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Teamwork is essential to provide quality services to individuals with disabilities (Morrison & Gleddie, 2019). Deficits across a variety of domains make interprofessional practice even more crucial (Dobbs-Oates & Morris, 2016). Interprofessional education (IPE) provides preprofessionals the opportunity to gain experience collaborating with various disciplines, better preparing them for interprofessional practice (Anderson et al., 2011; Ruebling, et al., 2014). Most IPE research has been completed with preprofessionals engaged in medical cases. The existing evidence for IPE in school-based settings is limited, which creates a gap for speech-language pathologists (SLPs) who are pursuing work in school-based settings. The first purpose of this study was to examine the perceptions and attitudes of participants following an IPE experience of a medical case with both quantitative and qualitative data. The second purpose of this study was to determine if a case could be adapted to a school-based setting. Seventy-one participants completed a survey following an IPE experience with eight later participating in a focus group. Preprofessionals self-reported interprofessional learning from the experience and recognized the importance of team interactions. The IPE experience was successfully adapted to a school-based case and in an initial program evaluation, perception of teamwork and interactions were also important. In both settings, preprofessionals rated themselves as having less bias towards others than others have towards their own disciplines. This study provides essential information regarding IPE for school-based settings that will ultimately benefit children with disabilities by encouraging interprofessional practice.

Introduction La collaboration interprofessionnelle (CI) est essentielle à l'efficacité des soins de santé au Canada. Cette pratique est modélisée par un ensemble de lois, règlements et politiques, mais la littérature quant à leur impact sur la CI est rare. Utilisant la théorie de la managérialisation du droit, cette étude vise à illustrer l'écart entre le cadre juridique propre à la CI et la connaissance de celui-ci par les cliniciens. Méthode Un sondage anonyme en ligne a été lancé en avril 2019 et envoyé aux infirmières et aux médecins du Québec, Canada. Les questions portaient sur le cadre juridique de la CI, les sources de connaissances juridiques et les perceptions ou croyances en regard de la CI. L’objectif principal était de déterminer l'écart entre le cadre juridique et la compréhension de celui-ci. L’objectif secondaire était d'identifier les sources de connaissances juridiques pour les cliniciens du Québec. Résultats Au total, 267 participants ont répondu au sondage, soit un taux de réponse de 35 %. 184 sondages ont été remplis par des infirmières et des médecins de toutes les régions du Québec. Pour l'acquisition de connaissances, 40 % des médecins se sont tournés vers les assureurs alors que 43 % des infirmières se sont tournées vers leur ordre professionnel. Seulement 30% des médecins ont correctement identifié quelle activité est réservée aux médecins uniquement tandis que 39% des infirmières ont correctement identifié leur iii activité réservée. En ce qui concerne les perceptions juridiques, 28 % des médecins et 39 % des infirmières pensaient que la CI pourrait accroître leur responsabilité. Ces participants ont plus tendance à nommer les problèmes liés à la responsabilité comme des obstacles à la CI. Interprétation Il existe un écart important entre les connaissances des cliniciens des lois et les politiques et le contenu réel de ceux-ci. Cette lacune peut conduire à des interprétations erronées des textes normatifs par les cliniciens, à des changements de politiques inefficaces par les décideurs et peut perpétuer une mise en oeuvre inefficace de la CI. / Background Interprofessional collaboration (IPC) is central to effective care in Canada. This practice is structured by an array of laws, regulations and policies but the literature on their impact on IPC is scarce. Using the managerialization of law theory, this study aims to illustrate the gap between the texts and clinicians’ knowledge of the legal framework. Method An anonymous web-based survey was launched in April 2019 and sent to nurses and physicians in Quebec, Canada. The questions were about the IPC legal framework, legal knowledge sources and IPC perceptions or beliefs. The primary outcome was to determine the gap between the law and understanding of the law. The secondary outcome was to identify legal knowledge sources for clinicians in Quebec. Results A total of 267 participants filled in the survey, a response rate of 35%. 184 surveys were completed by nurses and physicians from all areas. For knowledge acquisition, 40% of physicians turned to insurers whereas 43% of nurses turned to their regulatory body. Only 30% of physicians correctly identified what activity is reserved for physicians while 39% of nurses correctly identified their reserved activity. Regarding legal perceptions, 28% of physicians and 39% of nurses thought IPC could increase their liability. These participants have a higher tendency to name liability-related issues as barriers to IPC. Interpretation There is an important discrepancy between clinicians’ knowledge about law and policies, and the actual texts themselves. This gap can lead to misinterpretations of the law by clinicians, ineffective policy changes by policymakers and can perpetuate ineffective implementation of IPC.

