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?     

An interprofessional exploration of nursing and social work roles when working jointly with families

Ngala, an early parenting not-for-profit organisation in Western Australia, has provided services to families with young children since 1890. Child health nurses and mothercraft nurses were the primary workforce until the 1980s when a social worker was employed and a new era of interprofessional collaboration began. Evidence to date has focused on nursing workforce, interprofessional education, and interprofessional teams. Little is known about the roles of nursing and social work when working jointly with families. A new service commenced in 2012 for families with children with developmental delays. Social workers and child health nurses were employed for this service model. Our study aim was to explore the perceptions of how nurses and social workers work together with a family providing psychosocial support across a new service. The study was conducted alongside implementation of this new service. An exploratory case study approach was adopted to generate an in-depth understanding of the roles of nurses and social workers. In total, 22 semi-structured interviews and one focus group across the first year of implementing the new service were undertaken. Analysis of these data revealed four major themes. Findings presented in this article will inform further reflection and consideration into the future interprofessional workforce priorities and requirements for Early Parenting Services.     

Observation of interprofessional collaboration in primary care practice: A multiple case study

Interprofessional collaboration (IPC) is known to improve and enhance care for people with complex healthcare and social care needs and is ideally anchored in primary care. Such care is complex, challenging, and often poorly undertaken. In countries such as Canada, the United Kingdom, the Netherlands, Australia, and New Zealand, primary care is provided predominantly via general practices, where groups of general practitioners and nurses typically work. Using a case study design, direct observations were made of interprofessional activity in three diverse general practices in New Zealand to determine how collaboration is achieved and maintained. Non-participant observation of health professional interaction was undertaken and recorded using field notes and video recordings. Observational data were subject to analysis prior to collection of interview data, subsequently gathered independently at each site. Case-specific themes were developed before determining cross-case themes. Cross-case themes revealed five key elements to IPC: the built environment, practice demographics and location, practice business models, shared goals, and team structure and climate. The combination of elements at each practice site indicated that strengths in one area helped offset challenges in others. The three practices (cases) collectively demonstrated the importance of an “all of practice” commitment to collaborative practice so that shared decision-making can occur.     

A strategic initiative to foster interprofessional collaboration: A case report using a men’s healthy living programme

Interprofessional collaboration (IPC) can be challenging, yet it has shown benefits for providers and patients. We examined the existing enablers and barriers to IPC at a local Community Health Center (CHC) and report on the existing types of IPC practice. We also report how implementing a men-sensitive healthy living programme united a team of health professionals/managers in attending to the needs of a population that to date had been largely underserved. A total of 16 employees were interviewed at the CHC. All respondents spoke positively of existing IPC and provided examples of existing collaborative practices. These CHC professionals (clinicians and managers) experienced greater intra- and extra-organisational collaborations as a result of experiencing a community-delivered programme. It also allowed the CHC professionals/managers to rethink the management and structure of collaborative practices and understand the needs and challenges of working with non-traditional partners (men and workplace-based managers). While our findings are context sensitive (case study design), they shed light on how uniting health professionals/managers around a challenging and non-traditional health issue (i.e., improving health in a hard-to-reach population subgroup) can strategically reduce resistance to collaborative practice development by strengthening team cohesion and fostering innovative interactions.     

Preparing healthcare students who participate in interprofessional education for interprofessional collaboration: A constructivist grounded theory study protocol

This article presents a qualitative research protocol to explore and understand the interprofessional collaboration (IPC) preparation process implemented by clinical tutors and students of different professions involved in interprofessional education (IPE).

Many studies have shown that IPE initiatives improve students’ understanding of the roles and responsibilities of other professionals. This improves students’ attitudes towards other professions, facilitating mutual respect, and IPC. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams. This is a constructivist grounded theory (GT) study, which will involve data collection through in-depth semi-structured interviews (to 9–15 students and 6–9 clinical tutors), participant observations, and the analysis of documentation. After analysing, coding, integrating, and comparing the data if necessary, a second round of interviews could be conducted to explore any particularly interesting aspects or clarify any issues. This will then be followed by focused and theoretical coding. Qualitative data analysis will be conducted with the support of NVivo 10 software (Victoria, Australia). A better conceptual understanding will help to understand if IPE experiences have contributed to the acquisition of competencies considered important for IPC, and if they have facilitated the development of teamwork attitudes.     

