Showing papers in "Journal of Interprofessional Care in 2014"
TL;DR: This paper proposes moving this area of inquiry beyond theoretical assumptions to systematic research that will strengthen the evidence base for the effectiveness of IPE and collaborative practice within the context of the evolving imperative of the Triple Aim.
Abstract: The Triple Aim unequivocally connects interprofessional healthcare teams to the provision of better healthcare services that would eventually lead to improved health outcomes. This review of the in...
240 citations
TL;DR: An analysis of the barriers and enablers of IPE across the different stakeholder levels reveals five key “fundamental elements” critical to achieving sustainable IPE in higher education curricula.
Abstract: The effective incorporation of interprofessional education (IPE) within health professional curricula requires the synchronised and systematic collaboration between and within the various stakeholders. Higher education institutions, as primary health education providers, have the capacity to advocate and facilitate this collaboration. However, due to the diversity of stakeholders, facilitating the pedagogical change can be challenging and complex, and brings a degree of uncertainty and resistance. This review, through an analysis of the barriers and enablers investigates the involvement of stakeholders in higher education IPE through three primary stakeholder levels: Government and Professional, Institutional and Individual. A review of eight primary databases using 21 search terms resulted in 40 papers for review. While the barriers to IPE are widely reported within the higher education IPE literature, little is documented about the enablers of IPE. Similarly, the specific identification and importance of enablers for IPE sustainability and the dual nature of some barriers and enablers have not been previously reported. An analysis of the barriers and enablers of IPE across the different stakeholder levels reveals five key "fundamental elements" critical to achieving sustainable IPE in higher education curricula.
207 citations
TL;DR: The book offers a different way of talking about knowledge and learning, and of reflecting on what makes a meaningful group learning session, and highlighted for me the notions of the semantic wave and semantic gravity.
Abstract: Maton is one of the best-known proponents of ‘‘legitimation code theory’’ (LCT), which arises from the work of the British sociologist Basil Bernstein and is heavily influenced by Pierre Bourdieu. The latter’s concepts of field, habitus, and capital have informed the health professional literature particularly that concentrating on the sociology of the professions. At a first glance, this is not obviously a book about the health professions or interprofessional education. The 10 chapter titles focus on education in relation to the social sciences, mathematics, music, cultural studies, the arts, and humanities. But the text is about knowledge and the knowers of that knowledge with some interesting perspectives on what the author refers to as ‘‘knowledge blindness in education’’. In other words, Maton suggests that educational researchers have tended to concentrate on the idea of ‘‘knowledge as power’’, and how and why things are learned, rather than what is being learned. Furthermore, knowledge is typified dichotomously, for example, as either hard or soft, pure or applied, abstract or concrete (even perhaps preclinical and clinical). Such distinctions resonate with the contrast made between constructivist relativism and positivist absolutism: the quantitative–qualitative divide that may prevent an interdisciplinary and realist approach to evaluation and research. Maton argues that such divisions only describe the features of knowledge and tell us nothing about its structure. Maton suggests that research into knowledge tends to explore the ‘‘extent, intensity, and comparative value of flows of knowledge rather than its forms and their effects’’ (p. 2), i.e. how knowledge is used and transmitted rather than what it is. Moreover, during the process of learning, new knowledge, and existing knowledge are frequently not integrated so that the former does not build on and inform the latter. This can lead to students’ learning becoming segmented and thus, to use a word in common usage in relation to IPE, siloed. In health professions education, we see examples of what are here described as hierarchical curricular structures (learning and teaching builds on knowledge introduced earlier, for example, the spiral curriculum) and horizontal curricular structures (knowledge and skills are fragmented with little discussion of the relevance between courses, for example, how professionalism and ethics relate to the biomedical sciences, or even how early interprofessional learning activities relate to clinical practice). The segmented learning of the horizontal approach inhibits transfer from one context to another. Thus students may do interprofessional learning but fail to see its relevance in their uniprofessional courses. The code theory is difficult to summarise in a short review of this kind. The reader new to this approach will feel overwhelmed in jargon to begin with but persistence pays off. The book highlighted for me a number of concepts that are useful for educators, in particular, the notions of the semantic wave and semantic gravity. Maton draws