Michelle Giles

When do interprofessional teams succeed? Investigating the moderating roles of team and professional identity in interprofessional effectiveness

This study investigates the role of professional identity threat and team identity as moderators of the relationship between diverse composition and the performance of interprofessional teams. Survey data from 47 interprofessional teams in a tertiary referral hospital in New South Wales, Australia demonstrates the value of social identity in understanding the performance of such teams. The first finding, that team identity moderates the relationship between diversity and team effectiveness, indicates that commitment and attraction to their team enhances members’ ability to work together cooperatively. The second finding, that threat to professional identity plays a deleterious role by moderating an inverse relationship between diversity and effectiveness, suggests that professional dissent may increase the negative effects of diversity. Finally, support for the role of interprofessional motivation in strengthening team identity and reducing identity threat provides both an additional theoretical contribution, and offers a practical strategy for enhancing the effectiveness of interprofessional teams.

Toward Realizing the Potential of Diversity in Composition of Interprofessional Health Care Teams An Examination of the Cognitive and Psychosocial Dynamics of Interprofessional Collaboration

Interprofessional approaches to health and social care have been linked to improved planning and policy development, more clinically effective services, and enhanced problem solving; however, there is evidence that professionals tend to operate in uniprofessional silos and that attempts to share knowledge across professional borders are often unsuccessful.Interprofessional approaches to health and social care have been linked to improved planning and policy development, more clinically effective services, and enhanced problem solving; however, there is evidence that professionals tend to operate in uniprofessional silos and that attempts to share knowledge across professional borders are often unsuccessful.

Doing clinical research: The challenges and benefits

Abstract The need for research in practice is well documented within nursing and other health care disciplines. This acceptance is predicated on the belief that clinically applied research will inform and improve practice and health service delivery resulting in better outcomes for consumers and their families. Nurses, however, find doing clinical research challenging. This paper describes nurses’ experiences of doing clinical research. The main challenges of doing clinical research arise from a culture that prioritises practice where nursing work is core business and there is the need to address immediate and short term goals. There are also problems associated with the use of research language amongst clinical nurses and ambiguity in relation to research role expectations. Lack of support and resources for doing research along with keeping up the momentum for a research project also pose significant challenges. The benefits of doing clinical nursing research include experiential learning that has the potential to lead to practice change and improved patient outcomes that are evidence based.

A fracture prevention service reduces further fractures two years after incident minimal trauma fracture

To evaluate the impact of a fracture prevention clinic service on initiation of treatment, continuing treatment and subsequent minimal trauma fractures (MTF).

Tracheostomy management in Acute Care Facilities – a matter of teamwork

AIM Implement and evaluate an inter-disciplinary team approach to tracheostomy management in non-critical care. BACKGROUND Trends towards early tracheostomy in intensive care units (ICU) have led to increased numbers of tracheostomy patients. Together with the push for earlier discharge from ICU, this poses challenges across disciplines and wards. Even though tracheostomy is performed across a range of patient groups, tracheostomy care is seen as the domain of specialist clinicians in critical care. It is crucial to ensure quality care regardless of the patients destination after ICU. DESIGN A mixed method evaluation incorporating quantitative and qualitative approaches. METHOD Data collection included pre-implementation and postimplementation clinical audits and staff surveys and a postimplementation tracheostomy team focus group. Descriptive and inferential analysis was used to identify changes in clinical indicators and staff experiences. Focus group data were analysed using iterative processes of thematic analysis. RESULTS Findings revealed significant reductions in mean hospital length of stay (LOS) for survivors from 50-27 days (p < 0.0001) and an increase in the number of tracheostomy patients transferred to non-critical care wards in the postgroup (p = 0.006). The number of wards accepting patients from ICU increased from 3-7 and there was increased staff knowledge, confidence and awareness of the teams role. CONCLUSION The team approach has led to work practice and patient outcome improvements. Organisational acceptance of the team has led to more wards indicating willingness to accept tracheostomy patients. Improved communication has resulted in more timely referral and better patient outcomes. RELEVANCE TO CLINICAL PRACTICE This study highlights the importance of inter-disciplinary teamwork in achieving effective patient outcomes and efficiencies. It offers a model of inter-disciplinary practice, supported by communication and data management that can be replicated across other patient groups.

Transformation through tension: The moderating impact of negative affect on transformational leadership in teams

Transformational leadership has consistently been argued to enhance diverse team outcomes, yet related research has generated ambiguous findings. We suggest that effectiveness is enhanced in interprofessional teams when transformational leaders engender dynamics that are characterized by interprofessional motivation and openness to diversity. Drawing on the mood-as-information perspective, we argue that negative affective tone moderates the impact of these mediators on team effectiveness. Further, we suggest that this moderating role is such that conditions of high negative affect enhance the mediating role of interprofessional motivation, while low negative affect strengthens the mediating role of openness to diversity. In order to investigate these divergent effects, the current study develops a model of leadership and interprofessional team effectiveness through two pathways reflecting the parallel mediating effects of interprofessional motivation and openness to diversity, and a moderating role for negative affect. Findings from a survey-based study of 75 healthcare teams support the utility of this model.

