Multiple Professionals Research Articles

Integrating Palliative Care Into the ICU: From Core Competency to Consultative Expertise.

To propose a model describing levels of integration of palliative care into the care of ICU patients. Literature review and author opinion. All critical care team members should demonstrate and foster their core competencies in caring for patients with complex illness and uncertain prognosis, including at the end of life. We describe these core competencies of the ICU team member as "primary" palliative care skills. Some ICU team members will have special expertise in end-of-life care or symptom management and decision-making support and will serve as local experts within the ICU team as a resource to other team members. We call this skillset "secondary" palliative care. Some patients will benefit from the full range of expertise provided by a separate consulting team, with additional training, focused on caring for patients with palliative care needs across the full spectrum of patient locations within a health system. We term the skillset provided by such outside consultants "tertiary" palliative care. Solutions for meeting patients' palliative care needs will be unique within each system and individual institution, depending on available resources, history, and structures in place. Providers from multiple professions will usually contribute to meeting patient needs.

Spiritual Care Perspective of College Student-Athletes.

Spirituality in healthcare has been researched in multiple healthcare professions; however, very little research has been done in athletic training, and no studies have investigated the athletes' perception. The purpose of our online survey study was to determine the perceptions of college student-athletes on spiritual care. Our participants included 268 collegiate student-athletes from both faith-based and non-faith-based institutions. Respondents agree that spirituality may affect treatment progress, addressing spiritual concerns of the athlete could result in a more positive outcome, and certified athletic trainers should have some basic skills and knowledge to support the spiritual needs of the athlete.

Educating professionals who will work with children in the early years: an evidence-informed interdisciplinary framework

ABSTRACT The first five years of a child’s life are irrefutably important, establishing life-long health, social and economic outcomes. To optimize these outcomes, global policy is directing professionals from a range of disciplinary backgrounds to work more collaboratively than ever before with children in the early years. Such collaborations have proven problematic as individual disciplines and pre-service education requirements vary widely. Using Community-Based Participatory Research and Diffusion of Innovation approaches, this study aimed to develop an educational framework for professionals working with children in the early years and their families, to begin a cultural change for interdisciplinary collaboration and participation across the early years. Systematic reviews, modified Delphi rounds and focus groups identified the diverse demands of multiple professions, qualification levels and workforce agendas, as well as highlighting shared outcomes, knowledge and intentions across disciplines.

Creating a Collaborative Care Curriculum Framework.

A faculty-wide approach to curriculum design is required to ensure students within all health professional courses are provided with relevant interprofessional education opportunities across their course of study. Within the Faculty of Medicine, Nursing and Health Sciences at Monash University, Australia, a Collaborative Care Curriculum Framework was developed to detail the learning outcomes for collaborative care for pre-registration students. A six-stage process was undertaken. A working group was established, and existing literature, interprofessional frameworks and accreditation documents were analysed, and themes extracted. Consensus was obtained across the multiple professions (12 in our context) regarding the main themes and student learning outcomes. Multimedia was engaged to facilitate the communication of the framework across the faculty. Keys to the successful development of the framework included reference to profession-specific accreditation requirements, incorporating patient and student perspectives, and working with multimedia to produce clear professional documents. The outcome of the six-stage structured process was the establishment of an agreed framework for use across professions when planning an interprofessional curriculum. Subsequent benefits of developing the framework include a shared language, vision and priorities for the development of new interprofessional curriculum activities. A Collaborative Care Curriculum Framework was developed to detail the learning outcomes for pre-registration students CONCLUSION: Each stage of the framework development is outlined to allow others to replicate the process in their local context. The process undertaken and the challenges encountered are described, in addition to the subsequent benefits for faculty members and students.

Immediate and long-term effects of a team-based quality improvement training programme

BackgroundAlthough many studies of quality improvement (QI) education programmes report improvement in learners’ knowledge and confidence, the impact on learners’ future engagement in QI activities is largely unknown and few...

