The feasibility and acceptability of using virtual world technology for interprofessional education in palliative care: a mixed methods study

ABSTRACT

The objective of this mixed methods study was to evaluate the feasibility and acceptability of using a virtual world educational environment for interprofessional health professions students learning about palliative care. Graduate students (n = 35) from five different health professions programs (medicine, nursing, nutrition, physical therapy, and social work) across two educational institutions participated in a small-group immersive educational experience focused on palliative care in the virtual world of Second Life. Collected data included pre and post surveys of interprofessional attitudes using previously-published questionnaires as well as student reflective writing and photographs about their experience. We found it was feasible to create and deliver an interprofessional educational experience in palliative care in a virtual world environment. The educational experience was acceptable to participants, with an improvement in attitudes toward interprofessional education and interprofessional teamwork after a single virtual world educational session, based on both quantitative and qualitative results. Students found the virtual world environment acceptable for interprofessional education focused on palliative care, based on qualitative results. As health professions schools develop interprofessional education curricula, the use of virtual world technology may be an important modality to consider, to effectively and conveniently bring interprofessional learners together.     

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

Abstract

Health human resource and workforce planning is a global priority. Given the critical nursing shortage, and the fact that nurses are the largest group of healthcare providers, health workforce planning must focus on strategies to enhance both recruitment and retention of nurses. Understanding early socialization to career choice can provide insight into professional perceptions and expectations that have implications for recruitment, retention and interprofessional collaboration. This interpretive narrative inquiry utilized Polkinghorne’s theory of narrative emplotment to understand the career choice experiences of 12 millennial nurses (born between 1980 and 2000) in Eastern Canada. Participants were interviewed twice, face-to-face, 4 to 6 weeks apart prior to commencing their nursing program. The narratives present career choice as a complex consideration of social positioning. The findings provide insight into how nursing is perceived to be positioned in relation to medicine and how the participants struggled to locate themselves within this social hierarchy. Implications of this research highlight the need to ensure that recruitment messaging and organizational policies promote interprofessional collaboration from the onset of choosing a career in the health professions. Early professional socialization strategies during recruitment and education can enhance future collaboration between the health professions.     

Interprofessional simulation-based training in gynecologic oncology palliative care for students in the healthcare profession: A comparative randomized controlled trial

BackgroundPreprofessional palliative care education may be inadequate, leaving a gap in health professional students' knowledge and understanding of managing patients with gynecologic cancer and their families. Interprofessional simulation-based training may be useful in helping health professional students gain the necessary skills required for palliative care.ObjectiveThis study aimed to determine the effectiveness of different simulation methods used for interprofessional training on gynecologic oncology palliative care knowledge, interdisciplinary education perceptions, and teamwork attitudes of health professional students and to compare these methods.DesignA comparative randomized controlled trial was conducted with a pre-test and two post-tests.SettingsThis study was conducted at a university in Ankara, Turkey, in 2016–2017.ParticipantsA convenience sample of 84 interprofessional students (nursing, medical, nutrition-dietician, and social work) was used in the study.MethodsStudents were stratified by their profession and randomized by four blocks into high-fidelity simulation, hybrid simulation, and a control group. Data were collected using a semi-structured questionnaire form, palliative care knowledge test, interdisciplinary education perception scale, and teamwork attitudes questionnaire.ResultsThe high-fidelity simulation and hybrid simulation groups improved their palliative care knowledge, interdisciplinary education perception, and teamwork attitudes from pre-test to first and second post-tests compared to the control group.ConclusionThe introduction of high-fidelity simulation and hybrid simulation or hybrid simulation-based interprofessional training in undergraduate education can increase students' palliative care knowledge, interdisciplinary education perception, and teamwork attitudes. Training programs that are used together with high-fidelity simulation and hybrid simulation applications in interdisciplinary training should be integrated into the undergraduate curricula of future cooperating health professions.     

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.     