Yes / Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Methods: Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. Results: A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Conclusions: Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care. / This research was funded by the AUT University, Faculty of Health & Environmental Sciences Summer Student Grant 2021/2022 and the School of Public Health and Interdisciplinary Studies PBRF Funding 2021. The APC charge is covered by the School of Public Health and Interdisciplinary Studies PBRF 2022.

Ce mémoire traite de l’intégration d’une offre de soins surspécialisés, la gérontopsychiatrie, au sein du système de soins aux personnes âgées souffrant de troubles mentaux du Québec. L’objectif général de cette étude consiste à faire une analyse en profondeur des facteurs favorisant l’émergence de la pratique surspécialisée de gérontopsychiatrie et son implantation, afin d’en déduire des recommandations pour son développement. Dans un premier temps, nous avons analysé les forces porteuses qui ont soutenu l’implantation de cette nouvelle pratique clinique il y a trente années, dans la région de l’Estrie. Ensuite, nous avons identifié la dynamique conjuguée des facteurs cliniques, organisationnels et symboliques ayant soutenu l’institutionnalisation de cette nouvelle pratique. De cette analyse, nous avons tiré des recommandations pour le développement d’une telle pratique dans le réseau local de santé de Drummondville, puis en région Mauricie-Centre-du-Québec. Ces recommandations prennent en compte les particularités de ce nouveau contexte d’implantation. Notre cueillette de données s’appuie sur des entretiens individuels et de groupe, des observations non participantes et l’analyse de documents. L’information est présentée sous la forme d’études de cas permettant de rendre vivants les apports d’auteurs ayant éclairé la dynamique d’intégration d’une nouvelle discipline (Abbott, 1995; Abbott, 2003; Mintzberg, 1985, 1998; Nonaka, 1994). Quatorze recommandations émergent de cette étude. Les quatre premières traitent de la définition de l’objet gérontopsychiatrie, ainsi que de sa diffusion dans les espaces professionnels et organisationnels. Les cinq suivantes portent sur la construction de la dynamique de soutien qui se résume ainsi : tisser des liens dans l’environnement clinique et organisationnel. Quatre recommandations cherchent à faciliter l’institutionnalisation de cette nouvelle pratique dans une dynamique organisationnelle. Il s’agit d’investir la fonction de « champion » (Mintzberg, 1998), à partir d’un noyau où le leadership est partagé, de solliciter des espaces de création et d’alignement des logiques cliniques et organisationnelles. Enfin, la dernière recommandation encourage le soutien du processus de reconnaissance de la gérontopsychiatrie dans la province de Québec. Cette étude permet de générer certains apprentissages. Le premier est de mettre en lumière que des modèles universels pour améliorer l’organisation des services n’existent pas. Seuls des repères contextualisés à travers une analyse en profondeur permettent d’identifier les forces porteuses de l’environnement. Ensuite, il est possible de les utiliser pour identifier les dynamiques cliniques, organisationnelles et symboliques en présence. La réponse sera ainsi toujours adaptée. Le second apprentissage est venu de la mise à l’épreuve de notre modèle conceptuel. Ceci nous a permis de comprendre que nous ne devions pas considérer les facteurs d’intégration symboliques, organisationnels et cliniques comme séparées, tel que présentés dans notre modèle théorique initial. C’est plutôt en utilisant une représentation d’imbrication en spirale, tel que proposé par Nonaka (1994) comme un système « hypertexte », que nous avons pu trouver les repères utiles à une conceptualisation globale de l’interférence des facteurs entre eux. Nous considérons donc que les recommandations formulées pour l’émergence et le développement de la gérontopsychiatrie à Drummondville pourront avoir une pertinence dans une autre région, à la condition expresse de reposer sur une analyse du contexte local et de son environnement. / This memoir discusses the integration of a subspecialized offer of care: geriatric psychiatry in the healthcare system for older people with mental disorders in Quebec. The general objective of this study is to do a in-depth analysis of factors favoring the emergence of subspecialized geriatric psychiatry practice and its implementation, to deduce recommendations for its development. First, we analyzed the supporting strengths enabling the establishment of this new clinical practice, thirty years ago, in the Eastern Townships. Next, we identified the combined dynamic of clinical, organizational and symbolic factors which supported the institutionalization of this new practice. Then, we have identified the combined dynamic of the clinic, organizational and symbolic factors having supported the institutionalization of this new practice. From this analysis, we have deducted recommendations for the development of this practice in the Drummondville local healthcare network, then in Mauricie-Centre-du-Québec. Our data gathering is based on individual and group meetings, non-participating observations, and the analysis of documents. The information is presented in the form of case studies, permitting to bring alive contributions from leading authors who enlightened the dynamic integration of this new discipline (Abbott, 1995, 1999; Mintzberg, 1985, 1998; Nonaka, 1994). Fourteen recommendations emerge from this study. The first four dealt with the definition of geriatric psychiatry entity as well as its dissemination in professional and organizational spaces. The next five dealt with the support of the dynamic construction which can be summarized by the following: building links within the clinical and organizational environment. Four recommendations aim to