attention to the trend in professional education for authentic or situated learning, which provides students with access to working environments (he mentions journalism, we can think of clinical settings). Assessment of such learning frequently involves case studies in which students describe and analyse what they have observed in practice. In the health professions, we would hope that students reflect. Strong sematic gravity is when the learner remains rooted in a particular case and primarily describes what has been observed without relating this to his/her previous experiences or the wider literature. Weak semantic gravity (and the strong–weak adjectives are in no way judgmental) is when the learner extrapolates to other contexts, compares and contrasts, generalises, and abstracts to past and future cases. High achieving students move between these poles in semantic waves, whereas the weaker ones are too descriptive or too abstract. The book offers a different way of talking about knowledge and learning, and of reflecting on what makes a meaningful group learning session. Authentic learning environments may only work if students are able to move beyond that particular context and apply the knowledge cumulatively to other situations. But it is important to understand what that knowledge consists of and Maton proposes a way that we can code this. So this book is for those who want to take learning and knowledge in a new direction – you may not agree with everything here but there are certain challenges to the way we do things and potential areas for further research.
187 citations
TL;DR: Evidence regarding the validity and reliability of an instrument to measure the self-reported competencies of interprofessional care in interprofessional education programs and interventions suggests interventions influence learners’ understanding of inter professional care by promoting the recognition of the high degree of interrelation among interprofessional Care competencies.
Abstract: The purpose of this study was to obtain evidence regarding the validity and reliability of an instrument to measure the self-reported competencies of interprofessional care in interprofessional education programs. Five hundred and eighty-four students and clinicians in Canada and New Zealand who were registered in 15 interprofessional education undergraduate, postgraduate, and continuing professional development programs completed the Interprofessional Collaborative Competency Attainment Survey (ICCAS) using a retrospective pre-test/post-test design. Factor analyses showed the presence of two factors in the pre-program items and one factor in the post-program items. Tests conducted provided evidence in support of the validity and reliability of the ICCAS as a self-assessment instrument for interprofessional collaborative practice. Internal consistency was high for items loading on factor 1 (α = 0.96) and factor 2 (α = 0.94) in the pre-program assessment and for the items in the post-program assess...
181 citations
TL;DR: It is suggested that nurses and physicians do not share the same views concerning the effectiveness of their communication and nurses' role in the decision-making process of the patients' care, especially in countries with limited interprofessional collaboration culture.
Abstract: The aim of the study was to investigate the physician and nursing perceptions regarding communication and collaboration as well as the factors that may influence these activities. A self-administered questionnaire survey was sent to a random sample of 93 physicians and 197 nurses based in two large public hospitals in Athens, Greece. Descriptive statistics, t-test and chi square test were performed with the SPSS 19.0 statistical package. Years of experience, the size of the clinic, the university degree and the postgraduate studies were found to be significant factors according to nurses' view (p < 0.05). For the physicians, age, sex, years of experience and the size of clinic affected the communication and collaboration with the nursing staff significantly (p < 0.05). In summary, these findings suggest that nurses and physicians do not share the same views concerning the effectiveness of their communication and nurses' role in the decision-making process of the patients' care. The most important ...
136 citations
TL;DR: A descriptive review that covers the HCS and IPE literature, indicating factors that led to the use of HCS in IPE and a number of benefits in using HCS to address common challenges to IPE are outlined.
Abstract: This article explores the evolution and history of interprofessional education (IPE) using healthcare simulation (HCS). The evolution described here demonstrates an achievement of patient safety efforts as a consequence of the historical roots of healthcare and highlights HCS as a progressive method synergistic with IPE. This paper presents a descriptive review that covers the HCS and IPE literature, indicating factors that led to the use of HCS in IPE. Understanding the history of simulation-enhanced IPE provides healthcare educators with fertile ground to support future IPE. A number of benefits in using HCS to address common challenges to IPE are outlined, including natural relevance and engagement for learners, faculty attraction to its use, and the opportunity to explore socio-historical issues in teams. Several promising directions for future research are suggested.
