Shared goals, shared learning: evaluation of a multiprofessional course for undergraduate students

Twenty-eight undergraduate degree students from seven health care professions attended a two-day pilot course. Using small multiprofessional groups, final-year students from occupational therapy, orthoptics, therapy radiography, nursing, physiotherapy, medicine and dentistry explored professional roles and clinical problem-solving using a theme-based approach. A balance of didactic and interactive small-group learning enabled them to identify issues surrounding multiprofessional teamworking and collaboration in the National Health Service. Evaluation results showed that the course increased knowledge and understanding of other health care professions, developed more positive attitudes and demonstrated the importance of multiprofessional teamwork and communication. Participating students believed that both early and regular opportunities for shared learning should be essential aspects of undergraduate courses.     

Everyone's problem but nobody's job: Staff perceptions and explanations for poor nutritional intake in older medical patients

Aim: Up to 60% of older medical patients are malnourished with further decline during hospital stay. There is limited evidence for effective nutrition intervention. Staff focus groups were conducted to improve understanding of potential contextual and cultural barriers to feeding older adults in hospital. Methods: Three focus groups involved 22 staff working on the acute medical wards of a large tertiary teaching hospital. Staff disciplines were nursing, dietetics, speech pathology, occupational therapy, physiotherapy, pharmacy. A semistructured topic guide was used by the same facilitator to prompt discussions on hospital nutrition care including barriers. Focus groups were tape‐recorded, transcribed and analysed thematically. Results: All staff recognised malnutrition to be an important problem in older patients during hospital stay and identified patient‐level barriers to nutrition care such as non‐compliance to feeding plans and hospital‐level barriers including nursing staff shortages. Differences between disciplines revealed a lack of a coordinated approach, including poor knowledge of nutrition care processes, poor interdisciplinary communication, and a lack of a sense of shared responsibility/coordinated approach to nutrition care. All staff talked about competing activities at meal times and felt disempowered to prioritise nutrition in the acute medical setting. Staff agreed education and ‘extra hands’ would address most barriers but did not consider organisational change. Conclusions: Redesigning the model of care to reprioritise meal‐time activities and redefine multidisciplinary roles and responsibilities would support coordinated nutrition care. However, effectiveness may also depend on hospital‐wide leadership and support to empower staff and increase accountability within a team‐led approach.     

Attitudes of health sciences students towards interprofessional teamwork and education

Relatively little is known about the specific attributes of health professional students which may influence their attitudes towards both interprofessional teamwork and interprofessional education. A survey was distributed to all pre-licensure health professional students from medicine, nursing, pharmacy and social work programmes at our institution. Respondents were asked to rate their attitudes towards interprofessional healthcare teams and interprofessional education using validated and reliable scales reported in the literature. Information on the respondents' gender, profession, year of study and prior experience with interprofessional education was also collected. There was no significant difference between attitudes of medicine and nursing students towards interprofessional teamwork; however, both these student groups report significantly less positive attitudes towards interprofessional teams than pharmacy and social work students. Medicine students reported significantly less positive attitudes towards interprofessional education than nursing, pharmacy and social work students. Female students and senior undergraduate students reported significantly more positive attitudes towards interprofessional teamwork and interprofessional education, while students reporting prior experience with interprofessional education reported significantly more positive attitudes towards interprofessional teamwork. Profession, gender and year of study appear to be attributes which were related to more positive attitudes towards both interprofessional teamwork and education.     

