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