Introduction
The World Health Organization (WHO) defines Inter-Professional Collaboration Practice (IPCP) as a collaborative approach to healthcare delivery that involves providing comprehensive care through a team of health professionals from various backgrounds [1]. To ensure quality care for patients and create a positive work environment, physicians and nurses must work together [2‐4]. Collaboration between physicians and nurses enhances clinical outcomes and patient satisfaction, and it also improves behavioral interactions while reducing institutional costs, overall patient complications, length of hospital stay, caregiver stress and conflict, staff turnover, hospital admissions, clinical error rates, and mortality rates [2, 5‐10].
According to reports from the World Health Organization (WHO) framework for Interprofessional Education (IPE) and Interprofessional Collaboration (IPC), addressing unmet health demands has left many health systems and medical professionals worldwide disoriented and overburdened [11, 12]. A common source of conflict in hospitals stems from the lack of daily interprofessional collaboration between nurses and physicians, despite both professions being committed to patient well-being and working closely together [11‐13].
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Inpatient care relationships between nurses and physicians have always been complex on a global scale [14, 15]. Additionally, studies have shown that in their professional settings, physicians and nurses can have various types of relationships, including friendly stranger relationships, collaborative relationships, collegial relationships, student-teacher relationships, and even hostile relationships [16‐18]. The situation is far worse in developing nations such as those in sub-Saharan Africa and Asia, due to unfavorable clinical environments [19‐22]. Sub-Saharan Africa, in particular, is the most significantly affected region, where interprofessional collaborations between nurses and physicians are often ineffective [23]. Similar to other sub-Saharan African countries, Ethiopia has notably low levels of interprofessional collaboration between physicians and nurses [24, 25]. However, compared to other African nations [26, 27], there are relatively few studies available on this issue in Ethiopia as a whole [24, 26].
Ineffective nurse-physician interprofessional collaborations have compromised patient safety, care, and improvement, and have created moral discomfort for healthcare professionals [23, 28]. Numerous studies have shown that failures in interprofessional collaboration between nurses and physicians are the primary cause of adverse medical events, including hospital-acquired infections [29], prolonged hospital stays [30], medication administration errors [31‐33], unnecessary health-related costs [34], and other unfavorable outcomes that may jeopardize patient care, were due to interprofessional collaboration failure between nurses and physician [35].
According to the study, factors affecting interprofessional collaboration among nurses and physicians included a stressful hospital environment, differing treatment approaches, the absence of a forum for collaboration, a lack of defined roles, and discrepancies in payment and rewards related to clinical responsibilities [17, 36‐41]. Additionally, the study identified poor attitudes toward the profession, unfavorable management decisions, poor communication, lack of respect and trust, unequal power dynamics, misunderstanding of professional roles, inappropriate task prioritization, and inadequate evaluation as factors impacting nurse-physician collaboration [17, 39, 40, 42].
Interprofessional collaboration is crucial because it is unlikely that a single healthcare provider can manage the increasingly complex care needs on their own [43]. Teamwork enhances patient satisfaction, treatment quality, and overall well-being in a complex and dynamic healthcare environment [44]. Despite numerous epidemiological studies in Ethiopia, there is no published systematic review and meta-analysis that comprehensively examines interprofessional collaboration in patient care and the associated factors between nurses and physicians in Ethiopia to generate pooled, updated information.
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To obtain the best possible evidence regarding collaborative patient care from healthcare providers, a pooled systematic review and meta-analysis is necessary to address this significant issue observed in clinical practice. This approach could provide substantial support for collaborative evidence-based practices that enhance interprofessional collaboration. Therefore, this systematic review and meta-analysis aimed to assess pooled interprofessional collaboration in patient care and associated factors among nurses and physicians in Ethiopia.
Objectives and review questions
This investigation aimed to determine the cumulative of interprofessional collaboration in patient care and to synthesize data on the contributing factors to such collaboration between nurses and physicians in Ethiopia. The following review questions provide a framework for this systematic review and meta-analysis: (1) What are the overall proportions of interprofessional collaboration in patient care among nurses and physicians in Ethiopia? and (2) What factors contribute to interprofessional collaboration in patient care among nurses and physicians in Ethiopia?
Methods
Reporting the results of the review
The report of this systematic review and meta-analysis adhered to the guidelines outlined by the PRISMA-2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard [45]. Additionally, the study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration identification number CRD42024579370.