Interprofessional collaboration and the care and management of type 2 diabetic patients in the Middle East: A systematic review

ABSTRACTThe World Health Organization has ranked the Middle East (ME) as the second most prevalent region globally for type 2 diabetes. Currently, treatment options initiated by physicians focus mainly on pharmaceuticals; however, lifestyle factors also have a tremendous impact on a patient’s wellness or illness. A potential solution to this issue is to use an interprofessional team approach when caring for this patient population. The purpose of this systematic review is to look at the present literature involving the use of an interprofessional team approach to the care and maintenance of people with type 2 diabetes in the ME. A PRISMA flow diagram demonstrates the authors’ literature search and screening process. The systematic review includes nine studies with mixed-methodologies performed in the Middle Eastern region in an outpatient or primary care setting, and demonstrates the use of interprofessional collaboration when providing care for type 2 diabetic patients. A meta-analysis was not included due to the heterogeneity of the studies; however, data analysis is discussed and results are demonstrated through an extraction tool developed by the authors based on The Cochrane Collaboration’s data collection form. The aim of this review is to construct meaning surrounding the use and effectiveness of this collaborative approach with the adult and geriatric Middle Eastern diabetic patient population. Recommendations include continued support from multiple healthcare professions, involving nurses, pharmacists, dietitians, and physicians to promote holistic and patient-centred-care leading to fewer type 2 diabetes complications and hospital admissions.

Antimicrobial Resistance: a One Health Perspective.

One Health is the collaborative effort of multiple health science professions to attain optimal health for people, domestic animals, wildlife, plants, and our environment. The drivers of antimicrobial resistance include antimicrobial use and abuse in human, animal, and environmental sectors and the spread of resistant bacteria and resistance determinants within and between these sectors and around the globe. Most of the classes of antimicrobials used to treat bacterial infections in humans are also used in animals. Given the important and interdependent human, animal, and environmental dimensions of antimicrobial resistance, it is logical to take a One Health approach when addressing this problem. This includes taking steps to preserve the continued effectiveness of existing antimicrobials by eliminating their inappropriate use and by limiting the spread of infection. Major concerns in the animal health and agriculture sectors are mass medication of animals with antimicrobials that are critically important for humans, such as third-generation cephalosporins and fluoroquinolones, and the long-term, in-feed use of medically important antimicrobials, such as colistin, tetracyclines, and macrolides, for growth promotion. In the human sector it is essential to prevent infections, reduce over-prescribing of antimicrobials, improve sanitation, and improve hygiene and infection control. Pollution from inadequate treatment of industrial, residential, and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have included a One Health approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use regulation and policy, surveillance, stewardship, infection control, sanitation, animal husbandry, and alternatives to antimicrobials. WHO recently has launched new guidelines on the use of medically important antimicrobials in food-producing animals, recommending that farmers and the food industry stop using antimicrobials routinely to promote growth and prevent disease in healthy animals. These guidelines aim to help preserve the effectiveness of antimicrobials that are important for human medicine by reducing their use in animals.

Stress and Burnout in Nutrition and Dietetics

Literature from across multiple health professions points to a budding crisis where current and future health professionals are experiencing stress and burnout at an alarming rate that threatens the vitality of our healthcare system and it appears to be no different for professionals engaged in nutrition education and dietetics. We draw attention to stressors impacting the field of nutrition and dietetics and encourage a conversation for stronger interprofessional collaborations between registered dietitian nutritionists and other members of the healthcare team.

Interprofessional case conference: impact on learner outcomes.

Transition to interprofessional team-based care is a quickly progressing healthcare model and requires changes in medical training approaches. The Department of Veteran Affairs (VA) has taken a lead role in creating such training experiences, one of which is the establishment of multiple Centers of Excellence in Primary Care Education (CoEPCE). These sites are tasked with developing teaching innovations to better facilitate interprofessional team-based care. The patient-aligned care team interprofessional care update (PACT-ICU) is an interprofessional workplace learning activity with the goals of simultaneously addressing educational and patient care needs. Participants of the PACT-ICU included trainees and faculty of a variety of medical disciplines (e.g., internal medicine, psychology, and pharmacy) involved in a training primary care clinic. Two medically complex patients were presented at each PACT-ICU conference with the purpose of creating a plan of care that maintained an interprofessional team-based approach. Following implementation of the PACT-ICU conference intervention, two primary outcomes were assessed. First, self-assessment of PACT-ICU attendee learner outcomes was measured using a brief questionnaire surveying knowledge gain as it related to increase in knowledge of other professions' capabilities, roles, and responsibilities. Secondly, trainee provider behavior change was evaluated by measuring number of "within PACT" consults before and after participating in PACT-ICU. There was a significant positive change in self-assessed knowledge along with an indication of trainee behavioral change, as measured by electronic medical record consult patterns. This study demonstrates that interprofessional case conferences involving trainees and staff from multiple professions can increase awareness of other professions roles in patient care as well as facilitate interprofessional collaboration.

