Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis

Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts

BACKGROUND

Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed.

OBJECTIVE

To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts.

PARTICIPANTS AND SETTING

Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America.

METHOD

Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison.

RESULTS

Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones.

CONCLUSIONS

Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.

Medical secretaries' fears and opportunities in an increasingly digitalised workplace environment

PURPOSE

The purpose of this mixed-methods study was to explore how medical secretaries experience digital transformation in a Swedish healthcare organisation, with a focus on workplace climate and health.

DESIGN/METHODOLOGY/APPROACH

Data were collected using a sequential exploratory mixed-methods design based on grounded theory, with qualitative data collection (a Quality Café and individual interviews) followed by quantitative data collection (a questionnaire).

FINDINGS

Four categories with seven underlying factors were identified, emphasising the crucial need for effective organisation of digital transformation. This is vital due to the increased knowledge and skills in utilising technology. The evolving roles and responsibilities of medical secretaries in dynamic healthcare settings should be clearly defined and acknowledged, highlighting the importance of professionality. Ensuring proper training for medical secretaries and other occupations in emerging techniques is crucial, emphasising equal value and knowledge across each role. Associations were found between some factors and the health of medical secretaries.

RESEARCH LIMITATIONS/IMPLICATIONS

This study adds to the knowledge on digital transformation in healthcare by examining an important occupation. Most data were collected online, which may be a limitation of this study.

PRACTICAL IMPLICATIONS

Several aspects of the medical secretaries' experiences were identified. Knowledge of these is valuable for healthcare managers to make digital transformation more effective while avoiding excessive strain on medical secretaries.

ORIGINALITY/VALUE

Medical secretaries are expected to contribute to the digitalisation of healthcare. However, minimal research has been conducted on the role of medical secretaries in workplace digitalisation, focusing on workplace roles and its dynamics.

"Learning with each other, about each other": Interdisciplinary learning among genetic counseling students and clinical health psychology residents

Interprofessional collaborative healthcare is known to improve provider satisfaction and retention, as well as patient safety and quality of care. The specific knowledge, skills, and attitudes required to work in these environments are best taught interprofessionally. Despite having considerable overlap in training, orientation, and populations served, it is rare for trainees from genetic counseling and clinical health psychology to interact and learn together. In 2017, we developed an innovative week-long clinical health psychology rotation for students in the University of Manitoba MSc in Genetic Counselling Program, which aims to enrich psychotherapeutic/counseling knowledge and skills, as well as gain familiarity with the work of clinical psychologists. This rotation incorporates didactic teaching, observation, and structured reflection. Didactic teaching includes topics such as psychological assessment, adaptation to life-altering news, skills for managing intense emotional responses, and counseling for change. Observations of clinical health psychologists and clinical health psychology residents occur in a range of health settings. Structured reflection is practiced in both oral and written formats. Finally, both groups of trainees participate in an interprofessional case seminar series. Feedback from this experience has been very promising, and it was identified as a strength in the program's accreditation review. Adaptations over time include refining the clinical exposures to increase breadth and relevance, increasing the contact between the trainees from the two professions and enhancing the case seminar series to be more learner-driven and to focus on explicit interprofessional skills and themes. In addition to expected results, this rotation has led to some unanticipated findings, including an emergent emphasis on the social determinants of health and the need to work collaboratively for systemic change. Further, psychology residents have identified that it benefits them to learn more about genetic counseling and expressed interest in potential reciprocal learning opportunities in genetics clinics.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study

INTRODUCTION

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®".

OBJECTIVES

To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course.

METHODS

A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively.

RESULTS

Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®.

CONCLUSIONS

TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

[Interprofessional health education in the Region of the Americas from a nursing perspectiveEducação interprofissional em saúde na Região das Américas na perspectiva da enfermagem]

This study presents a reflective analysis of the implementation of interprofessional education in undergraduate nursing courses, considering as an example the curricula of undergraduate nursing careers in Brazil. Despite investments to advance interprofessional education, its practice is not institutionalized in the curricula of undergraduate courses. These findings represent a limitation for the implementation of interprofessional education in nursing courses, and the case of Brazil allows to learn lessons for the education of nursing professionals in other countries of the Region of the Americas. Recommendations are provided for training, management and intersectoral articulation of health and education services, with emphasis on primary health care and the Sustainable Development Goals, aimed at educational institutions wishing to implement interprofessional education.

