PROFESSIONAL
Implementing interprofessional learning in the community setting Margaret Pitt, Alison Kelley, Jacqui Carr
Margaret Pitt is District Nurse Practice Teacher, Nottinghamshire Healthcare Trust, County Health Partnership (Nottingham West); Alison Kelley is Lecturer, School of Health Sciences (Division of Nursing), University of Nottingham; Jacqui Carr is Lecturer, School of Health Sciences (Division of Nursing), University of Nottingham Email: [email protected]
T
o prepare future health and allied professionals to work collaboratively to facilitate and manage care that is seamless, evidence based and person centred, it has long been advocated that interprofessional learning (IPL) should be integrated into educational and clinical learning activities (World Health Organization, 1988; Department of Health, 2009). Interprofessional education takes place:
‘when two or more professions learn with, from and about each other to improve collaboration and the quality of care.’ (Centre for the Advancement of Interprofessional Education (CAIPE), 2002) The benefits of integrating IPL into clinical practice can be summarised as improving care by optimising resources on a cost-effective basis and collaborating with other professions to facilitate safe, person-centred care (CAIPE), 2012). Although IPL has taken place informally in the community setting for some time, this article describes how IPL has been formally instituted in one setting in clinical learning and in the community practice learning team (PLT) activity to encourage collaborative working practices that aim to improve care.
© 2014 MA Healthcare Ltd
Background IPL has been embedded within the nursing curriculum and students have already taken part in IPL learning within the academic components of their educational programme. Although IPL had taken place informally in the community locality, the PLT (a team of practitioners and university/ higher education institution (HEI) representatives facilitating and supporting learning and mentorship) considered it essential to integrate IPL explicitly into clinical practice learning experiences. Freeth et al (2005) recognise the informality of IPL in practice settings, but, given the intention to introduce students to the concept of collaborative working to optimise care in future, the need for a formal approach was evident (Makowsky et al, 2009). The move towards interprofessional working within teams needed to be reflected in the student learning experience to ensure that learning was maximised and interprofession-
British Journal of Community Nursing June 2014 Vol 19, No 6
al working is seen as the norm early on in people’s careers and adopted lifelong in practice. It was anticipated that the cost of doing this would be minimal, as the first-named author is a practice teacher and the facilitation of learning in practice is integral to this role. Currently there are plans to integrate different health and allied care practitioners into interprofessional teams across the Health Partnership Nottingham West locality, and it is anticipated that the prior initiation of IPL will enhance this process. Work completed by The University of Teesside (2004) had established that IPL opportunities could be facilitated and managed in two ways depending on how many students and different health professionals were in a care setting at one time. The first option was associated with different students learning in a group with a health professional who provided care. The second option involved a single student from any profession working with another health professional on a person-to-person basis. This model has been used successfully in care settings and was used by Aston and Kelley (2010) to facilitate a pilot study in a local community hospital linked to the HEI to evaluate IPL. Within that setting, the PLT and clinical educators from physiotherapy, dietetics, occupational therapy, speech and language, and social work teams worked together to identify IPL opportunities that could be experienced by
ABSTRACT
Given the need to facilitate and manage care, making every consultation count, knowledge of—and working with—different professional care providers is essential. To optimise care outcomes for clients, the adoption of interprofessional working is essential. This article describes how interprofessional learning was embedded in a community nursing practice placement environment with student nurses and students from other professions.
KEY WORDS
w Interprofessional working w Optimising care outcomes w Working together
291
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights res
PROFESSIONAL
Initiating IPL in the community setting Preparation
Within the PLT, it was proposed that IPL needed to be formalised within learning experiences for students from any profession to develop knowledge and skills that would inform their practice, improve working relationships and teamwork between different professions and improve patient care outcomes. The locality management team supported the initiative and this was essential to ensure that the change in practice was adopted and developed in future. Using the principles linked to the NHS Change Model (NHS Improving Quality, 2013) and Working with Others (NHS Leadership Academy, 2014), a strategy was identified to initiate the change to IPL optimising opportunity for the initiative to succeed. Initially, the first-named author developed networks with the second-named author and the pilot team in the local community hospital to learn what had been successful for them. The aim was to use strategies that had already been proven to work and to seek support and advice from practitioners who had successfully implemented IPL. All interested practitioners in the locality were then invited to attend an open meeting to explore IPL to ensure that everyone was consulted and could contribute to the development process. The PLT was immediately at an advantage as they already had diverse representation from the local HEI, child and adult community health, an intermediate care therapy team and a specialist nurse from the local back-pain team, both of which had allied health professionals working within the teams. Access to, and consultation with, different professional groups was thereby maximised in addition to the strengthening of the link between theory and practice (Murray-Davis et al, 2012). As with any innovation, it was essential to ensure that all the practitioners who would be helping to facilitate and manage IPL opportunities were involved. A lack of consultation could hinder support for implementation and render it unsuccessful (Jinks et al, 2009). It was also essential that practitioners were aware of the benefits. For example, IPL should not be onerous in terms of time and workload and would inform their own collaborative practice development. Pollard (2009) recognised the need for practitioners to develop these skills to ensure student IPL learning was effective. The period of consultation worked well and assisted the scoping of IPL opportunities that had not been previously considered.This resulted in new placement areas being identified, thereby increasing the diversity of learning experiences
292
and insight-giving visits. Additionally, this work also revealed the different types of student who were likely to attend placements within the locality and the dates they would be present. These included physiotherapy, medical, occupational and pharmacy students in addition to student nurses.
