No description available.

Purpose: To explore how non-physician team members of a health care team perceive their contributions to educating residents about interprofessional collaboration in an intensive care rotation and to compare this to residents’ perceptions. Method: Participants in this exploratory case study were selected using maximal variation, purposive and convenience sampling strategies. Data were collected through semi-structured individual and focus group interviews, and analyzed using inductive thematic analysis. Findings: Contributions occurred implicitly and explicitly during patient care activities and focused on role clarification, sharing of expertise, and help navigating the workflow. Contributions were influenced by a) Intensive Care Unit context, b) tension between working and teaching, c) expectations, d) resident engagement, e) power/hierarchy. Conclusion: Team members contribute to residents’ education about collaboration through participation in the everyday business of caring for critically ill patients. Recognition of this contribution may improve resident training. However, some residents may not be learning basic skills, what they learn about interprofessional collaboration may have limited transferability, and team interactions may influence the validity of judgements made about entrustability and performance.

Inadequate interprofessional collaboration (IPC) and communication among health care professionals are associated with medical errors and mortality. Guided by the theory of goal attainment and the chronic care model, a systematic review was conducted to explore the evidence related to whether interprofessional collaborative primary care can have a positive effect on health outcomes for patients living with diabetes (PLWD). The systematic review followed the Joanna Briggs Institute method for systematic reviews and results were complied with the PRISMA evidence-based minimum set for reporting. Data were analyzed to identify if IPC positively impacted the health outcomes of PLWD, as evidenced by a reduction in hemoglobin A1c and body mass index. Five studies met the inclusion criteria of English-speaking, peer-reviewed studies. Statistically significant improvement in hemoglobin A1c (p < 0.001) and body mass index (p = 0.026) was shown in 2 studies. Two studies lacked robust statistical analysis of the data; however, researchers showed an average reduction in participants' hemoglobin A1c from 10.6% to 8.8% (N = 45) in one study and a change of -0.7 to -0.9% (N = 3) in another. A fifth study showed that collaboration patterns that included equitable and comprehensive participation of 3 disciplines resulted in a lower proportion of patients with hemoglobin A1c levels greater than 9%. Four out of the 5 research studies noted the integration of pharmacists into the interprofessional collaborative team. The implication for positive social change for this systematic review is that the greater use of interprofessional collaboration and communication may improve the outcomes of patients with diabetes in primary care settings.

Indiana University-Purdue University Indianapolis (IUPUI) / Due to a shortage of affordable housing, gaps in social welfare infrastructure, and the criminalization of homelessness, public libraries find themselves providing daytime shelter to patrons experiencing homelessness. Their needs and crises have created demands on staff and security that exceed their training and role. Sometimes police are involved, exposing patrons to possible arrest. To fill this knowledge and service gap, libraries have begun hiring social workers. Early research on the broad role of social workers suggests they are changing how libraries respond to crises with patrons experiencing homelessness in four keyways: by providing an option to calling 911; influencing code of conduct implementation, serving patrons, and equipping staff. However, no study has given an in-depth explanation of how social workers are changing libraries’ responses to crises with patrons experiencing homelessness. The purpose of this study is to explain how the role of the social worker influences how libraries respond when patrons experiencing homelessness are in crises. Considered through lenses of role theory, social cognitive theory, and the humanization framework, this embedded multiple-case study of three U.S. urban libraries collected 91 surveys and conducted 46 Zoom interviews. It includes the perspectives of 107 participants across six roles: patrons experiencing homelessness, social workers, front-facing staff, security, location managers, and CEOs. The social workers’ influence was perceived to reduce behavior incidents, exclusions, and arrests around three themes: (1) being an option, with subthemes of in-house referrals and de-escalation; (2) running interference, with subthemes of low barrier access and barrier-busting services; and (3) buffering, with subthemes of equipping, influencing code of conduct implementation, and advocating and being present during security and police interactions. Three models of library social work and their impact on the social worker’s role of de-escalation were identified and described: The Sign Up and Summon Model, the Outreach and Summon Model, and the Social Work Center Model. In addition, a commingled rival was found: the impact of the Black Lives Matter movement. The implications of the findings include recommendations for structuring library social work practice to reduce exclusions and arrests of patrons experiencing homelessness. / 2025-05-22

