Interprofessional practice: beyond competence

Registered nurses' and speech language pathologists' interprofessional collaboration: A systematic scoping review of the literature

AIMS AND OBJECTIVE

To identify the current research involving interprofessional collaboration between registered nurses (RNs) and speech language pathologists (SLPs) in healthcare and educational settings.

BACKGROUND

As the complexity of healthcare increases, the need for active interprofessional collaboration between RNs and SLPs grows. A review of the literature revealed no systematic reviews currently exist about interprofessional collaborative studies between RNs and SLPs.

DESIGN

Researchers conducted a scoping review using PRISMA guidelines.

METHODS

Online databases were used to identify qualitative and quantitative research studies written in English and conducted between 2011 and 2020. Databases included Academic Search Ultimate, ASHA Wire, CINAHL, Cochrane Database of Systematic Reviews, ERIC, MEDLINE, PubMed, PsycINFO, and SEMANTIC SCHOLAR. The studies needed to focus on the interprofessional collaboration between RNs and SLPs or students in these professions.

FINDINGS

Of the 128 sources, only six studies met scoping review criteria. The primary focus of three studies was an evaluation of interprofessional education activities between nursing, speech language pathology, and other health profession students. One study explored interprofessional education in clinical practice between RNs and SLPs. Two studies explored interprofessional collaboration in the clinical setting.

CONCLUSION

More research is needed that investigates interprofessional collaboration and practice of RNs and SLPs in the healthcare setting.

RELEVANCE TO CLINICAL PRACTICE

This review identified the need for RNs and SLPs to work effectively as interprofessional teams are important in improving patient outcomes.

Interprofessional identity in clinicians: A scoping review

Interprofessional collaborative practice (IPCP) has been recognized as invaluable in delivering safe, high-quality patient care with finite resources. However, despite a decade of advances in interprofessional (IP) research, policy, and competency frameworks, IPCP does not always occur in practice. One reason may be the influence of a clinician's identity in an IP context. The purpose of this scoping review was to understand the nature of IP identity in healthcare clinicians. The PRISMA framework was used to support a comprehensive search strategy and screening of 1746 articles. Inclusion criteria included original research, theses, and reviews, a primary focus on IP identity or professional identity (PI) in an IP team, and a focus on health professionals, including students transitioning to practice. Ninety-five papers met the eligibility criteria, though once charted, just four of the 95 papers focused on IP identity in clinicians. Three further papers examined shared team identity, 25 papers referred to, but did not focus on IP identity, and the remaining 63 papers explored PI in an IP team. While limited studies on clinician IP identity restrict conclusive findings, patterns were identified to direct further research on the nature of IP identity in clinicians. These include values and beliefs, individual and personal factors, profession and professional experience, education, socialization, context, leadership, and the process of IP identity development. While identity is undeniably central to being a clinician, the values, beliefs, attributes, and experiences that contribute to clinician IP identity, how clinician IP identity develops, and factors that influence IP identity remain unclear. The results of this review highlight the value of further investigation of the nature of IP identity, the interplay between PI and IP identity, and identity in an IP context.

Enablers and barriers of first-year common semesters and semester-long courses aimed at interprofessional collaborative practice capability development: A scoping review

Designing a first-year undergraduate common semester aimed at developing interprofessional collaborative practice (IPCP) capabilities is challenging. A scoping review was conducted to identify enablers and barriers for common semesters. Due to limited numbers of eligible studies, the review was expanded to include studies of semester-long first-year courses aimed at IPCP development. Key enablers of common semesters or courses in 35 included studies were: real-world, problem-solving, hands-on, interprofessional teamwork aligned with graduate practice capabilities relevant across disciplines; continuous feedback and critical evaluation; relationship building amongst students and staff; cohesive, well-trained interprofessional teams of staff and leaders; secure, supportive institutional policies and structures. Key barriers included: students' lack of preparation, perceptions of irrelevance, and misaligned expectations; variable student capability and response amongst professions; miscommunicated or misaligned course outcomes; course, faculty or institutional non-integration; and cost, logistic, and evaluation issues. Outcomes were mainly positive improvements in self-evaluated student IPCP skills and understanding, variability between professions, and persistent misconceptions. Scales measuring capabilities lacked uniformity, and few studies were comparative or observational. Overall, the review suggests noncompetitive undergraduate first-year common semesters or courses positively impact IPCP capability development when robustly assessed, clearly evaluated, and supported by an integrated IPE culture.

