Interprofessional Research Articles

Development and Validation of the Pre-Operative Counselling Module for Total Laryngectomy-An Interprofessional Approach

Background: Total laryngectomy (TL) is necessary for patients with malignant tumor on the larynx. This could however cause a devastating situation affecting patients’ quality of life. A comprehensive pre-operative counselling could reduce their anxiety and prepare them for TL. Laryngectomy rehabilitation requires a team approach and we aimed at developing (Phase 1) and validating (Phase 2) the pre-operative counselling module for TL, using an interprofessional (IP) approach. Material and Method: Phase 1: Development of the pre-operative counselling module through the literature review and discussions among the IP team consisting of a speech-language pathologist, head neck surgeon, psychologist and physiotherapist. Phase 2: Validation of the module by another IP team having a minimum of five years clinical experience in alaryngeal rehabilitation. The changes done to an item following specific “ratings” by at least two experts were as follows: “highly appropriate”- item exactly retained; “just appropriate” - minor modification; “inappropriate”- major modification, and “highly inappropriate” - excluded. Findings: Phase 1 resulted in the module having six domains (D) focusing on speech subsystems, oncological aspects, physical limitations, respiratory, phonatory, swallowing changes and their management. Following phase 2, the items under all domains were retained as they were, except for D3.7 which was rated as “inappropriate”. Discussion and Conclusion: The item D3.7 i.e., ‘progressive resistance strengthening with thera-bands’ was rated as ‘highly inappropriate’ by two experts, and ‘inappropriate’ by another two. Therefore, the item was excluded. However, as per the suggestion of two experts ‘post-isometric relaxation techniques’ and ‘myofascial release of cervical region’ were included as D3.7. The finalized module has four items each under D1, D2, D4, D5, and eight items under D3 beneficial in providing comprehensive information for patients undergoing TL. Future studies can focus on comparing anxiety levels of patients undergoing TL, before and after counselling using the module presented.

Purposeful interprofessional team intervention improves relational coordination among advanced heart failure care teams

ABSTRACT Effective delivery of healthcare is highly interdependent within and between interprofessional (IP) care teams and the patients they serve. This is particularly true for complex health conditions such as advanced heart failure (AHF). Our Academic Practice Partnership received funding to carry out IP workforce development with inpatient AHF care teams. Our objectives were to (a) identify challenges in team functioning that affected communication and relationships among the AHF care teams, (b) collaboratively identify a focal work process in need of improvement, and (c) test whether facilitated the implementation of team training and work process changes would lead to improvements in team communication, relationships, and process outcomes. The health-care team identified implementation of structured IP bedside rounds (SIBR) as the preferred approach to improving collaborative care. Utilizing a cross-sectional pre/post design, changes in team communication and relationships before and after a team intervention that included TeamSTEPPS training and SIBR implementation, were assessed using a validated Relational Coordination (RC) survey. The study population included AHF care team members (n ~ 100) representing seven workgroups (e.g., nurses, pharmacists) from two inpatient cardiology units at a 450-bed academic medical center in the Pacific Northwest during 2015–2016. Improvements in RC scores were demonstrated across all seven RC dimensions from baseline (Year 1) to follow-up (Year 2). Percent change on each of the seven dimensions ranged from 3.57% to 9.85%. Changes were statistically significant for improvements between baseline and follow-up on all but one of the seven RC dimensions (shared knowledge). The IP team intervention was associated with improvements in RC from baseline to follow-up. Additional research is needed to assess patient perspectives and outcomes of the IP team intervention. Findings of this study are consistent with the growing body of RC and SIBR research and provide a useful model of an IP team-based intervention in clinical practice.

Attitudes of Students toward Inter Professional Healthcare Teams: A Comparison between 1st-Year and 3rd-Year Students at Mongolian National University of Medical Sciences

The purpose of this study is to describe attitudes toward inter professional education in Mongolia National University of Medical Sciences.