Multiprofessional learning: the attitudes of medical, nursing and pharmacy students to shared learning

OBJECTIVES: The belief that the effectiveness of patient care will improve through collaboration and teamwork within and between health care teams is providing a focus internationally for 'shared learning' in health professional education. While it may be hard to overcome structural and organizational obstacles to implementing interprofessional learning, negative student attitudes may be most difficult to change. This study has sought to quantify the attitudes of first-year medical, nursing and pharmacy students' towards interprofessional learning, at course commencement. DESIGN: The Readiness for Interprofessional Learning Scale (RIPLS) (University of Liverpool, Department of Health Care Education), was administered to first-year medical, nursing and pharmacy students at the University of Auckland. Differences between the three groups were analysed. SETTING: The Faculty of Medical and Health Sciences, University of Auckland. RESULTS: The majority of students reported positive attitudes towards shared learning. The benefits of shared learning, including the acquisition of teamworking skills, were seen to be beneficial to patient care and likely to enhance professional working relationships. However professional groups differed: nursing and pharmacy students indicated more strongly that an outcome of learning together would be more effective teamworking. Medical students were the least sure of their professional role, and considered that they required the acquisition of more knowledge and skills than nursing or pharmacy students. CONCLUSION: Developing effective teamworking skills is an appropriate focus for first-year health professional students. The timing of learning about the roles of different professionals is yet to be resolved.     

Changes in students' perceptions of interdisciplinary practice reaching the older adult through mobile service delivery

This study examined students' perceptions of interdisciplinary health care practice in a facilitated, community-based practicum experience. Students' perceptions of interdisciplinary practice relative to their own profession and other health disciplines were examined before and after involvement in mobile service delivery to the older adult in a collaborative team approach. The Interdisciplinary Education Perception Scale was used to collect data before and after planned and facilitated interdisciplinary experiences of students enrolled in health professional programs (nursing, dietetics, physical therapy, occupational therapy, pharmacy, health education, social work, and physician assistant). Univariate repeated-measures analysis of variance revealed significant pretest to posttest and discipline effects following the interdisciplinary interaction of students in the practicum experience. Univariate analysis revealed a significant change in students' perceptions of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and understanding of the value and contributions of other professionals from pretest to posttest. The findings support the need for educators to facilitate communication through innovative interdisciplinary clinical opportunities for health professions students to influence perceptions that promote active participation in a team approach to care delivery in an increasingly complex health care system.     

Assessing interdisciplinary education in U.S. dental hygiene programs

This study was done to examine the role of interdisciplinary education in dental hygiene curricula, identify factors associated with its implementation, explore the perceptions of dental hygiene educators related to interdisciplinary education, and explore these educators' perception of its validity and barriers to implementation. A 36-item questionnaire mailed to directors of all 216 dental hygiene programs in the United States elicited program demographics and information about participation in clinical and didactic interdisciplinary educational experience as well as attitudes regarding such experiences. The response rate was 63% (n = 136). Of the 136 respondents, 31% (n = 69) indicated that the dental hygiene curricula at their institutions included interdisciplinary activities; 15% (n = 33) indicated participation in both clinical and didactic interdisciplinary course work. Student participation was minimal, with most interdisciplinary activities taking place in didactic course work, but 74% (n = 160) of the respondents felt their students should be participating in interdisciplinary educational experiences. Chi-square analysis identified no consistent association among interdisciplinary activity variables. Many respondents felt that interdisciplinary educational experiences would benefit their students, but very few had incorporated them into their curricula, citing lack of resources and time as reasons. In addition, the term interdisciplinary was interpreted variably.     

Community group practices in Canada: are they ready to reform their practice?

