Wednesday September 17th 2014

All for one and one for all

Interprofessional education aims at fostering teamwork, quality care

Credit: The University of Alabama at Birmingham

Health care professionals who learn together, work better together. That is the premise behind the growing practice of interprofessional education (IPE) in both schools and clinical settings.

“If we want interprofessional collaboration and high-performing teams in hospitals and communities, we need to educate and train students together so they can function effectively to improve the quality of care in the real world,” said Doreen Harper, PhD, RN, FAAN, dean of the University of Alabama at Birmingham (UAB) School of Nursing and an Alabama State Nurses Association member. “It’s not going to happen magically.”

Added Kathy Chappell, PhD, RN, vice president, Accreditation Program and Institute for Credentialing Research with the American Nurses Credentialing Center (ANCC),  “Interprofessional education is important because health care is delivered by teams, not by a single profession. And there’s a building body of evidence that shows that improving team collaboration has a positive impact on patient outcomes.”

Not new, but building

Although there increasingly have been more calls for IPE, including by the Institute of Medicine, team learning is not a new phenomenon.

Jane Kirschling

“The reality is that interprofessional education has been around for three decades, but it’s [generally] been population-specific,” said Jane Kirschling, PhD, RN, FAAN, dean of the University of Maryland School of Nursing and director of IPE at the University of Maryland, Baltimore (UMB). For example, there have been strong interdisciplinary movements around the care of the elderly, and in hospice and palliative care.

“What’s happening now is it’s grounded in the quality and safety movement, and it’s seen as applying to the care of all patients across the continuum, especially as care has become more complex,” said Kirschling, a Maryland Nurses Association member.

She noted that the Interprofessional Education Collaborative (IPEC) developed competencies a couple of years ago aimed at fostering teamwork, better communication, an understanding of individual roles and other key factors. IPEC is comprised of six national associations representing schools of health professions, such as the American Association of Colleges of Nursing.

There are, however, barriers to IPE, nurses say. Sometimes it’s geographical; schools of nursing, medicine and pharmacy may not be close enough together to offer team learning. Other times it’s a question of workplace culture or resources.

Built into practice

Students see firsthand the value of every health care role in solving emergent patient issues. Credit: The University of Alabama at Birmingham

ANCC’s Chappell said there’s been increasing interest in the center’s Joint AccreditationTM program, which sets standards for and credentials organizations that develop interprofessional CE activities specifically designed to enhance collaborative practice among members of the health care team, including nurses, physicians and pharmacists.

Its value lies in allowing academic medical centers, government agencies and other institutions to offer interprofessional CE to several health care professionals at once, according to Chappell. This increases organizational efficiency, but moreover, helps those facilities break down silos that may exist among professionals and improve patient outcomes.

Interprofessional continuing education offerings typically fall under two categories, Chappell said. One is aimed at improving team performance, so content might focus on factors such as team communication and patient hand-offs.  The other category involves addressing a specific patient care issue or problem, such as sentinel events, or new interventions and treatments for cardiac patients.

One health care system that achieved Joint Accreditation is Baystate Health in Massachusetts.

With strong institutional support, Director of Continuing IPE Joanna Donahue, MBA, RN, began creating a structure to offer educational opportunities that focus on the patient, not the discipline, since coming to Baystate Health 26 years ago.

That patient-centered, team-based approach is one that’s shared by Anita Sarro, JD, MS, RN, a nurse and lawyer who now works with Donahue. Previously in risk management, Sarro found that miscommunication or lack of communication were often key factors when less-than-optimal patient outcomes occurred.

“When things go wrong, it should be looked at as a team,” she said. Team learning can help improve communication. Further, it can — and has — reinforced the notion at Baystate Health that all disciplines bring value to the team, and that one is not superior.

Added Donahue, “We need to use everybody’s strengths to take the best care of our patients.”

The core of coursework

Simulations help students learn to work as an interprofessional team for the good of the "patient." Credit: The University of Alabama at Birmingham

When planning interprofessional offerings, Donahue said she and her team first look at the specific patient population or issue. Then they determine who is within the circle of professionals providing care to that patient all along the continuum of care, and how that care can be improved.  Sometimes, that continuum includes community members.

