Interprofessional collaboration in nursing homes (interprof): A grounded theory study of nurse experiences of general practitioner visits

Fleischmann, Nina; Geister, Christina; Hoell, Andreas; Hummers-Pradier, Eva; Mueller, Christiane A.

doi:10.1016/j.apnr.2017.02.021

Cited by 15 publications

(16 citation statements)

References 24 publications

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“…The in depth exploration of the material took more time than the development of the measures. First publications on GPs´ and nurses´ perspectives on nursing home visits are already available [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

Interprofessional collaboration in nursing homes (interprof): development and piloting of measures to improve interprofessional collaboration and communication: a qualitative multicentre study

et al. 2018

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BackgroundGiven both the increase of nursing home residents forecast and challenges of current interprofessional interactions, we developed and tested measures to improve collaboration and communication between nurses and general practitioners (GPs) in this setting. Our multicentre study has been funded by the German Federal Ministry of Education and Research (FK 01GY1124).MethodsThe measures were developed iteratively in a continuous process, which is the focus of this article. In part 1 “exploration of the situation”, interviews were conducted with GPs, nurses, nursing home residents and their relatives focusing on interprofessional interactions and medical care. They were analysed qualitatively. Based on these results, in part 2 “development of measures to improve collaboration”, ideas for improvement were developed in nine focus groups with GPs and nurses. These ideas were revisited in a final expert workshop. We analysed the focus groups and expert workshop using mind mapping methods, and finally drew up the compilation of measures. In an exploratory pilot study "study part 3" four nursing homes chose the measures they wanted to adopt. These were tested for three months. Feasibility and acceptance of the measures were evaluated via guideline interviews with the stakeholders which were analysed by content analyses.ResultsSix measures were generated: meetings to establish common goals, main contact person, standardised pro re nata medication, introduction of name badges, improved availability of nurse/GP and standardised scheduling/ procedure for nursing home visits. In the pilot study, the measures were implemented in four nursing homes. GPs and nurses reviewed five measures as feasible and acceptable, only the designation of a “main contact person” was not considered as an improvement.ConclusionsSix measures to improve collaboration and communication could be compiled in a multistep qualitative process respecting the perspectives of involved stakeholders. Five of the six measures were positively assessed in an exploratory pilot study. They could easily be transferred into the daily routine of other nursing homes, as no special models have to exist in advance. Impact of the measures on patient oriented outcomes should be examined in further research.Trial registrationNot applicable.Electronic supplementary materialThe online version of this article (10.1186/s12875-017-0678-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Interprofessional collaboration in nursing homes (interprof): development and piloting of measures to improve interprofessional collaboration and communication: a qualitative multicentre study

et al. 2018

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“…Hence cooperation of the three professions is a promising approach for a safe and efficient medication management [2]. Systematic procedures on how to co-operate are not in place [3], and the professional groups involved in medication management (GPs, nursing staff and pharmacists) have been shown to poorly communicate and undervalue each other’s competencies on this matter [4].…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study)

et al. 2019

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BackgroundMedication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR’ health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists’ medication reviews linked with measures to strengthen interprofessional co-operation on NHR’ medication quality, health status and health care use.MethodsPragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist’s medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a “toolbox” to facilitate implementation in daily practice. Analysis: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs.DiscussionThe trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany.Trial registrationRegistered in the German register of clinical studies (DRKS, study ID DRKS00013588, primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.

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“…The confidence of healthcare staff, both in their own capacity and their professional role, is crucial for the quality of care and should receive more attention. 17 Leadership plays an important role in ethical qualitative care, supplying tools, confirmation and recognition such as common space and structures for the staff to be able to act in an evidence-based way. 18 Previous research with municipal healthcare staff shows a lack of confidence in their own capacity to apply such things as evidence to their own daily work.…”

Section: Introductionmentioning

confidence: 99%

Working with short-term goal-directed reablement with older adults: Strengthened by a collaborative approach

Gustafsson

Anbäcken

Elfström

et al. 2019

Nordic Journal of Nursing Research

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The increased number of older adults who experience longevity requires increased investment in healthcare services. Short-term goal-directed reablement is expected to strengthen the functional capacity and quality of life of older adults, while homecare hours, and thus municipal expenditures, decrease. Facilitation of successful interprofessional collaboration includes not only enhancing coordination structurally, but also establishing a commitment regarding culture that overcomes professionally differentiated attitudes. Nurses have an obvious role in these multi-professional teams and the study explores some aspects' of working in this type of collaboration. The aim was to illuminate the meaning of working with short-term goal-directed reablement of older adults as experienced by an interprofessional team. Data were collected after an intervention with goal-directed time-limited reablement of older people. Written narratives from an interprofessional team were analyzed using a phenomenological-hermeneutic approach. Findings identified four major thematic structures that characterized the meaning: 1) Reliable relationship; including the aspects ‘Confidence between the older adult and staff’, ‘A sense of security’ and ‘Continuity’, 2) Empowered participation, including the following aspects: ‘Listen to the older adult’s desires’ and ‘Put the person in control’, 3) Team with a negotiated approach, including the aspects: ‘Closeness’, ‘Same direction and overarching goal’, ‘Learning from interprofessional dialogue’, 4) Time for growth with the aspects ‘Creating harmony’ and ‘Building the older adult’s self-confidence’. The process of reablement seemed strengthened by the collaborative approach of different professions and their combined efforts. The present study argues that teamwork gives confidence both in terms of general knowledge of reablement but also specific confidence in one’s profession.

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Interprofessional collaboration in nursing homes (interprof): A grounded theory study of nurse experiences of general practitioner visits

Cited by 15 publications

References 24 publications

Interprofessional collaboration in nursing homes (interprof): development and piloting of measures to improve interprofessional collaboration and communication: a qualitative multicentre study

Interprofessional collaboration in nursing homes (interprof): development and piloting of measures to improve interprofessional collaboration and communication: a qualitative multicentre study

Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study)

Working with short-term goal-directed reablement with older adults: Strengthened by a collaborative approach

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