Interprofessional Knowledge Research Articles

Overcoming language barriers, enhancing collaboration with interpreters \u2013 an interprofessional learning intervention (Interpret2Improve)

BackgroundLanguage barriers (LB) are common in patient care. They can negatively impact the quality of care, and increase costs. LB can be overcome by using interpreters. However, collaboration with interpreters is a professional activity which can and needs to be learnt. Interpret2Improve is an innovative educational intervention where medical and nursing students learn together how to address LB and effectively collaborate with interpreters.MethodsThe three-hour course has two parts: After a short introduction on the relevance of LB and resulting issues of patient safety etc., students in interprofessional teams of two practice conversations with non-German-speaking simulated patients and professional interpreters. The course is evaluated in a pre-post format with the Freiburg Questionnaire for Interprofessional Learning Evaluation which has been validated in prior studies.ResultsFifty-one students (thirty of the participants were medical students, 21 participants were students in nursing care) participated from 11/2016–07/2018. Overall, the course was very well received (mean 1.73 (SD 0.85) on a five point scale: 1 = very good, 5 = insufficient). The evaluation by medical and nursing students differed significantly. Fourteen out of twenty-one items show a self-assessed increase in interprofessional knowledge or skills.ConclusionsStudents felt that their skills in addressing LB by effectively collaborating with interpreters increased during this interprofessional format. Further studies are needed to obtain further evidence beyond self-assessment and regarding the long-term outcomes.

Audiology, an Important Contributor to Interprofessional Holistic Care: An Interprofessional Collaborative Case Example.

Interprofessional collaboration improves health outcomes, enhances health care satisfaction, and facilitates more effective use of resources. Interprofessional collaborators increasingly understand and value other professions. A.T. Still University provides students from multiple programs with opportunities to develop interprofessional collaboration skills. This research note presents details of one such interprofessional education (IPE) opportunity, a collaborative case. Audiology was part of this case in two ways: Audiologic details of the simulated patient were provided to all students, and audiology students participated in the experience. The results of this involvement are reported. This research note is primarily descriptive in nature; however, the question of whether students viewed their interprofessional competencies as improving following the IPE experience was explored using a validated self-report tool, the Interprofessional Collaborative Competency Attainment Survey (ICCAS). A total of 23 students completed the ICCAS. Additionally, student case presentations were reviewed and audiology-based recommendations were tallied. Highly significant differences (p ≤ .01) for all 20 items on the ICCAS were observed for differences in self-assessed interprofessional skills knowledge. All but one of the 12 teams made specific recommendations regarding the communication needs of the patient. Students viewed their own competencies related to interprofessional collaboration as improved following the collaborative case experience. Overall, the collaborative case experience was effective in providing students with the opportunity to develop a breadth of skills needed for interprofessional collaboration. Providing audiologic information in the case history prompted all but one team to consider patient communication needs.

Students’ interprofessional workplace learning in clinical placement

Students’ learning in the workplace during their clinical placements is an important part of their education to become healthcare professionals. Despite the number of studies of student interprofessional learning in clinical placements, little is still known about the significance of interprofessional learning and how it is facilitated and arranged for to occur. This article aims to investigate interprofessional learning between students collaborating in a workplace-driven arrangement integrated into a clinical placement. A focused ethnographic research approach was applied, comprising observations of ten students participating in the arrangement organised by clinical supervisors on a medical emergency ward at a Swedish university hospital, followed by group interviews. Using a boundary-crossing lens, the article analyses the workplace arrangement, in which students’ learning across professional boundaries and their negotiations around a boundary object were prerequisites to coordinate their interprofessional knowledge and manage emerging challenges while being in charge of care on the ward.

