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Changing practice

Using interprofessional learning in practice to improve multidisciplinary working  

An outline of an initiative using interprofessional practice learning teams to improve multidisciplinary working between different disciplines

 

Authors

Alison Kelley, BSc, DipEd, RN, is lecturer, University of Nottingham; Liz Aston, MRes, BSc, RN, is associate professor, University of Nottingham; Alison Sharman, Bachelor of Speech Pathology, is specialist speech and language therapist, Lings Bar Hospital, Nottingham; Ann Coates, MCSP, is senior physiotherapist, Lings Bar Hospital, Nottingham; Janis Sim, RGN, ENB 931, is daycare team leader, Nottinghamshire Hospice; Rachel Ryan, DipN, RN (adult), is deputy ward manager, Frank Jacob Ward, Lings Bar Hospital, Nottingham; Corrina Naylor, DipN, RN (adult), is staff nurse, John Proctor Ward, Lings Bar Hospital, Nottingham; Angela Gamble, DipN, RN (adult), is staff nurse, John Proctor Ward, Lings Bar Hospital, Nottingham; Yvonne Welsh, DipN, RN (adult), is staff nurse, Castle Ward, Lings Bar Hospital, Nottingham; Kate Treahearn, BSc, is student nurse, adult branch, BSc course, University of Nottingham; Rebecca Clatworthy, BSc, is third-year occupational therapy student, University of Derby.

 

Abstract

Kelley A et al (2009) Using interprofessional learning in practice to improve multidisciplinary working. Nursing Times; 105: 43, early online publication.

This article describes how a system of interprofessional learning was established and developed. It gives practical tips on implementation and some short case studies demonstrating how students have benefited from this approach.

 Keywords: Interprofessional learning, Practice learning teams, Education, Multidisciplinary team

  • This article has been double-blind peer reviewed

Practice points

  • Interprofessional learning should not be viewed as an event that is separate from what already happens in the workplace.
  • The benefit of this form of learning is that students will have a better working knowledge of other professionals, enabling them to make appropriate referrals to other professions and work more closely with them.

 

Background

Practice learning teams have been used in the University of Nottingham since 2000 to support students and mentors in practice (Chapple and Aston, 2004). They arose following concern that the link teacher system of allocating teachers to support student nurse placements was ineffective and difficult to manage.

A consultation was held at the university and lecturers, students, mentors and service providers agreed that a partnership approach was the way forward. A decision was made to set up teams to cover specific specialties with responsibility for maintaining and developing the learning environment.

The teams are made up of lecturers and practitioner representatives who share responsibility for students and learning in specific placements. They meet regularly and discuss issues around mentorship, students, effective learning and how student evaluations can feed into the process of developing learning in practice.

Recently there has been a move to develop interprofessional learning as a response to incidents such as the Climbié Inquiry Report (Laming, 2003) and the Wayne Jowett inquiry (Toft, 2001). These highlighted the importance of professionals learning about each others’ roles and learning to work more effectively as a team (see Background box). Interprofessional learning is established in the university with shared teaching experiences and conferences for nursing, medical, physiotherapy, midwifery, pharmacy, dietitian and social work students.

Interprofessional practice learning teams

During 2006 and 2007 a project to introduce interprofessional learning into clinical areas using the existing practice learning teams was piloted. It was funded jointly by the former Learning in Practice Unit in Nottingham and the University of Nottingham. Practice learning teams were used to provide interprofessional opportunities for healthcare students in the clinical area and became interprofessional practice learning teams.

The project aimed to:

  • Develop four teams across our local health community;
  • Embed processes and structures to provide a sustainable interprofessional experience for students;
  • Evaluate the project and share the findings across the university.

Four teams were selected:

  • Cancer wards that provided proactive treatment and palliative care;
  • Trauma and orthopaedic wards;
  • Community hospital providing rehabilitation services;
  • Residential mental health care.

A project manager explored the possibility of developing interprofessional learning within the teams, and encouraged practitioners and teachers from all professions who delivered care in these clinical areas to become part of the project.

Within each team, champions for interprofessional learning were identified to lead and coordinate the learning experience in the clinical placement. This needed to be patient-focused, student-centred and facilitated.