INTRODUCTION: Governments and healthcare organizations in Canada are reforming the clinical practice structures and policies to deliver primary care to the population. A key component of primary healthcare reform is the establishment of an interdisciplinary, community-based team approach to patient care. This study was undertaken to provide in-depth insight regarding primary healthcare providers' beliefs and attitudes in regard to their current group practice, what changes they believe are occurring and those necessary to reform group practice settings, their willingness to embrace changes, and the challenges they face to realize the proposed reform. METHODS: This study employed a mixed-method research design (qualitative and quantitative data collection techniques) through day-long focus groups of primary healthcare professionals (eg, family physicians, specialists, dieticians, psychologists) from across Canada. RESULTS: There is considerable variation in the composition of primary care group practices across Canada. Respondents report that group practices are little more than an economic convenience to facilitate sharing of resources. Even when a practice is composed of several disciplines, there is little to no organized or systematic interaction among healthcare professionals aimed at improving patient care, lack of clarity as to identified leaders/managers of the team, and inconsistencies in the model of care provided to patients. However, there is a perception of value and benefit in working in a cohesive group practice to improve patient care. DISCUSSION: Findings revealed that although healthcare providers report themselves ready to make the necessary changes and willing to move to interdisciplinary team-based practices, there are substantive challenges that impede a movement to truly effective interdisciplinary team practice and functioning. These challenges include the type and allocation of funding, interprofessional healthcare provider education, changing the healthcare provision model, and barriers among healthcare professionals regarding shared and equitable team accountability for patient health outcomes.     

Does knowledge count? Attitudes toward smoking among medical,nursing, and pharmacy students in Hungary

Despite the fact that cigarette smoking in East Europe is a major health problem, no effective health policy responses have been developed thus far. Health care professionals represent a valuable resource for tobacco control. Therefore, we wanted to obtain information about the acceptance of smoking among medical, nursing and pharmacy students (n = 270) in Szeged, Hungary. The self-administered questionnaire contained items on smoking behavior, beliefs and attitudes related to smoking. ²-test were used to determine differences in the attitudes among students. Smoking was the most frequent among nursing students, followed by medical students. Pharmacy students not only reported smoking the least but they also showed the most acceptable attitudes toward smoking. The high frequency of smoking among students suggests that they themselves are unable to cope with avoiding the dangers of smoking. Moreover, responses reflect a generally poor appreciation of responsibility that health care professionals have in prevention. There is a need for an increasing emphasis on smoking-related attitude formation among medical and nursing students.     

Support in a time of need. The team approach at Mercy Medical Hospice addresses medical, emotional, and spiritual needs

Mercy Medical Hospice, Daphne, AL, uses an interdisciplinary team approach, which includes medical, nursing, social work, pastoral care, pharmacy, therapies, volunteer, and bereavement services. Mercy Medical has two home care offices and offers inpatient respite care for short periods, which is helpful for those who have an inadequate care giver system or need time to work out a better alternative to care in the home. An assessment of medical and nursing care needs, mental and emotional state, and psychological and spiritual needs is the first step after patients enter hospice. The entire team develops a care plan for the patient and family. Among the issues they address are education about the disease process, medication for pain control and symptom management, and how the patient and family cope with the patient's imminent death. Working with the dying and their families can be stressful for staff members, and they offer each other a lot of support. Working in hospice requires good stress management techniques, but staff feel that it is a calling that enriches their lives.     

Nutritional knowledge and attitudes of registered nurses.

Nutritional knowledge and attitudes of hospital nurses in Nebraska and their perceptions of the role of the dietitian in patient care were studied. In general, they had favorable attitudes toward nutrition. Although their knowledge was adequate, they lacked confidence in that knowledge. The nurses perceived dietitians in an educational rather than a service role. Older nurses had more favorable attitudes but were less knowledgeable than younger ones. More knowledgeable nurses had more positive attitudes toward their own role in nutrition education and toward the team approach to health care.     

Interprofessional Experiences and Attitudes Toward Interprofessional Health Care Teams Among Health Sciences Students

This study examined how the interprofessional experience, including education and practice, affects graduate health science students’ attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient’s care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.     

Evaluation of an educational program in health care teams

In July 1975, the Division of Ambulatory and Community Medicine at the University of California, San Francisco, initiated an interdisciplinary team education program as part of a required core medical clerkship in primary care. Significant emphasis was placed on evaluation of student and patient service outcomes. Overall, students rated the teaching in the program as moderately effective. The major measured gain for students was in their formal knowledge of the principles of teamwork, with secondary gains in patient problem-solving skills. The gains in knowledge were greatest for medicine and pharmacy students. During the team education program, the average number of patients seen by student providers was greater than it had been during previous clerkships. Similarly, the comprehensiveness of care provided was higher during the team education program. Although no significant differences were found between student teams and individual providers, those teams with consistent membership from all three participating disciplines (medicine, pharmacy, and nursing) delivered more comprehensive care.     

