Thesis (M.S.)--University of Wisconsin, School of Nursing. / eContent provider-neutral record in process. Description based on print version record.

Made available in DSpace on 2018-06-18T13:27:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2017 / Introdução: As residências multiprofissionais em saúde (RMSs) no Brasil surgem como uma das estratégias utilizadas para fomentar o processo de aprendizado em serviço, visando a consolidação das propostas do SUS. Enquanto tal, as RMSs se inseriram em diversos cenários, desde o hospitalar até o nível de atenção básica, quando de sua implementação na Estratégia de Saúde da Família. Contudo, apesar de seu grande alcance, ainda são restritas às iniciativas que buscaram compreender, conhecer e avaliar tais residências e seu impacto na formação dos profissionais de saúde. Objetivos: analisar a percepção dos residentes multiprofissionais em saúde em relação às motivações e vivências no âmbito dos Programas de Residências Multiprofissionais em Saúde desenvolvidas no Hospital São Paulo (HSP)/Universidade Federal de São Paulo (UNIFESP), assim como mapear suas motivações, apreender as concepções dos residentes sobre trabalho em equipe, discutir as dificuldades que os residentes identificam para o trabalho em equipe multiprofissional e mapear as contribuições da Residência Multiprofissional para o trabalho em equipe. Métodos: Trata-se de uma pesquisa qualitativa, de caráter descritivo-exploratório. Os dados foram coletados por meio de entrevistas semiestruturadas. A população analisada foi composta por residentes do primeiro e do segundo ano da Residência Multiprofissional em Saúde do HSP-UNIFESP. As entrevistas foram gravadas e transcritas e os dados analisados por meio da técnica de análise de conteúdo, modalidade temática. Resultados e Discussão: Um total de 17 residentes multiprofissionais foram entrevistados. As categorias temáticas relevantes para este estudo foram: motivação para a inserção da RMS, concepção sobre o trabalho em equipe na RMS, dificuldades do trabalho em equipe multiprofissional e contribuição da residência para a atuação em equipe multiprofissional. As percepções colhidas por meio deste trabalho apontam para uma heterogeneidade entre as experiências dos residentes multiprofissionais. As motivações que levaram à busca pela RMS foram, em sua maioria, pragmáticas e voltadas à obtenção de uma formação complementar após a graduação. Ainda que muitos dos sujeitos tivessem conhecimento prévio do conceito de trabalho em equipe multiprofissional, a experiência foi inédita para todos e foi apontado ganho significativo no que tange à prática da multiprofissionalidade. Os sujeitos apontam, contudo, dificuldades expressivas na condução de tal trabalho, notadamente uma dicotomia entre o projeto pedagógico elaborado e o implantado, evidenciando uma quebra de expectativas no processo de formação. Ainda assim, a experiência foi avaliada pela maioria como significativa enquanto preparo para a futura prática profissional fora do cenário acadêmico supervisionado. Ademais, muitos participantes salientaram o papel da experiência na RMS como catalisador de um processo de autoconhecimento. Conclusão: O estudo representa um aprofundamento sobre as atividades de ensino dentro das RMSs. As categorias analisadas representam pontos essenciais para o aperfeiçoamento do processo de formação dos residentes da área multiprofissional em saúde, além da necessidade de uma aproximação entre o projeto pedagógico elaborado e as práticas de ensino. Ações de integração ensino-serviço específicas poderão melhorar a avaliação da RMS por meio de estratégias de ensino. Dentre tais estratégias, emerge a criação de um grupo interprofissional de reflexão sobre as práticas na RMS, configurando-se o produto desta pesquisa. São necessários outros estudos que possam abordar a perspectiva do professor e do preceptor nas RMSs para ampliar e articular com os achados e as análises produzidas nesse estudo. / Introduction: Multiprofessional residencies in the health field exist in Brazil merging as one of the strategies employed to increase the process of hands-on learning, seeking the consolidation of the propositions of the SUS (Brazilian Public Health System). As such, the multiprofessional residency programs have inserted themselves in many scenarios, from hospital-based to primary care, when they were implemented in the Family Health Strategy. However, despite its broad reach, there are few initiatives seeking to understand, know and evaluate said residencies and their impact in the shaping of health professionals. Objectives: This research sought to analyze the perception of multiprofessional residents regarding conceptions and experiences of interprofessional work within Multiprofessional Residencies in Health in HSP-UNIFESP. Methodology: This project consisted in a qualitative research, of descriptive-exploratory character. The data was collected through semi-structured interviews. The analyzed population were the first and second year residents of the Multiprofessional Health Residency program of the HSP-UNIFESP. Interviews were recorded and transcripted and data was analyzed through the content analysis technique, thematic modality. Results: A total of 17 multiprofessional residents were interviewed. Thematic categories relevant to this study were: motivation for the insertion in the Multiprofessional Health Residency program, conception of teamwork in the Multiprofessional Health Residency program and contribution of the Multiprofessional Health Residency program to working in a multiprofessional team. The perceptions captured by this study point towards a certain heterogeneity among the experiences of residents. The motivations that led to seeking a Multiprofessional Health Residency program were, for the most part, pragmatic and aimed towards the obtention of a complementary formation after completing a degree. Even though many subjects had previous knowledge of the concept of work in a multiprofessional team, the experience was new to all and pointed as a significant gain regarding Multiprofessional practice. Subjects pointed out, however, that there were expressive difficulties in the conduction of said work, notably a dichotomy between the elaborated pedagogical project and the one that was implemented, showing a break of expectations in the formation process. Furthermore, many participants highlighted the part that the Multiprofessional Health Residency program played as a catalyzer in a self-knowledge process. Conclusion: The study represents a deepening on the teaching activities within the Multiprofessional Health Residencies. The analyzed categories represent essential points towards perfecting the formation process of residents in the multiprofessional health field and also the need of an approximation between the formulated pedagogical project and the teaching practices. Specific actions in integration between teaching and practice can improve the evaluation of Multiprofessional Health Residency programs through teaching strategies. Among those strategies is the creation of an interprofessional group meant to rethink practices in the Multiprofessional Health Residency program, as well as other studies that can address the professor and preceptor perspectives in Multiprofessional Health Residency programs in order to complement the information obtained in the study.