Interprofessional practice learning team At the end of the consultation and preparatory phase, the PLT was replaced by the newly formed interprofessional practice learning team (IPPLT) to demonstrate commitment and more strongly identify their activities with interprofessionalism. Members of the IPPLT included a district nurse practice teacher (chair, first-named author), a community nurse, a community matron, an occupational therapist, a physiotherapist, a social worker, a health visitor, a school nurse and HEI representatives (second-named and third-named authors). A medical educational professional also supported the initiative and acknowledged the need for medical students to work with and learn from other’s professions to form effective relationships leading to safe, high-quality care (General Medical Council, 2009). It was established that the first-named author (as the IPL champion) would coordinate IPL activities, and the members of the team would provide assistance. For example, the third-named author mapped the learning opportunities for student nurses and completed joint mentor updates with first- and second-named authors to promote IPL. The firstand second-named authors produced an information guide to IPL for practitioners. It was hoped that all of these initiatives would encourage mentors and practitioners to think about IPL when working with any student. Perhaps the most challenging part of implementing IPL was being sure which students would be on placement at any given time. This is where links with the local HEIs was useful. From the knowledge of the group, most student placements could be identified and IPL activities could be coordinated effectively to maximise the number of students who would participate.
Facilitating and managing learning by IPL The key to implementing IPL successfully was using a flexible approach to meet the needs of the students (Stew, 2005). Initially, the main approaches used were student-to-healthprofessional interactions or service-user learning activities and group workshops. There was already a culture of working informally with different students where short placements or insight visits were negotiated and these worked well. While mentors helped facilitate the process, it was the student’s responsibility to organise and take ownership of their learning needs. This enabled them to experience different aspects of care and ways of working with patients. Examples included working with the community matron, pharmacy and medical students, and working with the community therapy team or social services team. Some students elected to visit different aspects of patient or user care. For example, visits to the coroner’s court are now considered essential because many different students
© 2014 MA Healthcare Ltd
students. They then used the Teesside model of facilitation to structure IPL. Evaluation of the pilot study indicated that this approach was successful, that student understanding of different roles was enhanced, and that this could contribute to the improvement of care. Having successfully used these principles in the pilot study, it was proposed to use them to initiate IPL in the community setting, and the first-named author had plans to extend IPL to workshop activities.
British Journal of Community Nursing June 2014 Vol 19, No 6
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights res
iStock
PROFESSIONAL
It has long been advocated that interprofessional learning should be integrated into educational and clinical learning activities.
294
present anonymised scenarios that could be used to debate care challenges or issues they had experienced in practice. The aim was to explore perceptions and potential responses to the scenario to enhance learning by considering different perspectives and solutions. The scenarios presented by students were diverse and included: w Ethical and clinical issues w Mental capacity and safeguarding dilemmas w Health promotion and risk-reduction activities w Communication w Role analysis w Team working w Managerial issues w Leadership issues. Students responded well to this approach and the depth of feedback and discussion linked to complex issues was observed. Sharing knowledge appeared to help the students understand different roles and responsibilities and how collaborative working could improve care. This was important, since unless students work interprofessionally in the early part of their careers, they may not learn to work in teams effectively (WHO, 2010).
