<p>Nursing is a primary partner on the interprofessional team, yet there is minimal empirical evidence of nurse educators acting as architects of interprofessional education. Feminist poststructuralism (FPS) guides an exploration of nursing’s engagement in interprofessional education (IPE) using Yin’s (2009) case study methodology. A multiple case design of three English-language baccalaureate nursing programs investigates research questions: What are the antecedents of nursing’s engagement in IPE; how are nurse educators/nursing faculty engaged in IPE; how does gender impact nursing’s involvement in IPE development and implementation; and, how is nursing’s IPE engagement impacted by contextual factors inherent in health professional and academic contexts? Data from documents, archival records, individual and focus group interviews, field notes, non-participant observation, and a demographic questionnaire are reported in three individual case reports. A cross case analysis report is interpreted through FPS tenets including language, discourse, subjectivity, and power. Findings indicate that despite valuing IPE, nursing’s IPE engagement is minimal, inconsistent, and diverse in the presence of discrepant and/or uncertain understandings of the term interprofessional. The cross-case analysis outcome speaks principally of nursing’s general experience in the academy, with IPE engagement seemingly providing the vehicle to convey messages of enduring concern and tension inherent in nursing’s experience in the academy. Prominent concepts uncovered include nurse academic, professional subjectivity, and professional identity. Historic, hegemonic discourses of women, nurse, and nursing’s relationship with medicine impact nursing’s professional subjectivity such that nurse academics’ sense of professional self and professional confidence are viewed as antecedents to nursing’s IPE engagement.</p> / Doctor of Philosophy (PhD)

In recent years the complexity and integrated nature of health care has increased. It has become accepted that the needs of patients are often greater than one single health profession can address and requires collaboration on the part of health care providers (Freeth, 2001). Interprofessional health education (IPHE) is the interactive educational process and cooperation among various health care professions. It is a valuable pedagogical approach for teaching health care students that they cannot work effectively without the use of a team, and is thought to be the first step in the direction of changing health care practice in the clinical setting. Using a two phase mixed methods approach, this dissertation investigated changes in student attitudes and measured interprofessional readiness as a result of a longitudinal interprofessional educational experience at Thomas Jefferson University called Health Mentors. The health care professions included in this program are: medicine, nursing, physical therapy, occupational therapy, and pharmacy. Together, these students visit an individual living in the greater Philadelphia, PA region with one or more chronic health conditions four times during the year. Of the five hundred and seventy-six students participating in the Health Mentors program, four hundred and ninety-six completed two surveys in September 2008 and again in April 2009. These were the Interprofessional Education Perception Scale (IEPS) and the Readiness for Interprofessional Learning Scale (RIPLS) which measured their attitudes and readiness toward interprofessional education. Analysis revealed slight significant differences in the means of the health programs and showed small significant decreases in attitudes and readiness over time. Two focus groups were conducted to better understand the quantitative results. Using grounded theory, the following themes emerged: preparation for future professional experience, personal enjoyment from working with their Mentor, logistical conflicts, unknown roles, and program assignments seen as an `add on' or `busy work'. The results from both the qualitative and quantitative methods indicate that students have a high opinion of the theory of IPHE but find the application difficult in practice. / Educational Psychology

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.

BACKGROUND: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. METHODS: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. RESULTS: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. CONCLUSIONS: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway.

The problem exists that there are no education initiatives focused on teaching and taking into practice the skills of effective interprofessional discourse in this online, asynchronous, professional environment. The purpose of this study was to examine whether it is possible for students in the health professions to learn to practice effective interprofesssional online discourse in an electronic health record. This was a mixed methods study that included both quantitative ad qualitative inquiry underpinned by post positivism and used a method triangulation research design model. Both quantitative and qualitative data were collected and analyzed from an educational intervention and simulated electronic health record exercise. The students' perceptions of their practice in an electronic health record did not necessarily match their knowledge and skills in this group of students. Emergent themes from the study pointed in the possible direction of perceived value of the exercise, prior experience in an electronic health record, and logistical barriers to the activity. Perceived time constraints was a particularly strong concern of the students. The emergent themes might be valuable considerations for other interprofessional programs looking to implement similar activities concerning the electronic health record.

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.

