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How to Collaborate and Not Just Coexist: An Explanatory Sequential Mixed Methods Study on the Impact of a Physician and Nurse Interprofessional Education Program on the Development of Early Career Pediatrician Communication Skills and Collaborative Behaviors Once in Practice
Full text linkHealthcare organizations are challenged to build and develop interprofessional (IP) teams capable of delivering effective patient care (Tang et al., 2018). Historically, these multiple professional roles are not formally educated together but are all expected to work in unison once they enter practice (El-Hanafy, 2018). This lack of relational foundation has led to age-old conflict between the physician and nurse roles on the care team (Stein et al., 1990). This conflict has been attributed to a lack of role definition or an overemphasis on hierarchical structures, poor communication, and the inability of physicians to collaboratively work with their nurse counterparts (Crawford et al., 2012). These barriers can lead to ineffective patient care planning and management, decreased work satisfaction, and workplace tension between essential roles (Wang et al., 2018). The problem is that no standard curriculum currently exists in the literature that is being actively used in U.S. based graduate medical education programs that uniformly places importance on IP collaboration between nurses and physicians, yet there is an identified need in the clinical care setting (Allenbaugh et al., 2019; Looman et al., 2020, Wang et al., 2018).
This explanatory sequential mixed methods study aimed to determine the impact that participation in an interprofessional education (IPE) program had on graduates’ perceptions of collaborative behaviors and effective communication skills once in practice by answering the following research questions: Is there a difference in the participants’ perceived abilities across the six domains as they recall them on the Interprofessional Collaborative Competency Attainment Survey (revised; ICCASr) pre and post-assessment? Is there a difference between factor outcomes on the ICCASr pre/posttest between nurses’ and physicians’ professional roles? Is there a correlation between posttest factors for each participant group (nurses and physicians)? How do nurses and physicians describe their communication and collaboration with each other after participation in the program? The quantitative questions were answered using the ICCASr and the qualitative question was answered using open-ended survey questions and interviews.
This mixed methods explanatory sequential design was divided into two distinct phases. Phase 1 involved the collection and analyses of quantitative data via the ICCASr and Phase 2 used qualitative methods derived from open-ended questions and a semi-structured interview. In Phase 1, quantitative data were gained by distributing the ICCASr to 53 graduates from an IPE program, representing the first three cohorts with a return of 22 responses. The ICCASr underwent paired t-tests, independent t-tests, and correlational statistics that were calculated to determine if there was a difference in the participants’ perceived abilities across the six designated domains: communication, roles and responsibilities, conflict management/resolution, team functioning, collaboration, and collaborative patient-family centered approach pre and postintervention. In Phase 2, qualitative data were collected using responses from the open-ended questions on the ICCASr to reveal how the program impacted the participants’ perceived abilities to communicate and collaborate postintervention to offer better patient care. These initial data led to the development of 12 semi-structured interview questions. Virtual interviews were conducted with eight survey participants who volunteered to share their experiences. The qualitative data utilized multilevel descriptive, holistic, and In Vivo coding for analysis to locate significant themes from the position of the participants’ own experiences in relation to the overall study aim.
The ICCASr survey results showed a statistically significant difference in participants’ perceptions on all areas of the IP domains from pre to postintervention. There was no significant correlation between patient-family centered approach associated with conflict management/resolution or communication or team functioning associated with communication for the nurse role. The results of the descriptive statistics and comparative and correlation analyses supported the focused interview questions. The qualitative data generated four essential thematic interpretations as to the intervention’s impact: foundational deficits, construction of perspectives, development of relationship and organizational influence. Each essential theme was influenced through the discovery of categorizing data obtained from the participants’ narratives. The quantitative results were supported by qualitative insights, allowing for a more robust picture from the perspective of the learner as to how the intervention impacted their learning and why this type of programming is important. Using a mixed methods study design and sequential process aimed to determine perceptional behavior change and gain a deeper understanding of how participation in one institution’s early intervention program impacted communication skills and nurse–physician collaborative relationships.