One case in point is Baystate’s annual “victims rights” seminar, which this year focused on media saturation, sexual violence and toxic stress. This learning experience brought together health care professionals, such as nurses and physicians, as well as members of law enforcement, law professors, social services personnel and others.

“This community interprofessional program allows people to see the big picture, have the opportunity to interact and improve care and services [to this vulnerable population],” Sarro said.

Baystate Health also offers annual interprofessional CE in pain management, in addition to a wide range of Internet-based courses.

Added Donahue, “Planning an IPE activity is, itself, a model of collaboration. When planning CE, members of the health care team work together with mutual respect and professionalism, sharing their profession-specific perspectives.”

In Nebraska, at Creighton University’s Health Sciences Continuing Education (HSCE) Department — the first institution to gain Joint Accreditation — various professionals not only learn together, but also plan and implement programs together.

One recent interprofessional, two-day conference focused on the care of pulmonary patients, with content covering new pulmonary guidelines, medications and treatments. Participants included pharmacists, staff nurses, nurse practitioners, physicians and respiratory therapists. On the second day, the focus turned toward sleep apnea, and dentists, who often deal with patients with this condition, joined in the learning activity.

Other Creighton HSCE activities address street drugs, immunizations and psychiatric care in primary care.

Sally O'Neill

Sally C. O’Neill, PhD, associate vice provost of HSCE at Creighton, noted that CE conferences are designed to maximize attendee interaction, so activities include case studies, panels and question-and-answer sessions.

Higher education in Maryland, Alabama

“Collaboration and teamwork is a core value at UAB, and it’s built into how we do business across disciplines,” Harper said.

One place where nursing and medical students routinely learn together is in the simulation lab. All pre-licensure BSN students have at least five interprofessional education opportunities, and that number is expected to double — given the great interest among students. Medical students recently noted that without nursing students participating in an interprofessional simulation day, the learning experience is not as meaningful.

“In the lab, we really try to simulate real-world experiences, so we can see how they perform [individually and together],” Harper said.  For example, one simulated activity assesses how well medical and nursing students care for a pediatric patient who codes — from managing changing O2 sats to an out-of-control family member.

Additionally, there are opportunities for students to interact clinically. For instance, nursing students work collaboratively with dental teams at a clinic, where they perform initial assessments and histories before patients receive dental care. Again, dental students described having the involvement of nursing students as “a way of improving team care,” Harper shared.

Graduate nursing students also engage in IPE; student nurse anesthetists interact with the medical anesthesia team, and student psychiatric nurse practitioners work closely with other mental health experts and informaticists in rural mental health clinics, according to Harper.

At UMB, there are numerous initiatives where students come together to learn and improve care, such as in geriatrics, and in HIV and AIDS. Of the latter initiative, Kirschling said that UMB has trained about 300 health professions students to work together to do case identification and make appropriate referrals.

UMB also has interprofessional education days. Most recently, some 500 students attended a program focusing on ethics.

“We’re also building initiatives around point of care,” Kirschling said. For example,  “The Pediatric TEAM” pilot program will help medical, nursing and pharmacy students learn collaborative care of children who are predisposed to or experiencing delirium in critical care settings.

Current and future impact

At Creighton, O’Neill’s team will be sending follow-up surveys to those who participated in its interprofessional CE programs to see if they are implementing what they’ve learned.  She also reported that the strong bonds among the interprofessional CE planning committee members has yielded collaborative research projects.

Meanwhile at Baystate Health, an IPE conference on pain management has led to the creation of a model to better address this issue, with training aimed at all professionals and staff, including the person who answers the phone.

Finally, Kirschling added, “Employers are now saying they will no longer allow people to be disruptive, or to allow silos. They need professionals with good communication skills who are open to feedback and willing to step out of their comfort zone and learn.

“We don’t need to be fearful. We need to make changes through interprofessional education that will make collaborative practice happen.”

— Susan Trossman is the senior reporter for The American Nurse.

Resource

Learn more about ANCC’s Joint Accreditation program at www.jointaccreditation.org.

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