Inclusion criteria
This review considered studies employing cross-sectional, cohort, and case-control approaches. Although our search was language-specific, it yielded only English-language articles. To ensure comprehensive coverage, we considered all pertinent publications from the beginning of the study to the present that reported on interprofessional collaboration in patient care among nurses and physicians in Ethiopia, as well as associated factors. Consequently, the review included studies published from 2015 to 2023.
Peer-reviewed journal publications were taken into account. Additionally, findings from national surveys and studies conducted in various countries were included, with a particular emphasis on Ethiopia. Articles that evaluated interprofessional collaboration in patient care and associated factors among nurses and physicians in Ethiopia, based on the mean or median of interprofessional collaboration in patient care, were included in this systematic review.
Based on the previous literature collaboration defined as collective action among professionals that was used to integrate healthcare services for patients [46, 47]. Nurse-physician collaboration defined as the interaction between nurses and physicians, and working for patients and their families to deliver quality of care [13, 47]. As different literatures have described, nurse-physician collaboration is measured using the mean or median score on the nurse-physician collaboration scale [48‐51].
Exclusion criteria
The meta-analysis of pooled proportions of interprofessional collaboration in patient care among nurses and physicians did not include studies that lacked information on the proportion of interprofessional collaboration or for which it was not possible to obtain the necessary information even after contacting the authors. The exclusion list included conference proceedings, qualitative studies, commentaries, editorial letters, case reports, case series, and monthly and annual police reports.
CoCoP and PEO search guide
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Condition: Interprofessional collaboration toward patient care.
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Context: Healthcare settings in Ethiopia.
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Population: Nurses and physicians in Ethiopia.
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Exposure: Interprofessional collaboration toward patient care.
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Outcome: Nurses and physician interprofessional collaboration and associated factors.
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Search strategy and sources of information
Published research on the prevalence of knowledge of obstetrics danger sign and associated factors among reproductive age mothers in Africa was used in the review. Studies published from the start up to August 20, 2024 are methodically searched and found in the following electronic databases: Google Scholar, African Journals Online (AJOL), PubMed/MEDLINE and Google were included. For PubMed advanced searching, keywords, free text search terms, and Medical Subject Headings (Mesh) were all used (See Table 1). [“Inter-professional relations” OR” “Inter-relationship” OR “Collaboration” OR “Physician-Nurse relation “OR” Patient care” OR “Associated factors” OR” Risk factors” OR “Nurses” OR “Physician” OR” Health facilities” OR “Ethiopia”] / [“Inter-professional relations” AND” “Inter-relationship” AND “Collaboration” AND “Physician-Nurse relation “AND” Patient care” AND “Associated factors” AND” Risk factors” AND “Nurses” AND “Physician” AND ” Health facilities” AND “Ethiopia”] were utilized as substitute terms and merged using Boolean operators as search phrases.
To make sure the studies were comprehensive, we asked for advice from an experienced librarian. Using snowballing, the references to the publications that were located were filtered in order to locate any more potentially relevant studies. In addition, recommendations regarding other studies already conducted were sought from specialists, researchers, and relevant organizations. The electronic database search results were imported into the reference management system (Endnote™), which then removed any duplicate entries.