Introdução: O tema central deste estudo é a prática e a educação interprofissional em saúde (EIP) e enfermagem. Na EIP as profissões aprendem conjuntamente sobre o trabalho coletivo e as especificidades de cada área profissional, orientadas para o trabalho colaborativo em equipe interprofissional, interdisciplinar e o compromisso com a integralidade. Objetivos: O objetivo geral é analisar como ocorre a educação interprofissional na atenção primária à saúde (APS) no contexto brasileiro. Os objetivos específicos são: analisar as concepções da EIP e sua articulação com a prática interprofissional no cotidiano do trabalho da APS, na perspectiva de docentes, estudantes e trabalhadores. Método: Pesquisa qualitativa com abordagem compreensiva e interpretativa, cuja coleta de dados foi realizada em duas etapas. A primeira, por meio de 18 entrevistas semiestruturadas com docentes de oito universidades públicas brasileiras, que atuam na formação em saúde no contexto da APS. A segunda, com quatro sessões de grupos focais (GF) homogêneos, nas quais participaram cinco estudantes, seis docentes e 15 trabalhadores de duas Unidades Básicas de Saúde, vinculados ao Programa de Educação pelo Trabalho na Saúde (PET-Saúde). A análise dos dados foi realizada por meio da perspectiva crítico hermenêutica, com a triangulação dos resultados das duas etapas da pesquisa, à luz do quadro teórico, utilizando os conceitos: processo de trabalho em saúde e enfermagem, profissionalismo, teoria do agir comunicativo, interdisciplinaridade, EIP, prática colaborativa centrada no usuário e APS. Resultados: A triangulação dos resultados, da primeira e segunda fases da pesquisa, corroborou as três categorias empíricas contruídas a partir da análise das entrevistas, que indicam as concepções de EIP articuladas a prática de APS: A EIP desloca a ênfase da formação e das práticas para a integralidade do cuidado, A EIP contribui para a reconfiguração das relações profissionais colaborativas, Preservação das competências complementares da especificidade profissional, reconhecimento das competências comuns e construção das competências colaborativas. Porém, os GF permitiram identificar diferenças no olhar dos atores sociais: os estudantes destacam a participação do usuário no cuidado, os docentes enfatizam a ausência de apoio institucional para EIP e os trabalhadores ressaltam a desarticulação ensino-serviço, pois usualmente não participam do planejamento das atividades de ensino no campo. A triangulação também revela tensões para o avanço da EIP, com destaque para incompatibilidade da grade curricular dos diferentes cursos. Conclusão: As concepções de EIP identificadas, indicam a necessidade da reconfiguração das relações profissionais, com articulação de competências comuns, complementares/específicas e colaborativas para promover a prática interprofissional centrada no usuário no contexto da APS no Sistema Único de Saúde (SUS). / Introduction: The central theme of this study is the practice and interprofessional education in health (IPE) and nursing. In IPE professions learn together on collective work and the specifics of each professional field, oriented collaborative work in interprofessional and interdisciplinary team and a commitment to comprehensive health care. Objectives: The overall objective is to analyze how IPE occurs in primary health care (PHC) in the Brazilian context. The specific objectives are: to analyze the conceptions of EIP and its articulation with the interprofessional practice in PHC daily work, from perspective of teachers, students and health workers. Method: Qualitative research with comprehensive and interpretative approach, which data collection was performed in two stages. The first, through structured interviews, with 18 teachers from eight Brazilian public universities, who work in health education in PHC. The second, with four sessions of homogeneous focus groups (FG), which involved five students, six teachers and 15 health workers of two PHC units linked to Education Program for Health Work (PET-Health). Data analysis was performed using the critical hermeneutic perspective, with the triangulation of the two stages results of research, based on theoretical framework, using concepts: work process in health and nursing, professionalism, Theory of Communicative Action, interdisciplinarity, IPE, patient centered collaborative practice and PHC. Results: The triangulation of results, the first and second phases of the study corroborated the three empirical categories from analysis of the interviews indicate that the conceptions of IPE articulated the practice of PHC: \'IPE emphasis of training and practice for comprehensive health care\', \'IPE contributes to reconfiguration of collaborative professional relationships\', \'Preservation of complementary competences of professional specificity, recognition of common competences and construction of collaborative competences\'. However, the GF allowed to identify differences in the look of stakeholders: students highlight user participation in health care, teachers emphasize the lack of institutional support for IPE and health workers emphasize the teaching health service disarticulation, as usually workers do not participate in the planning of teaching activities in field. Triangulation also reveals tensions to advance of IPE, especially curriculum incompatibility of different courses. Conclusion: The conceptions of IPE identified indicate the need for professional relationships reconfiguration, with articulation of common, complementary/specific and collaborative competences to promote patient centered interprofessional practice in PHC settings in the Unified Health System (SUS).

