1
Examining theAattitudes of Nnurses TowtowardNnurse-Pphysician Ccollaboration
Grace Mayne
University of Alabama at Birmingham,
June 6th 2016
Background and Significance
The United States is experiencing a crisis as healthcare professionals struggle with a culture in which there is poor communication and lack of collaboration. More than 70% of major medical errors (The Joint Commission, 2014), have been attributed to poor nurse-physician[SD1], [SD2]According to the U.S. Department of Health and Human Services, (2010) the financial cost of medical errors is estimated to cost the Centers for Medicare and Medicaid Services approximately 4 billion annually. Interprofessional collaboration has gained the recognition of the World Health Organization (2010) as a strategy to strengthen healthcare organizations and subsequently improve health outcomes. Additionally, researchers have suggested that collaboration has the potential to improve various aspects of healthcare, including staff satisfaction and controlling costs,(Chang, Ma, Chiu, Lin, & Lee, (2009); Estabrooks, Midozi, Cummings, Ricker, & Giovannetti, (2005); McAllister, Stewart, Ferrua, & McMurray, (2004).
The purpose of this review is to identify common theses[SD3] associated with nurse-physician collaboration and discuss one strategy aimed at improving nurse-physician collaboration.
Historically, a hierarchical and patriarchal relationship has existed between nurses and physicians,(Thomas, Sexton, & Helmreich, 2003). Prior to the 1990s, physicians played a dominant role in managing the care of patients and nurses were delegated a subservient role, in which they carried out physicians’ orders (nursing care), (Sharma & Klocke, 2014). Research has shown theSome studies have described the nurse-physician relationship as hostile and adversarial in many western countries including the United States, Italy, Germany, and Asian countries such as China and Japan,(Morinaga, Ohtsubo, Yamauchi, & Shimada, 2008). Some studies have described some physician behavior as “intimidating,” “rude,”, and exhibiting disruptive behaviordisruptive, e.g. yelling and use of abusive language (e.g.,Robinson, Gorman, Slimmer,,Yudkowsky,, (2010); RosteinO’Daniel, (2005)).
The American Nurses Association (ANA 2003, p 33) noted that there are global and institutional pressures to foster[SD4] nurse-physician collaboration a “true partnership, in which the power is valued by both; with recognition and acceptance of separate and combined domains of activity and responsibility. Interprofessional collaboration is critical to all professionals in the healthcare arena, however many of the studies on the importance of nurse-physician collaboration has been conducted by nurses (e.g. , Gunnarsdottir, Clarke, Rafferty & Nutbeam, (2009); Kenaszchuk, Wilkins, Reeves, Zwarenstein & Russell, (2010). Onishi, Komi & Kanda, (2013); and Dougherty & Larson (2005) posited that nurses have a greater interest in the concept of nurse-physician collaboration than physicians.The importance of collaboration has been recognized by both nurses and physicians as important in promoting “patient safety, satisfaction, faster recovery and lower mortality rates,” (Rosenstein & O’Daniel, 2005).
Review of Literature
The purpose of this literature review was to evaluate and summarize current research focusing on one strategy that can improve nurse-physician communication and collaboration in the healthcare setting. The literature focused on the challenges faced by nurses in their interaction with physician andstructured interdisciplinary bedside rounding with a goal of improving collaboration.Collaboration requires intentional sharing of knowledge and shared responsibility for patient care Pritts & Hiller, (2014).Pritts and Hiller also noted that fostering an environment that is conducive to good nurse-physician collaboration improves patients’ outcomes.
A primary search was conducted that included key terms: “interprofessional teams” or “multidisciplinary teams,”“physicians,” nurses,”“nurse-physician,” “patient-centered rounding,””bedside rounding,”“structured bedside rounding,”“nurse-physician communication” and “nurse-physician collaboration.” Searches were conducted in the following databases; PubMED, Cumulative Index for Nursing and Allied Health (CINAHL), PsychoInfo and ERIC covering the years 2010 through 2016. The searches were customized to focus on the identified topic of interest. The initial search generated sixty-two articles. The numbers were reduced with narrowing of the criteria that includsed key search terms and phrasesto ten articles as they met the criterial for the main concepts and provided the strongest sources of evidence. Papers in this review included seven studies conducted in the United States. The additional studies included one in Greece, one in Iran and one in Italy. The latter three studies were chosen to explore the phenomenon of interest in other countries and cultures.
Search Outcomes
Ten studies are included in this review. Eight studies were written in English, and one was translated from Persian to English by one of the authors who is a certified translator and a second from Greek to English —also by a certified translator. The chosen articles were examined to ensure that they included key words and search terms related to nurse-physician collaboration. Three of the reviewed articles were descriptive studies. The other six articles included one qualitative,; one mixed- method study, one observational cross- sectional study, one controlled trial, one two-phased prospective pilot study and two quality improvement pilots.
Inclusion and Exclusion Criteria
Each study was read to assess for their relevance to the subject. Exclusion criteria were also assessed during the review process. Studies related to nurse-physician communication in outpatient clinics, nursing homes, surgery, studies that explored communication and collaboration among nurse, physician and other healthcare disciplines, commentaries and opinion papers were also excluded.
