The Turf and Baggage of Nursing and Medicine: Moving Forward to Achieve Success in Interprofessional Education

Interprofessional education has been identified as a core competency in nursing, medicine, dentistry, pharmacy, and public health. Students and trainees who learn with, from, and about one another in an interdisciplinary learning environment develop the skills necessary for team-based care. Faculty and experienced clinician preceptors are integral to this process because they develop curricula, interact with learners, and role model behaviors, yet most faculty and clinical preceptors were educated in a uniprofessional manner and bring to the table years of history and lived experiences. These turf and baggage issues are often subtle but influence our learners and invariably affect the care of the patient.     

Linking integrative medicine with interprofessional education and care initiatives: Challenges and opportunities for interprofessional collaboration

Although the fields of interprofessional education and collaboration (IPE/IPC) and integrative medicine (IM) are both recognised and clearly advancing as of late, a curious paradox exists: IPE/IPC and IM are both concerned with communicating about and attempting to resolve differences between healthcare professions with the fundamental goal of improving patient outcomes, yet they have remained quite distinct fields of research. This disconnect could be due to the fact that one field deals with integration within the general paradigm of biomedicine (IPE/IPC), while the other addresses integration across paradigms (IM). It is an opportune time for a critical comparison between the two. First, the main themes of IM are summarised as they are reflected in the IM literature. Second, a comparative analysis is presented focusing on the significant similarities and differences between IPE/IPC and IM. The final section addresses the question: What key learning areas from IM could benefit and enhance IPE/IPC?     

The pleasure of your company: attitudes and opinions of preceptors toward nurse practitioner preceptees

PURPOSE: To survey the attitudes and opinions of preceptors about their experiences with nurse practitioner students. DATA SOURCES: Original research using a mailed questionnaire designed by the researchers to 196 physician and nurse practitioner preceptors (23% response rate). CONCLUSIONS: Preceptors desired faculty support and feedback, wanted involvement in shaping the curriculum, and had strong opinions about the precepting experience. IMPLICATIONS FOR PRACTICE: The attitudes and opinions of preceptors are extremely important to the availability of a qualified and motivated pool of preceptors, the clinical growth of the students, the quality of the student's learning experience, and the survival of nurse practitioner programs.     

Development and evaluation of a primary care interprofessional education intervention to support people with dementia

ABSTRACT

International policy documents emphasize the need to develop interprofessional education (IPE) to support collaborative dementia care in the community. The aim of this short report is to describe the development and pilot evaluation of an interprofessional dementia education workshop for primary care healthcare professionals. A three-hour workshop was iteratively developed through consultation with an expert reference group and people with dementia. The workshop was piloted with three separate primary care teams. A total of fifty-four primary care based healthcare staff who represented fourteen different health care roles in primary care participated in the pilot evaluation. The pilot workshops were evaluated using a mixed method approach which included post-workshop questionnaires for participants (n= 54)and a post-workshop focus group (n=8) with the program design team and workshop facilitators. The results of the pilot phase indicated that the workshop was useful and feasible. The workshop improved participants’ self-reported knowledge, understanding and confidence to support people with dementia and their families.Areas for improvement were identified and will be used to inform improvements to the workshop content and delivery in advance of a national roll-out. Future evaluations of the implementation of this interprofessional educational workshop will focus on its impact on healthcare professional behavior and outcomes for the person with dementia and their families.     

Changes in attitudes toward interprofessional health care teams and education in the first- and third-year undergraduate students

The interprofessional education (IPE) program at Gunma University, Maebashi, Japan, implements a lecture style for the first-year students and a training style for the third-year students. Changes in the scores of modified Attitudes Toward Health Care Teams Scale (ATHCTS) and those of modified Readiness of health care students for Interprofessional Learning Scale (RIPLS) at the beginning and the end of the term were evaluated in the 2008 academic year. Two hundred and eighty-five respondents of a possible 364 completed the survey. In both the scales, the overall mean scores declined significantly after the lecture-style learning in the first-year students, while the scores improved significantly after the training-style learning in the third-year students. Exploratory factor analysis revealed that the modified ATHCTS was composed of three subscales, and the modified RIPLS two subscales. Analyses using regression factor scores revealed that the scores of “quality of care delivery” subscale in the modified ATHCTS and those of “expertise” subscale in the modified RIPLS declined significantly in the first-year students. Consequently, IPE programs may be introduced early in the undergraduate curriculum to prevent stereotyped perceptions for IPE, and comprehensive IPE curricula may result in profound changes in attitudes among participating students.     

