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Background. Many older stroke survivors live with multiple (> 2) chronic conditions (MCC), resulting in the need for care by multiple health and social service providers from multiple organizations and sectors. Managing the physical, social and psychological needs related to stroke in addition to other chronic conditions is a complex process that is best served by an interprofessional team of health care providers working collaboratively toward common goals. Interprofessional education (IPE) has been promoted by numerous organizations as a method to enhance collaborative practice. However, many home care providers have not received formal IPE or training to support collaborative practice. Providing IPE in the home care setting is challenging because providers rarely work in a common location, often work in isolation, and spend much of their time driving to provide care to clients in their homes. Moreover, the effectiveness of IPE on collaborative practice for stroke rehabilitation in the home care setting is undetermined. New approaches to IPE for practicing health care providers working in the home care setting are needed. The purpose of this study was to examine the feasibility and acceptability of implementing a new theory-based, IPE intervention, and to explore its effects on collaborative practice in home care for older adult stroke survivors with MCC. Method. This feasibility study involved the use of both a qualitative descriptive and a quantitative (one-group repeated measures) design. The IPE intervention was developed and evaluated within the context of a larger pragmatic randomized controlled trial (RCT), which evaluated the effectiveness of the Aging Community and Health Research Unit Community Partnership Program (ACHRU-CPP). Informed by the W(e) Learn Framework for Interprofessional Education, the National Interprofessional Competency framework, and the literature, the IPE intervention consisted of four key components: (a) an initial three-hour standardized IPE training session; (b) standardized training for care coordinators; (c) collaborative practice reflective huddles; and (d) outreach visits. The primary outcome was the feasibility of the IPE intervention (enrollment rate, attrition rate, implementation barriers/facilitators). Secondary outcomes included the acceptability of the IPE intervention, the feasibility of the study methods (recruitment/retention rates and procedures, eligibility criteria, data collection and analysis methods), and potential effectiveness of the intervention based on three-month changes in collaborative practice, as measured by the Collaborative Practice Assessment Tool (CPAT) and the 19-Item Team Climate Inventory (TCI). Feasibility and acceptability outcomes were based on descriptive statistics for enrollment and attrition rate and qualitative descriptive analysis of focus group content, field notes, and evaluation of training. The potential effectiveness of the IPE intervention was explored using paired t-tests and Cohen’s d, with the results expressed using descriptive statistics and effect estimates (95% confidence intervals). Results. A total of 37 home care providers from two provider agencies and one Community Care Access Centre (CCAC) in Ontario, Canada participated in the study. Participants included registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators as well as nursing, rehabilitation and personal support worker supervisors. Participants viewed the intervention as feasible and acceptable. It was effective in improving three domains of collaborative practice as measured by the CPAT (communication/information exchange; community linkage and coordination of care; decision-making and conflict management) and one domain of collaborative practice, as measured by the TCI (task orientation) at six months post initial training. Participants perceived many benefits to the intervention, including improved communication and collaboration within their teams, enhanced role understanding, increased learning with and from each other, and increased appreciation and valuing of the expertise of all team members. Facilitators to implementing the intervention included: funding from the larger trial, support from key stakeholders including agency leadership, provision of key resources (e.g., Team Charter, sample agenda), and continuity of the care coordinators. Barriers included unanticipated delays in recruitment of older adult stroke survivor participants into the larger trial, and higher than expected attrition rates. The study methods were feasible and effective in reaching the target population. We established that the intervention could be delivered as planned. Conclusion. The results of this study provide preliminary evidence for the feasibility, acceptability and preliminary effects of the IPE intervention on collaborative practice for an interprofessional stroke-specific team in home care caring for older adult stroke survivors with MCC. The results also provide knowledge of the facilitators and barriers to successfully implementing and sustaining the intervention into home care practice. Further research is warranted to test this intervention in other chronic populations and settings. / Thesis / Doctor of Philosophy (PhD) / This feasibility study used qualitative and quantitative methods to evaluate the implementation of a new theory-based, Interprofessional Education (IPE) intervention and explored its effects on collaborative practice in home care for older stroke survivors with multiple chronic conditions. The IPE intervention was developed and evaluated within the context of a larger pragmatic randomized controlled trial (RCT), which evaluated the effectiveness of the Aging Community and Health Research Unit Community Partnership Program. The six-month IPE intervention consisted of four key components: (a) an initial three-hour standardized IPE training session; (b) standardized training for care coordinators; (c) collaborative practice reflective huddles; and (d) outreach visits. Participants included 37 home care providers including registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators, and nursing, rehabilitation and personal support worker supervisors from two service provider agencies and one Community Care Access Centre (CCAC) in Ontario, Canada. The intervention was effective in improving collaborative practice (e.g., communication within teams, role understanding, team decision-making and conflict management). Facilitators to implementing the intervention included: funding from the larger trial, leadership support, provision of key resources, and continuity of the care coordinators. Barriers included unanticipated delays in recruitment of older adult stroke survivor participants into the larger trial, and higher than expected attrition rates. This study offers preliminary evidence that the intervention is feasible to deliver, acceptable to providers, and may improve collaboration within an interprofessional stroke-specific team. Further research is necessary to test this intervention in other chronic populations and settings.