This doctoral project presents an example of the integration occupational therapy (OT) into primary care to improve access to OT services that will address occupational performance challenges of veterans within the Eastern Colorado Veterans Affairs (VA) Health Care system. Informed by the Person Environment Occupation model of occupation and substantial evidence supporting the necessity of assessing functional cognition to better understand occupational performance, this doctoral project focuses upon the provision of OT services in a primary care setting, which included assessments of functional cognition and ADL/IADL performance and interventions addressing functional cognitive deficits, home safety, and activities of daily living/instrumental activities of daily living (ADL/IADL) performance. Satisfaction of primary care providers with inclusion of OT services as well as data on client factors of typical veterans referred to OT and assessments and interventions utilized were collected through survey and observation. Results of this project indicate that the inclusion of occupational therapy services in primary care can reduce the wait time from referral to evaluation for some veterans from 1–2 months to 15 minutes while increasing primary care provider (PCP) knowledge of the scope of OT services. However, several factors must be considered for the successful continued presence of OT in primary care. To improve OT productivity, follow-up appointments should be scheduled at the primary care office and group programing should address health and wellness and chronic disease management. Care must be taken to balance availability for “warm hand-offs” from PCPs and prescheduled appointment times. Furthermore, continued education of PCPs on scope of OT practice will be imperative for continuing to increase numbers of appropriate referrals.

Due to the nature of the complexity of the diagnosis of autism spectrum disorder (ASD), elementary-aged students with this disorder require a holistic, team-based approach to education in the school setting. A review of current literature has found that while interprofessional collaborative practice (ICP) in the school setting is effective and often recommended for students with ASD, a variety of barriers have resulted in fragmented care. Additionally, there is limited research supporting a cohesive model of interprofessional collaborative practive when working with students with ASD in the elementary school setting. This problem is likely leading to decreased outcomes for elementary-aged students with ASD. Occupational therapy practitioners’ role as holistic, client-centered practitioners creates an ability to bridge the gaps between the often-fragmented goals of the members of an interprofessional team. Interprofessional collaboration in the school setting between occupational therapy practitioners, physical therapy practitioners, psychologists, speech and language pathologists, social workers, and teachers is crucial to addressing the multi-faceted needs of children with ASD and providing the highest level of service in accordance with the Occupational Therapy Practice Framework: Domain and Process, Fourth Edition. This doctoral project aims to add to the limited body of research in this area in order to fulfill this role. The TOPPSS Model of Interprofessional Collaboration is an evidence-based school-year long plan of structured collaboration between staff members working with students with ASD in an elementary school setting through a professional development workshop. The workshop will educate participants on the TOPPSS Model of Interprofessional Collaboration. The participants that are being targeted for this workshop include elementary school-based teachers (T), occupational therapy practitioners (O), physical therapy practitioners (P), psychologists (P), speech-language pathologists (S), and social workers (S). The overall aim of this program is to improve interprofessional collaborative practice (ICP) among the participants in order to increase positive outcomes for students with ASD.

Background: Primary care providers, family physicians and nurse practitioners provide most mental health services in Canada. However, primary care providers lack knowledge, skills, and time to provide these services. Access to onsite mental health consultation or collaborative mental health care, affords primary care providers support to offer patients increased access to mental health services. Researchers suggest that interprofessional collaborative relationships are foundational to the success of collaborative mental health care. However, there is little understanding of how to build these relationships. Purpose: The purpose of this grounded theory study was to develop an understanding of how primary care and mental health care providers collaborate to deliver mental health care in primary care settings. Methods: Counsellors, family physicians, psychiatrists, nurse practitioners, and program leaders were recruited (N=40). Data were collected using individual (19) and focus group (7) semi-structured interviews. Interviews were audio recorded, transcribed and open coded. After open coding the first seven interviews, memos were written on each participant and focus group. These memos were sorted, compared to previous memos and then used to create a coding table. This iterative process of open coding, memo writing and then adding emergent codes to the coding table was repeated for all transcripts. Similar codes were grouped then collapsed to create the preliminary categories. Preliminary categories were sent to the participants after the primary care provider interviews and again after the provider focus groups to create the final categories. The final categories were compared to examine their relationships to one another. Findings: The main finding of this study is a theoretical rendering of the participants’ experiences and ascribed meaning of interprofessional collaboration to deliver mental health services in primary care. Specifically, a collaborative relationship building model with four developmental stages: 1) Primary Care Providers Need for Collaboration, 2) Initiating Co-location, 3) Fitting-in, and 4) Growing Reciprocity is offered. Conclusions: The findings underscore that collaborative care requires an understood need for collaboration, organizational support, contextually effective modes of communication, and a perception that collaboration improves patient care. Further research may explore the applicability of this model to other health care contexts. / February 2017

