Examining the implementation of collaborative competencies in a critical care setting: Key challenges for enacting competency-based education

Health and social care workers' professional values: A cross-sectional study

BACKGROUND

Professional values create a basis for successful collaboration and person-centred care in integrated care and services. Little is known about how different health and social care workers assess their professional values.

RESEARCH AIM

To describe and compare professional value orientation among different health and social care workers in Finland.

RESEARCH DESIGN

A quantitative cross-sectional study.

PARTICIPANTS AND RESEARCH CONTEXT

We carried out an online survey of health and social care workers from 8 March to 31 May 2022, using the Finnish version of the Nurses' Professional Values Scale-3. The data were analysed using descriptive and advanced statistics.

ETHICAL CONSIDERATIONS

Permission was received from all participating organizations and those who completed the survey provided informed consent.

RESULTS

A total of 1823 health and social care workers, representing seven professional groups and students, took part. The overall level of professional values among the participants was relatively high. Commitment to providing patients and clients with equal care was more important than engaging with society and professional responsibilities in the work environment. Professional values were strongest among professionals with higher educational degrees and training in professional ethics. The same was true for workers who received organizational support for ethical practice, were satisfied with their work and had shorter work experience.

DISCUSSION

Our results showed shared professional values among different health and social care workers and students. These results are meaningful for integrated care and services. At the same time, a clear need for strengthening engagement with society and professional responsibilities for developing work environments were identified.

CONCLUSIONS

Health and social care workers and students need training in professional ethics and organizational support for ethical practice and work satisfaction to maintain their professional values at different stages of their career.

It Takes a Team-Enhancing Student-Athlete Health and Well-Being through an Interprofessional Approach

Student-athlete well-being is a key objective for individuals working with or for university athletic departments. This paper will describe how a university athletic department used a team approach to enhancing student-athlete health and well-being. The Interprofessional Education Collaborative (IPEC) Core Competencies of (1) Values and Ethics; (2) Roles and Responsibilities; (3) Communication; and (4) Teams and Teamwork provide a guiding framework for interprofessional collaboration. (IPC; Interprofessional Education Collaborative, 2023). However, significant barriers exist in implementing IPC in university athletic departments and little research exists on how to overcome these barriers in university athletic departments to enhance student-athlete wellness. To address this gap, this paper will first provide a review of the literature on athlete well-being, followed by an applied section that describes the experience of an interprofessional wellness team (IWT) consisting of a clinical sports psychology doctoral student, a licensed mental health professional, an athletic trainer, and a sports dietitian. A case vignette is used to demonstrate how IPEC core competencies are operationalized by the team to address athlete health and well-being through IPC. Recommendations on the further implementation of IPC centered around student-athlete well-being will be provided.

What matters in low-threshold collaboration? Perceptions of interprofessional collaboration between education and social and healthcare professionals in Finnish primary schools

This study examined the factors linked to low-threshold interprofessional collaboration in the context of Finnish primary schools. The main purpose of the study was to analyze how education and health and social care professionals perceived their mutual collaboration. The PINCOM-Q scale was used to identify factors related to interprofessional collaboration in professionals' work settings. The results indicate that individual factors such as work motivation and personal power are prominent in low-threshold collaboration. At the group level, communication has an important role to play in interprofessional collaboration. Professionals (n = 204) perceived mutual exchange of information as an important aspect of working together. The aspects that matter in the low-threshold mode of interprofessional collaboration are a complex combination of individual, group and less obvious organizational factors, all of which both reflect and are reflected in an individual's motivation and commitment to cooperation. The establishment of long-term and systematic low-threshold, interprofessional collaboration presupposes that individual interests are realized in good interaction in equal encounters between different organizational domains.

Identifying the unique behaviors embedded in the process of interprofessional collaboration in the ICU

Interprofessional collaboration (IPC) is an important aspect of high-quality care in intensive care units (ICUs). The practice of IPC, however, is complex and the components that constitute IPC are not well defined. We sought to identify distinct behaviors embedded in clinician workflow that indicate engagement in the IPC process. We conducted a clinical ethnography in two ICUs in southeastern Michigan. From March 2017 to March 2019, we collected 31 hours of observations and completed 12 separate clinician shadowings and 12 interviews with ICU nurses, physicians, and respiratory therapists. We applied an iterative analytical approach to identify two types of IPC behaviors which we a priori labeled as "enablers" (i.e. the ways clinicians transition into or facilitate collaboration) and "collaborative activities" (i.e. behaviors clinicians use to directly collaborate with other professionals). 18 IPC behaviors were identified - ten "enablers" and eight "collaborative activities." Specifically, the enablers include: active listening, approach, coordinating work, intraprofessional consultation, invitation, nonverbal accessibility, reflexive questioning, sending pages/call, validation, and verbal accessibility. The collaborative activities are: correction, fill in the gap, information exchange, negotiation, providing help, socializing, teaching/training, and troubleshooting. By identifying IPC behaviors embedded in clinician workflow, our results may support more focused assessments of IPC in practice and guide clinicians toward behaviors they can use to engage in the IPC process.

