciplinary team development

After presenting a theory of team development, we propose that the informal role structure of a team is dependent upon the degree of anomie in the team culture, and we provide measures of anomie and informal roles that can be used in field settings. Then we test hypotheses on a national sample of 111 interdisciplinary health care teams in geriatrics in US Veterans Affairs medical centers. We find evidence that as teams develop from early to later stages, the interpersonal behavior of members becomes less differentiated on three dimensions: prominence, sociability, and task-orientation. In addition, we find that images of each member come into clearer focus, as evidenced by reduced variation in how each member is seen by other team members. Finally, we find that regardless of stage of team development, the more education the team members have, the more prominent and task-oriented they are. In general, physicians score highest in prominence and task-orientation, but relatively low in sociability.

Well-Being of Cancer Survivors

&NA; One hundred and four cancer survivors 3 years past their last cancer treatment reported a significantly lower sense of self‐control and more general health worries than a matched sample of healthy controls. The two groups did not differ on variables of anxiety, depression, positive well being, and vitality or on two composite scores of mental and general well‐being. The well‐being scores of the survivors from three geographically distinct cancer centers revealed no significant differences among centers on the composite or any of the individual subscores. Sociodemographic and treatment variables revealed only marriage and no change in job were significantly related to the amount of general well‐being experienced.

Core Competencies for Interprofessional Collaborative Practice: Reforming Health Care by Transforming Health Professionalsʼ Education

Concerns about the quality and safety of health care delivery continue to mount, and the deficiencies cannot be addressed by any health profession alone.1 Despite numerous reports citing the need for team-based education in health professions schools,2 meaningful preparation for collaborative practi

Collegiality in interdisciplinary health teams: Its measurement and its effects

Abstract Interaction during four to seven meetings of four interdisciplinary health care teams was videotaped and coded for amount of interaction initiated and received by doctor, nurses, and nutritionists in each team. Process categories such as “asks opinion,” “gives information,” and “gives order,” were also coded for each participant in each meeting. A model of collegial interaction was developed, and the teams were compared with the model. Outcome data, consisting of measures of social, physical, physiological, and emotional functions were combined into an index of changes in health status. This index was available for the patients under the care of each team. Teams were rank ordered according to the success of their patient outcome six months and one year after the team care was initiated. Results indicate that: (1) All of the teams differed from the collegial model; (2) there were differences among the teams in the extent to which they reflected the collegial model; these differences were present both for participation and for pattern data; (3) the rank order of the teams on a combined (participation plus pattern) collegiality score matched exactly the rank order of the teams on success of patient outcomes.

Development of brief measures of psychosocial adjustment to medical illness applied to cancer patients

The interrater reliability and validity of brief interview rated measures of psychosocial adjustment were examined in four sequential studies. A total of 25 videotaped interviews with cancer patients were rated by 105 social workers, nurses, physicians, and specialists in psychosocial oncology. The Rating of Psychosocial Function (RPF), Coping Adequacy Rating (CAR), and Global Adjustment to Illness Scale (GAIS) were used by various rating groups with an indication of interrater agreement. Agreement on ratings was not influenced by the length of interview (15 vs. 30 minutes) but appeared to the affected by the structure of the interview and profession of the raters. All three instruments showed a measure of matching with clinical impressions in addition to demonstrating a measure of both convergent and divergent construct validation. The GAIS was chosen as most adequately reflecting their clinical impression by a majority of raters. With a degree of training, any of the three instruments could be used to assess psychosocial adjustment with some measure of confidence in the validity of the rating.

Social support in health and illness: the concept and its measurement

The role of social support in health and disease recently has received considerable attention in the literature. Social support has been identified as a protector factor buffering the effects of stressor factors in the etiology of disease. Considerable research data exist tying stressor factors to disease etiology, and, an increasing amount exists concerning social support as a protector factor. However, the dynamics aspects of social support during the illness experience and its potential role in facilitating coping with disease has not been explored. The stressor concept has been used in research on the etiology of cancer. The general concept of buffer factors and, in particular, social support, has not been used much in looking at the etiology of cancer or coping with the presence of cancer, though it would seem to have great implications for the cancer patient. A global measure of stressor variables has been developed and used extensively in research on disease etiology. The lack of an adequate instrument to measure social support remains as a serious problem for research on the effects of this variable in disease etiology and coping with disease. This article documents past efforts to conceptualize social support, suggests some conceptual refinement, and proposes some guidelines for developing measurement of social support in health and illness.