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Family-centered care (FCC) is recommended as “best practice” across a variety of pediatric service settings, as it yields better health and wellness outcomes for clients, and greater work satisfaction for practitioners and administrators (American Academy of Pediatrics, 2012). However, providers in multiple health care fields report challenges with translation of FCC concepts into their practice (Bamm & Rosenbaum, 2008; Graham, Rodger, & Ziviani, 2008; Lawlor & Mattingly, 1998; MacKean, Thurston, & Scott, 2005). Therefore, the aim of this doctoral project was to understand the barriers to FCC implementation, and to propose ways for supporting practitioners to enact FCC in their practice. The resulting solution is Better Together, an on-line professional development course designed to empower health care providers to become ambassadors of FCC and effectively enact the FCC practices in their daily interactions with clients and their families. The Better Together course content and structure are based on findings from a review of the literature specific to identifying core skills and knowledge essential for effective FCC practice, as well as best practices for professional development instruction. Methods for course implementation, funding, and dissemination are described, as well as a research plan for program evaluation.

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: Interprofessional education (IPE) is a way to make students in healthcare professions equipped with the collaborative skills required for today’s complex healthcare. In clinical placements students from health profession programs can learn with, from and about each other so that they can collaborate effectively and deliver high-quality healthcare. The interprofessional education is possible through supervision from health professions who collaborate around the student learning and the patient healthcare.  Aim: The aim of this study is to gain knowledge about the learning process in IPE that take place in an Interprofessional Training ward (IPTW) from the supervisor teams’ perspective.  Method: In an IPTW students from occupational therapist-, physiotherapist-, medical- and nursing programs form teams for IPE in periods of two weeks with supervisor teams. With an inductive method, interviews with focus groups consisting of supervisor teams have been conducted and analyzed through thematic analysis.  Results: Based on the supervisor teams' experiences of creating interprofessional learning with student teams in the daily work with the care of patients, a learning process has been made visible. This learning process has been written out as a model and analyzed using known obstacles and enablers for IPE from supervisor perspective. The model has also been interpreted through pedagogical theory that has been used in IPE. Conclusion: The supervisor teams use a learning process with pedagogical models and strategies to handle obstacles and enablers to create understanding and change towards an interprofessional collaboration among the students. These models and strategies are supported by pedagogical theory. There is a gap in research on how IPE is carried out by interprofessional supervisor teams’, however the findings of this study contribute with new knowledge about how a learning process can be used in IPE.

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Att handleda studenter på klinisk undervisnings avdelning (KUA) har bedrivits under ett tjugotal år. Studenter från olika utbildningsprogram inom hälso- och sjukvårdsutbildningar utvecklar sin interprofessionella kompetens under en tvåveckorsperiod. Studier visar att interprofessionellt lärande ger studenter en möjlighet att dels få en helhetssyn av patientens vårdbehov dels ökar förståelsen för varandras yrkesroller och kunskaper. Få studier har fokuserat på handledarnas erfarenheter inom detta ämne och om sin roll på KUA. Studiens syfte var att beskriva fenomenet KUA handledare genom handledares uppfattning om rollen som interprofessionell handledare och interprofessionellt lärande på KUA. En kvalitativ metod användes och 19 interprofessionella handledare från professionerna, arbetsterapi, läkare, sjukgymnast och sjuksköterska intervjuades individuellt. Texterna bearbetades och analyserades utifrån innehållsanalys. Utifrån analysen identifierades tre kategorier, ”handledaren”, ”handledningen” och ”KUA konceptet”. Det visade sig att interprofessionella handledare har ett genuint intresse och engagemang för handledning, studenter, pedagogik och samarbete. Olika strategier används i den interprofessionella handledningen. Handledarna arbetar med teamet i fokus dels för studenters lärande, dels för att visa på teamets betydelse för patientens vård i hälso- och sjukvård. KUA konceptet kräver både tid och engagemang av handledarna men uppfattas som ett bra koncept där studenterna tillsammans kan utveckla det interprofessionella samarbetet. Handledarnas inställning till studenters lärande och handledning gör skillnad i handledningen. Att vara interprofessionell handledare kräver kunskaper om såväl pedagogik som grupp och grupprocess. Studentteamens kunskaper driver KUA vilket påverkar handledningen. KUA konceptet har en positiv inverkan på handledarna och interprofessionell handledning uppfattas som stimulerande och utmanande. / Supervising students in a clinical training ward (CTW) has been used for some 20 years. Studies show that interprofessional learning gives students an opportunity to get a comprehensive view of a particular patient’s health-care needs, as well as an increased and mutual understanding of their colleague’s position and knowledge. Only a few studies have focused on the supervisor’s view of his or her own role within the activity of the CTW. The purpose of the study was to describe the CTW supervisor and his or her own perception of her role as an interprofessional supervisor as well as to describe interprofessional learning on its own at the CTW. A qualitative method was used, and 19 interprofessional supervisors from and within occupational therapy, along with physicians, physiotherapists, and nurses, were interviewed. The texts were content-analysed. Three categories were identified: ‘the supervisor’, ‘the supervision’, and ‘the concept of CTW’. It turned out that the interprofessional supervisor has a genuine interest and commitment to supervise, to work pedagogically, to collaborate, and to work with students. The supervisors all used different strategies, and they worked with the team in focus, partly for the benefit of the students but also to show the team’s importance in relation to the patient’s health care situation. The CTW concept requires lots of time and dedication from the supervisor, but it is perceived as a good concept where students can develop interprofessional collaboration. The supervisor’s understanding and approach to student learning makes a huge difference in the process of supervision. Being an interprofessional supervisor requires a pedagogical knowledge and understanding of a group and of the group process. The student’s team knowledge influences the CTW, which affects the supervision. The concept of the CTW has a positive impact on the supervisors, and the interprofessional supervision is perceived to be stimulating and challenging.