Changing student attitudes through interaction: Findings from an interprofessional workshop

Healthcare professionals are increasingly expected to work in interprofessional teams. Students therefore need opportunities to learn and practise skills that will allow them to be effective team members when they enter the workforce. This article summarises an interprofessional learning experience for 289 undergraduate and graduate students representing 13 programmes in a College of Health Professions (CHP) at a US public university. The half-day workshop provided an opportunity for participants with no prior interprofessional education to collaborate in a problem-solving case study and to inform students of other professions about their professions. Faculty members from all CHP programmes collaborated in writing the case study and facilitating student discussions during the event. Attitudes related to interprofessional collaboration and professional roles were assessed prior to and after workshop participation. A paired t test showed a statistically significant difference in four attitude questions. Participants reported a significant increase in understanding the roles of other professionals in healthcare and community situations. They also reported an increased understanding of the benefits and challenges of working in interprofessional teams. This event successfully introduced participants to interprofessional collaboration and provided them the opportunity to share their professional expertise and understand the expertise of others.     

Views from the field: Medical student experiences and perceptions of interprofessional learning and collaboration in rural settings

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.     

Development of an interprofessional and interdisciplinary collaborative research practice for clinical faculty

This article describes an interprofessional collaborative research practice fellowship designed to foster the research skills of clinical faculty. The year-long fellowship was grounded in big data analysis and the triangle of informatics—knowledge, information, and data. Fellows were selected to include diverse perspectives, training, and knowledge but had limited experience in team science or being a member of an interprofessional research team. The underlying philosophy of the fellowship was experiential learning. Protected time and formal mentorship were necessary factors for developing the interprofessional research practice and the skills to participate in an interprofessional research team. We believe that this innovative interprofessional faculty research fellowship is a viable option for supporting scholarly activity and research collaboration. The findings could inform interprofessional clinical practice and be implemented for patient care. Engagement in interprofessional collaborative research and incorporation of the perspectives, knowledge and expertise of multiple professions, is a model to de silo knowledge creation.     

Observing of interprofessional collaboration in simulation: A socio-material approach

Simulation exercises are becoming more common as an educational feature of the undergraduate training of health professionals. Not all students participate in these activities, but are assigned as observers of the actual simulation. This article presents a study that explored how social-material arrangements for observation of interprofessional collaboration in a simulated situation are enacted and how these observations are thematised and made relevant for learning. The empirical data consisted of 18 standardised video recordings of medical and nursing students observing their peer students simulate. Practice theory is used to show how observation is embodied, relational, and situated in social-material relations. The findings show two emerging ways of enacting observation—proximate observation and distant observation. The enactments are characterised by different socio-material arrangements concerning the location where the simulation took place and its material set-up as well as embodied “doings” and “relatings” between the observing students and instructors. The observing students are participating in a passive, normative position as an audience and as judges of what is correct professional behaviour.     

Interprofessional collaboration within integrative healthcare clinics through the lens of the relationship-centered care model

Teamwork is a contemporary way to try to improve the healthcare system, not only for the patients but also for the practitioners involved. A new type of interprofessional working arrangement, integrative healthcare (IHC) clinics, has emerged in the last two decades. The literature on interprofessional collaboration is steadily increasing, but little is known about the collaborative organization of the biomedical and complementary and alternative medicine (CAM) practitioners that make up the teams in these clinics. The relationship-centered care model was used to guide an exploration of the interprofessional teamwork within a Canadian IHC setting. A sample of 31 IHC clinics and 228 biomedical and CAM practitioners were included. Eighty-nine questionnaires were returned from 25 clinics, representing a 62% practitioner response rate (within clinic responders). This study established that within the analytical model, practitioners behaviors and skills are the main factors associated with job satisfaction and inter-practitioner conflicts in interprofessional IHC practice. The results of the study also suggested the importance of interprofessional exposure for healthcare practitioners who are being expected to serve a clientele that is increasingly interested in being both cured and healed by the integration of biomedical and CAM paradigms and approaches.     