133 citations
TL;DR: An integrative review of the literature aimed to identify the specific elements of patient-centered care, which inform the development of protocols that can be used to promote the fidelity with which PCC is delivered by different professionals in a variety of healthcare settings.
Abstract: Patient-centered care (PCC) has been described as a vague concept, which yields an inconsistent operationalization and implementation of this approach to care. This integrative review of the literature, guided by the conceptualization of PCC as a complex intervention, aimed to identify the specific elements of PCC. Conceptual, empirical and clinical literature in different health professions (n = 178 articles) was critically analyzed. Comparing and contrasting the definitions and descriptions of PCC revealed three specific elements that were represented in these components: holistic, collaborative and responsive care. Activities that constitute each component were specified. The implementation of PCC components is facilitated by a non-specific element: the therapeutic relationship. The results inform the development of protocols that can be used to promote the fidelity with which PCC is delivered by different professionals in a variety of healthcare settings.
117 citations
TL;DR: Core Principles and Values of Effective Team-Based Health Care is a discussion paper produced by the Best Practices Innovation Collaborative of the Institute of Medicine Roundtable on Values and Science Driven Health Care and explains the core principles of shared goals, clear roles, mutual trust, effective communication, and measurable processes and outcomes.
Abstract: Institute of Medicine of the National Academies, October 2012. Downloaded from:http://www.iom.edu/Global/Perspectives/2012/TeamBasedCare.aspxCore Principles and Values of Effective Team-Based Healt...
116 citations
TL;DR: An exploration of the historical social positioning of nursing and medicine can provide an enhanced understanding of the barriers to interprofessional collaboration and inform future successes in interprofessional education and practice among all health and social care professions.
Abstract: For almost half a century, research has identified that effective teamwork is essential in order to enhance care provision and health outcomes for patients. Although the value of teamwork is well-recognized in healthcare, the historically rooted dynamics of workplace relationships create a myriad of challenges to creating collaborative teams. Understanding the history of interpersonal dynamics between health professionals can provide direction for future interprofessional education and collaboration strategies. The aim of this paper is to provide a historical overview of the social positioning of nursing and medicine in the context of interprofessional collaboration. Few professions work as closely as nursing and medicine. Despite the well-recognized benefits of interprofessional collaboration, these two professions are often socially positioned in opposition to one another and depicted as adversarial. This analysis will seek to advance our understanding of the historical roots between these two p...
112 citations
TL;DR: Examination of students’ perceptions of interprofessional attitudes and clinical reasoning following participation in an interprofessional service-learning course and participation in a SRFC finds improvements in interprofessional perceptions and attitudes.
Abstract: This article examines the benefits of a student run free clinic (SRFC) as a service learning experience for students in medicine, pharmacy, occupational therapy, physical therapy and physician assistant programs We hypothesized that students who participate in an interprofessional service learning course and volunteer at a SRFC would demonstrate significant increases in perceptions and attitudes for working in interprofessional health care teams and clinical reasoning skills compared to students who did not participate Three assessments were administered to an experimental and control group of pre-clinical students from medical, occupational therapy, physical therapy, pharmacy and physician assistant programs before and after participation in an interprofessional service-learning course and volunteering at the SRFC The tools were the Interdisciplinary Education Perception Scale (IEPS), Readiness for Interprofessional Learning Scale (RIPLS) and the Self-Assessment of Clinical Reflection and Reas
97 citations
TL;DR: A questionnaire based on the IPEC competencies might provide a measure to assess programmatic outcomes related to interprofessional education and how these results could provide valuable insights about the effect of different curricular approaches to inter professional education and the success of various educational programs at preparing students for collaborative practice.
