Impact of oral health management by nurses and dental professionals on oral health status in inpatients eligible for the Nutrition Support Team: A longitudinal study

OBJECTIVE

As the participation of dental professionals in multidisciplinary care is often limited, instructions on oral health management provided by dental professionals to other professionals are important to achieve transdisciplinary oral health management; however, the effectiveness of such instructions remains unclear. In this longitudinal study, we aimed to determine the impact of oral health management provided by dental professionals and nurses instructed on oral health management by dental professionals on the oral health of inpatients eligible for a Nurition Support Team (NST).

METHODS

The study participants were 117 patients (66 men and 51 women, mean age: 71.9 ± 12.5 years) who received oral health management during the NST intervention period. The participants received oral health management from nurses (Ns group) or dental professionals (D group). The nurses who conducted the oral health management received instructions from dental professionals. Oral health was assessed at the beginning and end of the NST intervention using the Oral Health Assessment Tool (OHAT).

RESULT

The Ns and D groups showed significant improvements in the total OHAT scores at the end of the NST intervention. Both groups showed significant improvements in the OHAT subitems of lip, tongue, gums and tissues, saliva, oral cleanliness and dental pain, while only the D group showed a significant improvement in the denture subitem.

CONCLUSION

Effective oral health management provided by dental professionals or by nurses trained by them improved the oral health status of inpatients eligible for NST at an acute-care hospital.

Community responses to persons with aphasia participating in CoActive therapeutic theatre: A pilot study

BACKGROUND

Persons with aphasia (PWA) experience a number of communicative and social-emotional challenges. Reported experiences of PWA include but are not limited to, being misunderstood, isolated, frustrated, and infantilised.

AIMS

The aim of this pilot study, involving a Life Participation Approach to Aphasia (LPAA), conducted over the course of 2 years, was to understand community perceptions of aphasia while PWA engaged in an interprofessional treatment program involving speech and drama therapy.

METHODS & PROCEDURES

The interprofessional treatment program involved PWA participating in a therapeutic theatre program using the CoActive Therapeutic Theater (CoATT) while also receiving speech-language therapy. Each year, the PWA performed a different, original therapeutic theatre production for a public audience, at the culmination of their interprofessional treatment program. In this paper, we share data obtained from perspectives of audience members who witnessed the theatre production and aphasia education during the first year of the study and friends and family of PWA who participated in the therapeutic theatre process during the second year of the study.

OUTCOMES & RESULTS

Responses from audience members who participated in aphasia education and witnessed the therapeutic theatre performance by the PWA during the first year, indicated an increased knowledge of aphasia. Friends and family members of PWA who witnessed their loved ones engaging in the CoATT process through interprofessional treatment, in the second year, reported that their loved ones benefited from the CoATT process, which was distinct from other therapeutic processes to their knowledge and that they were impacted by watching their loved one perform.

CONCLUSIONS & IMPLICATIONS

These initial findings create footing towards understanding impact of therapeutic theatre in combination with speech-language therapy in the lives of PWA. They help us to obtain an initial appreciation of how therapeutic theatre and aphasia education help connect PWA and their community.

WHAT THIS PAPER ADDS

What is already known on this subject Caregivers and communities at large play a significant role in and substantially impact the recovery of their loved ones (Dalemans et al., 2010; Grawburget et al., 2013; Kniepmann & Cupler, 2014) with aphasia. However, existing research suggests that persons with aphasia (PWA) are often misunderstood, isolated and infantilised by their communities. What this paper adds to existing knowledge The findings of our study reveal that friends, families and extended communities of PWA gain a positive and deep understanding of challenges experienced by PWA through therapeutic theatre supported by speech language therapy, based in a new CoActive Therapeutic Theatre (CoATT) model. This PWA community also agrees that therapeutic theatre in combination with speech-language therapy provides confidence and camaraderie between PWAs and strengthen connection between all constituencies. These results support the need for interprofessional intervention within the framework of a Life Participation Approach to Aphasia (LPAA). What are the potential or actual clinical implications of this work? Treatment paradigms that bring PWAs in contact with their communities using an LPAA approach can increase confidence and social engagement for PWAs potentially leading to better outcomes for their individual speech-language therapy as well as create means of educating communities about PWA, and their stories.

Interprofessional collaboration for children with physical disabilities: a scoping review

Interprofessional collaboration is vital in the context of service delivery for children with physical disabilities. Despite the established importance of interprofessional collaboration and an increasing focus on research on this topic, there is no overview of the research. A scoping review was conducted to explore current knowledge on interprofessional collaboration for children with physical disabilities from the point of view of the actors involved. The steps of this review included identifying a research question, developing a protocol, identifying relevant research, selecting studies, summarizing and analyzing the data, and reporting and discussing the results. Through databases and studies from hand-searches, 4,688 records were screened. A total of 29 studies were included. We found that four themes: communication, knowledge, roles, and culture in interprofessional collaboration illustrate current knowledge on the topic. Interprofessional collaboration for children with physical disabilities is shown to be composed of these four themes, depending on the actors involved. Interprofessional collaboration is affected by how these four themes appear; they mainly act as barriers and, to a lesser extent, as facilitators for interprofessional collaboration. Whether and how the themes appear as facilitators need further exploration to support innovation of interprofessional collaboration.

Exploring differences in and factors influencing self-efficacy for competence in interprofessional collaborative practice among health professions students

The value of health care delivered via effective interprofessional teams has created an imperative for interprofessional education (IPE) and interprofessional collaborative practice (ICP). To inform IPE strategies, we investigated differences in perceived self-efficacy (SE) for competence in ICP among health professions students. The study data were collected between 2015 and 2019 from students from 13 different health professions programmes (N = 3,497) before an annual institutional interprofessional programme. Students completed the IPECC-SET-27, a validated instrument evaluating perceived SE for competence in ICP, and rated their 1) amount of previous contact with, and 2) perceived understanding of, the role of different health professions. Students in different health professions education programmes were compared using parametric statistics. Regression analyses explored factors influencing SE for competence in ICP. Findings revealed significant differences in perceived SE for competence in ICP between programmes (p < .05). Specifically, health information management/health informatics, dentistry, medicine, and nursing students expressed relatively higher SE, whereas physical therapy and occupational therapy students expressed relatively lower SE. Perceived understanding of the role of health professions (p < .01) and gender (p < .01) contributed significantly to predicting perceived SE for competence in ICP, while the amount of previous contact with other health professions did not (p = .42). The findings highlight the value of designing IPE with consideration of specific learner needs.

Reducing the burden of knee osteoarthritis through community pharmacy: Protocol for a randomised controlled trial of the Knee Care for Arthritis through Pharmacy Service

INTRODUCTION

Knee osteoarthritis (OA) negatively impacts the health outcomes and equity, social and employment participation, and socio-economic wellbeing of those affected. Little community-based support is offered to people with knee OA in Aotearoa New Zealand. Identifying Māori and non-Māori with knee OA in community pharmacy and providing co-ordinated, evidence- and community-based care may be a scalable, sustainable, equitable, effective and cost-effective approach to improve health and wellbeing.

AIM

Assess whether the Knee Care for Arthritis through Pharmacy Service (KneeCAPS) intervention improves knee-related physical function and pain (co-primary outcomes). Secondary aims assess impacts on health-related quality of life, employment participation, medication use, secondary health care utilisation, and relative effectiveness for Māori.