Exploring the perceived challenges and support needs of Indonesian mental health stakeholders: a qualitative study

Background

Despite the large treatment gap in Indonesia, limited studies have attempted to explore both service users’ and providers’ evaluations of the current mental health system holistically. This study aims to explore the perceived challenges and support needs of Indonesian mental health stakeholders.

Methods

This qualitative study collected data from 17 participants from two mental health stakeholders in Yogyakarta (i.e., health professionals and service users) through a semi-structured interview. Thematic analysis was used to analyze the data.

Results

Findings reveal that service providers and users shared equally strong concerns regarding challenges and needs for improving mental health literacy, accessibility to services, and government support. However, a distinct emphasis was made in several areas—with service providers hinting more towards issues with interprofessional collaboration. In contrast, service users emphasized the negative attitude of health professionals and poor accessibility to service information.

Conclusion

The mental health service system is challenged by the lack of accessibility to service information, the limited spread of mental health practitioners, stigma, and lack of mental health literacy among both the public and professionals. A need for improvement in mental health promotion, accessibility, and quality of mental health workers is highlighted to satisfy the needs of both service users and providers.

Why allied health professionals use evidence-based clinical guidelines in stroke rehabilitation: A systematic review and meta-synthesis of qualitative studies

OBJECTIVE

To capture qualitative research about the perspectives and reasoning of allied health professionals about variability in the use of clinical guidelines in stroke rehabilitation.

DATA SOURCES

Ovid Medline, Psychinfo, Cochrane, Ovid Emcare, Scopus and Web of Science.

METHOD

The review protocol followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Qualitative or mixed methods research that provided qualitative data about use of clinical guidelines delivered by allied health professionals in stroke rehabilitation was included. Clinical guidelines included any evidence-based documents that guided allied health stroke rehabilitation practice. All studies were screened in duplicate at title and abstract and then at full text. Included studies were appraised using the McMaster Critical Appraisal Tool.

RESULTS

Data from 850 allied health professionals in 22 qualitative research studies from seven different countries were analysed and synthesised. Four themes were developed including: context necessitates strategy, all clients are different, systemic changes are needed and need a good reason to change something. The findings aligned with the four arms of evidence-base practice. Allied health professionals use clinical guidelines when they align with their reasoning and match the 'sweet spot' for client goals and circumstance. Clinical guideline use is attributed to sufficient resourcing, time and motivation and a strong research culture within health systems.

CONCLUSIONS

Variabilities in clinical guideline use by allied health professionals are due to their clinical reasoning, contextual factors, client characteristics and enabling health systems.

Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study

BACKGROUND

There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice.

METHODS

A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes.

RESULTS

Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions.

CONCLUSION

Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.

Leader empowering behaviour: relationships with nurse and patient outcomes

PURPOSE

This study aims to test a model examining the impact of leader empowering behaviour on experienced nurses' self-efficacy, interprofessional collaboration, job turnover intentions and adverse patient outcomes.

DESIGN/METHODOLOGY/APPROACH

Structural equation modelling in Mplus was used to analyse cross-sectional survey data from experienced nurses in Alberta, Ontario, and Nova Scotia, Canada (n = 478).

FINDINGS

The results supported the hypothesized model: (164) = 333.021, p = 0.000; RMSEA = 0.047; CFI = 0.965; TLI = 0.959; SRMR = 0.051. Indirect effects were observed between leader empowering behaviour and nurses' assessment of adverse events and leader empowering behaviour and nurses' job turnover intentions through interprofessional collaboration.

RESEARCH LIMITATIONS/IMPLICATIONS

Leader empowering behaviour plays a role in creating collaborative conditions that support quality patient care and the retention of experienced nurses.

PRACTICAL IMPLICATIONS

The findings will be of interest to academic and hospital leaders as they consider strategies to retain experienced nurses, such as nurse manager selection, development and performance management systems.

ORIGINALITY/VALUE

The influx of new graduate nurses to the nursing profession and changing models of care requires the retention of experienced nurses in the workforce. The findings suggest that leader empowering behaviour and interprofessional collaboration are important factors in supporting quality patient care and stabilizing the nursing workforce.

The VaRP Project: qualitative evaluation of the training effectiveness of Post Graduate Specializations for health professionals

INTRODUCTION

The healthcare professionals' specialized training has a positive impact on professional values, patient's outcome, and promotion of evidence-based practices. To raise the educational standard, the University of Parma has created Post Graduate Specializations which, in addition to learning sector-specific techniques and skills, include the acquisition of soft skills. Aim of the study is investigating the perception of the tutors dedicated to the organization, management, and teaching of the Post Graduate Specializations on the skills gained and the changes achieved in clinical practice, training, and research.

