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Interprofessional Communication Shaping Health-Promoting and Sustainable Working Life in Psychiatric Outpatient Units
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.ORCID iD: 0000-0001-6519-3374
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Description
Abstract [en]

This thesis research describes and explores how interprofessional communication shapes a health-promoting and sustainable working life in psychiatric outpatient units. Four studies are conducted using qualitative methods, including a concept analysis using a hybrid model, a focused ethnography, focus groups, and a vignette study. These methods analyze the role of inter-professional communication in collaboration, clarifying professional roles, and influencing the work environment in psychiatric outpatient units. The studies identify key elements such as trust, role understanding, and openness as central to strengthening communication, teamwork, and patient safety. The results show that leadership plays an important role in enabling an open communication culture but that hierarchical structures and unclear areas of responsibility can create barriers. Standardized communication tools, such as SBAR, contribute to structured information transfer, but at the same time, the importance of informal communication to build relationships and promote collaboration emerges. The studies highlight the need for a cultural change toward more equal and inclusive communication, which requires organizational changes in which all clinicians have a voice in decision-making. The work environment can be improved by strengthening interprofessional communication, promoting a longterm sustainable workplace, and contributing to better care for patients in psychiatric outpatient units.

Abstract [sv]

Denna avhandling beskriver och utforskar hur interprofessionell kommunikation formar ett hälsofrämjande och hållbart arbetsliv på psykiatriska öppenvårdsmottagningar. Fyra studier genomförs med kvalitativa metoder, inklusive en begreppsanalys baserad på en hybridmodell, en fokuserad etnografi, fokusgrupper och en vinjettstudie. Dessa metoder analyserar den interprofessionella kommunikationens roll i samarbete, tydliggörande av yrkesroller och påverkan på arbetsmiljön för kliniker. Studierna identifierar nyckelfaktorer såsom tillit, rollförståelse och öppenhet som centrala för att stärka kommunikation, teamarbete och i slutändan patientsäkerhet. Resultaten visar att ledarskap spelar en viktig roll för att möjliggöra en öppen kommunikationskultur, men att hierarkiska strukturer och otydliga ansvarsområden kan skapa barriärer. Standardiserade verktyg, såsom SBAR, bidrar till strukturerad informationsöverföring men samtidigt framträder vikten av informell kommunikation för att bygga relationer och främja samverkan. Studierna belyser behovet av en kulturell förändring mot mer jämlik och inkluderande kommunikation vilket kräver organisatoriska förändringar där alla kliniker ges en röst i beslutsfattandet. Genom att stärka den interprofessionella kommunikationen kan arbetsmiljön förbättras, vilket i sin tur främjar en långsiktigt hållbar arbetsplats och bidrar till bättre vård för patienter inom psykiatrisk öppenvård.

Place, publisher, year, edition, pages
Gävle: Gävle University Press , 2025. , p. 56
Series
Doctoral thesis ; 60
Keywords [en]
Collaboration, Interprofessional communication, Leadership, Psychiatric outpatient units, Sustainability, Qualitative method, Work environment
Keywords [sv]
Arbetsmiljö, Hållbarhet, Interprofessionell kommunikation, Kvalitativ metod, Ledarskap, Psykiatrisk öppenvård, Samverkan
National Category
Medical and Health Sciences
Research subject
Health-Promoting Work
Identifiers
URN: urn:nbn:se:hig:diva-46639ISBN: 978-91-89593-62-6 (print)ISBN: 978-91-89593-63-3 (electronic)OAI: oai:DiVA.org:hig-46639DiVA, id: diva2:1945519
Public defence
2025-06-05, 33:202, Kungsbäcksvägen 47, Gävle, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2025-05-14 Created: 2025-03-18 Last updated: 2025-10-02Bibliographically approved
List of papers
1. Interprofessional communication - a concept analysis inspired by Schwartz-Barcott and Kim's hybrid model
Open this publication in new window or tab >>Interprofessional communication - a concept analysis inspired by Schwartz-Barcott and Kim's hybrid model
2026 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 26, article id 308Article in journal (Refereed) Published
Abstract [en]

Aim: This concept analysis aims to describe and define interprofessional communication within healthcare contexts by synthesising empirical evidence and existing literature.

