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.     

More than one dollop of cortex: Patients' experiences of interprofessional care at an urban family health centre

While Canada's government has called for collaborative patient-centered care, there is a paucity of research on patients' perspectives of such interprofessional care. This qualitative study conducted at an urban health centre begins to address our knowledge gap through semi-structured interviews and narrative analysis strategies. Findings indicate that “good care” is interprofessional care in the sense that patients perceive it as based in a strong patient-professional relationship that facilitates access to and communication amongst health professionals. Patients affirmed a frequent refrain of family physicians that the most valued characteristics of a health care team are the three “A's”: availability, affability and ability. While on several dimensions, the delivery of care was rooted in a patient-centered model, professionals, at points, struggled to find common ground with patients and initiated interprofessional care as a strategy for grappling with this conflict.     

The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness?

The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the “Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey” developed by Robson and Haddad (2012). The 28‐item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.     

Interprofessional care review with medical residents: Lessons learned,tensions aired – A pilot study

Integrated interprofessional care teams are the focus of Canadian and American recommendations about the future of health care. Keeping with this, a family medicine teaching site developed an educational initiative to expose trainees to interprofessional care processes and learning (Interprofessional Care Review; IPC). A formative evaluation pilot study was completed using one-on-one interviews and a focus group (n?=?6) with family medicine residents. A semi-structured guide was utilized regarding: knowledge, skills and attitudes related to interprofessional care; their experience of the processes utilized in IPC. Data were analyzed using content analysis. Residents' perspectives on their learning revolved around four themes: changes to understanding and practice of interprofessional care; personal impact of IPC; learning about other health professionals; tension and challenges of IPC learning and clinical implementation. Residents valued the educational experience, but identified that faculty supervisors provided “mixed messages” in the value of collaborating with other health professionals. Implications regarding future educational and research opportunities are discussed.     

Perceptions of interprofessional collaboration within child mental health care in Norway

The present study investigates professionals' perceptions of interprofessional collaboration (IPC) in the field of mental health care for children and adolescents. In this study, a 48-item questionnaire was developed to measure perceptions of interprofessional collaboration. A theoretical model (PINCOM) is presented and suggests that interprofessional collaboration is perceived at the individual-, group- and organizational level. The questionnaire was distributed to a sample consisting of 157 professionals in Western Norway. The results of this exploratory study show that the most prominent constructs of collaboration perceived by the professionals were: motivation, group leadership, social support and organizational culture. Furthermore, results indicate that women are more oriented than men toward IPC aspects of communication, coping and organizational domain. It is suggested that the questionnaire may be used to help improve interprofessional collaboration in clinical practice by indicating new ways to enhance dialogue between professionals and to investigate changes in perception of interprofessional collaboration over time. Limitations of the present study were identified and suggestions for future studies within the field are provided.     

Intermediate care: An interprofessional education opportunity in primary care

Background

Primary Care Trust Intermediate Care Services provides a range of services from occupational therapists, physiotherapists, nurses and social workers to clients in a community setting. With pre-registration students from two universities participating in placements at the Primary Care Trust, an opportunity for the students to observe professionals working together and to take part in interprofessional education (IPE) sessions was identified. A pilot project was undertaken to study how IPE may be made an explicit objective of learning that was already occurring in practice, particularly in light of the document “Creating an interprofessional workforce: An education and training framework for health and social care in England” (), which aims to provide the guidance needed to “mainstream IPE across health and social care”.     

Pioneering a Primary Care Adult Nurse Practitioner Interprofessional Fellowship

The Department of Veterans Affairs Office of Academic Affiliations funded 5 Centers of Excellence in Primary Care Education. The West Haven site pioneered the first post-master's adult nurse practitioner (NP) interprofessional fellowship to address the gap in NP education. The experiences of the initial cohort were captured through semistructured interviews. Qualitative analysis revealed 4 common themes: (1) bridging into professional practice, (2) expanded appreciation of health professionals' roles, (3) commitment to interprofessional teamwork, and (4) the necessity of mentorship. The initial findings suggest that post-master's adult NP interprofessional fellowship programs are an essential “next step” for new NPs.     

From students to professionals: Results of a longitudinal study of attitudes to pre-qualifying collaborative learning and working in health and social care in the United Kingdom

During a longitudinal evaluation of a pre-qualifying interprofessional curriculum, health and social care students completed questionnaires concerning communication and teamwork skills and interprofessional learning and working. Data were collected on entry to their educational programme, during the second year of study, at qualification and after 9–12 months' qualified practice. This paper presents results from practice data from 414 professionals; 275 were educated on the interprofessional curriculum, 139 on previous uniprofessional curricula. The former were more confident at qualification about their communicative skills, their interprofessional relationships and other professionals' interaction, and showed positive correlations between perceptions of their relevant skills and their interprofessional relationships. They were also more positive about their interprofessional relationships than practitioners educated on uniprofessional curricula. Age and previous experience of higher education influenced professionals' attitudes negatively: mature individuals may require more support when entering the workforce. Between qualification and practice, respondents from the interprofessional cohorts grew more critical of interprofessional education. However, experience of interprofessional education appears to produce and sustain positive attitudes towards collaborative working, suggesting that individuals' perceptions of their own educational experience are inadequate as an evaluative measure of interprofessional learning initiatives. This study reinforces the argument for including IPE in pre-qualifying curricula.     