MATERIALS AND METHODS

Qualitative research was carried out through a semi-structured interview to 11 tutors who have been coordinating the Post Graduate Specializations.

RESULTS

The Qualitative analysis developed "thick" descriptions characterized by analytical density and interpretative richness. The emerging thematic nuclei were: General/unpredicted aspects, Professional empowerment, Satisfaction, Professional outcomes, Limits of the Post Graduate Specializations, and Development areas.

CONCLUSIONS

We identified the most effective areas of the Post Graduate Specializations that emerged consistently from the interviews. We hypothesized that the values and mission the Scientific Board, are effectively lived and championed in the everyday activities of the Post Graduate Specializations. Some domains still need to be furtherly developed, as the professional record, the absence of a "follow up" relationship with former students, and the effective management of workload both for students and tutors. The rise of these limits, can be particularly fruitful, as it gives the chance to identify the development trajectory the post-graduate trainings should pursue to raise the standard of excellence.

Financial Barriers Decrease Benefits of Interprofessional Collaboration within Integrated Care Programs: Results of a Nationwide Survey

Introduction

Interprofessional collaboration (IPC) is a key ingredient of integrated care. Nevertheless, IPC benefits remain unclear and its implementation within integrated care initiatives is not straightforward. In this study, we first explored whether IPC was associated with organisational and patient care improvements in Swiss integrated care initiatives; we then investigated the effect of various barriers faced by these initiatives, on these associations.

Methods

Self-reported data from 153 integrated care initiatives included in the Swiss Integrated Care Survey was used. We conducted moderated mediation analyses in which patient care improvements were the outcome, the degree of IPC implementation was the predictor, organisational improvements were the mediator, and professional, patient and financial barriers to integrated care, the moderators.

Results

IPC implementation within integrated care was associated with organisational improvements, which in turn were associated with patient care improvements; this path no longer existed when financial barriers to integrated care were considered.

Conclusion

Organisational improvements should be considered a priority when implementing IPC within integrated care initiatives since patient care improvements due to IPC can be expected mainly when organisational aspects are improved. More importantly, the role of financial barriers should be acknowledged, and actions taken to reduce their impact on integrated care.

The evolution of New Zealand's health workforce policy and planning system: a study of workforce governance and health reform

INTRODUCTION

While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand's health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives.

CASE DESCRIPTION

New Zealand's health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations.

DISCUSSION AND EVALUATION

The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand's more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care.

CONCLUSION

The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

The Experience of Family Physicians and Home Health Staff Involved in an Intervention to Increase Patient-Related Collaboration

Les médecins de famille (MF) et le personnel de soins de santé à domicile (PSD) canadiens rencontrent d'importants obstacles lorsqu'ils doivent collaborer pour la prestation de soins aux patients qu'ils ont en commun. Cette étude à méthodologie mixte visait à évaluer la qualité et la viabilité de l'utilisation de l'audioconférence sécurisée dans une optique d'amélioration de la planification des soins pour ces patients. Les données primaires incluaient les résultats d'un sondage réalisé avant et après l'intervention, ainsi que des entretiens semi-structurés et des groupes de discussion post-intervention. Des méthodes statistiques non paramétriques ont été utilisées pour analyser les résultats du sondage, et les données qualitatives ont fait l'objet d'une analyse thématique de contenu. Les résultats des analyses quantitatives et qualitatives ont ensuite été intégrés afin de faire ressortir les inférences reflétant les approches des MF et du PSD relatives aux obstacles et aux avantages de la planification interdisciplinaire des soins. Les MF et le PSD ont montré que des obstacles structurels limitent leur capacité à collaborer. Le PSD et les MF ont également convenu que les rencontres entre les intervenants des deux services étaient bénéfiques pour les patients et que l'utilisation de l'audioconférence constituait une méthode efficiente de planification collaborative des soins. Les limites comprenaient la petite taille de l'échantillon et la courte période d'intervention, compte tenu de l'ampleur des changements attendus.

Canadian family physicians (FPs) and home health staff (HHS) experience significant barriers to patient-related collaboration about patients they share. This mixed-methods study sought to determine the quality and sustainability of secure audio conferencing as a way to increase care planning about shared patients. Primary data sources included pre-and post-study administration of a published survey and post-study semi-structured interviews and focus groups. Non-parametric statistical procedures were used to analyze survey results and thematic content analysis was undertaken for qualitative data. Results from both quantitative and qualitative analysis were integrated into the overall analysis, in order to draw inferences reflecting both approaches to barriers and benefits of collaborative care planning for FPs and HHS. Both FPs and HHS provided evidence that structural barriers impede their ability to collaborate. HHS and FPs also agreed that joint conferences were beneficial for patients, and that the use of audio conferencing provided an efficient method of collaborative care planning. Limitations included a small sample size and short timeline for the intervention period, given the magnitude of the expected change.

