Educational Challenges of Interprofessional Practice Education

What Is Interprofessional Learning?

Interprofessional practice education (IPE) has been defined by the Centre for Advancement of Interprofessional Education (CAIPE) as two or more professions “learning with, from and about each other to improve collaboration and quality of care” (Barr, 2002).

In order to improve outcomes across healthcare through collaboration there is the need to “learn with, from, and about each other” (World Health Organization, 2010).

WHO (2010) framework for interprofessional education and collaborative practice key messages are:

  • “Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.
  • Interprofessional education is a necessary step in preparing a collaborative practice-ready health workforce that is better prepared to respond to local health needs.
  • Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care” (pg 7).

 

The Players

Nursing, medical, allied health (physical therapist, pharmacy, social work, speech and language) and this is within the hospital environment, the next level is how to then collaborate between the hospital with community services.

IPE occurs formally and informally, from a clinical practice view, we have likely experienced the debrief of a clinical incident within the workplace (Nisbet et al. 2007).

Educational Challenges

One of the main questions from an educational perspective will be to consider what IPE learning should focus on (O’Keefe, Henderson & Chick, 2017). Is it the procedural (technical skills) or soft skills (non-technical skills) that are key learning? There will be the need for education faculty to be trained in delivering IPE (Watkins, 2016).

There is an identified need in healthcare for experiential learning opportunities, set in the clinical environment and not just in the simulation laboratory or higher education settings, (Shrader et al, 2018). Difficulties of delivering IPE in the higher education, such as logistics of collaboration around busy schedules, resources, accreditation and varied assessments (O’Keefe, Henderson, & Chick, 2017). To deliver within the clinical environment these factors need to be considered to ensure effective training focuses on improving consumer outcomes, collaboration and evidence based practice.

 

IPE Barriers

  • Professional silo’s, not to breakdown but connect.
  • Understanding each professions roles and responsibilities.
  • Scope of practice.
  • Difficulties of delivering IPE in higher education.
  • Traditional workplace hierarchy of top down approach, the collaborative IPE challenges these values and beliefs in order to change culture.
  • Interprofessional feedback process across different professions and skill mix. Skilled and structured feedback is required to maintain trust and enquiry in a safe environment.
  • Resources to deliver quality simulation, both technical and non-technical skill training.
  • Learning from mistakes and shared learning in the no-blame culture of healthcare.

Essential Components For IPE

Steven et al. (2017) identified these essential components from IPE education programs:

  1. Knowledge for practice,
  2. Skills for practice,
  3. Ethical approach,
  4. Professionalism,
  5. Continuing professional development (CPD),
  6. Patient-centered approach,
  7. Teamwork skills.

The Future

The recognition for collaborative practice and improved consumer outcomes through dedicated IPE programs delivered by specific IPE faculty (Bridges et al, 2011).

There will be a need for interprofessional competencies as IPE in the education and the workplace occurs, and how these fit into specific regulatory requirements will have to be considered (Englander et al, 2013).

References

Ausmed (2018). Position Statement: Interprofessional Continuing Education.

Ausmed (2018). Interprofessional Education in Healthcare – Exploring the Benefits.

Ausmed (2018). Meeting the Challenges of Interprofessional Collaboration.

Barr, H. (2002). Interprofessional Education: Today, Yesterday and Tomorrow. CAIPE and LTSN Centre for Health Science and Practice.

Bridges, D., Davidson, R. A., Soule Odegard, P., Maki, I. V., & Tomkowiak, J. (2011). Interprofessional collaboration: three best practice models of interprofessional education.

Englander, R., Cameron, T., Ballard, A. J., Dodge, J., Bull, J., & Aschenbrener, C. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88(8), 1088-1094.

Hunt, S. (2007). Participatory community practice: Developing interprofessional skills. Focus on Health Professional Education: A Multi-Disciplinary Journal, 8(3), 71.

O’Keefe, M., Henderson, A., & Chick, R. (2017). Defining a set of common interprofessional learning competencies for health profession students. Medical teacher, 39(5), 463-468.

Nisbet, G., Thistlethwaite, J., Moran, M., Chesters, J., Jones, M., Murphy, K., & Playford, D. (2007). Sharing a vision for collaborative practice: the formation of an Australasian interprofessional practice and education network (AIPPEN). Focus on Health Professional Education: A Multi-disciplinary Journal, 8(3), 1.

Shrader, S., Jernigan, S., Nazir, N., & Zaudke, J. (2018). Determining the impact of an interprofessional learning in practice model on learners and patients. Journal of interprofessional care, 1-8.

Steven, K., Howden, S., Mires, G., Rowe, I., Lafferty, N., Arnold, A., & Strath, A. (2017). Toward interprofessional learning and education: Mapping common outcomes for prequalifying healthcare professional programs in the United Kingdom. Medical teacher, 39(7), 720-744.