A community-based approach to the medical humanities

BACKGROUND: This paper discusses the rationale behind, and an approach to, the development of a graduate level interdisciplinary curriculum in literature and health care that incorporates community-based learning. Such an innovative approach emerges from the recognition that professional training in both health care and humanities programmes often does not model the kinds of collaborative relationships and professional values desired by contemporary health care students, providers and patients. METHOD: Recent trends in literary study and the medical humanities are described, along with the function (and benefits to students) of interdisciplinary classrooms and the role of community-based learning in higher education. The authors discuss their experiences teaching, and offer students' responses to medical humanities courses from which the concept for such a curriculum evolved. The paper offers advice on developing, evaluating and disseminating such a model curriculum for medical, nursing and graduate literature students. PROPOSAL: By linking health care with graduate English literature students, such a course would promote dialogue and understanding among health professionals, enhance student awareness of the effects of illness on patients, their caregivers and families, and encourage student activism and community service. A common set of literary works would provide a shared vocabulary and opportunities for ethical, critical and personal response. Working together in a community-based project, students from different programmes would learn to appreciate alternative professional and lay perspectives on common experiences.     

Interprofessional Models for Shared Decision Making: The Role of the Health Care Chaplain

Shared decision making (SDM) is a central component of patient-centered care; however, a minimal amount is known about what health care chaplains contribute to this process. Data from 463 full-time chaplains practicing in the United States collected by an online survey was analyzed using SPSS 26 for bivariate and multivariate logistical regressions to identify variables impacting chaplain integration into SDM. Coding of free text responses yielded multiple domains for chaplain contributions and barriers. Thirty-eight percent of chaplains reported being often or frequently integrated into health care team discussions regarding medical decisions, with years of professional experience, time spent supporting the emotional processing of medical decisions, and being well-prepared as the strongest predictors for high integration. Qualitative analysis yielded a multifaceted picture that includes chaplain attention to the impact religion has on decision making, a focus on the patient story, and chaplains as mediators between patients, families, and the health care team. The full integration of chaplains into SDM will require education of the interdisciplinary team regarding the scope of chaplain knowledge and skills, as well as organizational level changes in chaplain to patient ratios and coverage models. In this era of increased fragmentation of health care provision and advancing complexity of medical decision making, models of Interprofessional Shared Decision Making (IP-SDM) such as the one proposed here that appreciate the specialized knowledge and skills of each member of the health care team hold promise for enhancing patient-centered care.     

Pay for performance in hospitals: implications for nurses and nursing care

As pay-for-performance programs gain momentum, hospital administrators and clinical leaders will need to consider the organization's infrastructure and measures that promote quality management initiatives. Many hospital performance measures by the Centers for Medicare & Medicaid Services involve chronic diseases that may be best managed by an interdisciplinary team-based approach, of which nurses are significant members. While the primary focus of pay-for-performance has been concentrated on physicians, comparatively less attention has been given to the potential impact on nurses and nursing care. Moreover, the impact of the pay-for-performance measures on nursing labor and processes has not been well studied. Within acute care settings, increasing attention has focused on the structure of nursing, such as number and skill mix of nursing personnel, processes of care, and influence on patient outcomes. As pay-for-performance standards evolve and encompass patient outcomes, attention to nursing's contribution will follow. Nursing leadership will need to address a number of strategies to (a) address the impact of pay-for-performance on nursing performance measures as well as (b) on staff nurses' ability to contribute to the organization's efforts in achieving pay-for-performance standards, including education, documentation, team collaboration, and patterns of care.     