The selected articles were critically appraised and a table was developed to synthesize the information. Data was further abstracted to rate the level of evidence using Melnyk’s Pyramid (2011) rating system for the hierarchy of evidence. Four pilot studies and a descriptive study had evidence that were deemed at a level 6. Two descriptive correlational studies and the evidence were deemed at a level 4. Three studies including a qualitative, a mixed- methods and an observational cross- section study had an evidence level of 6. There was one controlled trial with evidence was at a level 3.
Themes
Emerging themes from this review include: (1) factors that can influence nurse-physician communication and collaboration; (2) nurses’ perception of physician-nurse communication and collaboration and its impact on the quality of care provided by interprofessional teams; and (3) structured bedside rounds, which is now at the fore front of strategies to improve collaboration.
The first emerging theme from this literature review isthe concept of nurse-physician collaboration. Several of the studies reviewed found that collaboration was valued by both physicians and nurses(Pritts & Hiller, 2014). Nurse-physician collaboration has been supported by numerous research findings (, e.g. Wilkins, Reeves, Zwarenstein, & Russell; Piers et al., (2011); Streeton et al., (2016). Collaboration betweeeen nurses and physician continue to be a challenge asdisciplines continue to work in silos.As changes in healthcare continue to evolve the hierarchical and social influences and cultural differences of the nurse-physician dyad continue to be barriers to collaboration.
A second emerging theme in various studies identifies factors such as percieved lack of independence in decision-making, lack of knowledge of the nurses’ capabilities, and respect and trust within the nurse-physician relationship (e.g.Vaismoradi, Salsli, Esmaelpour & Cheraghi, (2011), Karanikola, Albarran, Drigo, Giannakopoulou, Kallafati, Mpouzika, … Papathanassoglou, (2014;)[SD5] Matziou, Vlahoti, Perdikaris, Matziou, & Magapanou, (2015; & Vaismoradi, Salsli, Esmaelpour & Cheraghi, 2011). Although these studies were conducted outside of the United States it can be noted that it is reflective of nurse’s perceptions globally. Results of a study by Hughes & Fitzpatrick (2010) & Thomson (2007) indicated that nurses had a more significantly positive attitude towards collaboration than physicians. Pritts & Hiller (2014) also noted that nurses perceived that rounding improved collaborative practice and work relationships.
The third theme identified one strategy that supports collaborative practice. Structured interdisciplinary bedside rounding (SIBR) was discussed in two research articles by Burns (2011) & Robinson, Gorman, Slimmer & Yudkowsky, (2010). SIBR allows a team of health care professionals to come together for a common goalof quality patient care, with the patient not only as a central focus but as a participatingve member of the team. Stein, Payne, Methvin, Bonsall, Chadwick, Clark … Dressler, et al. (2015), in describing an effective clinical microsystem,identified four key traits for success:“(1) unit-based teams, (2) structured interdisciplinary bedside rounds (SIBR), (3) unit-level performance reporting, and (4) unit-level nurse and physician coleadership.”Multiple studies examines structured bedside rounding and its positive impact on nurse- physicianna communication with evidence that it promotes positive patienteitn outcomes (e.g. Gausvik, Lautaur, Miles, Palleria, & Schlauderker,(2015); Henkin et al., 2016; O‘Leary, Wayne, Slade, & Williams, 2010; Southwick, Lewis, Treloar, Cherabuddi, Radhakrishnan, Leverence et al…& Cottler,(2014); Henkin, Chon, Christopherson, Halvorsen, Worden, & Ratelle, (2016); and O‘Leary, Wayne, Slade, & Williams, (2010). Implementation of this process among an interprofessional team requires buy- in and a team approach to achieve any level of success.Streeton et al. (2016) prior to implementation of a quality improvement project, assessed the need for nurse-physician collaboration and solicited input from the stakeholders (nurses and physicians).
Synthesizing the literature generated supporting evidence about the importance of physician-nurse communication and,collaboration and its influence on health outcomes. Additional evidence highlights the importance of nurse-physician collaboration and the impact it has on patient safety and outcomes (WHO, 2010). The astronomical financial cost as a result of medical errors related to poor nurses-physician collaboration cannot be ignored (U.S. Department of Health and Human Services, 2010). The evidence gleaned from the numerous studies indicates that this is not unique to the U.S, but it is also a global phenomenon, (Karanikola et al., 2015(; Matziou et al., 2015); Onishi et al. 20130; & Vaismoradi et al, 2011). The complexity of the interpersonal process of nurse-physician collaboration requires innovative strategies to streamline the process of collaboration between both disciplines. Sharma et al., (2014) and Prittsand Hiller (2014) in their research generated evidence in their research supporting structured interdisciplinary bedside rounding as one strategy in promoting nurse-physician collaboration. Southwick et al. (2014) in their study supported nurse-physician collaboration in their study using TPS, a business model to promote team building and collaboration in the healthcare setting. The evidence was further supported by Stein et al., (2015).
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[SD1]Poor nurse-physician what?
[SD2]Is this the end of the sentence?
[SD3]Should this say theses or themes?
[SD4]I might use the word “call,” or “name.” “Foster” means to encourage which doesn’t make sense in the context of this sentence.
[SD5]Is this all one source?