An Interprofessional Communication Training Program to Improve Nurses' Ability to Communicate With Stroke Patients With Communication Disorders.

The aim of the study was to evaluate change in nurses' knowledge, attitudes, and behaviors after an Interprofessional (IP) Communication Training Program designed to improve nurses' ability to communicate with stroke rehabilitation inpatients with communication disorders. A quasi-experimental longitudinal study was conducted to evaluate an IP Communication Training Program consisting of a full-day and booster workshop and speech language pathologist support for nurses. The Communication Impairment Questionnaire and the Providers Interactional Comfort Survey were collected prior to and 3 months and 1 year postintervention. Focus groups assessing program acceptability were conducted. Forty-six nurses participated. The Communication Impairment Questionnaire significantly improved postintervention (p = .001), but not at 1 year follow-up (3.76, p = .123). The Providers Interactional Comfort Survey significantly improved postintervention (p = .001) and remained significant 1 year later (8.84, p = .03). Focus groups indicated high acceptability and reported that the education increased their confidence and reduced their frustration. Nurses' attitudes toward and knowledge about communication strategies improved, which enhances their ability to care for stroke patients with communication disorders. Interdisciplinary workshops and speech language pathologist support appear beneficial to nurses working with patients with communication disorders.

Interprofessional communication in the emergency department: residents' perceptions and implications for medical education.

ObjectivesObjectives of the current study were to: i) assess residents’ perceptions of barriers and enablers of interprofessional (IP) communication based on experiences and observations in their clinical work environments, ii) investigate how residents were trained to work in IP collaborative practice, iii) collect residents’ recommendations for training in IP communication to address current needs. MethodsFocus group study including fourteen Emergency Medicine (EM) residents, who participated in four focus groups, facilitated by an independent moderator. Focus group interviews were audiotaped, transcribed verbatim, independently reviewed by the authors, and coded for emerging themes. ResultsFour themes of barriers and enablers to IP communication were identified: i) the clinical environment (high acuity; rapidly changing health care teams, work overload, electronic communications), ii) interpersonal relationships (hierarchy, (un)familiarity, mutual respect, feeling part of the team), iii) personal factors (fear, self-confidence, uncontrolled personal emotions, conflict management skills), and iv) training (or lack thereof). Residents indicated that IP communication was learned primarily through trial and error and observing other professionals but expressed a preference for formal training in IP communication. ConclusionsBased on this pilot study, barriers to effective IP communication in the ED were inherent in the system and could be exacerbated by relational dynamics and a lack of formal training. Opportunities for both curricular interventions and systems changes were identified and are presented.

Interprofessional Collaboration: The Future of Publishing in Oncology.

To explore avenues for establishing or expanding interprofessional (IP) collaboration, to provide guidance on authoring IP oncology publications, and to highlight platforms for IP publishing. Journal articles, organizational guidelines, panel reports, and personal experience. As health care becomes an increasingly IP field, publications authored by IP groups will become more common, and additional platforms for IP publication will be created. IP publications may ultimately replace some of the traditional, single-profession-focused publications in print today. Oncology care is ideally delivered by IP teams. In collaboration with this team, oncology nurses can identify topics suitable for publication, publish in IP journals, and tailor publications to be accessible and applicable to an IP audience.

Promoting Interprofessional Collaborative Practice Through Simulation.

A 12-week program was developed to educate nursing, medicine, and physician assistant faculty on the principles and best practices of simulation. The goal was to facilitate team building and collaborative practice through the implementation of an interprofessional (IP) simulation experience for students. Workshops focused on IP communication involving seminar-based instruction, discussion, and the progressive development of an IP simulation based on a National League for Nursing Advancing Care Excellence for Seniors scenario. During the final session, students participated in the simulation while faculty evaluated and revised the scenario to best meet the needs of students from the three disciplines.

