Involving service users in interprofessional education narrowing the gap between theory and practice

Calls for greater collaboration between professionals in health and social care have led to pressures to move toward interprofessional education (IPE) at both pre- and post-registration levels. Whilst this move has evolved out of “common sense” demands, such a multiple systems approach to education does not fit easily into existing traditional educational frameworks and there is, as yet, no proven theoretical framework to guide its development. A research study of an IPE intervention at the University of Liverpool in the UK drew on complexity theory to conceptualize the intervention and to evaluate its impact on a group of ～500 students studying physiotherapy, medicine, occupational therapy, nursing and social work. The intervention blended a multidisciplinary (non-interactive) plenary with self-directed e-learning and a series of interdisciplinary (interactive) workshops. Two evaluations took place: the first when the workshops were facilitated by trained practitioners; the second when the practitioners co-facilitated with trained service users. This paper reports findings from the second evaluation which focused on narrowing the gap between theory and practice. A multi-stakeholder evaluation was used including: students' reflective narratives, a focus group with practitioners and individual semi-structured interviews with service users. Findings showed that service users can make an important contribution to IPE for health and social care students in the early stages of their training. By exposure to a service user perspective, first year students can begin to learn and apply the principles of team work, to place the service user at the centre of the care process, to make connections between theory and “real life” experiences, and to narrow the gap between theory and practice. Findings also revealed benefits for facilitators and service users.     

Assessing the cognitive-interpersonal cycle

This article argues that Harry Stack Sullivan's conceptions of interpersonal psychotherapy have a number of important implications for both the theory and practice of cognitive behavior therapy. Sullivan's formulations, while compatible with cognitive behavioral theory in many respects, add both motivational and interpersonal contexts that are missing from cognitive behavior therapy. With regard to the first theme, it is argued that Sullivan's theory on the role of anxiety in the development and maintenance of dysfunctional cognitive structures has important implications for both cognitive assessment and modification. With regard to the second theme, it is argued that the therapist's role as a participant-observer in the therapeutic relationship provides him with a valuable opportunity for identifying maladaptive interpersonal patterns and assessing dysfunctional cognitive activities that are linked to these patterns.I would like to express my gratitude to an anonymous reviewer whose perceptive comments and suggestions on the Safran (1984) article were very helpful in writing the present article.     

Examining Affective-Motivational Dynamics and Behavioral Implications Within The Interpersonal Context of Pain

Emotional, motivational, and interpersonal dimensions are considered integral to pain experience but have largely been examined separately. In this focus article, we argue that an integrative theoretical account that acknowledges each of these elements is a critical next step to capture the complexity and nuance of interpersonal pain dynamics and to shape future research. The aim of this focus article is to provide a foundation for such an account by drawing upon established insights from appraisal theory of emotion, influential behavioral models, empathy/interpersonal pain research, and social psychology literature to highlight conceptual relationships, potential mechanisms of action, and avenues of inquiry that have not previously been examined in the context of pain. Specifically, we highlight the interpersonal nature of pain and the conceptual relationship between emotion and motivation in pain experience. We discuss an affective-motivational tension between self- and other-oriented goals that can arise within the interpersonal pain context, and how such dynamics may affect the nature and effectiveness of caregiving behavior. We then describe the role of emotion regulation and strategies that may facilitate optimal interpersonal pain dynamics and caregiving within a multiple goal context. Finally, we outline a foundation for an integrative theoretical model and directions for future research.

Health professionals in multi-disciplinary and multi-agency teams: Changing professional practice

The article draws on an Economic and Social Research Council (ESRC)-funded research project that aimed to investigate the reality behind the rhetoric of “joined up thinking”. The research project was a qualitative, multi-method study involving three phases, including observation and documentary analysis; interviews; and focus groups around decision making and knowledge sharing. The article reflects on the perspectives and experiences of health professionals and their colleagues in multi-agency teams about the impact of multi-agency teamwork on their professional knowledge and learning, and on their ways of working. Actual and potential conflicts between professionals are explored about models of understanding, about roles, identities, status and power, about information sharing, and around links with other agencies. Dilemmas of team building and of conflicting values and knowledge are exemplified from health professionals' accounts, using theoretical models of “communities of practice” and “activity theory”. The article presents groups of strategies that health professionals and their colleagues in multi-agency, multi-professional teams use to overcome barriers and to strengthen team cohesion. The conclusion reflects on some implications of our findings in theory and practice for professionalism within integrated, multi-professional teams that are building new ways of working.     