Abstract: Linking the outcomes from interprofessional education to improvements in patient care has been hampered by educational assessments that primarily measure the short-term benefits of specific curricular interventions. Competencies, recently published by the Interprofessional Education Collaborative (IPEC), elaborate overarching goals for interprofessional education by specifying desired outcomes for graduating health professions students. The competencies define a transition point between the prescribed and structured educational experience of a professional degree program and the more self-directed, patient-oriented learning associated with professional practice. Drawing on the IPEC competencies for validity, we created a 42-item questionnaire to assess outcomes related to collaborative practice at the degree program level. To establish the usability and psychometric properties of the questionnaire, it was administered to all the students on a health science campus at a large urban university in the mid-Atlantic of the United States. The student responses (n = 481) defined four components aligned in part with the four domains of the IPEC competencies. In addition, the results demonstrated differences in scores by domain that can be used to structure future curricula. These findings suggest a questionnaire based on the IPEC competencies might provide a measure to assess programmatic outcomes related to interprofessional education. We discuss directions for future research, such as a comparison of results within and between institutions, and how these results could provide valuable insights about the effect of different curricular approaches to interprofessional education and the success of various educational programs at preparing students for collaborative practice.
TL;DR: The historical evolution(s) of the discourse of professionalism is presented to assist us to develop a deeper understanding of socio-historical context within which interprofessional education (IPE) is embedded within, and collaborative person-centered practice (CPCP).
Abstract: Health care systems around the world are under tremendous pressure to change their models of health care delivery - from the current multiprofessional health care delivery into interprofessional collaborative care models with the ultimate goal of improving patient/client outcomes. The growing diversity of the population, the increasing number of vulnerable persons (elderly, homeless, those living with chronic health conditions), the complexity of health problems, and the shortage of health care providers have forced health policymakers to call for sweeping revisions to how health care is provided, impacting how health care program students are educated. However, in professional training emphasis is placed on uniprofessional education. Learners are socialized in isolation from those in other related professions to ensure the development of a shared professional identity. Consequently, by program completion each student will not only master the knowledge, skills and norms of his/her own profession, but will also develop a silo identity, called "uniprofessional identity". This isolationist identity creates a lack of understanding of others. In limiting their exposure to learning about the roles and value of other health care professionals, persistent negative stereotypical attitudes towards other professionals are reinforced. In this paper, we present the historical evolution(s) of the discourse of professionalism to assist us to develop a deeper understanding of socio-historical context within which interprofessional education (IPE) is embedded within, and collaborative person-centered practice (CPCP). With greater insight, we can (re)conceptualize the possibilities, and advance research on, interprofessional education and practice in the present.
TL;DR: There is some evidence that students who participate in an introductory IPE course early in their professional preparation not only keep positive attitudes toward interprofessional learning, but improve them.
Abstract: There is increasing acknowledgement that interprofessional education (IPE) holds promise for preparing health professionals as collaborative-ready practitioners. The effects of IPE on learning outcomes are critical in determining the value of such programs. Attitudes are recognized as a significant element in developing behaviors. This study was designed to determine attitudes and perceptions of students toward collaborative learning in an interprofessional context. Three hundred and five students completed a questionnaire regarding attitudes and perceptions toward interprofessional collaboration before and after an introductory IPE course. Also 202 graduating health professional students without IPE completed the same questionnaire. The questionnaire included questions from the University of West England Interprofessional Questionnaire (UWE IQ) and Readiness for Interprofessional Learning Scale (RIPLS). Independent samples t-tests revealed significant positive changes before and after the IPE cou...
TL;DR: It is argued that a primary mechanism hindering the achievement of the full promise of IPC stems not only from the rigid occupational status hierarchy nested within health care delivery, but also from the broader status differences between men and women – and how these societal-level disparities are exercised and perpetuated within health Care delivery.
Abstract: Researchers have demonstrated that team-based, collaborative care improves patient outcomes and fosters safer, more effective health care. Despite such positive findings, interprofessional collaboration (IPC) has been somewhat stunted in its adoption. Utilizing a socio-historical lens and employing expectation states theory, we explore potential reasons behind IPC’s slow integration. More specifically, we argue that a primary mechanism hindering the achievement of the full promise of IPC stems not only from the rigid occupational status hierarchy nested within health care delivery, but also from the broader status differences between men and women – and how these societal-level disparities are exercised and perpetuated within health care delivery. For instance, we examine not only the historical differences in occupational status of the more “gendered” professions within health care delivery teams (e.g. medicine and nursing), but also the persistent under-representation of women in the physician w...
