Mainstreaming interprofessional education in the United Kingdom: A position paper

Summary

Interprofessional education (IPE) is being built into the mainstream of professional education for all health and social care professions throughout the United Kingdom (UK) driven by the Labour Government elected in 1997, coincidentally the year that this Journal hosted the first All Together Better Health conference in London. The incoming government prioritized pre-qualifying IPE to be provided in partnership by universities and service agencies supported regionally by workforce development confederations, later absorbed into strategic health authorities (SHAs), and centrally by educational, professional and regulatory bodies. Ambitious agenda for pre-qualifying IPE set by government are being tempered by realistic assessment of current outcomes borne of experience and corroborated by evidence. This paper suggests some ways to ease constraints and improve outcomes, but emphasizes the need to generate continuing interprofessional learning opportunities that build on the basics. It argues that accumulating experience and evidence must be brought to bear in formulating criteria for the approval and review of IPE within regulatory systems for professional education. Can IPE be sustained within mainstream professional education once initial enthusiasm ebbs and earmarked funds run dry? That is the issue.     

The making of the interprofessional arena in the United Kingdom: a social and political history

Abstract

This article offers a critical sociological rendering of the making of the interprofessional arena in the United Kingdom. It offers an interpretation of the conditions that led to the formation, expansion and development of the interprofessional arena using a social worlds/arenas lens of secondary data. I propose that the making of the interprofessional arena has been achieved in three historiographical phases. First, the “recognition of the professionalisation conundrum” that led to the intuitive assumption that interprofessional education (IPE) could lead to improved collaboration in practice and improved outcomes. Second, the “legitimisation” of the interprofessional assumption through the development of networks, building consensus, nurturing an evidence base and negotiating with policymakers. Third, “Talking up and acting up” the interprofessional agenda by developing global communities of practice, pandering to a neoliberal agenda, disseminating exemplars of good practice and encouraging practical changes within diverse settings. Articulating these historical “moments” may allow us insights into the conditions that have created the contemporary interprofessional arena and offer us ways of considering how present conditions may re-shape the discourses that constitute the interprofessional arena of the future.     

A survey of interprofessional education in chiropractic continuing education in the United States

Objective

The purpose of this study is to describe the state of chiropractic continuing education vis-à-vis interprofessional education (IPE) with medical doctors (MD) in a survey of a sample of US doctors of chiropractic (DC) and through a review of policies.

Methods

Forty-five chiropractors with experience in interprofessional settings completed an electronic survey of their experiences and perceptions regarding DC-MD IPE in chiropractic continuing education (CE). The licensing bodies of the 50 US states and the District of Columbia were queried to assess the applicability of continuing medical education (CME) to chiropractic relicensure.

Results

The majority (89.1%) of survey respondents who attend CE-only events reported that they rarely to never experienced MD-IPE at these activities. Survey respondents commonly attended CME-only events, and 84.5% stated that they commonly to very commonly experienced MD-IPE at these activities. More than half (26 of 51) of the licensing bodies did not provide sufficient information to determine if CME was applicable to DC relicensure. Thirteen jurisdictions (25.5%) do not, and 12 jurisdictions (23.5%) do accept CME credits for chiropractic relicensure.

Conclusion

The majority of integrated practice DCs we surveyed reported little to no IPE occurring at CE-only events, yet significant IPE occurring at CME events. However, we found only 23.5% of chiropractic licensing bodies allow CME credit to apply to chiropractic relicensure. These factors may hinder DC-MD IPE in continuing education.Key Indexing Terms: Chiropractic, Medicine, Interprofessional Education, Continuing Education     

