Minding the gap: Prioritization of care issues among nurse practitioners, family physicians and geriatricians when caring for the elderly

Accumulating health problems of the elderly requires recognition of geriatric syndromes, while shifting away from a conventional disease-specific approach. 

Moore and colleagues recently surveyed 179 practitioners representing Family Physicians (FPs), Nurse Practitioners (NPs) and geriatricians in Ontario, in order to quantify how they prioritize syndromes, diseases and conditions in the elderly. Identifying differences may inform opportunities for interprofessional sharing of expertise among professionals pursuing a common goal, which is expected to improve interprofessional collaboration.

Their survey (response rate 36%) identifies that NP, FP and geriatrician respondents all recognize co-occurrence of “multiple morbidities” as one of the most frequently encountered issues when serving the elderly, however FPs and NPs place higher priority on managing individual chronic diseases than explicitly prioritizing geriatric syndromes. The findings identify a need for a more clearly defined role for the geriatrician as syndrome-educator and implies further need for collaborative approaches to caring for seniors that values different professional’s expertise.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.966352

Student reflections following exposure to a case-based interprofessional learning experience: Preliminary findings

Goldberg et al.'s recent study analyzed students’ written reflections following their initial exposure to interprofessional teamwork in case-based problem-solving. A three-hour seminar featuring three sequenced scenarios was developed and offered 12-times over two semesters. A total of 305 students from a variety of healthcare programs worked together with standardized patients in an on-campus laboratory simulating hospital ward and rehabilitation settings.

A thematic analysis of students’ reflections showed that they valued the shared learning and realistic case study. However, they felt the experience would be strengthened by working in smaller, more representative teams that included students from medicine, psychology, and social work to enable more effective communication and comprehensive case discussion. 

While useful for future planning, the identified themes did not enable a comparative statistical analysis of what students found helpful and difficult and a re-coding of students’ responses now is underway. Implications for measuring the effectiveness of future interprofessional case-based learning center on addressing the identified weaknesses, and establishing a research design that enables a comparison of pre- and post-seminar data, and the effectiveness of the IPE experience compared to profession-specific experiences.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.969835

Interprofessional mental health training in rural primary care: Findings from a mixed methods study

The benefits of interprofessional care in providing mental health services have been widely recognized, particularly in rural communities where access to health services is limited. There continues to be a need for more continuing interprofessional education in mental health intervention in rural areas. There have been few reports of rural programs in which mental health content has been combined with training in collaborative practice.

This study by Heath and colleagues used a sequential mixed-method and quasi-experimental design to evaluate the impact of an interprofessional, intersectoral education program designed to enhance collaborative mental health capacity in six rural sites.

Quantitative results reveal a significant increase in positive attitudes toward interprofessional mental health care teams and self-reported increases in knowledge and understanding about collaborative mental health care delivery. The analysis of qualitative data collected following completion of the program, reinforced the value of teaching mental health content within the context of collaborative practice and revealed practice changes, including more interprofessional and intersectoral collaboration.

This study suggests that imbedding explicit training in collaborative care in content focused continuing professional education for more complex and chronic health issues may increase the likelihood that professionals will work together to effectively meet client needs.


Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.966808

Greater commitment to the domestic violence training is required

Domestic violence (DV) is a major public health problem with high health and social costs. A solution to this multi-faceted problem requires that various help providers work together in an effective and optimal manner when dealing with different parties of DV.

The objective of this research and development project (2008–2013) by Leppakoski and colleagues was to improve the preparedness of the social and healthcare professionals to manage DV. They recently focused on the evaluation of interprofessional education (IPE) to provide knowledge and skills for identifying and intervening in DV and to improve collaboration among social and health care professionals and other help providers at the local and regional level. The evaluation data were carried out with an internal evaluation. The evaluation data were collected from the participants orally and in the written form.

The participants were satisfied with the content of the IPE programme itself and the teaching methods used. Participation in the training sessions could have been more active. Moreover, some of the people who had enrolled for the trainings could not attend all of them.

Overall, the study indicated IPE is a valuable way to develop intervening in DV. However, greater commitment to the training is required from not only the participants and their superiors but also from trustees.


Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.955913

Nurse–physician collaboration: A meta-analytical investigation of survey scores

This meta-analysis by Sollami and colleagues investigated differences between nurses and physicians in interprofessional collaboration (IPC) ratings. Fifty-one surveys, representing a total of 18 782 professionals and students (13 132 nurses and nursing students, and 5650 physicians and medical students), were meta-analyzed, considering several moderating variables.