TL;DR: Thirteen mechanisms were identified in the synthesis and findings for one mechanism, called “Support and value” are presented, which referred to the ways in which team members supported one another, respected other’s skills and abilities and valued each other's contributions.
Abstract: Realist synthesis offers a novel and innovative way to interrogate the large literature on interprofessional teamwork in health and social care teams. This article introduces realist synthesis and its approach to identifying and testing the underpinning processes (or "mechanisms") that make an intervention work, the contexts that trigger those mechanisms and their subsequent outcomes. A realist synthesis of the evidence on interprofessional teamwork is described. Thirteen mechanisms were identified in the synthesis and findings for one mechanism, called "Support and value" are presented in this paper. The evidence for the other twelve mechanisms ("collaboration and coordination", "pooling of resources", "individual learning", "role blurring", "efficient, open and equitable communication", "tactical communication", "shared responsibility and influence", "team behavioural norms", "shared responsibility and influence", "critically reviewing performance and decisions", "generating and implementing new ideas" and "leadership") are reported in a further three papers in this series. The "support and value" mechanism referred to the ways in which team members supported one another, respected other's skills and abilities and valued each other's contributions. "Support and value" was present in some, but far from all, teams and a number of contexts that explained this variation were identified. The article concludes with a discussion of the challenges and benefits of undertaking this realist synthesis.
TL;DR: Using a narrative approach to thinking about professional identity, provider–patient communication, and interprofessional teamwork expands the 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.
Abstract: Health and social care professionals increasingly use 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. This 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.
TL;DR: A systematic review of the limited evidence suggests that IPE programs may influence team and patient outcomes in delirium care, and more systematic studies of the effectiveness of interprofessionaldelirium education interventions are needed.
Abstract: Recent delirium prevention and treatment guidelines recommend the use of an interprofessional team trained and competent in delirium care. We conducted a systematic review to identify the evidence for the value of interprofessional delirium education programs on learning outcomes. We searched several databases and the grey literature. Studies describing an education intervention, involving two or more healthcare professions and reporting on at least one learning outcome as classified by Kirkpatrick’s evaluation framework were included in this review. Ten out of 633 abstracts reviewed met the study inclusion criteria. Several studies reported on more than one learning outcome. Two studies focused on learner reactions to interprofessional delirium education; three studies focused on learning outcomes (e.g. delirium knowledge); six studies focused on learner behavior in practice; and six studies reported on learning results (e.g. patient outcomes), mainly changes in delirium rates post-intervention. ...
TL;DR: This commentary describes a case example of what such change could look like, reviews current opportunities and challenges to progress, and offers a review of current initiatives and opportunities to move forward toward an optimal alignment of practice and education.
Abstract: Achieving the goals of health care reform – described by the Institute for Healthcare Improvement as the “Triple Aim” – will place new demands on the health care workforce. Interprofessional team-based care, quality and process improvement, and population health management are not skills that have been emphasized in traditional health professions education and training. Preparing health professionals to meet these demands will require significant changes in education and training – changes that can only occur if educational institutions align with practices, health systems and the communities they serve. Together they must define the knowledge and skills required for better care, added value, and improved health outcomes, and together they must align and integrate health professions education with the reformation and redesign of health systems that are currently underway. This commentary describes a case example of what such change could look like, reviews current opportunities and challenges to progress, and offers a review of current initiatives and opportunities to move forward toward an optimal alignment of practice and education that will improve population health, reduce costs, and improve the quality of care.
TL;DR: Evaluation data revealed that students were supportive of interprofessional learning and could recognise its benefits, and self-perceived improvements in knowledge, skills, confidence and competence when dealing with challenging end of life care communication situations.
