Perception of Nurses and Physicians about Importance of Their Collaboration in the Work

Introduction

Healthcare delivery system today challenges all of healthcare provider's contributors to provide patients with that are efficient, effective, saving time and cost for both patients and healthcare delivery systems, and also to be easily accessible. Nurse/physician collaboration is defined as actions related to information sharing about patients, contributing in decision-making related to patient care, and providing complete patient-centered perspective care. Three key factors form nurse/physician collaboration; joint participation in the cure/care decision-making process, sharing information of the patient, and degree of cooperation (1) .

Collaboration has been considering as one of the best approaches for healthcare systems to adopt when trying to progress the outcomes. Collaboration also improves the efficiency and effectiveness of healthcare practice, and develops patient’s outcomes. In other words, teamwork’s effective collaborative is designed for team members to understand and share the skills, responsibilities, trust, knowledge, and functions of each member of the team for the treatment decisions and improving patient’s outcomes (2). Nursing and medicine are two professions, which have many roles that interact with confused responsibilities in addition to areas of functions. Physicians are responsible for the patients and are legally accountable for their treatment (3).

Moreover, nurses carry out specific parts of the treatment, which requested to be provided because they have sufficient experiences and explanations. Temporarily, physicians rely on nurses on reporting any changes that might happen in patients' conditions, that’s include any adverse reactions from the treatment that they might observe during caring for patients (4). Successful collaboration between physicians and both registered nurses and nursing practitioners has been shown to reduce rates of both morbidity and mortality, decrease the cost of healthcare, and medical errors. The nursing workforce is expected to decrease by 20% by 2020, which might put the profession in a dangerous shortage. Nurse/physician collaboration has been evident to improve professional nurses’ job satisfaction and is considered an elevated priority for nurses’ retention (5).

A successful climate for patient’s safety is being considered as the primary and one of the major principles in organizations concerned with healthcare. This is because every process performed with a member of healthcare caries a potential risks and possible problems associated with its use in actual healthcare practice (6). Nursing and medicine are two entitles that have contribution in healthcare management and in market place. Hospitals improve compensation and be market share when healthy inter-professional physicians and nurses relationships are accomplished. Such relationships in turn reflect on patients’ quality of care (1).

Significance of the study

The researcher observed during working at Beni-Suef University Hospital that there were some conflicts between nurses and physicians due to poor communication and lack of collaboration. This miscommunication had affected patients’ care outcome, which may affect the total hospital productivity and quality of care. It also leads to nurses' job dissatisfaction, which lead to job burnout and turnover (7).

So it is important to assess nurses and physician perception about their collaboration at work.

Aim of the study:

[1].    Assess nurses’ perception about the importance of nurse/physician collaboration in work at Beni-Suef University Hospital

[2].    Assess physicians’ perception about the importance of nurse/physician collaboration in work at Beni-Suef University Hospital.

Research questions: To fulfill the aim of the study, the following research questions were formulated:

• Is there a positive collaboration between nurses and physicians in work at Beni-Suef University Hospital?
• Is there a relation between personal characteristics data and the level of collaboration between nurses and physicians in work at Beni-Suef University Hospital?

Subjects & methods

Research Design: A descriptive research design was utilized in the current study.

Setting: The study was conducted at Beni-Suef University Hospital located in Beni-Suef city, which developed in 1985. The capacity of the hospital is 380 beds in all departments and the current study was conducted at four critical care units (icu,ccu,pcu,nscu) plus medical and surgical departments. 

Subjects: A convenience sample was used in the current study. All nurses and physicians in four critical care units, medical and surgical departments at Beni-Suef University Hospital were included in the current study with no exclusion criteria.

Tool of data collection: to achieve the aim of the study, data collected by the following tools:

Tool (1): This included two parts

Part-1 Physicians’ personal characteristics data Questionnaire: structure interview sheet was designed by the researcher after reviewing the related literatures. It included 6 questions as age, gender, level of education, employment status, department and years of experience.

Part-2 Collaborative Practice Scale for Physicians (CPS): adopted from Weiss and Davis1985 (8) to assess collaborative practice of physicians and assess perception of physicians about collaboration with nurses at work. The CPS for physicians consists of 10 items. It is a 6-point Likert scale “never=1,” “rarely=2,” “sometimes=3,” “usually=4” “mostly=5,” and “always=6”. The minimum and maximum values range from 10 to 60.