The Definitions and Conceptualizations of the Practice Context in the Health Professions: A Scoping Review

INTRODUCTION

Health care professionals work in different contexts, which can influence professional competencies. Despite existing literature on the impact of context on practice, the nature and influence of contextual characteristics, and how context is defined and measured, remain poorly understood. The aim of this study was to map the breadth and depth of the literature on how context is defined and measured and the contextual characteristics that may influence professional competencies.

METHODS

A scoping review using Arksey and O'Malley's framework. We searched MEDLINE (Ovid) and CINAHL (EBSCO). Our inclusion criteria were studies that reported on context or relationships between contextual characteristics and professional competencies or that measured context. We extracted data on context definitions, context measures and their psychometric properties, and contextual characteristics influencing professional competencies. We performed numerical and qualitative analyses.

RESULTS

After duplicate removal, 9106 citations were screened and 283 were retained. We compiled a list of 67 context definitions and 112 available measures, with or without psychometric properties. We identified 60 contextual factors and organized them into five themes: Leadership and Agency, Values, Policies, Supports, and Demands.

DISCUSSION

Context is a complex construct that covers a wide array of dimensions. Measures are available, but none include the five dimensions in one single measure or focus on items targeting the likelihood of context influencing several competencies. Given that the practice context plays a critical role in health care professionals' competencies, stakeholders from all sectors (education, practice, and policy) should work together to address those contextual characteristics that can adversely influence practice.

Developing competence in interprofessional collaboration within integrated care teams for older people in the Republic of Ireland: A starter kit

Current evidence offers little guidance as to how interprofessional collaboration can be fostered within the context of integrated care and older people. This research describes the co-design of core competencies for interprofessional collaboration within integrated care teams for older people and the development of practical guidance to support teams in building proficiency. Using a co-design approach, we conducted three studies (co-design workshops, qualitative interviews, and an online validation forum), the combined output of which is a Core Competency Framework, that includes three domains describing six competencies for proficiency in interprofessional collaboration within integrated care of older people. Domain one, Knowledge of the Team, includes the competencies; understanding roles, and making referrals. Domain two, Communication, includes the competencies; sharing information and communicating effectively and Domain three, Shared Decision-making, includes the final two competencies; supporting decision making with older people and collective clinical decision-making. In presenting a formal understanding of the competencies for interprofessional collaboration in the integrated care of older people and practical guidance for developing proficiency, this framework provides direction for future health service workforce development.

A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours

Healthcare teams that practice collaboratively enhance the delivery of person-centred care and improve patient and systems outcomes. Many organizations have adopted existing interprofessional frameworks that define the competencies of individual health professionals that are required to meet practice standards and advance interprofessional goals. However, to support the collective efforts of team members to deliver optimal care within complex hospital settings, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. The Sunnybrook framework for interprofessional team collaboration was intentionally created as a set of collective team competencies. The framework was developed using a comprehensive literature search and consensus building by a multi-stakeholder working group and supported by a broad consultation process that included patient representation, organizational development and leadership, and human resources. The six core competencies are actionable and include associated team behaviours that can be easily referenced by teams and widely implemented across the hospital.

Incidence of Surgical Site Infections in Multicenter Study-Implications for Surveillance Practice and Organization

Introduction: WHO core components of healthcare-associated infections (HAIs) prevention and control include their surveillance system. In Poland, there are no widespread multi-center infection surveillance networks based on continuous, targeted, active methodology. One of the most important form of HAIs are surgical site infections (SSIs). The aim of this study was to analyze the incidence of SSIs, in the context of seasonal differentiation. Seasonal differentiation could be connected with weather conditions, but it also can be affected by personnel absence due to holidays and furlough. The second aspect may influence organization of work and increased absenteeism may contribute to lowering the quality of patient care. Healthcare associated infections are the phenomenon which can be especially affected by such factors. Methods: The data used originate from the targeted, active surveillance reports obtained from the six years period, based on the ECDC recommendations. Results: Highest incidence rates of SSIs were found after operations performed in June and August, equal to 1.8% and 1.5% respectively and the lowest in October was 0.8%. These differences were statistically significant: for June incidence: OR 1.6, 95% CI 1.03–2.5, p = 0.015. Another approach showed a significant difference between the level of incidence in the period from November to January together with from June to August (1.35%), comparing to the rest of the year (1.05%). Also the rates of enterococcal and Enterobacterales infections were significantly higher for the period comprising months from November till January and from June to August. In Poland these are periods of increased number of absences associated with summer, national and religious holidays. Conclusions: Our results show that the short-term surveillance data limited to several days or months are not sufficient to obtain a valuable description of the epidemiological situation due to HAI. Efforts should be undertaken in order to implement wide net of hospital acquired infections, including SSI on the country level.