METHODS AND ANALYSIS

A pragmatic randomised controlled trial will compare the KneeCAPS intervention to the Pharmaceutical Society of New Zealand Arthritis Fact Sheet and usual care (active control) at 12 months for Māori and non-Māori who have knee OA. Participants will be recruited in community pharmacies. Knee-related physical function will be measured using the function subscale of the Short Form of the Western Ontario and McMaster Universities Osteoarthritis Index. Knee-related pain will be measured using an 11-point numeric pain rating scale. Primary outcome analyses will be conducted on an intention-to-treat basis using linear mixed models. Parallel within-trial health economic analysis and process evaluation will also be conducted.

ETHICS AND TRIAL DISSEMINATION

Ethical approval was obtained from the Central Health and Ethics Committee (2022-EXP-11725). The trial is registered with ANZCTR (ACTRN12622000469718). Findings will be submitted for publication and shared with participants.

Evaluation of a newly developed flipped-classroom course on interprofessional practice in health care for medical students

Interprofessional education is expected to promote collaborative practice and should therefore be included in health professionals' curricula. Reports on interprofessional curricular development and its evaluation are rare. We therefore undertook a comprehensive quantitative and qualitative evaluation of a new, mandatory course on interprofessional collaboration for medical students during their third year of the Bachelor of Medicine study programme. The newly developed and implemented course spans over six weeks and was designed in a hybrid, flipped-classroom format. It incorporates experience- and case-based learning as well as interactions with other health professionals. Each student completes an eLearning and a clinical workshadowing individually before attending the - due to the pandemic - virtual live lectures. To assess quality and usefulness of teaching-learning formats and course structure to learn about interprofessional collaboration and to develop interprofessional competencies and identity, a quantitative and qualitative evaluation was performed with more than 280 medical students and 26 nurse educators from teaching hospitals using online surveys (open & closed-ended format). Data were analyzed descriptively and using content analysis processes. Students appreciated the flipped-classroom concept, the real-world case-based learning scenarios with interprofessional lecturer teams, and the possibility of an experience-based learning opportunity in the clinical setting including interaction with students and professionals from other health professions. Interprofessional identity did not change during the course. Evaluation data showed that the course is a promising approach for teaching-learning interprofessional competencies to medical students. The evaluation revealed three factors that determined the success of this course, namely, a flipped-classroom concept, the individual workshadowing of medical students with another health professional, mainly nurses, and live sessions with interprofessional teaching-learning teams. The course structure and teaching-learning methods showed potential and could serve as a template for interprofessional course development in other institutions and on other course topics.

Empowering the Radiation Oncology Triage Nurse Role: A Single-Center Analysis

BACKGROUND

Triage nurses play a crucial role in addressing patient telephone calls. However, topics that radiation oncology (RO) triage nurses encounter have not been thoroughly investigated.

OBJECTIVES

This project established baseline patient issues addressed via telephone by RO triage nurses in a clinically busy academic RO department; identified themes and potential areas for workflow improvement; and evaluated interprofessional perceptions of RO triage from nurses, physicians, and radiation therapists.

METHODS

This two-part study was conducted from September through November 2021 using a retrospective chart review that analyzed patient communications to the RO nurse triage line. Physicians, nurses, and radiation therapists completed an online survey about their experiences with nurse triage.

FINDINGS

Analysis revealed 13 message themes, with scheduling questions being the most common theme. Survey results indicated that average provider satisfaction with the effectiveness of triage was 3 of 5, perceived triage nurse preparedness to resolve encounters was 3 of 5, and perception of the triage program by physicians was 2.4 of 5.

"Many people know nothing about us": narrative medicine applications at a student-run free clinic

Narrative medicine is an approach to healthcare that acknowledges the stories of patients' lives both within and beyond the clinical setting. Narrative medicine has been increasingly recognized as a promising tool to support modern educational needs in health professions training, such as interprofessional practice, while enhancing quality of care. Here, we describe the development, implementation, and application of a narrative medicine program at the University of Minnesota Phillips Neighborhood Clinic. First, in a qualitative analysis of patient stories (n = 12) we identified themes regarding the value of the storytelling experience; patients' personal journeys; and patients' experiences in healthcare and other systems. Second, an interprofessional educational activity for student volunteers (n = 57) leveraging a patient narrative was observed to be satisfactory, significantly improve attitudes toward the underserved, and enhance quality of care from the perspectives of trainees. Together, findings from the two studies imply the potential benefits of broader incorporation of narrative medicine into interprofessional service settings, for both learners and patients.

Enhancing or impeding? The influence of digital systems on interprofessional practice and person-centred care in nutrition care systems across rehabilitation units

AIMS

Digital health transformation may enhance or impede person-centred care and interprofessional practice, and thus the provision of high-quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person-centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science.

METHODS

Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science.

RESULTS

We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems.

CONCLUSIONS

While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition-related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person-centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential.

The Arizona Nexus: the first five years

Arizona Nexus is a pioneer Nexus Innovations Network (NIN) member with the National Center for Interprofessional Practice and Education (National Center) and a statewide collaborative with members from five public and private universities and six health care organizations in Arizona. The Arizona Nexus grew from the request of interprofessional champions at two public state universities, Arizona State University (ASU) and the University of Arizona (UA), to be part of the University of Minnesota's application and vision for the first National Center cohort. Culture change, shared vision, resources, and leadership are factors that have been in play in the development and growth of the Arizona Nexus. In this case study, we tell the story of the Arizona Nexus, key landmarks in its development and how these four factors contributed to its growth and success. For the Arizona Nexus, the next five years and beyond will embody action. Building from the hard-won and exciting foundation we have built in our first five years, we are determined to accelerate the growth of interprofessional practice and education, inspire continued growth of academic and clinical partnerships, and use the knowledge, skills and creative thinking of all professions to improve and transform health care.

Determining the impact of an interprofessional learning in practice model on learners and patients

The Institute of Medicine recently expressed a need to measure the impact of interprofessional education (IPE) on health professions collaborative behavior in practice environments and patient outcomes, and the National Center for Interprofessional Practice and Education has focused research efforts to connect interprofessional practice and education. We describe a model intentionally designed to link interprofessional practice experience in ambulatory care setting and an IPE curriculum for students, called the Interprofessional Learning in Practice (ILIP) model. The study objective was to determine the impact of the ILIP model on student and patient outcomes during a 24-month intervention period. Student satisfaction was collected through a brief survey administered post-ILIP model. Patient outcomes were collected from before and after the intervention period through a retrospective chart review of patients who received care through the ILIP model. For the study, disease indicators for the top three chronic diagnoses of depression, hypertension, and type 2 diabetes mellitus were chosen as the patient outcomes. Student outcomes were analyzed using descriptive statistics and the Mann-Whitney U test. Patient outcomes were analyzed using McNemar's test and paired t-tests. Of the 382 students who participated in the ILIP model during the study period, 179 completed surveys, indicating that they valued the experience, valued learning from interprofessional preceptors, and gained interprofessional skills to use in their future practice. During the 24-month intervention, 401 patients were evaluated post-ILIP model, statistically significant results demonstrated HbA1c values for patients with diabetes were reduced by 0.5% and depression screening improved from 9% to 91%. Additionally, patients' hypertension control was similar to baseline and diabetes control (as defined as HbA1c ≤8%) was improved compared to baseline but did not reach statistical significance. By aligning interprofessional practice and education in the ILIP model, students had a positive experience, gained interprofessional collaboration skills, and provided value-added benefits to improve patient outcomes.