Abstract: This paper reports on the process and outcomes of a study, designed to pilot the use of interprofessional, simulation-based training in end of life care communication. Participants comprised 50 final year medicine, nursing, physiotherapy and pharmacy students. Learning methods included observation of role play and facilitated, interactive group discussion. A Likert scale rating questionnaire was used to evaluate the impact of the learning experience. Evaluation data revealed that students were supportive of interprofessional learning and could recognise its benefits. The results indicated self-perceived improvements in knowledge, skills, confidence and competence when dealing with challenging end of life care communication situations. Comparison of pre- and post-intervention scores revealed a statistically significant positive change in the students' perceptions about their level of knowledge (Z = −5.887, p = 0.000). The reported benefits need to be balanced against design and delivery issues that...
TL;DR: To achieve the kinds and levels of intersubjectivity required for these non-routine forms of care and intermittent interprofessional working, likely requires particular curriculum and pedagogic interventions within practice settings.
Abstract: Effective interprofessional work is premised on high levels of shared understandings (i.e. intersubjectivity) among those who are co-working. In particular, when quick or seemingly spontaneous responses are required for urgent or immediate action, what is termed as “shared intuition” is highly desirable. Much of the required intersubjectivity can arise ordinarily through everyday healthcare collaborations, such as through joint problem-solving. Yet, a concern is how best to develop these capacities in circumstances when co-working is temporary, fleeting and partial, and also when the goals to be achieved are ambiguous and uncertain, and the processes indeterminate. To achieve the kinds and levels of intersubjectivity required for these non-routine forms of care and intermittent interprofessional working, therefore, likely requires particular curriculum and pedagogic interventions within practice settings. These interventions may be used to shape the organisation and sequencing of experiences for i...
TL;DR: A systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals resulted in a product that was true-to-life and as a multifaceted workshop it appears to improve knowledge among health professionals.
Abstract: Vignettes and written case simulations have been widely used by educators and health services researchers to illustrate plausible situations and measure processes in a wide range of practice settings. We devised a systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals. A vignette was developed in six stages: (1) determine IP-SDM content elements; (2) choose true-to-life clinical scenario; (3) draft script; (4) appraise IP-SDM concepts illustrated using two evaluation instruments and an interprofessional concept grid; (5) peer review script for content validity; and (6) retrospective pre-/post-test evaluation of video vignette by health professionals. The vignette contained six scenes demonstrating the asynchronous involvement of five health professionals with an elderly woman and her daughter facing a decision about location of care. The script scored highly on both evaluation scale...
TL;DR: A case-based, IPE simulation activity for physician assistant and rehabilitation students using a computerized virtual patient software program effectively facilitated achievement of the IPE learning objectives, including development of greater student awareness of other professions and ways in which collaborative patient care can be provided.
Abstract: The purpose of this retrospective qualitative case report is to describe how a case-based, virtual patient interprofessional education (IPE) simulation activity was utilized to achieve physician assistant (PA), physical therapy (PT) and occupational therapy (OT) student IPE learning outcomes. Following completion of a virtual patient case, 30 PA, 46 PT and 24 OT students were required to develop a comprehensive, written treatment plan and respond to reflective questions. A qualitative analysis of the submitted written assignment was used to determine whether IPE learning objectives were met. Student responses revealed three themes that supported the learning objectives of the IPE experience: benefits of collaborative care, role clarification and relevance of the IPE experience for future practice. A case-based, IPE simulation activity for physician assistant and rehabilitation students using a computerized virtual patient software program effectively facilitated achievement of the IPE learning objectives, including development of greater student awareness of other professions and ways in which collaborative patient care can be provided.
TL;DR: This analysis suggests implications for the way different professions may or may not work with one another in the service of patient safety, as different professional groups intersect with the ways patient safety is thought about, talked about, and known about in an acute care hospital in Canada.