The Abc of health care team dynamics: Understanding complex affective, behavioral, and cognitive dynamics in interprofessional teams

Background: Interprofessional teams form the basis of many health care problem-solving and decision-making mechanisms. However, more than 70% of medical errors are attributable to dysfunctional team dynamics. The recent suggestion that health care teams are more complex than nonmedical teams suggests that we require more sophisticated knowledge of team dynamics and processes. Purposes: The mechanisms of dysfunctional interprofessional teams focusing on affective, behavioral, and cognitive effects are explored. We argue that interprofessional composition impacts team dynamics by increasing the likelihood of affective conflict, which mediates a decrease in elaborative behaviors and open-mindedness. Methodology: The hypotheses are investigated using a cross-sectional, correlational design. Survey data received from 218 members of 47 interprofessional teams employed in an acute care setting, representing a 39% response rate, is used to investigate two moderated mediation pathways. Findings: Analysis supports a significant relationship between interprofessional composition and affective conflict but only when team rate highly for professional identification. Results also support a dual moderated mediation pathway through which professional diversity has a dysfunctional effect on debate and open-mindedness. Practice Implications: A range of strategies emerge from the findings to minimize dysfunctional interprofessional team dynamics. These include the use of leadership strategies, such as transformational styles, reinforcement of shared values such as patient-centeredness, and development of a shared group identity.

Challenges confronting clinicians in acute care

AIM To engage acute care clinicians in prioritizing professional issues of concern and to help them identify and design change projects. Background In order to meet and respond to challenges and to ensure safety, efficiency and positive patient and staff outcomes, it is imperative to understand the nature of difficulties faced by health professionals and for clinicians to be included in decision making and change. METHOD A three-phase mixed-method design utilizing descriptive and interpretive approaches. Data were collected via survey, focus groups and nominal group workshops. RESULTS Communication, skill mix and work environments were identified as issues of most concern. Participants were able to identify and prioritize a range of projects to help them better understand and alleviate workplace problems. CONCLUSION This study highlights key directions for practice change and confirms previous findings identifying urgent need for research that aims to overcome poor communication and skill shortages. It differs from other studies by providing a platform for participants to design projects leading to solutions and participate in change. IMPLICATIONS FOR NURSING MANAGEMENT Support must be provided for managers in rostering, staffing, and resource procurement and allocation. The results of the present study highlights a need to refocus management styles on staff empowerment, participation and team building.

Trends and challenges in the management of tracheostomy in older people: the need for a multidisciplinary team approach.

Abstract The trend towards increasing representation of older people as recipients of health care in acute care settings is matched with a corresponding increase in the numbers of older people undergoing tracheostomy. The reasons for tracheostomy in this age group are varied, including respiratory failure, neurological injury/event and carcinomas. Further, current research supports early tracheostomy for patients requiring medium to long-term ventilation and unconscious patients at risk of airway obstruction. In spite of this increase very little has been written about decision making and ongoing nursing care for these patients. There is an abundance of literature on the physiological processes of aging and the problems related to comorbidities; however, there has been very little exploration of how these impact on the occurrence of complications and other outcomes for older patients with a tracheostomy, and the consequent implications for care provision. This article examines clinical issues of significance to older people with tracheostomy and outlines the implementation and benefits of a multidisciplinary team approach.

An interprofessional team approach to tracheostomy care: a mixed-method investigation into the mechanisms explaining tracheostomy team effectiveness.

BACKGROUND In an effort to reduce tracheostomy-related complications, many acute care facilities have implemented specialist tracheostomy teams. Some studies, however, generate only mixed support for the connection between tracheostomy teams and patient outcomes. This suggests that the effect of collaborative teamwork in tracheostomy care is still not well understood. OBJECTIVE The aim of this paper is to investigate the mechanisms through which an interprofessional team approach can improve the management of patients with a tracheostomy. DESIGN The achievement of this research objective requires the collection of rich empirical data, which indicates the use of a qualitative methodology. A case study approach provided an opportunity to collect a wealth of data on tracheostomy team activities and dynamics. SETTING AND PARTICIPANTS Data were collected on an interprofessional tracheostomy team in a large tertiary referral hospital in Australia. The team was composed of clinical nurse consultants, a physiotherapist, a speech pathologist, a dietician, a social worker and medical officers. METHODS Data were collected through a focus group and one-to-one, semi-structured in-depth interviews, and thematic analysis was used to analyse experiences of tracheostomy team members. RESULTS Qualitative analysis resulted in two main themes: interprofessional protocol development and implementation; and interprofessional decision-making. CONCLUSIONS Our findings suggest that tracheostomy teams enhance consistency of care through the development and implementation of interprofessional protocol. In addition, such team allow more efficient and effective communication and decision-making consequent to the collocation of diverse professionals. These findings provide new insight into the role of tracheostomy teams in successfully implementing complex protocol and the explanatory mechanisms through which interprofessional teams may generate positive outcomes for tracheostomy patients.