Opportunity, hierarchy, and awareness: an ethnographic exploration across rehabilitation units of interprofessional practice in nutrition and mealtime care

Interprofessional practice is increasingly cited as necessary in the delivery of high-quality nutrition and rehabilitation services. However, there is limited evidence available exploring the factors which influence interprofessional practice in subacute rehabilitation nutrition services. Our ethnographic study explored collaborative activities, influential factors and staff attitudes related to interprofessional practice in nutrition care. Fifty-eight hours of ethnographic field work were undertaken from September 2021-April 2022, across three subacute rehabilitation units, with a total of 165 patients, support persons and staff participating. Overall, 125 unique participants were observed and 77 were interviewed. We generated three themes through reflexive thematic analysis. First, the potential opportunities for interprofessional practice at mealtimes, as influenced by communication, role clarity and reciprocity. Second, hierarchy of nutrition roles and tasks impedes interprofessional practice, where the perceived lower importance of nutrition care to other clinical roles and physical therapies influences staff practice. Third, the mystery of nutrition care roles and systems in rehabilitation, which exposes gaps in the awareness of different team members regarding nutrition care roles and systems, hindering interprofessional practice. Our findings highlight the opportunity for embedded, innovative models of care and staff education to enhance interprofessional practice in nutrition and mealtimes.

Interdisciplinary considerations for diagnosing aphasia in the schizoaffective patient: A case report

BACKGROUND

Patients with schizophrenia present with both cognitive impairment as well as language difficulties. There are similarities in the language output of patients with schizophrenia and patients with aphasia, thus a differential diagnosis of patients who present with a question of dual diagnoses can be a clinical challenge. This case report highlights the importance of an interdisciplinary approach to a patient with schizophrenia who benefitted from intervention from both psychiatry and speech-language pathology services due to the patient's unique verbal output.

AIMS

The primary aim of this case report is to highlight the critical importance of interdisciplinary collaboration in this patient population. The secondary aim is to disseminate an interesting and unique clinical phenomenon whereby the patient demonstrated an awareness of two distinct speech patterns and the unique ability to 'code switch' between them, something not commonly appreciated in this clinical population.

METHODS & PROCEDURES

This case report describes a patient seen as part of routine clinical care. Information shared was solely observational and involved dissemination of information regarding case history, assessment and treatment plan. No interventions were implemented as a part of this study.

OUTCOMES & RESULTS

Interprofessional communication was critical in order to diagnose a patient with schizophrenia with an atypical speech pattern. The patient's language output did not manifest as a true aphasia but rather as two distinct language patterns that the patient could use at will. This ability to 'code switch' between languages is a unique clinical profile that is atypical of patients with schizophrenia.

WHAT THIS PAPER ADDS

What is already known on this subject Contemporary literature discusses the similarities between the language patterns of patients with aphasia and those with schizophrenia. There has been debate about how to classify and identify the mechanism of schizophrenic language. It is unclear whether the tangential press of speech in schizophrenia is a consequence of a formal thought disorder, or whether it constitutes an actual disorder or expressive language. Additionally, the mechanism for this speech pattern is not well defined in the literature as there is no consensus on whether it is a breakdown in linguistic processing or simply a patient's disordered thoughts being put into words. A less robust literature exists that suggests that there is a cognitive mechanism responsible for these speech patterns, as tangential speech has been linked to poor goal maintenance in other types of cognitive tasks. What this paper adds to existing knowledge This study adds an important discussion about the critical importance of interprofessional collaboration when differentially diagnosing this complex patient population. It highlights the importance of the clinical exchange of information between the two disciplines of psychiatry and speech-language pathology about a patient population where clinical information is intertwined in the way described above. Regardless of the cause of the disordered output, what is lacking in the literature is evidence of how to address the complexities of the output of these patients and how to best manage the care of the patient. This study adds a practical clinical approach to collaborating on the assessment and management of this complex patient population. Importantly, it adds a description of a clinical manifestation of the language output of a patient with schizophrenia that we do not believe to have been previously published in the literature. What are the potential or actual clinical implications of this work? Implications of this study include a much-needed shift in the field in two regards. First, to include this patient population in the groups of patients that can benefit from interprofessional collaboration for differential diagnosis and consideration for speech and language therapy. Second, it offers a practical clinical approach to inter-professional management in this patient population, something the literature is currently lacking. Additionally, publication of this unique clinical manifestation provides foundational knowledge for other clinicians appreciating similar clinical patterns of language output. To our knowledge, this is the first published case in which a patient could volitionally inhibit certain speech characteristics and thus this case study may assist in future differential diagnosis of patients with schizophrenia.

A-TEAM: An Interprofessional Approach to Mandated Reporting in the Hospital Setting

Reporting suspected child maltreatment in pediatric settings presents unique challenges. Variation in mandated reporter training may lead to discomfort and emotional dysregulation. Failure to collaborate inter-professionally potentially results in suboptimal care for vulnerable children and families. A-TEAM promotes awareness, transparency, empathy, a nonjudgmental strategy, and management by an interprofessional team when referring patients for child protective services evaluation. A faculty trained in pediatric trauma nursing led the development of A-TEAM. Integrating nursing and social work expertise protects the integrity of family-centered patient care. The A-TEAM approach may be a valuable contribution to the continuing education of pediatric health care professionals.

Demystifying Case Management in Aotearoa New Zealand: A Scoping and Mapping Review

BACKGROUND

Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand.

AIM

This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ).

METHODS

Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified.

RESULTS

A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships.

CONCLUSIONS

Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.

Combining an experiential learning model and interprofessional peer-mentoring to improve maternal and neonatal health: Lessons learned from Indonesia

Background

High maternal-neonatal mortality rate in the East Nusa Tenggara Timur Province, Indonesia, has raised a concern about improving quality health care and prevention. A task force team consisting of the district health office and the corresponding hospital implemented an interprofessional peer mentoring for improving maternal-neonatal health initiative involving various health professionals and community members. This study assesses the effectiveness of the interprofessional peer-mentoring program in improving health-care workers' capacity and community members' awareness of maternal-neonatal health in the primary care setting.

Methods

A mixed-methods action research was conducted to measure the effectiveness of the peer-mentoring program. The task force appointed 15 personnel to be trained as peer mentors for 60 mentees from various professions. Peer mentors' perceptions of knowledge and skills improvement were measured before and after the training program. A reflective logbook was then developed to document mentoring activities. Surveys and logbook observations were performed to measure the effectiveness of the 8-month peer-mentoring program. Mentees' capacity and perception were measured before and after the mentoring program. Quantitative data were analyzed using the descriptive statistics and Wilcoxon's paired-rank test, whereas open-ended responses and log-book reflection were analyzed using the content analysis.

Results

The peer-mentor training program improved peer mentors' knowledge and readiness from 3.64/5.00 to 4.23/5.00 (P < 0.001). Moreover, mentees viewed the program as effective in improving self-confidence and working capacity in maternal-neonatal health services from 3.47/5.00 to 3.98/5.00 (P < 0.001). Open-ended responses and a reflective logbook revealed that both mentees and peer mentors gained positive learning experiences. Seniority might become an obstacle to the mentoring process since peer mentors reported barriers in engaging elderly mentees due to seniority issues.

Discussion

The interprofessional peer-mentoring program was effective in improving both mentors' and mentees' knowledge, self-confidence, and working capacity in maternal-neonatal primary health services and experiential learning. Further observation of the long-term outcomes of the program should be undertaken.

