Exploring elements of interprofessional collaboration between pharmacists and physicians in medication review

In medication review involving community pharmacists and physicians, there is an underlying assumption that if community pharmacists provide evidence based pharmacotherapeutic recommendations, physicians, in turn, will implement these recommendations. However, although in general medication review has been shown to improve the quality of medicine use, medication management plans arising from the medication review process are not always implemented. There is a need for better understanding of the factors that influence outcomes in medication review. The current paper will address some cultural and procedural factors that may assist in understanding outcomes in medication review using research into collaboration from areas outside the healthcare as a framework.     

Shared learning in practice placements for health and social work students in East London: a feasibility study

A voluntary organisation providing family support and mental health services carried out an enquiry into the feasibility of setting up placements in primary care for students from professional qualifying courses in community nursing, social work and occupational therapy to experience shared practice learning in their placement. Consultation with a range of courses from two universities in London and with GP practices and other primary care agencies in East London established that there was wide support for the idea from practitioners, managers and academic teachers. It was recommended that a small number of pilot placements be set up. It was acknowledged that the diversity of placement requirements across the spectrum of professional education is a limiting factor in bringing students together for practice learning. The authors suggest that in the longer term, the development of an interprofessional approach to practice learning will require structural changes to professional courses so as to bring their placement requirements more into line with each other.     

Strategies and focus at an integrated,interprofessional training ward

For the last ten years, the main characteristics of the education for students at the Faculty of Health Sciences, Linköping, Sweden, have been problem based learning (PBL) together with programme integration. A few years ago, rotation at the Training ward at the Department of Orthopaedics was made a compulsory element for students in the six programmes. The students practise teamwork in a realistic care environment under professional supervision. An evaluation of the first year at this training ward was carried out partly based on qualitative data from students from all the programmes involved. The qualitative analysis, based on interviews and the critical incident method, focused on the integrated teamwork and how the students make use of everyday activities in order to collaborate and understand each other's competences. Students integrated by applying three different strategies. These strategies were delegation, differentiation and discussion together with a situational focus on the specific task, on an individual basis or on sessions with students and tutors. Critical examples of efficient situations for training interprofessional work were joint rehabilitation work with just one fellow student, planning for the patient going home and emergency situations. Two different modes of integration were used by the students; the equal work distribution approach and the life-long learning approach. The main differences between the students are described in terms of contrasting forms of experiencing. This part of the evaluation leads to a more profound understanding of the premises of interprofessional, undergraduate training.     

Assessment of interprofessional learning: the design of an interprofessional objective structured clinical examination (iOSCE) approach

In this article, we illustrate the application of a number of theoretical frameworks we have used to guide our work in interprofessional education (IPE) and collaborative interprofessional care (IPC). Although we do not claim to be experts in any one of these theories, each has offered important insights that have broadened our understanding of the complexities of interprofessional learning and practice. We have gained an appreciation for an increasing number of theories relevant to IPE and IPC, and, as a result, we have woven together more key principles from different theories to develop activities for all levels of interprofessional learners and clinicians. We pay particular attention to relational competencies, knotworking/idea dominance, targeted tension and situational awareness. We are now drawing on the arts and humanities and complexity theory to foster relationship-building learning. Evaluation of our endeavors will eventually follow these latter theories for methods that better match the human and social experiences that underpin learning. Our “theoretical toolbox” therefore may be of value to educators who develop and implement creative interprofessional learning activities, as well as clinicians interested in moving toward more effective collaboration.     

Use of reflective writing within interprofessional education: a mixed-methods analysis

ABSTRACT

Nurturing student’s development of interprofessional collaboration is fundamental. Assessment-For-Learning can use reflection as one technique to support students’ growth. Thus, we investigated using reflective-writing within an interprofessional education (IPE) course using an exploratory mixed-methods design. In 2015, student-nurses, student-pharmacists, and student-physicians participated in an IPE course and completed self-assessments of student learning objectives (SLOs). In 2016, new cohorts of student-nurses, student-pharmacists, and student-physicians participated in the course and completed their self-assessments of SLOs; however, student-nurses and student-pharmacists also reflectively-wrote. Quantitatively comparing SLOs from 2015 cohorts with 2016 cohorts, we found that the effect-sizes (magnitude of difference) for those who reflectively-wrote (student-nurses and student-pharmacists) grew more than historical controls, whereas the effect-sizes remained unchanged for a control group (student-physicians) who did not reflectively-write. Qualitatively, initial and final reflective-writings were explored using content analysis. Initial reflective-writings helped students create a baseline for their final reflective-writings. In final reflective-writings, most students discussed their growth in understanding roles/responsibilities and communication, though limited growth was discussed for teams/teamwork and values/ethics. Thus, initial and final reflective-writings appeared useful within this IPE course. Initial reflective-writing further enhanced students’ self-assessed IPE improvement and recorded students’ baseline perceptions for later review, while final reflective-writings documented students’ self-actualized IPE development.     

