Interprofessional Development Research Articles

Listening Visits to Mothers’ Suffering with Mild to Moderate Peri-Natal Depression; Critical Issues of Clinical Supervision, Training and Health Visiting Capacity to Tackle Health Inequalities

The importance of United Kingdom health visitors' in the detection and treatment of peri-natal depression in primary care services is well documented. Evidence based policy and clinical guidelines make recommendations for the prediction, detection and treatment of women with mild to moderate depression in the postnatal period continuing up to a year after delivery. An inter-professional cross organisational practice development project aimed to assess the provision of antenatal and peri-natal mental health care within one health visiting service in accordance with NICE guidelines (2007). This paper discusses the disparity between guidelines and health visiting practice; a lack of training in listening visits or other psycho therapeutic methods, poor access and availability of clinical supervision, commissioning reforms leading to larger health visiting caseloads suggesting the service is unable to meet NICE recommendations. Lastly, the evidence suggests the scope and practice of community nurses' within health visiting teams should be expanded.

Interprofessional primary care protocols: A strategy to promote an evidence-based approach to teamwork and the delivery of care

Primary care reform involving interprofessional team-based care is a global phenomenon. In Ontario, Canada, 150 Family Health Teams (FHTs) have been approved in the past few years. The transition to a FHT is complex involving many changes and the processes for collaborative teamwork are not clearly delineated. To support the transition to team-based care in FHTs, a project was undertaken to develop and implement a series of interprofessional protocols in four clinical areas. These interprofessional protocols would contain relevant and evidence-based resources to support both a team and evidence-based approach to care. This paper reports on a qualitative study to examine the process of interprofessional protocol development and pilot implementation. Adopting an exploratory case study approach (Robson, ), 36 interviews were conducted with health professionals and community group members who participated in the creation and piloting of the protocols, and with project managers. In addition, observational and documentary data were gathered on the protocol development and implementation processes. The findings from the protocol development stage demonstrate the value of the focus on evidence and team, the process of assessing and targeting FHT needs, inter-organizational and interprofessional sharing, the importance of facilitation and support, and expectations for implementation. The findings from the pilot implementation stage report on the importance of champions and leaders, the implementation strategies used, FHT and organizational factors affecting implementation, and outcomes achieved. Findings are discussed in relation to the knowledge translation and interprofessional literature. Research is ongoing to examine the effectiveness of dissemination of the protocols to FHTs across the province of Ontario and its impact on health care outcomes.

Rural interprofessional primary health care team development and sustainability: establishing a research agenda

Primary health care (PHC) plays a pivotal role in health system reform locally and globally. The use of well functioning interprofessional primary health care (IPHC) teams is recognized as a key strategy in widespread health system reform across global, national, and provincial jurisdictions. IPHC teams contribute to the improvement of the health and well being of the population. These teams engage in issues that are a priority for citizens, such as: providing good evidence-based care; supporting the efforts of individuals, families, and communities in leading healthy lives; actively and deliberatively involving citizens in decisions affecting their health and health care system; and addressing the systemic social, economic, and political causes of health disparities, such as poverty, violence, and rural isolation. Many jurisdictions have begun to experiment with and implement major changes in the delivery of PHC. This has required that health care managers and practitioners reconsider the ways in which they have traditionally worked. However, although many innovative PHC services were developed, the notion of how to best develop and sustain the service delivery team itself and within what contexts could have used more deliberate attention. There are no documented best practices for rural IPHC team development and sustainability in the scholarly literature. This paper presents the results of a literature review, including the empirical and conceptual evidence regarding team development, team sustainability, and the role of rural context in IPHC team development. An argument for advancing PHC research that focuses on rural IPHC team development and sustainability is posited.

Merging Social Networking Environments and Formal Learning Environments to Support and Facilitate Interprofessional Instruction

This study describes the redesign of an interprofessional team development course for health science students. A theoretical model is hypothesized as a framework for the redesign process, consisting of two themes: 1) the increasing trend among post-secondary students to participate in social networking (e.g., Facebook, Second Life) and 2) the need for healthcare educators to provide interprofessional training that results in effective communities of practice and better patient care. The redesign focused on increasing the relevance of the course through the integration of custom-designed technology to facilitate social networking during their interprofessional education. Results suggest that students in an educationally structured social networking environment can be guided to join learning communities quickly and access course materials. More research and implementation work is required to effectively develop interprofessional health sciences communities in a combined face-to-face and on-line social networking context.

Performance-based competencies for culturally responsive interprofessional collaborative practice

This paper will highlight how a literature review and stakeholder-expert feedback guided the creation of an interprofessional facilitator-collaborator competency tool, which was then used to design an interprofessional facilitator development program for the Partners for Interprofessional Cancer Education (PICE) Project. Cancer Care Nova Scotia (CCNS), one of the PICE Project partners, uses an Interprofessional Core Curriculum (ICC) to provide continuing education workshops to community-based practitioners, who as a portion of their practice, care for patients experiencing cancer. In order to deliver this curriculum, health professionals from a variety of disciplines required education that would enable them to become culturally sensitive interprofessional educators in promoting collaborative patient-centred practice. The Registered Nurses Professional Development Centre (RN-PDC), another PICE Project partner, has expertise in performance-based certification program design and utilizes a competency-based methodology in its education framework. This framework and methodology was used to develop the necessary interprofessional facilitator competencies that incorporate the knowledge, skills, and attitudes required for performance. Three main competency areas evolved, each with its own set of competencies, performance criteria and behavioural indicators.