Collaboration in interprofessional teams: A needs assessment of factors that impact new resident physicians

Many resident physicians struggle with effective interprofessional collaboration (IPC), but characterization of their challenges is not well known. This study examines gaps in IPC skills for graduating medical students entering residency. A needs assessment was completed to evaluate factors that impact resident physicians' ability to effectively collaborate with other healthcare professionals. This study included online surveys of 123 recent medical school graduates, 21 semi-structured interviews of residency program directors, and 3 focus groups of healthcare professionals who interacted with residents. Survey results were analyzed for means and narratives from surveys, interviews, and focus groups were analyzed for themes. We found that graduates felt they did not have a strong understanding of other providers' roles and did not feel well prepared to handle conflict with other providers or navigate interprofessional team dynamics. Themes emerging from narrative data generally aligned with the Interprofessional Education Collaborative core competencies including understanding team roles, communicating effectively, and working effectively in a team, but these interviews also elucidated an additional theme, overcoming system barriers. Data from this work can inform curricula in preparation for the transition to residency. The authors also offer an educational framework for learning effective IPC as a new team member.

Implementation of free water protocols in acute care: An observation of practice

Purpose: Evidence supporting free water protocols (FWP) in acute settings is limited and the potential risks and benefits for acutely ill patients are not well understood. This study aimed to observe how and with whom FWPs are implemented in acute stroke and general medical units.Method: Mixed methods parallel case study design. Medical and nursing records were evaluated for information pertaining to the implementation of the FWP and outcomes for three patients. Semi-structured interviews conducted with three patient-nurse-speech-language pathologist triads focussed on clinical decision-making and barriers and enablers to FWP implementation. Data were analysed descriptively and triangulated across sources.Result: Patients identified as suitable for a FWP had markedly different presentations to those described in the evidence-base and FWP were consequently significantly adapted. Although patients were permitted water, they received and consumed very small amounts. Speech-language pathologists and nurses identified more barriers than enablers to FWP implementation; cognitive impairments, reliance on others and insufficient documentation were perceived as the key barriers, while clear verbal communication was identified as a facilitator.Conclusion: Overall the findings suggest FWP implementation in the acute care setting is hindered by a lack of standardised procedures and current evidence-base that would otherwise inform best practice.

Supporting conscious competency: Validation of the Generic Supervision Assessment Tool (GSAT)

OBJECTIVES

Clinical supervision is essential for ensuring effective service delivery. International imperatives to demonstrate professional competence has increased attention on the role of supervision in enhancing client outcomes. Although supervisor competency tools are recognised as important components in effective supervision, there remains a shortage of tools that are evidenced-based, applicable across workforces and freely accessible.

DESIGN

An expert multidisciplinary group developed the Generic Supervision Assessment Tool (GSAT) to assess supervisor competencies across a range of professions. Initially the GSAT consisted of 32 items responded to by either a supervisor (GSAT-SR) or supervisee (GSAT-SE). The current study, using surveys, employed a cross-sectional design to test the reliability and construct validity of the GSAT.

METHODS

The study consisted of two phases and included 12 professional groups across Australasia. In 2018, exploratory factor analysis (EFA) was undertaken with survey data from 479 supervisors and 447 supervisees. In 2019 survey data from 182 supervisors and 186 supervisees were used to conduct confirmatory factor analysis (CFA). The results were used to refine and validate the GSAT.

RESULTS

The final GSAT-SR has four factors with 26 competency items. The final GSAT-SE has two factors with 21 competency items. The EFA and CFA confirmed that the GSAT-SR and the GSAT-SE are psychometrically valid tools that supervisors and supervisees can utilise to assess competencies.

CONCLUSION

As a non-discipline specific supervision tool, the GSAT is a validated, freely available tool for benchmarking the competencies of clinical supervisors across professions, potentially optimising supervisory evaluation processes and strengthening supervision effectiveness.

PRACTITIONER POINTS

Supervisor competency tools are recognised as important components of safe and effective supervision provision yet there is a dearth of valid, reliable and effective measures. The Generic Supervision Assessment Tool (GSAT-SR and GSAT-SE) are unique psychometrically valid, and reliable measures of supervisor competence. The GSAT-SR and the GSAT-SE can enhance translation of evidence-based supervision competency skills into regular practice. Validated with a broad cross section of professionals in diverse practice settings the GSAT provides a comprehensive conceptualization of supervisor competence.

Implementation and analysis of an enhanced screening and testing protocol for prediabetes in a dental school patient population

OBJECTIVES

This project aimed to enhance the identification of patients at-risk for prediabetes or diabetes within a dental school patient population by introduction of a modified screening tool and related training of dental residents and students.

METHODS

The American Diabetes Association Risk Tool (ADART) was modified by addition of three diabetes-linked oral health questions. Of the 1477 dental patients screened, 551 (37.3%) indicated an at-risk status using the modified tool. A subset of 138 patients received follow-up chairside HbA1c blood testing conducted by dental residents and students. Data was analysed to determine a) the influence of the modifications on the tool's discrimination strength and b) change in the tool's predictive value.

RESULTS

The addition of the 3 oral health questions to the 7-item ADART resulted in a 9.4% increase in identification of patients at-risk for pre-diabetes/diabetes. The predictive value of the tool remained stable. Residents and students successfully incorporated the new screening activities within their assigned clinics.

CONCLUSIONS

This project demonstrates that screening for risk for prediabetes/diabetes is both prudent and practical in the dental setting. Dental personnel, including trainees, can successfully incorporate enhanced screening methods within their traditional activities. Further, screening tools used in the dental setting might be enhanced by inclusion of certain oral health variables associated with diabetes. These findings add to emerging knowledge on the importance of screening for prediabetes/diabetes in dental settings and have particular relevance and application to institutional practice.

Leaving professional competition on the field: Professional collaboration in promoting college athlete mental health

The wide range of challenges facing college athletes often results in the need for micro and macro mental health services. This article examines a competency-based model of integrated care. A team of mental health professionals must be intentionally created to support athletes throughout various aspects of their unique experience. Interprofessional practice benefits college athletes by providing them with a broad spectrum of care throughout their college experience.

Clinicians' Experiences of Instrumented Gait Analysis in Management of Patients with Cerebral Palsy: A Qualitative Study

AIM

To identify the interaction of instrumented gait analysis (IGA) training, expertise, and application in gait-related management of cerebral palsy.

METHODS

Semi-structured interviews with 20 purposively sampled clinicians with varying professional backgrounds, expertise, and training, analyzed using the framework method.

RESULTS

Fifteen sub-themes were identified within three domains: training, equipment/outputs, and roles/reasons under the core theme IGA practice. Findings were illustrated using the Experience/Equipment/Roles/Training (Exp-ERT) Framework which identifies four user categories - based on influencing factors, beset by barriers, with experience reported as a common enabling factor. Clinicians who encountered barriers in one of the domains were categorized as either "frustrated" or "hesitant" users. Those who were no longer using IGA for clinical decisions were designated "confident non-users". Finally, the 'confident experts' reported the required level of training and access to interpret IGA outputs for clinical decision-making. Expertise gained at any level of clinical practice was shown to initiate advancement within domains.

CONCLUSIONS

Clinicians encounter a multitude of barriers to IGA practice that can result in failure to progress or impact on clinical decision-making. The Exp-ERT Framework emerges strongly from the data and could serve as an evaluation tool to diagnose barriers to confident expertise and support IGA-related professional development planning.

Promoting Whole Health in the Dental Setting: Steps Toward an Integrated Interprofessional Clinical Learning Environment Involving Pharmacy, Social Work, and Nursing

Introduction:

Dental settings have not traditionally functioned as access points to the health care system, however they can serve patients who may not otherwise seek routine health care. Millions of Americans annually visit either a dental or primary care provider, but not always both as recommended, even though multiple health co-morbidities can manifest in and impact oral health. Offering multidisciplinary health services in a dental setting has potential to reach unserved populations.