An interprofessional patient assessment involving medical and nursing students: a qualitative study

Interprofessional collaboration is fundamental to providing optimal patient care. The readiness of the team entering a framework of interprofessional collaborative practice is critical to its success. In this study, we conducted an interprofessional education (IPE) activity for medical and nursing students in an acute care setting. Over nine occasions, 21 student pairs (one nursing and one medical student per pair) jointly assessed a patient and created a list of problems and interventions to achieve the patient’s goals. Immediately after the activity, students were debriefed to gain insight into their experiences. Debriefing sessions were audiotaped and analysed using a phenomenological approach and four major themes were identified. Overall, students felt responsible for representing their profession and were initially apprehensive about the interprofessional task. Nevertheless, they identified their own shortcomings and recognized the value in their partner’s approach. These realizations promoted convergence on a shared vision to provide optimal care for patients as a team. Acknowledging and understanding these perceptions may help design better ways to improve patient care. This educational model may be utilized by others who are seeking IPE activities in acute care.     

Attitudes of clinician educators towards interprofessional education and collaboration: Insights from two interprofessional scales

The increasing complexity of healthcare needs underlines the growing importance of interprofessional education and collaborative practice (IPECP) in enhancing quality of patient care. In particular, clinician educators play an influential role in advocating IPECP. The primary goal of our exploratory pilot study is to explore 34 clinician educators’ attitudes towards IPECP by using the adapted 14-item Attitudes Toward Health Care Teams Scale (ATHCTS) and 15-item Readiness for Interprofessional Learning Scale (RIPLS). Mean scores of ATHCTS and RIPLS were 3.81 (SD = 0.90) and 4.02 (SD = 0.79), respectively. Using exploratory factor analysis, we identified four factors: team value (ATHCTS), team efficiency (ATHCTS), teamwork and collaboration (RIPLS), and professional socialisation (RIPLS). The “team efficiency” factor on the ATHCTS scored lowest (factor mean = 3.49) compared with other factors (factor means = 3.87–4.08). Correlation analyses revealed that the “team efficiency” factor had small correlations with other factors (r = ?0.05–0.37). Our clinician educators valued IPECP in promoting teamwork and professional socialisation but they perceived IPECP to compromise efficiency. The issue of perceived inefficiency by clinician educators merits attention in order to promote wider implementation of IPECP.     

Perceptions of experiences with interprofessional collaboration in public health nursing: A qualitative analysis

In public health nursing interprofessional collaboration has become a goal, however, there is little clarity on the distribution of responsibility or approach to cooperation between the professional groups. The aim of the study was to explore public health nurses’ perceptions of their experiences related to interprofessional collaboration. A qualitative content analysis was carried out. An interview study with a purposeful sample of 23 Norwegian public health nurses (PHNs) was conducted. Data were analysed using semi-structured interviews to identify categories and themes of PHNs’ working lives. The data were classified into three major themes: institutionality: the institutional understanding of the professional roles; competence: clarifying jurisdictional borders, and recognition: professionals’ recognition of different roles. There needs to be a robust strategy in collaborative working that involves public health nurses among other professionals to avoid role overlap, interpersonal and interprofessional conflict and reduce the damaging threat or stress that comes with informal or ad hoc rules of engagement and status claiming by one profession over another.     