Enhancing SLP Students' Perceptions of Older Persons and Collaborative Practice Through Geriatric Interprofessional Teamwork

Purpose To address the need for practice-ready geriatric health professionals, the Seniors Assisting in Geriatric Education (SAGE) program was developed and implemented by two partnering institutions. This study examines speech-language pathology students' perceptions of interprofessional (IP) teamwork and older persons following participation in the SAGE program. Specifically, students reflected on their IP competencies and attitudes toward older persons and overall perceptions of their SAGE experience and how this experience may impact their future practice. Method IP teams of three or four students ( n = 662) from eight disciplines and two partnering institutions participated in the SAGE program. Over three semesters, IP student teams visited a senior mentor's home, completing assignments aimed at growing skills in geriatric collaborative care. A mixed-method approach was used to examine 20 speech-language pathology students' perceptions post-SAGE. Students completed two questionnaires and provided written and verbal feedback, including retrospective pre–post comparisons. Results Moderate positive effect sizes were observed on retrospective reports examining perceptions of IP knowledge, attitudes, and skills. These reports were consistent with responses to additional questions examining values/ethics, roles and responsibilities, IP communication, and teamwork. Quantitative and qualitative measures reflected predominantly positive attitudes toward older persons, including an appreciation for older adults, increased knowledge and skills in geriatric care, and an interest in working with older persons in the future. Conclusions Speech-language pathology students participating on an IP geriatric team reported improved knowledge, attitudes, and skills in geriatric collaborative care. Additional study is needed to determine the impact of this experience on students' behaviors as future IP team members.

Gaining interprofessional knowledge and interprofessional competence on a training ward

Background Since 2017, interprofessional training wards have been established in Germany. On these wards, different health professions collaboratively provide patient care supervised by facilitators from the background. We investigated the gains in interprofessional knowledge and interprofessional competence reported after the mandatory placements on Mannheim’s Interprofessional Training Ward MIA. We also compared these levels of knowledge and competence at the end of the placement with control groups. Methods In a quasi-randomized controlled study, we used a questionnaire to collect self-reported data on the interprofessional learning outcome. We used t-tests to compare (a) pretest and posttest data in the experimental group and (b) the levels of interprofessional knowledge and competence between the experimental and control groups. Results The results confirmed that the MIA participants perceived a significant increase in interprofessional knowledge and competence during the placement on the training ward. MIA participants also reported significantly higher levels of interprofessional knowledge and competence than the control groups. Conclusions Placements on an interprofessional training ward make it possible to experience and practise interprofessional collaboration in real patient care. They help to prepare all future health professionals to assume their professional role in an interprofessional team to provide the best possible patient care.

The pharmacy residency program guide to Twitter

AbstractBackgroundTwitter has emerged as a powerful networking and educational tool within the health care community. The instantaneous and casual nature of Twitter allows for easy access to a near limitless pool of medical professionals and the opportunity to share intra‐ and interprofessional knowledge. Beyond individual development, Twitter has the potential to positively impact pharmacy residency programs in a multitude of ways.ObjectiveThis article serves as a practical guide for pharmacy residency programs to implement and maintain a successful Twitter account.RecommendationsAt the program level, a Twitter account creates an official voice and brand while simultaneously providing detail and perspective beyond what a residency website may offer. Additionally, it allows for dynamic ground‐level engagement with prospective residency candidates, current residents, and preceptors which is mutually beneficial to the program audience. In the age of virtual recruitment, successfully utilizing digital tools to meet candidates where they are is essential for attracting the right candidate for the program. Implementation of a successful social media strategy has potential barriers that include garnering buy‐in from departmental leadership, operationalizing a social media team, and maintaining engagement momentum.ConclusionPharmacy residency programs should consider starting an official Twitter account.

Peer Led Team Learning in a Foundational IPE Curriculum

BACKGROUND The Peer Led Team Learning (PLTL) instructional model utilizes Peer Leaders, advanced students who mentor and guide student teams to collaborate on applied course concepts. PURPOSE To apply a modified PLTL model in the university’s foundational, longitudinal, competency-based interprofessional education (IPE) curriculum. METHODS Twelve Peer Leaders were selected, trained, and deployed as facilitators for interprofessional teams of students during the IPE curriculum’s first three large-scale learning events. Peer Leaders completed an evaluation of training, a facilitation skills survey, and participated in a semi-structured focus group interview process. RESULTS After participating in the PLTL program, Peer Leaders reported increased confidence in their interprofessional knowledge and facilitation skills. The primary challenge for Peer Leaders in facilitating teams was lack of student engagement (n=7, 58%). CONCLUSION PLTL is a feasible model for IPE settings. It has the potential to both increase facilitator capacity in interprofessional learning activities and have a positive impact on Peer Leaders.