Description:

Innovative partnerships between schools of dentistry, pharmacy, social work, and nursing were designed to promote integrated service delivery in the emerging workforce and the purposeful inclusion of oral health in integrated care settings.

Discussion:

Oral complications of systemic disease and systemic complications of oral disease impose significant burdens on populations and the public health infrastructure in terms of economic cost, disability, and mortality. Exacerbated by the lack of integrated services, intersecting social, economic, and health issues perpetuate disparities and negative health outcomes. Care is often focused on reactive rather than preventive measures therefore addressing only the acute issue instead of the underlying, causative problem(s).

Conclusion:

We describe steps for integrated, whole-health services and lessons learned for other academic health institutions and interprofessional settings considering integrated clinical models.

Evaluating the impact of interprofessional forums on dental medicine students' collaborative practice skill perception

PURPOSE

This study evaluates third-year dental medicine students' perceived competencies related to interprofessional collaborative practice (IPCP) after completing two exposure level experiences with students from other professions across a large academic health center.

METHODS

Two cohorts of D3 dental medicine students (2018-2019 and 2019-2020) completed the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) after participating in in-person 2.5-h Interprofessional (IP) Forums in the Fall and Spring semesters. Self-reported competencies were compared between pre-and post-IP Forum ratings and between Fall and Spring.

RESULTS

Prior to the IP Forums, dental medicine students (n = 185) reported perceived skill in the interprofessional competencies to be from Good to Very Good using the ICCAS. After participation in the Fall IP Forum, students' ICCAS scores increased in all ICCAS subscales with large effect sizes. Students reported a perceived decline in these skills in the four months between Fall and Spring IP Forums and restoration of IP skill levels after participating in a second IP Forum (Spring).

CONCLUSIONS

Participation in IP Forums has a positive impact on students' IPCP skill perception. Our data suggest that perceived skill level requires repeated IP learning experiences. If dental medicine students are expected to embrace collaborative practice to enhance patient outcomes, then dental school educators must provide opportunities for students to engage in collaborative practice experiences at all levels of their training.

The Report of the 2020-2021 Professional Affairs Standing Committee: Pharmacists' Unique Role and Integration in Healthcare Settings

EXECUTIVE SUMMARY The 2020-21 Professional Affairs Committee was charged to (1) Read all six reports from the 2019-20 AACP standing committees to identify elements of these reports that are relevant to the committee's work this year; (2) Identify opportunities and models of integration of pharmacist care services in physician and other health provider practices beyond primary care; (3) Differentiate and make the case for the integration of pharmacist care services from that of other mid-level providers; and (4) From the work on the aforementioned charges, identify salient activities for the Center To Accelerate Pharmacy Practice Transformation and Academic Innovation (CTAP) for consideration by the AACP Strategic Planning Committee and AACP staff. This report provides information on the committee's process to address the committee charges, describes the rationale for and the results from a call to colleges and schools of pharmacy to provide information on their integrating pharmacist care services in physician and other health provider practices beyond primary care practice, and discusses how pharmacist-provided patient care services differ from those provided by other healthcare providers. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to CTAP and AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

Using Latent Class Analysis to Understand Social Worker Roles in Integrated Health Care

Purpose: Social work (SW) is a profession that fulfills important roles on integrated health teams, yet there remains a lack of clarity on SW's functions. The current study sought to identify typologies of SW's roles on integrated care teams using latent class analysis (LCA).Method: An electronic survey was developed, piloted, and administered to Masters level SW students and practitioners in integrated health care settings (N = 395) regarding weekly use of interventions. LCA was conducted to estimate latent sub-groups of respondents.Results: Respondents reported an average of 14.6 (SD = 4.7) interventions. Five classes of SW roles were identified and varied by setting and focus. One class (13%) completed a hybrid function providing behavioral health and social care interventions.Conclusions: Classes of SW roles on teams may reflect varying models of integrated care. A flexible SW on the team may adapt to patient and clinic needs, but increases the opportunity for role confusion.

An Advanced Clinician Practitioner in Arthritis Care (ACPAC) Maintains a Positive Patient Experience While Increasing Capacity in Rheumatology Community Care

Purpose

This study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices.

Materials and Methods

Patients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period.

Results

Of 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model.

Conclusion

The ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.

A comparative study of eating behaviours within and between conventional metabolic (bariatric) surgery procedures

AIMS AND OBJECTIVES

To compare eating behaviours within and between gastric bypass, sleeve gastrectomy and gastric band procedures and to investigate associations between eating behaviours and body weight.

BACKGROUND

Eating behaviours are subjective constructs representing physiological need and the hedonic need to eat. After metabolic surgery, eating behaviours have been observed to change. Little is known about whether eating behaviour change differs according to the metabolic procedure performed.

DESIGN

Adults (n = 204) with severe obesity from three countries were followed 1 year after metabolic surgical procedures (n = 121).

METHODS

We measured eating behaviours using the Three-Factor Eating Questionnaire and used linear mixed models to compare eating behaviours within and between three procedure groups. We complied with the STROBE checklist for reporting observational studies.

RESULTS

Within groups, there were statistically significant increases in restraint and decreases in disinhibition and hunger. Between groups, we observed differences in disinhibition associated with the band procedure. There were no significant differences between any group for body weight or body mass index a year post-surgery. Disinhibition was the only eating behaviour associated with body weight, body mass index and the per cent of weight loss.

CONCLUSIONS

Eating behaviours in adults with severe obesity who underwent any of the three metabolic procedures were associated with eating behaviour change 1 year post-surgery. Disinhibition was the only eating behaviour that was associated with body weight.

RELEVANCE TO CLINICAL PRACTICE

Irrespective of the procedure, we found participants had a statistically significant increase in restraint and decreases in disinhibition and hunger 1 year post-surgery. Despite the significant reduction in disinhibition within the band group, this behaviour was more pronounced post-surgery compared with other groups. Although the reduction in hunger showed the greatest change, it was not associated with weight outcomes. This is relevant clinical knowledge for nurses who support bariatric surgical patients.

Interprofessional collaboration and health policy: results from a Quebec mixed method legal research

Interprofessional collaboration (IPC) is central to effective care. This practice is structured by an array of laws, regulations and policies but the literature on their impact on IPC is scarce. This study aims to illustrate the gap between the texts and clinicians' knowledge of the legal framework using an anonymous web-based survey. The survey, sent to nurses and physicians in Quebec, Canada, focused on the IPC legal framework, legal knowledge sources and IPC perceptions or beliefs. The primary outcome was to determine the gap between the law and understanding of the law. The secondary outcome was to identify legal knowledge sources for clinicians in Quebec. A total of 267 participants filled in the survey. For knowledge acquisition, 40% of physicians turned to insurers whereas 43% of nurses turned to their regulatory body. Only 30% of physicians correctly identified what activity is reserved for physicians while 39% of nurses correctly identified their reserved activity. Regarding legal perceptions, 28% of physicians and 39% of nurses thought IPC could increase their liability. These participants have a higher tendency to name liability-related issues as barriers to IPC. These results show an important discrepancy between clinicians' knowledge about law and policies, and the actual texts themselves. This gap can lead to misinterpretations of the law by clinicians, ineffective policy changes by policymakers and can perpetuate ineffective implementation of IPC.

