Multidisciplinary team developed and implemented protocols to assist mechanical ventilation weaning : a systematic review of literature

Aim: The aim of this review was to determine if ventilation-weaning protocols developed and implemented by multidisciplinary teams (MDTs) reduced the duration of mechanical ventilation in adult intensive care patients compared to usual care.

Method: A systematic review was conducted to review published research studies from January 1999 to June 2009 to identify and analyse the best available evidence on MDT-based weaning protocols in adult intensive care patients. All relevant studies based on electronic searches of MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Registry and the Cochrane Database of Systematic Reviews were included. Where possible data were pooled and a meta-analysis performed. A narrative synthesis of data was conducted to provide a critical appraisal of nonrandomised controlled trials included in the review.

Results: Three pre- and postinterventional studies were identified for inclusion in this review. Results show equivocal support for weaning protocols developed and implemented by MDTs for reducing duration of mechanical ventilation.

Conclusion: Communication and organizational processes must be addressed for multidisciplinary protocols to be effective. Due to methodological limitations of included studies, large randomised controlled trials are required to provide high-level evidence of the effects of MDT-based protocols on duration of mechanical ventilation.

An observational study of health professionals’ use of evidence to inform the development of clinical management tools

Aim. This observational study sought to investigate the process of evidence use by health professionals during development of evidence-based clinical management tools.

Background. Studies conducted to explore the process of research use are scarce and knowledge of this process is essential for our understanding of the influences on research use in practice.

Design. A qualitative, non-participant, observational design.

Methods. Behaviour and actions of two separate multidisciplinary teams were observed and audio-recorded during a combined total of seven meetings for the development of clinical management tools. Semi-structured, one-to-one interviews were conducted approximately half-way through the development process and following completion of the clinical management tools.

Results. Three major themes emerged from this research. First, the process of clinical management tool development and evidence use. Nurses assumed responsibility for coordination of development which focused on describing current practice. Second, the forms of evidence employed during the development process included the use of experiential knowledge, opinions and knowledge of the context, in addition to research evidence. However, reference to research evidence was limited and its incorporation into the instrument was infrequently observed. Third, the use of research evidence emerged with respect to how such evidence was employed.

Conclusion. This study focused on real-life discussion and decision-making that occurred between health professionals when developing evidence-based clinical management tools. Health professionals may have a tendency to rely on their professional experience and current practice in preference to seeking and applying relevant research evidence.

Relevance to clinical practice. Nurses have an important role to play in the development of multidisciplinary evidence-based clinical management tools, but to actively participate in this process they need to be familiar with the relevant research evidence and have the skills and confidence to integrate the evidence into practice.

A peer-focused depression prevention program for preadolescent children

This thesis develops and evaluates the effectiveness of a peer-focused cognitive-behavioural depression prevention program (Kool Kids Program [KKP]) for preadolescent children. It was demonstrated that the KKP was partially effective at reducing depressive symptoms and improving the psychosocial functioning of preadolescent children up to 6 months following intervention. The professional portfolio discusses the unique role of clinical psychologists within multidisciplinary teams and the contribution they make to interdisciplinary collaboration. Four case studies are presented.

Renal access coordinators' impact on hemodialysis patient outcomes and associated service delivery: a systematic review

Background
Renal access coordinators contribute specifically to dialysis access care for people with chronic and end stage renal disease. Since the introduction of renal access coordinators into Australia in the early 2000s, there have been anecdotal examples of associated improvements in patient outcomes and service delivery; however scant published quantitative evidence exists. Thus, the impact of the implementation of renal access coordinators has not undergone a rigorous review to date.

Objective
The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the impact of renal access coordinators on dialysis patient outcomes and associated service delivery.

INCLUSION CRITERIA

Types of participants
This review considered studies that included renal access coordinators (noting variations of the titles) and adult hemodialysis patients (aged 18 years and over).

Types of intervention(s)
This review considered studies that evaluated the effectiveness of the renal access coordinator. This role typically consists of clinical and administration duties such as providing pre dialysis access coordination, access surveillance patient education and nurse education.

Types of studies
The types of studies considered within this review included experimental and epidemiological study designs. Thus randomized controlled trials (RCT), non-randomized controlled trials, and quasi-experimental, before and after studies, prospective and retrospective cohort studies were considered as were case control studies, analytical cross sectional studies and descriptive cross sectional studies.