Profiling mental health professionals in relation to perceived interprofessional collaboration on teams

OBJECTIVES

This study aims at identifying profiles of mental health professionals based on individual, interactional, structural and professional role characteristics related to interprofessional collaboration.

METHODS

Mental health professionals (N = 315) working in primary health care and specialized mental health teams in four Quebec local service networks completed a self-administered questionnaire eliciting information on individual, interactional, structural and professional role characteristics.

RESULTS

Cluster analysis identified four profiles of mental health professionals. Those with the highest interprofessional collaboration scores comprised two profiles labeled "highly collaborative female professionals with fewer conflicts and more knowledge sharing and integration" and "highly collaborative male professionals with fewer conflicts, more participation in decision-making and mutual trust." By contrast, the profile labeled "slightly collaborative professionals with high seniority, many conflicts and less knowledge integration and mutual trust" had the lowest interprofessional collaboration score. Another profile positioned between these groups was identified as "moderately collaborative female psychosocial professionals with less participation in decision-making."

DISCUSSION AND CONCLUSION

Organizational support, participation in decision-making, knowledge sharing, knowledge integration, mutual trust, affective commitment toward the team, professional diversity and belief in the benefits of interdisciplinary collaboration were features associated with profiles where perceived interprofessional collaboration was higher. These team qualities should be strongly encouraged by mental health managers for improving interprofessional collaboration. Training is also needed to promote improvement in interprofessional collaboration competencies.

Inter-Professionalism in Health Care Post-graduate specialization: an innovative Laboratory

BACKGROUND AND AIM

Inter- professional Collaboration (IPC) is an important component of a well-functioning healthcare system. It is linked to improvements in patient safety and case management, optimal use of the skills of each healthcare team member and provision of better health services. Inter- professional Education (IPE), is one key factor in the development of positive behaviors useful for IPC: the basic and post-basic training are key moments to raise awareness, train and help implement the IPC. Aim of this paper is to present and evaluate the use of an innovative laboratory of Consensus Conference implemented in the Nursing Post-graduate specialization at the University of Parma to train students to IPC.

METHODS

An Innovative Laboratory inspired by of the Consensus Conference (CC) methodology on the "Integrated Narrative Nursing Assessment" was designed. Three Post-graduate specialization courses were involved and assigned to different tasks in the CC, according to the characteristics of the specializations.

RESULTS

Strengths and weaknesses of the methodology were analyzed. Strengths: students' engagement in their competencies building, and the acquisition inter-professional collaboration skills. Weaknesses: the lack of time to develop the whole process, and the need of a deeper guidance in the scientific production.

CONCLUSIONS

Although the methodology have to be continuously improved through practice, this experimental Laboratory reached the aim of offering a real experience of IPC to the students. They really collaborated with different professionals to reach a common goal and being already considered an expert.

Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery

Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.

Children's complex care needs: a systematic concept analysis of multidisciplinary language

Complex care in the arena of child health is a growing phenomenon. Although considerable research is taking place, there remains limited understanding and agreement on the concept of complex care needs (CCNs), with potential for ambiguity. We conducted a systematic concept analysis of the attributes, antecedents, and consequences of children's CCNs from a multidisciplinary perspective. Our data sources included PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Inclusion criteria included publications in peer-reviewed journals between January 1990 and December 2017, written in the English language. One hundred and forty articles were included. We found that children's CCNs refer to multidimensional health and social care needs, in the presence of a recognized medical condition or where there is no unifying diagnosis.Conclusion: Children's CCNs are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. There remain extensive challenges to caring for these children and their families, precluding the possibility that any one profession can possess the requisite knowledge or scope to singularly provide high-quality competent care. What is Known: • Complex care is a growing phenomenon and population prevalence figures show that there is an increasing number of children with complex care needs (CCNs). However, the concept has not been systematically analyzed before, leaving it generally ill-defined and at times confusing. What is New: • This is the first time this concept has been systematically analyzed and this analysis provides a much-needed theoretical framework for understanding the multidimensional nature of CCNs in children. • Children's CCNs refer to multidimensional health and social care needs in the presence of a recognized medical condition or where there is no unifying diagnosis. They are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. It is clear that the very nature of CCNs precludes the possibility that any one profession or discipline can possess the requisite knowledge or scope for high-quality competent care for this population.