Leadership of interprofessional health and social care teams: a socio-historical analysis

reeves s., macmillan k. & van soeren m. (2010) Journal of Nursing Management 18, 258–264
Leadership of interprofessional health and social care teams: a socio-historical analysis Aim The aim of this paper is to explore some of the key socio-historical issues related to the leadership of interprofessional teams. Background Over the past quarter of a century, there have been repeated calls for collaboration to help improve the delivery of care. Interprofessional teamwork is regarded as a key approach to delivering high-quality, safe care. Evaluation We draw upon historical documents to understand how modern health and social care professions emerged from 16th-century crafts guilds. We employ sociological theories to help analyse the nature of these professional developments for team leadership. Key issues As the forerunners of professions, crafts guilds were established on the basis of protection and promotion of their members. Such traits have been emphasized during the evolution of professions, which have resulted in strains for teamwork and leadership. Conclusions Understanding a problem through a socio-historical analysis can assist management to understand the barriers to collaboration and team leadership. Implications for nursing management Nursing management is in a unique role to observe and broker team conflict. It is rare to examine these phenomena through a humanities/social sciences lens. This paper provides a rare perspective to foster understanding – an essential precursor to effective change management.     

Health science center faculty attitudes towards interprofessional education and teamwork

The attitudes of faculty towards interprofessional education (IPE) and teamwork impact the education of health professions education (HPE) students. This paper reports on a study evaluating attitudes from health professions educators towards IPE and teamwork at one academic health science center (HSC) where modest IPE initiatives have commenced. Drawing from the results of a previous investigation, this study was conducted to examine current attitudes of the faculty responsible for the training of future healthcare professionals. Survey data were collected to evaluate attitudes from HSC faculty, dentistry, nursing, medicine, pharmacy and public health. In general, positive HSC faculty attitudes towards interprofessional learning, education, and teamwork were significantly predicted by those affiliated with the component of nursing. Faculty development aimed at changing attitudes and increasing understanding of IPE and teamwork are critical. Results of this study serve as an underpinning to leverage strengths and evaluate weakness in initiating IPE.     

Interprofessional education on a training ward for older people: students' conceptions of nurses, occupational therapists and social workers

Collaboration between professionals in health and social care is essential to meet the needs of the patient. The collaboration is dependent on knowledge and understanding of each other's roles. One means of improving communication and collaboration among professionals is interprofessional education. The aim of this study was to describe the variation in how students in nursing, occupational therapy and social work perceived their own and the other professions. Over a three-week period two interviews were conducted with each of 16 students who were on an interprofessional training ward for older people in a municipal setting in Sweden. A phenomenographical approach was used in the analysis of the interviews. The findings showed great variation in how the students perceived the professions, from simplistic in terms of tasks to a more complex conception in terms of knowledge, responsibility and values. Differences in the ways professions were described concerning their professional stance towards the patients were especially accentuated. The findings indicate that the students need opportunities for reflection on and scrutiny of each other's beliefs and knowledge. The influence of interprofessional education involving reflection on the different health-care professions needs to be explored in future research.     

Effects of a graduate-level interprofessional education program on adult nurse practitioner student and internal medicine resident physician attitudes towards interprofessional care

Abstract

This article describes the development, implementation and evaluation of a longitudinal interprofessional education (IPE) experience for adult nurse practitioner students and internal medicine residents. This experience focused on providing care for complex community based patients during clinic and home visits, preceded by didactic learning that emphasized understanding one another’s professional roles and education, teamwork and conflict management. Evaluation demonstrated significant improvements in attitudes and beliefs associated with professional role, respect among health professions’ disciplines and conflict management. Results with regards to attitudes towards IPE and interprofessional practice, and valuing teamwork training were mixed. In particular, the curricular intervention did not change participants’self-reported skill in communication and did not affect attitudes and beliefs towards effects of interprofessional education on patient outcomes.     

Development and evaluation of an interprofessional seminar pilot course to enhance collaboration between health professions at a student-run clinic for underserved populations

ABSTRACT

This report describes the development and evaluation of an interprofessional pilot course aimed at health science students. The course was developed through collaboration of three health professions: Dentistry, Kinesiology, and Pharmacy. The coursework comprised of traditional lecture-based learning, interprofessional experiential education through four on-site visits at two area clinics that participate in team-based care, four student self-reflections following each site visit, and demonstration of interprofessional education and collaboration (IPEC) competencies through student evaluation of current interprofessional care at those existing clinics with a component for key improvement intervention. The study aims include evaluating both the course’s effectiveness and quality in increasing student preparedness for interprofessional practice and its ability to enhance collaboration between health professions at two area clinics. Methods of evaluation include the Interprofessional Collaborative Competency Attainment Survey (ICCAS) instrument, pre- and post- course surveys, and course evaluation survey. The results show that students felt their knowledge and skills increased across the four IPEC core competency domains: interprofessional communication, values and ethics, roles and responsibilities, and team and teamwork. We suggest that using an integrated course framework is an effective measure in enhancing interprofessional education (IPE) outcomes.     

