Currently, 4% of older adults reside in long-term care facilities in the Netherlands. Nursing home residents tend to have multimorbidity that is associated with considerable disabilities and a high level of care dependency. In the Dutch adult population the highest estimated prevalence (>40%) of visual impairment (low vision and blindness) was found in the subgroup of residents in nursing homes (NHs). The aim of this study is to describe the current practice of eye care by Dutch nursing home physicians (NHPs). A digital online survey was developed to describe the eye care activities of nursing home physicians and their cooperation in this perspective with other professionals. Of 1573 NHPs present in the Netherlands, 125 (8%) responded. Results show that more than 50% of the NHPs regularly examine ‘distant vision’, ‘near vision’ and ‘the visual field’ . However, 23%, 33% and 45% almost never or never examine the ‘visual field’, ‘near vision’ and ‘distant vision’, respectively. Data regarding eye care, regularly recorded in the client files by more than 50% of the NHPs, are medical data involving ‘use of eye medication’, ‘eye disease’, and ‘eye surgery in the past’. Less commonly recorded is ‘the use of reading glasses’ as well as ‘eye pain’. Inside of the NH, (head) nurses and ward nurses (chi 2 = 309, df = 5, p = 0.000), and outside of the NH, ophthalmologists and low vision specialists are most frequently contacted about eye related issues (chi 2 = 224, df = 4, p = 0.000). Opticians are rarely contacted, and optometrists and orthoptists are ‘never’ contacted by more than 50% of the NHPs. Moreover, 50% of the NHPs noted that collaboration with external eye care professionals is ‘not structural’. This study shows that, according to NHPs, relevant visual aspects are not structurally examined and recorded in the client files. Outside of the NH, NHPs tend to have a less frequent collaborative relationship with optometrists, orthoptists and opticians compared to ophthalmologists and low vision specialists. The NHP’s role in providing eye care can be improved by development of guidelines for structural eye screening, improvement of recording in client files, and exploring plus undertaking collaboration with other eye care professionals.
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Background: A highly promoted opportunity for optimizing healthcare services is to expand the role of nonphysician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to nonphysicians and identify drivers for and barriers to reallocation. Methods: A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians. Results: A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusions: Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed.
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Background: Guidance of patients treated with antidepressants is paramount for successful therapy. The aim was to assess patients’ needs and suggestions for improvement of guidance by physicians and pharmacists during second generation antidepressant (SGA) therapy. Methods: Five focus group discussions were held with a total of 34 patients using an SGA. The discussions were conducted flexibly and responsively using a semi-structured topic list. All focus group discussions were videorecorded and transcripts were analyzed using ATLAS.ti for coding, thematic and open analysis. Results: Participants stated they were in need of better guidance. They suggested improving content of information during decisional moments, patient-health care professional communication and communication between health care professionals, and finally, organization of guidance. Barriers to achieving improved guidance were cited. Conclusions: Content, communication and organization of guidance are pivotal for achieving optimal guidance. Participants mentioned their current experienced guidance had limitations and brought up solutions for improvement. A next step would be to discuss the suggested solutions with health care professionals to assess their views and to discuss the possibility for implementation. After implementation, future studies could be aimed at determination of its impact on patients’ treatment efficacy, quality of life, treatment satisfaction and healthcare costs. DOI 10.1186/s12888-017-1522-9
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BACKGROUND: Families are introduced as new partners in interprofessional communication and collaboration during hospitalisation of an adult patient. Their introduction into the healthcare team has consequences for the roles and responsibilities of all healthcare professionals. Role clarification is thus needed to create optimal communication and collaboration with families.AIM: To gain insight into how physicians and nurses view their own roles and each other's roles in communication and collaboration with families in the care of adult patients.METHODS: A qualitative interpretive interview design was used. Fourteen semi-structured interviews, with seven physicians and seven nurses, were conducted. Data were analysed according to the steps of thematic analysis. For the study design and analysis of the results, the guidelines of the consolidated criteria for reporting qualitative studies (COREQ) were followed. The ethical committee of the University Medical Center Groningen approved the study protocol (research number 202100640).FINDINGS: Thematic analysis resulted in three themes, each consisting of two or three code groups. Two themes "building a relationship" and "sharing information" were described as roles that both nurses and physicians share regarding communication and collaboration with families. The role expectations differed between physicians and nurses, but these differences were not discussed with each other. The theme "providing support to family" was regarded a nurse-specific role by both professions.CONCLUSION: Physicians and nurses see a role for themselves and each other in communication and collaboration with families. However, the division of roles and expectations thereof are different, overlapping, and unclear. To optimise the role and position of family during hospital care, clarification and division of the roles between physicians and nurses in this partnership is necessary.