Getting work done: a grounded theory study of resident physician value of nursing communication

ABSTRACT

Poor communication between nurses and physicians results in patient injury and increased healthcare costs. While multiple attempts have been made to improve communication between the two professions, evidence confirms little progress has been made. Previous research focused on standardizing communication processes and protocols between nurses and physicians rather than examining the relational component of these human interactions. The purpose of this study was to explore physician valuing of nursing communication in the context of patient care. Interviews were conducted with 15 internal medicine resident physicians. A constructivist grounded theory approach was used to develop the substantive theory of Getting Work Done. Getting Work Done incorporated three major categories: discerning the team, shifting communication, and accessing nurse knowledge and abilities. Hierarchical behaviors and language, and nurse collusion in both, characterized nurse-physician communication and situated the nurse outside the decision-making team. Complex work environments further devalued nurse-physician communication. Interprofessional education and practice must advance the unique and essential role of all health care professionals such that mutual valuing replaces hierarchical actions with collaborative systems for determining the most effective approaches to patient care.     

Revealing tacit knowledge used by experienced health professionals for interprofessional collaboration

ABSTRACT

With the current interest in interprofessional collaboration in health care as a response to ever-increasing complexity of health issues and scarcity of resources, many higher education institutions are developing interprofessional education (IPE) programs. However, there has been little empirical work on what. With the current interest for interprofessional collaboration in health care ever-increasing knowledge and skills are required to work collaboratively between health professions. We have undertaken to describe interprofessional collaboration as a practice largely underpinned by tacit knowledge acquired by experienced clinicians. Clinicians from all health professions in a large francophone university in Eastern Canada were invited to participate in explicitation interviews. Explicitation interviews require participants to freely recall an interprofessional collaboration event (e.g., team meeting or joint care delivery) and describe specific actions they personally enacted. An experienced health professional encounters many interprofessional situations over time; the actions they describe reflect their personal theories about the practice. Hence, it is highly probable that they use them frequently when working with colleagues in clinical settings. Unveiled tacit knowledge was divided into four themes: the importance of a sense of belonging to a team, the imperative to meet face-to-face, the practice of soliciting the working hypotheses of colleagues, and the art of summarizing meeting discussions.     

Building great health care teams: enhancing interprofessional work readiness skills,knowledge and values for undergraduate health care students

ABSTRACT

Collaborative ways of working have become increasingly important as healthcare adopts a more team-based approach to patient care. Interprofessional education (IPE) addresses some of the challenges associated with collaborative working and is increasingly offered to learners pre and post qualification. This article reports on a three-day IPE program designed to enable undergraduate health professional students develop interprofessional (IP) work readiness skills, knowledge, and values while undertaking clinical placement in a hospital setting. The curriculum built participant skills in culturally safe IP collaboration (IPC); focused on strategies for providing quality care to indigenous peoples and communities, and overtly linked IP competence to organizational mission and values. It highlighted the patient voice and displayed both the human cost of poor team communication and the comfort family members gained from watching united treating teams working with skill, compassion, and kindness. Twenty-four students from seven healthcare disciplines completed the program (N = 24). The Work Self-Efficacy Inventory (WS-Ei) and the Interprofessional Socialization and Valuing Scale (ISVS) assessed participant IP skills, knowledge, beliefs, values, attitudes, and confidence before and after program completion. A paired sample t-test showed an increase in mean scores in all responses on both scales. Results suggest that participation in the IPE program resulted in substantial shifts in knowledge, skills, and values as evidenced by changed assumptions and worldviews, enhanced knowledge and skills concerning IPC, improved understanding of other professional roles and increased confidence in managing workplace experiences.     

Interprofessional curriculum development achieves results: Initial evidence from a dementia-care protocol

This report describes the outcomes of a five-day, protocol-based interprofessional education (IPE) initiative to prepare undergraduate medical, nursing, and paramedic students for collaborative work with adults with dementia. Clinical placements provided a structured and supervised IPE experience for 127 students in two Residential Aged Care Facilities (RACFs) in Hobart, Australia, during 2013 and 2014. The IPE activity was based on a seven-step protocol formulated by an interprofessional team of educators and aged care practitioners that revolved around collaborative assessments of adults with complex health needs. This article describes the IPE protocol and presents the results of a pre- and post-placement attitude questionnaire and knowledge quiz administered to evaluate student attitudes towards IPE and knowledge of dementia. Data suggest that a five-day, supervised, and protocol-based IPE experience in a dementia-care setting can inculcate positive changes in student attitudes about collaborative practice and may encourage dementia-related learning outcomes.     

The use of trauma interprofessional simulated education (TIPSE) to enhance role awareness in the emergency department setting

Interprofessional simulation-based education (IPSE) is common in medicine and nursing curricula, however, less evident in diagnostic radiography. Previous work suggests graduate radiographers are unprepared in terms of trauma knowledge and experience. A trauma IPSE programme as a joint venture between two universities was developed. Our aim was to explore the views of radiography, nursing, and medical students regarding preparedness for trauma practice. Second-year radiography (n = 39), nursing (n = 10), and medical (n = 5) students were invited to participate in trauma simulations. Pre- and post-scenario questionnaires were completed and quantitative analysis undertaken. Prior to IPSE, the majority of students were unprepared to manage trauma. Post-scenario felt significantly more prepared to undertake their role in the team and had better understanding of their and other professions’ roles in trauma (P < 0.01). IPSE is an effective means of preparing undergraduate students in understanding both their and other professional’s roles within the trauma team.