Evaluating learning At the end of each IPL session, the students were asked to identify what learning had taken place using a short openquestion questionnaire. When asked how IPL activities and experiences enhanced understanding of other professionals’ roles in the health-care team, the students gave the follow-
© 2014 MA Healthcare Ltd
have identified and shared the benefits of attending. A further IPL initiative was to share the patient experience by accompanying the patient on their health journey. With consent, the student would accompany a patient to attend health appointments, investigations or group health activities. For example, a student nurse visited a patient in their own home who had a diagnosis of dementia. With the patient’s consent, the student accompanied them to the memory clinic. This enabled the student to learn about dementia and mental health in the community setting, and to understand the patient’s lived experience. There was also opportunity to explore the benefit of reminiscence therapy for those experiencing dementia. They were able to explore this in depth with mental health practitioners and this was valued, as they might not have had the opportunity to gain this level of insight and learning elsewhere. One of the most successful methods utilised in the community setting to facilitate IPL was the introduction of student-centred IPL workshops. Students from various professional backgrounds were invited to meet and share learning linked to their experiences in practice in an informal and relaxed atmosphere. The workshops were facilitated by the first-named author who, with the student participants, established ground rules for the interaction linked to confidentiality and respect. Students commenced each session by introducing themselves and sharing their educational pathway to initiate discussion about their role and context of that role within the community and wider health or social care setting. To stimulate discussion, students were encouraged to
British Journal of Community Nursing June 2014 Vol 19, No 6
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights res
PROFESSIONAL
ing responses:
‘I have been given a great deal of explanation and information about the role of the district nurse and how the assessment process works. I previously wasn’t aware of actually what they did.’ (Medical student) ‘I learnt what other professionals’ roles entail and cleared up any misunderstandings or misconceptions I had.’ (Nursing student) ‘A greater understanding of what nurses look for when assessing’. (Occupational therapy student) These responses appear to suggest that students may not, fundamentally, have a good knowledge of different roles, and it is suggested that this may reduce the opportunity to facilitate care effectively. The WHO (2010) has already identified the necessity of working in a unified manner to improve care. Knowing the role of different professional colleagues is an important part of this. The earlier that IPL is introduced to students in their career, the more likely they are to be open to different professional groups and their roles in collaborative health care (Coster et al, 2008). Therefore, introducing students to a non-threatening IPL activity in workshops that they control is anticipated to increase their interprofessional knowledge (Hanna et al, 2012). Additionally, Furze et al (2008) reported that students exposed to IPL in the community setting had more understanding and respect for other professionals. When asked whether IPL helped to optimise effective patient care, the students reported:
‘I think IPL will improve patient care overall and ensure that a holistic approach is taken to management of patients rather than just medical.’ (Medical student) ‘Improved communication and more professional efficiency.’ (Physiotherapy student)
© 2014 MA Healthcare Ltd
‘To be aware of other types of treatment other professionals do.’ (Nursing student) Students recognised that, when communicating and caring for people in a holistic manner, embracing different professional approaches to treatment is important. The majority of policies or guidelines that govern practice and care are dependent on interprofessional working. Each health professional needs to use skills optimally to maximise their effectiveness linked to improving care. Reeves et al (2013) reflected improved care outcomes where IPL activity had taken place on a limited basis. The main benefits were associated with diabetes care, emergency and operating theatre departments, mental health care delivery and domestic violence care interventions. These are all areas that are accessed
British Journal of Community Nursing June 2014 Vol 19, No 6
by students and have different professionals facilitating and managing care effectively in teams. It is suggested that exposing students to IPL in the community setting early on in their careers could have a similar effect by engendering interprofessional team working in their practice. Students were also asked how IPL opportunities had contributed to their own personal development. Their responses included the following:
‘Gave me knowledge on what other professions can do for patients with complex needs.’ (Nursing student) ‘I’ve now got a greater understanding of the sort of patients that require treatment in the community.’ (Occupational therapy student) ‘A deeper understanding of the nurse’s role and the large variation in nursing responsibility.’ (Medical student) These responses appear to indicate that students do need to be aware of the different professionals who facilitate and manage care and to know what their specific role might be. The Royal College of General Practitioners (RCGP) published their vision for integrated care (RCGP, 2011). The document’s promotion of shared learning and development to improve service delivery supports this. The Nursing and Midwifery Council (NMC) (2009) and Health and Care Professions Council (2013) both concur with the need to reinforce the personal responsibility of individuals for their personal learning and development and to work collaboratively with others for safe and effective care. This includes building and sustaining professional relationships with a view to providing care that is compassionate and delivered by the ‘right staff, at the right time, in the right place’ (NHS England, 2012).
Limitations and future directions It is acknowledged that this feedback is limited, and further in-depth evaluation is needed. However, the responses received do appear to support the value of IPL for students and concur with the literature which points out the benefits of such approaches. To maximise the impact of IPL there are plans for a countywide IPL workshop incorporating both hospitalbased and community-based students of nursing, therapy and mental health. It is hoped that this will engage mentors from the wider area to encourage more IPL. Based on the success of IPL and the benefits for students, the second-named author initiated IPL learning conferences for students and mentors. The first-named author presented and disseminated the IPPLT’s planning strategy and experiences to individuals engaged in educating students. The conferences have been well attended and have assisted change in practice and learning that is now the norm. Future plans include greater involvement with mental
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PROFESSIONAL
Recommendations for implementing IPL Having reflected on the innovation of IPL, there are a number of recommendations for others who wish to embed IPL within their community placements successfully: w Before starting consider visiting colleagues who have already successfully implemented IPL to share ideas and participate in an IPL activity if possible w Access the Centre for the Advancement of Interprofessional Education website (www.caipe.org. uk) for information, support and ideas based on best practice w Introduce and promote the concepts and benefits of IPL to colleagues involved in mentorship and learning w Ensure the IPL message is consistent and included in activities such as team meetings and mentor updates w Identify IPL learning champions to respond to questions and provide help w Map the IPL learning opportunities within the locality, think diversely, and put them in a user-friendly format—networking is essential w Find out which students are placed in the locality and when in order to focus shared learning in a timely manner w Start with implementing what is familiar: one-to-onetype activities do evaluate well and then larger group work can be developed w Encourage students to take responsibility for their own learning w As IPL develops, seek new activities and be innovative w Share successes and disseminate what worked well to assist development of IPL for others.