Table 1
PubMed search strategy for systematic review and meta-analysis on the interprofessional collaboration towards patient care and associated factors among nurses and physicians in Ethiopia, 2024
Search number | Search Details | Results |
|---|---|---|
1 | “Interprofessional relations“[MeSH Terms] | 73,146 |
2 | “Relations interprofessional“[Title/Abstract] OR ((“Etiquette“[All Fields] OR “etiquettes“[All Fields]) AND “Medical“[Title/Abstract]) OR “medical etiquette“[Title/Abstract] | 215 |
3 | “Physician nurse relations“[MeSH Terms] | 2,417 |
4 | “Physician nurse relation“[Title/Abstract] OR “physician nurse relations“[Title/Abstract] OR ((“family“[MeSH Terms] OR “family“[All Fields] OR “Relation“[All Fields] OR “relatability“[All Fields] OR “relatable“[All Fields] OR “related“[All Fields] OR “relates“[All Fields] OR “relating“[All Fields] OR “relational“[All Fields] OR “Relations“[All Fields]) AND “Physician-Nurse“[Title/Abstract]) OR ((“family“[MeSH Terms] OR “family“[All Fields] OR “Relation“[All Fields] OR “relatability“[All Fields] OR “relatable“[All Fields] OR “related“[All Fields] OR “relates“[All Fields] OR “relating“[All Fields] OR “relational“[All Fields] OR “Relations“[All Fields]) AND “Physician-Nurse“[Title/Abstract]) OR “physician nurse relationship“[Title/Abstract] OR ((“nurse s“[All Fields] OR “nurses“[MeSH Terms] OR “nurses“[All Fields] OR “Nurse“[All Fields] OR “nurses s“[All Fields]) AND “relationship physician“[Title/Abstract]) OR ((“nurse s“[All Fields] OR “nurses“[MeSH Terms] OR “nurses“[All Fields] OR “Nurse“[All Fields] OR “nurses s“[All Fields]) AND “relationships physician“[Title/Abstract]) OR “physician nurse relationships“[Title/Abstract] OR ((“Relationship“[All Fields] OR “Relationships“[All Fields]) AND “Physician-Nurse“[Title/Abstract]) OR ((“Relationship“[All Fields] OR “Relationships“[All Fields]) AND “Physician-Nurse“[Title/Abstract]) OR “nurse physician relations“[Title/Abstract] OR “nurse physician relation“[Title/Abstract] OR “nurse physician relations“[Title/Abstract] OR ((“family“[MeSH Terms] OR “family“[All Fields] OR “Relation“[All Fields] OR “relatability“[All Fields] OR “relatable“[All Fields] OR “related“[All Fields] OR “relates“[All Fields] OR “relating“[All Fields] OR “relational“[All Fields] OR “Relations“[All Fields]) AND “Nurse-Physician“[Title/Abstract]) OR ((“family“[MeSH Terms] OR “family“[All Fields] OR “Relation“[All Fields] OR “relatability“[All Fields] OR “relatable“[All Fields] OR “related“[All Fields] OR “relates“[All Fields] OR “relating“[All Fields] OR “relational“[All Fields] OR “Relations“[All Fields]) AND “Nurse-Physician“[Title/Abstract]) | 1,138 |
5 | “Intersectoral collaboration“[MeSH Terms] | 2,655 |
6 | “Collaboration Intersectoral“[Title/Abstract] OR “collaborations Intersectoral“[Title/Abstract] OR “Intersectoral collaborations“[Title/Abstract] OR “Intersectoral cooperation“[Title/Abstract] OR ((“cooperate“[All Fields] OR “cooperated“[All Fields] OR “cooperates“[All Fields] OR “cooperating“[All Fields] OR “Cooperation“[All Fields] OR “cooperation’s“[All Fields] OR “cooperative“[All Fields] OR “cooperatively“[All Fields] OR “cooperatives“[All Fields] OR “cooperativities“[All Fields] OR “cooperativities“[All Fields] OR “cooperator“[All Fields] OR “cooperators“[All Fields]) AND “Intersectoral“[Title/Abstract]) | 529 |
7 | “Risk factors“[MeSH Terms] | 996,847 |
8 | “Factor risk“[Title/Abstract] OR “risk factor“[Title/Abstract] OR “social risk factors“[Title/Abstract] OR ((“Factor“[All Fields] OR “factor s“[All Fields] OR “Factors“[All Fields]) AND “social risk“[Title/Abstract]) OR “factors social risk“[Title/Abstract] OR “risk factor social“[Title/Abstract] OR “risk factors social“[Title/Abstract] OR “social risk factor“[Title/Abstract] OR “health correlates“[Title/Abstract] OR “correlates health“[Title/Abstract] OR “population at risk“[Title/Abstract] OR “populations at risk“[Title/Abstract] OR “risk scores“[Title/Abstract] OR “risk score“[Title/Abstract] OR “score risk“[Title/Abstract] OR “risk factor scores“[Title/Abstract] OR “risk factor score“[Title/Abstract] OR “score risk factor“[Title/Abstract] | 339,201 |
9 | “Precipitating factors“[MeSH Terms] | 745 |
10 | “Factor precipitating“[Title/Abstract] OR “factors precipitating“[Title/Abstract] OR “precipitating factor“[Title/Abstract] | 1,896 |
11 | “Epidemiologic factors“[MeSH Terms] | 1,784,730 |