At the conclusion of the study, it was determined that the ICCASr was an effective assessment tool in identifying perceived changes in behavior as it relates to IP programming even years after an intervention. The statistical improvement identified between pre and post-learning surveys supports the effectiveness of this specific program to provide IPE knowledge long term. The themes that emerged from the interviews provided an in-depth look at how this specific program impacted the participants and revealed areas needing attention when developing future IPE programs, such as moving away from modules and simulation. There was a comprehensive belief that the deficit in IPE training in formal healthcare education created the most significant barrier to providing team care. IPE interventions should fill these gaps by providing the necessary job-related soft skills to ensure the positive collaboration between roles in the clinical care setting. Intervention activities should provide a pathway for participants to reflect on their own paradigms as they learn to see the “other” as a human instead of a role, which has not previously been role modeled but will change practice approaches immensely. Having a well-developed early career intervention will improve IP relationships immediately but also provide transferable skills to teach others as providers advance their careers. Finally, to truly support IPE education in the clinical care setting, there must be organizational support to maintain positive relationships and build trust among employees. Mixed methods designs are a novel approach to healthcare education research and provide a deeper dive into the lived experience and shared meaning of learners. The results of this study are meaningful for healthcare education as no other study has assessed the impact of a longitudinal IPE intervention between physicians-in-training and nurses. This study supports the importance of developing a standard IPE curriculum using interactive, relationship-driven activities as a meaningful and necessary part of training to preventatively reduce conflict and proactively develop effective IP communication and collaboration skills to meet healthcare organization and patient needs once in practice
Examining High School Girls’ Experiences in a Global Leadership Program: A Constructivist Grounded Theory Study
Full text linkThe proportion of women in influential leadership positions continues to grow at a slow pace (Beaupre, 2022; Hoyt & Johnson, 2012). Inequalities are still present in the representation of leadership and salary wages (Catalyst, Inc., 2022; Choi, 2018). While progress is evident in regard to diversity and inclusion policies and practices in the workplace, barriers continue to exist that hinder opportunities for women who strive to achieve higher-level positions (Elias, 2018). With more women in leadership positions, advocacy for women and girls can occur, such as access to leadership development programs in schools and organizations (Beaupre, 2022; Shier et al., 2018). Specifically, female leadership programs can help to guide the participants in self-identity, strengthen their self-confidence, and nurture leadership skills (Shier et al., 2018). This qualitative study examined the experiences of young women who participated in a girl-led global leadership program in San Antonio, Texas. The question guiding this study addressed the following: In what ways does a girl-led global leadership program influence high school girls’ future aspirations? Using Charmaz’s (2014) constructivist grounded theory methodology, this study investigated the pathways eight participant alumni followed after completing the female girl-led global leadership development program through semi-structured interviews. An examination of archival data was also conducted. Stead and Elliott’s (2009) Leadership Web model, the theoretical framework for this study, supported the findings throughout the study. This study focuses on the importance of global leadership development programs for high school girls. These programs enable them to take charge of their volunteer projects and initiatives, fostering confidence and empowering them to become self-directed learners and leaders in their communities
Medicare Shared Savings Performance: Three-Year Pandemic Analysis
Full text linkThe Centers for Medicare and Medicaid\u27s (CMS) Office of Actuary predicts that U.S. national health expenditures will surpass U.S. gross domestic product per capita by 1.1% annually until 2028, totaling $6.2 trillion in healthcare spending. A significant portion of this spending, 36%, is attributed to Medicare and Medicaid. To address this issue, CMS has implemented the Medicare Shared Savings Program (MSSP) to assist Accountable Care Organizations (ACOs) in reducing healthcare costs and improving the quality of care for beneficiaries. The main objectives of this dissertation are twofold. Firstly, it aims to investigate the relationship between various factors, such as quality score, savings rate, outpatient and inpatient emergency department visits, total primary care visits, total number of beneficiaries, and risk model selected, with the total savings or loss generated by MSSP ACOs during the 2019 and 2021 performance years. Secondly, this dissertation seeks to assess the impact of the 2020 COVID-19 Federal health response on these parameters, both before and after the pandemic, including the generated total savings, quality score, savings rate, outpatient and inpatient emergency department visits, total primary care visits, number of beneficiaries, and risk model selected. The analysis reveals sustained direct relationships over the three-year period between generated total savings or loss, savings rates, and the number of beneficiaries. Additionally, quality scores, outpatient and inpatient emergency department visits show a decline during the same period
Pupil involving oculomotor palsy- Examination, Cause and Outcome
Full text linkBACKGROUND: A patient with a third cranial nerve (CN III) palsy can be a stress inducing event for an optometrist due to the potentially life-threatening etiologies and infrequency of their presentation. The pathogenesis of a CN III palsy can vary from innocuous to life threatening. Palsy of the third cranial nerve results in an impairment of eye movement and / or pupillary response to light depending on the extent of the palsy. CASE REPORT: This case reviews a recent onset of a complete right oculomotor palsy. Literature of similar cases detail the likelihood of variable causes, and while a diagnostic work-up is indicated based on the risk, the etiology of the palsy in this case was determined to be more benign in nature. CONCLUSION: Large scale population studies in the literature reveal the etiology of a CN III palsy from life-threatening conditions is lower than indicated based on published case reports. However, a complete evaluation of a patient including neuro-imagining is still warranted due to the potential life-threatening complications. Further population studies with increased diversity need to be performed to advance knowledge in this area
Diagnosis and Management of a Patient with Methicillin-resistant Staphylococcus aureus Conjunctivitis