Safe Place

Interprofessional collaborative practice (ICP) is an essential skill in today’s healthcare environment that can be cultivated through interprofessional education (IPE) in higher education, as students are in the process of developing their professional identities. Undergraduate social work field students and nursing students in clinical rotation explored their experiences together in clinical supervision groups co-led by instructors from both fields. Researchers used a mixed methods approach to measure changes in feelings and skills related to ICP among students who participated in clinical supervision groups. Eighteen nursing and social work students participated; those involved in the interprofessional clinical supervision groups performed better on the Inter-professional Socialization and Valuing Scale (ISVS) than the comparison group. Qualitative themes indicated that students enhanced their interprofessional knowledge; improved their interprofessional communication skills; and increased their comfort levels on an interprofessional team. Implications and suggestions for implementation are discussed.

Using Organizational Theory to Explain ‘How’ EBP Implementation Occurs in HCOs

Despite increasing use of theory in the field of implementation science over the past decade, the literature has largely focused on using deterministic frameworks to retrospectively understand ‘what’ factors are essential for effective implementation of evidence-based practices (EBPs). On the other hand, gaps remain in using organizational theory to prospectively understand ‘how’ successful EBP implementation occurs in healthcare organizations (HCOs). This paper discusses the theoretical and empirical contributions of two selected recent exploratory research works, which provide a starting point for addressing the identified gaps in the literature, with the purpose of deriving implications for theory, practice, and research in implementation science. The selected works used the theory of ‘effective knowledge sharing network structures in professional complex systems (PCS),’ developed through an integration of organizational theories, to design prospective interventions for enabling EBP implementation in HCOs. In doing so, these studies have helped explain ‘how’ inter-professional knowledge exchange and collective learning occurred, to enable successful EBP implementation in HCOs. Correspondingly, the selected works have served a dual purpose in 1) identifying evidence-based management practice strategies for successful EBP implementation, while 2) further developing the theoretical literature on ‘effective knowledge sharing networks in PCS.’ Importantly, by addressing the identified gaps in the literature, the selected works serve to either complement or supplement existing theoretical approaches in implementation science. To this effect, they provide unique insights for theory, practice, and research in implementation science, including insights into a potential ‘dual-role’ for the future implementation researcher—one of advancing implementation science, while working to strengthen implementation practice. Based on these contributions, it could be argued that the selected works provide a starting point for a new research stream that has potential to occupy a distinct position in the taxonomy of theoretical approaches used in implementation science.

Preparing Master of Social Work Students for Interprofessional Practice

ABSTRACT Purpose This study aims to measure growth in interprofessional knowledge, skills, and values in MSW students from three universities who participated in a Behavioral Health Workforce Education and Training program focused on serving children, adolescents, and transition-age youth. Methods Students participated in an interprofessional field placement and specialized educational sessions that addressed interprofessional team-based care, engaging at-risk youth and families, and working with vulnerable populations. The Interprofessional Socialization and Valuing Scale (ISVS) was administered pre- and post-experience. Results Paired t-tests of the ISVS total score and each subscale showed statistically significant increases over time. Multiple regression models indicated only the pretest score was a significant predictor of the posttest score for the total or subscale of the ISVS. Conclusion Social work programs that create interprofessional education and training opportunities can achieve positive outcomes in student attitudes toward interprofessional practice.

Understanding Evidence-Based Practice (EBP) Implementation in HCOs Through the Lens of Organizational Theory.

Despite the increasing use of theory in the field of implementation science over the past decade, the literature has largely focused on using deterministic frameworks to retrospectively understand “what” factors are essential for the effective implementation of evidence-based practices (EBPs). On the other hand, gaps remain in using organizational theory to prospectively understand “how” successful EBP implementation occurs in health-care organizations (HCOs). This article discusses the theoretical and empirical contributions of two selected recent exploratory research works, which provide a starting point for addressing the identified gaps in the literature, with the purpose of deriving implications for theory, practice, and future research in implementation science. The selected works used the theory of “effective knowledge sharing network structures in professional complex systems (PCS),” developed through an integration of organizational theories, to design prospective interventions for enabling EBP implementation in HCOs. In doing so, these studies have helped explain “how” inter-professional knowledge exchange and collective learning occurred, to enable successful EBP implementation in HCOs. Correspondingly, the selected works have served a dual purpose in: 1) identifying evidence-based management (EBM) practice strategies for successful EBP implementation; while 2) further developing the theoretical literature on “effective knowledge sharing networks in PCS.” Importantly, by addressing the identified gaps in the literature, the selected works serve to either complement or supplement existing theoretical approaches in implementation science. To this effect, they provide unique insights for theory, practice, and research in implementation science, including insights into a potential “dual-role” for the future implementation researcher—one of advancing implementation science, while working to strengthen implementation practice. Based on these contributions, it could be argued that the selected works provide a starting point for a new research stream that has the potential to occupy a distinct position in the taxonomy of theoretical approaches used in implementation science.