Conclusion IPL has now been integrated in practice for 2 years and is firmly embedded in the ethos of the IPPLT and in the thinking of the mentors locally. Not only has it informed student learning, but has also assisted in the identification of very diverse placement options that may not have been considered. As the locality moves towards an integrated working model of care delivery, the opportunity for inte-
KEY POINTS
w Interprofessional learning (IPL) is not difficult to formalise and integrate into clinical practice and should be the norm w IPL is anticipated to improve care w IPL should improve working relationships and team work w IPL facilitates appreciation and understanding of different roles
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grated learning becomes even more pertinent. Networking between staff, understanding of each other’s professional roles and the way in which the work of health and allied professionals can complement each other for the benefit of the patient is now more important than ever. BJCN Aston L, Kelley A (2010) An evaluation of using champions to enhance inter-professional learning in the practice setting. Nurse Educ Practice 11(1): 36–40. doi:10.1016/j.nepr2010.06.03 Centre for the Advancement of Interprofessional Education (CAIPE) (2002) Interprofessional education: a definition. www.caipe.org.uk (accessed 10 February 2014) Centre for the Advancement of Interprofessional Education (CAIPE) (2012) Interprofessional Education in Pre-registration Courses. A CAIPE Guide for Commissioners and Regulators of Education. http://tinyurl.com/nfuo8yt (accessed 16 February 2014) Coster S, Norman I, Murrells T et al (2008) Interprofessional attitudes amongst undergraduate students in health professions: a longitudinal questionnaire survey. Int J Nurs Stud 45(11): 1667–81. doi: 10.1016/j. ijnurstu.2008.02.008 Department of Health (2009) Transforming Community Services: Ambition, Action, Achievement: Transferring Services for Acute Care Closer to Home. http://tinyurl.com/m3vzx8z (accessed 27 February 2014) Freeth D, Hammick M, Reeves S, Koppel I, Barr H (2005) Effective Interprofessional Education: Development, Delivery and Evaluation. Blackwell Oxford, UK Furze J, Lohman H, Mu K (2008) Impact of an interprofessional communitybased educational experience on students’ perceptions of other health professions and older adults. J Allied Health 37(2): 71–7 General Medical Council (2009) Tomorrow’s Doctors. http://tinyurl.com/ l4ov5dw (accessed 18 February 2014) Hanna E, Soren B, Telner D, MacNeill H, Lowe M, Reeves S (2012) Flying blind: the experience of online interprofessional facilitation. J Interprof Care 27(4): 298–304. doi: 10.3109/13561820.2012.723071 Health and Care Professions Council (2013) Standards for Proficiency. http:// tinyurl.com/paedv23 (accessed 15 April 2014) Jinks A, Armitage H, Pitt R (2009) A qualitative evaluation of an interprofessional learning project. Learning Health Soc Care 8: 263–71 Makowsky M, Schindel T, Rosenthal M, Campbell K, Tsuyuki R, Madill H (2009) Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. J Interprof Care 23(2): 169–84 Murray-Davis B, Marshall B, Gordon F (2012) From school to work: promoting the application of pre-qualification. Nurse Educ Pract 12(5): 289–96 NHS England (2012) Compassion in Practice. http://tinyurl.com/qfpwyp6 (accessed 16 April 2014) NHS Improving Quality (2013) An Introduction to the NHS Change Model. http://tinyurl.com/p4munrv (accessed 16 February 2014) NHS Leadership Academy (2014) Working with others. http://tinyurl.com/ pfcgh49 (accessed 14 February 2014) Nursing and Midwifery Council (2009) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. http://tinyurl.com/obhptm2 (accessed 30 April 2014) Pollard K (2009) Student engagement in inter-professional working in practice placement settings. J Clin Nurs 18(20): 2846–56. doi:10.1111/j.13652702.2008.02608.x Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M (2013) Interprofessional education: effects on professional practice and healthcare outcomes (update). The Cochrane Collaboration, John Wiley & Sons, Ltd Royal College of General Practitioners (2011) General Practice and the Integration of Care: An RCGP Policy Report. http://tinyurl.com/poybo49 (accessed 15 April 2014) Stew G (2005) Learning together in practice: a survey of interprofessional education in clinical settings in South-East England. J Interprof Care 19(3): 223–35 University of Teesside (2004) A multi-dimensional framework for clinical practice placements. University of Newcastle upon Tyne, UK World Health Organization (1988) Learning Together to Work Together for Health. World Health Organization, New York World Health Organization (2010) Framework for Action on Interprofessional Education and Collaborative Practice. http://tinyurl.com/nart3q6 (accessed 30 April 2014)
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health colleagues, social care workers and students of the wider therapy teams within the IPPLT’s locality, and this is a work in progress.