Abstract: Patient safety has been presented as a unifying concern across the health professions. This conceptual connection has been accompanied with efforts towards standardized, interprofessional safety competencies, as well as increased attention towards interprofessional education for systems improvement. Despite numerous program initiatives and research endeavors, progress towards improving patient safety in hospitals is viewed as disappointingly slow. This paper adds to a body of literature that suggests patient safety remains a difficult problem to solve because safety is not simply a technical issue, but is a practice embedded in organizational and professional contexts. In this paper, we explore the differences between the professions, as different professional groups intersect with the ways patient safety is thought about, talked about, and known about in an acute care hospital in Canada. We draw on findings from a critical discourse analysis of documents related to patient safety, as well as transcripts from interviews from (a) formal health care leaders and (b) practicing clinicians from medicine, nursing, occupational therapy, physiotherapy, and social work. This analysis suggests implications for the way different professions may or may not work with one another in the service of patient safety.
TL;DR: An ethnographic study focused on exploring leaders of team learning in well-established nephrology teams in an academic healthcare organization in Canada uses situational theory of leadership to generate a detailed illumination of the nature of leaders’ interactions within an interprofessional context.
Abstract: This article describes an ethnographic study focused on exploring leaders of team learning in well-established nephrology teams in an academic healthcare organization in Canada. Employing situational theory of leadership, the article provides details on how well established team members advance as "learning leaders". Data were gathered by ethnographic methods over a 9-month period with the members of two nephrology teams. These learning to care for the sick teams involved over 30 regulated health professionals, such as physicians, nurses, social workers, pharmacists, dietitians and other healthcare practitioners, staff, students and trainees, all of whom were collectively managing obstacles and coordinating efforts. Analysis involved an inductive thematic analysis of observations, reflections, and interview transcripts. The study indicated how well established members progress as team-learning leaders, and how they adapt to an interprofessional culture through the activities they employ to enable day-to-day learning. The article uses situational theory of leadership to generate a detailed illumination of the nature of leaders' interactions within an interprofessional context.
TL;DR: The Green Family NeighborhoodHELP™ (GFNHelp) program, developed by Herbert Wertheim College of Medicine, Florida International University, emphasizes the Core Competencies of the Interprofessional Education Collaborative through community-based service-learning, allowing student teams to engage firsthand and address the impact of social determinants on health.
Abstract: The implementation of interprofessional education for healthcare professionals has been lackluster, at best, since it was recommended by the Institute of Medicine. There have been various attempts in institutions of higher learning to meet this goal with mixed results. Herbert Wertheim College of Medicine, Florida International University has developed the Green Family NeighborhoodHELP™ (GFNHelp) program to meet this challenge. GFNHelp is an interprofessional, longitudinal, service-learning program for healthcare students. Through participation in this program medical students team up with students from other professions, such as nursing, social work, and law, and collaborate to improve health outcomes for medically underserved families in the community. This educational program emphasizes the Core Competencies of the Interprofessional Education Collaborative through community-based service-learning, allowing student teams to engage firsthand and address the impact of social determinants on health.
TL;DR: This process evaluation highlighted key program activities that were essential to the continuing education of interprofessional primary healthcare teams as they attempted to transform primary healthcare to improve chronic care.
Abstract: Process evaluations assess program structures and implementation processes so that outcomes can be accurately interpreted. This article reports the results of a process evaluation of Partnerships for Health, an initiative targeting interprofessional primary healthcare teams to improve chronic care in Southwestern Ontario, Canada. Program documentation, participant observation, and in-depth interviews were used to capture details about the program structure, implementation process, and experience of implementers and participants. Results suggest that the intended program was modified during implementation to better meet the needs of participants and to overcome participation barriers. Elements of program activities perceived as most effective included series of off-site learning/classroom sessions, practice-based/workplace information-technology (IT) support, and practice coaching because they provided: dedicated time to learn how to improve chronic care; team-building/networking within and across teams; hands-on IT training/guidance; and flexibility to meet individual practice needs. This process evaluation highlighted key program activities that were essential to the continuing education (CE) of interprofessional primary healthcare teams as they attempted to transform primary healthcare to improve chronic care.