Effects of a nurse practitioner on a multidisciplinary consultation team

Title.  Effects of a nurse practitioner on a multidisciplinary consultation team.
Aim.  This paper is a report of a study to evaluate the impact on office hours capacity, patient satisfaction, quality of life and costs of including a nurse practitioner in a multidisciplinary consultation team for patients with hand problems caused by rheumatoid arthritis.
Background.  Over 90% of patients with rheumatoid arthritis suffer symptoms in their hand joints and may be seriously disabled in performing daily, work or leisure activities. A recent promising development in the treatment of patients with a chronic disease is the co-ordinating and accompanying role of a nurse, such as a nurse practitioner, in a multidisciplinary treatment team.
Methods.  A two successive group time-series design was adopted. The intervention group ( n  = 78) visited a clinic with a nurse practitioner assigned to the team during 2003–2004. The control group ( n  = 69) was seen before inclusion of the nurse practitioner. Office hours capacity, patient satisfaction, quality of life and costs were assessed using questionnaires directly after consulting the team, and 3 and 6 months later.
Results.  Between-group comparisons of patient satisfaction and quality of life revealed no statistically significant differences. Changes within groups over time were not demonstrable. Mean office hour capacity increased by 17% ( t  = −1·906, d.f. = 32·879, P  = 0·065). The costs for professional home care or informal care were equal in the two groups.
Conclusion.  Evaluation of clinical practice using pre- and post-test design was impeded by changes in clinical practice, which made concrete conclusions difficult to draw. In future studies the satisfaction of participating clinicians should be evaluated, in addition to that of patients.     

Filipino therapists’ experiences and attitudes of interprofessional education and collaboration: A cross-sectional survey

For the past more than 50 years, the World Health Organisation has acknowledged through empirical findings that health workers that learn together work together effectively to provide the best care for their patients. This study aimed to: (1) describe the perceived extent of interprofessional education (IPE) experience among Filipino occupational therapists (OTs), physical therapists (PTs), and speech-language-pathologists (SLPs); (2) identify their attitudes towards interprofessional collaboration (IPC); and (3) compare their attitudes towards IPC according to: prior IPE experience, classification of IPE experience, profession, years of practice, and practice setting. Using a cross-sectional survey design, a two-part questionnaire was sent to Filipino OTs, PTs, and SLPs working in the Philippines via an online survey application. The first part of the survey contained eight items of demographic information and the second part contained the 14-item Attitudes Towards Health Care Teams Scale (ATHCTS). Findings revealed that among the Filipino OT, PT and SLP respondents (n = 189), 70.9% had prior experience on IPE. Moreover, the three most commonly used IPE teaching-learning strategies were case discussion (clinical setting), small group discussion, didactics, and case discussion (community setting), while the use of didactics and case discussion (community setting) yielded more agreeable attitudes towards IPC. Among the 14 items in the ATHCTS, 11 were rated with agreeability and three items with neutrality. For professional variables, only the practice setting variable yielded a statistically significant finding confirming those working in the academia to be more agreeable towards IPC compared to other settings. However, years of practice and professional background variables both yielded no statistically significant difference implying no association between years of practice and attitude towards IPC and a homogenous composition among respondents, respectively. The results of this research are to springboard IPE initiatives within Philippine higher education institutions to enable evidence-based IPC approaches in clinical practice.     

The costs of training a nurse practitioner in primary care: the importance of allowing for the cost of education and training when making decisions about changing the professional-mix

What is already known on this topic * Cost containment through the most effective mix of staff achievable within available resources and organisational priorities is of increasing importance in most health systems. However, there is a dearth of information about the full economic implications of changing skill mix. * In the UK a major shift in the primary care workforce is likely in response to the rapidly developing role of nurse practitioners and policies aimed to encourage GP practices to transfer some of their responsibilities to other, less costly, professionals. * Previous research has developed an approach to incorporating the costs of qualifications, and thus the investment required to develop a skilled workforce, for a variety of health service professionals including GPs. What this study adds * This paper describes a methodology of costing nurse practitioners that incorporates the human capital cost implications of developing a skilled nurse practitioner workforce. With appropriate sources of data the method could be adapted for use internationally. * Including the full cost of qualifications results in nearly a 24 per cent increase in the unit cost of a Nurse Practitioner. * Allowing for all investment costs and adjusting for length of consultation, the cost of a GP consultation was nearly 60 per cent higher than that of a Nurse Practitioner.     

Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctors

AIM: This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department. BACKGROUND: The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high-quality and cost-effective care to persons who seek help for non-urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role. METHODS: A questionnaire survey was carried out, and a 29-item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open-ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004. FINDINGS: An overall response rate of 74.8% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff. CONCLUSION: There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries.     