Using an interprofessional flipped classroom educational strategy for developing evidence-based practice knowledge and skills

Abstract Evidence-based practice (EBP) is the standard approach used by healthcare practitioners to provide high quality, patient-centered healthcare. Given that all health professions students require education in both EBP and interprofessional collaboration, we used the advantages of a flipped classroom instructional strategy to provide an interprofessional EBP instruction program. Health professions students who had a clear understanding of their professional roles and had engaged in some clinical experience participated in this pilot program. The program consisted of three online learning modules (3.5 h) and one in-person faculty facilitated interprofessional case-based EBP learning activity (2 h). This program was designed with the following objectives (and assessments): develop students' foundational EBP knowledge and skills (module quizzes); increase students' understanding of health professionals' roles and responsibilities (module quiz); and improve students' attitudes toward interprofessional teamwork and communication (Readiness for Interprofessional Learning Scale). Program feasibility was also assessed. Student evaluations of the program indicated they learned skills they felt contributed to their successful participation in the in-person activity. Additionally, students reported a better understanding of the benefits and challenges of working in interprofessional teams. Students preferred the flipped classroom approach to a more traditional approach and favored learning in an interprofessional group. The major impact of this program is the potential for health professions students to gain foundational EBP knowledge and skills and experience in interprofessional teams by transitioning uni-professional, traditional EBP instruction to a flipped classroom educational strategy with students from multiple health professions programs.

Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements.

IntroductionHealth workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions.MethodsResponses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software.ResultsThe core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions.ConclusionsThe study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.

P153 PATIENT, PARENT, AND PROVIDER PERCEPTIONS OF BARRIERS TO PEDIATRIC INFLAMMATORY BOWEL DISEASE CARE

Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed by various stakeholders. The main objective was to identify health system barriers, challenges, and potential solutions from existing patients, families, and providers via focus groups, which was the first part of a larger, prospective study. Participants for the focus groups were existing English-speaking patients (ages 9-18) with IBD, their caregiver(s), and providers including multiple professions (e.g., physician, nurse, pediatrician, social worker, care coordinator, scheduler, psychologist). Separate focus groups were led by experienced personnel for parents, children, and providers, using a standardized interview guide. Sessions were recorded, transcribed, and verified. Using content analysis, we systematically classified data through coding and identified themes. Three patient (n=20, 50% female; younger group M=11.4 ±1.5 years, older groups M=15.6±1.3 years), 3 parent (n=24, 83% female), and 2 multidisciplinary provider (n=19) focus groups were conducted. Barrier themes are summarized in Table 1. Families shared several common concerns with providers (e.g., school, care delay, psychosocial, financial) but varied on specifics. Some barriers may be addressable through family or staff education, improved communication (e.g., care delay/ access, transition), or training (e.g., labs, diet), while others may require change at an institutional or policy level (e.g., insurance). This qualitative analysis identified several barriers to IBD care, some shared, some unique to patients, parents, and providers, and with varying degrees of tractability.

Top ten best practices for interprofessional precepting

Abstract Background With increasing emphasis on positioning interprofessional education within clinical training, preceptors play a critical role in interprofessional learning. We define interprofessional precepting as intentionally educating learners from multiple professions in authentic practice-based settings, combining clinical teaching and patient care with explicit conversations about how interprofessional collaboration contributes to high-quality, patient-centered, team-based care. Interprofessional precepting requires a unique skillset, and we provide our top ten best practices for interprofessional precepting based on our experiences in the interprofessional education field and evidence from the literature. These best practices support interprofessional preceptors providing interprofessional education experiences in practice-based settings and can serve as a resource to guide preceptor development of the abilities necessary for establishing a high-quality educational experience.