Interprofessional education: The student perspective

The Toronto Rehabilitation Institute (Toronto Rehab) is a current leader in the movement of interprofessional education (IPE) initiatives in Ontario, Canada. Nine students from seven different health care disciplines, including medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech language pathology participated in the second IPE clinical placement in the winter of 2005 on Toronto Rehab's Stroke inpatient unit. In an effort to increase interprofessional collaboration, improve communication skills, foster respect and enhance knowledge of the different roles each discipline plays on the health care team, these students met together over a five week period and participated in interprofessional group sessions led by different health care professional leaders from the unit. This paper discusses the students' perspectives on this IPE experience and the corresponding benefits and challenges. All participants in the study recognized the importance of interprofessional teamwork in patient care and agreed that all health care education should include opportunities enabling them to develop the skills, behaviours and attitudes needed for interprofessional collaboration.     

Academic administrators' attitudes towards interprofessional education in Canadian schools of health professional education

Interprofessional education is an approach to educating and training students and practitioners from different health professions to work in a collaborative manner in providing client and/or patient-centred care. The introduction and successful implementation of this educational approach is dependent on a variety of factors, including the attitudes of students, faculty, senior academic administrators (e.g., deans and directors) and practitioners. The purpose of this study was to examine attitudes towards interprofessional teamwork and interprofessional education amongst academic administrators of post-secondary health professional education programs in Canada. A web-based questionnaire in English and French was distributed via e-mail messaging during January 2004 to academic administrators in Canada representing medicine, nursing, pharmacy, social work, occupational therapy and physiotherapy post-secondary educational programs. Responses were sought on attitudes towards interprofessional teamwork and interprofessional education, as well as opinions regarding barriers to interprofessional education and subject areas that lend themselves to interprofessional education. In general, academic administrators responding to the survey hold overall positive attitudes towards interprofessional teamwork and interprofessional education practices, and the results indicate there were no significant differences between professions in relation to these attitudinal perspectives. The main barriers to interprofessional education were problems with scheduling/calendar, rigid curriculum, turf battles and lack of perceived value. The main pre-clinical subject areas which respondents believed would lend themselves to interprofessional education included community health/prevention, ethics, communications, critical appraisal, and epidemiology. The results of this study suggest that a favourable perception of both interprofessional teamwork and interprofessional education exists amongst academic administrators of Canadian health professional education programs. If this is the case, the post-secondary system in Canada is primed for the introduction of interprofessional education initiatives which support the development of client and patient-centred collaborative practice competencies.     

Interprofessional education: the student perspective

The Toronto Rehabilitation Institute (Toronto Rehab) is a current leader in the movement of interprofessional education (IPE) initiatives in Ontario, Canada. Nine students from seven different health care disciplines, including medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech language pathology participated in the second IPE clinical placement in the winter of 2005 on Toronto Rehab's Stroke inpatient unit. In an effort to increase interprofessional collaboration, improve communication skills, foster respect and enhance knowledge of the different roles each discipline plays on the health care team, these students met together over a five week period and participated in interprofessional group sessions led by different health care professional leaders from the unit. This paper discusses the students' perspectives on this IPE experience and the corresponding benefits and challenges. All participants in the study recognized the importance of interprofessional teamwork in patient care and agreed that all health care education should include opportunities enabling them to develop the skills, behaviours and attitudes needed for interprofessional collaboration.     

The challenge of achieving interprofessional collaboration: Should we blame Nightingale?

The goal of implementing true interprofessional collaboration within the health care system seems to be elusive. The historical role of medicine as primary clinical leader and decision maker is particularly entrenched in the Western health care system. Florence Nightingale, the acknowledged founder of modern, Western nursing, is often blamed for the subservient role of nursing and other female-dominated health and social care professions. Is it fair to lay the blame on Nightingale? This paper seeks to place Nightingale in context and to revisit her own words to explore the Victorian world in which she worked as a social reformer. It argues that Nightingale made pragmatic compromises to gain acceptance for the new profession of nursing; that these compromises had unanticipated consequences that persist – but are not unchangeable.     