Health care improvement and continuing interprofessional education: Continuing interprofessional development to improve patient outcomes

Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social learning theory creates a continuum between work-based interprofessional learning and service improvement in which each is integral to the other. This continuum provides a framework for continuing interprofessional development that enables service improvement in the workplace to serve as a vehicle through which individual professionals and teams can continually enhance patient care through working and learning together. The root of this lies in understanding that undertaking improvement and learning about improvement are co-dependent and that health care professionals must recognize their responsibility to improve as well as complete their everyday work. We believe that significant opportunities exist for health care commissioners, service providers, and educational institutions to work together to promote continuing interprofessional development in the workplace to enhance patient outcomes, and we outline some of the opportunities we believe exist.

Accountancy in the midst of a surplus-value-adding inter-functional development process

This article builds on the notion that, in order to meet the increasing management requirement for data, successful in-house accountancy professionals are internalising ever more capabilities and responsibilities, thereby reflecting a partnership role in professions related to basic operations. The study investigates the organisational interfaces of the accountancy profession vis-à-vis other professions during the change process. The findings identify some possible factors contributing to the traditional way of producing and utilising accounting information, and suggest some possible measures to be used as key facilitators in starting a change process aimed at securing an enlarged, more customer-oriented and highly interactive role for accountancy. The contribution of the study lies in increasing our understanding of surplus-value-producing inter-professional development processes. In addition, based on the case of rescue services the study provides a holistic view on accountancy knowledge management in public-sector services provided in inter-municipal cooperation.

Nurses and paramedics in partnership: Perceptions of a new response to low-priority ambulance calls

AimsTo explore patients’ and staffs’ perceptions of a pilot service which dispatched a nurse and paramedic to low-priority ambulance calls. However, Methods: Patients’ opinions of both pilot and standard service groups were obtained through qualitative questionnaire data and individual interviews. Staffs’ perceptions were explored via two focus groups. Questionnaires were sent to a convenience sample of 128 patients attended by the pilot service and 128 patients receiving the standard service. Initially 19 questionnaire participants agreed to be interviewed. Focus group participants (n=11) included nurses and paramedics involved in the pilot service. Results: Sixty-four questionnaires were returned and 11 interviews were conducted. Patients receiving the pilot service were enthusiastic about opportunities for care to be provided in their home. Involvement in the pilot service was a positive experience for staff. They felt confident in managing calls effectively because of their combined knowledge and skills, and believed that the quality of patient care had been improved. They also experienced increased job satisfaction and skills development. Conclusion: Both patients and staff expressed positive views about the pilot service. Patients appreciated being treated at home and staff believed that working together provided more appropriate care for patients and enhanced interprofessional development.

Challenges and promises for nurse education curriculum development in Kosovo: Results of an “accidental ethnography”

Kosovo's infrastructure was devastated by armed conflict through the 1990s; in 1999 a visiting inter-disciplinary team described healthcare services as being in "disarray". Several collaborative programs were initiated to enhance delivery of emergency medical (EM) services. Our inter-disciplinary team traveled to Kosovo in 2004 to evaluate EM physician education and training. A brief renewed outbreak of hostilities created a mass casualty incident. An "accidental ethnography" focused on nurse education was conducted by team members during and after the event. Results indicated low levels of professionalization of nurses as indicated by expressions of professional self-identity and self-esteem, autonomy, and submission to patriarchal attitudes. Undergraduate nurse education is restricted to a diploma program and one foreign training project, one graduate degree program exists abroad, and no national board examination exists. Nurses' social location is described as marginalized and disenfranchised, and retention of nurses is a persistent problem. Based on these observations we outline an inter-professional curriculum development program to foster professionalization of Kosovar nurses through a synthesis of participatory action research with elements of grounded theory and standard curriculum development methodologies. The collaborative, emancipatory, and empowering nature of PAR is described in the context of professionalizing nurse education programs.

The place of 360 degree appraisal within a team approach to professional development

The role of appraisal within professional development has assumed a higher profile in response to national policies including those relating to clinical governance and workforce development. Under the guidance of a service development manager trained in human resource management, a new interprofessional Primary Care Practice Team near Cambridge defined and implemented a new appraisal system drawing on the principles of 360 degree appraisal. The appraisal system was designed to support the service function and the team culture, and took into account good management practice and the requirements of partner organizations and professional affiliations. This paper describes how the system was introduced, tailored to the particular needs of the interprofessional practice team, and evaluated. Early experience suggests that the approach enhances understanding of roles and responsibilities and is supportive to interprofessional team development. It is well received by team members involved and by some of the external partner organizations. However, it is demanding on resources and concerns were raised about the completeness of this approach to appraisal.

