INTERPROFESSIONAL EDUCATION

STUDENT PRE-READING DOCUMENT

Prepared by: Lynn Casimiro & Pippa Hall, 2011

Academic Health Council - Champlain Region 1 Stewart Street, Room 124 Ottawa, Ontario K1N 6N5 Tel: 613-562-5800, Extension 8920 Ahc-cas@uottawa.ca

Introduction Learning how to work more effectively and efficiently with coworkers including patients and families as well as administrators and governance bodies (i.e. medical college) is becoming part of healthcare providers required competencies (Nahrwold, 2005). The recommendations in favour of effective teamwork have multiplied as shortages of healthcare providers are documented, particularly in remote or rural communities, and the complexity and chronicity of healthcare issues increases with improved longevity (Barr, 2002; Shortell, 2000; World Health Organisation, 1988; 2000, 2001). In this evolving healthcare climate, one single type of health care provider is no longer sufficient to deliver the required care (Gilbert 2005; Hall & Weaver, 2001). Advantages of effective teamwork have been documented, including improved working relationships, decreased staff turnover rates, improved patient satisfaction, more efficient and better quality of care, and greater cost-effectiveness (Aston, Shi, Bullt, Galway, & Crisp, 2005; Pearson & Pandya, 2006). Future healthcare providers will need to assess the complexity of each healthcare situation and decide how to collaborate effectively with colleagues. The goal is to ensure that the best possible outcomes are achieve while including the patient and family as an integral part of the team. Definitions The purpose of this section is to clarify some of the terms used in healthcare. Providers: Providers include individuals from regulated and non-regulated healthcare professions, healthcare workers, social science personnel or any other trained personnel that may interact with patients, families, and other caregivers in health and social care settings. Healthcare providers may be used interchangeably with healthcare practitioners. Discipline and profession: The use of the terms discipline or profession has caused some confusion in the health care literature (Figure 1).

Discipline
There can be several disciplines within one profession

Profession
Professions have different roles, functions

MEDICINE Family Doctor Surgeon Oncologist MEDICINE VOLUNTEER NURSING

Figure 1: Distinction between the terms discipline and profession in healthcare

Uniprofessional Care:

Uniprofessional teams are defined as instances when one healthcare professional team member collaborates with one patient and/or family. These are care interactions where one provider, who has appropriately assessed the situation, teams up with the patient to address the situation without the involvement of other care providers.
Legend - In the following diagrams: F = family member or meaningful other P = Patient CP = care provider (different colour CPs = CPs from different professions) Irregular circle = patients presenting health situation Ball(s) = particular need(s) in the presenting health situation Threads = contributing collaboration between patient and care provider(s)

Multiprofessional Care:

Multiprofessional teams are defined as instances when more than one care provider from different professions assess the patients situation and then work collaboratively individually with the patient (and family , when appropriate) to achieve the patients goal, but cooperate and coordinate with each other to achieve the desired outcome. The primary purpose of multiprofessional practice is to coordinate individual care strategies while individual care providers stay committed to their profession (Poulton & West, 1997).

Interprofessional Care:

Interprofessional teams are defined as instances when the knowledge and expertise of care providers from different professions, including the knowledge and expertise of the patient and/or family, are integrated together, decision-making is shared and the team sets common goals of care using an interdependant collaborative approach. The patients health circumstance requires the providers, patient and/or family to work from their own areas of expertise and to integrate strategies learned from each other, to achieve common team goals.
Blueprint for Action Ontario; www.healthforceontario.ca/IPCProject

Collaborative Patient-Centred pratice: Interprofessional Collaborative Care is a practice orientation, a way of health care professionals working together and with their patients. It involves the continuous interaction of two or more professionals or disciplines, organized into a common effort, to solve or explore common issues with the best possible participation of the patient. Collaborative patient-centred practice is designed to promote the active participation of each discipline in patient care. It enhances patient- and family-centred goals and values, provides mechanisms for continuous communication among care givers, optimizes staff participation in clinical decision making within and across disciplines, and fosters respect for disciplinary contributions of all professionals (Herbert, 2005, p.2). This definition is often used to explain the notion of interprofessional care.