Health professional-educator collaboration in the delivery of school-based tiered support services: A qualitative case study

BACKGROUND

Educators and health professionals support the learning and participation of diverse children in school environments. Tiered approaches to service delivery may assist these efforts through consideration of universal supports that are useful to all children, targeted supports for some children and individualized supports for the smallest number of children. This study explored how an interprofessional team worked with educators to develop and implement tiered services in two school communities where many families experience economic and social disadvantages.

METHODS

Using a participatory action research approach and qualitative case study methods, the research and stakeholder teams jointly designed and conducted this study in two schools during the 2017-2018 school year. Data collected included weekly logs written by the interprofessional team members and 16 interviews conducted with team members, parents, educators and administrators.

RESULTS

The team provided a variety of services to individual students, groups, whole classes and the school community. Collaboration and communication were needed to define roles and expectations and to plan and share student information. Reported benefits included timely service, capacity building and student goal achievement. The main barriers were related to service fragmentation, time and workload.

CONCLUSIONS

Recommendations included clearer direction about expectations and improved coordination within the systems that offer services. Further research should include exploration of comparative cases with varying contexts, the inclusion of child perspectives and direct observation.

Pharmacist-Physician Interprofessional Collaboration to Promote Early Detection of Cognitive Impairment: Increasing Diagnosis Rate

The increased pressure on primary care makes it important for other health care providers, such as community pharmacists, to collaborate with general practitioners in activities related to chronic disease care. Therefore, the objective of the present project was to develop a protocol of action that allows close pharmacist-physician collaboration to carry out a coordinated action for very early detection of cognitive impairment (CI). Methods: A comparative study to promote early detection of CI was conducted in 19 community pharmacies divided into two groups: one group with interprofessional collaboration (IPC) and one group without interprofessional collaboration (NonIPC). IPC was defined as an interactive procedure involving all pharmacists, general practitioners and neurologists. A total of 281 subjects with subjective memory complaints were recruited. Three tests were used in the community pharmacies to detect possible CI: Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Individuals with at least one positive cognitive test compatible with CI, were referred to primary care, and when appropriate, to the neurology service. Finally, we evaluated the differences in clinical and diagnostic follow-up in both groups after six months. Results: The NonIPC study group included 38 subjects compatible with CI referred to primary care (27.54%). Ten were further referred to a neurology department (7.25%) and four of them (2.90%) obtained a confirmed clinical diagnosis of CI. In contrast, in the IPC group, 46 subjects (32.17%) showed results compatible with CI and were referred to primary care. Of these, 21 (14.68%) were subsequently referred to a neurology service, while the remaining 25 were followed up by primary care. Nineteen individuals out of those referred to a neurology service obtained a confirmed clinical diagnosis of CI (13.29%). The percentage of subjects in the NonIPC group referred to neurology and the percentage of subjects diagnosed with CI, was significantly lower in comparison to the IPC group (p-value = 0.0233; p-value = 0.0007, respectively). Conclusions: The creation of IPC teams involving community pharmacists, general practitioners, and neurologists allow for increased detection of patients with CI or undiagnosed dementia and facilitates their clinical follow-up. This opens the possibility of diagnosis in patients in the very early stages of dementia, which can have positive implications to improve the prognosis and delay the evolution of the disease.

Perceptions, attitudes and understanding of health professionals of interprofessional practice at a selected community health centre

BACKGROUND

Despite being identified as a solution to the challenges related to healthcare service delivery, the incorporation of interprofessional practice (IPP) into clinical practice has been limited. To implement an interprofessional model of healthcare, successfully, health professionals need to have an understanding of IPP and its related content.

AIM

The aim of this study was to explore and describe the health professionals' perceptions, attitudes and understanding of IPP at a selected community health centre.

SETTING

This study was conducted at a primary healthcare facility in the Western Cape, South Africa.

METHODS

Ethical clearance and permission to conduct the study was obtained from all relevant stakeholders. Four focus group discussions were conducted with health professionals at the facility. Themes, codes and categories were highlighted from the transcripts of the audiotape-recorded data.

FINDINGS

The findings suggest that health professionals do not have an understanding of IPP, and are thus unable to apply it practically. The health professionals perceived certain healthcare processes in the facility as barriers to the integration of practices. In addition, the health professionals expressed the need for interprofessional relationships, creation of opportunities for IPP, and communication to transform the current practice.

CONCLUSION

To implement IPP into this facility, effectively, the authors of this study recommend that facility management implement campaigns for and training on, the transition to IPP, staff induction programmes and regular meetings.

Developing the next generation of healthcare professionals: the impact of an interprofessional education placement model

Interprofessional education (IPE), as preparation for interprofessional practice, is considered essential for quality, coordinated, outcome-focussed patient care. To develop capacity in our future healthcare practitioners, IPE needs to be developed within curricula, and opportunities provided to practise within the placement setting. The aim of this study was to examine the effect of a structured IPE placement program on students' perceptions of IPE within an authentic healthcare setting. This paper reports on changes in students' attitudes toward IPE, as measured by the SPICE-R2 instrument, in response to program involvement. Thirty-six students from six health professions participated in the study and reported significantly improved perceptions toward IPE, particularly in their understanding of roles and responsibilities, teamwork, and patient outcomes. The outcomes reinforce the importance of offering intentional and structured IPE activities during placement and the value provided to health students, preparing them for future collaborative practice.

Exercise Therapy Teamwork in German Rehabilitation Settings: Results of a National Survey Using Mixed Methods Design

A key prerequisite for implementing biopsychosocial exercise therapy concepts as parts of multimodal rehabilitation programs is interprofessional teamwork. Based on a nationwide survey of exercise therapy using a mixed methods design, it is of interest to determine to what extent there are links between team-related processes (e.g., interprofessional exchange) and structural features of the exercise therapy departments (e.g., department size) and the individual rating of interprofessional teamwork. The first part of the study involved a questionnaire-based survey, where exercise therapy heads of 1146 rehabilitation facilities were contacted. In the second part of the study, 58 exercise therapy heads held discussions in six focus groups. The results from both parts showed that interprofessional teamwork was rated positively overall. Team meetings were seen as the central platform for exchange. However, particularly in larger facilities, the hierarchical position of medical management and lacking resources were negatively associated with interprofessional exchange. The results affirm empirically that a more binding provision of adequate structural and organizational conditions, such as sufficient time slots for liaising on content, are essential for effective teamwork. This would facilitate and improve the promotion of physical activity in multimodal rehabilitation programs.

"You never stop being a social worker:" Experiences of pediatric hospital social workers during the acute phase of the COVID-19 pandemic

The COVID-19 pandemic has wrought widespread devastation upon children and families across the United States, widening existing health disparities and inequities that disproportionately affect communities of color. In health care settings specifically, social work is the key workforce tasked with responding to patient and family psychosocial needs, both of which have increased substantially since the emergence of COVID-19. There is a need to understand ways in which hospital social workers' roles, responsibilities, and integration within interprofessional teams have evolved in response to these challenges. In this qualitative study, focus groups were conducted with 55 social workers employed across multiple settings in a large, urban, pediatric hospital in Spring 2020. Thematic analyses revealed salient superordinate themes related to the pandemic's impact on social work practice and social workers themselves, institutional facilitators and impediments to effective social work and interprofessional practice, and social work perspectives on future pandemic recovery efforts. Within each theme, a number of interrelated subthemes emerged elucidating nuances of telehealth adoption in the context of remote work, the salience of social determinants of health, and the critical role of social work in social justice oriented pandemic preparedness and response efforts. Implications for interprofessional practice and the profession at large are discussed.