Room for family-centered care – a qualitative evaluation of a neonatal intensive care unit remodeling project

The physical layout of a Neonatal Intensive Care Unit (NICU) seems to play an important, yet disregarded role in establishing family-centered care (FCC). Based on two focus group interviews this article qualitatively evaluates how a physical layout intervention changed matters for parents and health personnel. Collectively, the participants experienced three interior design layouts: open space design, modified rooms and smaller rooms. Inspired by grounded theory, the article explains how establishing smaller rooms equipped with a parent bed placed next to the sick infant provided “room for family-centered care” in a double sense: it reduced the parents’ burden by providing space for them to come to terms with the situation and to start the bonding process; it allowed professionals to commit to meeting increased demands. The study concludes that smaller rooms enhance FCC in a NICU when personnel are prepared to accept the challenge.     

The changing role of residential intervention

ABSTRACT

The role of therapeutic residential care (TRC) is changing. In fact, this article reframes the terminology of TRC and uses “residential interventions” to more accurately reflect that residential programs provide time-limited “intervention” and treatment efforts must connect and extend to families and communities. Such changes are being compelled by necessity and innovation. Necessity is demanding evidence, data, and durable positive outcomes for this expensive intervention. Innovation is transforming basic service delivery through meaningful inclusion of youth and families and effective collaboration with community-based organizations. Service elements that confound this changing role are being reconsidered, including reductions in length of stay, a focus on long-term permanency, and the location of the actual intervention from program-centric practice to interventions in the home and community.     

A triage model of psychotherapeutic group intervention

The cofacilitator of a veteran's therapy group conducted by a Veterans Administration (VA) clinical nurse specialist uses his participant-observer role to analyze the theoretical constructs used in the group. A unique group psychotherapy model blending nursing triage techniques with “hot seat” client focus and interpersonal theory is presented and compared with similar models. Clinical issues arising from its use among combat veterans with post-traumatic stress disorder at a New Hampshire VA Medical Center are also discussed.     

How media empower the vulnerable: Using community structure theory to analyze relationships between demographics and health reporting

Instead of studying the impact of media on society, the traditional “top down” orientation of most communication studies scholars, this keynote presentation adopted the opposite perspective, exploring the “bottom-up” impact of “society” on “media”. Unlike conventional “agenda-setting theory”, which suggests that nationally prominent news media set issue “agendas” for other news media and public opinion, and also unlike the “guard dog” view that media essentially protect the interests of political and economic elites, the “community structure theory” explores links between different community (typically city or nation-state) demographics and variations in reporting on critical health concerns. Summarizing his scholarship on health communication presented and published over decades, the speaker outlined community structure theory’s illumination of two overall patterns in US and cross-national coverage of health communication issues. In US coverage, broad measures of economically “buffered” privilege (educational, income, or occupational advantage) are linked to “favorable” or “government responsibility” coverage of health issues, and specific measures of “health” privilege (physicians, hospitals) are connected to “favorable” or “government responsibility” coverage promoting selected health issues. In cross-national coverage, specific measures of national “health vulnerability” (such as percent without improved water access, infant mortality rate) are linked to “government” responsibility coverage for selected health issues (human trafficking, water handling/contamination). In addition, broad measures of “macro” vulnerability conditions (agricultural dependence, political instability) are associated with “government” responsibility coverage for a wide range of health issues (genetically modified foods, drug trafficking, condom promotion, and food security). Overall, community structure theory’s “bottom up” perspective reveals how the vulnerable are empowered by their demographic alignment with variations in health communication.     

Old Friends With New Faces: Are Sodium Channel Blockers the Future of Adjunct Pain Medication Management?

