Exploring the nature of interprofessional collaboration and family member involvement in an intensive care context

Paradis, Elise; Reeves, Scott; Leslie, Myles; Aboumatar, Hanan; Chesluk, Ben; Clark, Phillip G.; Courtenay, Molly; Franck, Linda S.; Lamb, Gerri; Lyndon, Audrey; Mesman, Jessica; Puntillo, Kathleen; Schmitt, Mattie; Soeren, Mary van; Wachter, Bob; Zwarenstein, Merrick; Gropper, Michael A.; Kitto, Simon

doi:10.3109/13561820.2013.781141

Cited by 14 publications

(8 citation statements)

References 9 publications

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“…Our data were collected in a year long comparative ethnographic study of team interactions in four ICUs at four academic hospitals in the US (see Paradis et al 2014). Ethnography is the preferred methodology for studying the context within which healthcare practices are embedded , and a key element in the successful design, implementation and evaluation of interventions in healthcare delivery (Bosk et al 2009;Dixon-Woods and Bosk 2010;Leslie et al 2014).…”

Section: Methodsmentioning

confidence: 99%

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

Paradis

Leslie

Gropper

2015

Adv in Health Sci Educ

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Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed.

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Section: Methodsmentioning

confidence: 99%

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

Paradis

Leslie

Gropper

2015

Adv in Health Sci Educ

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“…patient-centred care, shared decision-making, citizen advisory boards) [123]. Grounded in this emerging ethos of partnership, the fields of research on interprofessional collaboration for patient-centred care and shared decision-making in healthcare are each still relatively young [45]. Over the past decades there has been a shift in focus from the patient-doctor dyad as the primary unit of analysis to the interprofessional healthcare team [6].…”

Section: Introductionmentioning

confidence: 99%

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

Dogba

Menear

Stacey

et al. 2016

International Journal of Integrated Care

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Introduction:Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn’s theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time.Methods:In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team’s four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn’s theory.Results:The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain.Discussion:This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.

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“…We draw on a year‐long comparative study (Paradis et al. ) of three intensive care units (ICUs) to highlight the effects HIT is having on clinical relationships. We approach HIT as part of a “socio‐technical ensemble” (Bijker ), viewing technical infrastructures, and the clinicians who work with them, as two sides of a single coin (Bijker and Law ; MacKenzie and Wajcman ).…”

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confidence: 99%

An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units

Leslie

Paradis

Gropper

et al. 2017

Health Services Research

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HIT has the potential to accentuate social and professional divisions as clinical communications shift from being in-person to electronically mediated. Socio-technically informed usability testing is recommended for those hospitals that have yet to implement HIT. For those hospitals already implementing HIT, we suggest rapid, locally driven qualitative assessments focused on developing solutions to identified gaps between HIT usage patterns and organizational quality goals.

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Exploring the nature of interprofessional collaboration and family member involvement in an intensive care context

Cited by 14 publications

References 9 publications

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units

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