Transprofessional Care:

Transprofessional teams are defined as instances when a health care provider takes on a role that is normally outside of his/her usual scope of practice but for which he/she does have the necessary base of expertise and teams up with the patient and/or family to provide care. This type of situation is common in smaller or rural hospitals that may not have all the
necessary expertise.

Summary One can therefore look at effective teamwork along a continuum ranging form uniprofessional to transprofessional depending on the complexity of the presented healthcare situation and the resources available. Regardless of the type of teamwork adopted, the patient and/or family are central to the team process, participating in shared-decision making and care planning to the degree that they are able. Each health care provider must be aware of the continuum of effective teamwork and be able to assess the type of teamwork required for any given health situation, a skill referred to as situation awareness (Mackintosh et al, 2009). In addition, each health care provider should be aware of his/her own strengths and limitations along the continuum in order to insure that the optimal care is being provided, and not simply reflecting the specific style of the provider. References Aston, J., Shi, E., Bullt, H., Galway, R., & Crisp, J. (2005). Qualitative evaluation of regular morning meetings aimed at improving interdisciplinary communication and patient outcomes. International Journal of Nursing Practice, 11, 206-213. Barr, H. (2002). Interprofessional education: Today, yesterday and tomorrow. A review commissioned by the Learning and Teaching Support Network for Health Sciences & Practice. London: CAIPE. Barr, H., Koppel, I., Reeves, S., Hammick, M., & Freeth, D. (2005). Effective interprofessional education: Arguments, assumptions & evidence. Malden, MA: Blackwell Publishing.

Choi, B.C.K., & Pak, A.W.P. (2006). Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clinical and Investigative Medicine, 29(6), 351-364. Choi, B.C.K., & Pak, A.W.P. (2007). Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 2. Promotors, barriers, and strategies of enhancement. Clinical and Investigative Medicine, 30(6), E224-E232. Freeth, D., Hammick, M., Reeves, S., Koppel, I., Barr, H. (2005). Effective Interprofessional Education: Development, Delivery & Evaluation. Malden, MA: Blackwell Publishing. Gilbert, J.H.V. (2005). Interprofessional education for collaborative, patient-centred practice. Nursing Leadership, 18(2), 32-38. Hall, P. (2005). Interprofessional teamwork: Professional cultures as barriers. Journal of Interprofessional Care, 19(Suppl. 1), 188-196. Hall, P., & Weaver, L. (2001). Interdisciplinary education and teamwork: A long and winding road. Medical Education, 35(9), 867-875. Herbert, C. (2005). Changing the culture: Interprofessional education for collaborative patient-centred practice in Canada. Journal of Interprofessional Care, 19(Suppl. 1), 1-4. Mackintosh, N., Berridge, E-J., & Freeth, D. (2009). Supporting structures for team situation awareness and making: insights from four delivery suites. Journal of Evaluation in Clinical Practice, 15, 46-54. Meads, G., & Ashcroft, J. (2005). The case for interprofessional collaboration: In health and social care, Malden, MA: Blackwell Publishing. Nahrwold, D.L. (2005). Continuing medical education reform for competency-based education and assessment. The Journal of Continuing education in the Health Professions, 25, 168-173. Pearson, D., & Pandya, H. (2006). Shared learning in primary care: Participants view of the benefits of this approach. Journal of Interprofessional Care, 20(3), 302-313. Poulton, B., & West, M. (1997). Defining and measuring effectiveness for primary health care teams. In P. Pearson, & J. Spencer (Eds.), Outcome Promoting Teamwork in Primary Care: A Research-Based Approach (pp. 39-55). Arnold: London. Shortell, S.M. (2000). Slowly remaking the US healthcare system. Health Services Research, 35(1 Pt. 1), 1-4. World Health Organisation (1988). Learning together to work together for health. Report from a World Health Organisation study group on multiprofessional education of health personnel: The team approach. Technical report series 769, Geneva: WHO. World Health Organisation (2000). Towards unity for health: Coordinating changes in health services and health professions practice and education. Newsletter N2, Geneva: WHO. World Health Organisation (2001). Developing human resources for health. Report on a Meeting with WHO Collaborating Centres and Selected International Organizations. Copenhagen: European Health 21 Target 18. Zeiss, A. M. & Steffen, A. M. (1998). Interdisciplinary health care teams in geriatrics: an international model. In B. A. Edelstein (Ed.) Clinical Geropsychology Vol 7. of A. S. Bellack & M. Hersen (Eds.) Comprehensive Clinical Psychology (pp. 551-570). London: Pergamon Press. Zwarenstein, M., & Reeves, S. (2006). Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork. The Journal of Continuing education in the Health Professions, 26, 46-54.