12 | “Determinants epidemiologic“[Title/Abstract] OR “epidemiologic determinant“[Title/Abstract] OR “epidemiologic determinants“[Title/Abstract] OR “determinant epidemiologic“[Title/Abstract] OR “factor epidemiologic“[Title/Abstract] OR “factors epidemiologic“[Title/Abstract] OR “epidemiologic factor“[Title/Abstract] | 146 |
13 | “Nurses“[MeSH Terms] | 101,072 |
14 | “Nurse“[Title/Abstract] OR “nursing personnel“[Title/Abstract] OR “personnel nursing“[Title/Abstract] OR “registered nurses“[Title/Abstract] OR “nurse registered“[Title/Abstract] OR “nurses registered“[Title/Abstract] OR “registered nurse“[Title/Abstract] | 159,815 |
15 | “Physicians“[MeSH Terms] | 186,993 |
16 | “Physician“[Title/Abstract] | 235,584 |
17 | “Ethiopia“[MeSH Terms] | 21,390 |
18 | “Federal democratic republic of Ethiopia“[Title/Abstract] | 11 |
19 | #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR | 75,991 |
20 | #7 OR #8 OR #9 OR #10 OR #11 OR #12 | 1,977,292 |
21 | #13 OR #14 OR #15 OR #16 | 587,946 |
22 | #17 OR #18 | 21,394 |
23 | #19 AND #20 AND#21 AND #22 | 16 |
Selection of studies
After evaluating the studies according to the inclusion and exclusion criteria, two authors (AH & KU) selected the ones to include. The review was conducted using the following methodologies: First, the search yielded article titles, which were evaluated. Second, their eligibility was abstractly screened using the predetermined criteria. Lastly, the abstracts of these chosen titles were included in the final round of full-text screening. The data charting and screening process was completed using Microsoft Excel™. Only studies approved by both authors were included in the full review. Any disagreements between the authors were resolved through discussion or consultation with a third reviewer (BK). After all non-relevant articles were removed, the final article list for data extraction was produced.
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Data extraction and management
Once every eligible article had been found, the pertinent data was extracted onto a Microsoft Excel spreadsheet by two independent reviewers (BF&AH). The Joanna Briggs Institute (JBI) data extraction form for systematic reviews and research syntheses served as the model for the development of a data extraction format [52, 53]. All review team members participated in an independent test of the data extraction procedure using Microsoft Excel prior to the actual data extraction.
The data extraction tool contained the following information for each included article: the last name of the first author or corresponding authors, the year the study was published, the region the study was conducted in, the study design, sample size, response rate, proportion of interprofessional collaboration towards patient care, interprofessional collaboration measurement criteria, study setting, sampling methods, related factors, two by two table value, and effect size of risk factors(odd ratio). Throughout the extraction process, disagreements between data extractors were resolved in order to reach a consensus. A third reviewer (KG) was consulted with the authors in case a consensus could not be reached.
Quality assessment
The listed studies were assessed independently by two reviewers (KU&BK). The JBI checklists [54, 55] for prevalence or proportions were used to assess the articles’ quality. The tool has nine parameters: (1) a suitable sampling frame; (2) a suitable sampling technique; (3) a suitable sample size; (4) a description of the subject and setting of the study; (5) a suitable data analysis; (6) the application of valid methods for the conditions that have been identified; [7] valid measurement for each participant; (8) the application of suitable statistical analysis; and 9) an adequate response rate [56].
The tools offer options such as yes, no, not applicable, and unclear. Responses marked as ‘yes’ received a score of one for each parameter, while ‘unclear,’ ‘not applicable,’ or ‘no’ were recorded as zero. Studies were classified as low, medium, or high quality if they scored less than 50%, between 50% and 70%, and above 70%, respectively [57, 58] and were included in the final analysis. Consequently, the maximum score from the study evaluation was nine, and the minimum was seven. The total score was converted to a percentage by dividing it by the maximum possible score [9] and multiplying by 100. The lowest percentage from the study was 77.77%, and all studies were categorized as high quality. Throughout the critical evaluation, one author (AH) settled the arguments between the two authors.