Introdução: O tema central deste estudo é a prática e a educação interprofissional em saúde (EIP) e enfermagem. Na EIP as profissões aprendem conjuntamente sobre o trabalho coletivo e as especificidades de cada área profissional, orientadas para o trabalho colaborativo em equipe interprofissional, interdisciplinar e o compromisso com a integralidade. Objetivos: O objetivo geral é analisar como ocorre a educação interprofissional na atenção primária à saúde (APS) no contexto brasileiro. Os objetivos específicos são: analisar as concepções da EIP e sua articulação com a prática interprofissional no cotidiano do trabalho da APS, na perspectiva de docentes, estudantes e trabalhadores. Método: Pesquisa qualitativa com abordagem compreensiva e interpretativa, cuja coleta de dados foi realizada em duas etapas. A primeira, por meio de 18 entrevistas semiestruturadas com docentes de oito universidades públicas brasileiras, que atuam na formação em saúde no contexto da APS. A segunda, com quatro sessões de grupos focais (GF) homogêneos, nas quais participaram cinco estudantes, seis docentes e 15 trabalhadores de duas Unidades Básicas de Saúde, vinculados ao Programa de Educação pelo Trabalho na Saúde (PET-Saúde). A análise dos dados foi realizada por meio da perspectiva crítico hermenêutica, com a triangulação dos resultados das duas etapas da pesquisa, à luz do quadro teórico, utilizando os conceitos: processo de trabalho em saúde e enfermagem, profissionalismo, teoria do agir comunicativo, interdisciplinaridade, EIP, prática colaborativa centrada no usuário e APS. Resultados: A triangulação dos resultados, da primeira e segunda fases da pesquisa, corroborou as três categorias empíricas contruídas a partir da análise das entrevistas, que indicam as concepções de EIP articuladas a prática de APS: A EIP desloca a ênfase da formação e das práticas para a integralidade do cuidado, A EIP contribui para a reconfiguração das relações profissionais colaborativas, Preservação das competências complementares da especificidade profissional, reconhecimento das competências comuns e construção das competências colaborativas. Porém, os GF permitiram identificar diferenças no olhar dos atores sociais: os estudantes destacam a participação do usuário no cuidado, os docentes enfatizam a ausência de apoio institucional para EIP e os trabalhadores ressaltam a desarticulação ensino-serviço, pois usualmente não participam do planejamento das atividades de ensino no campo. A triangulação também revela tensões para o avanço da EIP, com destaque para incompatibilidade da grade curricular dos diferentes cursos. Conclusão: As concepções de EIP identificadas, indicam a necessidade da reconfiguração das relações profissionais, com articulação de competências comuns, complementares/específicas e colaborativas para promover a prática interprofissional centrada no usuário no contexto da APS no Sistema Único de Saúde (SUS). / Introduction: The central theme of this study is the practice and interprofessional education in health (IPE) and nursing. In IPE professions learn together on collective work and the specifics of each professional field, oriented collaborative work in interprofessional and interdisciplinary team and a commitment to comprehensive health care. Objectives: The overall objective is to analyze how IPE occurs in primary health care (PHC) in the Brazilian context. The specific objectives are: to analyze the conceptions of EIP and its articulation with the interprofessional practice in PHC daily work, from perspective of teachers, students and health workers. Method: Qualitative research with comprehensive and interpretative approach, which data collection was performed in two stages. The first, through structured interviews, with 18 teachers from eight Brazilian public universities, who work in health education in PHC. The second, with four sessions of homogeneous focus groups (FG), which involved five students, six teachers and 15 health workers of two PHC units linked to Education Program for Health Work (PET-Health). Data analysis was performed using the critical hermeneutic perspective, with the triangulation of the two stages results of research, based on theoretical framework, using concepts: work process in health and nursing, professionalism, Theory of Communicative Action, interdisciplinarity, IPE, patient centered collaborative practice and PHC. Results: The triangulation of results, the first and second phases of the study corroborated the three empirical categories from analysis of the interviews indicate that the conceptions of IPE articulated the practice of PHC: \'IPE emphasis of training and practice for comprehensive health care\', \'IPE contributes to reconfiguration of collaborative professional relationships\', \'Preservation of complementary competences of professional specificity, recognition of common competences and construction of collaborative competences\'. However, the GF allowed to identify differences in the look of stakeholders: students highlight user participation in health care, teachers emphasize the lack of institutional support for IPE and health workers emphasize the teaching health service disarticulation, as usually workers do not participate in the planning of teaching activities in field. Triangulation also reveals tensions to advance of IPE, especially curriculum incompatibility of different courses. Conclusion: The conceptions of IPE identified indicate the need for professional relationships reconfiguration, with articulation of common, complementary/specific and collaborative competences to promote patient centered interprofessional practice in PHC settings in the Unified Health System (SUS).

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