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Background: Medical consultations with older patients often include triadic conversations and decision-making processes involving physicians, patients, and family members. The presence of family members may change the communication dynamics and therefore increase the complexity of the consultation and decision-making process. Objective: This study explored associations between physicians' shared decision-making (SDM) behaviour and patients' and family members' participation in the decision-making process. Methods: Using an observational design, we analysed 95 recorded consultations between medical specialists, patients aged ≥65 years, and accompanying family members at a Dutch hospital. The OPTIONMCC was used to assess the physicians' SDM behaviour and patients' and family members' levels of involvement in SDM. Results: We found a strong positive correlation between physicians' behaviour and patients' and family members' participation in SDM (0.68 and 0.64, respectively, p < .01). Family members were more involved in SDM for patients aged 80 and older. Conclusion: While not asserting causation, our study suggests physicians potentially play a facilitating role in shaping the SDM process together with proactive contributions from patients and family members. Innovation: The results offer new insights into triadic SDM and provide suggestions for refining the OPTIONMCC. Further research is recommended into participants' mutual directional influences in triadic SDM.
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Objectives: To understand healthcare professionals' experiences and perceptions of nurses' potential or ideal roles in pharmaceutical care (PC). Design: Qualitative study conducted through semi-structured in-depth interviews. Setting: Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. Participants: In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. Data collection and analysis: All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. Results: 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses' autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. Conclusions: European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.
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AIM: Identification and synthesis of research data related to the roles and competencies of physicians and nurses that are prerequisites for careful shared decision-making with patients potentially undergoing cardiac surgery.DESIGN: A scoping review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews and the PRISMA Extension for Scoping Reviews.METHODS: PubMed, EMBASE and CINAHL were searched from inception dates up to March 2022, to identify primary studies published in a peer-reviewed journal. Study selection, assessment of the methodological quality and data extracting of the included studies were done by at least two independent researchers. To describe the findings of the studies, an emergent synthesis approach was used to visualize a descriptive representation of professional roles and competencies in shared decision-making, in an overview.RESULTS: The systematic search revealed 10,055 potential papers, 8873 articles were screened on title and abstract and 76 full texts were retrieved. Eight articles were included for final evaluation. For nurses and physicians, 26 different skills were identified in the literature to practice shared decision-making in cardiac surgery. The skills that emerged were divided into five professional roles: moderator; health educator; data collector; psychological supporter and translator.CONCLUSIONS: This review specifies the professional roles and required competencies related to shared decision-making in cardiac surgery. Further research is needed to compare our findings with other clinical areas and from there to arrive at a professional division of roles between the different clinical disciplines involved.IMPACT: The visualization of generic shared decision-making competencies and roles should establish the professional division of positions between various clinical physician and nurse disciplines in order to create a treatment plan based on evidence, values, preferences and the patient's personal situation.PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Objectives In order to recognise and facilitate the development of excellent medical doctors (physicians and residents), it is important to first identify the characteristics of excellence. Failure to recognising excellence causes loss of talent, loss of role models and it lowers work ethos. This causes less than excellent patient care and lack of commitment to improve the healthcare system. Design Systematic review performed according to the Association for Medical Education in Europe guideline. Information sources We searched Medline, Embase, Psycinfo, ERIC and CINAHL until 14 March 2022. Eligibility criteria We included original studies describing characteristics of excellent medical doctors, using a broad approach as to what is considered excellence. Assuming that excellence will be viewed differently depending on the interplay, and that different perspectives (peers, supervisors and patients) will add to a complete picture of the excellent medical doctor, we did not limit this review to a specific perspective. Data extraction and synthesis Data extraction and quality assessment were performed independently by two researchers. We used the Quality Assessment Tool for Different Designs for quality assessment. Results Eleven articles were eligible and described the characteristics from different perspectives: (1) physicians on physicians, (2) physicians on residents, (3) patients on physicians and (4) mixed group (diverse sample of participants on physicians). The included studies showed a wide range of characteristics, which could be grouped into competencies (communication, professionalism and knowledge), motivation (directed to learning and to patient care) and personality (flexibility, empathy). Conclusions In order to define excellence of medical doctors three clusters seem important: competence, motivation and personality. This is in line with Renzulli's model of gifted behaviour. Our work adds to this model by specifying the content of these clusters, and as such provides a basis for definition and recognition of medical excellence.