Interprofessional education for health science students' attitudes and readiness to work interprofessionally: a prospective cohort study

BACKGROUND

Interprofessional education of healthcare providers is necessary to foster collaborative practice and improve patient outcomes.

OBJECTIVE

To examine the effectiveness of the single-session interprofessional education in improving interprofessional attitudes, increasing knowledge of healthcare professions, and improving perceived-readiness for working interprofessionally and with older adults in students in occupational therapy, physical therapy, and physician assistant graduate programs.

METHODS

We used a prospective, pre-post cohort design. Fall risk evaluation for older adults was selected as the topic of the 4-hour interprofessional education session. Graduate students from three professional programs including occupational therapy (n=20), physical therapy (n=26), and physician assistant studies (n=35) participated in the study, and 17 older adults aged 65 years or older volunteered for the session. Our primary outcome measure was the Interprofessional Attitudes Scale measuring interprofessional attitudes, and our secondary outcome measure was the study-specific questionnaire measuring the direct effect of our interprofessional education session.

RESULTS

Graduate students showed significant improvements in the subscale of teamwork, roles, and responsibilities in the Interprofessional Attitudes Scale. Students also showed significant improvements in "understanding of other professions," "perceived-readiness to work interprofessionally," and "perceived-readiness to work with older adults" in the study-specific questionnaire. Ceiling effects were observed in most of the subscales in the Interprofessional Attitudes Scale.

CONCLUSION

This study demonstrates that a single 4-hour interprofessional education session can improve interprofessional attitudes, knowledge of other professions, and perceived-readiness of health science graduate students to work interprofessionally and to work with older adults.

Transforming Nursing Education to Strengthen Health System in Malawi: An Exploratory Study

Background:

Malawi made great strides to increase the number of nurses through the Emergency Human Resource for Health Program. However, quantity of health workforce alone is not adequate to strengthen the health system. Malawi still reports skill mix imbalance and geographical mal-distribution of the nursing workforce. Health systems must continuously adapt and evolve according to the health care needs and inform health professionals’ education to accelerate gains in health outcomes. The Lancet Commission reported that health professionals’ education has generally not lived up pace with health care demands.

Objectives:

The aim of this study was to describe the strategies being implemented in Malawi to improve nursing education. Specifically, the objectives of the study were to explore strategies being implemented, identify stakeholders and their targets in order to share practices with countries experiencing similar nursing education challenges.

Methods:

This was a cross sectional descriptive study with a concurrent mixed method design. One hundred and sixty participants including nurse practitioners and educators responded to a questionnaire. Fifteen nurse practitioners and eight nurse educators were also engaged in one to one interview.

Results:

Respondents showed varied opinion on how nursing education is being implemented. Six themes as regards strategies being implemented to improve nursing education emerged namely- capacity building, competency based curriculum, regulation, clinical learning environment, transformative teaching and infrastructure/ resources.

Conclusion:

Findings of this study show that the strategies being implemented to improve nursing education are relevant to closing the gap between health care needs and nursing education.

A middle-range model for improving quality of nursing education in Malawi

Background

Despite a global consensus that nurses and midwives constitute the majority and are a backbone of any country’s health workforce system, productive capacity of training institutions remains low and still needs more guidance. This study aimed at developing a middle-range model to guide efforts in nursing education improvements.

Objective

To explore challenges facing nursing education in Malawi and to describe efforts that are being put in place to improve nursing education and the process of development of a model to improve nursing education in Malawi.

Method

The study used a qualitative descriptive design. A panel discussion with eight nursing education and practice experts was conducted guided by core concepts derived from an analysis of research report from a national nursing education conference. Two focus group discussions during two quarterly review meetings engaged nurse educators, practitioners and clinical preceptors to fill gaps from data obtained from a panel discussion. A qualitative abductive analysis approach was used for the development of the model.

Results

Transforming and scaling up of nursing education emerged as the main concept of the model with nursing education context, academic practice partnership, regulation, competent graduate and nursing workforce as sub concepts. Key main strategies in the model included curriculum reforms, regulation, transformative learning, provision of infrastructure and resources and capacity building.

Conclusion

The model can be used to prioritise nursing education intervention aimed at improving quality of nursing education in Malawi and other similar settings.