facilitate the institutionalization of this new practice in an organizational dynamic. It is a question of fully engaging oneself as a "champion" (Mintzberg, 1998), from a core where the leadership is shared, to request spaces for the creation and the alignment of the clinical and organizational logics. The final recommendation is to support the geriatric psychiatry recognition process in the province of Quebec. This study permits the generation of some learning. The first one is to highlight that universal models to improve organization do not exist. Only contextualized benchmarks, through an in-depth analysis, will allow us to identify and use promising environmental strengths. Afterwards, we will be able to use them for the identification of clinical, organizational and symbolic dynamics involved. The answer provided then will always be adapted. The second learning emerged from testing our conceptual model. This enabled us to realize that we could not use clinical, organizational and symbolic factors of integration in separate boxes, as presented in our initial theoretical model. It is rather in using a spiral nesting representation, such as the one proposed by Nonaka (1994), called an «hypertext» system, that we were able to find the needed benchmarks, within the global conceptualization of the interference of factors between them. We therefore consider that the results, expressed in the recommendations supporting the emergence and the development of geriatric psychiatry in Drummondville, may be of relevance in another region, with the express condition that the local and environmental contexts be analyzed.

Collaborative care is a philosophy which guides the work of interdisciplinary teams and patients and their families internationally. It has been demonstrated to improve quality of care, safety, and patient and staff satisfaction, yet applying this philosophy still requires much investigation. This thesis describes processes of change directed towards a vision to enhance collaborative care relationships with patients and families within one hospital site of a non-acute academic health science centre in Ontario, Canada. By building focused conversations around existing patient and family centred education and using an initial conceptual framework of customer service, healthcare providers, mid- and senior level leaders shared their perspectives, negotiated meanings and created innovations to enhance collaborative relationships within the organization. Based within the critical paradigm, a critical collaborative ethnography was constructed with the use of sequential and mixed research methodologies. The ethnography evolved over three phases in a step-wise and additive design during the three year period of study. Phase 1 examined the perspectives of healthcare providers in an exploratory case study which contributed to mid-level leaders’ discussions in Phase 2. Cumulative findings from Phases 1 and 2 were brought to discussions with senior leaders in Phase 3. Members of a participative action research team assisted with research design and study processes. Shared meanings and innovative change ideas were developed and captured through the use of semi-structured focus groups and interviews, survey, participant observation and inductive analysis. A conceptual framework of ‘partners-in-care’ emerged and was used to assist participants to make sense of the values and factors important in their work with respect to collaborative relationships. The research processes facilitated the development of many innovations to enhance collaborative practice within the hospital. The organization was described by the research as undergoing directed change to enhance collaborative care as evidenced through participant self-reports, observed initiatives and the ethnographic descriptions. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2012-06-25 15:06:24.687

The demands on health and social care organisations require professions to work more collaboratively. During pre-registration training, health care and social work students learn within practice settings, supported by practice mentors. These settings are rich learning environments to experience interprofessional working (IPW) and for students to learn together through interprofessional practice learning (IPPL). There is, however, evidence that students' experiences of both are varied or limited. The value placed on IPW, and IPPL, is therefore of interest. This thesis will investigate practice mentors' attitudes to IPW and IPPL, and explore their perspectives of the enablers and barriers to these occurring in practice settings. A mixed-methods case study approach was used to measure the attitudes of practice mentors from health and social work, and to identify enablers and barriers to IPW, and IPPL for students. Online surveys and semi-structured face to face interviews were carried out with a range of professions within one Scottish health board and associated local authority. Results showed that attitudes to IPW, and IPPL for students were generally positive. Attitudes were not significantly affected by governing body, gender, area of work, years of experience, or prior experience of IPE. IPW was perceived to be enabled by shared processes and policies, IPPL for staff, effective communication, established teams, and shared processes and policies. Proximity to other professions and shared spaces encouraged informal communication and positive interprofessional relationships. Regular structured IPPL opportunities for students were limited. However, where opportunities did occur, this was linked to areas where practice mentors perceived that there was a strong interprofessional team identity. Although attitudes to IPW, and IPPL for students are positive, further work is needed to identify systems for improving IPW, to strengthen professions' identity as interprofessional teams, and to increase IPPL opportunities for students.

