Nursing - Interprofessional Education - Essay Example

?Topic: Interprofessional Education Introduction With the ongoing reforms in nursing education, there is growing consensus that working relationships between nurses and other health professionals are important in healthcare delivery. Nurses are increasingly working in a reform-prone healthcare environment and patient needs have become more complicated, requiring nurses to implement requisite skills and competencies in evidence-based practice, health policy and system improvement. Collaboration and teamwork is particularly important in the achievement of this goal. Further, nurses must broaden their skills and scope of practice while collaborating with a team of different health professionals. The ultimate solution lies in promote academic progression within nursing that recognizes the complex and evolving nature of nursing practice. Efforts aimed at promoting the team-based education for health professionals are not new or unique. The development in this area of education has been driven by concerns that the existing healthcare workforce must meet patient and community health in a cost-effective manner and that educational institutions must take more responsibility to produce a skilled workforce (Interpersonal Education Collaborative Expert Panel, 2011). Interprofessional education (IPE) has been described in a variety of ways. The World Health Organization (2010) defined IPE as occurring when professionals from different professional backgrounds learn about each other and from each other to enable collaborative improvement in health outcomes. Lowe et al (2012) described IPE as the interrelationship occurring between professionals and learners, able to learn from each other via effective collaboration to improve health outcomes. The purpose of IPE is therefore to facilitate the preparation of health workforce with regard to their ability to respond to local health needs (Lowe et al, 2012). The World Health Organization (2010) identifies interprofessional collaboration as an important strategy for mitigating global health challenges, especially regarding improvement of health outcomes and developing strong health system. Arguably, most of the health care in the U.S. is delivered via multidisciplinary approach (Pecukonis et al., 2008; Isaacs and Benjamin, 1991). This approach involves multidisciplinary work that runs parallel to client systems. More importantly, the communication work in this approach is embedded within a leadership hierarchy (Pecukonis et al., 2008). Within this system of health care, team members are responsible for activities related to their discipline, and there is little sense of shared responsibilities for team development or even patient outcomes. The notion of interprofessional education and its impact on the provision of services is not novel or unique. Pecukonis et al (2008) notes that interprofessional teams and collaborative groups were used as early as the mid 20th century at the level of community health care especially to underserved populations. From a historical perspective, inter-professional education was originally illustrated in the 1972 Conference Steering Committee recommendations (Interpersonal Education Collaborative Expert Panel, 2011; Davidson, 2005). The Conference made multilevel recommendations including organizational, administrative, instructional, and interpersonal. At the instructional and organizational level, the committee recommended obligations of academic institutions with regard to conducting interdisciplinary education and patient care aimed at developing methods to link education with requirements essential for practice. Other recommendations included use of ambulatory settings as sites for inter-professional education, an effort aimed at integrating classroom instruction to develop faculty skills. At the national level, the recommendations emphasized on the need to developing national framework for sharing practice models and instructional capacities, supporting government agency for innovative instructional and practice models and fostering interdisciplinary education by eliminating obstacles (Interpersonal Education Collaborative Expert Panel. (2011). Despite the growing evidence that IPE improves health outcomes and quality of care, many training programs remain reluctant to institutionalize and operationalize IPE in their programs (Pecukonis et al., 2008). This reluctance has been attributed to various challenges. The challenges include lack of faculty support, difficulties in scheduling inter-school activities and labor costs (Pecukonis et al., 2008). However, efforts to build team-based care and inter-professional teamwork continue, especially in improving institutional effectiveness on quality care and safety (Interpersonal Education Collaborative Expert Panel, 2011). The importance of team-based care delivery and better teamwork to facilitate these competencies cannot be ignored in the current educational system. Growing body of evidence suggests that health care delivery by health professionals working in teams improves the quality of care