Interprofessional collaboration in a community virtual ward: A focus group study

Background

The problem of a lack of nurses is expected to worsen in the future. With an ever-increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations.

Aim

The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context.

Methods

Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis.

Results

The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow-up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward.

Conclusion

We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient-centred and health promotion approach, seems to increase the quality of the follow-up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow-up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services.     

Diabetes empowerment related to Pender's Health Promotion Model: A meta‐synthesis

Diabetes self‐management is a challenge for both clients and health‐care professionals. Empowerment plays a vital role in helping clients to achieve successful self‐management. This study adopted a meta‐ethnographic approach. Nine qualitative studies were synthesized in order to contribute to a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self‐management. Four central metaphors that influenced empowerment were identified: trust in nurses' competence and awareness, striving for control, a desire to share experiences, and nurses' attitudes and ability to personalize. The lines‐of‐argument synthesis suggested the need for an evaluation system to appraise clients' diabetes knowledge, health beliefs, and negative emotions, as well as the outcome of interventions. Based on Pender's Health Promotion Model, this study emphasizes the fact that health‐care professionals need to understand and address modifiable behavior‐specific variables. The study suggests that an effective empowerment strategy would be to use activity‐related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health‐promoting behaviors.     

Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study

This article draws on data from a 5-year project that examined the effectiveness of Comprehensive primary healthcare (CPHC) in local communities. A hallmark of CPHC services is interprofessional teamwork. Drawing from this study, our article presents factors that enabled, or hindered, healthcare teams working interprofessionally in Australian primary healthcare (PHC) services. The article reports on the experiences of teams working in six Australian PHC services (four managed by state governments, one non-government sexual health organisation, and one Aboriginal community-controlled health service) during a time of significant health sector restructure. Findings are drawn from two key methods: an online survey of practitioners and managers (n = 154), and interviews with managers and practitioners (n = 60) from the six study sites. The majority of survey respondents worked with other health professionals in their service to provide interprofessional care to clients. Processes included formal team meetings, case conferencing, referring clients to other health professionals if needed, informal communication with other health professionals about clients, and team-based delivery of care. A range of interrelated factors affected interprofessional work at the services, from contextual, organisational, processual, and relational domains. Funding cuts and policy changes that saw a reorientation and re-medicalisation of South Australian services undermined interprofessional work, while a shared CPHC culture and commitment among some staff was helpful in resisting some of these effects. The co-location of services was a factor in PHC teams working interprofessionally and not only enabled some PHC teams to work more interprofessionally but also created barriers to interprofessional teamwork through disruption resulting from restructuring of services. Our study indicates the importance of decision makers taking into account the potential effects of policy and structural changes on interprofessional teamwork. Decision makers should strive to minimise unintended negative effects of changes on the functioning of interprofessional teams.     

Interprofessional collaboration with young people in residential care: some professional perspectives

The article discusses interprofessional collaboration with young people experiencing psychosocial problems living in residential care in Norway. The professionals involved (n=23) were social workers, psychologists, teachers, doctors/psychiatrists, unqualified graduates and other staff. The aim was to explore the professionals' contributions and grasp a sense of the wholeness of the collaboration process. A grounded theory approach was applied. During the analysis five categories emerged regarding professionals contributions; knowledge of own and others' agency/service, problem perception, priority, commitment and space for action. Three categories emerged regarding interprofessional interaction; building networks, developing trust and using flexibility. The core category was identified as ‘readiness to act’. The findings show an apparent contradiction between health and social policy that encourages the standardisation of services and responding flexibly to the needs of young people for ‘tailor made’ solutions through access to a range of services. A further finding was extensive use of flexibility and willingness to go beyond boundaries leading to the distinction between routinised and radical coordination.     

Exploring the potential for joint training between legal professionals in the criminal justice system and health and social care professionals in the mental-health services

Effective screening of mentally-ill defendants in the criminal court system requires cooperation between legal professionals in the criminal justice system (CJS), and health and social care workers in the mental-health service (MHS). This interagency working, though, can be problematic, as recognized in the Bradley inquiry that recommended joint training for MHS and CJS professionals. The aim of this study was to examine the experiences and attitudes of workers in the CJS and MHS to inform the development of relevant training. The method was a survey of mental-health workers and legal professionals in the court. The results showed that both agencies were uncertain of their ability to work with the other and there is little training that supports them in this. Both recognized the importance of mentally-ill defendants being dealt with appropriately in court proceedings but acknowledged this is not achieved. There is a shared willingness to sympathize with defendants and a common lack of willingness to give a definite, unqualified response on the relationship between culpability, mental-illness and punishment. Views differ around defendants' threat to security.Findings suggest there is scope to develop interprofessional training programs between the CJS and MHS to improve interagency working and eventually impact on the quality of defendants' lives. Recommendations are made on the type of joint training that could be provided.     