Interprofessional training and team function in patient-centred medical home: Findings from a mixed method study of interdisciplinary provider perspectives

ABSTRACT Transitioning from profession-specific to interprofessional (IP) models of care requires major change. The Veterans Assessment and Improvement Laboratory (VAIL), is an initiative based in the United States that supports and evaluates the Veterans Health Administration’s (VAs) transition of its primary care practices to an IP team based patient-centred medical home (PCMH) care model. We postulated that modifiable primary care practice organizational climate factors impact PCMH implementation. VAIL administered a survey to 322 IP team members in primary care practices in one VA administrative region during early implementation of the PCMH and interviewed 79 representative team members. We used convergent mixed methods to study modifiable organizational climate factors in relationship to IP team functioning. We found that leadership support and job satisfaction were significantly positively associated with team functioning. We saw no association between team functioning and either role readiness or team training. Qualitative interview data confirmed survey findings and explained why the association with IP team training might be absent. In conclusion, our findings demonstrate the importance of leadership support and individual job satisfaction in producing highly functioning PCMH teams. Based on qualitative findings, we hypothesize interprofessional training is important, however, inconsistencies in IP training delivery compromise its potential benefit. Future implementation efforts should improve standardization of training process and train team members together. Interprofessional leadership coordination of interprofessional training is warranted.

Examining interprofessional team interventions designed to improve nursing and team outcomes in practice: a descriptive and methodological review

ABSTRACT Effective interprofessional (IP) team-based care is critical to enhance the delivery of efficient care and improve nursing and IP team outcomes. This study aims to review the most recent IP team intervention studies that focused on outcomes related to nursing and IP teams. PubMed, CINAHL, PsycINFO, and Embase were searched for existing literature published between January 2011 and December 2016. The search strategy was developed through both literature review and consultation with a health sciences librarian. This review included IP team intervention studies published in peer-reviewed journals and written in English. Studies were included if they conducted an IP team intervention for healthcare teams that include nurses and examined outcomes related to nursing and the IP teams. Based on inclusion and exclusion criteria, 41 articles were included for the final review. Two authors extracted data on the characteristics of IP team interventions, assessment methods, and their outcomes related to nursing and IP teams using a data abstraction tool developed by the research team. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. We found that most of the included studies were conducted in the US and on inpatient units. A quasi-experimental study design was most commonly employed. Most studies conducted IP team training such as TeamSTEPPS® as a one-time activity. The most common outcomes measured were attitudes or perceptions about IP teamwork or communication, followed by patient-related outcomes, and knowledge or skills about IP competencies. The quality of the included studies was generally low. The findings from this review will contribute to understanding the characteristics of current IP intervention studies and call for IP scholars to design more rigorous yet realistic IP intervention studies.

Clinical nurses' experiences and perceptions after the implementation of an interprofessional team intervention: A qualitative study.

To explore clinical nurses' experiences and perceptions following a purposeful interprofessional (IP) team intervention in practice. Despite increasing interest in IP collaborative practice to improve teamwork, nursing outcomes and quality of care, there has been little research that focused on nurses' perspectives of IP collaboration after a purposeful IP team intervention. A qualitative descriptive study using focus group interviews of registered nurses who care for patients with advanced heart failure. This study is part of a larger study that conducted and evaluated a purposeful IP team intervention. Registered nurses (n=10) were invited to participate in three focus groups following the IP team intervention. Data were audio-recorded, transcribed and analysed using a conventional content analysis approach and constant comparative method. We identified six interrelated themes: (a) IP team building, (b) psychological safety and cultural change, (c) efficiency in delivery of care, (d) quality of patient care, (e) job outcomes and (f) team challenges. Notably, participants reported that they could better understand the patient's care plan of the day because every team member was "on the same page at the same time." Registered nurses perceived that they were more satisfied with their job through improved IP team performance, enhanced psychological safety and cultural change, efficient workflow and better quality of patient care. The IP team intervention contributed to enhancing IP team functioning as well as improving registered nurse job satisfaction. To sustain the improved perceptional and behavioural changes, team strategies to improve workflow and communication should be considered. Effective teamwork and communication between multiple healthcare professionals including nurses are the cornerstones to improve care delivery, nursing outcomes and quality of patient care in clinical settings.