British Journal of Community Nursing June 2014 Vol 19, No 6
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights res
Implementing interprofessional learning in the community setting Margaret Pitt, Alison Kelley, Jacqui Carr
Margaret Pitt is District Nurse Practice Teacher, Nottinghamshire Healthcare Trust, County Health Partnership (Nottingham West); Alison Kelley is Lecturer, School of Health Sciences (Division of Nursing), University of Nottingham; Jacqui Carr is Lecturer, School of Health Sciences (Division of Nursing), University of Nottingham Email: [email protected]
T
o prepare future health and allied professionals to work collaboratively to facilitate and manage care that is seamless, evidence based and person centred, it has long been advocated that interprofessional learning (IPL) should be integrated into educational and clinical learning activities (World Health Organization, 1988; Department of Health, 2009). Interprofessional education takes place:
‘when two or more professions learn with, from and about each other to improve collaboration and the quality of care.’ (Centre for the Advancement of Interprofessional Education (CAIPE), 2002) The benefits of integrating IPL into clinical practice can be summarised as improving care by optimising resources on a cost-effective basis and collaborating with other professions to facilitate safe, person-centred care (CAIPE), 2012). Although IPL has taken place informally in the community setting for some time, this article describes how IPL has been formally instituted in one setting in clinical learning and in the community practice learning team (PLT) activity to encourage collaborative working practices that aim to improve care.
© 2014 MA Healthcare Ltd
Background IPL has been embedded within the nursing curriculum and students have already taken part in IPL learning within the academic components of their educational programme. Although IPL had taken place informally in the community locality, the PLT (a team of practitioners and university/ higher education institution (HEI) representatives facilitating and supporting learning and mentorship) considered it essential to integrate IPL explicitly into clinical practice learning experiences. Freeth et al (2005) recognise the informality of IPL in practice settings, but, given the intention to introduce students to the concept of collaborative working to optimise care in future, the need for a formal approach was evident (Makowsky et al, 2009). The move towards interprofessional working within teams needed to be reflected in the student learning experience to ensure that learning was maximised and interprofession-
British Journal of Community Nursing June 2014 Vol 19, No 6
al working is seen as the norm early on in people’s careers and adopted lifelong in practice. It was anticipated that the cost of doing this would be minimal, as the first-named author is a practice teacher and the facilitation of learning in practice is integral to this role. Currently there are plans to integrate different health and allied care practitioners into interprofessional teams across the Health Partnership Nottingham West locality, and it is anticipated that the prior initiation of IPL will enhance this process. Work completed by The University of Teesside (2004) had established that IPL opportunities could be facilitated and managed in two ways depending on how many students and different health professionals were in a care setting at one time. The first option was associated with different students learning in a group with a health professional who provided care. The second option involved a single student from any profession working with another health professional on a person-to-person basis. This model has been used successfully in care settings and was used by Aston and Kelley (2010) to facilitate a pilot study in a local community hospital linked to the HEI to evaluate IPL. Within that setting, the PLT and clinical educators from physiotherapy, dietetics, occupational therapy, speech and language, and social work teams worked together to identify IPL opportunities that could be experienced by
ABSTRACT
Given the need to facilitate and manage care, making every consultation count, knowledge of—and working with—different professional care providers is essential. To optimise care outcomes for clients, the adoption of interprofessional working is essential. This article describes how interprofessional learning was embedded in a community nursing practice placement environment with student nurses and students from other professions.
KEY WORDS
w Interprofessional working w Optimising care outcomes w Working together
291
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights res
PROFESSIONAL
Initiating IPL in the community setting Preparation
Within the PLT, it was proposed that IPL needed to be formalised within learning experiences for students from any profession to develop knowledge and skills that would inform their practice, improve working relationships and teamwork between different professions and improve patient care outcomes. The locality management team supported the initiative and this was essential to ensure that the change in practice was adopted and developed in future. Using the principles linked to the NHS Change Model (NHS Improving Quality, 2013) and Working with Others (NHS Leadership Academy, 2014), a strategy was identified to initiate the change to IPL optimising opportunity for the initiative to succeed. Initially, the first-named author developed networks with the second-named author and the pilot team in the local community hospital to learn what had been successful for them. The aim was to use strategies that had already been proven to work and to seek support and advice from practitioners who had successfully implemented IPL. All interested practitioners in the locality were then invited to attend an open meeting to explore IPL to ensure that everyone was consulted and could contribute to the development process. The PLT was immediately at an advantage as they already had diverse representation from the local HEI, child and adult community health, an intermediate care therapy team and a specialist nurse from the local back-pain team, both of which had allied health professionals working within the teams. Access to, and consultation with, different professional groups was thereby maximised in addition to the strengthening of the link between theory and practice (Murray-Davis et al, 2012). As with any innovation, it was essential to ensure that all the practitioners who would be helping to facilitate and manage IPL opportunities were involved. A lack of consultation could hinder support for implementation and render it unsuccessful (Jinks et al, 2009). It was also essential that practitioners were aware of the benefits. For example, IPL should not be onerous in terms of time and workload and would inform their own collaborative practice development. Pollard (2009) recognised the need for practitioners to develop these skills to ensure student IPL learning was effective. The period of consultation worked well and assisted the scoping of IPL opportunities that had not been previously considered.This resulted in new placement areas being identified, thereby increasing the diversity of learning experiences
292
and insight-giving visits. Additionally, this work also revealed the different types of student who were likely to attend placements within the locality and the dates they would be present. These included physiotherapy, medical, occupational and pharmacy students in addition to student nurses.