Design: Utilising Schwartz-Barcott and Kim´s hybrid model, the study integrates theoretical exploration with empirical data analysis.

Methods: A comprehensive literature review and dictionary references inform the selection of theoretical frameworks. Data collection involves screening articles from databases including CINAHL, PSYCHINFO, WEB OF SCIENCE, SCOPUS, and PUBMED, resulting in 37 articles for review. Secondary analysis includes observational studies and focus groups conducted in psychiatric outpatient units, integrating theoretical and empirical insights for a nuanced understanding of communication complexities in healthcare settings.

Results: Theoretical exploration reveals the multifaceted nature of interprofessional communication, emphasising information sharing, collaboration, and decision-making. Antecedents, including education, logistical challenges, legal frameworks, and cultural dynamics, are identified. Empirical findings underline the importance of competence, curiosity, trust, cooperation, and clarity in communication. Influential factors such as leadership, cultural understanding, informal communication, transparency, and hierarchy emerge.

Conclusions: The synthesis highlights the central role of communication in healthcare and emphasises its impact on outcomes. Addressing communication barriers and promoting facilitators is important to supportive work environments and patient safety. Further research is necessary to deepen understanding and improve communication effectiveness in health care.

Place, publisher, year, edition, pages
Springer, 2026
Keywords
Concept analysis; Hybrid model; Interprofessional collaboration; Interprofessional communication; Literature review
National Category
Psychiatry
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-46688 (URN)10.1186/s12913-026-14180-3 (DOI)41703559 (PubMedID)2-s2.0-105031507132 (Scopus ID)
Available from: 2025-03-26 Created: 2025-03-26 Last updated: 2026-03-16Bibliographically approved
2. Interprofessional communication in a psychiatric outpatient unit – an ethnographic study
Open this publication in new window or tab >>Interprofessional communication in a psychiatric outpatient unit – an ethnographic study
2023 (English)In: BMC Nursing, E-ISSN 1472-6955, Vol. 22, article id 286Article in journal (Refereed) Published
Abstract [en]

Background

Communication in healthcare has been extensively studied, but most research has focused on miscommunication and the importance of communication for patient safety. Previous research on interprofessional communication has mainly focused on relationships between physicians and nurses in non-psychiatric settings. Since communication is one of the core competencies in psychiatric care, more research on interprofessional communication between other clinicians is needed, and should be explored from a broader perspective. This study aimed to explore and describe interprofessional communication in a psychiatric outpatient unit.

Method

During spring 2022, data consisting of over 100 h of fieldwork were collected from observations, formal semi-structured interviews and informal conversations inspired by the focused ethnography method. Data was collected at an outpatient unit in central Sweden, and various clinicians participated in the study. The data analysis was a back-and-forth process between initial codes and emerging themes, but also cyclical as the data analysis process was ongoing and repeated and took place simultaneously with the data collection.

Results

We found that a workplace’s history, clinicians´ workload, responsibilities and hierarchies influence interprofessional communication. The results showed that the prerequisites for interprofessional communication were created through the unit’s code of conduct, clear and engaging leadership, and trust in the ability of the various clinicians to perform new tasks.

Conclusion

Our results indicate that leadership, an involving working style, and an environment where speaking up is encouraged and valued can foster interprofessional communication and respect for each other´s professional roles is key to achieving this. Interprofessional communication between different clinicians is an important part of psychiatric outpatient work, where efficiency, insufficient staffing and long patient queues are commonplace. Research can help shed light on these parts by highlighting aspects influencing communication.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Code of conduct; Focused ethnography; Interprofessional communication; Psychiatric outpatient care
National Category
Health Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-42959 (URN)10.1186/s12912-023-01446-y (DOI)001088254300003 ()37626326 (PubMedID)2-s2.0-85169145954 (Scopus ID)
Available from: 2023-08-31 Created: 2023-08-31 Last updated: 2025-12-09Bibliographically approved
3. Adjustments in Interprofessional Communication: A Focus Group Study in Psychiatric Outpatient Units
Open this publication in new window or tab >>Adjustments in Interprofessional Communication: A Focus Group Study in Psychiatric Outpatient Units
2024 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 45, no 4, p. 417-428Article in journal (Refereed) Published
Abstract [en]