Strategic planning for future learning environments: an exploration of interpersonal,interprofessional and political factors

Abstract

This article, written from the stance of a public planner and a policy maker, explores the challenges and potential in creating future learning environments through the concept of a new learning landscape. It is based on the belief that physical planning can support the strategic goals of universities. In Denmark, a political focus on education as a mean to improve national capacity for innovation and growth are redefining the universities role in society. This is in turn changing the circumstances for the physical planning. Drawing on examples of physical initiatives in three different scales – city, building and room scale, the paper highlights how space and place matters on an interpersonal, an interprofessional and a political level. The article suggests that a wider understanding of how new learning landscapes are created – both as a material reality and a political discourse – can help frame an emerging community of practice. This involves university leaders, faculty and students, architects, designers and urban planners, citizens and policy makers with the common goal of creating future learning environments today.     

Praxis and reflexivity for interprofessional education: towards an inclusive theoretical framework for learning

Abstract

While there is growing evidence of theoretical perspectives adopted in interprofessional education, learning theories tend to foreground the individual, focusing on psycho-social aspects of individual differences and professional identity to the detriment of considering social-structural factors at work in social practices. Conversely socially situated practice is criticised for being context-specific, making it difficult to draw generalisable conclusions for improving interprofessional education. This article builds on a theoretical framework derived from earlier research, drawing on the dynamics of Dewey’s experiential learning theory and Archer’s critical realist social theory, to make a case for a meta-theoretical framework enabling social-constructivist and situated learning theories to be interlinked and integrated through praxis and reflexivity. Our current analysis is grounded in an interprofessional curriculum initiative mediated by a virtual community peopled by health and social care users. Student perceptions, captured through quantitative and qualitative data, suggest three major disruptive themes, creating opportunities for congruence and disjuncture and generating a model of zones of interlinked praxis associated with professional differences and identity, pedagogic strategies and technology-mediated approaches. This model contributes to a framework for understanding the complexity of interprofessional learning and offers bridges between individual and structural factors for engaging with the enablements and constraints at work in communities of practice and networks for interprofessional education.     

The role of interprofessional collaboration for intimate partner violence in psychiatric care: A research and development project

In Finland, policy requirements have demanded providers to work collaboratively together with regard to intimate partner violence (IPV). This research and development project seeks to identify efficient tools for stopping IPV. The project included staff training to recognize and respond to IPV, the development of a research-based guideline for use in the care situations of victims and perpetrators and the integration of the guideline into practices and staff development. Networking was developed during the project through interprofessional and multiagency collaboration, whereas appraisal information was collected at different stages of the process. This paper focuses on the issues of interprofessional collaboration, and uses psychiatric care as an example. There is some evidence that interprofessional interventions reduce the cost of patient care and improve the quality of IPV services. That is why it is important to discuss these issues and solve possible problems arising in interprofessional patient care.     

Clients as mediators of interprofessional collaboration in mental health services in Iran

Interprofessional collaboration (IPC) has long been identified as a way of providing optimal mental health services (MHS). It is important, therefore, to identify and facilitate factors driving IPC. This paper presents health professionals' experiences and perceptions regarding the clients' role as a driving factor for IPC in MHS in an Iranian context. Health professionals included nurses, physicians (general physicians and medical specialists), psychologists and consultants. Qualitative methods were employed in the form of in-depth individual interviews and focus groups to collect data from 24 professionals and 4 clients. Data analysis generated four key themes: “Clients as axis of IPC”, “Seamless services as a common incentive for IPC”, “Clients as a common interprofessional linkage” and “Clients as a driving force to achieve IPC”. From the professionals' perspective, it was found that clients had a mediating role in their collaborative relationships and practices. These findings are discussed in relation to the interprofessional literature. This paper goes on to argue that professionals need to be aware of and be trained about how to manage, as well as benefit from, the clients' fundamental role in IPC.     

Innovations in interprofessional education and collaboration in a West Australian community health organisation

This article is a short report that describes an initiative in interprofessional education (IPE) and collaboration in health practices in a community health organisation. Staff and students from nursing and allied health professions collaborate to implement a video feedback parenting programme. The results include an increased awareness of the benefits of both IPE and infant mental health principles, in particular the establishment of a common language across professions. Further systematic evaluations are required.