Appendix: Team Members Role Descriptions Person with a health care situation & his/her family: Are active partners in the care team goals. Play a central role in identifying goals and making decisions. Audiologist Provides primary care in auditory health, specializing in the prevention of hearing loss and in the diagnosis, evaluation, management and treatment of hearing and balance disorders. Evaluates the degree of hearing loss and associated balance disorders and then recommend appropriate treatment. Serves not only deaf and hearing-impaired persons but also those at risk of hearing loss due to noise exposure, the effects of medications, middle-ear infections or heredity. Works with adults and children who need rehabilitation for hearing loss including auditory training and lip reading. Educates other professionals and clients about ways to prevent hearing loss. (See http://www.caslpa.ca/english/profession/audiology.asp) Chaplain/Spiritual Care Worker Allows patients and families to ask the difficult questions which often trouble ill persons. Enables patients to search for meaning and purpose in what they are living. Ensures that spiritual as well as religious needs are responded to for all persons. Client Relations Advisor Relates effectively to patients/families and staff at all levels and have an in-depth understanding of human behaviour. Works in highly emotional situations bringing a sense of empathy, professionalism, realism and hope. Interacts effectively to bring diverse groups together as a team, including patients/families, physicians, managers, employees. Models and provides leadership in problem/issue diagnostics, problem-solving, facilitation, and conflict resolution. Collects, analyzes, interprets and reports statistical data in a meaningful, user-friendly manner in view of improving care, service and relationships. Clinical Manager Plans, organizes, directs, controls and evaluates all activities of their care unit in order to provide high quality patient care within a health care organization. Dental Hygienist Provides oral health care within the dental hygiene scope of practice to treat and prevent oral diseases and conditions. Provides oral health care education to patients and caregivers for the maintenance of oral tissues and promotion of the important relationship of oral health to general health and well-being. Plays an important role in education to team members. Makes referrals to and communicates with team members as appropriate. Provides individual dietetic counselling and favourite foods. Is available to a patient/family member for discussions concerning difficult issues related to nutrition (e.g., forced feeding). Is available as a resource person for the community. Intervention is important when the patient is experiencing difficulties with loss/reduced appetite secondary to a wide range of difficulties. Dietitian Provides individual attention and support to patients and residents in the hope of improving/maintaining quality of life by providing dietetic counselling and favourite foods. Plays an important role in education of team members. Is available as a resource person for the community.

Kinesiologist Assesses human movement, performance. Manages, maintains, rehabilitates and/or enhances movement and performance. Applies the latest evidenced based medicine principles to preserve and enhance human movement in all settings and populations. Nursing Personnel Dispense care both independently and collaboratively to families, groups, communities and persons of all agesboth sick and wellin all settings. Involved in health promotion, disease prevention, and the provision of care to ill, disabled and dying persons. Protect and promote a healthy environment, conduct research, participate in health policy development and the management of health care systems and patients, and education. (See http://www.icn.ch/index.html) Registered Nurse (RN) Provides direct care to patients within his or her scope of practice. Provides education to patients/residents and their family members. Makes referrals to and communicates with team members as appropriate. Advocates for patient/resident and family needs. Registered Practical Nurse (RPN) Provides direct care to stable, predictable patients with low complexity of care needs. Provides education to patients/residents and their family members about predictable conditions and known and evaluated interventions. Identifies and recognizes abnormal or unusual patient responses and consults with or makes referrals to members of the team as required. Performs interventions for which he/she can manage the outcomes or has access to resources to manage outcomes. Evaluates outcomes of specific interventions and modify the plan of care based on predictable and expected patient/resident responses using professional judgment. Collaborates with the Registered Nurse when aspects of care or patient/resident condition are beyond RPN scope of practice. Advanced Practice Nurse Works to improve clinical outcomes through an advanced and expanded role in nursing that includes program planning and delivery, consultation, education research, efficient resource utilization and effective leadership. Occupational Therapist (OT) Uses a systematic approach based on evidence and professional reasoning to enable individuals, groups and communities to develop means to identify and engage in their chosen occupations and to improve their functional capacities. The process involves assessment and intervention with clients aimed at determining and raising their performance in self-care, work, study, volunteerism and leisure. Provides specific advice on occupational health, health promotion, and active living programs for elderly persons. Offers one-to-one professional services and may also work in management, research, program design and education. Assists with Activities of Daily Living (ADLs) such as feeding and personal care in order to maintain a sense of control. Occupational Therapy Aide Provides and assists with occupational therapy treatments according to the policies, procedures and standards of the institution. Functions as a member of the occupational therapy team.