Patients' Experiences of Interprofessional Collaborative Practice in Primary Care: A Scoping Review of the Literature

Interprofessional collaboration (IPC) has been shown to improve patient safety and quality of care. Particularly, IPC assists health care providers to manage complex and chronic diseases. To this end, primary care centers around the world have begun practicing IPC; however, little is known about the patient's experience of IPC in primary care (IPC-pc). The goals of this scoping review were to identify the studies exploring patients' perspectives on IPC-pc and to reveal gaps in the literature for future research in order to inform policy and practice. A key word search strategy was conducted using PubMed to identify studies published from 1997 to 2017 on IPC-pc that included data collected from patients or their caregivers about patient experience or satisfaction. Seven studies met the inclusion criteria for the scoping review, and these studies were evaluated by interprofessional intervention, collaboration, and outcomes.

Designing, implementing and sustaining IPE within an authentic clinical environment: the impact on student learning

Interprofessional education (IPE), as preparation for interprofessional practice (IPP), is essential for quality, coordinated, outcome-focussed patient care. To develop capacity for IPP in future healthcare practitioners, IPE needs to be developed within curriculum and applied within authentic settings. The study aims were threefold: (a) determine if an established type 2 Diabetes Mellitus (T2DM) exercise and healthy lifestyle program could be replicated and delivered at a satellite health precinct; (b) report on changes in students' attitudes to IPP in response to involvement in the program; (c) explore the perceptions of students in response to participation in the program whilst on placement. This paper reports on the quantitative changes in perceptions of IPE as measured by the SPICE-R2 instrument and a qualitative analysis of the student reflection of participating in IPP. Thirty-five students, from 4 health professions, participated in the study. The quantitative outcomes showed significant improvement in the perceptions of IPE (p <.01), including significant improvements understanding of roles and responsibilities, teamwork, and patient outcomes (p <.01). The qualitative analysis included a subset of 18 students who participated across two focus groups, highlighting four key themes: (a) health students reported varied initial experience with, and understanding of IPE; (b) the IPE program enabled students to see the value of teamwork for patient care; (c) IPE enhanced role clarity amongst the students, and (d) the IPE program provided an authentic learning experience, best suited to final year students. Our findings reinforced the value of a partnership between higher education and health services to deliver IPP care and learning, student valuing of the importance of IPE as part of authentic learning, and need for a scaffolded approach toward IPE is needed across health curriculums, and clinical placement to ensure all students can develop IPE capabilities that will enable them to work together to deliver the best healthcare to clients.

Addressing adverse childhood experiences, trauma and resilience through interprofessional course development

National and international organizations are increasingly focused on interprofessional education in health-related fields to address complex and emerging health issues. One public health concern is the impact of adverse childhood experiences (ACEs). At one public university in Appalachia, faculty of nursing, public health, and social work collaborated to develop an interprofessional course at the undergraduate and graduate levels that focus on ACEs, trauma, and resiliency literature as well as interprofessional collaboration and evidence-based prevention and treatment. In this paper, the faculty detail the approach undertaken to develop this interprofessional course, lessons learnt and key resources.

Experiences of Patient-Centered Medical Home Staff Team Members Working in Interprofessional Training Environments

BACKGROUND

Evidence is growing that interprofessional team-based models benefit providers, trainees, and patients, but less is understood about the experiences of staff who work beside trainees learning these models.

OBJECTIVE

To understand the experiences of staff in five VA training clinics participating in an interprofessional team-based learning initiative.

DESIGN

Individual semi-structured interviews with staff were conducted during site visits, qualitatively coded, and analyzed for themes across sites and participant groups.

PARTICIPANTS

Patient-centered medical home (PCMH) staff members (n = 32; RNs, Clinical and Clerical Associates) in non-primary care provider (PCP) roles working on teams with trainees from medicine, nursing, pharmacy, and psychology.

APPROACH

Benefits and challenges of working in an interprofessional, academic clinic were coded by the primary author using a hybrid inductive/directed thematic analytic approach, with review and iterative theme development by the interprofessional author team.

KEY RESULTS

Efforts to improve interprofessional collaboration among trainees and providers, such as increased shared leadership, have positive spillover effects for PCMH staff members. These staff members perceive themselves playing an educational role for trainees that is not always acknowledged. Playing this role, learning from the "fresh" knowledge imparted by trainees, and contributing to the future of health care all bring satisfaction to staff members. Some constraints exist for full participation in the educational efforts of the clinic.

CONCLUSIONS

Increased recognition of and expanded support for PCMH staff members to participate in educational endeavors is essential as interprofessional training clinics grow.

Medical student volunteering during COVID-19: lessons for future interprofessional practice

Due to the unprecedented pressures on healthcare systems during the COVID-19 pandemic, many medical students internationally volunteered to assist in hospitals. In the United Kingdom, most students worked in roles similar to Healthcare Assistants: helping to support nurses in providing patient care. Although the current situation is exceptional, with medical students eager to contribute to the COVID-19 response, they have also gained valuable experience in interprofessional collaboration. By working closely with nurses, medical students have gained practical understanding of the different roles within the hospital environment and been involved in providing hands-on care to patients. The experience of the current pandemic has shown the willingness of medical students to volunteer in Healthcare Assistant roles and demonstrated the ability of hospitals to successfully integrate students into established nursing teams. This short report provides a reflection on the advantages of these placements and argues for their continuation in future practice.

Preparing Master of Social Work Students for Interprofessional Practice

PURPOSE

This study aims to measure growth in interprofessional knowledge, skills, and values in MSW students from three universities who participated in a Behavioral Health Workforce Education and Training program focused on serving children, adolescents, and transition-age youth.

METHODS

Students participated in an interprofessional field placement and specialized educational sessions that addressed interprofessional team-based care, engaging at-risk youth and families, and working with vulnerable populations. The Interprofessional Socialization and Valuing Scale (ISVS) was administered pre- and post-experience.

RESULTS

Paired t-tests of the ISVS total score and each subscale showed statistically significant increases over time. Multiple regression models indicated only the pretest score was a significant predictor of the posttest score for the total or subscale of the ISVS.

CONCLUSION

Social work programs that create interprofessional education and training opportunities can achieve positive outcomes in student attitudes toward interprofessional practice.

Navigating the path: a qualitative exploration of New Zealand general practitioners' views on integration of care with acupuncturists

BACKGROUND

Increasingly, many patients believe that a combined approach of complementary and alternative medicine (CAM), including acupuncture, and conventional medicine is better than either on its own, and more patients now have the desire to discuss CAM with well-informed general practitioners (GPs). However, to our knowledge, the interaction and collaboration between GPs and acupuncturists specifically in relation to shared care have not been investigated. This research explored interprofessional communication between GPs and acupuncturists in New Zealand. This article specifically reports the GPs' viewpoints.

METHODS

This study was part of a larger mixed-methods research project. Semi-structured interviews of 14 purposively sampled GP participants were conducted and analysed using thematic analysis.

RESULTS

The data analysis identified both facilitators of and barriers to integrative health care. Facilitators included the willingness of GPs to engage in communication and a recognition of the importance of patient choice. Barriers included the limited opportunities for sharing information and the lack of current established pathways for communication or direct referrals. GPs also highlighted the confusion around scopes of practice in terms of the different styles of and approaches to acupuncture.

CONCLUSION

This research contributes to the body of knowledge concerning interprofessional communication and collaboration between GPs and acupuncturists and suggests that while there are significant barriers to collaboration, there is also the potential to impact provider satisfaction and patient well-being. It provides context within a New Zealand health care setting and also provides additional insights regarding acupuncture, specifically through the disaggregation of specific CAM modalities.