Misalignments of purpose and power in an early Canadian interprofessional education initiative

Interprofessional education (IPE) has been widely incorporated into health professional curricula and accreditation standards despite an arguably thin base of evidence regarding its clinical effects, theoretical underpinnings, and social implications. To better understand how and why IPE first took root, but failed to grow, this study examines one of the earliest documented IPE initiatives, which took place at the University of British Columbia between 1960 and 1975. We examined a subset of 110 texts (academic literature, grey literature, and unpublished records) from a larger study that uses Critical Discourse Analysis to trace the emergence of IPE in Canada. We asked how IPE was promoted and received, by whom, for what purposes, and to what effects. Our analysis demonstrates that IPE was promoted as a response to local challenges for the Faculty of Medicine as well as national challenges for Canada's emerging public healthcare system. These dual exigencies enabled the IPE initiative, but they shaped it in somewhat divergent ways: the former gave rise to its core component (a health sciences centre) and the latter its ultimate purpose (increasing the role of non-medical professions in primary care). Reception of the initiative was complicated by a further tension: nurses and allied health professionals were sometimes represented as independent experts with unique knowledge and skills, and sometimes as assistants or substitutes for medical doctors. We relate the successes and frustrations of this early initiative to particular (mis)alignments of purpose and relationships of power, some of which continue to enable and constrain IPE today.

Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area

To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p < .0001). Healthcare providers perceived the interprofessional care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

Introduction:

Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn’s theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time.

Methods:

In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team’s four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn’s theory.

Results:

The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain.

Discussion:

This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.

Introduction of a team-based care model in a general medical unit

BACKGROUND

Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban acute care hospital Evidence-based care processes were introduced, including an initial patient assessment and orientation, comfort rounds, bedside shift reports, patient whiteboards, Name Occupation Duty, rapid rounds, and team huddles. Small teams of nurses cared for a portion of patients on the unit. The model was intended to enhance safety and quality of care by allowing providers to work to full scope in a collaborative practice environment.

METHODS

We evaluated the new model approximately one year after implementation using interviews with staff (n = 15), surveys of staff (n = 25 at baseline and at the final evaluation) and patients (n = 26 at baseline and 37 at the final evaluation), and administrative data pulled from organizational databases.

RESULTS

Staff interviews revealed that overall, the new care processes and care teams worked quite well. Unit culture and collaboration were improved, as were role clarity, scope of practice, and patient care. Responses from staff surveys were also very positive, showing significant positive changes in most areas. Patient satisfaction surveys showed a few positive changes; scores overall were very high. Administrative data showed slight decreases in overall length of stay, 30-day readmissions, staff absenteeism, staff vacancies, and the overtime rate. We found no changes in unit length of stay, 30-day returns to emergency department, or nursing sensitive adverse events.

CONCLUSIONS

Conclusions from the evaluation were positive, providing initial support for the idea of the collaborative practice model vision for adult medical units across Alberta. There were also a few positive effects on patient care suggesting that models such as this one could improve the organization's ability to deliver sustainable, high-quality, patient- and family-centred care without compromising quality.

Indicators and measurement tools for health system integration: a knowledge synthesis protocol

BACKGROUND

Health system integration is a key component of health system reform with the goal of improving outcomes for patients, providers, and the health system. Although health systems continue to strive for better integration, current delivery of health services continues to be fragmented. A key gap in the literature is the lack of information on what successful integration looks like and how to measure achievement towards an integrated system. This multi-site study protocol builds on a prior knowledge synthesis completed by two of the primary investigators which identified 10 key principles that collectively support health system integration. The aim is to answer two research questions: What are appropriate indicators for each of the 10 key integration principles developed in our previous knowledge synthesis and what measurement tools are used to measure these indicators? To enhance generalizability of the findings, a partnership between Canada and Brazil was created as health system integration is a priority in both countries and they share similar contexts.

METHODS/DESIGN

This knowledge synthesis will follow an iterative scoping review process with emerging information from knowledge-user engagement leading to the refinement of research questions and study selection. This paper describes the methods for each phase of the study. Research questions were developed with stakeholder input. Indicator identification and prioritization will utilize a modified Delphi method and patient/user focus groups. Based on priority indicators, a search of the literature will be completed and studies screened for inclusion. Quality appraisal of relevant studies will be completed prior to data extraction. Results will be used to develop recommendations and key messages to be presented through integrated and end-of-grant knowledge translation strategies with researchers and knowledge-users from the three jurisdictions.

