Longitudinal evaluation of attitudes to interprofessional collaboration: time for a change?

ABSTRACT

Longitudinal evaluation of interprofessional programming is necessary to understand the impact of interprofessional education (IPE) for collaborative practice. Attitude is one measure of intended behavior. The Interprofessional Attitude Scale (IPAS) was developed as an improved measure to examine the readiness for interprofessional education and collaborative practice. As a means to pilot a protocol for a longitudinal comprehensive evaluation of an interprofessional program with 13 health professional programs in 6 health science faculties, the IPAS was administered over a 3-year period to three cohorts of students. The results of the IPAS indicated no significant differences detected across the 3 years. Although there was a significant difference on the Patient Centredness subscale for Cohorts 2 and 3 the effect size was small. Previous experience in an interprofessional course was a predictor of more positive patient centeredness attitudes, but other IPE experience and years of education were not predictors of any interprofessional attitudes. Students from the Medicine & Dentistry (M&D) faculty ranked significantly lower on the teamwork roles and responsibilities subscale compared to the other faculties, except Rehabilitation Medicine (RM). However, once the outliers in RM were removed, there was a significant difference on this subscale between RM and M&D. This paper outlines the challenges with using the IPAS as part of a comprehensive program evaluation and identifies issues with longitudinal data collection for evaluation with large student cohorts.     

Real world application of an intervention to reduce absconding

Absconding by acute psychiatric inpatients is associated with risk of harm to self and others, and creates considerable emotional as well as tangible burdens for staff. Previous research has led to the development of an effective nursing intervention to reduce absconding. In this project, that intervention was encapsulated in a self-training package, and offered freely to wards across the UK who agreed to implement it and audit the results. Fifteen wards completed this distributed audit, and achieved overall a 25.5% decrease in their absconding rates, as measured by official reports. The results support the efficacy of the intervention, and indicate that significant reductions can be made in absconding rates from unlocked or partially locked acute psychiatric wards.     

Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders

boomer c.a. & mccormack b. (2010) Journal of Nursing Management  18, 633–644
Creating the conditions for growth: a collaborative practice development programme for clinical nurse leaders Aim To evaluate a 3-year practice development (PD) programme for clinical nurse leaders. Background The development of effective leaders is a key objective to progress the modernization agenda. This programme aimed to develop the participants alongside development of the culture and context of care. Methods Programme evaluation methodology to determine the ‘worth’ of the programme, inform the experience of the participation, effect on workplace cultures and determine effectiveness of the process used. Results Created the conditions for growth under two broad themes: process outcomes demonstrating growth as leaders contributing to cultural shifts; and general outcomes demonstrating practice changes. Conclusions Developing communities of reflective leaders are required to meet demands within contemporary healthcare. PD provides a model to develop leaders to achieve sustainable changes and transform practice. Implications for nursing management Active collaboration and participation of managers is crucial in the facilitation of and sustainability of cultural change. Approaches adopted to develop and sustain the transformation of practice need to focus on developing the skills and attributes of leaders and managers as facilitators.     

Moving on from interpretivism: an argument for constructivist evaluation

Moving on from interpretivism: an argument for constructivist evaluation This paper examines the research process in the context of an evaluation of work-based learning. The findings of the evaluation are used to illustrate issues around roles and relationships within interpretivist research where a separation is maintained between the researcher, as investigator, and the participants, as the subject of their investigation. The discussion focuses on: the threatening nature of evaluation and the way in which that affects the process of inquiry and learning; the ways in which people's perceptions of research can act as barriers to the implementation of change; and the consequences of this role separation for practice development. In exploring these issues the paper argues for an approach to evaluation research which (a) emphasizes collaboration, (b) is orientated to change and (c) treats the evaluation process as a learning opportunity through which professionals acquire the skills and knowledge to investigate and advance their own practice.     

Hypospadias repair: an overview

Hypospadias is a birth defect in boys where the meatus is not placed at the tip of the glans of the penis. This article reviews the rapidly developing international literature surrounding hypospadias and hypospadias repairs paying specific attention to important aspects of nursing care, including preparing for surgery, use of dressings, stents and catheters as well as medication. It concludes by considering the long-term impact of hypospadias and its surgical correction on the patient's life. Hypospadias is treated surgically, normally during the second 6 months of the boy's life. Hospitalization periods vary from day case surgery to several days. The success of the hypospadias repair can be measured according to functional results and cosmetic appearance of the penis. The post-operative use of dressings as well as urinary catheters or stents is common but not uniform. Complication rates for hypospadias surgery vary from below 10% in boys with distal hypospadias to above 50% in children with a proximal meatus. The most common complications are urethral fistulas, strictures and stenoses. The continuing efforts by paediatric urologists focus on further optimizing the cosmetic and functional results.     