HIV and AIDS: a survey of nurse education in the United Kingdom

A survey conducted throughout the United Kingdom examined the current provision being made to train nurses to care safely and sensitively for patients with HIV and AIDS Problems relating to intolerance and prejudice are still commonly encountered The study recommends that HIV and AIDS should be set into a wider context of sexuality, death and infection control rather than singled out for special attention Nurses, both students and qualified staff, need to gain insight into their own values and prejudices if these are not to inhibit the giving of good quality care Teaching in this subject area requires special skills and there is concern that nursing is not equipped to deal with it The involvement of clinical specialists in educating nurses is perceived to have a strongly positive effect, helping to bridge a credibility gap and compensating for the lack of clinical experience amongst the teachers Providing opportunities for nurses to meet with people whose lives have been profoundly affected by the virus is also a powerful form of learning There is, however, a great need for support in this stressful area of practice     

The Harlaxton experience: transcultural nursing education in the United Kingdom

Studying nursing in the English countryside provides valuable insight for students taking community health nursing at the University of Evansville's Harlaxton College campus in Grantham, England. Students gain understanding of new, creative methods of nursing while learning to appreciate the value of time-honored approaches to health care delivery. This program can serve as a model particularly for those wishing to study transcultural nursing and alternative ways of delivering nursing and health care.     

'Transparency': the missing link in nurse education reform in the United Kingdom

Recent changes to nurse education within the United Kingdom (UK) have proved to be a source of great confusion in many respects, much of which is based on a manifest lack of appreciation of the nature and basis of the changes which are in fact driven by the requirements of European integration This paper argues that the lack of clarity and publicity,'transparency', in the process of transposing the requirements of European policy relating to nurse education into UK domestic policy can be blamed for aspects of the lingering confusion within the profession     

The interprofessional clinical experience: interprofessional education in the nursing home

Abstract

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. To evaluate the impact of ICE on attitudinal change, the UCLA Geriatric Attitudes Scale and a post-experience assessment were used. 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. ICE is a novel program that allows trainees across healthcare professions to experience interprofessional teamwork in the nursing home setting.     

Nursing research: a position paper

It is argued herein that orthodox approaches to nursing research reflect a fundamental misunderstanding concerning the nature of nursing, a misunderstanding that results in the production of findings that are perceived as irrelevant to clinical practice. The reasons for this are analysed and two specific research monographs, Hayward (1975) and Ogier (1982) are criticized where appropriate in order to illuminate the analysis. Nursing is explicated as a social phenomenon and practice discipline and the peculiar suitability of action research to its investigation is demonstrated.     

英、美两国护理教育认证体制比较及其对我国护理教育的启示

目的:通过英、美两国护理教育认证体制的比较研究,为构建具有中国特色的高等护理教育认证体系提供借鉴。方法:以比较研究为主,文献研究为辅。结果:英国和美国的认证分别由学校和认证机构占主导地位,学校在认证中都具有很大的自主权;两国认证程序相似,都有中介认证机构和认证标准。结论:建立多元化的护理教育认证体系;在认证标准的构建中必须处理好标准的精细程度、质性和量性指标、评估群体的广泛性问题。     

Pain: A content review of undergraduate pre-registration nurse education in the United Kingdom

BackgroundPain is a global health issue with poor assessment and management of pain associated with serious disability and detrimental socio economic consequences. Pain is also a closely associated symptom of the three major causes of death in the developed world; Coronary Heart Disease, Stroke and Cancer. There is a significant body of work which indicates that current nursing practice has failed to address pain as a priority, resulting in poor practice and unnecessary patient suffering.Additionally nurse education appears to lack focus or emphasis on the importance of pain assessment and its management.DesignA three step online search process was carried out across 71 Higher Education Institutes (HEIs) in the United Kingdom (UK) which deliver approved undergraduate nurse education programmes. Step one to find detailed programme documentation, step 2 to find reference to pain in the detailed documents and step 3 to find reference to pain in nursing curricula across all UK HEI websites, using Google and each HEIs site specific search tool.ResultsThe word pain featured minimally in programme documents with 9 (13%) documents making reference to it, this includes 3 occurrences which were not relevant to the programme content. The word pain also featured minimally in the content of programmes/modules on the website search, with no references at all to pain in undergraduate pre-registration nursing programmes. Those references found during the website search were for continuing professional development (CPD) or Masters level programmes.ConclusionIn spite of the global importance of pain as a major health issue both in its own right, and as a significant symptom of leading causes of death and illness, pain appears to be a neglected area within the undergraduate nursing curriculum. Evidence suggests that improving nurse education in this area can have positive impacts on clinical practice, however without educational input the current levels of poor practice are unlikely to improve and unnecessary patient suffering will continue. Undergraduate nurse education in the UK needs to review its current approach to content and ensure that pain is appropriately and prominently featured within pre-registration nurse education.     