Paramedic Secures and maintains safety of trauma site. Assesses extent of injuries or illness of trauma victims, patients with respiratory disease and stress, overdose and poisoning victims, industrial accident victims and other ill or injured individuals to determine emergency medical treatment. Liaises with ambulance dispatch centres, base hospital staff, police, fire, and family members to ensure relevant information is collected and proper treatment is administered. Administers pre-hospital emergency care, such as cardiopulmonary resuscitation (CPR), oxygen, bandaging and splinting to patients. Establishes and maintains intravenous treatment (IV), applies adjunctive equipment for ventilation and circulation complications, administers medications and provides other emergency treatment to patients. Transports patients by air, land or water to hospital or other medical facility for further medical care. Documents and records nature of injuries and treatment provided. Assists hospital personnel with provision of medical treatment, if necessary. Maintains ambulances and emergency care equipment and supplies. Personal Care Assistant (PCA) Provides aspects of personal care and basic nursing care as assigned by a Registered Nurse or Registered Practical Nurse. Examples may include personal hygiene, dressing, grooming, feeding, toileting, ambulation and transfers. Promotes the autonomy and the independence of patients/residents according to their functional abilities in the activities of daily living such as: bathing, dressing, grooming, feeding, toileting, mobility. Pharmacist Provides drug therapy for the purpose of achieving definite outcomes (good symptom control) that improve the patients quality of life (pharmaceutical care). Collaborates with the patient and/or team to identify drug-related problems and makes every effort to resolve them. Counsels patients and family about medication, discharge planning, or leave of absence. Physician Promotes health; prevents illness; and evaluates, diagnoses and treats human health impairments. Roles of the physician: Clinician - Assesses, diagnoses, treats and manages illness. Communicator - Establishes therapeutic, patient-centred communication through shared decision-making and effective, efficient, empathetic and ethical interactions with patients, families, colleagues and caregivers. Collaborator - Collaborates with other health care providers to deliver effective and efficient health care services. Manager - Uses health care resources wisely in clinical care. Health Advocate - Identifies and advocates for an individual patients needs including physical, psychological, social/cultural, and spiritual aspects of health, as well as for the needs of the community and population. Scholar - Applies new evidence-based concepts and knowledge into the care provided to patients and their families. Professional - Practices medicine in an ethically responsible manner. Physiotherapist (PT) Physiotherapy includes, without being limited to, client assessment, arriving at a diagnosis, planning and implementing a treatment plan, educating clients and other team members, research, and management. Assists the patients/residents in fulfilling their own goals toward an optimal level of independence and functioning and by assisting in the relief of pain, discomfort and suffering.