and patient outcomes, leads to improved efficiency and job satisfaction as well as increased patient satisfaction (The Carnegie Foundation for the Advancement of Teaching, 2010). Academic medicine and nursing has been slow in initiating education reforms despite increased interests in this area. There are a variety of factors that explain this trend. For instance, the explosion in technological and scientific advances, especially in health informatics has made educational reforms necessary. The problem is that new scientific advances and technologies must ne integrated at every level of training and teaching (The Carnegie Foundation for the Advancement of Teaching, 2010). On the other hand, the delivery of medical care has changed more drastically than educational curricula. In this respect, it is imperative that education and training has been slow in responding to changes in health care practice (The Carnegie Foundation for the Advancement of Teaching, 2010). According to the Carnegie Foundation for the Advancement of Teaching (2010), the development in inter-professional education has been hampered by various factors. These barriers include logistical and administrative challenges, cultural barriers, pedagogical barriers, and sustainability. From an administrative perspective, inter-professional programs must coordinate among medical and nursing schools in scheduling classes, planning academic calendars and accommodating the increased number of students (The Carnegie Foundation for the Advancement of Teaching, 2010). Health professions have their own culture. The Carnegie Foundation for the Advancement of Teaching (2010) asserts that health professions traditionally emphasize on compartmentalization and learning environment functioning within the perspectives of the overall health profession. This includes separation of students in the formative years of education a factor attributed to inherent miscommunication among the professions. This culture has been shown to fuel competition and misunderstanding among practitioners from different health disciplines (The Carnegie Foundation for the Advancement of Teaching, 2010). On the other hand, questions about the implementation of new educational curricula and content design are attributed to pedagogical barriers (Hylin et al., 2004). The challenges hampering inter-personal education with regard to team-work collaboration and health quality care must be addressed. Team-work is one element that must be addressed. The Carnegie Foundation for the Advancement of Teaching (2010) argues that teamwork is not a primary focus in many health professions. Students are often taught to practice independently with instructors encouraging students to work in teams of the same profession. This model has been described as inadequate in equipping students with inter-professional skills. The autonomy and independence inculcated during training and learning limits the ability of practitioners to effectively collaborate with their peers from different health professions. This problem has been attributed to differences in interprofessional cultures. According to Hall (2005), health profession has unique set of customs, values attitudes and behaviors. The culture of physician training emphasizes less on relationships (Hall, 2005). The central focus in physician training is on the appropriate actions and patient outcomes. The physician is focused more on saving patents life than building relationships (Hall, 2005). Other health professions have different value systems, mostly instilled during the training process. Hall (2005) argues that values are usually internalized and create potential barriers in creating collaborative work environment. There are usually overlapping roles and competencies among interpersonal team members (Hall, 2005; Helm, 2001). The roles of such members are often blurring due to lack of clear boundaries on one’s practice. Based on this background, it is imperative that the risk for conflicts and burn-out are high unless effective conflict resolution efforts are put in place (Thomson and Mathias, 1992). Conflict resolution is an important factor in interprofessional teams. Consequently, conflict resolution is a skill that is not taught routinely in health professional schools (Hall, 2005). Students are often taught on communication skills in the context of building interactions with patients, families and with members of the same profession (Hall, 2005). Students are not taught how to communicate across professions. This means that students are prepared to work only within their professions and therefore begin practice with different approaches to problem-solving, interpretation of vocabularies and general understanding of professional values (Hall, 2005). On the other hand, interprofessional education is strongly linked to the quality of health care. Hall (2005) asserts the impossibility of improving the quality of care without comprehensive involvement and participation of the various health professionals. From this perspective, health educators argue for the integration of efforts to increase role modeling for