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Statistical analysis
The STATA 17 version software is used for data analysis because of its adaptation to the Metan program after data imported from excel software. The data were displayed using tables and graphs according to the findings of the selected study’s conclusions. The random effect model was used to show the pooled proportion of the effective interprofessional collaboration towards patient care among nurses and physician [59]. We used the Freeman Tuckey variant of the arcsine square root transformation of proportions to avoid variance variability because the random-effects model takes into account sources of between-study variance [60, 61]. The effect size used to determine whether there is a significant association between the related factors and interprofessional collaboration towards patient care among nurses and physician in Ethiopia. P-values less than 0.05 with confidence interval are used to determine the statistical significance level for effect size.
Using the I2 statistic and a chi-squared test in accordance with Cochran’s Q statistic with a 5% significance level, heterogeneity was measured based on statistical findings, outcome presentations, and methodological [62]. I2 values of 25%, 50%, and 75% were considered indicative of low, moderate, and high heterogeneity, respectively [63]. When I2 > 50% and p-value less than 0.05, the existence of heterogeneity were declared [63]. Subgroup analyses and meta-regressions were performed to investigate sources of heterogeneity [64]. Further, to ascertain the effect of individual studies on pooled estimates, a sensitivity analysis was also carried out [64].
Publication bias
For the purpose of examining the possibility of publication bias and small-study effects, funnel plots and Egger’s test [65] were utilized. Publication bias was identified when the p-value was statistically significant (p value < 0.10).
Results
Study selection and identification
An electronic search using MEDLINE/PubMed, Google Scholar, and African Journal Online initially identified 168 articles. Of these, 30 were eliminated due to duplication. After reviewing titles and abstracts, 108 studies were deemed irrelevant for this review. A manual search of reference lists and Google yielded an additional 48 articles. Out of the 27 retrieved studies, fifteen were excluded for various reasons, such as lack of full text, insufficient quality, not being conducted in Ethiopia, or absence of the main outcome of interest. Ultimately, five publications [51, 66‐69] that met all. inclusion criteria were incorporated into the review and meta-analyses. The PRISMA flow diagram (See Fig. 1) details the searching and screening procedure.
Fig. 1
PRISMA flow diagram showing the selection of the included articles for interprofessional collaboration towards patient care and associated factors among Nurse and physician in Ethiopia, 2024
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Characteristics of included studies
This systematic review and meta-analysis included five [51, 66‐69] original publications that were conducted in three regions in Ethiopia. Among these, 2 (40%) studies [66, 67] were conducted in Amhara region Ethiopia, 2(40%) studies [69, 70] were conducted in Oromia region, and 1(20%) studies [47] were conducted in Tigray, Ethiopia. Among the included studies, 4 (80%) studies [66‐69] were published in 2019 and above. It was discovered that articles published in 2015 and later met the inclusion criteria and included in this meta-analysis, regardless of the study period’s unlimited duration.
All the included studies were cross-sectional surveys, institution based and study participants were randomly selected. A total of 1686 participants were included in this systematic review and meta-analysis. Out of 5 included studies, four studies [47, 66‐68] measured interprofessional collaboration using mean and one studies [69] used median. Regarding methodological quality, all studies included for this systematic review ranging from moderate to high score. According to the JBI critical appraisal checklist [71], for studies that reported prevalence data, four studies [66‐69] scored 9 points, and the remaining one study [47] scored 7 points (Table 2).
Table 2
Characteristics of included studies for the interprofessional collaboration towards patient care and associated factors among nurses and physician in Ethiopia, 2024
Author and year of publication | Region | Country | Study setting | Collaboration measurement criteria | Study design | Sampling technique | Sample size | Prevalence of IPC (frequency) | Quality score |
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Degu et al. (2023) [66] | Ahmara | Ethiopia | Facility | Mean | Cross sectional | Random | 366 | 207 | 9 |
Endris et al. (2022) [67] | Ahmara | Ethiopia | Facility | Mean | Cross sectional | Random | 260 | 115 | 9 |
Eukubay et al. (2019) [68] | Tigray | Ethiopia | Facility | Mean | Cross sectional | Random | 409 | 222 | 9 |
Tsegay et al. (2015) [70] | Oromia | Ethiopia | Facility | Mean | Cross sectional | Random | 293 | 125 | 7 |
Melkamu et al. (2020) [69] | Oromia | Ethiopia | Facility | Median | Cross sectional | Random | 358 | 234 | 9 |
Pooled interprofessional collaboration towards patient care among nurses and physician in Ethiopia
All studies used to studies used to pool interprofessional collaboration towards patient care among nurses and physician in Ethiopia. A total of 1686 participants included to analyze the combined interprofessional collaboration towards patient care among nurses and physician. Accordingly, the pooled proportion of interprofessional collaboration towards patient care among nurses and physician in Ethiopia was 52.73% (95% CI = 44.66, 60.79%) with a significant heterogeneity observed among studies (I2 = 91.5%, P-value = 0.000) (Fig. 2). Regarding studies weight, the highest weight among studies observed from the studies conducted by Eukubay et al. [68]. Symmetry of the funnel plot (Fig. 3) and Egger’s statistical test ((P-value 0.286) (Table 3) evidenced that there is no a publication bias among the included studies.