Interprofessional practice learning team At the end of the consultation and preparatory phase, the PLT was replaced by the newly formed interprofessional practice learning team (IPPLT) to demonstrate commitment and more strongly identify their activities with interprofessionalism. Members of the IPPLT included a district nurse practice teacher (chair, first-named author), a community nurse, a community matron, an occupational therapist, a physiotherapist, a social worker, a health visitor, a school nurse and HEI representatives (second-named and third-named authors). A medical educational professional also supported the initiative and acknowledged the need for medical students to work with and learn from other’s professions to form effective relationships leading to safe, high-quality care (General Medical Council, 2009). It was established that the first-named author (as the IPL champion) would coordinate IPL activities, and the members of the team would provide assistance. For example, the third-named author mapped the learning opportunities for student nurses and completed joint mentor updates with first- and second-named authors to promote IPL. The firstand second-named authors produced an information guide to IPL for practitioners. It was hoped that all of these initiatives would encourage mentors and practitioners to think about IPL when working with any student. Perhaps the most challenging part of implementing IPL was being sure which students would be on placement at any given time. This is where links with the local HEIs was useful. From the knowledge of the group, most student placements could be identified and IPL activities could be coordinated effectively to maximise the number of students who would participate.
Facilitating and managing learning by IPL The key to implementing IPL successfully was using a flexible approach to meet the needs of the students (Stew, 2005). Initially, the main approaches used were student-to-healthprofessional interactions or service-user learning activities and group workshops. There was already a culture of working informally with different students where short placements or insight visits were negotiated and these worked well. While mentors helped facilitate the process, it was the student’s responsibility to organise and take ownership of their learning needs. This enabled them to experience different aspects of care and ways of working with patients. Examples included working with the community matron, pharmacy and medical students, and working with the community therapy team or social services team. Some students elected to visit different aspects of patient or user care. For example, visits to the coroner’s court are now considered essential because many different students
© 2014 MA Healthcare Ltd
students. They then used the Teesside model of facilitation to structure IPL. Evaluation of the pilot study indicated that this approach was successful, that student understanding of different roles was enhanced, and that this could contribute to the improvement of care. Having successfully used these principles in the pilot study, it was proposed to use them to initiate IPL in the community setting, and the first-named author had plans to extend IPL to workshop activities.
British Journal of Community Nursing June 2014 Vol 19, No 6
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights res
iStock
PROFESSIONAL
It has long been advocated that interprofessional learning should be integrated into educational and clinical learning activities.
294
present anonymised scenarios that could be used to debate care challenges or issues they had experienced in practice. The aim was to explore perceptions and potential responses to the scenario to enhance learning by considering different perspectives and solutions. The scenarios presented by students were diverse and included: w Ethical and clinical issues w Mental capacity and safeguarding dilemmas w Health promotion and risk-reduction activities w Communication w Role analysis w Team working w Managerial issues w Leadership issues. Students responded well to this approach and the depth of feedback and discussion linked to complex issues was observed. Sharing knowledge appeared to help the students understand different roles and responsibilities and how collaborative working could improve care. This was important, since unless students work interprofessionally in the early part of their careers, they may not learn to work in teams effectively (WHO, 2010).
