VISIONSERIES
VISIONSERIES
VISIONSERIES
TRANSFORMING NURSING EDUCATION
LEADING THE CALL TO REFORM
Interprofessional Collaboration in
Education and Practice
A Living Document from the National League for Nursing
NLN Board of Governors
December 2015
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Interprofessional Collaboration in Education and Practice, Summaries of Nursing
Mission: Promote excellence in nursing education to build a strong and diverse nursing workforce to advance the health of our nation and the global community.
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VISIONVISIONVISIONSERIESSERIESSERIES
TRANSFORMING NURSING EDUCATION L E A D I N G T H E C A L L T O R E F O R M
Interprofessional Collaboration in
Education and Practice
A Living Document from the National League for Nursing
NLN Board of Governors
December 2015
Interprofessional Collaboration in Education and Practice A Living Document from the National League for Nursing Mission: Promote excellence in nursing education to build a strong and diverse nursing workforce to advance the health of our nation and the global community. Core Values: Caring, Integrity, Diversity, Excellence
INTRODUCTION
The National League for Nursing believes that current educational approaches must include opportunities for students to engage in interprofessional education (IPE) and practice (IPP). IPE and IPP deliver team-based care that strengthens health systems and improves health outcomes. There is consensus that health care professionals must have the competency to work in teams to provide safer, quality care to multiple populations in varied health care settings (Thibault, 2013). Because team training in educational programs lags behind the actual practice of working in teams, a gap exists between the realities of practice (IPEC, 2011) and the utilization of teamwork skills to deliver patient-centered care. As a result, today’s graduates from well-intended, accredited institutions are not prepared for the practice environments in which they will work (Speakman & Arenson, 2015). Recognizing that the nurse is integral in the delivery of team-based, patient-family centered care, the NLN challenges nurse educators to collaborate with other health professions to develop meaningful interprofessional education and practice opportunities for students.
In response to this publication, a cascade of new accreditation standards and health profession curricula redesigns have emerged (Brandt, 2015). › The World Health Organization Framework for Action on Interprofessional Education and Collaborative Practice (WHO, 2010) identified interprofessional education as the way health care professionals learn with, from, and about one another to improve collaboration and the quality of care for individuals, families, and communities. WHO further defined collaborative interprofessional practice (IPP), stating that it occurs when multiple health workers from different professional backgrounds work together with patients, families, care-givers, and communities to address the local health care need to deliver the highest quality care. › The Future of Nursing: Leading Change, Advancing Health (IOM, 2011) recommended that nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. Interprofessional education and practice also align with report recommendations to expand opportunities for nurses to lead and build an infrastructure for the collection and analysis of interprofessional health care workforce data. › In 2012, the National Center for Interprofessional Practice and Education was established to lead, coordinate, and study the advancement of collaborative, team- based, health professions education and patient care as an efficient model for improving quality, outcomes, and cost. The center brought national prominence to the need for team-based care in the United States and solidified the value of interprofessional education and practice. › Measuring the Impact of Interprofessional Education and Collaborative Practice and Patient Outcomes (IOM, 2015) recommended that future research focus beyond the classroom and address the impact of Interprofessional education and practice on such issues as patient safety, patient and provider satisfaction, quality of care, health promotion, population health, and the cost of care. FACTORS AFFECTING THE IMPLEMENTATION OF INTERPROFESSIONAL AND COLLABORATIVE PRACTICE IN HEALTH PROFESSIONS EDUCATION › Teaching Differently for a Team-Based Health Care System Most clinicians, trained as silo providers, were neither educated nor practiced in an interprofessional, team-based environment. Consequently they are ill-prepared to implement a new learning paradigm that includes students from various professions. The logistics of merging silo-based curricula within the academic setting further complicates the integration of IPE. Competing issues such as different schedules and calendars, lack of meeting space, and incongruent curricula plans and pedagogies
are often cited when IPE and IPP initiatives fail to be created or implemented. This failure is related to the traditional planning models used to create learning experiences for students from multiple professions. Developing models with increased team- based learning experiences requires educators to re-think, revise, and reframe delivery of IPE and IPP educational programs within traditional curricula structures (e.g., standard 15-week semester courses, “like” experiences for all students). To promote IPE and IPP, educators must see themselves, not as profession-centric practitioners, but as interprofessional faculty charged with inspiring students to embrace and champion an interprofessional team-based health care system. Insti- tutional support is critical for innovative programs to succeed. Brasher, Owen and Haizlip (2015) conclude that “the complexity of implementing interprofessional ed- ucation and practice strategies that