A training session was developed to help these champions gain the necessary skills to encourage learning between different types of students. A champion could be a practitioner from any health profession who is passionate about facilitating student learning.

Evaluation

Interprofessional learning experiences were delivered in the teams and evaluated using a questionnaire developed to measure the project’s effectiveness. Fifty-three students from eight different healthcare professions took part in the project from March- September 2007.

The evaluations looked at the type of interprofessional opportunities available, how they enhanced understanding of other healthcare professionals, and patient care. The ways these learning experiences had contributed to students’ professional development were also evaluated.

The evaluations were positive and comments included:

  • “Realisation of how closely these teams have to work together and how each profession is directly dependent on the other to provide a good and effective treatment for the patient concerned”(physiotherapy student, third year);
  • “Useful to discuss patients’ care with other healthcare professional students and formulate plans based on a team’s input as they will (hopefully) be part of my everyday job” (medical student, fourth year);
  • “It allows better communication between the different professions and better understanding of each others’ roles. This can only contribute better quality of care for patients, more effective working and quicker/better discharge” (student nurse, second year).

The only negative comments were that not enough disciplines were involved, which was expected as we had decided not to manipulate student numbers but to work with students normally allocated to those areas involved.

After completing the project, the interprofessional approach has continued. This sustainability is due to:

  • The key role played by the champions, who felt the approach enhanced the quality of students’ education;
  • The support the mentors/clinical educators gained from this collaboration when they were planning interprofessional learning experiences.

Using interprofessional learning

The interprofessional practice learning team meets every three months to discuss allocation of students and opportunities for interprofessional learning as well as student experiences, identifying what went well and what could have worked better.

A system of allocation mapping is used to identify when students from different disciplines are allocated to a clinical area at the same time. This mapping allows the team to plan activities to ensure students have opportunities to work together.

When students start on a ward they have a period of time to settle in and get to know the routine, patients and colleagues before being introduced to interprofessional learning. During their orientation they meet students from other disciplines.

When they have settled into their placement students are invited to a meeting where they are introduced to the aims of interprofessional learning. They are given an opportunity to discuss learning options they might consider, such as presenting a patient at a case conference, and are advised to get together as a group to decide on shared goals for the placement and how they will achieve them.

Students are asked to present what they have learnt and how they have benefited from the experience to their facilitators. This is done both verbally and in writing. The outcome of the experience is fed back to team members at the next meeting.

The benefits and pitfalls of interprofessional practice learning teams are listed in Box 1.

Box 1. Benefits and pitfalls

Benefits:

  • Students feel comfortable learning together;
  • Increases students’ knowledge of each others’ roles and contribution to patient care;
  • Improves multidisciplinary working and a team approach;
  • Students know how and when to refer to other disciplines;
  • Better communication and more effective care, particularly in care planning and discharge planning;
  • Students can reflect on interprofessional practice learning teams as part of their portfolio of evidence. Physiotherapy, dietitian and speech and language therapy students have to reflect on interprofessional learning in their assessment documentation and these are formally marked. Physiotherapy students’ work is assessed by the university; the others are marked by clinical educators. Nursing and medical students also use the evidence to contribute to achievement of their outcomes and proficiencies.

Pitfalls:

  • It can be difficult to find the time and opportunity to get all students together with a facilitator to reflect on their experiences;
  • Some students do not take advantage of the opportunities available;
  • Students from different disciplines may not be on placements simultaneously for a long enough period;
  •  It can be a challenge to ensure facilitators are available for students undertaking interprofessional learning experiences.

Experiences of using interprofessional learning

Below are a series of case studies where this form of learning has been used. The case studies are provided by interprofessional practice learning team members and students. Box 2 gives students’ comments on their experiences.

Nursing and physiotherapy students

An initial meeting about interprofessional learning was held with a student nurse and a student physiotherapist. They decided to look at a pressure risk assessment tool, and where their respective roles fitted in, for example nutrition. The nurse saw the importance of nutrition in relation to wound healing and preventing skin breakdown, while the physiotherapist focused on the energy levels needed to perform prescribed exercises.

