Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care

Abstract

Aims and objectives To explore how community nurses experience the collaboration with general practitioners and specialist palliative home care team nurses in palliative home care and the perceived factors influencing this collaboration. Background The complexity of, and the demand for, palliative home care is increasing. Primary palliative care is provided by community nurses and general practitioners, often in collaboration with palliative home care team nurses. Although these professionals may each individually be part of a fixed team, a new temporary team is often composed for every new palliative patient. These membership changes, referred to as team membership fluidity, challenge professionals to work effectively. Design and methods A qualitative research design, using semi‐structured interviews with community nurses. Participant selection happened through regional palliative care networks in Belgium. The network's palliative home care team nurses selected community nurses with whom they recently collaborated. Twenty interviews were conducted. A constant comparative analysis approach was used. Consolidated criteria for reporting qualitative research guidelines were followed. Results Formal interprofessional team meetings were not common practice. The other's approachability and knowing each other positively influenced the collaboration. Time constraints, the general practitioners' lack of expertise, communication style, hierarchy perception and income dependency negatively influenced the collaboration with general practitioners and determined palliative home care team nurses' involvement. The coping strategies of community nurses balanced between a behaviour focused to the patient and to the professional relationship. Specialist palliative home care team nurses were relied upon for their expertise but also to mediate when community nurses disagreed with general practitioners. Conclusion Community nurses showed to be highly adaptable within the fluid team. Strikingly, dynamics described in the doctor–nurse game 50 years ago are still present today and affect the interprofessional communication. Interprofessional education interventions can contribute to improved interprofessional collaboration. Relevance to clinical practice The study findings uncovered critical knowledge gaps in interprofessional collaboration in palliative home care. Insights are relevant for and related to professional well‐being and workplace learning.

Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports

“…4,7–10 It requires the establishment of a dynamic caring relationship with the patient and family to reduce suffering, and also among nurses themselves and the multi-professional healthcare team. 11–21…”

Leadership in specialist palliative home care teams: A qualitative study

“…Other challenges are that members of palliative care teams rarely are educated together, come from different disciplines and educational programmes, and, nonetheless, are expected to function together effectively (Klarare, Hagelin, Furst, & Fossum, ). Traditional medical hierarchies still influence interprofessional collaboration in palliative care negatively (Mertens, De Gendt, Deveugele, Van Hecke, & Pype, ). These are some of the dimensions that affect leadership, whether leaders are aware of them or not.…”

“…Indicators for effective collaboration in specialist care teams are team performance, effective communication, trust, respect and clear common goals, while ineffective cooperation is related to deficient communication, task conflict, goal ambiguity and lack of team commitment (Junger, Pestinger, Elsner, Krumm, & Radbruch, ; Mertens et al, ; Salas & Frush, ). Interprofessional education has been shown to improve knowledge and attitudes towards teamwork collaboration in a recent scoping review (Fox et al, ).…”

Nurses’ experiences and perspectives on collaborative discharge planning when patients receiving palliative care for cancer are discharged home from hospitals

“…Sources of nurses' distrust may involve doubt about other healthcare professionals´ motivation in providing care, feeling threatened by other nurses' involvement and lack of confidence in other nurses' skills (Karam et al, 2018). In interprofessional collaboration in the home care setting, a history of working together and knowing each other results in feelings of trust (Mertens, De Gendt, Van Hecke, & Pype, 2019).…”

“…Previous studies have predominantly investigated the home care services' perspective (Danielsen et al, 2018;Mertens et al, 2019;Tonnesen et al, 2016) or perspectives at the hospital level (Aamodt et al, 2013;Nosbusch et al, 2011). With the expected increase of patients in demand of palliative care, there is a need to acquire a deeper understanding regarding nurses' perspectives on collaboration between healthcare professionals in the primary and secondary care settings.…”