Providers are being asked to decrease the emphasis and overutilization of long-term opioid therapy, but many are left without proper guidance on appropriate utilization of nonopioid therapies. Furthermore, therapeutic options are quite limited and many providers lack confidence in distinguishing available alternatives. When first-line therapy has failed in a patient, there is an apparent lack of knowledge on how to proceed with choosing subsequent therapy. To choose among alternative agents, an understanding of pharmacology, pharmacokinetics, and efficacy in targeting various pain conditions is necessary. This article focuses on the use of the carboxamide class of sodium channel blockers (carbamazepine, oxcarbazepine, eslicarbazepine) for adjunct pain medication management including research updates in pharmacology, pharmacokinetics, and current evidence for pain along with promising areas of research. It is an evidence update for clinical use of sodium channel blockers, clarifies misconceptions regarding their use, and highlights emerging research for improved pain targets that justifies additional study. We performed a complete review of the literature using the search terms, “oxcarbazepine,” “carbamazepine,” and “eslicarbazepine” in conjunction with “pharmacokinetics,” “adverse effects,” “pharmacology,” “voltage-gated sodium channel subtype,” “neuropathic pain,” “inflammatory pain,” “metabolism,” “epoxide metabolite formation,” “drug interactions,” “CYP450 interactions,” “pain phenotype,” and “chronic pain management.” Databases searched included PubMed and Google Scholar. Package inserts were used for drug structure illustration, adverse reactions, and bioavailability. Pharmacology and pharmacokinetic data were taken from randomized controlled trials evaluating this area as well as in vitro published results. For validity, only peer-reviewed literature was included. Evidence for sodium channel blockers in chronic pain management was limited. This review focuses on highlighting the data available for the use of sodium channel blockers for certain pain syndromes as well as underutilized potential. Emerging literature on sodium channel subtypes and their connection to neuropathic, inflammatory, and mechanical pain transmission is elucidated. The authors also scrutinize literature surrounding the pharmacokinetics of oxcarbazepine and eslicarbazepine to provide clearer guidance to the significance of any drug interactions and refute assumptions made on the basis of structural similarity to carbamazepine and its known undesirable drug interactions. Side effect profiles are outlined and compared, emphasizing the differences between agents. Sodium channel blocker doses used in certain pain syndromes are outlined with a call for further research to better understand their place in chronic pain management. Identification of sodium channel subtypes with links to specific pain conditions and the ability to target them hints at the potential for truly individualized therapy. Sodium channel inhibitors are underutilized on the basis of available evidence, and emerging research has identified this area as promising for additional clinical trials to better guide clinical practice.

The effect of the training of presence in care (TPinCare) on the care-oriented patient-nurse interaction and the caring behaviors of nurses working with oncology patients: A randomized controlled trial

AimThe aim of this study is to investigate the effects of “The Training of Presence in Care-TPinCare” of nurses working with oncology patients on care-oriented patient-nurse interaction and caring behaviors.BackgroundHelping the individual to realize, protect and maintain his/her existence can be considered as the basis of "good nursing care". Presence is a way of care for the nurse and patient that fosters human-to-human bonding and deep contact experience and healing.DesignThis is a randomized controlled study.MethodData were collected between January 2019 and May 2019. The sample selection consisted of 52 nurses working with oncology patients, 26 interventions and 26 controls in accordance with the criteria of inclusion, exclusion and exemption by randominization and blinding. The data were collected by using the "Nurses Introductory Features Form", "Caring Behaviors Scale − 24 " and "Caring Nurse-Patient Interaction Scale". The training was applied to nurses in the intervention group. In data analysis used SAS 9,4 program; statistically Mean score, t test, Repeated Measures ANOVA. In the context of these effect sizes, the power of the study was calculated to be 0.99 for each scale. This study was conducted in line with the principles of the Declaration of Helsinki.ResultsAccording to the control group of nurses in the intervention group, there were no statistically significant differences in the mean scores of caring behaviors at different measurement times. A statistically significant difference was found in favor of the intervention group for caring nursing patient interaction general, sub-dimensions of "importance”, “competence” and “practicality", in nursing interventions (p < 0.05). Although the pretest mean scores of the nurses in the intervention group were lower compared with the control group, it was found that the posttest mean scores increased and the level of follow-up was maintained by a little increasing or decreasing. It was determined that there was no significant change in the posttest and follow-up scores of the nurses in the control group according to the pre-test mean scores.ConclusionsThis study showed that TPinCare has a positive effect on nurses working with oncology patients with respect to care quality perception and viewing “importance”, “competence” and “practicality", of attitude and behaviours related to care-focused patient nurse interactions. In this context, it can be suggested to continue the trainings which will contribute to caring behaviors and patient-nurse interactions of nurses and to support them with institutional contribution.     