‘I can actually talk to them now’: qualitative results of an educational intervention for emergency nurses caring for clients who self‐injure

Aim and objectives. This Australian study evaluated the effectiveness of a solution‐focused education intervention in extending and improving emergency nursing responses to patients who present because of self‐injury. Background. Emergency nurses commonly report lack of training and feeling unskilled in managing people who present because of self‐harm. Most educational interventions have provided content knowledge, yet rarely have they focused on conveying the value of health promotion strategies such as proactive skills and coping strategies. Design. A mixed method pretest–posttest group design was used. Methods. Nurses (n = 36) were interviewed to examine differences in professional identity, awareness of self‐injury and clinical reasoning. Results. The qualitative results are presented in this paper and these showed improvements in knowledge and understanding of self‐harm, self‐belief in nurses’ capacity to positively influence clients and the value of health promotion skills. The intervention produced a positive attitudinal shift towards clients and an expressed intention to act in ways that were more person‐centred and change oriented. Conclusions. The solution‐focused education intervention appears to show promise as an intervention for enabling nurses to value their unique contribution to providing a health service that is more proactive and health‐promoting. Relevance to clinical practice. Interactive education bringing psychosocial skills to technical nursing staff builds confidence, competence and more person‐focused care.     

Audit or research – what is the difference?

• ? Audit and research are activities which have some characteristics in common and others which are rather different.
• ? This paper presents working definitions of each process and then examines their attributes and interrelationships in some detail.
• ? Areas covered include their purposes, what types of process they are, their theoretical bases, the methods used in each, sampling, the use of findings, confidentiality and the time frame of each.
• ? If nurses are to use or undertake research and/or audit appropriately in their practice, it is important that the similarities and differences between the two are clear.

     

Finding time for patients: an exploration of nurses' time allocation in an acute psychiatric setting

This article explores the proportion of work time psychiatric nurses spend in potentially psychotherapeutic one-to-one communication with patients. Twenty staff nurses from three acute admission wards in a psychiatric hospital in Northern Ireland were observed. The time spent in a selection of routine activities was recorded using a specially developed observation system Nurses' Daily Activity Recording System (NURDARS). The main findings were: (i) less than half of the working day (42.7%) was spent in patient contact, and (ii) the proportion of work time which was devoted to potentially psychotherapeutic interaction with patients was very small (6.75%). The implications and limitations of the study are discussed and suggestions are made for the management and practice of psychiatric nursing, for the education of psychiatric nurses, and for further research.     

Ethical dilemmas of a large national multi-centre study in Australia: time for some consistency

Aims and objectives. To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large‐scale national multi‐centre clinical audit called the National Benchmarks and Evidence‐based National Clinical guidelines for Heart failure management programmes Study. Background. Multi‐centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects. Methods. The National Benchmarks and Evidence‐based National Clinical guidelines for Heart failure management programmes study used an investigator‐developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence‐based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC. Results. Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six‐ to eight‐month delay in commencing the national study. Conclusions. Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi‐centre research which is now normative process for health services. Relevance to clinical practice. The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi‐centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.     

Qualitative Outcome Analysis: Evaluating Nursing Interventions for Complex Clinical Phenomena

Purpose: To describe a method that allows evaluating nursing interventions derived from a qualitative research project, and that shows appropriate interventions.
Organizing Framework: Qualitative research has expanded over the last decade and has contributed significantly to Inderstanding patients' experiences of health, illness, and injury. Yet the value of qualitative research in determining clinical interventions and subsequently evaluating the effects of these interventions on patients' outcomes has been limited. This method is used to confirm the efficacy of nursing interventions when experience changes over time, to extend the repertoire of intervention strategies, and to further clinicians' understanding of possible outcomes.
Design: From a completed study, Qualitative Outcome Analysis (QOA) enhances the identification of meaningful intervention strategies and plans for utilization. The researcher identifies the type of qualitative data that will enable the interpretation and evaluation of interventions, devises a means of data ecording and analysis, and finally, disseminates the findings.
Conclusions: QOA is a systematic means to confirm the applicability of clinical strategies developed from a single qualitative project, to extend the repertoire of clinical interventions, and to evaluate clinical outcomes.     

Evaluation of an interprofessional educational curriculum pilot course for practitioners working with post-stroke patients

Abstract

This report describes the design and evaluation of an interprofessional pilot training course aimed at pre-licensure practitioners working with post-stroke patients in community-based settings. The course was developed by community-based practitioners from nine health professions. Course learning activities included traditional methods (lectures) and interactive modules (problem-based learning and exchange-based learning). The study’s aim was to assess the program’s effectiveness in adapting and incorporating knowledge, skills and self-confidence when delivering tertiary care in therapeutic pool environments; gauge adoption of course principles into practice, and assess overall course satisfaction. Methods of evaluation included conceptual mapping of course format, pre- and post-questionnaires, daily reflection questionnaires, course satisfaction survey and adoption survey, 10 weeks follow-up. Overall, the findings indicate students’ knowledge, skills and self-confidence in delivering effective post-stroke care increased following the training. Students reported adopting clinical practices in 10 weeks follow-up. Implications for designing interprofessional curricula are discussed.     