Fig. 2
Forest plot showing the pooled proportion of the interprofessional collaboration towards patient care among nurses and physician in Ethiopia, 2024
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Fig. 3
Funnel plot indicating the absence of publication bias on the pooled proportion of the interprofessional collaboration towards patient care among nurses and physician in Ethiopia, 2024
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Table 3
Egger’s test for small-study effects indicating absence of publication bias for the studies of interprofessional collaboration towards patient care among nurses and physician in Ethiopia, 2024
Number of studies = 5 | Root MSE = 1.422 | ||||
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Standard effect | Coefficient | Standard error | t | P-value | 95%CI |
Slope | 0.4876193 | 0.87247 | 0.56 | 0.615 | -2.28897, 3.264208 |
Bias | -10.21863 | 7.884008 | -1.30 | 0.286 | -35.30907, 14.8718 |
Subgroup analysis
A subgroup analysis was conducted based on the year of publication, region, collaboration measurement criteria, and sample size due to the heterogeneity reported in pooled interprofessional collaboration. In the subgroup analysis, a random-effects model was used to report the pooled interprofessional collaboration. In this meta-analysis, pooled estimates from individual studies were not used during the subgroup analysis. Despite conducting subgroup analysis based on the year of publication, region, collaboration measurement criteria, and sample size, the sources of heterogeneity among the studies were not addressed.
Subgroup analysis by year of publication
The subgroup analysis by year of publication revealed that the highest pooled proportion of interprofessional collaboration in patient care among nurses and physicians was reported in studies conducted between 2020 and 2023 (55.49%; 95% CI: 43.94, 67.05; I2 = 92.9%) (Fig. 4). This was followed by studies conducted between 2015 and 2019 (48.57%; 95% CI: 37.19, 59.95; I2 = 89.3%). A high level of heterogeneity was observed in studies published between 2020 and 2023 (I2 = 92.9%, P value = 0.000) compared to studies conducted between 2015 and 2019 (I2 = 89.3%, P-value = 0.002).
Fig. 4
Forest plot showing the pooled proportion interprofessional collaboration towards patient care among nurses and physician by year of publication in Ethiopia, 2024
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Subgroup analysis by region
The subgroup analysis by region indicated that the pooled proportions of interprofessional collaboration towards patient care among nurses and physician was highest (54.06%) in Oromia region (54.06% (95% CI: 31.81, 76.30; I2 = 97.2%)), followed by Amhara region (50.51% (95% CI: 38.43, 62.58; I2 = 89.3%)). A high level of heterogeneity was seen in studies conducted in Oromia region (I2 = 97.2%, P-value = 0.000) compared to studies conducted in Amhara (I2 = 89.3%, P-value = 0.002) (Fig. 5).
Fig. 5
Forest plot showing the pooled proportion interprofessional collaboration towards patient care among nurses and physician by region in Ethiopia, 2024
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Subgroup analysis by collaboration measurement criteria
Subgroup analysis for interprofessional collaboration, based on collaboration measurement criteria, showed that the highest pooled proportion of interprofessional collaboration among nurses and physicians (49.58%) was observed using the mean, with the highest heterogeneity (49.58%; 95% CI: 42.76, 56.40; I2 = 84.5%) (Fig. 6).