Evaluating learning At the end of each IPL session, the students were asked to identify what learning had taken place using a short openquestion questionnaire. When asked how IPL activities and experiences enhanced understanding of other professionals’ roles in the health-care team, the students gave the follow-
© 2014 MA Healthcare Ltd
have identified and shared the benefits of attending. A further IPL initiative was to share the patient experience by accompanying the patient on their health journey. With consent, the student would accompany a patient to attend health appointments, investigations or group health activities. For example, a student nurse visited a patient in their own home who had a diagnosis of dementia. With the patient’s consent, the student accompanied them to the memory clinic. This enabled the student to learn about dementia and mental health in the community setting, and to understand the patient’s lived experience. There was also opportunity to explore the benefit of reminiscence therapy for those experiencing dementia. They were able to explore this in depth with mental health practitioners and this was valued, as they might not have had the opportunity to gain this level of insight and learning elsewhere. One of the most successful methods utilised in the community setting to facilitate IPL was the introduction of student-centred IPL workshops. Students from various professional backgrounds were invited to meet and share learning linked to their experiences in practice in an informal and relaxed atmosphere. The workshops were facilitated by the first-named author who, with the student participants, established ground rules for the interaction linked to confidentiality and respect. Students commenced each session by introducing themselves and sharing their educational pathway to initiate discussion about their role and context of that role within the community and wider health or social care setting. To stimulate discussion, students were encouraged to
British Journal of Community Nursing June 2014 Vol 19, No 6
h Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights res
PROFESSIONAL
ing responses:
‘I have been given a great deal of explanation and information about the role of the district nurse and how the assessment process works. I previously wasn’t aware of actually what they did.’ (Medical student) ‘I learnt what other professionals’ roles entail and cleared up any misunderstandings or misconceptions I had.’ (Nursing student) ‘A greater understanding of what nurses look for when assessing’. (Occupational therapy student) These responses appear to suggest that students may not, fundamentally, have a good knowledge of different roles, and it is suggested that this may reduce the opportunity to facilitate care effectively. The WHO (2010) has already identified the necessity of working in a unified manner to improve care. Knowing the role of different professional colleagues is an important part of this. The earlier that IPL is introduced to students in their career, the more likely they are to be open to different professional groups and their roles in collaborative health care (Coster et al, 2008). Therefore, introducing students to a non-threatening IPL activity in workshops that they control is anticipated to increase their interprofessional knowledge (Hanna et al, 2012). Additionally, Furze et al (2008) reported that students exposed to IPL in the community setting had more understanding and respect for other professionals. When asked whether IPL helped to optimise effective patient care, the students reported:
‘I think IPL will improve patient care overall and ensure that a holistic approach is taken to management of patients rather than just medical.’ (Medical student) ‘Improved communication and more professional efficiency.’ (Physiotherapy student)
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‘To be aware of other types of treatment other professionals do.’ (Nursing student) Students recognised that, when communicating and caring for people in a holistic manner, embracing different professional approaches to treatment is important. The majority of policies or guidelines that govern practice and care are dependent on interprofessional working. Each health professional needs to use skills optimally to maximise their effectiveness linked to improving care. Reeves et al (2013) reflected improved care outcomes where IPL activity had taken place on a limited basis. The main benefits were associated with diabetes care, emergency and operating theatre departments, mental health care delivery and domestic violence care interventions. These are all areas that are accessed
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by students and have different professionals facilitating and managing care effectively in teams. It is suggested that exposing students to IPL in the community setting early on in their careers could have a similar effect by engendering interprofessional team working in their practice. Students were also asked how IPL opportunities had contributed to their own personal development. Their responses included the following:
‘Gave me knowledge on what other professions can do for patients with complex needs.’ (Nursing student) ‘I’ve now got a greater understanding of the sort of patients that require treatment in the community.’ (Occupational therapy student) ‘A deeper understanding of the nurse’s role and the large variation in nursing responsibility.’ (Medical student) These responses appear to indicate that students do need to be aware of the different professionals who facilitate and manage care and to know what their specific role might be. The Royal College of General Practitioners (RCGP) published their vision for integrated care (RCGP, 2011). The document’s promotion of shared learning and development to improve service delivery supports this. The Nursing and Midwifery Council (NMC) (2009) and Health and Care Professions Council (2013) both concur with the need to reinforce the personal responsibility of individuals for their personal learning and development and to work collaboratively with others for safe and effective care. This includes building and sustaining professional relationships with a view to providing care that is compassionate and delivered by the ‘right staff, at the right time, in the right place’ (NHS England, 2012).
Limitations and future directions It is acknowledged that this feedback is limited, and further in-depth evaluation is needed. However, the responses received do appear to support the value of IPL for students and concur with the literature which points out the benefits of such approaches. To maximise the impact of IPL there are plans for a countywide IPL workshop incorporating both hospitalbased and community-based students of nursing, therapy and mental health. It is hoped that this will engage mentors from the wider area to encourage more IPL. Based on the success of IPL and the benefits for students, the second-named author initiated IPL learning conferences for students and mentors. The first-named author presented and disseminated the IPPLT’s planning strategy and experiences to individuals engaged in educating students. The conferences have been well attended and have assisted change in practice and learning that is now the norm. Future plans include greater involvement with mental
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Recommendations for implementing IPL Having reflected on the innovation of IPL, there are a number of recommendations for others who wish to embed IPL within their community placements successfully: w Before starting consider visiting colleagues who have already successfully implemented IPL to share ideas and participate in an IPL activity if possible w Access the Centre for the Advancement of Interprofessional Education website (www.caipe.org. uk) for information, support and ideas based on best practice w Introduce and promote the concepts and benefits of IPL to colleagues involved in mentorship and learning w Ensure the IPL message is consistent and included in activities such as team meetings and mentor updates w Identify IPL learning champions to respond to questions and provide help w Map the IPL learning opportunities within the locality, think diversely, and put them in a user-friendly format—networking is essential w Find out which students are placed in the locality and when in order to focus shared learning in a timely manner w Start with implementing what is familiar: one-to-onetype activities do evaluate well and then larger group work can be developed w Encourage students to take responsibility for their own learning w As IPL develops, seek new activities and be innovative w Share successes and disseminate what worked well to assist development of IPL for others.