Full text linkBackground : Methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming more common. These infections can cause various ocular conditions including conjunctivitis. Conjunctival cultures are an important tool to assist with proper diagnosis and treatment of these infections. Case Report : A 61-year-old African American male presented with the complaint of redness and drainage from his eyes. With the assistance of conjunctival cultures, he was diagnosed with MRSA conjunctivitis. Treatment with vancomycin ultimately led to resolution of the condition. Conclusion : MRSA conjunctivitis should always be considered when a conjunctivitis is not responding to empirical therapy. Eye care professionals should be aware of the susceptibility profiles of these microorganisms in order to appropriately manage patients with the proper medications
Setting Goals for Patients With Type 2 Diabetes in Primary Care
Full text linkBackground. Type 2 diabetes is prevalent amongst the Hispanic population and increases the risk of developing chronic serious health issues (CDC, 2022, April 4). Setting attainable and realistic goals for patients with type 2 diabetes is foundational in achieving glycemic control and improving quality of life (ElSayed et al., 2023a). Purpose. To increase goal setting in patients with type 2 diabetes in the primary care setting. Goal. To promote self-management in patients with type 2 diabetes. Objectives. 100% of staff and providers will attend an in-service on goal setting using a self-management goal tool; 75% of patients will choose to adopt and implement one self-management goal; Providers will review self-management goal sheets for 100% of patients that completed the sheet documenting the goal in treatment plans and scanning the sheets into the electronic health record; 100% of patients that completed the self-management goal sheet will be referred to the in-house diabetic educator. Methods. Education regarding use of the self-management goal sheet was provided. Completion of the self-management goal sheets, placement in the electronic health record, documentation of identified goals in treatment plans and referrals to the in-house diabetic educator were monitored. Outcomes. Three of the four objectives were met with 100% attainment. However, only 44% of patients completed the self-management goal sheet. Implications for Practice. Utilization of the self-management goal sheet promotes self-management and self-efficacy of patients with type 2 diabetes, improves glycemic control, and helps prevents serious and chronic health issues thereby improving quality of life
Mentorship in Academia and Career: A Scholarly Personal Narrative of a Latina Millennial’s Experience
Full text linkThis dissertation, my scholarly professional narrative (SPN), is a self-reflection of mentoring experiences as a Latina millennial in academia and professional settings. These experiences are told through the art of storytelling using testimonio, which promotes a critical awareness of cultural intersectionality and intercultural understanding through first person narrative. My experiences with mentorship in personal, academic, and professional workspaces include mentors who may or may not have influenced my own journey as a doctoral student and business professional as a Latina millennial. Using testimonio helps explain certain cultural challenges, specific scenarios or experiences, familial responsibilities, and cultural barriers, and how identities are preserved, used, and recognized in individual social contexts. This deeply reflective SPN-testimonio introduces a deeper, meaningful, and mutual learning relationship for audiences to connect with the researcher. This dissertation follows a non-traditional format because many personal experiences serve as the data of experiences for this SPN-testimonio. The goal of this study is to use SPN-testimonio to emphasize the weight of responsibility one Latina woman has had to complete a doctorate program and maintain a professional career outside of academia and how the umbrella of mentorship has been a part of that journey. Most importantly, this study shows the capability and adaptability of a Latina’s experiences within multiple personal and professional environments and how identities are often created because of cultural influences, decision making, and personal motivation
A Self-Exploration of a Project Leader’s Career Tilt, Transformation, and Motivational Challenges in the Face of a Mass Organizational Layoff: An Organizational Evocative Autoethnography
Full text linkIn this study, I reflected on my behavior as a project leader in an organizational culture undergoing significant transformations. I explored motivational and engagement best practices for personal and professional career growth in a changing environment, such as layoffs due to downsizing. This study includes my research rationale for improving performance given the impacted career of a project leader. I highlighted the role of goal setting as a critical part of project leadership to facilitate performance in times of organizational crisis. Additionally, I focused on autoethnography as a research method to self-reflect on the impact of self-determination on goal achievement. Through personal reflection, I have identified and analyzed the most effective motivational factors in project leadership and optimal strategies to efficiently achieve organizational goals related to changing organizational cultural environments
Qualities of Effective Saudi University Presidents
Full text linkThe transformation of educational resources in the Kingdom of Saudi Arabia (KSA) was presented as a crucial part of vision 2030 by Crown Prince Mohammad bin Salman in 2016 as an important part of an overall strategy to diversify the KSA from its over-dependence on oil revenues. Vision 2030 imagined the transformational development of knowledge resources in the KSA including the development of leadership and knowledge applications to support the social and economic needs of the nation. High on the list of priorities was transformation of the 33 public universities in the KSA to be able to operate autonomously. Clearly, there would have to be uniquely qualified leadership to undertake such a transformational objective that would call for unique visionary, educational, as well as financial development and staffing entrepreneurship. Defining qualities of effective leadership that a university president should have to lead these objectives that are not currently required was the focus of this Delphi, quantitative, cross-sectional, correlation research survey. This study was organized around an original framework consisting of Transformational, Kirton’s Adaption-Innovation, and Knowledge Hub theories. Opinions of 377 senior KSA educational administrators – presidents, provosts, deans, and department chairs - of 33 Saudi Arabian public universities were gathered to address five research questions and eight research hypotheses. The findings of the study demonstrated that the senior administrators of Saudi Arabia’s public universities are fully aware of the current state of their organizations and what qualities that effective university presidents should be required to have