Mary van Soeren

Leadership of interprofessional health and social care teams: a socio‐historical analysis

AIM The aim of this paper is to explore some of the key socio-historical issues related to the leadership of interprofessional teams. BACKGROUND Over the past quarter of a century, there have been repeated calls for collaboration to help improve the delivery of care. Interprofessional teamwork is regarded as a key approach to delivering high-quality, safe care. EVALUATION We draw upon historical documents to understand how modern health and social care professions emerged from 16th-century crafts guilds. We employ sociological theories to help analyse the nature of these professional developments for team leadership. KEY ISSUES As the forerunners of professions, crafts guilds were established on the basis of protection and promotion of their members. Such traits have been emphasized during the evolution of professions, which have resulted in strains for teamwork and leadership. CONCLUSIONS Understanding a problem through a socio-historical analysis can assist management to understand the barriers to collaboration and team leadership. IMPLICATIONS FOR NURSING MANAGEMENT Nursing management is in a unique role to observe and broker team conflict. It is rare to examine these phenomena through a humanities/social sciences lens. This paper provides a rare perspective to foster understanding - an essential precursor to effective change management.

Simulated interprofessional education: An analysis of teaching and learning processes

Simulated learning activities are increasingly being used in health professions and interprofessional education (IPE). Specifically, IPE programs are frequently adopting role-play simulations as a key learning approach. Despite this widespread adoption, there is little empirical evidence exploring the teaching and learning processes embedded within this type of simulation. This exploratory study provides insight into the nature of these processes through the use of qualitative methods. A total of 152 clinicians, 101 students and 9 facilitators representing a range of health professions, participated in video-recorded role-plays and debrief sessions. Videotapes were analyzed to explore emerging issues and themes related to teaching and learning processes related to this type of interprofessional simulated learning experience. In addition, three focus groups were conducted with a subset of participants to explore perceptions of their educational experiences. Five key themes emerged from the data analysis: enthusiasm and motivation, professional role assignment, scenario realism, facilitator style and background and team facilitation. Our findings suggest that program developers need to be mindful of these five themes when using role-plays in an interprofessional context and point to the importance of deliberate and skilled facilitation in meeting desired learning outcomes.

Success Indicators and Barriers to Acute Nurse Practitioner Role Implementation in Four Ontario Hospitals

Changes in healthcare environmental factors resulted in the introduction of the acute care nurse practitioner (ACNP) role in Ontario. The purpose of the study was to identify success indicators, barriers, and recommendations for role implementation to assist healthcare providers to develop strategies for integrating ACNPs into teams. Acute care nurse practitioners (n = 14), physicians (n = 14), administrators (n = 12), and staff nurses (n = 48) from four tertiary care hospitals completed a researcher-developed, self-administered questionnaire with fixed and open-ended questions. Specialty practice areas (cardiac/critical care, geriatrics, and nephrology) were matched within the four sites. Acute care nurse practitioners (n = 14), physicians (n = 12), administrators (n = 8), and staff nurses (n = 34) responded. The major indicator by all groups for successful role implementation was level of preparation. Barriers included lack of mentorship and knowledge of the role, and perceived lack of support from administration and physicians. Themes reflecting impact on patient care were improved communication and attention to patient care issues. Respondents accepted the role, concluding that enhanced continuity of care was a result. Role clarity before and during implementation would assist team members in understanding the purpose and value of the role, thus easing the integration of the ACNP into the healthcare team.

The role of nurse practitioners in hospital settings: implications for interprofessional practice.

Expansion of the nurse practitioner (NP) role worldwide indicates a need to understand how the role functions in interprofessional healthcare teams. Through the adoption of a mixed methods approach that gathered on-site tracking and observation, self-recorded logs of consultations and focus group interviews of team members and NPs, we describe the extent of role activity and the nature of interprofessional practices of 46 NPs and their team members in nine hospital sites across the province of Ontario, Canada. Findings outline the nature of the NP role activities, which largely focused on providing clinical care, with the support of their team, to a range of patients across the study settings. We discuss how ‘embedding’ the NP in this way appears to contribute to utilization of expertise of all professions as well as enabling team members to promote evidence-based practices. We argue that the use of NPs augments interprofessional role utilization through their desire to consult with a range of professionals and the capacity to perform holistic care for patients that is not limited to traditional nursing boundaries.

Understanding interprofessional relationships by the use of contact theory

The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students’ understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students’ perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allports (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allports theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs.