Introdução. O trabalho em equipe interdisciplinar é considerado um importante pressuposto para reorganização do processo de trabalho nas práticas de promoção da saúde e prevenção de doenças, visando a uma abordagem mais integral e resolutiva. Objetivo. Discutir aspectos das relações disciplinares entre profissionais de saúde, incluindo barreiras e facilitadores à prática da interdisciplinaridade, tomando como referência o caso de um centro universitário voltado ao ensino e pesquisa em promoção da saúde e prevenção de doenças na prática clínica. Método. Pesquisa qualitativa, realizada no Centro de Promoção da Saúde do Serviço de Clínica Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (CPS-HCFMUSP), com emprego de observação participante e entrevistas semiestruturadas com profissionais de saúde, iniciada após prévia aprovação do Comitê de Ética em Pesquisa e consentimento esclarecido dos entrevistados. Os dados foram submetidos à análise qualitativa, através da análise de conteúdo, modalidade temática. Resultados. Encontram-se práticas realizadas por profissionais com mesmos objetivos, porém com pequena interação entre si, sem método e linguagem comuns, trabalhando sem integração, mas com conhecimento unificado e com diferentes níveis de hierarquia horizontal. No conjunto, esta situação pode representar um momento de transição da pluridisciplinaridade para a interdisciplinaridade. Conclusão. A interdisciplinaridade no caso avaliado não é uma realidade posta, mas um processo ainda em evolução. Fatores sócio-culturais, institucionais e subjetivos podem agir tanto como facilitadores quanto como obstáculos à interdisciplinaridade. / Introduction. Interdisciplinary teams are considered an important premise for the rearrangement of the work process in practices of health promotion and disease prevention, aiming at an integral and resolutive approach. Objective. Discuss the disciplinary relationships among health professionals, including barriers and facilitators to the practice of interdisciplinarity, in the context of a university center for education and research in health promotion and disease prevention in clinical practice. Method. Qualitative research, conducted at the Centro de Promoção da Saúde do Serviço de Clínica Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo -CPS-HCFMUSP, using participant observation and semi-structured interviews with health professionals, started up after approval by the HCFMUSP - Research Ethics Committee and the informed consent of interviewees. The data was subjected to qualitative content analysis, on the basis of thematic modality. Results. It was observed practices performed by professionals with little interaction, no common language and method and lack of integration, but with similar goals, unified knowledge and different levels of horizontal hierarchy. Overall, this may represent a moment of transition from multidisciplinary to interdisciplinary work. Conclusion. Interdisciplinarity is not a fact, but a process still in evolution. Socio-cultural, institutional and individual factors can act both as facilitators or as barriers to its implementation.