continuous role quality improvement and increased focus on clinically-based learning (Hall, 2005; Bevil, 2008). In addition to health professional culture, stereotyping has been shown to create barriers in interpersonal education. Carpenter (1995) opines that inter-group stereotypes hamper effective working relationships between the various health professionals. In a study that involved nursing and medical student participants Carpenter (1995) established that students hold clear positive and negative professional stereotypes. Nurses were seen as caring, good communicators and dedicated while doctors were viewed as confident, decisive and caring (Carpenter, 1995). While positive stereotypes have beneficial effects on interpersonal education, negative perceptions about health professions impacts on the same. For instance, Carpenter (1995) asserts that positive stereotypes diminish negative ‘heterostereotypes’. However, it is clear that interprofessional education alone cannot eliminate attitudinal barriers among health professions or even promote equality (Carpenter, 1995). Fostering positive stereotypes will promote more collaborative teamwork, an important aspect in improving interprofessional education. The problem is even bigger considering that both systemic and personal barriers hamper effective interprofessional education and practice. The historical significance of the problem cannot be understated. However, these challenges are surmountable and efforts should target on breaking traditional barriers between professions (Rivanjee, 1997; Zeiss and Steffer, 1996; Miller and Prentice, 1994; Kirchhoff and Haase, 1995). Various skills are required for effective teamwork in the health professions (Freeth and Reeves, 2007; Freeth et al., 2001). These collaborative skills include cooperation, assertiveness, responsibility, and communication skills. Other skills include autonomy and independence as well as coordination in the performance of group tasks and assignments (Carpenter, 1995; Rafter et al., 2006). Oabdasan and D’Amour (2005) developed a model frame for understanding the development of integrated health care among professionals. The proposed model gives clear distinction between inter-professionalism and ‘interdisciplinarity’. Oabdasan and D’Amour (2005) argue that interdisciplinarity relates to the development of integrated knowledge in response to fragmented disciplinary knowledge. On the other hand, the authors assert that inter-professionality relates to the process and determinants that influence interprofessional educational initiatives. From this perspective, Oabdasan and D’Amour (2005) proposed a model, a frame of reference based on the need to establish linkages between determinants and processes of collaboration at various levels. This includes linking learners with educators on one hand, and collaboration between educators and professionals on the other hand (Oabdasan and D’Amour, 2005; Sweeney and Schuster, 2000; McCallin, 2003). The authors drew useful distinctions between the interdisciplinarity and interprofessionality and proposed a framework for identifying processes and determinants of interprofessionality. To this end, it appears that interprofessional education is strongly dependent on collaborative practice and vice versa (Oabdasan and D’Amour, 2005; Marcus, 2000; Makary et al., 2006; Sommers et al., 2000). Barr et al (2000) identified the methods by which interprofessional education in health and social care has been evaluated. The UK experience with interprofessional educational illustrates the efficacy of introducing these concepts. Barr et al (2000) presented an attempt to describe the state of evaluation in interprofessional education both in the UK and globally. The researchers concluded that further research is required to help researchers draw on the experiences of others and facilitate decision-making. Mackezie et al (2007) assert that interprofessional education is an important concept in the delivery of health services and integration of working and learning. The study established that students experiences of the interprofessional training ward were positive (Mackezie et al., 2007). This included enabling students to gain understanding of how both intrapersonal and interpersonal skills affect teamwork and group communication (Mackezie et al., 2007). The students demonstrated willingness to participate in meetings and reported attending the daily handover meetings, which could open opportunities for leadership experiences. In conclusion, Mackezie et al (2007) established the value of evaluation in interprofessional education. The researchers concluded that evaluation could help identify negative and positive learning experiences as well as the challenges faced by students and professionals working in inpatient working settings. In particular, the students experienced important learning and training on interprofessional communication, gained valuable exposure in different team roles and appreciated the complexities of working in a challenging care environment as a team (Mackezie et al (2007). However, the evaluation described by