Interprofessional collaboration between residents and nurses in general internal medicine: a qualitative study on behaviours enhancing teamwork quality.
BACKGROUND
Effective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards.


OBJECTIVE
To describe resident physicians' and nurses' actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward.


METHODS
A volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis). Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit.


RESULTS
Most resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building.


CONCLUSIONS
Although they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional education should insist on better redefinition of respective roles and reinforce behaviours shown to enhance teamwork quality.
Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Virginie
V
Muller-Juge
Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland; Institute of Demographic and Life Course Studies, Faculty of Economic and Social Sciences, University of Geneva, Geneva, Switzerland.
Stéphane
S
Cullati
Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Katherine S
KS
Blondon
Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Patricia
P
Hudelson
Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Fabienne
F
Maître
Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Nu V
NV
Vu
Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland.
Georges L
GL
Savoldelli
Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Mathieu R
MR
Nendaz
D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D007388:Internal Medicine; D007857:Leadership; D008297:Male; D009726:Nurses; D005791:Patient Care; D010348:Patient Care Team; D019555:Physician-Nurse Relations; D010820:Physicians; D036301:Qualitative Research; D011787:Quality of Health Care