Fig. 6
Forest plot showing the pooled proportion interprofessional collaboration towards patient care among nurses and physician by collaboration measurement criteria in Ethiopia, 2024
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Subgroup analysis by sample size category
Subgroup analysis for sample size showed that, the highest (55.36%) proportion of the pooled interprofessional collaboration among nurses and physician was observed from sample size greater than 358 by median (55.36% (95% CI: 51.86, 58.86; I2 = 0.0%)) followed by sample size category less than or equal to 358 by median studies (50.82% (95% CI: 35.69, 65.95; I2 = 95.6%)). Heterogeneity among studies showed that, highest heterogeneity for sample size subgroup analysis displayed in a sample size category less than or equal to 358 by median studies (I2 = 95.6%, P-value = 0.000) and no heterogeneity observed in a sample size greater than 358 by median studies (I2 = 0.00%, P-value = 0.524) (Fig. 7).
Fig. 7
Forest plot showing the pooled proportion interprofessional collaboration towards patient care among nurses and physician by sample size category in Ethiopia, 2024
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Sensitivity analysis
The subgroup analysis revealed a high degree of heterogeneity among the studies. In order to determine the impact of each study on the total effect size, sensitivity analysis performed. As a result, the total pooled proportion of interprofessional collaboration towards patient care among nurses and physician in Ethiopia (Fig. 8) were unaffected by any one study.
Fig. 8
Sensitivity analysis plot for the pooled interprofessional collaboration towards patient care among nurses and physician in Ethiopia, 2024
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Factors associated with interprofessional collaboration among nurses and physician
As a result of the few studies conducted in Ethiopia, we identified only two factors (attitude and organizational support) to assess association between interprofessional collaboration among nurses and physician in Ethiopia. Accordingly, attitude (favorable attitude towards collaboration) and organizational support (satisfaction towards organizational support) were not associated with interprofessional collaboration towards patient care among nurses and physicians in Ethiopia.
Attitude (favorable attitude towards collaboration) and interprofessional collaboration towards patient care
A total of two [67, 69] studies included to estimate the association between interprofessional collaboration and favorable attitude. A total of 669 participants included to analyze the association. The results of the test statistics indicate that there is a significant heterogeneity was observed among studies (I2 = 97.7%, P-value = 0.000). The random effects model estimate indicated that, attitude (favorable attitude towards collaboration) had no statistically significant association with effective interprofessional collaboration towards patient care (OR = 1.13, 95% CI: 0.13, 9.89) (Fig. 9). According to the random effects model estimate from the sensitivity analysis, no single study significantly affects the pooled effect size (Fig. 10).
Fig. 9
Forest plot showing that no association between Attitude (favorable attitude) and collaboration towards patient care among nurses and physicians in Ethiopia from pooled estimate of effect size analysis, 2024
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Fig. 10
Sensitivity analysis plot for the association between pooled interprofessional collaboration and attitude (favorable attitude towards collaboration) among nurses and physician in Ethiopia, 2024
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Organizational support (satisfaction towards organizational support) and interprofessional collaboration towards patient care
To determine the association between organizational support (satisfaction towards organizational support) and effective interprofessional collaboration towards patient care, three studies [66‐68] were incorporated. A total of 1,035 participants included to analyze the association of satisfaction towards organizational support with effective interprofessional collaboration towards patient care.
Result from random effect model showed that, there was no statistically significant association found between organizational support (satisfaction towards organizational support) and effective interprofessional collaborations towards patient care (OR = 0.38, 95% CI: 0.07, 2.10) (Fig. 11). There was statistically significant heterogeneity across studies (I2 = 97.5%, P-value = 0.000). According to sensitivity analysis, no single study significantly affects the pooled estimate of organizational support and effective interprofessional collaboration towards patient care (Fig. 12).
Fig. 11
Forest plot showing that no association between organizational support (satisfied towards organizational support) and collaboration towards patient care among nurses and physicians in Ethiopia from pooled estimate of effect size analysis, 2024
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Fig. 12
Sensitivity analysis plot for the association between pooled interprofessional collaboration towards patient care and organizational support (satisfaction towards organizational support) among nurses and physician in Ethiopia, 2024
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Discussion
This systematic review and meta-analysis revealed that the pooled proportion of the overall interprofessional collaboration towards patient care among nurses and physicians in Ethiopia is 52.73% (95% CI = 44.66, 60.79%). However, this finding is lower than the previous studies conducted in Egypt 70% [72], China (77.4%) [73], and USA (70%) [73],. Moreover, this proportions of the interprofessional collaboration towards patient care higher than a study conducted in Egypt 22.7% [74]. This discrepancy may be due to the sociodemographic differences, number of study participants, study period and methods [47, 66]. Furthermore, the disparity may also be influenced by various quality study environments, professional respect and adherence, national health sector development levels, and variances in professional development [73]. Therefore, this systematic review and meta-analysis findings revealed low collaboration that requires special attention to be improved in order to enhance patient outcomes raise patient satisfaction, professional satisfaction and improve the quality of patient care [68].