The need to incorporate interprofessional education (IPE) as part of any healthcare profession curricula is growing in an approach to prepare a collaborative practice-ready workforce. Pharmacy students should be equipped with the necessary competencies and skills needed for them to practise interprofessionally, commensurate with the expanding and evolving role of the pharmacist. Thus, the Qatar University College of Pharmacy has decided to incorporate IPE initiatives formally into the pharmacy curriculum in collaboration with other healthcare institutions in Qatar to meet the accreditation standards set by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) and fulfil the recommendations set in the World Health Organization (WHO) framework. To implement effective IPE strategies, it is important to consider the prior attitudes and expectations of various stakeholders in the process -- particularly students, faculty, and practising pharmacists. The overall aim of this PhD research is to explore the pharmacy perspectives of IPE and collaborative practice from a Middle Eastern context. The research started with a comprehensive systematic review of the literature focusing on the perspectives of pharmacy students, pharmacy faculty, and practising pharmacists on IPE and collaborative practice. Five themes have been identified from the systematic review: inconsistency in reporting IPE research, professional image of the pharmacist, lack of longitudinal follow-up, lack of IPE research on faculty, and lack of mixed method studies. This was followed by three sequential explanatory mixed method designs, to explore the perception of faculty, students, and practising pharmacists, individually. This was undertaken to gain an in depth understanding of the strengths and challenges of each group that can affect the implementation and perspectives toward IPE and collaborative practice. Two data collection methods were used: quantitative surveys and qualitative focus groups. Quantitative data were imported into SPSS® version 22 and analysed using both descriptive and inferential statistics. Qualitative data from the focus groups were analysed using thematic analysis. For the quantitative surveys, the overall response rate was 117 out of 334 (35%) for pharmacy faculty in the Middle East, 102/132 (77%) for pharmacy students in Qatar and 178/285 (63%) for practising pharmacists in Qatar. This was followed by seven focus groups with a total of 51 participants. Findings, from both the survey and focus groups, support that students, faculty and practising pharmacists are ready to engage in IPE and collaborative practice. The findings further identified positive attitudes that reinforce the need to incorporate IPE into healthcare curricula. They perceive anticipated benefits to them as professionals and to the patients. However, a large number of challenges have been highlighted, including the existence of a hierarchical culture, pharmacists’ role and image, a weak sense of professional identity among pharmacists, their marginalised contribution, resistance from the healthcare teams to the evolving role of the pharmacists, and the heterogeneous background of healthcare professionals. Promisingly, the education and healthcare system in Qatar is undergoing significant changes with some positive influences noted within education and practice settings. This is the first study investigating pharmacy perspectives of IPE in Qatar, the Middle East, and worldwide. The findings from this research generated a body of knowledge regarding the pharmacy perspectives of IPE and provided a better understanding of what shapes this perspective from a Middle Eastern context. The research presents a new model based on collective input, efforts, and readiness in five key stages: academic institution, faculty, student, practice, and environment. The model moves beyond focusing on the individual stages separately and expands to consider the complexity of linking and aligning the stages together. Coordinated efforts, between the stages, focused on a more comprehensive and holistic implementation, is essential for successful implementation of IPE and collaborative practice.