Overall, nurses scored higher on IPC than physicians. Sensitivity analysis revealed that while physicians perceived more existing collaboration than nurses, nurses had a more positive attitude toward collaboration than physicians. Moreover, IPC ratings of nursing and medical students did not differ from those of practitioners. Finally, it appeared that interprofessional education interventions were able to reduce the difference in IPC between nurses and physicians.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.955912

Using an interprofessional competency framework to examine collaborative practice

Healthcare organisations are starting to implement collaborative practice to increase the quality of patient care. However, operationalising and measuring progress towards collaborative practice has proven to be difficult. Various interprofessional competency frameworks have been developed that outline essential collaborative practice competencies for healthcare providers. If these competencies were enacted to their fullest, collaborative practice would be at its best.

In this study, Hepp and colleagues have examined collaborative practice in six acute care units across Alberta using the Canadian Interprofessional Health Collaborative (CIHC) competency framework (CIHC, 2010). The framework entails the six competencies of patient-centred care, communication, role clarification, conflict resolution, team functioning and collaborative leadership (CIHC, 2010). A secondary analysis of interviews was conducted with 113 healthcare providers from different professions, which were conducted as part of a quality improvement study. 

The study found positive examples of communication and patient-centred care supported by unit structures and processes (e.g. rapid rounds and collaborative plan of care). Some gaps in collaborative practice were found for role clarification and collaborative leadership. Conflict resolution and team functioning were not well operationalised on these units. Strategies were presented to enhance each competency domain in order to fully enact collaborative practice. Using the CIHC competency framework to examine collaborative practice was useful for identifying strength and areas needing improvement.


Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.955910

Interprofessional collaborative patient-centred care: a critical exploration of two related discourses

There has been sustained international interest from health care policy makers, practitioners, and researchers in developing interprofessional approaches to delivering patient-centred care.

Ann Fox and Scott Reeves offer a critical exploration of a selection of professional discourses related to these practice paradigms, including interprofessional collaboration, patient-centred care, and the combination of the two. They argue that for some groups of patients, inequalities between different health and social care professions and between professionals and patients challenge the successful realization of the positive aims associated with these discourses. Specifically, they argue that interprofessional and professional–patient hierarchies raise a number of key questions about the nature of professions, their relationships with one another as well as their relationship with patients. The authors explore how the focus on interprofessional collaboration and patient-centred care have the potential to reinforce a patient compliance model by shifting responsibility to patients to do the “right thing” and by extending the reach of medical power across other groups of professionals.

The broader goal of this exploration was to stimulate debate that leads to enhanced practice opportunities for health professionals and improved care for patients.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.954284

Attaining interprofessional competencies through a student interprofessional fellowship program

For students interested in enriching their interprofessional competencies beyond those required and offered by their academic programs, an elective interprofessional education fellowship can serve that need.

Amy Blue and colleagues designed a fellowship for students linking a conceptual framework grounded in adult learning principles. During the fellowship, students progress through three levels of learning as they acquire, apply, and demonstrate interprofessional collaborative knowledge and skills; fellowship activities are self-directed.

A content analysis of students' fellowship summary reports sought to determine the effectiveness of the fellowship as a learning experience to acquire interprofessional collaborative competences. Results indicated that students most consistently report competencies associated with acquisition of values and ethics for interprofessional practice, roles/responsibilities, and teams/teamwork; interprofessional communication was implied. All students expressed commitment to interprofessional collaborative behavior when in practice.

Based on the results from this study, this fellowship structure may serve as a model for other institutions to adapt and implement for best practice and best fit.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.954283

Continuous interprofessional coordination in perioperative work: An exploratory study

Coordination of perioperative work is challenging. Advancements in diagnostic and therapeutic possibilities have not been followed by similar advancements in the ability to coordinate care. 

A recent study by Lillebo and Faxvaag explored the nature of continuous coordination as practiced by perioperative staff in order to coordinate their own activities with respect to those of their colleagues. In-depth interviews (n = 14), and combined observations and focused interviews (n = 31) with perioperative staff (physicians, nurses, technicians, and cleaners), were conducted at a major university hospital in Norway. Data were analysed qualitatively with systematic text condensation.

The results indicated that a surgical schedule was important for informing staff members about the cases and tasks they had been assigned. Staff also depended on ad hoc, explicit communication to ensure timeliness of particular perioperative activities. This, however, left little room for adjustments of other activities. Hence, to be able to proactively coordinate their own work some staff tried to predict future perioperative activities by observing the workplace, monitoring the surgical scheduling software for changes, and sharing their colleagues' progress updates and predictions. These findings could be important for those developing support for perioperative coordination.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.950724

Interprofessional teamwork in stroke care: Is it visible or important to patients and carers?

Interprofessional teamwork is seen in healthcare policy and practice as a key strategy for providing safe, efficient and holistic healthcare and is an accepted part of evidence-based stroke care. The impact of interprofessional teamwork on patient and carer experience(s) of care is unknown, although some research suggests a relationship might exist. 