Top tips for interprofessional education and collaborative practice research: a guide for students and early career researchers

Interprofessional research within the contexts of education and health and social care practice has grown exponentially within the past three decades. To maintain the momentum of high-quality research, it is important that early career researchers embarking on their first research journey and new to interprofessional education or interprofessional collaborative practice feel supported in making their contribution to the field. This guide, developed by the Center for the Advancement of Interprofessional Education (CAIPE) Research Group, has been written with these groups in mind who are embarking on their first research journey, and new to the interprofessional field. It aims to raise awareness of academic resources and share practical advice from those who have previously experienced problems when undertaking interprofessional research in education or health and social care practice.

Eat Like a Chef: A Mindful Eating Intervention for Health Care Providers

OBJECTIVE

To compare changes in mindful eating habits between students receiving a mindful eating intervention (MEI) vs those who were engaged in usual course work.

METHODS

From 2017 to 2019, 109 nutrition and medical students completed a quasi-experimental study, including usual course work either with or without the addition of a 5-week MEI. The Mindful Eating Questionnaire (MEQ) was completed before and after the MEI. Repeated measures MANOVA was used to detect differences in changes in the overall MEQ score and its 5 subscales between groups.

RESULTS

Within the MEI group (n = 64), overall MEQ, disinhibition, and eating with awareness scores increased significantly (P < .001, P < .001, and P = .004, respectively). No significant changes were noted within the comparison group (n = 45). Significant between-group differences were noted for the changes in the overall MEQ (P = .03) and disinhibition scores (P = .01).

CONCLUSIONS AND IMPLICATIONS

MEI participation may improve students' overall mindful eating scores. Future research could assess a larger cohort of participants, including health care professionals from other disciplines, assess additional mindfulness measures, and follow students for a longer period to determine the long-term effects on participants' mindful eating.

Implementation and Effectiveness of an Interprofessional Support Program for Patients with Type 2 Diabetes in Swiss Primary Care: A Study Protocol

This research protocol illustrates the use of implementation science to support the development, dissemination and integration in primary care of effective and sustainable collaborative pharmacy services for chronic care management. The objective is to evaluate the implementation and the effectiveness of a pharmacist-led patient support program including regular motivational interviews; medication adherence, patient-reported outcomes, and clinical outcomes monitoring; and interactions with physicians, for patients with type 2 diabetes taking at least one oral antidiabetic medication in the French-speaking part of Switzerland. This is a prospective, multi-centered, observational, cohort study using a hybrid design to assess the patient support program. The evaluation includes three levels of analysis: (1) the implementation strategies, (2) the overall implementation process, and (3) the effectiveness of the program. Qualitative and quantitative methods are used, and outcomes are assessed at each stage of the implementation process: exploration, preparation, operation, and sustainability. This research project will provide key insights into the processes of implementing patient support programs on a large scale and adapting the traditional community pharmacy practices towards the delivery of person-centered and collaborative services.

Incorporating Oral Health Considerations for Medication Management in Care Transitions

Transitions of care involve multifaceted considerations for patients, which can pose significant challenges if factors like oral health are overlooked when evaluating medication management. This article examines how oral health factors should be considered in medication management of patients who may be at risk for hospital readmission. This article also explores successes and challenges of a pharmacy consult service integrated into a dental clinic practice, and the opportunities within that setting to improve overall patient outcomes including those related to care transitions.

A scoping review of community paramedicine: evidence and implications for interprofessional practice

Community paramedicine (CP) is an evolving method of providing community-based health care in which paramedics function outside of their traditional emergency response roles in order to improve access to primary and preventive health care and to basic social services. Early evidence indicates that CP programs have contributed to reducing health care utilization and improving patient outcomes leading some to call for a transformation of EMS into value-based mobile healthcare fully integrated within an interprofessional care team. The purpose of this scoping review was to understand the evidence base of CP in order to inform the further evolution of this model of care. Following the PRISMA extension for Scoping Reviews, 1,163 titles were screened by our research team. Eligibility criteria were publication in English after January 1, 2000; description of a CP program located in a Western nation; and inclusion of a discussion of outcomes. Twenty-nine publications met the criteria for inclusion. The literature was varied in terms of study design, program purpose, and target audience. The lack of rigorous, longitudinal studies with control groups makes rendering conclusions as to the value and effectiveness of CP programs difficult. Further, the extent to which community paramedics operate within interprofessional teams remains unclear. However, some programs demonstrated improvement in both health services and patient outcomes. As stakeholders continue to explore the potential of CP, results of this review highlight the importance of further investigation of outcomes, the professional identity of the community paramedic, and the role of the community paramedic on interprofessional teams.

A mixed-methods evaluation of an interprofessional clinical education model serving students, faculty, and the community

The clinical learning environment significantly affects students' preparedness to enter practice. Nursing programs may struggle securing relevant clinical sites necessary for student learning and meeting accreditation standards. Programs must be creative in developing community-based experiences that facilitate students' learning. However, authentic interprofessional practice is often missing. We evaluated how an interprofessional clinical education model provided preventive health services through a faculty-student-led clinic and delivered an effective avenue to educate health profession students while serving the community. The model was implemented as a pilot project over the course of one semester. We used mixed-methods to analyze data from pre/post-instruments and focus groups to gain a comprehensive understanding of the effect of the model on students, faculty, and the community. Student growth in interprofessional competencies, measured with the Interprofessional Education Collaborative Self-Assessment Tool and the Interprofessional Socialization and Valuing Scale, indicates significant difference pre/post-participation. Four themes were identified from the focus groups highlighting the impact of the clinical education model: interprofessional teamwork, an unorthodox learning environment, delivery of primary and secondary prevention in the community, and reaching underserved populations. This clinical education model has promising utility in providing an interprofessional clinical learning environment while serving the community.

Perceptions of interdisciplinary rounding practices

AIMS AND OBJECTIVES

To explore practitioner perspectives on the facilitators, barriers and outcomes associated with interdisciplinary rounding practices (IDR).

BACKGROUND

Interdisciplinary rounding practices is frequently used intervention to promote collaboration and patient-centred care in hospital units. Previous research supports that having IDR in place can lead to greater perceptions of collaboration and practitioner satisfaction; however, the practice does not always lead to better outcomes for patients. For IDR to be successful, unit leadership needs a greater understanding of facilitators and barriers as perceived by team members. At both the individual and organisational levels, there is limited understanding on what influences the success of IDR. This study seeks to explore factors influencing interdisciplinary rounding and perceived outcomes by team members.

DESIGN

A quasi-qualitative design was used to address the aim of this study. Four open-ended questions were emailed to practitioners across fifteen units in two academic health centres. All units identified as having IDR in place.

METHODS

A directed content analysis of practitioner responses was used to identify key themes. The Standards for Reporting Qualitative Research checklist was consulted for reporting of the results.

RESULTS

A total of 141 practitioners responded to the open-ended questions. Three themes emerged from the data: (a) setting the stage; (b) the work of the team; and 3) benefits to patient care.

CONCLUSIONS

The study provides a nuanced perspective of facilitators, barriers and potential outcomes associated with IDR. Future research is needed to gain additional perspective on the role the organisation plays in promoting a healthy workplace environment as well as providing patient-centred care.

RELEVANCE TO CLINICAL PRACTICE

This study provides insight into facilitators and barriers to conducting interdisciplinary rounding practices in the inpatient setting. Results can be useful to unit leaders and staff that advocate for more collaborative and patient-centred rounding practices.