extend across the learning continuum requires that institutions create a structure to support effective and organized coordination among interested administrators, faculty and staff” (p. 95). › Faculty Workload The addition of IPE and IPP curricula is often perceived as contributing to an increased faculty workload. Faculty often ask for a template to ease the burden of “adding” IPE and IPP when updating the curriculum. Yet the reality is that IPE and IPP objectives and learning experiences complement quality and safety outcomes rather than add content. Developing newer educational models with more longitudinal team-based experiences will lead to greater opportunities for students to build relationships with patients, families, faculty, and other clinicians (Cox and Naylor, 2013). › Providing Adequate Opportunities for All Levels of Students Finding purposeful collaborative practice environments remains a challenge especially for nursing programs who may have limited opportunities to engage with medical , pharmacy, and other health care students. These real challenges should not preclude active engagement with students from varied health professions (e.g., respiratory, PT, OT), as well as students from other professions (e.g., counseling, social work, and arts and sciences) to find meaningful learning opportunities. Using the IPEC core competencies as a framework for students to practice team- based approaches to patient-centered care is fundamental to creating a collaborative learning environment. The key is for students to practice being both team members and team leaders and to engage students to learn with, from, and about one another. › New Roles and New Focus on Health Health care redesign around primary care, prevention, and building a culture of health (RWJF, 2015) and the growth of emerging practice roles (e.g., nurse practitioners, physician assistants, clinical pharmacists, informatics specialists) have moved the focus of health care reform to consideration of the “right worker partnering with
For Faculty › Pursue interprofessional development opportunities. › Use the IPE core competencies as a framework to develop systematic plans that help students meet the IPEC competency domains in varied educational settings (e.g., classroom, clinical and simulation-learning environment). › Examine curricula content and traditional approaches (e.g., scheduling) to determine bias and messaging that impede interprofessional practice approaches and subsequent health care delivery. › Inspire nursing students to seek out teamwork training and collaborative practice opportunities. › Thread interprofessional education throughout the program of learning as an essential program outcome to foster IPP. › Implement courses and learning opportunities that prepare graduates to focus on patient-family centered care in interprofessional teams. › Provide opportunities for students to work on interprofessional research teams and service-learning activities. › Develop new clinical models of interprofessional education that strengthen the links between education, practice, and research and draw upon nursing expertise in knowledge generation and translation of research. For the National League for Nursing › Offer faculty development programs to prepare faculty to teach in team- based, care-focused educational programs including how to teach the collaborative practice skills necessary to mentor a new generation of graduates. › With other nursing and health professional organizations, develop model curricula for undergraduate and graduate programs that integrate IPE and IPP. › Develop leadership programs for nurses, from both education and practice, to co- create positive organizational cultures that promote collaborative IPP. › Work with policy makers to advocate for funding for schools to deliver educational and practice models that foster greater collaboration among the professions. › Seek research funding to investigate linkages between educational approaches for collaborative practice and health care outcomes.
REFERENCES
Brandt, B. (2015). Interprofessional Education and Collaborative Practice: Welcome to The “New” Forty-Year-Old Field. The Advisor (Journal of the National Association of Advisories for the Health Professions. Retrieved from http://www.naahp.org/ Publications/TheAdvisorOnline/Vol35No1/35102.aspx Brashes, V., Owen, J., & Haizlip, J. ( 2015) Interprofessional education and practice guide No. 2: Developing and implementing a center for interprofessional education. Journal of Interprofessional Care, 29 (2), 95-99. Cox, M. & Naylor, M. (Eds), 2013) Transforming patient care: Aligning interprofessional education with clinical practice redesign. New York: Josiah Macy Jr. Foundation. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Institute for Healthcare Improvement: IHI Triple Aim Initiative (2008). Triple Aim for Populations. Retrieved from http://www.ihi.org/Topics/TripleAim/Pages/Overview.aspx Institute of Medicine. (1972). Educating for the health team. Washington, DC: The National Academies Press. Institute of Medicine. Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: The National Academies Press. Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: The National Academies Press. Institute of Medicine (IOM). (2011). The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press. Institute of Medicine (IOM). (2015). Measureing the impact interprofessional education and collaborative practice and patient outcomes. Washington, DC: The National Academies Press. Lutfiyya, M.N., Brandt, B., Pechacek, J., Cerra, F. (2015). Setting a research agenda for interprofessional education and collaborative practice in the context of U.S health system reform. Journal of Interprofessional Education. Early on-line July 31, 2015,1-8. Robert Wood Johnson Foundation (2015). Nation Makes Headway in Averting Nurse Shortage, Federal Study Finds. Retrieved from