Interprofessional Collaboration: An Evaluation of Social Work Students’ Skills and Experiences in Integrated Health Care

ABSTRACT Evidence shows that when an interprofessional (IP) approach is effectively implemented, it can counteract some of our most pressing health care problems. One such challenge is the lack of training in IP teamwork health care professionals receive during their education. Using a quasi-experimental matched comparison group design, this study assessed pre- and posttest changes in IP knowledge, attitudes, and skills of MSW students (N = 52) from 2015–2017, who received a specialized curriculum, and clinical internships working in IP teams, compared to an internal control group involving clinical IP teams alone. Two validated measures assessed changes in students’ IP knowledge, values, and skills. Quantitative findings and qualitative responses to open-ended questions elucidate barriers and facilitative factors in IP teams.

Integrating Interprofessional Case Scenarios, Allied Embedded Actors, and Teaching Into Formative Observed Structured Clinical Exams.

Interprofessional education is a critical component of medical student training, yet it is often difficult to implement. Medical students who learn with, from, and about learners from other disciplines have been shown to create more effective and safe health care teams. The investigators wanted to know how participating in two interprofessional observed structured clinical exams (OSCEs) at Tufts University School of Medicine (TUSM) would affect changes in medical students' attitudes and values in interprofessional teamwork. For the academic years 2017 and 2018, two interprofessional case scenarios were integrated into OSCEs for third-year medical students at TUSM, with an allied embedded actor (AEA) playing a social worker to an end-of-life scenario, and an AEA playing the role of a pharmacy student added to a chronic pain scenario. Students participated in didactic training about interprofessional teamwork and received structured feedback regarding interprofessional competencies following simulation cases. Changes in interprofessional knowledge and attitudes were assessed by comparing student pre- and postscenario mean scores on the Interprofessional Socialization and Valuing Scale (ISVS-21, a 21-item scale survey), with students rating themselves on a Likert scale from 1 (not at all) to 7 (to a very great extent). We performed paired t-test analysis on individual pre- and post-ISVS-21 means. Three hundred fifty-three of the 417 participating medical students fully completed pre- and postsurveys. Students reported significant changes in interprofessional knowledge and attitudes (mean change=1.3, P<.0001). Students and faculty regarded the interprofessional cases very highly. Placing interprofessional cases involving AEAs into OSCE events is easily replicated, and positively impacts students' attitudes and values in interprofessional knowledge.

The implementation of a Technician Enhanced Administration of Medications [TEAM] model: An evaluative study of impact on working practices in a children's hospital.

Children are frequently prescribed unlicensed and off-label medicines meaning dosing and administration of medicines to children is often based on poor quality guidance. In UK hospitals, nursing staff are often responsible for administering medications. Medication Errors [MEs] are problematic for health services, though are poorly reported and therefore difficult to quantify with confidence. In the UK, children's medicines require administration by at least two members of ward staff, known as a 'second check' system, thought to reduce Medication Administration Errors [MAEs]. To assess the impact on working practices of the introduction of a new way of working, using Technician Enhanced Administration of Medications [TEAM] on two specialist wards within a children's' hospital. To evidence any potential impact of a TEAM ward-based pharmacy technician [PhT] on the reporting of MEs. A TEAM PhT was employed on two wards within the children's hospital and trained in medicines administration. Firstly, an observational pre-and-post cohort design was used to identify the effect of TEAM on MEs. We analysed the hospital's official reporting system for incidents and 'near misses', as well as the personal incident log of the TEAM PhT. Secondly, after implementation, we interviewed staff about their perceptions of TEAM and its impact on working practices. We affirm MEs are considerably under-reported in hospital settings, but TEAM PhTs can readily identify them. Further, placing TEAM PhTs on wards may create opportunities for inter-professional knowledge exchange and increase nurses' awareness of potential MAEs, although this requires facilitation. TEAM PhT roles may be beneficial for pharmacy technicians' motivation, job satisfaction, and career development. Hospitals will need to consider the balance between resources invested in TEAM PhTs and the level of impact on reporting MEs. Health economic analyses could provide evidence to fully endorse integration of TEAM PhTs for all hospital settings.