Abstract P-058: INTEGRATED CARE TEAM CASE ROUNDS: ENHANCING THE TEAM APPROACH FOR COMPLEX CRITICALLY ILL CHILDREN

Aims & Objectives: Inter-professional (IP) education can facilitate enhanced team function and learning. Performing well as an integrated care team is a continuous process requiring IP learning opportunities be embedded into systems and practice. This is challenging in the clinical setting. We will describe the development and early experiences of Integrated Care Team Case Rounds (ICT-CR) in a quaternary critical care program. Methods ICT-CR’s purpose is to promote IP knowledge-sharing in a case-based learning format. The IP team selects 2 cases each week, one case each from the cardiac and paediatric ICUs for a 45-minute, high-level facilitated discussion. Discussion goals are pre-articulated and facilitators circulate selected relevant materials beforehand. Weekly de-briefings of key participants are conducted to identity effective learning strategies and opportunities to improve. Results Refinement and articulation of the ICT-CR process was attained. ICT-CR are well attended with 40–50 individuals representing the range of health care professionals in critical care. Topics presented include chronic critical illness, team relationships and rehabilitation approaches. Occasional discipline-specific presentations that complement case content are provided. Discussions include generalizable educational and clinically relevant points for follow-up and integration into the child’s plan of care. Sessions are most productive when facilitators respect the established format, ensure safety for all participants and when partner teams actively participate. Conclusions ICT-CR are an established part of the critical care education program. Collaborative contributions of the entire team have achieved team learning, clinical goals and have enhanced IP team function.

Attitudes Toward Interprofessional Education: Comparing Physical Therapist and Other Health Care Professions' Students

Background and Purpose. Interprofessional teams provide the potential of comprehensive and reliable care for patient/clients with complex problems. Interprofessional education (IPE) may change students' attitudes and knowledge necessary to maintain interprofessional (IP) teamwork after graduation. Learning experiences that include interaction with standardized patients enable students to increase their skills to become IP health care providers. This case study assessed the first-time experience of a College of Health Professions in using standardized patients for an IPE activity. Case Description. Interprofessional student teams, representing 178 students, were formed representing the following health professions education programs: physical therapist (PT), physician assistant (PA), communication sciences and disorders (CSD), dental hygiene (DH), nursing, medical laboratory science, and public health. Standardized patients interacted with the students. Students participated in a faculty facilitator–guided discussion related to each disciplines' professional roles and patient care goals. Each discipline had faculty representation. Students received feedback from standardized patients and faculty facilitators. A pre-post design was used with a mixed quantitative–qualitative methodology. Quantitative data were analyzed using 1-way analysis of variance. Qualitative data were evaluated using frequency data. Outcomes. Only PT, PA, CSD, and DH students participated in sufficient numbers for use in analyses. All groups improved their ratings on the postsurvey statements. Percentages of students whose ratings improved on the postevent survey were examined by department. Physical therapist and PA students showed similar percentages. These percentages of improvements were smaller than improvements of CSD and DH students. Qualitative analysis of open-ended questions revealed four themes: collaborating without judgment of others, learning about the roles and responsibilities of their profession, as well as those of other professions, learning about themselves, and communicating with different personalities. Discussion and Conclusion. Students' perceptions of themselves and of other health care professional students changed. Overall, this 4-hour IPE exercise had a positive influence on these students' attitudes toward working as a team member and in being an effective member of that team.

A pilot study on interprofessional education: how prepared are faculty to teach?

