Narrative in interprofessional education and practice: implications for professional identity, provider–patient communication and teamwork

In a new paper published by Philip Clark in the Journal of Interprofessional Care, he argues that health and social care professionals are increasingly using narrative approaches to focus on the patient and to communicate with each other. Both effective interprofessional education (IPE) and practice (IPP) require recognizing the various values and voices of different professions, how they relate to the patient’s life story, and how they interact with each other at the level of the healthcare team. Clark's article analyzes and integrates the literature on narrative to explore: self-narrative as an expression of one’s professional identity; the co-creation of the patient’s narrative by the professional and the patient; and the interprofessional multi-vocal narrative discourse as co-constructed by members of the healthcare team. Using a narrative approach to thinking about professional identity, provider–patient communication, and interprofessional teamwork expands our thinking about both IPE and IPP by providing new insights into the nature of professional practice based on relationships to oneself, the patient, and others on the team. How professionals define themselves, gather and present information from the patient, and communicate as members of a clinical team all have important dimensions that can be revealed by a narrative approach. Implications and conclusions for the further development of the narrative approach in IPE and IPP are offered.

For further information see: http://informahealthcare.com/doi/abs/10.3109/13561820.2013.853652

The social context of career choice among millennial nurses: implications for interprofessional practice

Health human resource and workforce planning is a global priority. Given the critical nursing shortage, and the fact that nurses are the largest group of healthcare providers, health workforce planning must focus on strategies to enhance both recruitment and retention of nurses. Understanding early socialization to career choice can provide insight into professional perceptions and expectations that have implications for recruitment, retention and interprofessional collaboration. 

 

In a newly published paper by Sheri Price and colleagues, these authors used Polkinghorne’s theory of narrative emplotment to understand the career choice experiences of 12 millennial nurses (born between 1980 and 2000) in Eastern Canada. 

 

Participants were interviewed twice, face-to-face, 4 to 6 weeks apart prior to commencing their nursing program. The narratives present career choice as a complex consideration of social positioning. The findings provide insight into how nursing is perceived to be positioned in relation to medicine and how the participants struggled to locate themselves within this social hierarchy. 

 

The authors state that the implications of this research highlight the need to ensure that recruitment messaging and organizational policies promote interprofessional collaboration from the onset of choosing a career in the health professions. Early professional socialization strategies during recruitment and education can enhance future collaboration between the health professions.

Read More at: http://informahealthcare.com/doi/abs/10.3109/13561820.2013.816660

Intersections between interprofessional practice, cultural competency and primary healthcare

The concepts of interprofessional collaborative practice (IPCP), cultural competency and primary healthcare (PHC) appear to be linked in theory and practice. A recently published JIC paper (Oelke et al 2013) provides arguments explicating the potential linkages between IPCP and cultural competency. The authors argue that cultural competency is an important component of IPCP both for relationships with patients and/or communities in which providers work and between team members. 

The authors note that organizational structures also play an important role in facilitating IPCP and cultural competency. The integration of both IPCP and cultural competency has the potential to enhance positive health outcomes. Furthermore, the authors argue IPCP and cultural competency have important implications for PHC service design, given interprofessional teams are a key component of PHC systems. Linking these concepts in providing PHC services can be essential for impacting outcomes at all levels of primary healthcare, including patient, provider and systems.

To read more about these issues go to: http://informahealthcare.com/doi/abs/10.3109/13561820.2013.785502

 

The Rise and Rise of Interprofessional Competence

In the past few years, we have seen a continued growth in the use of competency frameworks for the traditional health and social care professions (e.g. nursing, medicine) as well as the emerging professions such as physician assistants. In this editorial, I attempt to explore the continued rise of competence, with a focus on the use of competency frameworks in the interprofessional field. In doing this, I initially outline the growth of interprofessional competency frameworks and discuss some of the benefits they offer before examining their current shortcomings. The overall aim of this editorial is to argue that, while our efforts in identifying and synthesizing interprofessional competence have taken some important steps forward in defining the key attitudes, knowledge, skills and behaviors for effective interprofessional practice, collectively there are still areas in which we need to improve to ensure the interprofessional competency frameworks we produce are done so in as robust a fashion as possible.

