Interprofessional Roles

Hospital Briefing

About Briefings

Thought leadership articles from leading academic journals and trade magazines are identified and analyzed for answers to the six question-types central to decision making (what, why, how, when, where, who).

Questions

Thought Leadership

Hospital Briefing

Balancing Ethical Uncertainty: The Dance of Interprofessional Roles

The feature article is examined for answers to six question-types associated with decision making at hospitals to improve interprofesional (IP) collaborations between nurses, doctors, social workers, pastoral care, genetics counselors, and others. Specifically, the analysis identifies the strategy (what, why) and implementation (how) associated with IP collaborations in context (when, where), while identifying who needs the insights.

Citation

Payne, C., & Farrell, K. (2015). Balancing Ethical Uncertainty: The Dance of Interprofessional Roles. Hospital Topics, 93(4), 77–83. JOUR. (view source article)

Abstract (from authors)

Interprofessional (IP) education has emerged globally as a means of improving overall healthcare quality, and to increase healthcare provider understanding of other roles. However, in situations of moral uncertainly, there are not clear procedures to address IP role interactions when tension and conflict emerge. This study reports secondary analysis findings from data in a large study related to moral distress in IP ethics consultations and collaborations. A basic qualitative, exploratory approach was utilized for data analysis with overtones of grounded theory. Eleven IP participants representing five disciplines comprised the sample. A model of IP role interaction was constructed from themes which were revealed to identify distinct facilitating actions and barriers as components of IP interactions serving to balance ethical decision making in the context of patient care. Specific role boundaries of the professions identified uncertainty as they interacted with multiple healthcare roles in patient care dilemmas.

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When/Where

Each role involved in interprofessional collaborations is likely to have role-based differences in perceptions about strategies and the effectiveness of implementation.

  • registered nurse
  • social workers
  • pastoral care
  • genetics counselor

For example, a pastoral care worker indicated "care is dependent upon a nurse's or tech--doctor's experience and do you want chaplaincy or religion. It's not consistent." (emphasis added).

Communication

  • Communication is important for IP collaborators to reach effective quality of care and reduce provider moral uncertainty.
  • For example, "I think everyone's comfort level is already starting out differently [about ethical decision making]; but once we've gotten a little bit better traiing, then we kind of act as the liaison between, let's just say it's a critical care team and the family and how to digest some of the medical jargon and bring it down to kind of a way that they could digest and understand better."

Role Boundaries

  • IP healthcare providers have genuine differences in knowledge and perspectives that emanate from differences in role boundaries.  Role boundaries shape interactions with patients and families concerning ethical decisions.
  • For example, small changes in understanding a role, can lead to positive changes in framing ethical decision making. One provider said, "you know, the barrier is a lot of how to deal with [role perceptions], and how to reframe something that at least for a moment could be workable.  And then you literally work from that moment to the next moment, to the next time medication may be the indicator, or the next time a wound change, or the next time we have to deal with you know the belligerent behavior or whatever that be."

Moral Agency

  • Many barriers to ethical decision making relate to the nature of being human.  Specifically, each IP provider has their own moral agency which entails making one's own decisions about ethics.
  • As the authors point out, sometimes IP providers need to make their own mistakes.
  • For example, "So, you know, sometimes you think: How much am I justifying it?  But how much is reality?"

Conflict

  • The desired outcomes are impacted by the conflicts originated by the patient and family.
  • Family members have conflicts that involve decisions that can have implications for years. For example, "Perhaps she just wants to be real clear that the rest of her life she can convince herself that she's done absolutely everything that can be done to him to keep him alive."
  • For example, "Sometimes there's too much family and there's not consensus among the family.  The family is all of one mind until the nephew from Philadelphia comes and changes everything."

How

  • To improve IP ethical decision making, hospitals must implement initiatives and actions effectively.
  •  The authors identify (1) educational programs and (2) a common IP competency framework as two hospital initiatives that should be examined for their impact upon role boundaries, communication, moral agency, and moral conflict.

Why

The four strategies are identified by the authors as having a significant impact upon the outcomes of provider moral uncertainty and patient/family quality of care.

Moral Uncertainty

  • Moral uncertainty is different then moral distress.  The latter is dealing with perceived ethical conflicts, the former is wresting with uncertainty about the proper course of actions.
  • For example, "There so much value.  [Each IP provider] bring something to the team."
  • For example, "So, ethically, it's trying to reach what could be some workable consensus."

Quality of Care

  • Ethical decision making is important to quality of care.
  • For example, "I always tell people: 'You know, sometimes your mom and dad or your loved one would probably be okay to be on the machines for a couple more days, if it's knowing that you won't feel guilty for the rest of your life.'  You know?  What's two more days so that their loved ones aren't forever scared? And that could scare people.  And that's not our goal."

Who

  • IP providers (registered nurse, social worker, pastoral care, genetics counselor) need to understand the implications of this model.
  • Administrators funding IP initiatives need to understand the important strategies and implementation efforts to improve moral decision making.

 

Beyond Thought Leadership to People Analytics

Ideas from thought leadership are important, but readiness to make decisions with precision remains a serious issue, unless there is data from your organization. If you like the sixQ model of interprofessional role interactions, why don’t you use it to assess your hospital? Did you know sixQ can turn any framework into a custom assessment?

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