Interprofessional and multiprofessional approaches in quality improvement education

The imperative for all healthcare professionals to partake in quality improvement (QI) has resulted in the development of QI education programs with participants from different professional backgrounds. However, there is limited empirical and theoretical examination as to why, when and how interprofessional and multiprofessional education occurs in QI and the outcomes of these approaches. This paper reports on a qualitative collective case study of interprofessional and multiprofessional education in three longitudinal QI education programs. We conducted 58 interviews with learners, QI project coaches, program directors and institutional leads and 135 h of observations of in-class education sessions, and collected relevant documents such as course syllabi and handouts. We used an interpretive thematic analysis using a conventional and directed content analysis approach. In the directed content approach, we used sociology of professions theory with particular attention to professional socialization, hierarchies and boundaries in QI, to understand the ways in which individuals' professional backgrounds informed the planning and experiences of the QI education programs. Findings demonstrated that both interprofessional and multiprofessional education approaches were being used to achieve different education objectives. While each approach demonstrated positive learning and practice outcomes, tensions related to the different ways in which professional groups are engaging in QI, power dynamics between professional groups, and disconnects between curricula and practice existed. Further conceptual clarity is essential for a more informed discussion about interprofessional and multiprofessional education approaches in QI and explicit attention is needed to professional processes and tensions, to optimize the impact of education on practice.

Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study

Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.

Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study

BACKGROUND

Use of wearable sensor technology for studying human teamwork behavior is expected to generate a better understanding of the interprofessional interactions between health care professionals.

OBJECTIVE

We used wearable sociometric sensor badges to study how intensive care unit (ICU) health care professionals interact and are socially connected.

METHODS

We studied the face-to-face interaction data of 76 healthcare professionals in the ICU at Mie University Hospital collected over 4 weeks via wearable sensors.

RESULTS

We detail the spatiotemporal distributions of staff members' inter- and intraprofessional active face-to-face interactions, thereby generating a comprehensive visualization of who met whom, when, where, and for how long in the ICU. Social network analysis of these active interactions, concomitant with centrality measurements, revealed that nurses constitute the core members of the network, while doctors remain in the periphery.

CONCLUSIONS

Our social network analysis using the comprehensive ICU interaction data obtained by wearable sensors has revealed the leading roles played by nurses within the professional communication network.

Factors Affecting Interprofessional Teamwork in Emergency Department Care of Polytrauma Patients: Results of an Exploratory Study

Considering that traumatic injuries are the leading cause of death among young adults across the globe, emergency department care of polytrauma patients is a crucial aspect of optimized care and premature death prevention. Unfortunately, many studies have highlighted important gaps in collaboration among different trauma team professionals, posing a major quality-of-care challenge. Using the conceptual framework for interprofessional teamwork (IPT) of , the aim of this qualitative descriptive exploratory study was to better understand IPT from the perspective of health professionals in emergency department care of polytrauma patients, specifically by identifying factors that facilitate and impede IPT. Data were collected from a sample of 7 health professionals involved in the care of polytrauma patients through individual interviews and a focus group. In the second phase, 2 structured observations of polytrauma patient care were conducted. Following a thematic analysis, results revealed multiple factors affecting IPT, which can be divided into 5 broad categories: individual, relational, processual, organizational, and contextual. Individual factors, a category that is not part of the conceptual framework of , also emerged as playing a major part in IPT.

Use of tabletop exercises for healthcare education: a scoping review protocol

INTRODUCTION

There is a growing interest in developing interprofessional education (IPE) in the community of healthcare educators. Tabletop exercises (TTX) have been proposed as a mean to cultivate collaborative practice. A TTX simulates an emergent situation in an informal environment. Healthcare professionals need to take charge of this situation as a team through a discussion-based approach. As TTX are gaining in popularity, performing a review about their uses could guide educators and researchers. The aim of this scoping review is to map the uses of TTX in healthcare.

METHODS AND ANALYSIS

A search of the literature will be conducted using medical subject heading terms and keywords in PubMed, Medline, EBM Reviews (Evidence-Based Medicine Reviews), CINAHL (Cumulative Index of Nursing and Allied Health Literature), Embase and ERIC (Education Resources Information Center), along with a search of the grey literature. The search will be performed after the publication of this protocol (estimated to be January 1st 2020) and will be repeated 1 month prior to the submission for publication of the final review (estimated to be June 1st 2020). Studies reporting on TTX in healthcare and published in English or French will be included. Two reviewers will screen the articles and extract the data. The quality of the included articles will be assessed by two reviewers. To better map their uses, the varying TTX activities will be classified as performed in the context of disaster health or not, for IPE or not and using a board game or not. Moreover, following the same mapping objective, outcomes of TTX will be reported according to the Kirkpatrick model of outcomes of educational programs.