Pathophysiology and Implications for Treatment of Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome is a complex group of signs and symptoms caused by direct or indirect lung injury. In spite of decades of research, it is still associated with a high mortality rate. Pathogenesis of this disease is related to alveolar endothelial and epithelial cell injury and associated release and sequestration of inflammatory mediators and cells, including cytokines and neutrophils, respectively. Pharmacologic interventions have been largely unsuccessful, and ventilation strategies to support oxygenation while limiting ventilator associated lung injury have not demonstrated any significant reductions in the mortality rate. However, novel therapies are in development, based on the knowledge of the pathologic processes of acute respiratory distress syndrome. In this article an overview of the disease process and mediator involvement is presented, followed by a review of pharmacologic and ventilation treatments currently in use or under study.

Consortium approach for nurse practitioner education.

Consortium approach for nurse practitioner education In 1995, a 10-university consortium approach to deliver a post-baccalaureate primary care nurse practitioner programme funded by the Ontario Ministry of Health was launched throughout Ontario, Canada. A combination of traditional and distance teaching methods, in English and French, were used. A 5-year research project was initiated to evaluate the entire programme, the effect of nurse practitioners on patient and health-care system outcomes and examine practice patterns. Participants included deans and directors (n=10), regional co-ordinators (n=5) and course developers, some of whom were also course professors (n=8). This article is a report of the evaluation of the consortium programme after the first year from the perspective of groups involved in implementation and delivery. Results of qualitative analyses of participant perceptions from researcher-led focus groups and asynchronous electronic interviews provided the framework for the evaluation, and revealed the rationale for the consortium method, strengths, limitations and recommendations. Sharing ideas, resources and delivery and increased student access in remote areas were perceived as positive outcomes. Limitations included the short time period to develop programme content, identify and plan for distance education resources, and too little communication between universities and students. Researchers concluded that the consortium approach was effective for nurse practitioner education. Key factors identified for programme planning were communication, resources, curriculum and workload. Included among the recommendations was to allow sufficient time for role and course development before beginning a similar programme.

Interprofessional learning and virtual communities: An opportunity for the future

As various agencies increasingly advocate interprofessional care (IPC), it is paramount that the educational implications of this approach are considered. Interprofessional learning (IPL) is necessary for IPC and this paper argues that an emerging educational model, narrative-based virtual communities (VCs), meets this goal. We therefore argue for the fusion of narrative pedagogy with the VC approach to further the IPL agenda. Using stories to teach is not new. Technological innovations now make the possibility of using narrative, a way to enable students to experience greater reality in complex situations. Recently, two multimedia VCs have been developed. Here, we review the use of “The Neighborhood” and “Stilwell”, as IPL tools. Early evaluation of these communities has been very positive and they offer a unique and innovative approach to IPL in ways that immerse learners from many professions into the context of the lives of individuals requiring health and social care, and the people who provide that service. Thus, it is possible to more fully realize and teach about collaboration and partnerships among professionals and patients.

The value of the hospital-based nurse practitioner role: development of a team perspective framework

Abstract There is a need to understand nurse practitioner (NP) interprofessional practice within hospital teams to inform effective role integration and evolution. To begin this understanding a supplementary analysis of 30 hospital team member focus groups was carried out using constructivist grounded theory methodology. This conceptual rendering of the team members’ shared perspective of NP actions provides insight into the meaning and importance of the NP role. Participants emphasized three hospital-based (HB) NP practice foci as the meaning of role value; easing others’ workload, holding patient care together and evolving practice. Trust emerged as a pre-requisite condition for HB NP role efficacy. A team member perspective framework of HB NP practice is presented as the first stage in developing a model of HB NP interprofessional practice within hospitals. The framework provides multiple perspectives to the meaning and value of the HB NP role beyond basic role description. The framework may be used by healthcare professionals, operational leaders, academia and HB NPs to enhance role respect and understanding.

Medicine and nursing: a social contract to improve collaboration and patient-centred care?

The call for effective interprofessional collaboration to deliver safe, high quality patient-centred care has echoed across the world for over the past 30 years (e.g. Department of Health, 1996; Institute of Medicine, 2000; World Health Organization, 1988, 2010). Through such calls, it is argued that collaboration can reduce duplication of effort, improve job satisfaction of staff, help overcome fragmentation of service delivery and improve patient safety and quality. While research has indicated that professionals can work in an effective manner spread across the continuum of care, professional biases, boundary protectionism and little opportunity to develop interprofessional competence has made effective collaboration extremely difficult (e.g. Gibbon, 1999; Reeves & Lewin, 2004; Skjorshammer, 2001; Zwarenstein, Goldman, & Reeves, 2009). However, the oldest of the two health professions – medicine and nursing – are particularly imbedded in this problematic relationship. In this editorial, we argue that this combination of historical roles and practice patterns, as well as a lack of understanding of the social contract each profession has with patients, limits broad adoption of effective collaborative practice and impairs patient-centred care.