The challenge of achieving interprofessional collaboration: Should we blame Nightingale?

The goal of implementing true interprofessional collaboration within the health care system seems to be elusive. The historical role of medicine as primary clinical leader and decision maker is particularly entrenched in the Western health care system. Florence Nightingale, the acknowledged founder of modern, Western nursing, is often blamed for the subservient role of nursing and other female-dominated health and social care professions. Is it fair to lay the blame on Nightingale? This paper seeks to place Nightingale in context and to revisit her own words to explore the Victorian world in which she worked as a social reformer. It argues that Nightingale made pragmatic compromises to gain acceptance for the new profession of nursing; that these compromises had unanticipated consequences that persist - but are not unchangeable.     

Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication,teamwork, and patient-centred care

Abstract

Achieving safe, quality health care is highly dependent on effective communication between all members of the healthcare team. This study explored the attitudes and experiences of recent healthcare graduates regarding interprofessional teamwork and communication within a clinical setting. A total of 68 pharmacy, nursing, and medicine graduates participated in 12 semi-structured focus group discussions in clinical workplaces across three Australian states. Discussion focussed on graduates’ experiences of interprofessional education and its impact on their capacity for interprofessional teamwork and communication. The Social Identity and Realistic Conflict theories were used as a framework for qualitative data analysis. A consistent pattern of profession-focussed, rather than patient- or team-focussed goals was revealed along with reports of negative stereotyping, hierarchical communication, and competition for time with the patient. Graduates acknowledged the importance of communication, teamwork, and patient-centred care and felt a better understanding of the roles of other health professionals would assist them to work together for patients’ wellbeing. Identifying workplace identities and differential goals has uncovered possible motivations underlying health professionals’ behaviour. These insights may help improve interprofessional collaboration by focusing attention on common team goals, increasing feelings of worth and being valued among different professionals, and decreasing the need for competition.     

How does culture show? A case study of an international and interprofessional course in palliative care

Research shows slow improvement of the care of dying persons and their significant others. One of the reasons for that is the lack of palliative care education as an integral part of health professionals' undergraduate education. The paper discusses an attempt to develop innovative forms of palliative care education: an international, interprofessional and IT-supported undergraduate course for Swedish and Slovenian students of nursing, medicine, occupational therapy, physiotherapy, psychology and social work, which has been developed jointly by the two authors. One of the aims of the course has been to address differences in professional and national cultures relevant to quality in palliative care. The development and pilot implementation phases of the course were analysed qualitatively, using evaluation materials from students and teachers and from an external evaluation study. The results show that the interprofessional approach in the course enabled students to get to know other professions, as well as enabling them to work together as a team and resolve conflicts. Cultural differences between Sweden and Slovenia were not very pronounced, yet they came to the fore regarding teamwork and relationships between professions, as well as in respect of the “right thing” to do in relation to patient’ problems.     

Transforming Preprofessional Health Education Through Relationship-Centered Care and Narrative Medicine

Issue: The Institute of Medicine identified health care education reform as a key to improving the error prone, costly, and unsatisfying U.S. health care system. It called for health care education that no longer focuses exclusively on the mastery of technical skills but teaches students the human dimensions of care and develops their ability to collaborate with patients and colleagues to alleviate suffering and improve health. When should this educational reform begin, by what frameworks should it be guided, and which methods should it employ are important questions to explore. Evidence: There is increasing evidence that practitioners' relational skills, such as empathy and reflection, improve patients' health outcomes. Efforts to shift education toward patient-centered care in interprofessional teams have been made at the professional level, most notably in medical schools. However, reform must begin at the preprofessional level, to start cultivation of the habits that support humane care as early as possible and protect against empathic decline and the development of counterproductive attitudes to collaboration. The conceptual basis for reform is offered by relationship-centered care (RCC), a framework that goes beyond patient-centered care and interprofessional teamwork to focus on the reciprocal human interactions at the micro, mezzo, and macro levels of care. RCC identifies practitioners' relationships with patients, colleagues, community, and self as the critical interpersonal dimensions of healthcare and describes a foundation of values, knowledge, and skills required for teaching each dimension. The teaching of these foundations can be facilitated with techniques from narrative medicine, a compatible care model that conceptualizes health care as a context in which humans exchange stories and thus require narrative competence. Implications: We suggest beginning the educational reform at the preprofessional level with the implementation of a formal curriculum based on the 4 RCC dimensions with students expected to gain beginner levels of competency on these dimensions in addition to evidence-based principles of health sciences. This requires interprofessional collaboration among health professions, social science, and liberal arts faculty and training of health professions faculty in narrative medicine. Next, we suggest engaging in incremental change in the organizational culture with professional development and team-building activities. Although we need systematic research on the efficacy of the components of the transformation, their impact on students' learning, and their costs, it is important to engage in efforts to prepare professionals who are able to respond to the complex health needs of individuals and society in the 21st century.     