Culturally‐grounded mother–daughter communication‐focused intervention for Thai female adolescents

Teenage pregnancy‐prevention interventions have fallen short in significantly decreasing risk of pregnancy for Thai populations. The “breaking the voice” (“rak luk khun tong pood”) culture‐appropriate teenage pregnancy‐prevention program was developed using community‐based research. Qualitative analyses of focus group data identified salient factors related to sexual communication and behavior. The integration of focus group results with theoretical constructs guided the development of an intervention to reduce risky sexual behavior by increasing communication between mothers and their adolescent daughters. A total of 157 mother–daughter dyads from congested areas in Bangkok participated in pilot testing of the intervention by the use of a survey. The findings indicated a significant increase in the frequency of and number of sexual risk communication (P < .05). There was a significant increase in perceived power in relationship control, ability to prevent sexual risk, assertiveness, and ability to decrease sexual risk among daughters (P < .05). “Breaking the voice” represents a female‐focused and culturally‐relevant intervention to combat teenage pregnancy.     

The Weighty Matter Intervention: A Family-Centered Way to Tackle an Overweight Childhood

The complexity of childhood overweight and obesity requires that researchers continue to investigate potential solutions. We developed “The Weighty Matter” intervention to prevent obesity in mildly overweight 4- and 6-year-old children. This article describes the intervention protocol, the health habits of families (n?=?86), and the effect of the intervention on children's weight for height, parents' body mass indices, and family health habits after a 12-month follow-up. Positive changes were seen in families' health habits, although the results did not reach statistical significance. As a result of this study, a new and practical method was developed to focus on the issue of family health habits.     

Navigating Interprofessional Spaces: Experiences of Clients Living with Parkinson’s Disease,Students and Clinical Educators

When students in interprofessional education and practice programmes partner with clients living with a long-term condition, the potential for a better client and educational experience is enhanced when the focus is on client self-management and empowerment. This paper reports the findings from a phenomenological study into the experiences of five clients, six speech language therapy students, eight physiotherapy students, and two clinical educators participating in a university clinic-based interprofessional programme for clients living in the community with Parkinson’s Disease. Collaborative hermeneutic analysis was conducted to interpret the texts from client interviews and student and clinical educator focus groups held immediately after the programme. The overarching narratives emerging from the texts were: “client-centredness”; “who am I/why am I here?”; “understanding interprofessional collaboration and development”; “personal and professional development, awareness of self and others”; “the environment - safety and support”. These narratives and the meanings within them were drawn together to develop a tentative metaphor-based framework of “navigating interprofessional spaces” showing how the narratives and meanings are connected. The framework identifies a temporal journey toward interprofessional collaboration impacted by diverse identities and understandings of self and others, varying expectations and interpretations of the programme, intra- and interpersonal, cultural and contextual spaces, and uncertainty. Shifts in being and doing and uncertainty appear to characterise client-driven, self-management focused interprofessional teamwork for all participants. These findings indicate that students need ongoing opportunities to share explicit understandings of interprofessional teamwork and dispel assumptions, since isolated interprofessional experiences may only begin to address these temporal processes.     

Educators working together for interprofessional education: From “fragmented beginnings” to being “intentionally interprofessional”

This article explores the development of interprofessional relationships between healthcare educators working together for interprofessional education (IPE). As part of a collaborative dialogical inquiry, data from 19 semi-structured interviews and 9 focus groups were used to explore how IPE educators develop shared purpose to help students learn to work with other health professions. Consistent with this methodology, the research group and study participants comprised educators from eight different professions. Questions asked of the data, using a lens of intersubjectivity, included: “What implicit assumptions are brought to interactions?” and “What happens to these assumptions as educators interact?” The emergent themes caution against assuming that all educators initially bring to interprofessional spaces only positive attitudes towards all professions. Educators beginning in a fragmented interprofessional space needed to reflect on earlier negative experiences with particular professions for reframing in a socially aware interprofessional space to enable collaborating in an intentional interprofessional space.     