DISCUSSION

This project will directly benefit policy and decision-makers by providing an easy accessible set of indicators and tools to measure health system integration across different contexts and cultures. Being able to evaluate the success of integration strategies and initiatives will lead to better health system design and improved health outcomes for patients.

Implementation and evaluation of an interprofessional simulation-based education program for undergraduate nursing students in operating room nursing education: a randomized controlled trial

BACKGROUND

The present study was designed to implement an interprofessional simulation-based education program for nursing students and evaluate the influence of this program on nursing students' attitudes toward interprofessional education and knowledge about operating room nursing.

METHODS

Nursing students were randomly assigned to either the interprofessional simulation-based education or traditional course group. A before-and-after study of nursing students' attitudes toward the program was conducted using the Readiness for Interprofessional Learning Scale. Responses to an open-ended question were categorized using thematic content analysis. Nursing students' knowledge about operating room nursing was measured.

RESULTS

Nursing students from the interprofessional simulation-based education group showed statistically different responses to four of the nineteen questions in the Readiness for Interprofessional Learning Scale, reflecting a more positive attitude toward interprofessional learning. This was also supported by thematic content analysis of the open-ended responses. Furthermore, nursing students in the simulation-based education group had a significant improvement in knowledge about operating room nursing.

CONCLUSIONS

The integrated course with interprofessional education and simulation provided a positive impact on undergraduate nursing students' perceptions toward interprofessional learning and knowledge about operating room nursing. Our study demonstrated that this course may be a valuable elective option for undergraduate nursing students in operating room nursing education.

Feasibility of a practical nurse administered risk assessment tool for drug-related problems in home care

AIM

To evaluate feasibility of a practical nurse-administered Drug-related Problem Risk Assessment Tool among home care clients ⩾65 years.

METHODS

Altogether, 36 practical nurses participated in the study. They were trained about the purpose and use of the tool. The training consisted of a day long interactive workshop and involved reviewing four self-selected clients' medications using the tool (one as a pre-assignment before and three as post-assignments after the workshop). The data of this study were collected during the training. Triangulation, i.e. combination of methods and data, was used to evaluate the feasibility of the tool. Quantitative data were gathered from returned post-assignment tools and qualitative data from face-to-face discussions and open questions in feedback forms the practical nurses returned after the training.

RESULTS

Practical nurses spent 10-45 minutes reviewing one client's medication using the tool (mean 20±8). They identified reliably 88% of the risk medicines used by the clients listed in the tool. Of the respondents (n=23) of the feedback forms, 43% reported that they felt it easy or quite easy to answer the questions of the tool. Generic names of medicines, time constraints, home-care workers'/client's lack of interest to client's pharmacotherapy and short client contacts were the most common barriers to use the tool.

CONCLUSIONS

The Drug-Related Problem Risk Assessment Tool turned out to be feasible among practical nurses. The brief training on the content and use of the tool seems to be sufficient for ensuring reliable use of the tool.

Interventions for increasing the proportion of health professionals practising in rural and other underserved areas

BACKGROUND

The inequitable distribution of health professionals, within countries, poses an important obstacle to the optimal functioning of health services.

OBJECTIVES

To assess the effectiveness of interventions aimed at increasing the proportion of health professionals working in rural and other underserved areas.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including specialised register of the Cochrane Effective Practice and Organisation of Care Group; March 2014), MEDLINE (1966 to March 2014), EMBASE (1988 to March 2014), CINAHL (1982 to March 2014), LILACS (February 2014), Science Citation Index and Social Sciences Citation Index (up to April 2014), Global Health (March 2014) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (June 2013). We also searched reference lists of all papers and relevant reviews identified, and contacted authors of relevant papers regarding any further published or unpublished work.

SELECTION CRITERIA

Randomised trials, non-randomised trials, controlled before-and-after studies and interrupted time series studies evaluating the effects of various interventions (e.g. educational, financial, regulatory or support strategies) on the recruitment or retention, or both, of health professionals in underserved areas.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles and abstracts and assessed full texts of potentially relevant studies for eligibility. Two review authors independently extracted data from eligible studies.

MAIN RESULTS

For this first update of the original review, we screened 8945 records for eligibility. We retrieved and assessed the full text of 125 studies. Only one study met the inclusion criteria of the review. This interrupted time series study, conducted in Taiwan, found that the implementation of a National Health Insurance scheme in 1995 was associated with improved equity in the geographic distribution of physicians and dentists. We judged the certainty of the evidence provided by this one study very low.