ABSTRACTFaculty development for interprofessional (IP) teaching and learning is a complex and evolving part of educators’ preparation for IP teaching and learning. A review of the literature highlighted a gap of rigorous research in the area of faculty development for interprofessional education (IPE). This pilot study used a mixed-methods approach to explore how faculty development affected educators’ preparedness for IP teaching and looked at the possible effects of IP and teaching experiences. Pre- and post-faculty development evaluations were captured using validated instruments and helped to explore the impact faculty development had on educators’ preparedness for IPE. The qualitative data offered insights using participants’ perspectives about IPE where the quantitative method could not. This pilot study offers findings that explored important characteristics that may have a role in faculty preparation for IPE teach and learning and could possibly be used in future research.

Interprofessional pain education-with, from, and about competent, collaborative practice teams to transform pain care.

Pain is a complex experience that impacts health, productivity, and well-being. It requires a collaborative team approach with a common language and clear understanding of roles and responsibilities. With few exceptions, a minimum amount of pain content has been documented in health sciences curricula, and much of that has been fragmented by profession and delivered within a crowded agenda of conventional course topics such as anatomy and physiology.21 Most health professionals learn pain management on the job and are often ill-prepared to function as a team member in the real world. Despite documentation of the need for improved education on pain of all types, consistent professional training in pain is not widespread and innovation is warranted. The 2018 IASP Global Year for Excellence in Pain Education is a call to action on multiple levels. The purpose of this report is to describe opportunities for mutual learning through interprofessional (IP) pain education. Interprofessional education (IPE) is a growing trend across health professions and has been defined (Table ​(Table1)1) as when 2 or more professions learn with, from, and about each other to improve collaboration and the quality of care.16 For IP learning to occur, all 3 “with, from, and about” must be present.11 Table 1 Operational definitions.

The Power of a Team: Using Unfolding Video Cases in Interprofessional Education for Advanced Health Trainees.

Few interprofessional (IP) learning opportunities are designed specifically for advanced health learners who are early in their training yet have already had some clinical experience. This group of learners requires activities that are didactic based but extend beyond the introductory IP curricula typically geared towards prelicensure students. This highly interactive curriculum aims to fill that gap in the literature. An interprofessional case-writing team created two unfolding video cases-a mother-infant dyad seeking care and an elderly non-English-speaking man experiencing disjointed care-for a large IP event with doctors of nursing practice (DNPs), pharmacy practice, and dental science, masters in social work, and physician assistant (PA) trainees, individualized to learner interest. The team also developed a highly detailed faculty guide, including specific talking points, to assist IP teams of faculty facilitators. Learners were evaluated using a Likert-scale postsession survey and open-ended questions. Qualitative data were analyzed for themes related to the objectives. Survey results indicated that learning objectives were met and students were highly satisfied with the overall curriculum. Mean scores for organization, utility, and facilitation effectiveness were all above 4.6 (range: 1-5), with the DNP, pharmacy, and PA students indicating higher levels of satisfaction compared to the other professions. Faculty feedback was very positive, particularly with respect to the faculty guide. Challenges were concentrated around implementation of the curriculum rather than the curriculum itself. This curriculum can be used with a variety of learners with minimal adaptation of discussion questions.

Straddling care and education: Developing interprofessional collaboration through a hotspotting service learning project

Interprofessional (IP) team work has been shown to decrease burnout and improve care and decrease costs. However, institutional barriers have challenged adoption in practice and education. Faculty and students are turning to IP service-learning projects to help students gain experience and provide needed services. This paper highlights a “hotspotting” program where students from different health professions work collaboratively to improve high utilizing patients’ health. Benefits, challenges and preliminary results including cost savings and student efficacy are shared. Institutions should surmount barriers that make hotspotting service-learning challenging as IP team-based experiences prepare students for the workplace and can help mitigate burnout.

Integrative Review of Interprofessional Simulation in Nursing Practice.

