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Level of Evidence and Grading Recommendation

Appendix A1


AuthorTitle          Level and type of EvidenceRecommendations
Boyle DK, Kochinda, C. (2004).  Enhancing collaborative communication of nurse and physician leadership in two intensive care unitsC This study intended to study an intervention to increase collaborative communication in physician leaders and nurses. A pretest- posttest repeated measures design was used for collection of baseline data, for the implementation of the study’s intervention for over eight months, immediate, and post collection of data after 6 months. The study provided supporting evidence that collaborative between nurses and physicians could be improved.Collaboration between physicians and nurses was found to be essential. As a result, the study recommends that these collaborations should be increased in hospitals to increase efficiency and productivity.
  Bronstein LR. (2003).  A model for interdisciplinary collaborationF The author utilizes multidisciplinary theoretical pieces of literature and research and conceptual pieces from literature on social work to support the development of this kind of model. The author first notes the relevant current trends to the interdisciplinary practice for the purposes of pointing out its essentiality.The article describes a model that is made up of two parts. The first part of the model has five categories that form interdisciplinary collaborative relations between social workers and other professionals. These include flexibility, professional activities that have been newly created, ownership of goals that is collective, interdependence and process reflection. The second part recommends the use of such influences on collaboration as structural characteristics, professional role, history of collaboration, and personal characteristics.
Brown, B. Crawford, P. and Carter, R. 2006Evidence-based health communicationB The book provides the readers with a critical and a comprehensive review of the health communication field and the different types of evidence that have been collected concerning communication that is effective. In addition to this, the book sets out what has been researched about the micro- structure of encounters in health care and interactions.The book offers the concerned professionals essential new agendas for research practice and training in health care, based on lessons acquired from linguistics, using a broad range of evidence to identify patterns that can lead to improved practices in healthcare. The book recommends brief, effective and ordinary activity in communication in addition to consultations that are formal.
Hughes, R.B.2008  Patient Safety and Quality: An Evidence-Based Handbook for NursesA The effects of errors in health care have essential implications. The article utilizes peer- reviewed reviews and discussions of a broad range of literature and issues regarding quality of health care and safety of patients. The article provides some insight in to the many aspects that determine the safety and quality of health care as well as outcomes of systems, patients and nurses. The book does this by presenting an examination of the evidence and scientific research behind safety and quality concepts and issues.One of the most prevalent recommendations of the book is that hospitals and other health institutions should not only utilize evidence and research to alter practices but also to be actively involved in developing the base of scientific evidence to address crucial gaps in knowledge. Patient quality and safety care is inherently dependent on nurses, and to attain safety and quality goals nurses must assume the roles of leaders.
International Association for Hospice and Palliative Care 2004  I. Principles and Practice of Palliative Care. The IAHPC Manual of Palliative CareB This article utilizes a number of sources to comprehensively define palliative care. Further, the same literature is utilized to indicate the essentiality, need, goals and principles of palliative care.Many health care professionals believe that this model of care is the soft option many physicians adopt after therapy has stopped. However, the article argues that palliative care should be taken as active care or therapy as it addresses all the psychological and physical needs of a patient.
Manojlovich, M., Antonakos, C.L., Ronis, D.L.   2009Intensive Care Units, Communication Between Nurses and Physicians, and Patients’ Outcomes.D This study sought to examine the relations or associations that exist between physicians and nurse, and especially during communication, in addition to examining the practice environment of the intensive care unit and some of the associated adverse outcomes.Though some associations between adverse events and communication were documented, it was found that this relationship was not consistent, and that the perception of nurses of the environment of practice was not clearly related to the adverse outcomes.
McCaffrey, R.G., Hayes, R., Stuart, W., Cassel, A., Farrell, C., Miller-Reyes, S and Donaldson, A.2011    An Educational Program to Promote Positive Communication and Collaboration Between Nurses and Medical StaffD The results of this study were based on an educational program that was designed and implemented for medical residents and nurses to improve collaboration and communication.It was found that collaboration and communication between members of the health care system improved patient and treatment outcomes as well as satisfaction in jobs.
Oliver, D.P., Wittenberg-Lyles, E.M. and Day, M. 2007Measuring Interdisciplinary Perceptions of Collaboration on Hospice Teams. American Journal of Hospice & Palliative MedicineF This was a project that was based on the modification of the interdisciplinary collaboration index to develop a tool that could be used to measure perceptions of collaboration by the hospice team members. The study utilized the 42- item instrument questions.The MIIC, or the new Modified Index for Interdisciplinary Collaboration showed a strong reliability for the subscales of the original instrument and the for the total instrument. The study also recommended that further testing and use for the instrument be carried out.
Riesenberg, L.E., Leitzsch, J., Massucci, J.L., Jaeger, J., Rosenfeld, J.C., Patow, C. et al 2009Residents’ and Attending Physicians’ Handoffs: A Systematic Review of the LiteratureD The researchers carried out a systematic and thorough review of articles in English language, most of which were indexed in the PubMed database published between 2008 and 1987. These articles were those that focused on the handoffs of physicians in the US. The search results provided the authors with 2590 articles, after which 401 were taken for further review by abstractors who were more skilled.The authors recommended that there is a great need for handoff outcomes research and studies that are of high quality, and those focused on human performance, system factors, and effectiveness of interventions and protocols that are structured.
Thompson, J.E., Collett, L.W., Langbart, M.J., Purcell, N.J., Boyd, S.M., Yuminaga, Y. et al.2011Using the ISBAR Handover Tool in Junior Medical Officer Handover: A Study in an Australian Tertiary HospitalD The authors recruited JMOs who participated in handover of after hours during a clinical term that ran for 11 weeks from June to august in 2009. The authors then audiotaped the handover after- hours and the JMOs finished a study to examine the current practice and perception of handover. The JMOs then took part in education sessions that took 1 hour each on use of ISBAR and handover, and were motivated to handover utilizing the ISBAR method. Following this session, they were surveyed to measure changes in handover using the ISBAR, and then the authors audiotaped the handover again to examine the differences in transfer of information and duration.The study indicated that the JMO perception of communication in handover could be improved by the utilization of the ISBAR tool. The author, however, recommended that considerations should be given to the introduction of the ISBAR method in all the handover settings of JMOs.
Tschannen, D., Keenan, G., Aebersold, M.,Kocan, M.J., Lundy, F., Averhart, V. 2011Implications of Nurse-physician Relations: Report of a Successful InterventionD This article sought to examine the effects of intervention that was collaborative on improving patterns of communication between physicians and nurses on two units of study. The intervention was composed of two physicians and two nurses per unit meeting for eight hours to develop, collaboratively, a solution to issues in communication on their units.It was recommended that strategies must be pointed out to break down the barriers brought about by culture and that limit the development of a culture that is team- centered supporting relations that are collaborative among professionals in health care.
  Gazmararian, J., 1999Health Literacy Among Medicare Enrollees in Managed Care OrganizationsA The study utilized 3260 new enrollees in Medicare aged 65 and above as interviewees between December 1997 and June 1997.304 spoke Spanish while 2956 spoke English as their native language.The elderly enrollees managed in health care may not possess the literacy skills needed to function properly in a medical environment. It was shown that low literacy in health might affect negatively the understanding of the elderly patients of messages of health and limit their capacity to care for their medical challenges.
Gulmans, J.,   2007Evaluating Quality of patient care communication in integrated care settingsC The approach used in this case followed a mixed design that had three steps in which the outcomes of each step were utilized to mark out the focus of the following step. The first step questionnaire aimed to identify quality gaps most patients experience comparing their experiences and expectancies in relation to the communication between patients and professionals and between professionals.It was recommended that further research is needed to find out the feasibility of the approach in practice.
McCaffrey, R., 2011An Educational Program to promote Positive Communication and Collaboration Between Nurses and Medical StaffThe study utilized a pre test, post test method in quasi- experiment. The Jefferson Scale of Attitudes towards the collaboration a d communication between nurses and physician was also used in addition to Critical Thinking for Quality Patient Outcomes Survey tool.  It was recommended that continuing education for medical resident, nurses and other medical professionals may help in creating positive communication methods and teamwork.
Melnyk, B., 2009Evidence based Practice: Step-by-Step Igniting a Spirit of Inquiry.A This article utilized the evidence- based approach, which is the kind of approach that integrates the best evidence from surveys and data on patient care with patience values and preferences and clinical expertise.This is recommended to give nurse and other health professionals the skills and knowledge needed to implement EBP.
Nadzan, D. and Westergaard, F. 2008Pediatric Safety in the Emergency DepartmentC This utilized the kind of evidence found in published reviews and articles.It was recommended that further research is needed in the area.