Initially each student observed the other’s role, with the nurse attending a falls group and activity classes, and the physiotherapist helping the nurse to wash and dress a patient. Both then met with their mentors and gave verbal feedback on the experience and how they had benefited. They both presented written feedback in greater detail, which was shared at the interprofessional practice learning team meeting.

Social work, occupational therapy and student nurses

Hospices and day hospices are ideally suited to interprofessional learning. We involved three students - one from social work, one from occupational therapy and one from nursing - in the care of a patient who was undergoing chemotherapy for advanced breast cancer with brain metastases.

Following a home visit the nurse identified at the multidisciplinary team meeting that the patient was having difficulty moving around her home. A joint visit with the occupational therapy student resulted in modifications being made and equipment was provided. While visiting, they identified a lack of equipment and funding to enable the patient to cook and store food. Following a visit by the nurse and social work student the patient was able to secure a grant to buy a microwave and fridge-freezer.

The outcome was a well supported, safe patient, who was able to receive nutritious meals in her home environment. Each student gained an understanding of how their role contributed to this outcome.

Speech and language therapy, nursing and medical students

Anne Green* was admitted to the acute hospital following a collapse/fall. She presented with right-sided weakness, hemianopia, dysarthria and confusion. A CT scan revealed an acute subdural haematoma, which required neurosurgical intervention. A few days after her neurosurgery she had a cerebrovascular accident (CVA). This resulted in a dense right-sided hemiparesis requiring hoisting for all transfers, dysarthria and dysphagia. She was transferred to a rehabilitation hospital.

The team involved in interprofessional learning were a student nurse, speech and language therapy student, medical student, two staff nurses and a speech and language therapist. The aim of the interprofessional learning experience was for students to understand the multidisciplinary team (MDT), the role of each others’ profession, as well as their specific involvement with Mrs Green and how this would affect management of her condition and treatment.

The students were able to organise time to meet to discuss their roles and also prepare feedback to present at the ward case conference about Mrs Green’s current condition and also to contribute to MDT planning and goal setting. They were able to discuss this with other healthcare professionals and the consultant.

The speech and language therapy student commented that her learning experience gave her increased awareness of other professional roles and developed her confidence in patient management and communication skills. She was able to feedback confidently during case conference and developed a much more holistic view of Mrs Green’s needs.

*The patient’s name has been changed.

 

Box 2. Students’ experiences of interprofessional learning

“It was interesting to see how the different professions put a very different emphasis on aspects of a patient’s care.”

Medical student

An occupational therapy student and student nurse worked together as a team to help a patient with bathing.

“Our reflection concentrated on the importance of promoting independence. I highlighted the difficulty nurses sometimes have in finding time on a daily basis to truly encourage independence with the time constraints of shift organisation.

“It was interesting to hear the OT student’s perspective of the knock-on effect of not promoting independence to speed recovery and elongated time for the patient in hospital. This highlighted the importance to me of trying not to be task-orientated as a nurse and allowing the patient to be truly independent by giving them time to wash and dress at their own speed.”

Student nurse

“By discussing in advance with the other students it helped to clarify each of our roles as well as showing where they overlap. By attending the case conference where the whole multidisciplinary team came together, it helped me appreciate the vital role of each one as well as the importance of sharing and discussing that information within the team and reaching agreement on the best way forward for the patient.”

Speech and language therapy student

“It made me realise the sheer volume of work involved in caring for a ward of full patients.”

Dietitian student

“It made me realise how strong, compassionate and caring the nurses are to be able to give palliative care to very sick people without it causing them to despair.”

Radiotherapy student

“It also helped me understand the importance of several perspectives for discharge.”

Social work student

 

 Conclusion

Interprofessional learning requires: committed practice learning team members from all the multiprofessional team; carefully planned student timetables; enthusiastic students capable of managing self-directed learning; and excellent communication. The benefits are improved understanding of each others’ roles and improved patient care facilitated by appropriate referral and reduced duplication of care.

Background

  • Traditionally, healthcare professionals had clear boundaries and learnt in specific, separate learning institutions.
  • Certain roles and responsibilities are now shared as patients are placed at the centre of healthcare activity. This requires students to learn more about each others’ professions.

 

 

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