Attitudes of pharmacy and nutrition students towards team-based care after first exposure to interprofessional education in Qatar

Abstract

Little is known regarding attitudes of healthcare professional students towards team-based care in the Middle East. As modernization of health systems is rapidly occurring across the Gulf Cooperation Council countries, it is important for students to engage in interprofessional education (IPE) activities. The objective of this study was to assess pre-clinical students’ attitudes towards interprofessional healthcare teams after completion of their first IPE activity. A previously validated questionnaire was distributed to 25 pharmacy and 17 nutrition students at Qatar University after participation in an IPE event. Questions related to quality of team-based care and physician centricity. Results showed high agreement regarding high quality care provided by teams yet students were unsure of the value of team-based care when considering required time for implementation. Results provide baseline data for future studies to assess student attitudes throughout the professional programs and give valuable insight for future IPE program design in the Middle East.     

Interprofessional Education and Practice Guide No. 7: Development,implementation, and evaluation of a large-scale required interprofessional education foundational programme

Health profession educators and administrators are interested in how to develop an effective and sustainable interprofessional education (IPE) programme. We describe the approach used at the University of Kansas Medical Centre, Kansas City, United States. This approach is a foundational programme with multiple large-scale, half-day events each year. The programme is threaded with common curricular components that build in complexity over time and assures that each learner is exposed to IPE. In this guide, lessons learned and general principles related to the development of IPE programming are discussed. Important areas that educators should consider include curriculum development, engaging leadership, overcoming scheduling barriers, providing faculty development, piloting the programming, planning for logistical coordination, intentionally pairing IP facilitators, anticipating IP conflict, setting clear expectations for learners, publicising the programme, debriefing with faculty, planning for programme evaluation, and developing a scholarship and dissemination plan.     

Understanding faculty perspectives of supports and barriers to interprofessional collaboration within a clinical scholars program: A qualitative study

AimThis study explores the faculty perspective of an interprofessional clinical scholars program to identify recommendations for strengthening team collaboration between academia and clinical practice.BackgroundInterprofessional evidence-based practice, pairing higher education and clinical practice, is a critical part of nursing education.DesignThis qualitative study consisted of two phases of participant engagement, in both data collection and data analysis.MethodsSpecifically, faculty participated in a focus group discussion followed by a card sort of initial codes.ResultsThe major themes identified are Unifying the Team and Navigating Layers of Challenge, encompassing concepts of teamwork and programmatic context that supported or disrupted interprofessional collaboration. This study affirms the importance of role clarity, connectedness, intentionality and continuity within clinical teams. Moreover, faculty identified barriers to teamwork based on workload, leadership turnover and constraining environmental forces.ConclusionsRecommendations for effective teamwork in an interprofessional setting will strengthen future collaboration between higher education and clinical settings.     

本科护生实习前后医护合作态度的研究

目的 比较本科护生的医护合作态度在临床实习前和临床实习后是否存在差异。 方法 采用一般情况调查表和Jefferson医护合作态度量表对中山大学新华学院165名实习前的2015级三年级学生和93名已在临床实习满6个月的2014级四年级学生进行问卷调查。用SPSS 20.0软件对所得结果进行统计分析。 结果 三年级和四年级学生的医护合作态度总分的中位数分别是53.00和51.00，92.1%的三年级学生和88.2%的四年级学生总分在46～60分之间。三年级学生在医护合作态度总分和医护共同教育和合作、护士自主权两个维度的得分显著高于四年级学生（P<0.05）。 结论 实习前后护生的医护合作态度均较高，但学生实习后的医护合作态度略低于实习前，学校和医院的实习培训应强化护生医护合作态度方面的教育。     

Impact of a novel interprofessional dental and pharmacy student tobacco cessation education programme on dental patient outcomes

The dental setting presents a unique opportunity to assist patients with tobacco cessation. Many dental providers do not feel prepared to provide tobacco cessation, particularly with regard to education on pharmacological treatments. An interprofessional practice experience with dental and pharmacy students provides a novel approach to tobacco cessation in the dental setting, but it is not known whether such methods affect patient outcomes. The goal of the study was to examine the impact of a novel dental and pharmacy student tobacco cessation education programme on patient knowledge gained, barriers to utilising cessation medications, quit intentions, and quit behaviours as compared to standard care. Dental patients who were seen at the dental admissions clinic of a dental school on interprofessional care (IPC) days and received tobacco cessation education from the dental-pharmacy student team (N = 25) were compared with dental patients at the clinic seen on Standard Care (SC) days (N = 25). Patients completed a post-appointment survey and a 4-week follow-up survey. IPC patients reported greater perceived knowledge post-appointment and at follow-up regarding tobacco cessation compared with SC patients and had greater intentions to utilise medication to assist with tobacco cessation. At follow-up there were no differences between groups in terms of quit attempts. Among patients who made a quit attempt those in the IPC group were more likely to have set a quit date and contacted a provider for assistance regarding tobacco cessation. Dental-pharmacy student interprofessional tobacco cessation may be an innovative way to provide tobacco cessation education to dental patients and provide students with interprofessional practice experiences.     