AUTHORS' CONCLUSIONS

There is currently limited reliable evidence regarding the effects of interventions aimed at addressing the inequitable distribution of health professionals. Well-designed studies are needed to confirm or refute findings of observational studies of educational, financial, regulatory and supportive interventions that might influence healthcare professionals' decisions to practice in underserved areas. Governments and medical schools should ensure that when interventions are implemented, their impacts are evaluated using scientifically rigorous methods to establish the true effects of these measures on healthcare professional recruitment and retention in rural and other underserved settings.

Bridging Silos

Canadian family physicians (FPs) and home health staff (HHS) experience significant barriers to collaboration regarding patients whose needs are complex. This study used mixed methods to examine whether pre-scheduled, structured audio-conferencing could improve patient-related collaboration between physicians and HHS. The number of shared patients and contacts was collected across three phases: baseline, pre-intervention, and intervention. Interviews with FPs and focus groups with HHS were conducted post-intervention. Mixed effects Poisson regressions for count data, and content analysis for interview and focus group data, were used. No statistically significant “intervention” effect was observed in either the number of shared patients or the average patient contacts. Physicians participating in at least one audio-conference had a lower patient contact rate than the rest of the intervention group and controls. Qualitative data suggested that audio-conferences led to fewer contacts due to more efficient communication.

The influence of empowerment, authentic leadership, and professional practice environments on nurses' perceived interprofessional collaboration

AIM

The aim of this study was to examine the influence of structural empowerment, authentic leadership and professional nursing practice environments on experienced nurses' perceptions of interprofessional collaboration.

BACKGROUND

Enhanced interprofessional collaboration (IPC) is seen as one means of transforming the health-care system and addressing concerns about shortages of health-care workers. Organizational supports and resources are suggested as key to promoting IPC.

METHODS

A predictive non-experimental design was used to test the effects of structural empowerment, authentic leadership and professional nursing practice environments on perceived interprofessional collaboration. A random sample of experienced registered nurses (n = 220) in Ontario, Canada completed a mailed questionnaire. Hierarchical multiple regression analysis was used.

RESULTS

Higher perceived structural empowerment, authentic leadership, and professional practice environments explained 45% of the variance in perceived IPC (Adj. R² = 0.452, F = 59.40, P < 0.001).

CONCLUSIONS

Results suggest that structural empowerment, authentic leadership and a professional nursing practice environment may enhance IPC.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders who ensure access to resources such as knowledge of IPC, embody authenticity and build trust among nurses, and support the presence of a professional nursing practice environment can contribute to enhanced IPC.

A systematic process for creating and appraising clinical vignettes to illustrate interprofessional shared decision making

Vignettes and written case simulations have been widely used by educators and health services researchers to illustrate plausible situations and measure processes in a wide range of practice settings. We devised a systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals. A vignette was developed in six stages: (1) determine IP-SDM content elements; (2) choose true-to-life clinical scenario; (3) draft script; (4) appraise IP-SDM concepts illustrated using two evaluation instruments and an interprofessional concept grid; (5) peer review script for content validity; and (6) retrospective pre-/post-test evaluation of video vignette by health professionals. The vignette contained six scenes demonstrating the asynchronous involvement of five health professionals with an elderly woman and her daughter facing a decision about location of care. The script scored highly on both evaluation scales. Twenty-nine health professionals working in home care watched the vignette during IP-SDM workshops in English or French and rated it as excellent (n = 6), good (n = 20), fair (n = 0) or weak (n = 3). Participants reported higher knowledge of IP-SDM after the workshops compared to before (p < 0.0001). Our video vignette development process resulted in a product that was true-to-life and as part of a multifaceted workshop it appears to improve knowledge among health professionals. This could be used to create and appraise vignettes targeting IP-SDM in other contexts.

Interprofessional education: effects on professional practice and healthcare outcomes (update)

BACKGROUND

The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional education (IPE) offers a possible way to improve interprofessional collaboration and patient care.

OBJECTIVES

To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the effectiveness of IPE interventions compared to no education intervention.

SEARCH METHODS

For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all included studies, the proceedings of leading IPE conferences, and websites of IPE organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client or healthcare process outcomes.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study designs and outcome measures. Consequently, the results are presented in a narrative format.

MAIN RESULTS

This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes 15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care, emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes (positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care.

AUTHORS' CONCLUSIONS

This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the 2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; third, cost-benefit analyses.

Systematic review of knowledge translation strategies in the allied health professions

BACKGROUND

Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology.

METHODS

A health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions.

RESULTS

A total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations.

CONCLUSIONS

Across five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.