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