 Analyzes the effect of injury, disease and other conditions affecting the bodys mobility and function. Participates in team approaches to the provision of health care services. Physiotherapy is a primary care, autonomous, client-centred health care profession focused on: Improving and maintaining functional independence and physical performance. Preventing and managing pain, physical impairments, and limits on participation. Promoting fitness, health and wellness. Physiotherapy Aide Provides and assists with physiotherapy treatments according to the policies, procedures and standards if of the institution. Functions as a member of the physiotherapy team. Porter in health care organizations Transports patients as needed (e.g., to and from their appointments, assisting with the transportation of bodies to the morgue; assist patients in X-ray department if necessary). Transports equipment, materials and supplies as needed. Provides general support: assisting in the transfer of patients, answering the telephone, providing support at meal time in the patients dining room; retrieving and delivering mail within the organization; maintaining supplies quota. Psychologist Carries out neuropsychological assessments. Carries out assessments of complex psychological issues of patient/family to assist in the implementation of an intervention plan. Supportive therapy and group sessions for family members are provided as indicated. Capacity assessments under the Substitute Decisions Act and provision of opinions about capacity to manage property and personal care or assign/revoke powers of attorney may also be provided. Provides interventions for patients with psychological conditions which are treatable by behavioural, cognitive and other therapy approaches. Acts as a resource in the provision of education and support for the health care team. Recreation Therapist Addresses the individual and /or family members to identify his/her leisure-related needs, interests and abilities. Develops documents and evaluates a plan of intervention (e.g., complementary therapies such as Art Therapy, Music Therapy and Dog Therapy). Recreation Participation: facilitates patient participation in structured therapeutic and social activities and outings as appropriate. Facilitates linking of patient with appropriate community organization. Meets with the referred individual and/or family member to determine appropriateness for intervention. Recreation Assistant Works closely with the recreation therapist in the design, implementation and evaluation of leisure activities; plan, organize and facilitate patient-centred activities, including groups, individual activities, outings and special events. Helps organize internal activities, outings, activities for small and large groups; assigns responsibilities to volunteers and students. May assign responsibilities to volunteers and students. Rehabilitation Assistant Assists the registered therapist (Occupational Therapist/Physiotherapist) in the implementation of an established patient-specific treatment plan provided by the registered therapist. Organizes patients in exercise/activity groups in accordance with the treatment objectives and patients conditions as defined by the registered therapist. Instructs, supervises and assists patients in the safe and proper use of equipment, tools, and material in accordance with treatment objectives and registered therapists instructions.

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Respiratory Therapist Provides support for patients on ventilators and other respiratory support systems. Treats patients with various lung diseases. Provides emergency care to victims of heart attacks, stroke and drowning. Assesses the breathing capabilities of patients using various equipment. Social Service Worker Works closely with social worker to coordinate social services for patients and families. Assesses patient/family needs for financial assistance and collaborates with community agencies (e.g. Meals and Wheels, Helpline, private income supplies) toward meeting these needs. Facilitates visits or escorts patients and families to community agencies and placement facilities as required. Makes referrals and arrangements for transportation as needed. Makes referrals/applications to community transportation resources. Updates information on community services and resources to ensure availability of resource information to patients/residents and families. Social Worker (SW) Focuses primarily on the patients family, the relationships and interactions between patient and family, and their coping abilities in dealing with the illness and/or approaching death, provide counselling sessions as needed. Monitors communication among patient, family and team and act as liaison, if necessary. Coordinates liaison with home care, facilitates arrangement of community supports as needed. Co-ordinates/facilitates patient/resident/family conferences or meetings for purposes of communication and care planning, progress updates, and discharge planning. Speech Language Pathologist (SLP) Provides screening, identification, assessment, interpretation, diagnosis, rehabilitation and prevention of: - speech and language disorders (articulation, voice and parameters of language); - oral pharyngeal function and related disorders (e.g., swallowing); - cognitive communication disorders. Provides counselling services to clients, families, caregivers and others regarding all aspects of communication disorders. Works closely with other professionals, sometimes as part of a multidisciplinary or interprofessional team, in providing a coordinated program of care. Volunteer Assists in providing emotional, physical, psycho-social and spiritual support to patients and their loved ones. Receives extensive training about the roles of team members; physical, psycho-social and spiritual needs of the patient, including family and friends the complexity of communication; the helping relationship (identifying ones strengths and limitations). Responsibilities will vary according to specific program. Ward Clerk in a health care organization Organizes and prepares for admissions, discharges, transfers, autopsies. Transcribes physician orders. Arranges investigations ordered by health care team, transportation for patients to external appointments, home, retrieves films and reports from other hospitals/labs. Ensures equipment is available. Answers and directs calls from/for patients, their families, physicians and other team members. Facilitates the smooth functioning of the health care unit.

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