Implementation of a novel population panel management curriculum among interprofessional health care trainees

BackgroundGaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown. We developed and implemented a novel, interprofessional PPM curriculum targeted to diverse health professions trainees.MethodsThe curriculum was implemented annually among internal medicine residents, nurse practitioner students and residents, and pharmacy residents co-located in a large, academic primary care site. Small groups of interprofessional trainees participated in supervised quarterly seminars focusing on chronic disease management (e.g., diabetes mellitus, hypertension, or chronic obstructive pulmonary disease) or processes of care (e.g., emergency department utilization for nonacute conditions or chronic opioid management). Following brief didactic presentations, trainees self-assessed their clinic performance using patient-level chart review, presented individual cases to interprofessional staff and faculty, and implemented subsequent feedback with their clinic team. We report data from 2011 to 2015. Program evaluation included post-session participant surveys regarding attitudes, knowledge and confidence towards PPM, ability to identify patients for referral to interprofessional team members, and major learning points from the session. Directed content analysis was performed on an open-ended survey question.ResultsTrainees (n = 168) completed 122 evaluation assessments. Trainees overwhelmingly reported increased confidence in using PPM and increased knowledge about managing their patient panel. Trainees reported improved ability to identify patients who would benefit from multidisciplinary care or referral to another team member. Directed content analysis revealed that trainees viewed team members as important system resources (n = 82).ConclusionsStructured interprofessional training in PPM is both feasible and acceptable to trainees across multiple professions. Curriculum participants reported improved panel management skills, increased confidence in using PPM, and increased confidence in identifying candidates for interprofessional care. The curriculum could be readily exported to other programs and contexts.

Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review

BackgroundTo ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience.MethodsDatabases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience.ResultsSeventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience.ConclusionsClinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health outcomes. While few studies found a direct effect on patient health outcomes, when provided to mental health professionals clinical supervision may be associated with a reduction in psychological symptoms of patients diagnosed with a mental illness. There was no association found between clinical supervision and the patient experience.Review RegistrationCRD42015029643.

Service learning in developing countries: Student outcomes including personal successes, seeing the world in new ways, and developing as health professionals

Background Service learning in developing countries (SLID) can develop students’ skills such as teamwork, cultural responsiveness, ethical practice, and professional skills. However most research has been done in a single country, does not include multiple professions, involves small sample sizes, and only includes service learning at a single time point. Purpose This research explores physiotherapy, occupational therapy and speech pathology student outcomes from interprofessional service learning in Vietnam and Timor Leste over three years. Method Post-placement questionnaires (n = 30) were analysed thematically. Findings ‘Personal successes’, ‘seeing the world in new ways’, and ‘developing as health professionals’ were identified as student outcomes. These outcomes arose from new experiences and relationships. Discussion and conclusions Interprofessional education can occur in SLID placements. Transformative learning might occur for students on SLID placements and SLID placement outcomes align with requirements for graduating health professionals, supporting the legitimacy of SLID as a formal aspect of professional education programs.

The South Dakota Model: Health Care Professions Student Disaster Preparedness and Deployment Training.

The Association of American Medical Colleges recommended an increase in medical education for public health emergencies, bioterrorism, and weapons of mass destruction in 2003. The University of South Dakota Sanford School of Medicine (USD SSOM) implemented a 1-day training event to provide disaster preparedness training and deployment organization for health professions students called Disaster Training Day (DTD). Hospital staff and emergency medical services personnel provided the lecture portion of DTD using Core Disaster Life Support (CDLS; National Disaster Life Support Foundation) as the framework. Pre-test and post-test analyses were presented to the students. Small group activities covered leadership, anaphylaxis, mass fatality, points of dispensing deployment training, psychological first aid, triage, and personal protective equipment. Students were given the option to sign up for statewide deployment through the South Dakota Statewide Emergency Registry of Volunteers (SERV SD). DTD data and student satisfaction surveys from 2009 to 2016 were reviewed. Since 2004, DTD has provided disaster preparedness training to 2246 students across 13 health professions. Significant improvement was shown on CDLS post-test performance with a t-score of -14.24 and a resulting P value of <0.00001. Students showed high levels of satisfaction on a 5-level Likert scale with overall training, small group sessions, and perceived self-competency relating to disaster response. SERV SD registration increased in 2015, and 77.5% of the participants registered in 2016. DTD at the USD SSOM provides for an effective 1-day disaster training course for health professions students. Resources from around the state were coordinated to provide training, liability coverage, and deployment organization for hundreds of students representing multiple health professions. (Disaster Med Public Health Preparedness. 2017;11:735-740).