In the past 5 years or so, especially in North America, we have witnessed a growth in the number of interprofessional competency frameworks both from national organizations. We have also seen a number of publications that discuss and explore how competences can contribute to the development of more effective interprofessional practitioners. As I previously argued, the use of competences and competency frameworks has a wide appeal as they help provide consistent standards of professional and interprofessional practice, help validate areas of health care work which are regarded as important (e.g. patient-centered care), can provide observable indicators of performance and also offer an indication of the complex interplay between knowledge, skills and behaviors.

When one reviews the interprofessional frameworks, it is encouraging to note that they have a degree of consistency with the core domains of competence they identify.  In addition, from the perspective of interprofessional education in the USA, it appears that the focus on interprofessional competence has engaged a number of policy-makers and funders into re-investing into the field. As noted above, one of the strengths of the competency movement, which arguably appeals to policy-makers and funders, is the use of competency statements that can potentially provide observable indicators of collaborative performance across an array of clinical contexts.

Nevertheless, the interprofessional competency frameworks produced so far contain two main issues which need some further thought. The first is conceptual. When one reads the various competency statements within the domains of these frameworks, an extremely popular focus is on “teams” and “teamwork”. While interprofessional teams are a very common arrangement in the delivery of health care, they are not the only division of labour. This almost exclusive focus on teams overlooks the fact that there are other forms of interprofessional work which learners also need to have competence in working together effectively when delivering care.

Recently, with colleagues I published a typology of interprofessional work which classified activities into four forms: teamwork, collaboration, coordination and networking (Reeves et al 2010 - Interprofessional Teamwork for Health and Social Care).  We differentiated these forms of interprofessional work as follows: teamwork was seen as encompassing a number of elements such as shared team identity, clarity of roles, interdependence between team members, integration of tasks and shared responsibility. In contrast, collaboration was a “looser” form of interprofessional work, as shared identity and integration of individuals were less important, but there were some shared accountability and interdependence between professions. For coordination, while there was some sense of shared identity, integration and interdependence were less important; there was also little shared accountability or clarity of roles, tasks and goals. Lastly, networking was a relationship in which shared team identity, clarity of roles/goals, interdependence and shared responsibility were less essential; networks were therefore seen as virtual, whereby none of the members necessarily needed to meet face to face, as they could communicate online in an asynchronous manner.

The aim of presenting this topology here is to provide a reminder that we have, so far, neglected to incorporate other forms of interprofessional work, which occur across a range of health and social care settings. Teamwork is one form, but we also need to think about developing competency statements that reflect these wider forms of interprofessional work.

The second issue is focused on measurement. At the moment, we are not clear about how to robustly measure (assess) the many different statements which make up the interprofessional competency frameworks. Importantly, each of the competency statements is very complex in its composition. Each statement can combine multi-faceted attributes related to collaborative attitudes, values, knowledge, skills and behaviors – packaged together in a single sentence. However, it is difficult to see how to tease apart each of the embedded attributes and measure them in a rigorous manner.
Efforts to date, which have used self-assessment approaches, only provide a limited form of evidence. We therefore need to embrace other assessment methods, such as observation of performance.

Another measurement difficulty is that the unit of analysis for these interprofessional competency frameworks is focused on the individual learner. Although this focus is appropriate, as assessment of individuals is extremely important, it overlooks any measurement of the shared learning experience. We fail to assess collectively the interprofessional group or team of learners. This oversight is arguably an important limitation, as we are not focusing on a key element of interprofessional education – its shared, collective approach. We therefore need to better understand, through measurement, this dimension.

Finally, we have little evaluation data, to date, which provide an insight into whether any of these interprofessional frameworks are being implemented. We have no empirical evidence into how effective (or not) they are in capturing the essence of effective interprofessional collaboration. This is another area where we need data to help us understand the broader issues linked the use of interprofessional competence and the frameworks which aim to synthesize its core elements.