Collaboration between mental health and employment services to support employment of individuals with mental disorders

Purpose: The aim of this study was to investigate the extent of the interdisciplinary collaboration between mental health (MHS) professionals and social security professionals (SSI), their perceptions of this interdisciplinary collaboration and whether these perceptions differed between professionals of the two organizations. Method: We obtained data from mental health professionals and social security professionals in the context of a national agreement between MHS and SSI to improve the collaboration between MHS professionals and SSI professionals in the support of individuals with mental disorders to improve work outcome of these individuals. Results: Mental health professionals as well as SSI professionals reported a moderate level of interdisciplinary collaboration, which does not seem to be affected by demographic variables, such as age, gender, profession and region. When professionals collaborated in a structural way they were more positive regarding their interdisciplinary collaboration with professionals of the other organization than professionals that collaborated in an ad hoc manner. Conclusions: Interdisciplinary collaboration was perceived as moderate by collaborating mental health professionals and social security professionals. In order to improve the collaboration between MHS and SSI on a local microlevel, organizations need to facilitate more structural collaboration between the professionals.

• Implications for Rehabilitation

• Collaborating mental health professionals and social security professionals perceived their interdisciplinary collaboration as moderate.

• In order to improve the collaboration between mental health services (MHS) and vocational rehabilitation services on a local microlevel, organizations need to facilitate more structural collaboration between the professionals.

• Integrated services with the participation of MHS as well as vocational rehabilitation services, e.g. to share client information and to refer clients to each other, need to be developed.

• A national agreement between MHS and vocational rehabilitation services is a good starting point to improve collaboration between both the sectors.

     

Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course

As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled “Health Care System and Health Promotion” was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students’ views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.     

New way of working: Professionals’ expectations and experiences of the Culture and Health Project for clients with psychiatric disabilities: A focus group study

There is a need for various types of interventions when meeting needs of clients with psychiatric disabilities and complementary interventions may also influence their well‐being. The Culture and Health project, based on complementary interventions with 270 clients, was created in a county in Sweden for clients with psychiatric disabilities and for professionals to carry out the interventions. The aim of this study was to investigate the professionals’ expectations regarding the project and their clients’ possibilities for participating, and to investigate the professionals’ experiences of the project after its completion. Focus group data with a total of 30 professionals participating were collected. A qualitative content analysis revealed four categories of the professionals’ expectations before entering the project: “Clients’ own possibilities and limitations for their development and independence”, “Professionals’ possibilities for supporting the clients”, “Societal prerequisites”, and “Expectations of a new way of working”. Furthermore, the analysis regarding professionals’ experiences after working with the project revealed three categories: “Adopting the challenges”, “Having ways of working that function – prerequisites and possibilities”, and “Meeting the future – an ambition to continue”. Conclusion: Working in the Culture and Health project together with the clients in group‐based activities was perceived as beneficial, although challenges arose. When implementing cultural activities, support from stakeholder organisations is needed.     

A multiple-group measurement scale for interprofessional collaboration: Adaptation and validation into Italian and German languages

This article presents a study that aimed to validate a translation of a multiple-group measurement scale for interprofessional collaboration (IPC). We used survey data gathered over a three month period as part of a mixed methods study that explored the nature of IPC in Northern Italy. Following a translation from English into Italian and German the survey was distributed online to over 5,000 health professionals (dieticians, nurses, occupational therapists, physicians, physiotherapists, speech therapists and psychologists) based in one regional health trust. In total, 2,238 different health professions completed the survey. Based on the original scale, three principal components were extracted and confirmed as relevant factors for IPC (communication, accommodation and isolation). A confirmatory analysis (3-factor model) was applied to the data of physicians and nurses by language group. In conclusion, the validation of the German and Italian IPC scale has provided an instrument of acceptable reliability and validity for the assessment of IPC involving physicians and nurses.     

Interprofessional postgraduate education in primary health care: Is it making a difference?

This paper explores attitudes to, and perceptions of, the impact of interprofessional postgraduate education for primary health care professionals, based on a postal survey of 153 primary health care professionals undertaking postgraduate qualifications in New Zealand. The response rate was 75% (114/153 responses); comprising 79 doctors, 28 nurses, 7 other health professionals. As a result of their postgraduate education, 92% (104/113) reported improvement in their own practice; 68% (72/106) reported a positive influence on their workplace practice. Forty-eight percent (53/111) increased their understanding of their own professional role; 79% (77/98) increased their understanding of another professional groups' skills and competencies. Twenty-two percent (25/114) perceived increased career opportunities within a year; 56% (64/114) in the longer term. Only 12% (14/114) perceived future increases in income as a result of their study. Interprofessional postgraduate qualification study for primary health care professionals in New Zealand resulted in personal and professional benefit for individuals and their clinical practice, and increased understanding about their own and other health professionals' roles. The interprofessional nature of the education was seen as positive, contributing to a modest increase in collaboration between health professional groups. Barriers to furthering participation in interprofessional learning and increasing intersectorial collaboration in the workplace are identified and discussed.