Boyle, D. K. & Kochinda, C. (2004). Enhancing Collaborative Communication of Nurse and Physician Leadership in Two Intensive Care Units. Journal of Nursing Administration, 34 (2), 60-70.

Bronstein, L. R. (2003). A model for interdisciplinary collaboration. Soc Work, 48 (3), 297- 306.

Brown, B., Crawford, P. & Carter, R. (2006). Evidence- based health communication. New York: McGraw.

Gazmararian, J. et al. (1999). Health literacy among Medicare enrollees in a managed care organization. JAMA, 281 (6), 545- 51.

Gulmans, J. et al. (2007). Evaluating quality of patient care communication in integrated care settings: a mixed method approach. Int J            Qual Health Care, 19 (5), 281- 88.

Hughes, R. G. (2008). Patient safety and quality: an evidence based handbook for nurses. AHRQ Publication. Rockville, MD:           Agency for Healthcare Research and Quality.

International Association for Hospice and Palliative Care. (2004). Principles and practice of Palliative care. The IAHPC Manual of            Palliative Care.

Manojlovich, M., Antonakos, C. L. & Ronis, D. L. (2009). Intensive care units, communication between nurse and physicians, and       patient’s outcomes. Am J Crit Care, 18, 21- 30.

McCaffrey, R. G. et al. (2011a). An educational program to promote positive communication and collaboration between nurses and       medical staff. J Nurses Staff Dev. 27 93) 121- 7.

McCaffrey, R., et al. (2011b). The effect of an educational program on attitudes of nurses and medical residents towards the benefits             of positive communication and collaboration. Journal of Advanced Nursing, 1365-2648.

Melnyk, B. M. et al. (2009). Evidence- based practice: step by step: igniting a spirit of inquiry. AJN, 109 (11), 49- 52.

Nadzam, D. & Westergaard, F. (2008). Pediatric safety in the emergency department: identifying risks and preparing to care for child      and family. J Nurs Care Qual, 23 (3), 189- 94.

Oliver, D. P., Wittenberg- Lyles, E.M. & Day, M. (2007). Measuring interdisciplinary perceptions of collaboration on hospice teams.         Am J Hosp Palliat Care, 24 (1), 49- 53.

Riesenberg, L.A. et al. 92009). Residents’ and attending physicians’ handoffs: a systematic review of the literature. Acad Med., 84        (12),    1775- 87.

Thompson, J. E. et al. (2011). Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital. Postgrad Med J. 87 (1027), 340-4.

Tschannen, D. et al. (2011). Implications of nurse- physician relations: report of a successful intervention. Nurs Econ. 29 (30), 127-        35.

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