VOL: 96, ISSUE: 38, PAGE NO: 39
Scott Reeves, MSc, BSc, PGCE, is a researcher, senior lecturer at City University, St Bartholomew School of Nursing and Midwifery, London;
Della Freeth, PhD, BSc, CertEd, andMaggie Nicol, MSc, BSc, RGN, are senior lecturers at City University, St Bartholomew School of Nursing and Midwifery, London;Diana Wood is a senior lecturer at St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of LondonClinical governance is at the centre of the government's ambitious plans to improve quality in the NHS. A First Class Service (Department of Health, 1998) outlines the key elements of the policy, which include adopting an evidence-based approach and implementing systems for increased accountability and enhanced clinical performance.
Clinical governance is at the centre of the government's ambitious plans to improve quality in the NHS. A First Class Service (Department of Health, 1998) outlines the key elements of the policy, which include adopting an evidence-based approach and implementing systems for increased accountability and enhanced clinical performance.
Underpinning this quality agenda is the need for clinicians to work in a more coordinated fashion. Information-sharing, networking and teamwork are all required to forge, and then maintain, effective interprofessional relationships (Hayward et al, 1999).
However, research continues to demonstrate that communication and collaboration between clinicians is often fragmented (Porter, 1995; Allen, 1997). Such findings are hardly surprising given clinicians' limited opportunities to learn how to work together effectively (Reeves and Freeth, 2000).
To begin to address this problem, an interprofessional education pilot project was set up for preregistration house officers (PRHOs) and newly qualified nurses - two professions who work closely in delivering care - allowing them to meet and enhance their clinical and collaborative skills.
An interprofessional approach was adopted because it is viewed as a potentially effective method of resolving interprofessional difficulties (DoH, 1997) and because research suggests interprofessional education can help professionals learn the necessary skills for collaborative practice (Parsell et al, 1998).
Staff from two schools, St Bartholomew School of Nursing and Midwifery and St Bartholomew's and The Royal London School of Medicine and Dentistry (Reeves and Pryce, 1998), jointly developed a series of interprofessional education sessions. Table 1 sets out the sessions' aims.
The sessions focused on discharge planning, pain management and intravenous drug administration - areas in which hospital data suggested the service might be improved through collaboration.
All the sessions were held at lunchtimes and lasted for two hours. To encourage attendance and provide an informal atmosphere each session started with lunch. Educational activities focused on interactive group work in which PRHOs and staff nurses undertook joint problem-solving based around a number of case scenarios. The scenario above is taken from the pain management session.
Where possible, the sessions included hands-on activities, such as setting up intravenous pumps. This allowed participants to engage in task-sharing and interprofessional discussion. Clinical experts from medicine, nursing and pharmacy offered their perspectives during group work and also during participant feedback on their discussions.
Evaluation was seen as a crucial element of the pilot sessions. Three methods were used to capture both the process and outcomes of the initiative: questionnaires were given to participants at the beginning and end of the sessions; two researchers observed the sessions, focusing on facilitation and participant interaction; and participants were interviewed by telephone three months later to find out the longer-term impact on their clinical practice.
Questionnaire data collected from the 19 participants at the start of the sessions showed that they were attracted by the clinical content and interprofessional approach, both of which they felt would be useful in their work.
Two of the PRHOs were anxious about time constraints, which could restrict their full attendance, and also the possibility that the sessions may contain irrelevant information.
The follow-up questionnaires revealed that participants rated all three sessions highly in terms of enjoyment and clinical relevance. Time away from busy clinical areas was considered valuable in allowing participants to discuss their interprofessional relationships and also how to work together more effectively in future.
Participants felt the sessions should be continued and expanded to include members of other professional groups such as pharmacists and social workers.
The observational data collected during the sessions revealed that all participants worked constructively together. Only one of the interprofessional groups experienced conflict during the first session, but this was worked out, so that by the third session it had become the most cohesive group. There was a problem with facilitation as one of the clinical experts tended to dominate. In future we hope to address this by more careful briefing of visiting experts.
Findings from the three-month follow-up interviews were encouraging. Participants felt that they were working together in a more coordinated and collaborative fashion in a number of areas. For example, one PRHO noted that he now liaised more frequently with nursing staff over discharge planning.
One staff nurse said she now offered additional help to PRHOs when they were setting up IV pumps: 'I thought junior doctors knew a lot about IV pumps. Now I know they don't, it's easier to help them if I see them fiddling with a pump.'
To help validate this work, some of the early results were presented to an audience of around 50 organisers, tutors and researchers involved in running interprofessional education. Feedback indicated that their experiences strongly resonated with our work.
This initiative can be considered successful for a number of reasons:
- By giving participants time away from the pressures of their busy clinical work, they began to focus on enhancing their collaborative work for the benefit of user care;
- By focusing on specific areas of clinical activity the sessions began to address the clinical governance agenda while being highly relevant to participants' day-to-day work;
- Offering short lunchtime sessions overcame some of the time pressures that would have restricted these staff from attending;
- Findings from the observational data were useful in examining the nature of participant interaction, in particular the role of facilitators on interprofessional group work. Facilitators need to be aware that assisting interprofessional groups is potentially more demanding than uniprofessional groups. They must ensure that they do not adversely influence the dynamics of these groups;
- Finally, the changes in behaviour reported by the participants in follow-up data were encouraging, especially when compared with findings from other evaluations of interprofessional education. Preliminary findings from a systematic review of interprofessional education, on which the authors are currently working, suggest that reported outcomes tend to be grouped around participant 'reaction' (enjoyment of the experience) and/or knowledge acquisition. There are far fewer reports of (positive) change in collaborative behaviour resulting from interprofessional education.
Interprofessional education linked to clinical governance has provided a valuable learning experience for these newly qualified professionals, and the sessions will be probably be repeated later this year. This will allow further data to be collected and provide a more substantial dataset of the effects of this type of interprofessional education.
Over time, it is hoped that high-quality, clinically relevant, interprofessional learning sessions will be 'rolled out' and delivered to much larger numbers of clinical staff working in the NHS.