How and where clinicians exercise power: Interprofessional relations in health care

Nugus, Peter; Greenfield, David; Travaglia, Joanne; Westbrook, Johanna I.; Braithwaite, Jeffrey

doi:10.1016/j.socscimed.2010.05.029

Cited by 243 publications

(244 citation statements)

References 21 publications

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“…Additionally, our observations indicated the possible wider impact of medical dominance on shaping these routines and hierarchies, as evident in the informal rules that govern practices such as rounds and decision-making. The dominant role of medicine has been well-researched in various 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 fields, and our findings contribute to literature on the dominant role of medicine within a larger interprofessional work environment (44)(45)(46).…”

Section: Discussionsupporting

confidence: 60%

Beyond the Team

Alexanian

Kitto

Rak³

et al. 2015

Critical Care Medicine

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Main results: While the concept of teamwork is often central to interventions to improve patient safety in the ICU, our observations suggest that this concept does not fully describe how interprofessional work actually occurs in this setting. With the exception of crisis situations, most interprofessional interactions in the two ICUs we studied could be better described as forms of interprofessional work other than teamwork, that include collaboration, coordination, and networking.Conclusions: A singular notion of team is too reductive to account for the ways in which work happens in the ICU, and therefore cannot be taken for granted in quality improvement initiatives or amongst health care professionals in this setting. Adapting interventions to the complex nature of interprofessional work and each ICUs unique local 1

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Section: Discussionsupporting

confidence: 60%

Beyond the Team

Alexanian

Kitto

Rak³

et al. 2015

Critical Care Medicine

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“…3,26 While individual efforts are laudable, it is important to create environments conducive to interprofessional interactions and to maximize the contributions of different professionals to care rather than relying on the benevolence of individuals. 35 The creation of an effective workplace learning culture was identified as another priority area in a survey of medical education research. 18 In this survey, workplace learning was conceptualized as balancing training and service conflicts and creating an effective workplace learning culture.…”

Section: Discussionmentioning

confidence: 99%

Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation

Goldman

Reeves

et al. 2015

J GEN INTERN MED

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BACKGROUND:Interprofessional collaboration is an important aspect of patient discharge from a general internal medicine (GIM) unit. However, there has been minimal empirical or theoretical research that has examined interactions that occur between medical residents and other healthcare professionals in the discharge process. This study provides insight into the social processes that shape and characterize such interactions. OBJECTIVE: To explore factors that shape interactions between medical residents and other healthcare professionals in relation to patient discharge, and to examine the opportunities for negotiations about discharge between these professional groups. DESIGN: A qualitative ethnographic approach using observations, interviews and documentary analysis. PARTICIPANTS AND SETTING: Healthcare professionals working in a GIM unit in Canada. APPROACH: Sixty-five hours of observations were undertaken in a range of settings (e.g. interprofessional rounds, medical and nursing rounds, nursing station) in the unit over a 17-month period. A maximum variation sampling approach was used to identify healthcare professionals working in the unit. Twenty-three interviews were completed, recorded and transcribed verbatim. A directed content approach using theories of medical dominance and negotiated order was used to analyze the data. KEY RESULTS: The organization of clinical work in combination with clinical teaching influenced interprofessional interactions and the quality of discharge in this GIM unit. While organizational activities (orientation and rounds) and individual activities (e.g. role modeling, teaching) supported negotiations between medical residents and other healthcare professionals around discharge, participants had varied perspectives about their effectiveness. CONCLUSIONS: This study illuminates social factors and processes that require attention in order to address challenges with interprofessional collaboration and discharge in GIM. These findings have implications for medical education, workplace learning, patient safety and quality improvement.KEY WORDS: Medical education-practice-based learning; Qualitative research; Quality improvement; Health services research.

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“…In spite of some local opposition from medicine, the perspective emerging is that although medical dominance does appear to have moderated over time, it continues to have an impact and a relevance (Nugus et al 2010and Currie et al 2010, Bacon and Borthwick 2013. Others have drawn attention to diversity within medicine, problematizing medical dominance as an overarching category by proposing that not all physicians exercise power to the same degree (Long et al 2006).…”

Section: Requirements and Standards For Nurse Education Programmes Fomentioning

confidence: 99%

Nurses’, physicians’ and radiographers’ perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

Hyde

Coughlan

Naughton

et al. 2016

International Journal of Nursing Studies

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How and where clinicians exercise power: Interprofessional relations in health care

Cited by 243 publications

References 21 publications

Beyond the Team

Beyond the Team

Medical Residents and Interprofessional Interactions in Discharge: An Ethnographic Exploration of Factors That Affect Negotiation

Nurses’, physicians’ and radiographers’ perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

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