ETHICS AND DISSEMINATION

No institutional review board approval is required for this review. Results will be submitted for publication in a peer-reviewed journal. The findings of this review will inform future efforts to TTX into the training of healthcare professionals.

Validity evidence and use of the IPEC Competency Self-Assessment, Version 3

To guide interprofessional education (IPE), a variety of frameworks have been suggested for defining competency in interprofessional practice, but competency-based assessment remains challenging. One self-report measure developed to facilitate competency-based assessment in IPE is the IPEC Competency Self-Assessment. It was originally described as a 42-item measure constructed on the four domains defined by the Interprofessional Education Collaborative (IPEC) Expert Panel. Response data, however, identified only two factors labeled Interprofessional Interaction and Interprofessional Values. In this study, we tested a revised 19-item, two-factor scale based on these prior findings with a new sample (n = 608) and found good model fit with three items not loading on either factor. This led to a 16-item instrument, which was then tested with an additional sample (n = 676). Internal consistency was high, and scores for both subscales showed variance based on prior healthcare experience. The interprofessional interaction subscale was primarily comprised of items from the Teams and Teamwork domain, with one item each based on competencies from the Interprofessional Communication and Values/Ethics domains; and scores varied by year of enrollment. The interprofessional values subscale was comprised solely of items from the Values/Ethics domain. Scores for both subscales were strongly correlated with scores from the Interprofessional Socialization and Valuing Scale. This study further establishes the validity, reliability, and usability of an assessment tool based on interprofessional competency. The findings also suggest the constructs underlying the subscales may be affected differently by experience and training. Additional study using longitudinal data is needed to test this hypothesis.

Cross-Disciplinary Care: A Systematic Review on Teamwork Processes in Health Care

As health care delivery moves toward more complex, team-based systems, the topic of medical teamwork has gained considerable attention and study across disciplines. This systematic review integrates empirical research on teamwork and health care to identify broad trends. We identified and coded 1,818 relevant, English, and peer-reviewed journal articles using a teamwork processes rubric. Several themes emerged. The health care teamwork literature has grown substantially over the past 20 years. Approximately half of the studies were descriptive (rather than interventional or psychometric); the majority relied on quantitative methods. Health care teamwork was also studied in thematically distinct manners. Interpersonal processes were most commonly studied across fields. Of all disciplines, medicine focused most on transition processes, whereas those from team science centered more highly on action processes. There were also finer grained disciplinary differences in content areas of communication and collaboration. Interprofessional journals represent a potential area for interdisciplinary efforts. Implications and future directions are discussed.

de Souza interprofessional practice cancer competency framework

PURPOSE

As the demand in cancer care continues to increase, health systems require a workforce of highly educated specialists and generalists to provide continuity of care across settings.

OBJECTIVES

Led by de Souza Institute in Canada, an interdisciplinary working group was formed to develop a competency framework with relevance across regulated health professionals involved in cancer care.

METHODS

The working group was presented with results from a scoping review of national and international guidelines, standards, and competencies in oncology, as well as data from needs assessments on continuing education opportunities and oncology topics most relevant to clinicians. Fifty-one professionals from, e.g., family medicine, pharmacy, social work, psychology, occupational therapy, and nursing participated in seven focus groups. An additional 32 nurses participated in a nursing-specific needs assessment survey. Using modified Delphi technique, working group members conducted three iterative rounds to review data and built consensus on competency items in relation to three levels of expertise, from early learner/novice practitioner, advancing practitioner, to expert practitioner.

RESULTS

A final consensus was reached for the selection of competencies that reflect optimal cancer care mapped into three levels of expertise, as well as knowledge, skills, and attitudes expected of each level. Examples for the competency for early learner/novice practitioner include the following: Have awareness of common ethical issues in cancer care (knowledge); demonstrate ability to discuss, educate, and counsel patients and their support persons(s) regarding preferences (skills); and appreciate the impact of culture, the sensitivity, and diversity of attitudes in relation to cancer (attitude). Expert practitioner examples include: recognition of need for, and ability to advocate for challenges involving equity and access in order to improve health outcomes (skill) and awareness of workplace complexities, such as provider roles, team functioning, and organizational environments affecting patient-practitioner relationships (attitude).

CONCLUSION

The de Souza Interprofessional practice cancer competency framework provides a set of shared competencies and a novice to expert pathway for clinicians across disciplines and supports a more standardized learning and comprehensive approach in organizing professional development towards a coordinated, high quality, and person-centered care.