The aim of this integrative review was to examine what is known about interprofessional (IP) simulation involving practicing nurses. The use of simulation within health care education and practice has rapidly expanded; however, there is a gap in what is known about the benefits of nurses engaging in IP simulation. Five reviewers conducted a systematic literature search on studies of IP simulation among practicing nurses, published between January 1, 2010, and July 1, 2016. An initial sample of 1,400 articles was found and was further narrowed to 18 studies. There is a role for IP simulation in enhancing nurses' roles and understanding of the roles of other practitioners. However, the diversity of studies and lack of rigor prevents the formation of conclusive evidence to support IP simulation in enhancing patient care quality and safety. Structured simulation research designs using published guidelines for best practice implementation are needed. J Contin Educ Nurs. 2018;49(2):91-96.

The Process and Implication of Inter-Professional Education: A Systematic Review

Background: The practice of inter-professional education (IPE) is expanding rapidly especially in the developing countries. The goal of IPE is to develop knowledge, skills, and attitudes that result in effective Inter-professional (IP) team behaviors and competency. Therefore, it is essential to understand more about the activity, other professional’s involvement and its implications for nursing students and institutions.Purpose: This paper aimed to review the process and other professional’s involvement in IPE’s nursing education, and describe the implication after implementing IPE for nursing students and institution.Methods: A comprehensive multi-step search of the literature in IPE using ProQuest, EBSCO and Cengage databases was performed. Samples of 19 studies met the inclusion criteria and were used in this study.Results: None of the studies reported findings from developing country, while there were only two studies conducted in Asia. IPE programs utilize a variety of combinations of interactive learning methods, such as group problem solving, focus group interview, social networking (website), and simulated patient or simulated based training (SBT) which is becoming the most common methods employed. IPE gives benefits for the students, such as improving communication skills, recognizing the role and responsibilities, understanding the value and ethics and also increasing teamwork and team-based care.Conclusion: Despite the limitations, this systematic review found a number of activities and other professionals that can be involved with nursing in the IPE implementation. It also found out that IPE applied in a variety of clinical settings is well received by the students and enable them to learn the knowledge and skills for collaborative learning.

Assessment of Inter Professional Competencies among Graduate Students in Nursing, Communication Disorders and Exercise Science in the US

Assessment of Inter Professional Competencies among Graduate Students in Nursing, Communication Disorders and Exercise Science in the US

Addressing Opioid Misuse and Abuse through Interprofessional Engagement and Education

Purpose: The purpose of this initiative was to develop and implement an interprofessional panel aimed to expose a university audience to the magnitude of opioid misuse and abuse, as well as demonstrate each health professional’s role in curbing the epidemic. Further, this experience was to provide a platform for interprofessional discussion and to share with attendees tangible action items to begin combatting the opioid epidemic. Methods: An interdisciplinary committee of healthcare professionals collaborated to initiate a dialogue around opioid misuse and abuse to highlight the power of interprofessional (IP) collaboration in addressing the opioid epidemic. Each panel member shared a personal vignette about his or her professional experience with the epidemic, then the audience members were asked to participate in a question and answer session. Primary outcomes from this IP experience were derived from an eight-item satisfaction survey. The event was held in April 2016. The interdisciplinary committee marketed this event to all students, faculty, and staff in the Rueckert-Hartman College of Health Care Professionals one month before the event through electronic emails and posters. Results: Forty-four (63%) of participants completed the satisfaction survey of which 88.6% were students of healthcare professions. The satisfaction survey evaluative results were positive and referenced the panel as being an excellent IP event that was helpful, informative, and enjoyable. The results support that the initiative successfully increased understanding of the magnitude of the opioid epidemic for the attendees of this pilot event. The target audience of students expressed a greater awareness of the magnitude of the problem (43.2%) and an increased appreciation of the IP aspects of opioid management strategies (36.4%). Attendees also identified the need for ownership of their role as existing and future health care professionals and the need to work as an IP team to address the problem. Conclusion: An interprofessional panel format as an optional extracurricular event is an effective way to communicate key educational messages about opioid misuse and abuse to a target audience of graduate students at a mid-sized college of health professions.