"Although there is widespread and growing belief that Interprofessional Education (IPE) may improve interprofessional collaboration, promote team-based health care delivery, and enhance personal and population health, definitive evidence linking IPE to desirable intermediate and final outcomes does not yet exist." (Institute of Medicine [IOM], 2015, p. 6)
Nursing professional development (NPD) specialists are increasingly being tasked to develop educational curricula that are associated with measurable quality improvements and/or clinical outcomes. In order to address these needs, it is imperative that NPD specialists offer training programs that are evidence based, data driven, and associated with a particular quality improvement or patient care goal while maintaining relevance for the learners. At first glance, this task may appear daunting, however, it is certainly not insurmountable. One solution we recommend involves prioritization of the learning objectives, while using the interprofessional team (IPT) platform to provide the realism and clinical relevance.
Almost all of what we do as clinicians involves interprofessionalism. Although our roles and responsibilities may differ, as we focus on our patients and the optimal care to be delivered, it is not difficult to see how interprofessional (IP) training and team environment brings together the competency domains (Values/Ethics, Roles/Responsibilities, IP Communication, and Teams and Teamwork) described in the 2011 Core Competencies for Interprofessional Collaborative Practice that all disciplines strive to achieve. So, why not develop our training curriculum involving IPT setting?
Our previous column introduced these interprofessional collaborative competency domains, and challenged NPD specialists to think about ways to incorporate these domains into their existing interprofessional education (IPE). One strategy to consider involves utilizing the framework set forth by the IOM and the five competencies for IPT. This IOM framework below highlights individual components and how they can be developed to enhance the quality of the IPT training, which we believe will ultimately improve patient-centered care (IOM, 2003) (see Figure 1).
Here are two practical suggestions to consider for all of our outstanding NPD specialists. For the vast majority of the NPD specialists, the objective of training involves an aspect of applying the current evidence-based practice to improve the quality of patient care. We encourage strategies that allow for data acquisition that is simple but relevant, to support the notion that it has improved the overall IPT training experience.
Using code response emergency team training as an example, one might track the rate and depth of the CPR being performed as well as the percentage of time off the chest. Using the actual data from the team's performance to debrief can serve as a powerful tool to allow for meaningful reflection and for identification of key areas for improvement. Both are essential to promote deliberate practice. The resuscitation literature clearly demonstrates the importance of adherence to the American Heart Association Basic Life Support and Advanced Cardiac Life Support guidelines. Deviation in rate, depth, percentage of time off the chest, and similar metrics have all been associated with a decrease in percentage of return of spontaneous circulation and overall survival to discharge (Ornato et al., 2012).
For other NPD specialists who are already armed with data to support the value of their training, we would encourage moving toward obtaining objective data over subjective data. As an example, many NPD specialists still rely on the Likert-based evaluation (reaction evaluation) to provide the main thrust for the validation of their training curriculum. Although it is important to show one can engage and motivate the learners to learn, it would be more compelling to the healthcare administration, if one could show a correlation between increases in individual and team motivation to patient care outcome measures. One way to approach this may be to maintain a log of the observed behavior or performance measures of the team, and to perform a longitudinal chart review or institutional data review to see if there is any positive correlation between the training results and improved patient care.
One of the most effective ways to improve the quality of simulation training is by improving the quality of the debriefing. Debriefing in simulation is arguably one of the most important facets of the training session. It also provides an outstanding platform for the NPD specialist to highlight aspects of the five core competencies of the IOM IPT principles and to reinforce their adoption into clinical practice. Discussions involving who, what, why, and how to better integrate the five competencies will certainly engage the learners to think more proactively and outside the proverbial box, providing them with the opportunity to generate more insight on how to improve patient outcomes. Such debriefing facilitation also goes beyond the more traditional debriefing techniques of asking the learners what went well and what could be done better.
So what does this mean for NPD specialists whose scope of influence is primarily in nurse-focused departments? It means that there might be a need to seriously consider developing partnerships with other professions within or outside of the facility in order to build an IP dimension to team training. We are doing ourselves a great disservice if we fail to train interprofessionally, as most of all patient care involves interprofessionalism. This can pose a challenge for many practice areas if authentic collaboration among the different professions is underdeveloped. Before effective IPE can be taught in a clinical area, there must already be a shared commitment to develop a solid baseline of IP collaborative practice; otherwise, IP team training will likely never materialize.
NPD specialists are well versed in evaluating competencies for nursing and nursing staff, particularly those competencies related to clinical skills. The time has come for NPD specialists to move beyond simply providing IPE. We must also advocate for IPE based on IP competencies, evaluating healthcare provider competencies in this area and documenting improvements in outcome measures. NPD specialists need to heed the call of the IOM and seek ways to demonstrate that IPE actually makes a difference for our patients, and does not just end with what is perceived to be good teamwork without the betterment of patient outcomes.
Our future columns will explore ways to develop simulation debriefing sessions focused on the differing viewpoints of the learner and the patient. We will explore debriefing techniques that lead the learner to develop insight into how their IP skills can lead to better patient outcomes. We will also explore debriefing techniques that focus on determining how a patient would view the teamwork and communication skills exhibited by the healthcare team. Did the team's communication and teamwork lead to a better patient outcome? Or did it just result in better communication and teamwork, but had little to no effect on the patient?
Do you currently engage in IP simulation education at your facility? How are you documenting end results? Please e-mail us to continue the conversation at mailto:[email protected] and mailto:[email protected].
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