Types of outcomes
Patient outcomes considered included: days to first vascular access complication (such as stenosis or thrombosis) and/or primary intervention (such as angioplasty or surgical intervention); percentage of central line insertions (negative); rate of arteriovenous fistula (AVF)/arteriovenous graft (AVG)/central venous catheter (CVC) at start of dialysis (incidence); prevalent rate of AVF/AVG/CVC; time to occlusion of AVF and time from referral to surgery. Service outcomes included: knowledge/up skilling of renal nurses; cannulation skills, ultrasound skills, knowledge of anatomy and physiology and other access related knowledge.

Search strategy
The search strategy aimed to locate published and unpublished studies, utilizing a three-step searching approach. Studies published in English from 1990 to October 2013 were considered for inclusion in this review.

Methodological quality
The studies were assessed by two independent reviewers using the appropriate standardized critical appraisal instruments from the Joanna Briggs Institute.

Data collection
Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute, namely JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

Data synthesis
This review aimed to conduct meta-analyses of the findings: however, because of the limitations of the data found, this was not possible and so the findings are presented in a narrative format.

Results
Five studies were identified for inclusion in the review. No RCTs were found, therefore four of the five studies were pre-post intervention cohort studies and one was a prospective quality assurance report. Data were heterogeneous and thus did not allow for meta-analysis. All studies included multidisciplinary teams with variable emphasis on the renal access coordinator role. The pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the hemodialysis population and the quality assurance report measured the difference in patency rates between AVF and AVG. All discussed the role of central coordination as a contributor to the success of vascular access care.

Conclusions
This review found insufficient data to make firm conclusions about the impact that renal access coordinators have on patient outcomes. The results of this review suggest an association between renal access coordinators and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs.

Do renal access coordinators make a difference? What is the evidence?

Background
Since the introduction of the renal access coordinator (RAC) role into Australia there have been only anecdotal examples of associated improvements in patient outcome and service delivery and scant published quantitative extant evidence exists.

Aim
To review the literature related to the impact of RACs on dialysis patient outcomes and associated service delivery, gauge the level of evidence available and identify gaps in the literature.

Method
A three stage Joanna Briggs Institute (JBI) systematic review process was used to collect and synthesise data. The review considered studies that explored and measured the RAC role in the adult haemodialysis context. All quantitative study designs were considered. Due to lack of homogeneity a narrative synthesis was undertaken.

Results
Five studies met the inclusion criteria for the review. All studies included multidisciplinary teams with variable emphasis on the RAC role. Four pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the haemodialysis population and the quality assurance report measured differences in patency rates between AVF and AVG and associated hospital length of stay. All discussed the role of central coordination as a contributor to the success of vascular access care.

Conclusion
The available reports do suggest an association between RACs and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs
 

Adult cardiothoracic transplant nursing: an ISHLT consensus document on the current adult nursing practice in heart and lung transplantation.

The role of nurses in cardiothoracic transplantation has evolved over the last 25 years. Transplant nurses work in a variety of roles in collaboration with multidisciplinary teams to manage complex pre- and post-transplantation issues. There is lack of clarity and consistency regarding required qualifications to practice transplant nursing, delineation of roles and adequate levels of staffing.

The organisational benefits of teams

This study presents an analysis of the benefits of two team structures - quality circles and self-managing work groups - for Australian work organizations utilizing the Australian Workplace Industrial Relations Survey for 1995. The analysis indicates that firms with team structures have higher labor productivity, a flatter management structure and reduced employee turnover. The presence of team structures in Australian firms indicates a decrease in industrial harmony. The findings were inconclusive regarding absenteeism and profitability.

Ethnography and the Australian drug field: emaciation, appropriation and multidisciplinary myopia

In this paper, I provide a critical commentary on the current state of drug ethnography in Australia. I identify and discuss funding problems and the appropriation of ethnography by qualitative and quantitative researchers, both of which undermine the credibility and potential contribution of ethnography to the Australian drug field. I also interrogate the much-heralded but little-scrutinised idea of ‘multidisciplinary drug research’, drawing on examples of non-drug multidisciplinary research to argue that, while multidisciplinary drug research is a worthy goal, the research vision offered by advocates of such research is frequently an intellectually impoverished one. I conclude by suggesting possible ways to strengthen Australia's capacity to conduct both stand-alone ethnographic drug research and high-quality multidisciplinary drug research involving ethnography.