Improving patient outcomes has long been the rationale supporting calls to reform health care delivery systems and health profession education programs (Greiner, 2002; Institutes of Medicine, 2001, 2004; O’Neil & Pew Health Professions Commission, 1998). In 2003, the Institute of Medicine shared its vision statement for health professions education, asserting that “[a]ll health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches and informatics” (Knebel & Greiner, 2003, p. 3). Despite the importance placed on teamwork in health sciences education, little attention has been devoted to understanding underlying factors influencing student attitudes towards team learning (Curran, Sharpe, Forristall, & Flynn, 2008). The purpose of this study is to explore the importance of emotional and cultural intelligence in shaping pre-health students’ attitudes towards team-based learning. A non-experimental, cross-sectional study design was used employing correlational and multivariate regression analysis. Findings indicate: a) significant relationships between emotional and cultural intelligence to the value students place on group work; and, b) emotional intelligence accounts for approximately 3% of variance above and beyond the Big Five personality factors in predicting student attitudes towards group work. This study will inform interprofessional education policy and practice in two fundamental ways. First, the study provides insight on the importance of non-academic factors in shaping students’ attitudes towards team-based learning. Secondly, increasing understanding of emotional and cultural intelligence in early stagse of a student’s development influences their preparation for health professions careers.

Patient centred collaborative practice between nurses and physicians is currently being promoted worldwide. There is increasing evidence that post licensure interprofessional educational interventions improve patient outcomes but similar evidence for pre-licensure interprofessional learning is lacking. The impact of contemporary nursing and medical education on graduates’ ability to collaborate in the workplace is also unclear. To address this gap, an interview based qualitative study underpinned by hermeneutic phenomenology and informed by the theoretical lens of social identity was designed. Eleven junior registered nurses and eleven junior residents from a single healthcare jurisdiction each, in Canada and the United Kingdom (UK) were interviewed to explore how the processes that lead to socialization, professional identification and identity formation in professional schools are perceived to influence collaborative teamwork upon graduation. Data were as analyzed through iterative naive and thematic interpretations aligned with the hermeneutic process, to arrive at a comprehensive understanding. The impact of contemporary undergraduate nursing and medical education on the ability to practice collaboratively was found to be obfuscated by internal contradictions and overshadowed by the contingencies and demands of the workplace, during residency and early nursing practice in both locations. In medical schools, the intense socialization described in literature was replaced by individual reflection and a struggle to maintain work-life balance. Values internalized were of a sense of responsibility and hard work. Students espoused an attitude of collaboration but lacked training in enabling competencies and practical application. Exposure to interprofessional learning and its impact was variable and inconsistent and formal assertions of collaboration were not consistently modeled by faculty. In nursing schools, the value of caring, self-awareness and assertiveness was promoted. Training for collaboration with physicians was largely transactional and teaching about the status of the nurse vis-à-vis the physician was mired in contradictions. Residents and the nurses could not rely on their experience of professional school as they transited to the workplace. Initiation was frequently precipitous and contingencies of the workplace determined how they acted. For residents the community of clinical practice was fluid and repeatedly new. Both residents and nurses were overwhelmed by unpreparedness, workload, and responsibility and acted to get by and get the job done. Residents learned to preface doing the best for the patient and not compromising patient care, while nurses became proficient at routine tasks and found fulfilment as the patient’s advocate. There was a propensity for conflict when uniprofessional roles and values collided. In busy wards each group had interdependent but competing priorities which lead to adversarial expressions of uniprofessional identity and consequent derogatory out-group stereotyping. In contrast situations demanding urgent focused attention, such as a cardiac arrest, lead to the spontaneous formation of a collaborative team which briefly expressed an interprofessional identity. Complex cross-generational and gender based interactions were sometimes adversarial and provoked resentment. Consequently junior nurses retreated to derive fulfilment as the patient`s advocate while residents looked forward to collaborating with other health professionals on their own terms, in the future. Neither contemporary professional education nor the hospital environment sustained consistent collaborative practice. / Graduate

Collaborative practice in the healthcare system is of global interest to become cost-efficient and adaptable towards health care needs due to more complex challenges and shortages in qualified health workers. Health-sciences education should provide interprofessional education to promote learning for collaborative practice in their curricula. The interprofessional training ward is one form of interprofessional education in the clinical setting. Previous studies in the field of interprofessional education focused on self-reports by students. The focus on students leads to a lack of the supervisor´s perspective in interprofessional education. The aim of this study is to get insides of the supervisor´s perspective on how they perceive their work. This study was conducted with a qualitative methods approach with semi-structured interviews. Main results of this study were in different areas. Power relations between managers, supervisors, and students show a big impact about supervisor´s work satisfaction from appreciation from the managers. Supervisors usually feel appreciated by students but lack of appreciation from managers can lead to distress and decreased satisfaction. Supervisors go through different stages during their work period: First they have low confidence in their job role, after a period of time they are confident, but after a long period of time they can get tired of their work. The conclusion is even though the interprofessional training wards have already a lot of positive aspects, the managers should always remember themselves to support this kind of setting. Without the support of the managers, the whole project decreases its quality and the supervisor’s satisfaction.