To read more - go to: http://informahealthcare.com/doi/full/10.3109/13561820.2012.695542

Physician Assistants in Interprofessional Teams - A Study

Ensuring that interprofessional health care teams have a mix of skilled professionals to meet patient need, safely and effectively. Like a number of other countries, the UK have been exploring the contribution physician assistants (PAs), who are well established in the US, can make to interprofessional  teams. In a study recently published in the J Interprof Care investigated the employment of PAs in primary care and their contribution through an electronic, self report, survey. Sixteen PAs responded, who were working in a variety of types of general practice teams. A range of activities were reported but the greatest proportion of their time was described as seeing patients in booked surgery appointments for same day/urgent appointments. The scope of the survey was limited and questions remain as to patient and professional responses to a new professional group within an interprofessional primary care context.

For more information see: http://informahealthcare.com/doi/abs/10.3109/13561820.2012.686538

Informal interprofessional learning: Visualizing the clinical workplace

Very interesting article on JIC early online: Informal interprofessional learning.


Written by: Judith Martine Wagter (Foreest Medical School, Medical Centre Alkmaar, 

Alkmaar

, The Netherlands), Gerhard van de Bunt (Faculty of Social Sciences, VU Amsterdam University, 

Amsterdam

, The Netherlands), Marina Honing (ICU/MCU, Medical Centre Alkmaar, 

Alkmaar

, The Netherlands), Marina Eckenhausen (Foreest Medical School, Medical Centre Alkmaar, 

Alkmaar

, The Netherlands), Albert Scherpbier (School of Health Professions Education, Maastricht University, 

Maastricht

, The Netherlands).

Daily collaboration of senior doctors, residents and nurses involves a major potential for sharing knowledge between professionals. Therefore, more attention needs to be paid to informal learning to create strategies and appropriate conditions for enhancing and effectuating informal learning in the workplace. The aim of this study is to visualize and describe patterns of informal interprofessional learning relations among staff in complex care. Questionnaires with four network questions – recognized as indicators of informal learning in the clinical workplace – were handed out to intensive and medium care unit (ICU/MCU) staff members (N = 108), of which 77% were completed and returned. Data were analyzed using social network analysis and Mokken scale analysis. Densities, tie strength and reciprocity of the four networks created show MCU and ICU nurses as subgroups within the ward and reveal central but relatively one-sided relations of senior doctors with nurses and residents. Based on the analyses, we formulated a scale of intensity of informal learning relations that can be used to understand and stimulate informal interprofessional learning.

For more information, please read the Journal of Interprofessional Care, early online (February 14 2012).

From the nurses' station to the health team hub: How can design promote interprofessional collaboration?

Great article on how can design promote interprofessional collaboration.
Written by: Lyn Frances Gum (School of Medicine, Flinders University Rural Clinical School, 

South Australia

, Australia), David Prideaux (School of Medicine, Flinders University, 

Adelaide

, Australia), Linda Sweet (School of Medicine, Flinders University Rural Clinical School, 

South Australia

, Australia), Jennene Greenhill (School of Medicine, Flinders University Rural Clinical School, 

South Australia

, Australia)

Interprofessional practice implies that health professionals are able to contribute patient care in a collaborative environment. In this paper, it is argued that in a hospital the nurses' station is a form of symbolic power. The term could be reframed as a “health team hub,” which fosters a place for communication and interprofessional working. Studies have found that design of the Nurses' Station can impact on the walking distance of hospital staff, privacy for patients and staff, jeopardize patient confidentiality and access to resources. However, no studies have explored the implications of nurses' station design on interprofessional practice. A multi-site collective case study of three rural hospitals in South Australia explored the collaborative working culture of each hospital. Of the cultural concepts being studied, the physical design of nurses' stations and the general physical environment were found to have a major influence on an effective collaborative practice. Communication barriers were related to poor design, lack of space, frequent interruptions and a lack of privacy; the name “nurses' station” denotes the space as the primary domain of nurses rather than a workspace for the healthcare team. Immersive work spaces could encourage all members of the healthcare team to communicate more readily with one another to promote interprofessional collaboration.


For more information, please read the Journal of Interprofessional Care January 2012, Vol. 26, No. 1 , Pages 21-27.