Evaluation of an assertive outreach intervention for problem families: intervention methods and early outcomes

Scand J Caring Sci; 2011; 25; 211–219
Evaluation of an assertive outreach intervention for problem families: intervention methods and early outcomes Families who experience a chronic complex of socio‐economic and psycho‐social problems are hard to reach with mainstream care. Evidence exists that the core of this problem lies in a problematic interaction between this type of family and current systems of care. The adults and children involved have needs in multiple domains, while the care system is fragmented and highlights well‐defined requests for help. To improve access to this target group, an assertive outreach intervention was implemented into the preventive child healthcare system in the Netherlands. Evaluation research was carried out to get a detailed insight into the content of this intervention. Also, early outcomes were examined. Information was gathered by interviews, attending meetings on method development, analysing registration forms and a survey on client satisfaction. Five intervention stages were identified: case finding, making contact, sustaining contact, developing a family plan and linking (arranging for services to be delivered). Practical support was used to build rapport and clear the way to the uptake of follow‐up help. The professionals delivering the intervention need a broad range of competencies to establish a working relation with the families and to link them to care and services. A good care network across professionals from various organisations must exist to provide a variety of linking options. Early outcomes indicate that professionals were able to get in touch with the families within a mean of 13.2 days. Goals of the intervention were mainly practical support (73%), starting new assistance for a child (63%) and starting new assistance for a parent (43%). Linking to care and services was attained in the majority of the cases and parents expressed satisfaction. The findings indicate that the studied intervention is a promising one. Some potent components can be indicated: the outreach approach, practical support, maximising participation of the family and building bridges between the family and (in)formal support and assistance.     

Interprofessional student-led clinics: An innovative approach to the support of older people in the community

A student-led clinic was established to provide both an opportunity for interprofessional student education and the delivery of patient care. Fourth- or final-year students from allied health, medicine, and nursing worked in mixed professional teams to review the health of community-dwelling older people recently discharged from acute hospitals. We designed a prospective evaluation to study services delivered and their perceived value. Between 2011 and 2013, 98 patients who had been recently discharged from an acute medical ward attended the clinic. Students generated referrals for many services, most commonly physiotherapy, podiatry, and review by a general practitioner. Patient perceptions of consultations, measured with the Patient Experience Questionnaire, were gathered from 61 out of 96 (64%) participants and were generally favourable, with the communication domain scoring the most favourably. Undergraduate students, working in mixed professional teams, are able to deliver a useful additional health promotion service to older people.     

Mothers' involvement in caring for their premature infants: an historical overview

BACKGROUND: Advances in technology have resulted in increasing survival rates even for extremely premature infants. While sophisticated medical management is vital to infant survival, research has found that social factors and care giving processes are important predictors of infants' later outcome. Consequently, evidence is accumulating to demonstrate the fundamental role of mothers and families to the optimal developmental outcome of premature infants. AIM: The aim of the work reported here was to undertake an historical overview of premature infant care practices to increase neonatal nurse's knowledge of the crucial role of mothers and families in the care of their premature infants. Understanding past practice and current trends can provide neonatal nurses with critical insight which will assist in formulating current and future care. METHOD: Research and historical articles focusing on maternal involvement in preterm infant care from the development of the incubator to the present time were examined. A search of the literature between 1960 and 2002 was conducted using the MEDLINE, CINAHL and PSYCLIT databases. The search terms were premature infant, neonatal intensive care, history, and maternal care. FINDINGS: Three major themes were identified which reflect the development of neonatal care. Firstly, over the last century advances in medical and public health practice saw a decline in mortality rates for mothers and infants. Secondly, the application of this new knowledge resulted in the institutionalization and professionalization of obstetric and neonatal care which, in turn, resulted in the isolation of infants from their mothers. Finally, concurrent advances in infant research emphasized the importance of mother-infant relationships to infants' developmental outcome, resulting in greater flexibility in hospital practices regarding parental contact with their infants. CONCLUSION: As biomedical advances in technology continue to help smaller, sicker premature infants to survive, neonatal nurses are strategically placed to promote positive outcomes for infants and their families through the integration of social science and behavioural research into nursing practice.     

CLINICAL AUDIT: Audit in British general practice: domination or disillusionment?

Abstract: The history of audit is traced over the past 30 years demonstrating how it has come to dominate attempts to improve the quality of patient care in British general practice. Nevertheless it is still uncertain whether audit usually or occasionally yields such improvements. There is much more to learn about audit including whether any benefits it brings are through professional education. I suggest that the use of audit as a foundation upon which clinical governance is built is not a secure one.     

Mentoring for nurses in general practice: an Australian study

This paper presents findings from a project conducted to recommend a national framework for mentoring for general practice nurses in Australia. The first phase identified challenges and key issues; the second and third phases (reported here) engaged practice nurses and general medical practitioners in discussion to advance thinking on the topic. Outcomes revolved around seven core areas: role confusion and diversity of practice nursing; lack of a defined career pathway for practice nurses; professional isolation of practice nurses; need for general practitioner support; expectations of mentoring; importance of resourcing and infrastructure; and roles, skills and qualities of mentors. Implications of these for the development of a systemic approach to supporting nurses in general practice are discussed, taking into account the inter-professional context and special working relationship between nurses and doctors. Findings revealed keen support for the idea of mentoring for nurses in general practice and indicate success will depend on appropriate resourcing and infrastructure through national, state and local coordination processes.