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BACKGROUND: Prognostic assessments of the mortality of critically ill patients are frequently performed in daily clinical practice and provide prognostic guidance in treatment decisions. In contrast to several sophisticated tools, prognostic estimations made by healthcare providers are always available and accessible, are performed daily, and might have an additive value to guide clinical decision-making. The aim of this study was to evaluate the accuracy of students', nurses', and physicians' estimations and the association of their combined estimations with in-hospital mortality and 6-month follow-up.METHODS: The Simple Observational Critical Care Studies is a prospective observational single-center study in a tertiary teaching hospital in the Netherlands. All patients acutely admitted to the intensive care unit were included. Within 3 h of admission to the intensive care unit, a medical or nursing student, a nurse, and a physician independently predicted in-hospital and 6-month mortality. Logistic regression was used to assess the associations between predictions and the actual outcome; the area under the receiver operating characteristics (AUROC) was calculated to estimate the discriminative accuracy of the students, nurses, and physicians.RESULTS: In 827 out of 1,010 patients, in-hospital mortality rates were predicted to be 11%, 15%, and 17% by medical students, nurses, and physicians, respectively. The estimations of students, nurses, and physicians were all associated with in-hospital mortality (OR 5.8, 95% CI [3.7, 9.2], OR 4.7, 95% CI [3.0, 7.3], and OR 7.7 95% CI [4.7, 12.8], respectively). Discriminative accuracy was moderate for all students, nurses, and physicians (between 0.58 and 0.68). When more estimations were of non-survival, the odds of non-survival increased (OR 2.4 95% CI [1.9, 3.1]) per additional estimate, AUROC 0.70 (0.65, 0.76). For 6-month mortality predictions, similar results were observed.CONCLUSIONS: Based on the initial examination, students, nurses, and physicians can only moderately predict in-hospital and 6-month mortality in critically ill patients. Combined estimations led to more accurate predictions and may serve as an example of the benefit of multidisciplinary clinical care and future research efforts.
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Background: Inequities in health have garnered international attention and are now addressed in Sustainable Development Goal 3 (SDG3), which seeks to ‘promote well-being for all’. To attain this goal globally requires innovative approaches, one of which is twinning. According to the International Confederation of Midwives, twinning focusses on empowering professionals, who can subsequently be change-agents for their communities. However, twinning in healthcare is relatively new and because the definition and understanding of twinning lacks clarity, rigorous monitoring and evaluation are rare. A clear definition of twinning is essential for the development of a scientific base for this promising form of collaboration. Method: We conducted a Concept Analysis (CA) of twinning in healthcare using Morse’s method. A qualitative study of the broad literature was performed, including scientific papers, manuals, project reports, and websites. We identified relevant papers through a systematic search using scientific databases, backtracking of references, and experts in the field. Results: We found nineteen papers on twinning in healthcare. This included twelve peer reviewed research papers, four manuals on twinning, two project reports, and one website. Seven of these papers offered no definition of twinning. In the other twelve papers definitions varied. Our CA of the literature resulted in four main attributes of twinning in healthcare. First, and most frequently mentioned, was reciprocity. The other three attributes were that twinning: 2) entails the building of personal relationships, 3) is dynamic process, 4) is between two named organisations across different cultures. The literature also indicated that these four attributes, and especially reciprocity, can have an empowering effect on healthcare professionals. Conclusions: Based on these four attributes we developed the following operational definition: Twinning is a crosscultural, reciprocal process where two groups of people work together to achieve joint goals. A greater understanding and a mature definition of twinning results in clear expectations for participants and thus more effective twinning. This can be the starting point for new collaborations and for further international studies on the effect of twinning in healthcare.
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