Scoring for Collaborative Practice Scale for Physicians:

Tool (2): This included two parts

Part 1- Nurses’ personal characteristics data Questionnaire: Structure interview sheet was designed by the researcher after reviewing the related literatures. It included 6 questions as age, gender, level of education, employment status, department and years of experience.

Part-2 Collaborative Practice Scale for Nurses (CPS): adopted from Weiss and Davis1985(8) to assess collaborative practice of nurses and assess perception of nurses about collaboration with physicians in work. The CPS for nurses consists of 9 items.

Scoring System It is a 6-point Likert scale.

 (Never=1 “rarely=2,” “sometimes=3,” “usually=4” “mostly=5,” and “always=6)

Scoring for Collaborative Practice Scale for Nurses:

Validity and Reliability

The tools were tested and evaluated for their content validity, and reliability. Content validity is tested by three experts, one expert in community health nursing and two experts in nursing administration. They were from different academic categories, i.e., professor and assistant professor.

Reliability

The reliability of the data collection tools was assessed through measuring their internal consistency by Cronbach’s Alpha Coefficient test. It was 0.787 for CPS for Nurses and 0.801 for CPS for physicians. 

Field work

The actual fieldwork for the process of data collection has consumed six months. Nurses and physicians included in the study were asked to give an oral agreement prior to participating in the study. This agreement was after the researcher explained the nature and aim of the study, they were reassured that information collected was used for the research purposes only.

The researcher sat with each participant and  asked  the questionnaire. The average time of data collection was about 20 to 30 minutes for each participant.

Pilot Study:

A pilot study was conducted before starting the current study to investigate the visibility of data collection tools, their content validity, clarity of the items and the time required to fill them. It included 10 nurses and 5 physicians, which represented 10% from total sample size and was excluded from the total sample size. No comments regarding the difficulty of terminology, questions structure or items clarity were reported by the study sample.

Ethical Considerations:

The ethical research considerations in this study included the following items:

A written initial approval was obtained from the research ethical committee at the Faculty of Nursing, Minia University and Individual oral agreement was obtained from each participant after explaining the nature and purposes of the study. And the anonymity and confidentiality were also assured. The  researcher cleared the aim of the study to participants. The researcher  maintained on confidentiality of participants. Written consent was taken from the director of Beni-Suef University Hospital. An official permission to conduct the proposed study was issued from the Faculty of Nursing, Minia University to the Director of a Beni-Suef University Hospital requesting approval for conducting this study procedure

Statistical Analysis

The collected data were organized, analyzed using appropriate statistical significant tests. The data were collected and coded. Using the Computer Statistical Package for Social Science (SPSS), version 21, the statistical analysis of data was done. Data were presented using descriptive statistics in the form of frequencies and percentages. Chi square test was used to compare the frequencies in two groups.

Results

Table (1): Distribution of personal Characteristics of Physicians and Nurses in the Study

Table (1) showed that nearly three quarter (72%) of studied physicians were males and more than half (52%) were aged more than thirty years with mean age 31±8.41 year. Regarding years of experiences 62% of the studied physicians had less than five years of experience and 52% of them were residents.

Also, table (1) revealed that more than three quarters (78%) of studied nurses were females and more than two thirds(70%) of them aged more than thirty years with mean age 33±28.24 year. Regarding to years of experience 91% of them had less than five years and 70% of them were beside nurses and nursing assistants. Regarding education and working department, 52% of them had a bachelor degree in nursing.

Figure (1): Percentage distribution levels of perception regarding nurse/physician collaboration among studied sample

Figure (1), illustrated that, all studied physicians (100.0%) vs 77% of studied nurses had suboptimal perceptions regarding nurse/physician collaboration and 23% of nurses had optimal perceptions vs. no one of physician.

Table (2): Relationship between demographic Characteristics and levels of Collaboration Perception for Nurses in the Study. (n=100).

* Significant at p<0.05

Table (2) Showed that,  58% of nurses aged more than 30 years and 20% of nurses had suboptimal collaboration perception working in medical department with statistical significant differences which p ≤ 0.034 & .033 respectively. At the same times, the table presented that there no significant relationship as regard sex, years of experience, employment status and education level of studied nurses and collaboration perception level of nurses.

Table (3): Mean score of personal characteristics and Collaboration Perception level among subjects  in the study.

* Significant at P ≤ 0.05

Table (3) Revealed a significant relation between mean score collaboration perception of physicians who had five years of experience or less and physicians who had more than five years of experience at P ≤ 0.05. In the same table no significant relation between mean collaboration perception of nurses and demographic characteristics except nurses age which P ≤ 0.05.