Nurse prescribing, nurse education and related research in the United Kingdom: a review of the literature

This literature review aims to explore nurse education and the impact this has had on preparing nurses to become nurse prescribers and nurse prescribing research. Research about the initial nurse prescribing education and training programme indicated that although patients were content with nurses prescribing medication, nurses lacked confidence in applied pharmacology and therapeutics and hence, required additional scientific education. With the implementation of extended nurse prescribing, it is conjectural to assume that nurses have been prepared more effectively until results from the national evaluation are available. One can suggest that pre-registration nurses should receive a comprehensive scientific foundation in applied pharmacology and therapeutics and professional knowledge in order to prepare them for post graduate education and training in medication management.     

A review of curriculum evaluation in United Kingdom nursing education

Recently we have witnessed several significant changes to the nursing curriculum in the United Kingdom (UK). This review forms part of a larger study evaluating the 'fitness for practice' elements of the nursing curriculum in Scotland. Systematic review methods were used including the following databases: CINAHL and BNI. Twenty six papers were retrieved and 14 remained after applying the review criteria, the main rationale being the empirical focus. It appears that there is a paucity of research in this area in the UK and papers dealt exclusively with either content, process or outcome evaluation of the nursing curriculum. National, well funded, multi-centre studies tended to be more rigorous. Results, where they were positive about curricular changes, tended to be limited. There is clearly a need for rigorous research into curriculum evaluation, both at the micro and macro level, which investigates content, process and outcome. Without such research, curriculum change will be uninformed.     

Triage decisions of United Kingdom police firearms officers using a multiple-casualty scenario paper exercise

INTRODUCTION: British police officers authorized to carry firearms may need to make judgments about the severity of injury of individuals or the relative priority of clinical need of a group of injured patients in tactical and non-tactical situations. Most of these officers receive little or no medical training beyond basic first aid to enable them to make these clinical decisions. Therefore, the aim of this study is to determine the accuracy of triage decision-making of firearms-trained police officers with and without printed decision-support materials. METHODS: Eighty-two police firearms officers attending a tactical medicine course (FASTAid) were recruited to the study. Data were collected using a paper-based triage exercise that contained brief, clinical details of 20 adults and 10 children. Subjects were asked to assign a clinical priority of immediate or priority 1 (P1); urgent or priority 2 (P2); delayed or priority 3 (P3); or dead, to each casualty. Then, they were provided with decision-making materials, but were not given any instruction as to how these materials should be used. Subjects then completed a second triage exercise, identical to the first, except this time using the decision-support materials. Data were analyzed using mixed between-within subjects analysis of variance. This allowed comparisons to be made between the scores for Exercise 1 (no decision-support material) and Exercise 2 (with decision-support material). It also allowed any differences between those students with previous triage training and those without previous training to be explored. RESULTS: The use of triage decision-making materials resulted in a significant increase in correct responses (p < 0.001). Improvement in accuracy appears to result mainly from a reduction in the extent of under-triage. There were significant differences (p < 0.05) between those who had received previous triage training and those who had not, with those having received triage training doing slightly better. CONCLUSION: It appears that significant improvements in the accuracy of triage decision-making by police firearms officers can be achieved with the use of appropriate triage decision-support materials. Training may offer additional improvements in accuracy, but this improvement is likely to be small when decision-support materials are provided. With basic clinical skills and appropriate decision-support materials, it is likely that the police officer can make accurate triage decisions in a multiple-casualty scenario or make judgments of the severity of injury of a given individual in both tactical and non-tactical situations.