Learning through participating on an interprofessional training ward

Learning in clinical education can be understood as a process of becoming a legitimate participant in the relevant context. Interprofessional training wards (IPTWs) are designed to give students from educational programmes in health and social care a realistic experience of collaboration for the purpose of developing teamwork skills. IPTWs have been found to be appreciated by the students and to influence students' understanding of each other's professions. The aim of this study was to describe and analyse the students' learning on an interprofessional training ward in care for older persons through focusing on the students' ways of participating in the communities of practice on the ward. A case study design was chosen. Multiple data sources were used. The findings show that the students engaged as active participants in the care. At the same time there was sometimes a discrepancy between on the one hand expectations and goals, on the other hand actual participation. There were difficulties in making the training relevant for all the student groups involved. The findings indicate that in the planning of interprofessional education the choice of setting and learning situations is crucial with regard to the learning that will occur.     

Interprofessional student groups using patient documentation to facilitate interprofessional collaboration in clinical practice – A field study

BackgroundThis article explores and provides insights into how students learn interprofessional collaboration in a clinical placement. This topic is of interest for stakeholders in health services and education and for the research field of interprofessional education.ObjectivesHow patient documentation facilitates collaboration in interprofessional student groups is explored.DesignThis study uses qualitative research with an ethnographic design.SettingsThis research studies interprofessional education at a Norwegian university.ParticipantsThree student groups that participated in a two-week interprofessional clinical placement in a geriatric rehabilitation ward were studied, which comprised students of medicine, nursing, occupational therapy and physiotherapy.MethodsData were generated through observational studies and informal conversations with the students in interprofessional placement and consists of written field notes and transcribed audio-recorded conversations. The analysis drew on concepts from practice theory related to the social practices of learning.ResultsThe students creatively and dynamically used a narrative note in the electronic patient record system in the ward to create an overview of care and ensure continuity of care for the patients for whom they were responsible. By using the narrative note in the record, the students aimed to develop a comprehensive understanding of their patients' clinical situations and care needs. When new information was entered in the note, information already written by individual students and student pairs was reviewed by all students, revised and mutually refined. As a result, multidimensional representations of the patients' health statuses and care needs emerged, including how the patients responded to the students' suggested interventions.ConclusionsPatient documentation can be a tool for stimulating interprofessional collaboration when students are allowed to organize patient care independently. We suggest that students' natural meaning-seeking capability is a hidden resource that can be exploited in interprofessional education.     

The global emergence of IPE and collaborative care

Abstract

As the United States faces an impending shortage in the primary care workforce, interprofessional teamwork training to improve clinic efficiency and health outcomes is becoming increasingly important. Currently there is limited integration of interprofessional training in educational models for health professionals. The implementation of Patient Aligned Care Teams at the Department of Veterans Affairs (VA) has provided an opportunity for interprofessional collaboration among trainee and faculty providers within the VA system. However, integration of interprofessional education is also necessary to train future providers in order to provide effective team-based care. We describe a transportable educational model for health professional collaboration from our experience as a VA Center of Excellence in Primary Care Education, including a complementary novel one-year post-Master’s adult nurse practitioner interprofessional clinical fellowship. With growing recognition that interprofessional care can improve efficiency and outcomes, there is an increasing need for programs that train future providers in collaboration and team-based care.