Objectives: Transitions of care (ToC) for a high-risk neonatal population, and in some cases inappropriate and early discharge, can have important implications for community and broader population health. As it is a key indicator of the efficiency of the system of health services, the ease of ToC has been a priority for improving care outcomes across all settings in our nation’s healthcare system. Research shows that inappropriate discharges can lead to negative outcomes for patients and their families, health professionals, and the health system. Collaboration amongst the health care professionals, the community, and the patient’s family is needed for an efficient transition. This research examined how interprofessional collaboration (IPC) can act as a catalyst for efficient and effective ToC from a high-risk neonatal unit to care back in the community. Approach: Twelve infants were observed from their admission on the Neonatal Intensive Care Unit (NICU) until their discharge home. The 12 consisted of four patients discharged directly home, four to another unit within the same hospital, and four to another institution. Stage one involved a document analysis of documents related to ToC policy on the NICU. Stage two involved observation. Stage three involved interviews with healthcare professionals (HCPs) in the hospital and community (n=30) and family members (n=12). Stage four consisted of deliberative workshops with the hospital management and research participants to share the results and obtain their feedback. Results: Including parents early in the ToC planning process helps parents feel they’re a part of the interprofessional care team, in-charge of their infant’s care and thus better equipped mentally to handle their infant’s ToC. Knowing early on their infant’s discharge plan allows parents the opportunity to ask questions regarding caring for the infant at home or to meet the new healthcare team at the new site (hospital/floor) prior to the transfer. Mechanisms need to be in place to ensure that communication regarding ToC is consistent and clear to and between all HCPs whether in the hospital (e.g. bedside nurse) or in the community (e.g. family doctor). Having a clear understanding of what information should be transferred during a ToC will prevent unnecessary tests and misunderstandings. Increasing HCPs’ knowledge of available community resources will aide in transitioning infants to community care and thus freeing bed space and decreasing unnecessary costs at the hospital (i.e. A feeding and growing baby can be weighed by family doctor or Rapid Response Nurse and not necessarily the neonatologist). A consistent ToC policy across all NICUs would also be beneficial to ensuring a smoother ToC of infants. Conclusion: It is believed that communication and education in an interprofessional context is critical for more efficient and effective ToC of neonates.

The purpose of this DNP project was to determine the feasibility of implementing a nurse practitioner led interprofessional collaborative management model of caring for patients with complex medical conditions who are at high risk for ED and hospital readmission. The target of the feasibility study was an accountable care organization (ACO) in Idaho. The ACO assumes greater financial risk for providing care to a population that includes Medicare Advantage patients - dual insured Medicare/Medicaid patients. The care management teams are currently led by physicians. The members of the population that suffer most from multiple chronic conditions often encounter barriers to accessing high quality primary care, in particular when transitioning between different levels of care. Interprofessional collaborative team based care coordination can address medical and social issues that can affect a patient’s ability to achieve/maintain wellness. The literature suggests that nurse practitioners are ideally suited to lead those teams Approval was given by leadership in the ACO to accomplish a study to determine the feasibility of successfully implementing an innovative NP led interprofessional collaborative care management model: the AEIØOU Bundle of Care Practices. Principles of qualitative descriptive methodology, using content analysis, were applied to explore the responses provided at individual interviews by thirteen key stakeholders. The data collected were not intended to be generalized, but rather to evaluate the potential for implementation of a new model of interprofessional collaborative care within the ACO. Findings suggest that implementation of this model is feasible within the ACO. Common themes uncovered include: (a) change is challenging, (b) coordinated patient care aligns with organizational goals, (c) success requires cost analysis, a comprehensive business plan, buy-in from primary care physicians, and a pilot program, and (d) strong support among all participants for NP and RN home visits was notable.

Philosophiae Doctor - PhD / The complexity of human health and its determinants has been developing gradually and the means to attend to them has gone beyond the scope of a specific health discipline. Advocacy is underway by health stakeholders such as the World Health Organisation (WHO), higher learning institutions and individual scholars to incorporate interprofessional practice initiatives in health as a means of ensuring that health practitioners share ideas communicate and collaborate in order to put forward a comprehensive management plan for patients. These initiatives seek to ensure that a problem that could hardly be solved uniprofessionally is shed light on. The University of the Western Cape (UWC) is among the universities in the world that have incorporated an Interdisciplinary Core Courses Curriculum to be undertaken by all undergraduate students enrolled in the Faculty of Community and Health Sciences (FCHS) hence aiming at producing graduates who are collaboration conscious in their practice. This effort adds into the UWC’s endeavor of producing socially responsible graduates. This study analysed the UWC curriculum in order to ascertain its cognitive rigor for delivery of the interprofessional competencies. It further sought to identify whether the effort that the FCHS is putting through the Interdisciplinary Core Courses in having an impact on the perceptions of final year students during their field work placements in various health care institutions. The study also sought to find out whether the health care institutions practice policies are interprofessional practice friendly. Finally, the views and perceptions towards interprofessional collaboration (IPC) of institutional manager’s for institutions where UWC places more than one discipline of students for practice were explored.