Mackezie et al (2007) raises various limitations. For instance, the evaluation does not consider potential changes in student perceptions and attitudes. This is especially important considering that student perceptions and attitudes could have long-term effects and influence experiences gained from placement learning. Further, the findings are not generalisable. References Barr, H. Freeth, D. Hammick, M. Koppel, I & Reeves, S 2000. Evaluation of interprofessional education. British Educational Research Association. Retrieved April 26, 2012 from www.caipe.org.uk/silo/files/evaluations-of-interprofessional-education.pdf Bevil, D. 2008. Toward a core curriculum for interdisciplinary collaboration between universities and clinics. The American Journal of Occupational Therapy, 49 (3): 207-213. Carpenter, John. 1995. Doctors and nurses: stereotypes and stereotype change in interprofessional education. Journal of Interprofessional Care, vol. 9 (2): 151-161. Davidson, A. 2005. A historical overview of interdisciplinary family health: a community-based interprofessional health professions course. Academic Medicine, 80(4): 334-338. Education Collaborative Expert Panel. 2011. Core Competencies for interpersonal collaborative practice: Report of an expert panel. Washington, D.C.: Interpersonal Education Collaborative. Freeth, D. & Reeves, S. 2007. Interprofessional training ward pilot phase evaluation project report. City University, London. Freeth, D. Reeves, S. Goreham, C. Parker, P. Haynes, S. Pearson, S. 2001. Nursing Education Today, 21 (5): 366-72. Hall, Pippa. 2005. Interpersonal teamwork: professional cultures as barriers. Journal of Interprofessional Cultures, vol. 1: 188-196. Helm, D 2001. Interdisciplinary Training Guide. Washington, Dc: Association of University Centers on Disability. Hylin, P. Kusoffsky, A. Lauffs, M. Lonka, K. Mattiasson, A. & Nordstrom, G. 2004. Interpersonal training in the context of clinical practice: goals and students perceptions on clinical education wards. Medical Education, vol.38 (7): 727-36. Isaacs, M. & Benjamin, P. 1991. Towards a culturally competent system of care: programs which utilize culturally competent principles, Vol. II. Washington, DC. Kirchhoff, T. & Haase, E. 1995. The way of the future: interdisciplinary research. Reflections Sigma Theta Tau, 21 (3): 15. Lowe, M. Paulenko, T. Jardine, J. Martin-Daniel, P. Summers, S. Demeris, H. & Freedman, J. 2012. Interprofessional education for internationally educated nurses: a resource to support group clinical placement program planning, implementation and evaluation. Toronto Rehab and George Brown College: Torornto., ON. Mackezie, A. Craik, C. Tempest, S. Cordingley, K. Buckingham, I. & Hale, S. 2007. Interprofessional learning in practice: the student experience. British Journal of Occupational Therapy, Vol. 70 (8): 359-361. Makary, A. Sexton, B. Holzmueller, G. & Rowen, L. 2006. Operating room teamwork among phsyiscans and nurses: teamwork in the eye of the beholder. Journal of the American College of Surgeons, 205 (5): 746-752. Marcus, T. 2000. An interdisciplinary team model for substance abuse prevention in communities. Journal of Professional Nursing, vol.16 (3): 158-168. McCallin, A. 2003. Developing effective interdisciplinary teams. Nursing New Zealand,9 (9): 21-23. Miller, T. & Prentice, A. 1994. The self and the collective. Personality and Social Psychology Bulletin, 20, 451-453. Oabdasan, Ivy. & D’Amour, Danielle 2005. Journal of Interprofessional Care, supplementary 1:8-20. Pecukonis, E. Doyle, O. & Bliss, D. 2008. reducing barriers to interprofessional training: promoting interprofessional cultural competence. Journal of Interprofessional Care, 22(4): 417-428. Rafter, E. Pesun, J. Herren, M. Linfante, C. Mina, M. Wu, D. 2000. A preliminary survey of interprofessional education. Journal of Dental Education, 70 (4): 417-427. Rivanjee, P. 1997. Shared expertise: family participation in interprofessional training. Journal of Emotional and Behavioral Disorders, Vol. 5 (4): 205-211. Sommers, S. Marton, I. & Randolph, J. 2000. Physician, nurse, and social worker collaboration in primary care for chronically ill seniors. Archives of Internal Medicine, 160 (12): 1825-1833. Sweeney, A. & Schuster, L. 2000. Collaboration between pharmacy and osteopathic medicine to teach via the internet. The Journal of the American Osteopathic Association, 100 (12): 792-794. The Carnegie Foundation for the Advancement of Teaching. 2010. Educating Nurses and Phhsyicians; towards new horizons. Conference Summary, Palo Alto, California. Thomson, T. & Mathias, P. 1992. Interprofessional training-learning disability as a case study. Journal of Interpersonal Care, Vol. 6 (3): 231-241. World Health Organization. 2010. Framework for action on interprofessional education and collaborative practice. Retrieved April 26, 2012 from http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf Zeiss, M. & Staffer, M. 1996. Interdisciplinary health care teams: the basic unit of gyniatrics care. In L.l. Carstensen, B et al (Eds.), The Practical handout of clinical gerontology. Thousand Oaks, CA: Sage. Read More