Communication in healthcare extends beyond patient care, impacting the work environment and job satisfaction. Interprofessional communication is essential for fostering collaboration, but challenges arise from differences in training, roles, and hierarchies. The study aimed to explore psychiatric outpatient clinicians’ experiences of interprofessional communication and their perceptions of how the communication intersects the organizational and social work environment of healthcare. Qualitative research involved focus group interviews with clinicians from five psychiatric outpatient units in Central Sweden, representing diverse professions. The authors analyzed semi-structured interview data thematically to uncover clinicians’ perspectives on interprofessional communication. An overarching theme, “Adjustment of communication,” with subthemes “Synchronized communication” and “Dislocated communication,” emerged. Clinicians adapted communication strategies based on situations and needs, with synchronized communication promoting collaboration and dislocated communication hindering it. Communicating with each other was highly valued, as it contributed to a positive work environment. The study underscores the importance of an open, supportive environment that fosters trust, and respect among healthcare clinicians. Consistent with prior research, collaboration gaps underscore the urgent need to improve interprofessional communication.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
National Category
Health Sciences
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-44000 (URN)10.1080/01612840.2024.2308556 (DOI)001195473700001 ()38564368 (PubMedID)2-s2.0-85189830513 (Scopus ID)
Available from: 2024-04-06 Created: 2024-04-06 Last updated: 2025-10-02Bibliographically approved
4. Interprofessional Communication in Psychiatric Units: Barriers, Prerequisites, and Its Role in Shaping Person-Centered Practices – A Vignette Study
Open this publication in new window or tab >>Interprofessional Communication in Psychiatric Units: Barriers, Prerequisites, and Its Role in Shaping Person-Centered Practices – A Vignette Study
2025 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 46, no 9, p. 891-901Article in journal (Refereed) Published
Abstract [en]

Interprofessional communication is fundamental in healthcare, particularly where patient needs demand coordination and shared understanding. It fosters role clarity, care coordination, and team cohesion. However, unclear hierarchies, heavy workloads, and interpersonal conflicts can disrupt collaboration, affecting professional relationships and patient outcomes. This study explores experiences of and reflections on prerequisites for and barriers to interprofessional communication in psychiatric outpatient settings. While previous research has described barriers, few studies have examined how communication itself constitutes professional roles, boundaries, and collaborative practices. To address this gap, the study applies the Four Flows framework—membership negotiation, self-structuring, activity coordination, and institutional positioning—as an interpretive lens. Using vignettes and semi-structured interviews with 11 clinicians in psychiatric outpatient units, the study analyzed how communication shapes and is shaped by interprofessional collaboration. Analysis identified four key categories: systemic barriers and organizational challenges; social dynamics and interprofessional relationships; supportive leadership and team culture; and patient focus and involvement. These categories intersect across the Four Flows, illustrating how communication acts as a structuring process rather than a neutral tool. The overarching theme,” From Separate Paths to Shared Care,” highlights how clinicians enact person-centered collaboration through communicative practice in psychiatric outpatient settings.

Place, publisher, year, edition, pages
Taylor & Francis, 2025
National Category
Psychiatry
Research subject
Health-Promoting Work
Identifiers
urn:nbn:se:hig:diva-46689 (URN)10.1080/01612840.2025.2535652 (DOI)001564208500001 ()40906969 (PubMedID)2-s2.0-105015189432 (Scopus ID)
Available from: 2025-03-26 Created: 2025-03-26 Last updated: 2026-03-17Bibliographically approved

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Rudberg, Ingela

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