Les orientations ministérielles du Québec encouragent une pratique interprofessionnelle centrée sur le patient (ICP), au cours de la trajectoire de soins, pour soutenir les patients diagnostiqués d’un cancer. Cette pratique assure une meilleure communication entre les professionnels et la sécurité des patients, et améliore les soins et l'accès aux services (Santé Canada, 2010). Cependant, les études rapportent généralement les perceptions des professionnels en regard des soins et des services et informent sur les facteurs organisationnels, procéduraux et relationnels liés à cette pratique. Considérant l’importance de celle-ci, il semble nécessaire de la documenter selon les perceptions de patients, de proches et de professionnels dans un contexte réel de soins. L’étude avait pour but de décrire la pratique ICP au cours de la trajectoire de soins en oncologie. Pour soutenir cette description, l’adaptation du cadre de référence Person centred nursing framework (PCNF) de McCormack et McCance (2010) a été réalisée en incluant l’interprofessionnalité, telle que définie par Couturier (2009) et utilisée. Une étude qualitative de cas multiples a été réalisée auprès de deux équipes interprofessionnelles d’un centre hospitalier universitaire de la région de Montréal. L’échantillon (N=31) était composé de 8 patients, 3 proches, 18 professionnels et 2 gestionnaires. Vingt-huit entrevues ont été réalisées ainsi que 57,6 heures d’observation d’activités cliniques auxquelles participait le patient (ex., rendez-vous, traitement). Les résultats suggèrent que la pratique ICP des équipes est empreinte d’un dualisme de cultures (culture centrée sur le traitement versus culture davantage centrée sur le patient). De plus, les équipes étudiées ont présenté une pratique ICP fluctuante en raison de l’influence de nombreux facteurs tels le « fonctionnement de l’équipe », l’« environnement physique » et le « positionnement » des patients et des professionnels. Les résultats ont aussi suggéré que le déploiement des équipes de soins se fait à intensité variable au cours de la trajectoire. Il a été soulevé que les patients ont pu faire l’expérience d’une pratique ICP changeante, de bris dans la continuité des soins et de transition difficile entre les différentes périodes de la trajectoire. De plus, la description d’une pratique ICP souhaitée par les patients, leurs proches et les professionnels propose un accompagnement respectant le rythme du patient, sans prédominance des valeurs du professionnel ainsi qu’une assiduité dans la collaboration des membres de l’équipe. Cette étude suggère que les sciences infirmières peuvent ajouter aux connaissances interprofessionnelles actuelles en utilisant une perspective centrée sur le patient, perspective cohérente avec ses valeurs disciplinaires. De plus, de nombreuses pistes de réflexion sont proposées pour la pratique, la recherche, la gestion et la formation. / The ministerial orientations drawn up by the Quebec government promote the concept of interprofessional patient-centred practice (IPPC) throughout the care trajectory to support patients who have been diagnosed with cancer. That form of practice improves communication between professionals and patients’ sense of security, as well as improving care and access to services (Health Canada, 2010). However, studies generally report professionals’ perceptions of care and services and provide information on organizational, procedural and relationship factors connected to that practice. It is necessary to document this important practice based on the perceptions of patients, family members and professionals in a real context of care. This study was designed to describe IPPC practice throughout the trajectory of oncology care. The Person Centred Nursing Framework (PCNF) of McCormack and McCance (2010) was adapted by integrating interprofessionality, as defined by Couturier (2009), and used to support that description. A qualitative study of multiple cases was conducted with two interprofessional teams at a teaching hospital in the Montreal region. The sampling (N=31) consisted of 8 patients, 3 family members, 18 professionals and 2 managers. Twenty-eight interviews were conducted, as well as 57.6 hours of observation of clinical activities in which patients were participating (e.g. appointments, treatments). The results suggest that the teams’ IPPC practice reflected a duality of cultures (treatment-centred culture versus patient-centred culture). In addition, the IPPC practice of teams in the study fluctuated due to the influence of many factors, such as “how the team works,” “the physical environment” and the “stance” of patients and professionals. The results further suggested that the deployment of healthcare teams varied in intensity over the trajectory. The point was raised that patients experienced a variable IPPC practice, breakdowns in continuity of care, and difficult transitions between different periods in the trajectory. In addition, the description of the IPPC practice that patients, their family members and professionals would like to see suggests a form of accompaniment that would follow the patient’s own pace, without imposing professionals’ values, with assiduous collaboration from members of the team. This study suggests that nursing could advance current interprofessional knowledge by taking a patient-centred perspective, a perspective consistent with values in this discipline. In addition, many avenues for further reflection are put forward in terms of practice, research, management and training.