The high level of heterogeneity (I2 = 91.5%) among studies were observed in this systematic review and meta-analysis could have several causes. It may arise from differences in the between collaboration measurement criteria, region of the studies, year of publication and sample size. As a result, we considered post-hoc subgroup analyses based on a category of the groups, such as the year of publication, sample size, collaboration measurement criteria, and region.
The factors that contribute to interprofessional collaboration towards patient care are also identified in this systematic review and meta-analysis. Due to a smaller number of studies, only two factors (satisfaction towards organizational support and favorable attitude towards collaboration) assessed in the pooled estimate of the random effects model. Accordingly, the pooled effects of the organizational support (satisfaction towards organizational support) revealed no association with interprofessional collaboration towards patient care. This finding is in contrast with the study conducted in Kenya [75], Nigeria [76], Iran [77], Canada [78], Norway [79], and USA [80] which stated that inter-professional collaboration significantly increased among nurses and physicians who satisfied with their organization’s support. This discrepancy may be due to the sample size, methods and number of included studies.
Furthermore, the pooled effects of the attitude (favorable attitude towards collaboration) showed that no association with interprofessional collaboration towards patient care. This findings is in line with studies conducted in Malaysia and Egypt [81, 82]. However, this finding is in contrast with the study conducted in Turkey [83], China Chongqing medical university [84], and Gaza City State of Palestine [85] which stated that interprofessional collaboration between nurses and physicians occurred among respondents who had a positive attitude toward collaboration. The difference can be explained by the fact that differences in socio-cultural variation, sample sizes of the included studies, and methods.
This study follows some limitations. There was, nevertheless, notable variation among studies that was statistically significant. Even after subgroup analysis, there was still a significant amount of heterogeneity observed. Only English-language publications were included. A small number of studies (only five articles) from only three regions (Oromia, Amhara and Ethiopia) in Ethiopia were included in this review, and it was limited to observational studies only. Only articles conducted in public hospitals were included, and no articles conducted in private hospitals were found throughout the search. Due to the small number of studies, no multiple factors were recruited, and only two factors were pooled for the analysis. EMBASE, CNAHL, and Web of Sciences databases were excluded because access to them was restricted in Ethiopia. Furthermore, the meta-analysis’s findings were highly heterogeneous, and the subgroup analysis revealed some I2 overlap.
Conclusion and recommendations
In conclusion, this systematic review and meta-analysis indicate that interprofessional collaboration between nurses and physicians in Ethiopia is moderately prevalent, with a pooled proportion of 52.73%. This finding underscores the importance of continued efforts to enhance collaborative practices to further improve patient care outcomes. Moreover, this systematic review and meta-analysis identified two factors: satisfaction with organizational support and favorable attitudes towards collaboration as potential contributors to interprofessional collaboration in patient care. However, the pooled effects of these factors showed no significant association with collaboration. This highlights the need for further primary research to explore additional factors that may influence interprofessional collaboration and improve patient care outcomes.
Based on the finding of this review, we recommend those health planners, policymakers, and the community of the hospitals managers should strengthen health organization to enhance training programs focused on interprofessional collaboration skills for both nurses and physicians and ensure that healthcare facilities are equipped with the necessary resources to support collaborative practices, such as shared workspaces and communication tools. In addition, organize regular team-building activities and workshops to build trust and mutual respect among healthcare professionals are also important. Furthermore, conduct primary research to explore other potential factors that may influence interprofessional collaboration, such as leadership styles, cultural influences, and workload management using experimental design and large sample.
Acknowledgements
We thank Samara University for providing free Internet and library access.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Protocol registration
This systematic review and meta-analysis was registered in PROSPERO with the registration ID and link as follows: CRD42024579370; CRD register@york.ac.uk. https://www.york.ac.uk/inst/crd. https://www.crd.york.ac.uk/prospero/#recordDetails.
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