Enhancing the learning curve in child and adolescent forensic psychiatry: inter-professional relationships, resource and policy development

Enhancing the learning curve in child and adolescent forensic psychiatry: inter-professional relationships, resource and policy development

Preparing placement supervisors for primary care: an interprofessional perspective from the UK

All the professions working in primary care provide placements for students. How common, or how profession-specific, are the competency requirements of the different professions for their members who supervise students on placements? If there is a significant degree of commonality in these competency requirements, how feasible would it be to develop an integrated interprofessional development and support programme for placement educators? These were the main questions addressed in this research project. The requirements for placement educators of four professions in the UK – nursing, medicine, occupational therapy and social work – were analysed and classified. Categories identified included the skills of enabling learning, knowledge of the theory and principles of learning, the ability to manage the learning environment and the ability to impart a sense of professional responsibility, as well as up-to-date knowledge on professional practice and on the relevant curricula. We concluded that only the last of these was profession-specific. The potential to use this classification for the development of an interprofessional placement educator training and support programme was explored, and the potential benefits of using this area to promote interprofessional learning were discussed. Issues that need to be considered include gaining cross professional involvement, whether service providers or universities should run programmes, whether there should be one or several programmes, and accreditation. In order to explore and take action on these issues a working group with representatives of the four professions was set up in the Primary Care Trust.

Achieving cardiovascular health through continuing interprofessional development.

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.

Achieving Cardiovascular Health Through Continuing Interprofessional Development

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing interprofessional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.

A Multi-professional Taught Course in Primary Care Therapeutics: Description and Evaluation

Aim: To describe and present an evaluation of a taught certificate course in therapeutics for primary care professionals. Design: A questionnaire study of the course participants analysed qualitatively and quantitatively. Subjects and setting: Students attending four primary care therapeutics courses held in east London and North Essex. Outcome measures: Participation and pass rates, participants comments and measures of course effectiveness in fulfilling participants aims. Results: 44 pharmacists, 48 GPs, and eight nurses attended the courses. They attended 91% of the sessions, 83% of assignments were submitted and 83% of students were awarded a certificate in primary care therapeutics. The course appears to be effective in satisfying most of the participants’ aims particularly “general interest” and promoting professional and inter-professional development; it was less successful in fulfilling specific objectives such as the development of formularies, becoming a trainer, participating in prescribing reviews and in reducing drug costs. Conclusions: Community pharmacists, general practitioners and senior primary care nurses have much to gain from being educated together in an activelearning environment. This programme meets the demand for courses of intermediate length and difficulty within primary health care. There is the possibility that such courses will enhance inter-disciplinary working and encourage rational prescribing.

Interprofessional Student Teaching Field Project: Building collaboration across disciplines

Preparing the next generation of educators to face the growing challenges posed by the social problems affecting youth requires an innovative approach and team effort . In response, the authors trace the development of an interprofessional student teaching field project involving university faculty, school district personnel, social work interns, cooperating teachers, and student teachers. Suggestions include the importance of a receptive field placement site where interprofessional connections are valued. The article describes various integrated field experience opportunities, such as a shadowing program and an interprofessional development seminar series. Recommendations are offered for implementing a collaborative model, including an examination of each discipline's ethical framework. The end result is a culminating field experience where professionals engage in open communication and a shared understanding of each other's roles in meeting the many challenges posed by the diverse needs of clients/students.

Interprofessional standards for the care sector—history and challenges

During 1995-1997, a major interprofessional development programme took place across the UK to develop national occupational standards for professional activity in health promotion and care. National occupational standards specify from the perspective of service users what needs to be achieved in the delivery of high quality services irrespective of setting and no matter who is involved. The aim of the work was to develop standards of high quality which had meaning across all of the practitioner groups to whom they applied. The processes used to develop the standards were collaborative across agencies and professions—-from the initial planning of the work, through its development and consultation phases, to the current testing during implementation. This paper locates the developments within the interprofessional context and provides an insight to the processes. the stakeholders and the challenges. It also looks forward to how the standards are likely to be implemented and evaluated.

Antenatal exercise: a personal perspective

Antenatal exercise sessions are offered to pregnant women in a variety of ways by different professional groups. These include midwives, physiotherapists, swimming teachers, trained and non-trained exercise instructors. Several questions have to be asked. Have these exercise sessions kept apace with the demands of fit healthy pregnant women who wish to carry on exercising throughout their pregnancy? Are there contraindications? Who should teach the women? Is the research information now available and incorporated into advantageous exercise sessions that help pregnant women cope with the massive physiological adaptation that occurs throughout pregnancy and the postpartum period? This paper presents an overview of what is currently available and attempts to establish a framework for standard setting and teacher training. This would ensure uniformity of knowledge, prevent conflicting advice and give opportunity for interprofessional liaison and development.