A Mobile Learning Module to Support Interprofessional Knowledge Construction in the Health Professions

Objective. To develop and evaluate a mobile learning module to support knowledge construction between medical and pharmacy students through structured dialogue prompts. Methods. Rheumatologists and pharmacists collaboratively developed a two-week, case-based, asynchronous interprofessional learning module that was delivered via a mobile app and focused on collaborative medication management of a complex case involving a patient with systemic lupus erythematosus. The clinical case evolved over three phases: diagnosis, initial treatment, and medication-related complications. Dialogue prompts were incorporated in each phase as a mechanism to support knowledge construction among learners. Pharmacy and medical student pairs were randomized to receive either high guidance or low guidance prompts for collaborative learning. The student pairs worked together, asynchronously, online, to develop three collaborative care plans. The evaluation of the learning module to support knowledge construction included: analysis of text-based dialogue coded for knowledge construction phases; the accuracy and completeness of the three collaborative care plans; and quantitative and qualitative participant feedback. Results. Sixteen pairs of medical and pharmacy students (n=32) participated. Pairs who received high guidance engaged in all phases of knowledge construction more often than pairs who received low guidance. Guidance phase did not differentially impact collaborative care plan scores. Ninety-eight percent of students agreed or strongly agreed that the module improved their clinical reasoning, interprofessional communication, and knowledge of systemic lupus erythematosus. Conclusion. The knowledge construction framework can guide the design and evaluation of educational interventions such as a mobile learning module to support knowledge construction among health professionals.

Variables associated with interprofessional collaboration: a comparison between primary healthcare and specialized mental health teams

BackgroundThis study has two aims: first, to identify variables associated with interprofessional collaboration (IPC) among a total of 315 Quebec mental health (MH) professionals working in MH primary care teams (PCTs, N = 101) or in specialized service teams (SSTs, N = 214); and second, to compare IPC associated variables in MH-PCTs vs MH-SSTs.MethodsA large number of variables acknowledged as strongly related to IPC in the literature were tested. Multivariate regression models were performed on MH-PCTs and MH-SSTs respectively.ResultsResults showed that knowledge integration, team climate and multifocal identification were independently and positively associated with IPC in both MH-PCTs and MH-SSTs. By contrast, knowledge sharing was positively associated with IPC in MH-PCTs only, and organizational support positively associated with IPC in MH-SSTs. Finally, one variable (age) was significantly and negatively associated with IPC in SSTs.ConclusionsImproving IPC and making MH teams more successful require the development and implementation of differentiated professional skills in MH-PCTs and MH-SSTs by care managers depending upon the level of care required (primary or specialized). Training is also needed for the promotion of interdisciplinary values and improvement of interprofessional knowledge regarding IPC.

Advancing a School of Nursing Center for Climate Change, Climate Justice, and Health.

This chapter addresses the development and advancement of the Center for Climate Change, Climate Justice, and Health (CCCCJH) in the School of Nursing at the MGH Institute of Health Professions, the first nurse-led center emerged from the overwhelming evidence of climate change and its associated deleterious health consequences. The Center steering committee developed a mission, vision, and core values as well as a logo to guide the first year of initiatives and galvanize the efforts for the future. Workshop and symposium development, implementation, and evaluation are discussed. Future directions and the importance of educational initiatives aimed at expanding nursing and interprofessional knowledge of the intersection of climate and health are discussed.