Respiratory effects of increased intra-abdominal pressure

There has been an exponentially increasing interest in intra-abdominal hypertension (IAH). Comparison of the published data however is difficult due to the lack of consensus definitions. This review will focus on the available literature from the last years. A Medline and Pubmed search was performed using “intra-abdominal pressure” (IAP), “IAH”, and “abdominal compartment syndrome” (ACS) in combination with “cardiac”, “cardiovascular”, “organ function”, “respiratory” or “pulmonary” as search items. The aim was to find an answer to two questions: first, “Is it not time to pay attention to IAP in the critically ill?” And second, “what is the cardiovascular and respiratory impact of increased IAP?”Although the number of studies published on this topic is steadily increasing and confirms the pathophysiologic implications of IAH on end-organ function within and outside the abdominal cavity it remains difficult to compare the literature data because measurement methods and definitions used are not uniform. Therefore the World Society on Abdominal Compartment Syndrome (WSACS – www.wsacs.org) recently published a consensus definitions report. Provocative data have been published regarding the interactions between the abdominal and thoracic compartments especially in patients with capillary leak and fluid overload. In conclusion we can state that the answer is that it is now time to pay attention to IAP in the critically ill, but it is also time for standardized IAP measurement methods and multicenter randomized interventional studies.     

Cancer rehabilitation from the perspectives of oncology nurses in Korea

The purpose of this study was to understand the perception of oncology nurses and how it is related to cancer rehabilitation in Korea. A qualitative study with three focus groups consisting of 6–8 Korean oncology nurses (n = 21) was conducted. The interviews were thematically analyzed. Two main themes for the attributes of cancer rehabilitation were “comprehensive activities of nurses” and “active involvement of survivors.” Six subthemes from the oncology nurses' care experiences were identified: “incorporating partnership and sharing feelings,” “fulfilling individualized needs,” “providing timely and practical support,” “enhancing internal strength with optimistic mindset,” “regaining functional independence,” and “getting family members in.” The findings suggest that oncology nurses can play a key role in rehabilitation for cancer survivors. Nursing interventions focused on comprehensive activities of nurses as well as active involvement of survivors can be effective in enhancing cancer survivors' strength and resilience in order to lead a healthy life. Oncology nurses need to be taught a psychosocial intervention based on individualized assessment and family partnership for cancer survivors.     

Care and Control: Working Alliance Among Adolescents in Authoritarian Settings

This article reviews the literature published in the last 20 years on working alliance in adolescents involuntarily enrolled in intervention programs. Firstly, Bordin's adaptation of the concept of working alliance to adolescent populations is discussed. This is followed by an analysis of the main results of empirical studies on helping relationships in authoritarian settings. Finally, the results of these studies are used as the basis for a multidimensional (personal, interpersonal, contextual) model of working alliance in young people in authoritarian settings. A key conclusion of this article is that differences in intervention context are essential to the understanding of the establishment of working alliance in young people. A dyadic vision of working alliance (patient/therapist) does not appear to significantly advance the theory of clinical practice.     

The empty space phenomenon: The process of grief in the bereaved family

Abstract

Forty-nine families who experienced a death following childhood cancer were interviewed 7–9 years after the death. Interviews were analyzed using grounded theory technique for qualitative data for the purpose of examining the long-term responses of families to childhood death. In contrast to bereavement theories which claim that grief is usually resolved within two years, findings of this study suggest that many parents and siblings still experience pain and loss after 7–9 years. Analysis suggests that the death of a child creates an “empty space” for surviving family members. Three patterns of grieving were described by family members in response to this sense of emptiness: “getting over it,” “filling the emptiness,” and “keeping the connection.” Differences and similarities of these patterns are enumerated. The perceived significance of the relationship to the pattern of grief is hypothesized. Situations which stimulate a recurrence or continuation of the “empty space” are suggested and changes over time in the bereavement process are described. Further research implications are proposed.