Lynda Weaver

The Last 48 Hours of Life in Long‐Term Care: A Focused Chart Audit

TAs a component of palliative care educational program development, the faculty at the University of Ottawa Institute of Palliative Care wished to assess end‐of‐life care for patients in long‐term care (LTC) settings to develop an educational strategy for physicians.

Developing collaborative person-centred practice: A pilot project on a palliative care unit

Maximizing interprofessional collaborative patient-centred practice holds promise for improving patient care and creating satisfying work roles. In Canadas evolving health care system, there are demands for increased efficiency, cost-effectiveness, and quality improvement. Interprofessional collaboration warrants re-examination because maximizing interprofessional collaboration, especially nurse-physician collaboration, holds promise for improving patient care and creating satisfying work roles. A palliative care team seized the opportunity to pilot a different approach to patient and family care when faced with a reduction in medical staff. Grounded in a collaborative patient-centred practice approach, the Canadian Hospice Palliative Care Associations National Model to Guide Hospice Palliative Care ([4]), and outcomes from program retreats and workgroups, a collaborative person-centred model of care was developed for a 12-bed pilot project. Preliminary findings show that the pilot project team perceived some specific benefits in continuity of care and interprofessional collaboration, while the presence of the physician was reduced to an average of 3.82 hours on the pilot wing, compared with 8 hours on the non-pilot wings. This pilot study suggests that a person-centred model, when focused on the physician-nurse dyad, may offer improved efficiency, job satisfaction and continuity of care on a palliative care unit. Incorporating all team members and developing strategies to successfully expand the model across the whole unit are the next challenges. Further research into the impact of these changes on the health care professionals, management and patients and families is essential.

A Method to Enhance Student Teams in Palliative Care: Piloting the McMaster-Ottawa Team Observed Structured Clinical Encounter

BACKGROUND The need for palliative and end-of-life care (PEOLC) education in prelicensure education has been identified. PEOLC requires effective collaborative teamwork. The competencies required for effective collaborative teamwork are only now emerging and methods to evaluate them must be developed. OBJECTIVE The adaptation of the traditional Objective Structured Clinical Examination (OSCE) for assessment of a student team addressing palliative care issues was undertaken. The McMaster-Ottawa Team Observed Structured Clinical Encounter (TOSCE) is intended as a formative evaluation tool for both competencies in interprofessional collaboration for patient-centered practice and PEOLC. METHODS Three stations based on palliative care scenarios were developed. From January 2007 to January 2008, a total of 141 students and 38 observers participated in the evaluation of three stations, with 6-7 students per group and two observers per station. Observers completed checklists for both PEOLC and interprofessional collaborative competencies and, after completing the TOSCEs, students and observers completed questionnaires on their feasibility and acceptability. RESULTS Eighty-nine percent of the students and 44% of the observers were from medicine. Students and observers found the TOSCE to be an acceptable and feasible assessment tool for both sets of competencies. Reliability and validity data show that the items in both the clinical and interprofessional checklists fit well together, and interrater reliability is readily achieved. CONCLUSIONS The new formative evaluation TOSCE tool, adapted from the traditional OSCE, was acceptable and feasible to students and observers.

Theories, relationships and interprofessionalism: learning to weave.

In this article, we illustrate the application of a number of theoretical frameworks we have used to guide our work in interprofessional education (IPE) and collaborative interprofessional care (IPC). Although we do not claim to be experts in any one of these theories, each has offered important insights that have broadened our understanding of the complexities of interprofessional learning and practice. We have gained an appreciation for an increasing number of theories relevant to IPE and IPC, and, as a result, we have woven together more key principles from different theories to develop activities for all levels of interprofessional learners and clinicians. We pay particular attention to relational competencies, knotworking/idea dominance, targeted tension and situational awareness. We are now drawing on the arts and humanities and complexity theory to foster relationship-building learning. Evaluation of our endeavors will eventually follow these latter theories for methods that better match the human and social experiences that underpin learning. Our “theoretical toolbox” therefore may be of value to educators who develop and implement creative interprofessional learning activities, as well as clinicians interested in moving toward more effective collaboration.