Development of an Integrated National Model of Care for Eating Disorder Services across Multiple Settings

Introduction: (comprising background and problem statement) Eating disorders have the highest mortality and morbidity of all of the mental health conditions, with top causes of death including cardiac and suicide (Arcelus, 2011). Patients with eating disorders present across the age range and transition across multiple service boundaries including primary care, mental health, paediatrics, acute medicine, and emergency departments. Evidence based treatment improves eating disorder outcomes substantially (Lock, 2015). Ireland has had no public eating disorder service to date. With a growing incidence, the development of a national clinical programme for eating disorders was prioritised by HSE. Description of policy context and objective: The development of a national eating disorder services is part of HSE’s national strategy and clinical programme which aims to deliver integrated, accessible clinician developed care to patients. In the absence of existing policy and service for eating disorders, a national working group was established in order to develop an integrated Model of Care for HSE eating disorder services. Targeted population: The Model of Care for eating disorders targets all patients with DSM V/ ICD 10 eating disorders (approximately 188, 895 patients in Ireland will develop eating disorders in their lifetime; estimated incidence in Ireland is approximately 1756 cases per annum). Child, adolescent and adult patients are included at all stages of illness and levels of severity. Settings include mental health, primary care and acute hospitals. Highlights: (innovation, Impact and outcomes) The working group comprised of 16 clinicians from both child and adult services representing stakeholder groups (psychiatry, psychology, social work, OT dietetics and nursing), a national manager, and national patient support group representative. This geographically spread group took an incremental approach to developing the model of care, progressing from papers on uniprofessional roles and views, though a patient and evidence lens, towards an interprofessional collaborative consensus model of care which was strongly evidence based. External consultation with other HSE national clinical programmes in paediatrics, acute medicine and primary was integrated into the document. This 360 degree approach to developing the national model of care enabled individual positions to be addressed and has ensured acceptability and feasibility across multiple professions, settings and services. Comments on transferability: This 360 degree incremental approach to Model of Care design is adaptable to other complex disorders presenting to multiple service settings and which require an integrated approach. Conclusions: (comprising key findings, discussion and lessons learned) The initial stages of working group formation, when stakeholders described their roles and individual perspectives to the group, was key to addressing professional tribalism and moving towards a collaborative group stance and model of care. Patient representation at all meetings was essential to this, as it kept patient values and needs central to this varied group of stakeholders. External consultation in the later stages but before completion, enabled future interagency collaboration. Integrated pilot projects are now being developed across these programmes as the model of care moves towards implementation.

The Role of Accreditation in Achieving the Quadruple Aim

Intersections of Accreditation Interprofessional education (IPE) and collaborative practice continue to gain momentum within the health sector. Recently, accreditors from multiple health professions have joined together to discuss their […]

Case studies of applying electronic flexible material and technology to create the new media arts

The new media-arts revolution which combines art and design with innovative technology has made the shift of social and cultural texts into computer-mediated forms of production, distribution and communication. The invention of digital devices and contents has also revolutionized the quality of sound, image, and data, the way in which they are contemplated and served as the forms of art in relation to the convergence of multiple professions. Within this study, the social context and scenery are visualized and transcoded into design objects. The researcher delves further into the use of new electronic media-FleXpeaker™, which was invented by the Industrial Technology Research Institute, Taiwan. The researcher put specific images printed on both sides of the surface of FleXpeaker™, as well as with sound effects far-distance monitored by a Bluetooth receiver to call out one’s imagination of the events, the time and the underlying environment encoded in the new media. Therefore, the devices viewed as design objects do help users to converge diverse elements in relation to artistic expression and cultural representation. As the result, this particular case of media convergence leads to a new hyper-real experience for the viewers and audience.