Diversity, friction, and harmonisation: an ethnographic study of interprofessional teamwork dynamics

Background

Although diversity, friction, and harmonisation in interprofessional teamwork are aspects frequently conceptualised, no empirical study discusses them in combination. Focusing on risk and function with respect to each aspect, this article empirically examines how dynamics between these aspects during interprofessional teamwork interactions fosters conditions for effective teamwork.

Methods

An ethnographic study of three interprofessional teams, in the context of mental health and substance use, was conducted in Norway. Data were collected through observations of 14 team meetings and 18 in-depth interviews with health and social work professionals. Thematic analysis was applied to code the data.

Results

A conceptual ideal-type model, which includes all three aspects was developed to represent the emergent findings. The results suggest that the diversity of professional perspectives inherent in interprofessional teams is the foundation of interprofessional teamwork. However, friction is needed to promote innovation, encourage new insights, and intensify discussions. In addition, harmonisation balances professional distinctions, fosters trust, and ties professionals together.

Conclusion

This article presents a comprehensive model of how professionals work together in interprofessional teams. The model makes visible the functions and risks of each aspect and the dynamics between them. Furthermore, the article argues for mobilisation and balance of all three aspects in combination to maximise the capacity of interprofessional teamwork. Such insight can be used to support the development and successful implementation of interprofessional teamwork in health care.

The impact of interprofessional task-based training on the prevention of surgical site infection in a low-income country

BACKGROUND

Training is considered instrumental in reducing surgical site infection. We developed training based on authentic tasks, interprofessional learning, and reflective learning for implementation in a low-income country where such training opportunities are rare. This study evaluated the results of training in terms of participants' acceptance, participants' knowledge acquisition, and their self-perceived behavior change.

METHODS

We included 145 participants in the voluntary training program, comprising 66 technologists (45.5%), 43 nurses (29.7%), and 36 doctors (24.8%) from Shifa International Hospital, Islamabad, Pakistan. We measured "satisfaction" using a questionnaire at the end of the training, "knowledge" through pre-and post-intervention assessments, and "self-perceived behavior change" using a questionnaire and interviews 8 weeks post-training.

RESULTS

Pre- and post-test scores showed a significant increase in knowledge. Participants were favorable to the training and eager to participate. They positively applied in practice what they had learned about preventing surgical site infection. Our qualitative data analysis revealed two categories of themes, representing the upsides of the training as it stood, and existing factors or downsides that hindered the effective transfer of learning to practice.

CONCLUSION

Participants were very enthusiastic about the training format. The knowledge test showed a gain in knowledge. Moreover, participants acknowledged that their behavior toward the prevention of surgical site infection in the operating rooms had changed. The use of authentic tasks from daily clinical practice, as well as the interprofessional approach and reflection, were considered to promote the transfer of learning. Although promising, our findings also pointed to obstacles limiting the application of evidence-based knowledge, such as a shortage of supplies and conventional practices.

Interprofessional practice: the path toward openness

This article seeks to shed light on the meanings healthcare practitioners attach to practicing interprofessionally and how interprofessional relationships play out in "everyday" practice. It draws on findings from a hermeneutic phenomenological study of health professionals' lived experience of practice, interpreted in relation to Martin Heidegger's concept of a path through the dense forest which leads to an open space where there is no predefined path to follow. Analysis of data from in-depth, semi-structured interviews with 12 health professionals from medicine, midwifery, nursing, occupational therapy, physiotherapy, speech and language therapy, and social work suggests that health practitioners come upon the clearing having walked their own track toward practicing interprofessionally. Our argument is that when: getting to know others; genuine dialogue; trust; and respect are in play, a spirit of interprofessional practice flourishes. The ontological view presented, sheds light on the nature of the relationships and the personal qualities that foster a spirit of interprofessional practice in these human-to-human interactions. It highlights how health practitioners need to be free to enact their humanity; to move beyond the "professional" pathway, which encourages them to leave "who they are" at home.