Organizations face challenges constantly owing to limited resources. As such, to take advantage of new opportunities and to mitigate possible risks they look for new ways to collaborate, by sharing knowledge and competencies. Coordination among partners is critical in order to achieve success. The segmented South African public sector is no different. Driven by the desire to ensure proper service delivery in this sector, various government bodies and service providers play different roles towards the attainment of common goals. This is easier said than done, given the complexity of the distributed nature of the environment. Heterogeneity, autonomy, and the increasing need to collaborate provoke the need to develop an integrative and dynamic coordination support service system in the SA public sector. Thus, the research looks to theories/concepts and existing coordination practices to ground the process of development. To inform the design of the proposed artefact the research employs an interdisciplinary approach championed by coordination theory to review coordination-related theories and concepts. The effort accounts for coordination constructs that characterize and transform the problem and solution spaces. Thus, requirements are explicit towards identifying coordination breakdowns and their resolution. Furthermore, how coordination in a distributed environment is supported in practice is considered from a socio-technical perspective in an effort to account holistically for coordination support. Examining existing solutions identified shortcomings that, if addressed, can help to improve the solutions for coordination, which are often rigidly and narrowly defined. The research argues that introducing a mediating technological artefact conceived from a virtual community and service lenses can serve as a solution to the problem. By adopting a design-science research paradigm, the research develops a model as a primary artefact to support coordination from a collaboration standpoint. The suggestions from theory and practice and the unique case requirement identified through a novel case analysis framework form the basis of the model design. The proposed model support operation calls for an architecture which employs a design pattern that divides a complex whole into smaller, simpler parts, with the aim of reducing the system complexity. Four fundamental functions of the supporting architecture are introduced and discussed as they would support the operation and activities of the proposed collaboration lifecycle model geared towards streamlining coordination in a distributed environment. As part of the model development knowledge contributions are made in several ways. Firstly, an analytical instrument is presented that can be used by an enterprise architect or business analyst to study the coordination status quo of a collaborative activity in a distributed environment. Secondly, a lifecycle model is presented as meta-process model with activities that are geared towards streamlining the coordination of dynamic collaborative activities or projects. Thirdly, an architecture that will enable the technical virtual community-centric, context-aware environment that hosts the process-based operations is offered. Finally, the validation tool that represents the applied contribution to the research that promises possible adaptation for similar circumstances is presented. The artefacts contribute towards a design theory in IS research for the development and improvement of coordination support services in a distributed environment such as the South African public sector.

This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. A comparative case study was conducted with two interprofessional primary health care teams. The data collection included a total of 26 interviews (13 with each team) and non-participant observations of team meetings (2-3 meetings at each site). Thematic analysis was used to analyze the data and a model was developed to represent the emergent findings. The role boundaries are organized around interprofessional interactions (autonomous-collaborative boundaries) and the distribution of tasks (interchangeable-differentiated boundaries). Salient influences are categorized as structural, interpersonal and individual dynamics. The implications of role construction include professional satisfaction and more favourable wait times for patients. The elements in this conceptual model may be transferable to other interprofessional primary health care teams. It may benefit these teams by raising awareness of the potential impact of various within-team influences on role construction.

Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students in five universities across Ontario, Canada Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. The results of the survey demonstrated that self-reported knowledge confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy’ students. The percentage of residents and students who self-reported themselves confident was less than 60% for all global health issues. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and face and content validity. The new century requires professionals competent in global health. Improvements in the core competencies in global health can be a bridge to a more equal world. Institutions must offer interprofessional approaches and a curriculum that exposes them to a varied learning methods and opportunities to improve their knowledge and skills in global health.

Class of 2017 Abstract / Objectives: To facilitate a discussion among various healthcare professionals about the facets of interprofessionalism that occur, or do not occur, in a rural acute healthcare setting, and how interprofessionalism could be integrated into the facility’s current healthcare professional student programs. Methods: A focus group was conducted with 8 participants lasting about 45 minutes. Participants were one of three different professions (nurse, medical doctor, or pharmacist) and included administrators as well as staff employees. Six questions were discussed among participants and the answers from each participant were scripted onto a word document. This document was thematically analyzed and compared and contrasted to a previous study, which asked the same six questions in a different rural acute healthcare site. Results: The main findings of this study were that workforce shortage, lack of computerized physician order entry (CPOE), and lack of a uniformity throughout the hospital affected interprofessional practice, learning, and education. Conclusions: Perceived barriers of interprofessional practice at Canyon Vista Medical Center included: poor communication, understaffing, lack of a unified, computerized EHR throughout the hospital, and unclear policies. Some proposed ways to overcome these barriers include having a full staff, creating a unified electronic health record (EHR) system, offering interprofessional learning opportunities, and providing employees the opportunity to gain experience in departments other than their own.