RURAL INTERDISCIPLINARY HEALTHCARE TRAINING IN HAWAII: A CROSS-CULTURAL PROJECT

ABSTRACT: In 1993, a federally funded project began at the University of Hawaii to educate students from a variety of health professions (nursing, medicine, dental hygiene, psychology, public health, and social work) about the challenges of working as an interdisciplinary team in rural health settings. After nine months of study, this education culminated in students participating in interdisciplinary team projects in rural areas of Hawaii. The development and funding of interdisciplinary rural health projects across the United States reflects the growing awareness that limited resources and access to health in rural areas requires resource sharing, both physical and non-physical. Exposing students to information about rural health care, and then providing hands-on opportunities for teamwork with fellow students in a rural setting, can serve an additional and critical function: to recruit to rural areas healthcare workers who are already aware of the challenges and rewards of this type of practice.     

The effects of death education on nurses' attitudes toward caring for terminally ill persons and their families.

This study sought to determine the effectiveness of an education program on nurses' attitudes toward caring for terminally ill persons and their family members. The program, based on the hospice concept of care, included a didactic section based on Kubler-Ross' stages of death and dying, and a role-play model designed by the researcher. Data were collected from 34 licensed nurses, aged 18 to 65, practicing in the midwestern United States. The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) was designed by the researcher to assess nurses' attitudes. The FATCOD was found to be a valid and reliable tool. All nurses completed the tool before and after the education program (pre-test, post-test). Compared by a t-test, the scores for the nurses were significantly higher after participation in the educational program. The t-value was found to be 2.97, significant at the less than 0.01 level, 2-tailed probability = 0.006. These findings support the hypothesis that nurses have a more positive attitude toward caring for terminally ill persons and their family members after participation in the program, than the same nurses had before participating in the program. Demographic information including age, years of experience in nursing, highest degree held, basic type of nursing preparation and previous education on death and dying were analyzed to determine their relationship to the nurses' attitudes. The only information which demonstrated any significant relationship to the nurses' attitudes was that of previous education on death and dying. These were computed by an analysis of variance (ANOVA) F = 3.22, F prob = 0.04, significant at less than 0.05 level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Decisions near the end of life.

Designing behavior change programs and evaluating their effects on patient care has been a persistent challenge in research on continuing medical education. The challenge becomes even more complex when we aim to change behaviors that are interactive and highly influenced by the formal and informal institutional context. The authors describe an interdisciplinary continuing education program in bioethics that is designed to effect just such behaviors. The program aims to help hospital and long-term care facilities improve their ability to resolve the ethical dilemmas inherent in terminal care decisions. Targeted to interdisciplinary groups of physicians, nurses, social workers, pastoral counselors, and administrators, Decisions Near the End of Life will provide strategies and tools for examining institutional policies and team practices as well as more traditional information, education, and skill building. The authors describe the program's rationale and design, and raise questions about the potential for developing interdisciplinary, action-oriented CME on other topics.     

Interdisciplinary education as a facet of health care policy: the impact of attitudinal research

The past decade has seen a move toward a conscious interdisciplinary practice in health care delivery. Spurred on by intractable issues of fragmentation of services and lack of comprehensiveness, the proliferation of team and other kinds of integrated models have been reported in the literature but seldom conceptualized for their potential impact on service. Moreover, the literature generally lacks an empirical base and can be characterized as ideological. Educational institutions have remained largely untouched structurally in regard to providing interdisciplinary models of education, and issues such as the professional "hierarchies" in health and "turf" are seen as barriers to institutional response. This article describes a program of interdisciplinary education at one university, specifically in the context of potential impact on educational policies. The interdisciplinary health education program began as an informal, voluntary arrangement among four health-related professional schools and ultimately involved six schools. Research on cognitive and attitudinal learning of participating students was undertaken, supporting the educational rationale for conjoint, problem-focused learning. The article traces the history of the program's impact on education policies and points to the need for a stronger empirical base. Innovative education experiences, constructed from the earlier research undertaken, are described.