Development of interprofessional healthcare teamwork skills: mapping students' process of learning

Higher education institutions commonly prepare future healthcare workers to engage in increasingly complex, interprofessional healthcare environments through interprofessional education. Development of appropriate teamwork skills is complex and takes time. However, much of the research on student engagement with teamwork in higher education has been focused on the end goal of teamwork. This obscures the process of how students learn to work in interprofessional healthcare teams and in what ways, over time. The current study used an exploratory interpretive approach to obtaining students' experiences, perceptions and developing understanding of teamwork from the start of their undergraduate studies, through to completion of five semesters of group or teamwork projects. Through qualitative methodology, educators explored student experiences of teamwork, their focus at designated points of their undergraduate teamwork, and the meaning they attributed to being a member of a team. Student perceptions of successful teamwork developed over time to a positive and purposeful orientation toward teamwork, learner attributes that enhanced team function, and a growing awareness of how the assessment context affected team function. By mapping these processes of learning over time, educators can gain a clearer understanding of influences and experiences that impact on student learning in teamwork.

When boundaries blur - exploring healthcare providers' views of chiropractic interprofessional care and the Canadian Forces Health Services

INTRODUCTION

Musculoskeletal (MSK) conditions are primary reasons prohibiting Canadian Armed Forces (CAF) personnel from being deployed, with back pain the second most common activity-limiting condition. CAF provides a spectrum of services, including chiropractic care. There is a paucity of data related to chiropractic interprofessional care (IPC) within CAF healthcare settings.

METHODS

A qualitative study, using an Interpretative Phenomenological Analysis (IPA) approach, involving 25 key informant interviews explored factors that impact chiropractic IPC. We used a systematic but not prescriptive process, based on a thematic analysis, to interconnect data to develop meaning and explanation. Initially, we explained and interpreted participant's experiences and meanings. Next, we used extant literature and theory, together with expert knowledge, to explain and interpret the meanings of participants' shared accounts.

RESULTS

We present findings central to the domain, Role Clarity, as described in the IPC Competency Framework. Our findings call for strengthening IPC specific to MSK conditions in the CAF, including an examination of gatekeeping roles, responsibilities and outcomes.

CONCLUSION

It is timely to investigate models of care that nurture and sustain inter-provider relationships in planning and coordinating evidence-based chiropractic care for MSK conditions, within the CAF, and its extended referral networks.

Taking the classroom to camp: The facilitators' role in creating an impactful interprofessional experiential learning opportunity

A case study approach was used to describe faculty facilitators' perspectives on the creation and implementation of an interprofessional experiential learning opportunity for students at an aphasia camp. The facilitators serendipitously created an interprofessional experiential learning opportunity for speech-language pathology, occupational therapy, and physical therapy students volunteering at the aphasia camp. During focus groups several weeks after the camp, students discussed the interprofessional nature of their camp experiences and stated they had learned more about collaborative practice while volunteering at the aphasia camp than they had in any interprofessional course work, simulation experience, or clinically based fieldwork they had previously engaged in. The students spoke very highly of the facilitators' creation of the interprofessional experience. The interviewer, an interprofessional educator, wanted to know what the 'magic' was from the facilitators. Facilitators were asked to document their teaching philosophies and reflections and participate in a group interview. Three key themes emerged: educational philosophy, the environment, and facilitator characteristics. The facilitators created an environment where there was a balance between providing structure and clear expectations, with a flexible learning space where students could make mistakes yet feel supported. It was within this psychologically safe learning space that students had autonomy over many camp activities and opportunities to experiment and problem solve. The results from the study were compared to the characteristics of experiential learning. The article concludes with a summary of facilitators' characteristics that led to an impactful interprofessional experiential learning experience.

Healthcare professionals' perceptions of the pre-requisites and realisation of interprofessional collaboration in cancer care

OBJECTIVE

The purpose of this study is to describe the pre-requisites and realisation of interprofessional collaboration as perceived by healthcare professionals working in the cancer care setting and to produce knowledge to support the development of collaborative practices.

METHODS

This study employed a descriptive survey design. The data were collected in one Finnish cancer centre between May and October 2018 from nurses, physicians and other healthcare professionals using an electronic survey (n = 350). The survey focused on the pre-requisites of interprofessional collaboration (appreciation and competence) and its realisation in cancer care. The data were analysed using descriptive and interferential statistics.

RESULTS

The pre-requisites of interprofessional collaboration were perceived as good and the collaboration was well realised in the cancer centre. The perceptions of pre-requisites and realisation were associated with each other. Male respondents, physicians and professionals belonging to interprofessional teams had more positive perceptions of the pre-requisites and realisation of interprofessional collaboration than others.

CONCLUSION

The findings indicate that the pre-requisites of interprofessional collaboration and its realisation seem to be well implemented in the cancer care setting. However, the ongoing evaluation of interprofessional collaboration requires further attention from healthcare administration and professionals to support the systematic development of collaborative practices.