Mediating workplace situational pressures: The role of artefacts in promoting effective interprofessional work and learning
Introduction: This theoretical paper is a scenario-based account of interprofessional healthcare work that highlights tensions between desired and actual practice behaviour in clinical settings.
Case Study: In this account, against his best clinical judgment and because of situational ward pressures, a junior doctor prescribes antipsychotic medication for a high-risk confused, frail, elderly patient. A healthcare assistant, who possesses key patient-specific information, holds back on sharing this information because of similar pressures.
Analysis: Sociocultural analysis of this account identifies three epistemological factors constraining an individuals’ discretion and behaviour. First, situated team collective practice overrides individual knowledge. Secondly, collective practice, though held strongly by core members of clinical teams, may in fact be erroneous, and fail to support new learning about and through practice, to the detriment of patient care. Thirdly, situated practices of the ward community may marginalise some team members and inhibit their contributions to patient safety.
Conclusions: To redress such constraints, we propose the development of, and engagement with, artefacts or tools that shape inclusive practice and assist improvements in practice. Such an approach can lead to productive learning through practice in interprofessional healthcare teams. To elaborate the case, the illustrative example of the Delirium Early Monitoring System (DEMS) is used. This artefact can be effective in socioculturally mediating unhelpful situational pressures that impact on clinical teams’ management of delirium, by including and legitimising a range of professional voices. This mediation can also include voices that are external to the immediate clinical situation, which can inform interprofessional care, promote interdependence and foster patient-centred working communities of healthcare practice.
Billett, S. (2006). Relational interdependence between social and individual agency in work and working life. Mind, Culture and Activity, 13, 53–69.
Billett, S. (2014). Mimesis: Learning through everyday activities and interactions at work. Human Resource Development Review, 13(4), 462–482.
Chia, R., & MacKay, B. (2007). Post-processual challenges for the emerging strategy-as-practice perspective: Discovering strategy in the logic of practice. Human Relations, 60(1), 217–242.
Clissett, P., Porock, D., Harwood, R. H., & Gladman, J. R. (2014). The responses of healthcare professionals to the admission of people with cognitive impairment to acute hospital settings: An observational and interview study. Journal of Clinical Nursing, 23(13–14), 1820–1829. doi:10.1111/jocn.12342
Donnelly, L. (2015, 17 March). National probe into maternity care ordered after "lethal" mix of failings found. The Telegraph. Retrieved from http://www.telegraph.co.uk/news/health/news/11448226/National-probe-into-maternity-care-ordered-after-lethal-mix-of-failings-found.html
Fox, A., & Reeves, S. (2015). Interprofessional collaborative patient-centred care: A critical exploration of two related discourses. Journal of Interprofessional Care, 29(2), 113–118. doi:10.3109/13561820.2014.954284
Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust public inquiry. Retrieved from https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry
Gherardi, S. (2009). Community of pratice or practices of a community? In S. J. Armstrong & C. V. Fukami (Eds.), The SAGE handbook of management learning, education and development (pp. 514–530). London, England: Sage. doi:10.4135/9780857021038
Greysen, S. R. (2015). Delirium and the "know-do" gap in acute care for elders. JAMA Internal Medicine, 175(4), 521–522. doi:10.1001/jamainternmed.2014.7786
Haynes, A. B., Weiser, T. G., Berry, W. R., Lipsitz, S. R., Breizat, A. H., Dellinger, E. P., . . . Gawande, A. A. (for the Safe Surgery Saves Lives Study Group). (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine, 360(5), 491–499. doi:10.1056/NEJMsa0810119
Lakoff, G., & Johnson, M. (1999). Philosophy in the flesh: The embodied mind and its challenge to western thought. New York, NY: Basic Books.
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge, UK: Cambridge University Press.