Conclusion IPL has now been integrated in practice for 2 years and is firmly embedded in the ethos of the IPPLT and in the thinking of the mentors locally. Not only has it informed student learning, but has also assisted in the identification of very diverse placement options that may not have been considered. As the locality moves towards an integrated working model of care delivery, the opportunity for inte-
KEY POINTS
w Interprofessional learning (IPL) is not difficult to formalise and integrate into clinical practice and should be the norm w IPL is anticipated to improve care w IPL should improve working relationships and team work w IPL facilitates appreciation and understanding of different roles
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grated learning becomes even more pertinent. Networking between staff, understanding of each other’s professional roles and the way in which the work of health and allied professionals can complement each other for the benefit of the patient is now more important than ever. BJCN Aston L, Kelley A (2010) An evaluation of using champions to enhance inter-professional learning in the practice setting. Nurse Educ Practice 11(1): 36–40. doi:10.1016/j.nepr2010.06.03 Centre for the Advancement of Interprofessional Education (CAIPE) (2002) Interprofessional education: a definition. www.caipe.org.uk (accessed 10 February 2014) Centre for the Advancement of Interprofessional Education (CAIPE) (2012) Interprofessional Education in Pre-registration Courses. A CAIPE Guide for Commissioners and Regulators of Education. http://tinyurl.com/nfuo8yt (accessed 16 February 2014) Coster S, Norman I, Murrells T et al (2008) Interprofessional attitudes amongst undergraduate students in health professions: a longitudinal questionnaire survey. Int J Nurs Stud 45(11): 1667–81. doi: 10.1016/j. ijnurstu.2008.02.008 Department of Health (2009) Transforming Community Services: Ambition, Action, Achievement: Transferring Services for Acute Care Closer to Home. http://tinyurl.com/m3vzx8z (accessed 27 February 2014) Freeth D, Hammick M, Reeves S, Koppel I, Barr H (2005) Effective Interprofessional Education: Development, Delivery and Evaluation. Blackwell Oxford, UK Furze J, Lohman H, Mu K (2008) Impact of an interprofessional communitybased educational experience on students’ perceptions of other health professions and older adults. J Allied Health 37(2): 71–7 General Medical Council (2009) Tomorrow’s Doctors. http://tinyurl.com/ l4ov5dw (accessed 18 February 2014) Hanna E, Soren B, Telner D, MacNeill H, Lowe M, Reeves S (2012) Flying blind: the experience of online interprofessional facilitation. J Interprof Care 27(4): 298–304. doi: 10.3109/13561820.2012.723071 Health and Care Professions Council (2013) Standards for Proficiency. http:// tinyurl.com/paedv23 (accessed 15 April 2014) Jinks A, Armitage H, Pitt R (2009) A qualitative evaluation of an interprofessional learning project. Learning Health Soc Care 8: 263–71 Makowsky M, Schindel T, Rosenthal M, Campbell K, Tsuyuki R, Madill H (2009) Collaboration between pharmacists, physicians and nurse practitioners: a qualitative investigation of working relationships in the inpatient medical setting. J Interprof Care 23(2): 169–84 Murray-Davis B, Marshall B, Gordon F (2012) From school to work: promoting the application of pre-qualification. Nurse Educ Pract 12(5): 289–96 NHS England (2012) Compassion in Practice. http://tinyurl.com/qfpwyp6 (accessed 16 April 2014) NHS Improving Quality (2013) An Introduction to the NHS Change Model. http://tinyurl.com/p4munrv (accessed 16 February 2014) NHS Leadership Academy (2014) Working with others. http://tinyurl.com/ pfcgh49 (accessed 14 February 2014) Nursing and Midwifery Council (2009) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. http://tinyurl.com/obhptm2 (accessed 30 April 2014) Pollard K (2009) Student engagement in inter-professional working in practice placement settings. J Clin Nurs 18(20): 2846–56. doi:10.1111/j.13652702.2008.02608.x Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M (2013) Interprofessional education: effects on professional practice and healthcare outcomes (update). The Cochrane Collaboration, John Wiley & Sons, Ltd Royal College of General Practitioners (2011) General Practice and the Integration of Care: An RCGP Policy Report. http://tinyurl.com/poybo49 (accessed 15 April 2014) Stew G (2005) Learning together in practice: a survey of interprofessional education in clinical settings in South-East England. J Interprof Care 19(3): 223–35 University of Teesside (2004) A multi-dimensional framework for clinical practice placements. University of Newcastle upon Tyne, UK World Health Organization (1988) Learning Together to Work Together for Health. World Health Organization, New York World Health Organization (2010) Framework for Action on Interprofessional Education and Collaborative Practice. http://tinyurl.com/nart3q6 (accessed 30 April 2014)
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health colleagues, social care workers and students of the wider therapy teams within the IPPLT’s locality, and this is a work in progress.
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