Watkins, K. D. (2016) ‘Faculty development to support interprofessional education in healthcare professions: A realist synthesis’, Journal of Interprofessional Care, 30(6), pp.

World Health Organization. 2010. Framework for action on interprofessional education and collaborative practice. WHO Press.

 

 

 

Journal Club: Factors influencing nurses’ intentions to leave adult critical care

Journal Club Article: Khan, N., Jackson, D., Stayt, L., & Walthall, H. (2018). Factors influencing nurses’ intentions to leave adult critical care settingsNursing in critical care.

 

Background:

“Nurse retention is a global problem across all specialities but is exacerbated in critical care areas where elevated nurse–patient ratios and the use of advance technologies require greater numbers of highly educated and specialized nurses impacting costs and quality of patient care.”

Factors identified in previous research such as working conditions, burnout syndrome, organisational climate, staffing levels, empowerment, personal health and work pressure.

Relevance to practice:

“The shortage of critical care nurses is currently a global issue impacting costs and quality of patient care.”

Method:

A systematic mixed-method literature review.

Findings:

3 themes identified were quality of the work environment, nature of working relationships and traumatic/stressful workplace experiences.

  1. Quality of the work environment

Empowerment and professional development opportunities. Having enough time to recover from night shifts and the impact of inflexible rotations on work–life balance.

2. Nature of working relationships

When conflict occurs with families and relatives. Poor relationships between nurse to manager and nurse to physician, especially not being involved in the decision making process.

3. Traumatic/stressful workplace experiences

Futility in the level of care being provided, caring for the dying patient and decisions to forego life‐sustaining treatments.

Conclusion:

High nursing turnover is a global issue and nurse leaders in critical care areas need to take these findings into consideration when developing strategies to improve turnover and support strategies.

Keywords: Burnout; Culture: Nurse Retention; Stress; Teamwork.

Additional Resource: Best Nursing Degree from Shanna Shafer (BSN) regarding shortage of nurses and also nurse faculty in the US, and reshaping the future of nursing and nurse education.

 

Workplace Training: Informal Learning?

Workplaces as Centres of Inquiry

Workplace learning and experiences are often seen as informal and subsequently ‘informal learning’ occurs. Billet (2002) states that an educational workplace pedagogy exists, and that learning does not just occur in schools and higher education. Workplace education delivers structured goal-directed activities and work practice relevancy so this ‘informal’ tag is actually incorrect. Learning is deemed as being “interdependent between the individual and the social practice” (Billet, 2002). This structuring of learning experiences is shaped and directed towards sustaining the continuity of current practice.

“Workplace practices and affordances, are dynamic, as their tasks, goals, interactions, participants and relations are likely to be constantly changing” (Billet, 2002, pg. 64).

Learning through work, and the participation and engagement in the social practice is an essential aspect. Just think of the importance of role modelling to set the culture of your workplace environment. Vocational learning is often considered of lower quality than education provided by educational institutions, but with current lifelong learning policies, the role of workplace learning is essential. Workplace participation and sustaining practice are required for positive learning experiences and outcomes. Workplace training can vary between ad-hoc to over structured teaching, which have contributed to some of the negative terms for workplace learning. If we think of the learners motivation to learning, there will likely be a difference in the learners level of engagement of learning in those opportunities chosen by the individual to that of enforced learning (such as mandatory training). Just think to the last time you went to an education event of your choice and compare to one you were ‘encouraged’ to attend, likely you experienced very different motivators. The workplace will have more mandatory training requirements so enthusiasm is likely to be low for such training, as the educator you will need to find a way to make the training meaningful for the participants.

Pathways of learning activities as part of a constructivist approach for skill development are approaches in contemporary work settings. Mentoring and apprenticeships are important learning pathways to navigate workplace practices and learn from experienced practitioners, again part of the social learning experience. Continuity of social practices and the opportunities of unintended learning is a product of these mentorship experiences in the work setting.

Relevancy in Nursing 

Nurse training is forever looking for the right balance between providing higher education and workplace experience for nurse training. Finding the perfect mix of theoretical with the hands on learning experience in the actual clinical setting is the overall aim. The mentor model is an essential part of nurse training in providing learning in the workplace setting. Workplace education is commonly more hands on and has a practical focus, combining theoretical and clinical. With simulation increasingly part of formal educational approaches to nurse training, a more hands on experiential learning approach is being embraced over the traditional ‘sage on the stage’ lecture approach. The multi-disciplinary teamwork and bonding that can occur in workplace training is vital as part of building a positive team culture.

Educator Program Aims

  • Professional growth and change (transformative practice).
  • Personal Change- Reorientation of values of attitudes.
  • Self-esteem linked to workplace confidence.
  • Teamwork and community of practice.

References

Billett, S. (2002). Critiquing workplace learning discourses: participation and continuity at work. Studies in the Education of Adults, 34(1), 56-67.

Harteis, C. & Billett, S. (2008). The workplace as learning environment: Introduction