An ethnographic study comparing approaches to inter-professional knowledge sharing and learning in discharge planning and care transitions

PurposeThe purpose of this paper is to investigate how three communication interventions commonly used during discharge planning and care transitions enable inter-professional knowledge sharing and learning as a foundation for more integrated working. These interventions include information communication systems, dedicated discharge planning roles and group-based planning activities.Design/methodology/approachA two-year ethnographic study was carried out across two regional health and care systems in the English National Health Service, focussing on the discharge of stroke and hip fracture patients. Data collection involved in-depth observations and 213 semi-structured interviews.FindingsInformation systems (e.g. e-records) represent a relatively stable conduit for routine and standardised forms of syntactic information exchange that can “bridge” time–space knowledge boundaries. Specialist discharge roles (e.g. discharge coordinators) support personalised and dynamic forms of “semantic” knowledge sharing that can “broker” epistemic and cultural boundaries. Group-based activities (e.g. team meetings) provide a basis for more direct “pragmatic” knowledge translation that can support inter-professional “bonding” at the cultural and organisational level, but where inclusion factors complicate exchange.Research limitations/implicationsThe study offers analysis of how professional boundaries complicate discharge planning and care transition, and the potential for different communication interventions to support knowledge sharing and learning.Originality/valueThe paper builds upon existing research on inter-professional collaboration and patient safety by focussing on the problems of communication and coordination in the context of discharge planning and care transitions. It suggests that care systems should look to develop multiple complementary approaches to inter-professional communication that offer opportunities for dynamic knowledge sharing and learning.

Outcomes from a single-intervention trial to improve interprofessional practice behaviors at a student-led free clinic

Abstract Background Interprofessional collaboration (IPC) is the practice of two or more healthcare professionals working together and learning from one another to improve health outcomes. IPC is important for quality training, typically improving individual and group level outcomes. Students value the opportunity for leadership and teamwork development when IPC is offered in their curriculum. The Indiana University Student Outreach Clinic (IUSOC) is a student run clinic that provides free primary care services to underserved residents residing in Indianapolis, Indiana. The IUSOC partner leaders identified a need to enhance knowledge about partner roles, scope of practice, and professional training with the hopes of improving quality of care through IPC and utilization of clinic resources. Methods A cluster randomized design consisted of education session days and control days. Participants had an equal selection probability. Student partners from ten different disciplines were involved. Two survey instruments were used for data collection: 1) The Interprofessional Socialization and Valuing Scale and 2) The Professional Consciousness Raising Questionnaire. The former measured the attitudes and beliefs that underlie interprofessional socialization, while the latter assessed pre/post student knowledge of the roles and responsibilities of each partner. Results The control arm of the study was composed of 167 student participants and the intervention arm had 170 participants. Participants in the intervention arm had greater scores for “ability to work with others”, “value in working with others”, and “comfort in working with others.” The intervention arm also had significantly increased odds of correctly identifying the roles responsibilities of the nursing, law, dental, and global health disciplines. Conclusions Results of this study demonstrate that administering a short interprofessional education exercise to healthcare professional students leads to improved IPC through increased interprofessional knowledge about other professions and change in beliefs and values toward the value of interprofessional collaboration among healthcare professionals.

A Health System's Pilot Experience with Using Social Knowledge Networking (SKN) Technology to Enable Meaningful Use of EHR Medication Reconciliation Technology.

Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. In fall 2016, a two-year grant was secured from the U.S. Agency for Healthcare Research and Quality (AHRQ), to pilot a Social Knowledge Networking (SKN) system pertaining to "EHR-MedRec," to enable AU Health to progress from "limited use" of EHR MedRec technology, to "meaningful use." The rationale behind an SKN system, is that it could provide a platform for inter-professional knowledge exchange on practice issues related to EHR MedRec, across diverse provider subgroups and care settings, to highlight adverse consequences of gaps in practice for patient safety, and emphasize the value of adhering to best-practices in EHR MedRec. This, in turn, is expected to increase provider engagement in addressing issues related to EHR MedRec, and promote inter-professional learning of best-practices, to create a foundation for practice change or improvement (e.g., Meaningful Use of EHR MedRec technology). This Case Report describes AU Health's experiences with this novel initiative to pilot an SKN system for enabling Meaningful Use of EHR MedRec technology. It also discusses lessons learned in regard to the potential of an SKN system to enable inter-professional learning and practice improvement in the context of EHR MedRec, which, in turn, helps identify strategies and practice implications for healthcare managers.