Lewis, P. J., & Tully, M. P. (2009). Uncomfortable prescribing decisions in hospitals: The impact of teamwork. Journal of the Royal Society of Medicine, 102(11), 481–488. doi:10.1258/jrsm.2009.090150
Lloyd, V., Schneider, J., Scales, K., Bailey, S., & Jones, R. (2011). Ingroup identity as an obstacle to effective multiprofessional and interprofessional teamwork: Findings from an ethnographic study of healthcare assistants in dementia care. Journal of Interprofessional Care, 25(5), 345–351. doi:10.3109/13561820.2011.567381
Marshall, M. (1999). "They should not really be here": People with dementia in the acute sector. Age and Ageing, 28(Suppl. 2), 9–11.
Marshall, M. (2001). The challenge of looking after people with dementia. BMJ, 323(7310), 410–411.
Milne, J., Greenfield, D., & Braithwaite, J. (2015). An ethnographic investigation of junior doctors' capacities to practice interprofessionally in three teaching hospitals. Journal of Interprofessional Care, 29(4), 347–353. doi:10.3109/13561820.2015.1004039
Moore, A., Patterson, C., Nair, K., Oliver, D., Brown, A., Keating, P., & Riva, J. J. (2015). Minding the gap: Prioritization of care issues among nurse practitioners, family physicians and geriatricians when caring for the elderly. Journal of Interprofessional Care, 29(4), 401–403. doi:10.3109/13561820.2014.966352
Reeves, S., Rice, K., Conn, L. G., Miller, K. L., Kenaszchuk, C., & Zwarenstein, M. (2009). Interprofessional interaction, negotiation and non-negotiation on general internal medicine wards. Journal of Interprofessional Care, 23(6), 633–645. doi:10.3109/13561820902886295
Regehr, G. (2010). It's NOT rocket science: Rethinking our metaphors for research in health professions education. Medical Education, 44(1), 31–39. doi:10.1111/j.1365-2923.2009.03418.x
Rippon, D., Milisen, K., Detroyer, E., Mukaetova-Ladinska, E., Harrison, B., Schuurmans, M., . . . Teodorczuk, A. (2016). Evaluation of the delirium early monitoring system (DEMS). International Psychogeriatics, 28(11), 1879–1887. doi:10.1017/s1041610216000983
Schuurmans, M. J., Shortridge-Baggett, L. M., & Duursma, S. A. (2003). The Delirium Observation Screening Scale: A screening instrument for delirium. Research and Theory for Nursing Practice, 17(1), 31–50.
Subbe, C. P., Kruger, M., Rutherford, P., & Gemmel, L. (2001). Validation of a modified early warning score in medical admissions. QJM, 94(10), 521–526.
Swanwick, T. (2005). Informal learning in postgraduate medical education: From cognitivism to "culturism". Medical Education, 39(8), 859–865.
Tabet, N., & Howard, R. (2006). Prevention, diagnosis and treatment of delirium: Staff educational approaches. Expert Review of Neurotherapeutics, 6(5), 741–751.
Teodorczuk, A. (2011). Developing educational approaches for Liaison Old Age Psychiatry teams: A grounded theory study of the learning needs of hospital staff in relation to managing the confused older patient. Unpublished doctoral disseration, Newcastle University—Newcastle upon Tyne.
Teodorczuk, A., Mukaetova-Ladinska, E., Corbett, S., & Welfare, M. (2015). Deconstructing dementia and delirium hospital practice: Using cultural historical activity theory to inform education approaches. Advances in Health Science Education: Theory and Practice, 20(3), 745–764. doi:10.1007/s10459-014-9562-0
Teodorczuk, A., Welfare, M., Corbett, S., & Mukaetova-Ladinska, E. (2009). Education, hospital staff and the confused older patient. Age and Ageing, 38, 252–253.
Yanamadala, M., Wieland, D., & Heflin, M. T. (2013). Educational interventions to improve recognition of delirium: A systematic review. Journal of American Geriatrics Society, 61(11), 1983–1993.
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