Behavioral adaptation within cross-cultural virtual teams

With today's business environments no longer confined to national borders, much work is undertaken in global virtual teams. Such teams consist of members located in different countries that communicate via technology media to complete a project task. Much of the research in this area has been focused on the technological aspects of such environments; there is, however, a lack of research into the behavioral aspects and the issue of cultural differences in particular. It has been acknowledged that when cultural diversity is neither recognized nor acted upon, significant challenges can arise for the team. Current advice in the literature suggests that team members should adapt their normal working behavior in consideration of cultural differences. However, there is little indication of how team members should do so. This study investigated if and/or how team members adapt their behavior in cross-cultural virtual teams. The results of this study indicate that team members can adapt their behavior in both spoken and written communication as well as allowing for religious beliefs and time zone differences. This paper discusses specifically how behavior can be adapted, including a discussion of behaviors that caused concern. Finally, a framework of behavioral adaptations is presented for ways to improve cross-cultural virtual team interactions.

Learning in virtual teams: exploring the student experience

In 2005 an existing undergraduate course in project management was converted from face-to-face mode to wholly online mode. Wholly online mode means that there are no face-to-face classes at all, and all teaching and learning is facilitated through an online environment.

The revised project management course was designed with an underlying problem-based learning (PBL) pedagogy and used a simulated, fictitious telecommunications company, United Enterprises (UE), as a case study learning resource. The students worked in virtual teams to complete online learning activities and to solve authentic project management tasks for UE. Employees of UE were available online to provide direction and answer further questions about the tasks.

The overall research study used an action research methodology in which feedback was elicited from two groups of stakeholders involved in the project management course - students and teaching staff. The feedback was used to plan, develop and implement the new Information Technology (IT) Professional Practice course.

This paper reports on the findings of three anonymous student surveys that were conducted after each of the main project management topics and tasks were completed. The surveys sought feedback in a number of areas. However, the feedback reported here relates specifically to student opinions about their experiences of working in virtual teams within the learning environment. Other aspects of the research, including student perceptions of UE and feedback from the teaching staff, are not reported here.

Across the three surveys, most students indicated that they valued the opportunity to discuss various aspects of the course with peers and teaching staff online, and to interact with real-life employees of UE. Although discussion forums were the prescribed method for communication other forms of communication such as email, chat and face-to-face meetings were also used. According to the students, the best things about online group work were that it provides the flexibility of time and place; it allows communication and participation to be recorded; and is an ‘efficient’ way of working. The worst things about online group work were that communication is more difficult and that team members leave participation and submission to
the last minute. While up to 15 percent of students did not like the experience of online group work at all, overall students were generally satisfied with this style of learning and enjoyed the experience of working collaboratively within a virtual team.

The research has highlighted a number of areas where improvements can be made to the student experience of working in virtual teams. These improvements will be adopted in the development and delivery of the new course as part of the action research study.

Work teams : perceptions of a ready-made support system?

Much research on work teams has been focused at the team-level, considering such issues as effectiveness, productivity, and overall interaction. Using qualitative in-depth interviews, the author has asked the question: what is the experience of the individual working within a team? This paper discusses one theme to have emerged, that of perceptions of support being provided within the team. Respondents' accounts presented an expectation that support would be forthcoming from other team members. The discussion considers the experiences of respondents both when this support was received and when it was not, prompting a reconsideration of our understanding of work teams. Further discussion shows how the expectation and provision of this support has implications for how individuals view both teams and organizational work in general, and how consideration of this issue can assist managers in the renewal of employees' energy and well-being.

Working in teams : the influence of rhetoric-from sensemaking to sadness

At a time when teams are increasingly and routinely being used in Public Administration (PA) organizations, the prevailing wisdom about teams continues to confirm that teams axiomatically bring increases and improvements in effectiveness, productivity and communication. There has been relatively little critical address of whether these benefits actually accrue, nor what the experience of team members actually is. The PA literature, in particular, remains silent on this important issue. This paper shares findings from an exploratory phenomenological study. Members of teams in organizations were interviewed and asked about their experiences of working in teams. In contrast to the current wisdom, not only did team members not report the anticipated improvements and benefits, their stories tended to highlight the negative influence that the rhetoric surrounding teams might have on individuals. This paper shares the responses of team members to that rhetoric, revealing themes of "Teams, Rhetoric and Sensemaking," a challenge to the notion of "Teams as One Big Happy Family?" while identifying "Teams as Crucibles of Resignation and Sadness." These findings indicate the continuing need for further research into understanding the experience of individuals within various team and organizational structures, especially as they operate in PA organizations.

Establishing quality online: supporting productive academic teams

Quality online education requires successful management of resources and services. This paper examines the increasing need to support productive academic teams and foster collaboration in developing a high quality online environment. The paper is based on a study into academic support services and collaboration at Deakin University. The provision of quality support was found to be increasingly challenging given the complexity of the online university environment. A number of recommendations arise out of the study including some practical changes to service, the need to commit to innovation, the importance of frameworks and standards as well as a range of broader cultural, organisational and political changes.