Objective: To analyze factors that lead nurses and doulas to have positive views of each other. Design: A multivariate analysis of a cross-sectional survey, the Maternity Support Survey. Setting: Online survey with labor and delivery nurses, doulas, and childbirth educators in the United States and Canada. Participants: A convenience sample of 704 labor and delivery nurses and 1,470 doulas. Methods: Multiple regression analysis was used to examine five sets of hypotheses about nurses' and doulas' attitudes toward each other. Scales of nurses' attitudes toward doulas and doulas' attitudes toward nurses included beliefs that nurses/doulas enhance communication, are collaborative team members, enhance a woman's birth experience, interfere with the ability to provide care, or interfere with relationships with the women for whom they care. Results: For nurses, exposure to doulas in their primary hospitals was associated with more positive views, whereas working more hours, feeling overworked, and a preference for clinical tasks over labor support were associated with more negative views of doulas. For doulas, working primarily in one hospital and certification were associated with more positive views of nurses. Nurses with more positive attitudes toward common obstetric practices had more negative attitudes toward doulas, whereas doulas with more positive attitudes toward common obstetric practices had more positive attitudes toward nurses. Conclusion: Our findings show factors that influence mutual understanding and appreciation of nurses and doulas for each other. These factors can be influenced by educational efforts to improve interprofessional collaboration between these maternity care support roles.

Thesis advisor: Susan Kelly-Weeder / Background: Addressing childhood obesity requires a multidisciplinary approach. School based BMI screening and referral provided an opportunity for school nurses (SNs) and pediatric primary care physicians to collaborate. Understanding the capacity to collaborate, as well as the barriers and benefits, help to support interprofessional care. Purpose: The purpose of this investigation was to determine SNs’ and pediatric physicians’ attitudes toward collaboration as well as the presence of successful collaboration proposed in the Four Dimension of Collaboration Model (FDCM). Methods & Sample: An exploratory, cross-sectional mixed methods study of SNs’ and pediatric physicians’ attitudes and practices regarding collaboration was conducted using a combination of web-based and mailed survey instruments utilizing both open and closed-ended questions. One hundred and fourteen school nurses and sixty-three pediatric physicians completed the study. Results: While SNs and physicians both reported high scores on the Jefferson Scale of Attitudes toward MD-RN Collaboration (JSAC) indicating a positive attitudes toward physician – nurse collaboration; SNs scores were significantly higher than physician scores (55.05 + 3.30 v 52.42 + 5.74, p = .001). A regression model identified that physician’s age, community location, and having a moderate percentage of obese patients within their practices were associated with positive (age) and negative (community and moderate percent obese patients) effects on attitude toward collaboration. Providers’ responses indicated deficits throughout the FDCM. Dimension indicator, “mutual acquaintanceship” indicated that 37% physicians did not know any SNs. Similarly, 24% SNs reported that they did not “trust” local physicians to listen to their concerns. Qualitative analysis indicated the myriad of challenges faced by both providers. Benefits and barriers were similar for SNs and physicians; however, their experiences suggested a lack of mutual knowledge. Conclusions: Collaboration around childhood obesity is a unique struggle due to its multifaceted nature. School nurses and physicians showed positive attitudes toward collaboration; however, their capacity to act was limited. School nurses and pediatric physicians recognized the value of interprofessional collaboration recommending improvements to the current system. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Current literature regarding quality health services frequently identifies interprofessional collaboration (IPC) as essential to patient-centred care, sustainable health systems, and a productive workforce. The IPC literature tends to focus on interprofessionalism and collaboration and pays little attention to the concept of practice, which is thought to be a represented world of objects and processes that have pre-given characteristics practitioners can know cognitively and apply or manage correctly. Many strategies intended to support IPC simplify and codify the complex, contested, and unpredictable day-to-day interactions among interdependent agents that I argue constitute the practices of a community. These strategies are based in systems thinking, which understand the system as distinct from experience and subject to rational, linear logic. In this thinking, a leader can step outside of the system to develop an ideal plan, which is then implemented to unfold the predetermined ideal future. However, changes in health services and healthcare practices are often difficult to enact and sustain.This thesis problematises the concept of ‘practice’, and claims practices as thoroughly social and emergent phenomenon constituted by interdependent and iterative processes of representation (policies and practice guidelines), signification (sense making through negotiation and reflective and reflexive practices), and improvisation (acting into the circumstances that present at the point and in the moments of care). I argue that local and population-wide patterns are negotiated and iteratively co-expressed through relations of power, values, and identity. Moreover, practice (including the practice of leadership or consulting) is inherently concerned with ethics, which I also formulate as both normative and social/relational in nature. I argue that theory and practice are not separate but paradoxical phenomena that remain in generative tension, which in healthcare is often felt as tension between what we should do (best practice) and what we actually do (best possible practice in the contingent circumstances we find ourselves in). I articulate the implications this has for how knowledge and knowing are understood, how organisations change, and how the role of an internal practice consultant is understood. An important implication is that practice-based evidence and evidence-based practice are iterative and coexpressed(not sequential), and while practice is primordial, it is not privileged over theory.I propose that a practice consultant could usefully become a temporary participant in the practices of a particular community. Through a position of ‘involved detachment’, a consultant can more easily notice and articulate the practices of a community that for participants are most often implicit and taken for granted. Reflective and reflexive consideration of what is taken for granted may change conversations and thus be transformative.