A recent study by Hewitt and colleagues aimed to explore patient and carer perceptions of good and poor teamwork and its impact on experiences of care. Critical incident interviews were conducted with 50 patients and 33 carers in acute, inpatient rehabilitation and community phases of care within two UK stroke care pathways. An analytical framework, derived from a realist synthesis of 13 ‘mechanisms’ (processes) of interprofessional teamwork, was used to identify positive and negative ‘indicators’ of teamwork.

Participants identified several mechanisms of teamwork, but it was not a subject most talked about readily. This suggests that interprofessional teamwork is not a concept that is particularly important to stroke patients and carers; they do not readily perceive any impacts of teamwork on their experiences. These findings are a salient reminder that what might be expected by healthcare professionals to be important influences on experience may not be perceived to be so by patients and carers.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.950727

An innovative approach to providing collaborative education to undergraduate students in the area of child maltreatment

Frontline workers in the area of child welfare often enter the field without having taken any specialized coursework in the area of child maltreatment.

Lisa Johnson discusses an interdisciplinary certificate program that is specifically designed to teach persons from various academic areas the knowledge and skills necessary to work with children who experience maltreatment. The child advocacy studies certificate program specifically focuses on coursework in the area of child maltreatment and child advocacy to better train future frontline workers in their vital roles.

This certificate will decrease underreporting of child abuse cases by mandated reporters by making them more aware of the signs and symptoms of child maltreatment and also give students a greater understanding of how to work with individuals from various fields.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.947361

The interprofessional clinical experience: Interprofessional education in the nursing home

The interprofessional clinical experience (ICE) was designed to introduce trainees to the roles of different healthcare professionals, provide an opportunity to participate in an interprofessional team, and familiarize trainees with caring for older adults in the nursing home setting. Healthcare trainees from seven professions (dentistry, medicine, nursing, nutrition, occupational therapy, optometry and social work) participated in ICE. This program consisted of individual patient interviews followed by a team meeting to develop a comprehensive care plan.

Sheppard et al. recently evaluated the impact of ICE on attitudinal change using the UCLA Geriatric Attitudes Scale and a post-experience assessment. The post-experience assessment evaluated the trainees’ perception of potential team members’ roles and attitudes about interprofessional team care of the older adult.

Attitudes toward interprofessional teamwork and the older adult were generally positive. The study concluded that ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.942776

The health mentors program: three years experience with longitudinal, patient-centered interprofessional education

Arenson and colleagues recently conducted a mixed-methods approach to assessing attitudes towards the health mentors program (HMP) and towards interprofessional practice. The health mentors program (HMP) is a required, longitudinal, interprofessional curriculum for all matriculating students from medicine, nursing, occupational therapy, physical therapy, pharmacy, and couple and family therapy. A mixed-methods approach has been employed since program inception, evaluating 2911 students enrolled in HMP from 2007 to 2013. Program impact on 577 students enrolled from 2009–2011 is reported. Two interprofessional scales were employed to measure attitudes toward IPE and attitudes toward interprofessional practice. Focus groups and reflection papers provide qualitative data. Students enter professional training with very positive attitudes toward IPE, which are maintained over 2 years. Students demonstrated significantly improved attitudes toward team care, which were not different across programs. Qualitative data suggested limited tolerance for logistic challenges posed by IPE, but strongly support that students achieved the major program goals of understanding the roles of colleagues and understanding the perspective of patients. Ongoing longitudinal evaluation will further elucidate the impact on future practice and patient outcomes.

Read More: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.944257

Interprofessional Education and Practice Guide No. 1 - Focus on Faculty Development

Introducing our new Interprofessional Education and Practice (IPEP) Guides - A series of papers which aim to provide practical advice and support for colleagues engaged in designing, developing, assessing and evaluating interprofessional education and practice.

The first guide by Les Hall and Brenda Zierler is entitled 'Developing faculty to effectively facilitate interprofessional education'. The guide draws on the authors' experience of develoing and implementing a faculty development program to prepare leaders for interprofessional education. Using a variety of techniques, including didactic teaching, small group exercises, immersion participation in interprofessional education, local implementation of new IPE projects, and peer learning, the program positioned each site to successfully introduce an interprofessional innovation. Participating faculty confirmed the value of the program, and suggested that more widespread similar efforts were worthwhile.

Based on this work, the first IPEP guide identifies a range of key lessons learned from this initiative, including:

• Peer learning arising from a faculty development community
• Adaptation of curricula to fit local context
• Experiential learning
• Ongoing coaching/mentoring

Each lesson is described and discussed. Collectively, these lessons provide the key elements needed for the delivery of effective interprofessional faculty development.

 Read More at: http://informahealthcare.com/doi/abs/10.3109/13561820.2014.937483