Investigating the effect strength of positive risk-taking barriers on discharge decisions in occupational therapy intermediate care: A factorial survey

Introduction:

Positive risk-taking in occupational therapy intermediate care is a requirement, yet little is known about how positive risk-taking barriers influence discharge decisions at different experience levels.

Method:

A factorial survey was used to investigate positive risk-taking barriers (Limited Capacity, Risk Averse Family, Blame Culture and No Support). Participants self-categorised their experience level into Novice or Semi-expert or Expert before analysing four vignettes relating to recommending a home discharge for an older adult. Data were analysed using Multiple Regression and One-Way Analysis of Variance.

Results:

Seventy-four participants responded to two hundred eighty-one vignettes. The barriers that reduced the likelihood to recommend a home discharge for an older adult were ‘No Support’, Novices (β = −0.315, p = 0.002), Semi-experts (β = −0.313, p = 0.001) Experts (β = −0.254, p = 0.009); ‘Limited Capacity’, Novices (β = −0.305, p < 0.003), Semi-experts (β = −0.254, p = 0.006) Experts (β = −0.376, p = 0.001) and ‘Blame Culture’ Semi-experts (β = −0.240, p = 0.010). Novices were found to be less likely to recommend a home discharge by comparison.

Conclusion:

The ‘Limited Capacity’, ‘No Support’ and ‘Blame Culture’ barriers had the strongest effect and Novices were less likely to recommend a home discharge overall. These findings could inform future research and pre-registration Occupational Therapy education.

Interdisciplinary interprofessional education using an online learning environment called values exchange: A qualitative investigation

INTRODUCTION

Interprofessional education (IPE) is implemented throughout the curricula of student healthcare professions as it is understood to provide positive impact on patient outcomes in the clinical environment. There are different methods to provide IPE such as through online learning or traditional face-to-face methods. However, there is a lack of research surrounding the use of Online Learning Environments (OLEs) to teach IPE.

METHODS

In a pilot study, seventy-one undergraduate radiography students and twenty Master of Pharmacy students engaged in an ethical scenario using the OLE, Values Exchange (Vx). Following the activity, students were invited to complete an open-ended response question. Fourteen students responded and these data were used for qualitative analysis.

RESULTS

A thematic analysis of the students' open-ended responses found the emergence of three major themes, namely; understanding the roles of other healthcare professionals, developing self-reflection skills and, preparing for the clinical environment. Students suggested that additional time allocated for undertaking the study would benefit their engagement in the activity. Students would benefit from added engagement in the Vx task in both the short and long term for IPE.

CONCLUSION

Students are receptive in utilising contemporary approaches such as OLEs in furthering their IPE. Positive interpretations and suggestions by both radiography and pharmacy students in this study demonstrate how Vx as an OLE teaching tool can be used effectively. OLEs can overcome barriers that exist in face-to-face education experiences. OLEs should be considered for greater use within academic curricula of healthcare professions, but only if they have been evaluated for effectiveness.

Does the indicator of relative need (IoRN2) tool improve inter-professional conversations?

Purpose

This paper provides an overview of an improvement project that explored whether the implementation of IoRN2, a validated freely available tool designed for any health or social care professional to use, resulted in improved conversations across professions within an integrated rehabilitative reablement service.

Design/methodology/approach

A qualitative descriptive evaluative approach was applied underpinned by quality improvement Lean and Total Quality Management (TQM) to capture perceptions, variables and IoRN2 value-add. Professionals' (N = 8) across Nursing, Allied Health Professions, Social Work, Quality Improvement and Support Workers participated in one-to-one semi-structured <1 h interviews. Recurring themes and experiences were identified.

Findings

IoRN2 improved collaborative conversations. The evaluation of the tool demonstrated greatest impact when all professionals were IoRN2 trained. Participants, regardless of profession, believed that their conversations, professional relationships and outcomes improved when using IoRN2. When differing judgments arose with colleagues who were not IoRN2 trained, fear and tension emerged around trust, cultural manners and power play causing disconnects. Incorporating IoRN2 led to psychologically safe environments where trust, confidence and motivation to explore new creative conversations enhanced strength-based outcomes and helped to generate transformational change.

Research limitations/implications

The small sample size offered transferable learning worthy of larger future study. The project lead was also the reablement service manager, which may have generated unintended influence.

Originality/value

IoRN2 has the potential to improve how HSC professionals converse, acting as a catalytic tool for system-level integration, transformation and sustainable improvement.

Regulation of healthcare and medical imaging in Australia: A narrative review of the evolution, function and impact on professional behaviours

OBJECTIVES

This review explores the literature about the status and influence of statutory regulation in healthcare with a focus on medical imaging. It summarises the status of regulation in Australia for radiographers and sonographers, with brief reference to the global situation. The role of regulation is explored in terms of its evolution, function and effect on professional behaviours.

KEY FINDINGS

Reports of medical errors, sentinel events and professional misconduct in healthcare have raised concern about how health care professionals are regulated. Patient-centric healthcare delivery has changed how people interact with healthcare, contributing to the development of statutory regulation for many healthcare professions. In Australia, the Health Practitioner Regulation National Law (The National Law) 2009, established the National Registration and Accreditation Scheme (NRAS) in order to practice. Not all health care professions are included in the scheme. In medical imaging, radiographers are included but sonographers are a notable exception. Regulation is designed to positively influence practitioners' professional behaviours. The available evidence however is limited, but suggests that under certain circumstances, it can negatively impact practitioners' professional behaviours.

CONCLUSION

Statutory regulation has been implemented to address serious issues highlighted in reports of medical errors and professional misconduct, but it may have unintended consequences on the professional behaviours of practitioners. Limited research means the relationship between statutory regulation of healthcare practitioners and its impact upon professional behaviours remains unclear.

IMPLICATIONS FOR PRACTICE

If statutory regulation of healthcare professionals is to achieve its aim of protecting the public, it is imperative that we understand the impact that it has on professional behaviours. This review highlights that it can negatively impact professional behaviours which may be detrimental to patient's safety.