Interprofessional immersion: Use of interprofessional education collaborative competencies in side-by-side training of family medicine,pharmacy, nursing,and counselling psychology trainees

While supported by the Affordable Care Act, in the United States, interprofessional training often takes place after healthcare providers graduate and are practicing in the field. This article describes the implementation and evaluation of an interprofessional training for graduate-level healthcare trainees. A group of interprofessional healthcare faculty provided a weeklong interprofessional immersion for doctoral-level healthcare trainees (n = 24) in Pharmacy, Counselling Psychology, Nursing, and Family Medicine residents. Healthcare faculty and staff from each profession worked side-by-side to provide integrated training utilising the Interprofessional Education Collaborative core competency domains. Trainees were placed into small teams with representatives from each profession; each team observed, learned, and practiced working within teams to provide quality patient care. Qualitative and quantitative data were collected to identify the effect of the training on trainees’ self-reported team skills, as well as the extent to which the trainees learned and utilised the competencies. The results suggest that after completing the training, trainees felt more confident in their ability to work within an interprofessional team and more likely to utilise a team-based approach in the future.     

Perspectives of pharmacy students in Qatar toward interprofessional education and collaborative practice: a mixed methods study

ABSTRACT

In an IPE environment, students are expected to have better understanding of the roles, responsibilities, and contribution of other health care professions to enhance interprofessional working and collaboration with an end result of improving patient-centred and team-based care. Although many studies have investigated students’ attitudes, very few employ a mixed methods design and hardly are from Middle Eastern countries. A two-staged sequential explanatory mixed method design was used to comprehensively capture the perspectives of pharmacy students toward IPE and collaborative practice. A quantitative survey was conducted as the first stage of the study, followed by an in-depth discussion of these perspectives through a qualitative phase by conducting two focus groups. For the quantitative surveys, the overall response rate was 102/132 (77%) for pharmacy students in Qatar. This was followed by two focus groups with a total of 27 participants from senior and junior students. In exploring the qualitative data, three main themes were identified in relation to the pharmacy students’ perspectives. These were on the pharmacy students’ perception on the enablers (professional related benefits, patient-related benefits and current positive influences), barriers (previous IPE experiences, educational related issues and current working practices and processes), and recommendations to implementing IPE and collaborative practice (future IPE and pharmacy profession).

Overall, the results demonstrate a strong readiness and positive perception by pharmacy students toward IPE and collaborative practice. This study has highlighted different dimensions in pharmacy students’ perceptions. It also provided a useful insight into the readiness of pharmacy students in a Middle Eastern university. Students are seeking more IPE experiences formally incorporated into their curriculum and hence educators should capitalise on these positive and enthusiastic attitudes to identify the most effective means for delivering IPE and inform curricula planning. Collaborative practice-ready graduates will produce better-educated professionals delivering higher quality care.     

Impact of a nurse practitioner role on metabolic monitoring completion and referrals for consumers admitted to the intensive care area of an acute inpatient psychiatric unit

Mental illness increases a person's risk of physical health issues, including cardiovascular disease, leading to premature morbidity and mortality. Screening for cardiovascular disease through metabolic monitoring is recommended to aid in early detection. The aim of the present study was to ascertain whether consumers admitted to an inpatient mental health unit receive routine metabolic monitoring, and to explore the contribution of a nurse practitioner to metabolic monitoring and the actioning of abnormal results. The present study used a retrospective mirror image cohort method to look at clinical consumer files for two separate 6‐month periods before and after a nurse practitioner role commenced. Metabolic monitoring variables were computed as completion frequencies and percentages. Univariate analyses were computed to describe differences among metabolic monitoring variables. A total of 497 consumers were admitted to the mental health inpatient unit's intensive care area across the two 6‐month data‐collection periods. Prior to the nurse practitioner role, only 2% of consumers had their body mass index (BMI) risk calculated; less than 1% had their waist circumference measured, and no abnormal results were referred to a general practitioner (GP). After the nurse practitioner role commenced, BMI risk was calculated for 67% of consumers, waist circumference recorded for 68%, and referrals for abnormal results were forwarded to 37 consumers’ GPs. A nurse practitioner on the inpatient mental health unit has allowed for a considerable increase in the metabolic screening of admitted consumers resulting in a number of referrals being forwarded to consumers’ GPs to be acted upon.     

医护合作单元在脑梗死患者健康教育中的应用与效果

目的探讨医护合作单元在脑梗死患者健康教育中的应用与效果。方法组成医护合作单元，制订健康教育制度，根据健康教育流程及健康教育手册内容实施健康教育，每位医生和护士负责相对固定的一组患者，每位患者的健康教育工作由其主管医生和责任护士合作完成。结果患者健康教育首次评分和出院评分均有提高（P〈0．01）；患者出院后3个月依从性（除烟酒嗜好）提高（P〈0．01或P〈0．05）。结论医护合作单元的健康教育方法能有效提高脑梗死患者健康教育质量。