An interprofessional educational intervention on delirium for health care teams: Providing opportunities to enhance collaboration

Interprofessional collaborative practice is acknowledged as enhancing patient-centred care (Health Canada, 2004). Successful collaborative practice requires educational experiences that enhance team building (Hall & Weaver, 2001). Learning activities must provide the opportunity for health care providers to learn to work together and share in problem solving and decision making (Health Canada, 2004). This approach is particularly applicable in the management of terminally ill patients experiencing delirium. Delirium is a common major complication of advanced illness, particularly in the older adult and during the last weeks of life (Breitbart & Strout, 2000). Health care professionals experience feelings of incompetence, lack of confidence, and stress surrounding the care they provide these patients and report insufficient knowledge and skills in this area (Brajtman, 2005). As no one health care professional can meet all of these patients’ multiple, complex needs, interprofessional health care teams are particularly important in delivering delirium care. We developed an interprofessional educational intervention on delirium for a palliative care team to enhance team cohesiveness and effectiveness in dealing with delirious patients. Specifically, we wished to develop and assess content, instructional strategies and evaluation instruments; provide educational resources; enhance participants’ awareness of the roles and contributions of the different team members; and increase their knowledge of delirium. This pilot study received ethical approval from the university and clinical agency Research Ethics Boards.

Establishing face and content validity of the McMaster-Ottawa team observed structured clinical encounter (TOSCE)

The Objective Structured Clinical Evaluation (OSCE) has become the criterion standard for the assessment of clinical competence in undergraduate and postgraduate medical and other health profession...

Interprofessional education in palliative care: A pilot project using popular literature

Summary A need to introduce the concepts of death and dying to the medical and health sciences undergraduate curriculum was identified at the University of Ottawa, Ontario, Canada. As care of the terminally ill is complex and requires the collaborative involvement of a diverse group of health care professionals, an interprofessional educational approach was utilized to address this need. A seminar course was developed using popular literature as the basis for learning, and offered to first and second year medical students, fourth year nursing students and graduate students in spiritual care. The discussion of roles and the provision of care within the context of works of selected literature provided a focus that enabled the students to transcend their disciplinary barriers, and to better understand the perspectives and contributions that other team members bring to patient care. Evaluation findings suggest that meaningful interprofessional education can be introduced effectively to students either prior to or while they are maturing in their professional roles.

Learning collaborative teamwork: an argument for incorporating the humanities

Abstract A holistic, collaborative interprofessional team approach, which includes patients and families as significant decision-making members, has been proposed to address the increasing burden being placed on the health-care system. This project hypothesized that learning activities related to the humanities during clinical placements could enhance interprofessional teamwork. Through an interprofessional team of faculty, clinical staff, students, and patient representatives, we developed and piloted the self-learning module, “interprofessional education for collaborative person-centred practice through the humanities”. The module was designed to provide learners from different professions and educational levels with a clinical placement/residency experience that would enable them, through a lens of the humanities, to better understand interprofessional collaborative person-centred care without structured interprofessional placement activities. Learners reported the self-paced and self-directed module to be a satisfactory learning experience in all four areas of care at our institution, and certain attitudes and knowledge were significantly and positively affected. The module’s evaluation resulted in a revised edition providing improved structure and instruction for students with no experience in self-directed learning. The module was recently adapted into an interactive bilingual (French and English) online e-learning module to facilitate its integration into the pre-licensure curriculum at colleges and universities.

Health care providers’ roles and responsibilities in management of polypharmacy: Results of a modified Delphi

Background: Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy. Objectives: To identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy. Methods: Four focus groups with 35 team members practising in geriatrics were generated to inform survey development. The sessions generated 63 competencies, roles or responsibilities, which were categorized into 4 domains defined by the Canadian Interprofessional Health Collaborative. The resulting survey was administered nationally to geriatric health care professionals who were asked to rate the importance of each item in managing polypharmacy; we sought agreement within and across professions using a confirmatory 2-round Delphi method. Results: Round 1 was completed by 98 survey respondents and round 2 by 72. There was high intra-professional and interprofessional consensus regarding the importance of competencies among physicians, nurses and pharmacists; though pharmacists rated fewer competencies as important. Less consensus was observed among other health care professionals or they indicated the nonimportance of competencies despite focus group discussion to the contrary. Discussion: Although there is a strong consensus of polypharmacy management competencies across team members who have been more traditionally involved in medication management, there continue to be health care providers with differing understandings of competencies that may contribute to reduced reliance on medication. Lower importance ratings suggest pharmacists may not acknowledge or recognize their own potential roles in interprofessional polypharmacy management. Conclusion: Further exploration to understand the underutilization of professional expertise in managing polypharmacy will contribute to refining role clarity and translating competencies in practical settings, as well as guiding educators regarding curricular content.