Studies of older adults' health status and health-related quality of life (HRQoL) often rely on proxy responses when subjects have problems that affect their ability to respond. With the increased interest in outcomes research in health care, it is important to examine proxy reliability on HRQoL instruments. This study compares 32 pairs of subject-andproxy responses on the eight subscales and two summary scales of the Short Form 36 (SF-36). Subjects and their proxies, recruited from senior centers and residential facilities, were interviewed face-to-face within a seven-day period. Subjects were 60 years of age or older and had passed a brief cognitive screen, and proxies were geographically proximate and had seen the subject during the past week. Results showed that although moderate intra-class correlations were found on six of the eight measures, an item-level kappa statistic indicated poor to fair agreement on all subscales except items of Physical Functioning and Role Physical. Moreover, paired t-tests revealed proxy mean scores that were significantly lower on the Physical Functioning, Vitality, and Mental Health subscales. Given the mixed findings, until further research is done, researchers and clinicians should exercise caution when using proxy responses for older adults with the SF-36.
Background: High-performing and high-reliability teams are an important component of service delivery. With a focused emphasis on safety in acute care hospitals, understanding the nature of surgical teams and team performance is an essential component to achieving high-quality surgical care. More information is needed about the challenges to effective team functioning in the operating room, the influence of working conditions, and the environmental context on surgical team performance. Purpose: The purpose of this study is to describe the nature of surgical teams and how they perform in the operating room to contribute to a broader knowledge about high-performing and high-reliability teams in health care settings. Methodology/Approach: We conducted a qualitative study involving direct observation and semistructured interviews. Field observations of 10 high-complexity surgeries and face-to-face interviews with 26 members of surgical teams were completed at one university medical center. A conceptual framework derived from the literature was developed to guide the selection of surgeries and surgical teams to be observed. Data were transcribed and analyzed to identify the factors and different conditions that influence the performance of these surgical teams. Findings: The type of coordination and the degree of independent and interdependent coordination vary among the seven observed stages of the surgical process. Most of the surgical teams were ad hoc teams and as such, further challenged by consistently frequent ''hand-offs'' for break relief. Additional role demands influence the situational dynamics which can alter the adaptive capacity of the team. Practice Implications: The surgical event evokes a changing degree of coordination and adaptation to complexity and uncertainty. In such environments, relational coordination through leadership can contribute to a successful surgical result, improvement of the overall process, including error reduction, and enhanced knowledge creation and dissemination, particularly germane in research university teaching hospitals.
Observations of surgical teams in the operating room (OR) and interviews with surgeons, circulating registered nurses (RNs), anaesthesiologists and surgical technicians reveal the importance of leadership, team member competencies and an enacted environment that encourages feelings of competence and cooperation. Surgical teams are more loosely coupled than intact and bounded. Team members tend to rely on expected role behaviours to bridge lack of familiarity. While members of the surgical team identified technical competence and preparation as critical factors affecting team performance, they had differing views over the role behaviours of other members of the surgical team that lead to surgical team performance. Observations revealed that the work climate in the OR can shape interpersonal relations and begins to be established when the room is being set up for the surgical case, and evolves as the surgical procedure progresses. The leadership and supervisory competencies of the circulating RNs establish the initial work environment. Both influenced the degree of cooperation and support that was observed, which had an effect on the interactions and relationships between other members of the surgical team. As the surgery unfolds, the surgeon's behaviours and interpersonal relations modify this environment and ultimately influence the degree of team work, team satisfaction and team performance.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.