TL;DR: A protective effect against declining interprofessional attitudes and skills for the student volunteers in a SRFC is suggested, likely a function of the design of the clinical and educational experience in the clinic and of the length of contact the students have with other professions.
Abstract: Student-run free clinics (SRFCs) often include an interprofessional group of health professions students and preceptors working together toward the common goal of caring for underserved populations. Therefore, it would seem that these clinics would be an ideal place for students to participate in an interprofessional collaborative practice and for interprofessional education to occur. This article describes a prospective, observational cohort study of interprofessional attitudes and skills including communication and teamwork skills and attitudes about interprofessional learning, relationships and interactions of student volunteers in a SRFC compared to students who applied and were not accepted to the clinic and to students who never applied to the clinic. This study showed a decrease in attitudes and skills after the first year for all groups. Over the next two years, the total score on the survey for the accepted students was higher than the not accepted students. The students who were not accepted also became more similar to students who never applied. This suggests a protective effect against declining interprofessional attitudes and skills for the student volunteers in a SRFC. These findings are likely a function of the design of the clinical and educational experience in the clinic and of the length of contact the students have with other professions.
TL;DR: The study findings indicate that some readmissions are perceived to be inevitable due to the burden of disease while others are perceive to be preventable and associated with factors both in hospital and post-discharge.
Abstract: An understanding of what complex medical patients with chronic conditions, family members and healthcare professionals perceive to be the key reasons for the readmission is important to preventing their occurrence In this context, we undertook a study to understand the perceptions of patients, family members and healthcare professionals regarding the reasons for, and preventability of, readmissions An exploratory case design with semi-structured interviews was conducted with 49 participants, including patients, family members, nurses, case managers, physicians, discharge planners from a general internal medicine unit at a large and academic hospital Data were analyzed using a directed content analysis approach that involved three investigators Two contrasting themes emerged from the analysis of interview data set The first theme was readmissions as preventable occurrences Our analyses elucidated contributing factors to readmissions during the patients’ hospital stay and after the patients we
TL;DR: The two-factor ATHCTS can be used as an assessment tool to evaluate the effectiveness of educational or training programs designed to improve the attitude of graduate students toward interprofessional teamwork.
Abstract: The purpose of this study was to assess reliability and validity of the adapted "Attitudes Toward Health Care Teams Scale (ATHCTS)" with graduate professional students. Data using a cross-sectional design were collected from 288 graduate students who were enrolled at an urban professional university in the Mid-Atlantic region of the United States. A confirmatory factor analysis (CFA) was run and it was found that a two-factor ATHCTS better represented the sample. Further, it provided evidence that the two-factor model is valid, and the quality of care and time constraint subscales are reliable. This study suggested that the two-factor model should be tested with different populations, such as undergraduate students, health care professionals and persons at other training programs. The ATHCTS can be used as an assessment tool to evaluate the effectiveness of educational or training programs designed to improve the attitude of graduate students toward interprofessional teamwork.
TL;DR: Attitudes of nursing staff at the authors' tertiary care community hospital were surveyed before and after implementation of a patient-centered interprofessional (hospitalist–nurse) rounding process for patients.
Abstract: Historically, medicine and nursing has had a hierarchical and patriarchal relationship, with physicians holding monopoly over knowledge-based practice of medical care, thus impeding interprofessional collaboration. Power gradient prevents nurses from demanding cooperative patient rounding. We surveyed attitudes of nursing staff at our tertiary care community hospital, before and after implementation of a patient-centered interprofessional (hospitalist–nurse) rounding process for patients. There was a substantial improvement in nursing staff satisfaction related to the improved communication (7%–54%, p < 0.001) and rounding (3%–49%, p < 0.001) by hospitalist providers. Patient-centered rounding also positively impacted nursing workflow (5%–56%, p < 0.001), nurses’ perceptions of value as a team member (26%–56%, p = 0.018) and their job satisfaction (43%–59%, p = 0.010). Patient-centered rounding positively contributed to transforming the hospitalist–nurse hierarchical model to a team-based collabor...