Depuis l'avènement des technologies portables et du réseau Internet, de nombreux artistes conçoivent leurs œuvres au delà d'un espace et d'un temps donnés et inventent des formes permanentes et immatérielles disséminées sur les réseaux. Dans le cadre de cette recherche, il s'agit de produire à la fois une série de travaux sonores utilisant le réseau, des modes de participation collaboratifs et également de proposer une pensée sur les concepts révélés par ces nouvelles pratiques et ces formes d'écritures artistiques comme celle du noise, de la poésie sonore et des musiques expérimentales. La recherche est concentrée sur les éléments nécessaires pour constituer un laboratoire connecté de production sonore partagée, dans lequel toutes les questions (et d'autres à venir et à définir ensemble) sont posées à travers notre pratique artistique, des formes d'installations “dé-géolocalisées” ou “non géolocalisées” et enfin des performances musicales en simultané sur Internet. Il est intéressant de pouvoir à la fois envisager une production avec une communauté d'artistes et de penseurs ayant une pratique et des connaissances dans le domaine mais aussi de savoir comment ces artistes, théoriciens formulent leurs pensées et créent de nouveaux concepts. Ainsi, le travail de recherche peut croiser un projet de création, une pratique, un savoir- faire et en dégager une méthodologie théorique qui donne accès à des clefs, à la compréhension de ces nouvelles formes d'écritures / Since the advent of portable technologies and the Internet, many artists conceive their works beyond a given space and time and invent permanent and immaterial forms scattered over the networks. Within the framework of this research, the aim is to produce a series of sound works using the network and collaborative modes of participation, as well as to stimulate discussion of the concepts revealed by these new practices and forms of artistic language: noise, sound poetry and experimental music. This research will focus on the key elements of a connected laboratory of shared sound production: questions will be raised through the lens of the author’s own artistic practice using geodelocalised forms of installation and simultaneous musical performances on the Internet. I will also consider the work and thinking of a community of artists within this field and seek to understand how these artists and theorists formulate their thoughts and create new concepts. Finally, this thesis addresses these creative projects, practices and expertise and articulates a theoretical methodology which draws together current forms of artistic language relating to cutting edge music and poetry and networked practices

Made available in DSpace on 2018-06-18T13:12:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2016 / As Diretrizes Curriculares Nacionais do curso de Fisioterapia referem-se às competências e habilidades gerais e específicas a serem desenvolvidas durante a graduação. Preveem que a formação deve contemplar as necessidades sociais da saúde, com ênfase no Sistema Único de Saúde estimulando o pensamento crítico e produtivo, com base nos problemas da população assistida e valorizando o conhecimento que é cotidianamente produzido nas unidades de saúde e articulando-o com o que é produzido na universidade. Em 2010 a Organização Mundial da Saúde reconhece que o trabalho em equipe e a prática colaborativa podem fortalecer os sistemas de saúde e promover melhor resolutividade e qualidade dos serviços em saúde. O presente estudo teve por objetivo identificar a percepção de fisioterapeutas sobre sua formação profissional para o trabalho em equipe e a prática colaborativa através de uma pesquisa exploratória com abordagem quali-quantitativa. O instrumento, hospedado no GoogleForms, foi respondido por 67 fisioterapeutas atuantes em serviços públicos e privados de atenção e recuperação à saúde, contendo dados de identificação, características sobre a formação profissional, 27 assertivas em Escala “tipo Likert” e questões abertas sobre a prática profissional, competências para o trabalho em equipe e sugestões para implementar/aprimorar o trabalho em equipe no ambiente de prática. Todos os participantes possuem tempo de experiência profissional superior a um ano e assinaram o Termo de Consentimento Livre e Esclarecido. De posse dos dados coletados foi realizada a análise estatística exploratória em busca de indicadores para demonstrar a percepção dos fisioterapeutas em relação às competências desenvolvidas durante sua formação em preparação para o trabalho em equipe e a prática colaborativa. Os resultados indicaram que ainda há dificuldades enfrentadas nos cenários de prática quanto ao trabalho em equipe e prática colaborativa, principalmente no que diz respeito à atenção centrada no paciente, observando-se que ainda vigora o modelo biomédico centrado na doença e na figura do médico. No que diz respeito ao desenvolvimento de competências e habilidades para o trabalho em equipe parece que, mesmo estando presentes em momentos da formação profissional, isso não garante a efetividade do trabalho e das práticas colaborativas nos cenários de prática. / The “Diretrizes Curriculares Nacionais” for Physical Therapy Graduation Course is a curriculum guideline that lists general and specific skills and abilities to be developed by students during graduation. The document is substantiated on the perspective of social and healthcare needs, comprised by the Brazilian Public Health System “Sistema Único de Saúde” (SUS) and aims to encourage critical thinking and productive reasoning based on the main public health issues, valuing practical knowledge regularly produced in health facilities that ought to be linked with the information produced at the University. In 2010 the World Health Organization recognizes that teamwork and collaborative practice can encourage better resolution, improve quality and strengthen health services. The present study aimed to identify physical therapists’ perception about their training for teamwork and collaborative practice through an exploratory research with qualitative and quantitative approaches. An assessment questionnaire, hosted on GoogleForms, was answered by 67 physical therapists’ active in public and private health care services and includes identification data, information on vocational training, 27 assertions in Likert type scale, open-ended questions regarding professional practice skills for teamwork and suggestions to implement and enhance teamwork in the clinical environment. All participants of this study have more than one year of professional practice and signed the consent form. Using the collected data, an exploratory statistical analysis was carried out searching for indicators to demonstrate the physical therapists’ perception concerning the skills developed during their training regarding teamwork and collaborative practice. The outcomes of the research indicated that there are still some difficulties perceived in clinical scenarios regarding teamwork and collaborative practice, especially underlining the patient as the main focus of attention, instead of the still prevailing biomedical model focused on the disease and the doctor. Regarding the development of skills and abilities for teamwork, it seems that even being present during training, this does not guarantee the effectiveness collaborative work practices in clinical scenarios.