Enablers and barriers of first-year common semesters and semester-long courses aimed at interprofessional collaborative practice capability development: A scoping review.

Designing a first-year undergraduate common semester aimed at developing interprofessional collaborative practice (IPCP) capabilities is challenging. A scoping review was conducted to identify enablers and barriers for common semesters. Due to limited numbers of eligible studies, the review was expanded to include studies of semester-long first-year courses aimed at IPCP development. Key enablers of common semesters or courses in 35 included studies were: real-world, problem-solving, hands-on, interprofessional teamwork aligned with graduate practice capabilities relevant across disciplines; continuous feedback and critical evaluation; relationship building amongst students and staff; cohesive, well-trained interprofessional teams of staff and leaders; secure, supportive institutional policies and structures. Key barriers included: students' lack of preparation, perceptions of irrelevance, and misaligned expectations; variable student capability and response amongst professions; miscommunicated or misaligned course outcomes; course, faculty or institutional non-integration; and cost, logistic, and evaluation issues. Outcomes were mainly positive improvements in self-evaluated student IPCP skills and understanding, variability between professions, and persistent misconceptions. Scales measuring capabilities lacked uniformity, and few studies were comparative or observational. Overall, the review suggests noncompetitive undergraduate first-year common semesters or courses positively impact IPCP capability development when robustly assessed, clearly evaluated, and supported by an integrated IPE culture.

Interprofessional practice: the path toward openness.

This article seeks to shed light on the meanings healthcare practitioners attach to practicing interprofessionally and how interprofessional relationships play out in "everyday" practice. It draws on findings from a hermeneutic phenomenological study of health professionals' lived experience of practice, interpreted in relation to Martin Heidegger's concept of a path through the dense forest which leads to an open space where there is no predefined path to follow. Analysis of data from in-depth, semi-structured interviews with 12 health professionals from medicine, midwifery, nursing, occupational therapy, physiotherapy, speech and language therapy, and social work suggests that health practitioners come upon the clearing having walked their own track toward practicing interprofessionally. Our argument is that when: getting to know others; genuine dialogue; trust; and respect are in play, a spirit of interprofessional practice flourishes. The ontological view presented, sheds light on the nature of the relationships and the personal qualities that foster a spirit of interprofessional practice in these human-to-human interactions. It highlights how health practitioners need to be free to enact their humanity; to move beyond the "professional" pathway, which encourages them to leave "who they are" at home.

Existing models of interprofessional collaborative practice in primary healthcare: a scoping review.

Educating students to provide interprofessional collaborative practice (IPCP) in primary healthcare (PHC) requires a robust rigorous model relevant to future practice. A scoping review was undertaken to identify existing models of IPCP in PHC, the interprofessional or collaborative theories on which the models were based, reported outcomes, and enablers of and barriers to IPCP in PHC. The 35 eligible studies included 27 models, most of which were designed for a specific PHC site or program. Although almost half of the studies cited established interprofessional competencies in support of the models, only 13 included theoretical support, and only two cited interprofessional theory. Outcomes for clients, practitioners, practices, and students were primarily experiential and positive. A few researchers reported negative experiences or no difference between comparison groups. Key enablers of IPCP in PHC were strong supportive, inclusive relationships and practices. The most common barriers were time and resource constraints and poor understanding of IPCP. The review suggests a need for a stronger theoretical basis for IPCP in PHC that can accommodate different settings, and for more observational research that links relationship factors to outcomes at the practice, population, and wider health system levels.

Interprofessional practice: beyond competence.

Interprofessional practice is commonly discussed in the literature in terms of competencies. In this study we move away from the theoretical notions of criteria, concepts and guidelines to adopt an ontological approach which seeks to stay as close to the lived experience as possible. Our research asked 12 participants from a variety of health disciplines to tell their stories of working interprofessionally. We sought to glean meaning from the lived experience. Our phenomenological hermeneutic approach and interpretation were informed by Heidegger and Gadamer. Rather than offering a thematic overview, in this article we share three stories from the research that were congruent with other stories. The first, told by a doctor, is of a resuscitation in an emergency department. It shows how the effective working together of the interprofessional team was more than each member following a resuscitation protocol. There was 'something' about how they worked together that made this story stand out, even though the patient died. The second story showcases how 'who' the person is makes a difference. This nurse makes an effort to get to know other staff as people, to find common interests. In such a way interprofessional practice comes to flourish. The third story shows how a physiotherapist and a psychologist joined in conversation to seek innovative possibilities for a challenging situation. In such a way each built on the others expertise and were excited at the success they achieved for the patient. From these ontological accounts we have come to see that interprofessional practice flourishes when practitioners are their authentic, caring selves. Who the person is matters.

Working in a spirit of interprofessional practice: a hermeneutic phenomenological study.

Interprofessional practice is recognized as essential to providing patient-centered, collaborative and high quality care, contributing to optimal health outcomes. Understandings of how best to cultivate practitioners able to 'be' and 'become' interprofessional remain problematic. To advance that understanding, this hermeneutic phenomenological study addressed the question: 'What are health professionals' experiences of working with people from other disciplines?' In-depth, semi structured interviews with 12 health professionals from nursing, occupational therapy, physiotherapy, speech and language therapy, medicine, social work, and midwifery were undertaken using a conversation style. Three unifying themes revealed things which appear to be at the 'heart' of interprofessional practice; the call to interprofessional practice, working in a spirit of interprofessional practice and safeguarding and preserving interprofessional practice. This paper focuses on the first two themes. The findings contribute to a deeper understanding of interprofessional practice as a way of being that extends beyond known and measureable skills and knowledge, to dispositions and qualities. Dispositional qualities come from within a person and what they care about, and from experiences that shape their understandings. This study points toward interprofessional practice as being about a spirit. Who people are, what they bring and how they act is what matters.

Navigating Interprofessional Spaces: Experiences of Clients Living with Parkinson's Disease, Students and Clinical Educators.

When students in interprofessional education and practice programmes partner with clients living with a long-term condition, the potential for a better client and educational experience is enhanced when the focus is on client self-management and empowerment. This paper reports the findings from a phenomenological study into the experiences of five clients, six speech language therapy students, eight physiotherapy students, and two clinical educators participating in a university clinic-based interprofessional programme for clients living in the community with Parkinson's Disease. Collaborative hermeneutic analysis was conducted to interpret the texts from client interviews and student and clinical educator focus groups held immediately after the programme. The overarching narratives emerging from the texts were: "client-centredness"; "who am I/why am I here?"; "understanding interprofessional collaboration and development"; "personal and professional development, awareness of self and others"; "the environment - safety and support". These narratives and the meanings within them were drawn together to develop a tentative metaphor-based framework of "navigating interprofessional spaces" showing how the narratives and meanings are connected. The framework identifies a temporal journey toward interprofessional collaboration impacted by diverse identities and understandings of self and others, varying expectations and interpretations of the programme, intra- and interpersonal, cultural and contextual spaces, and uncertainty. Shifts in being and doing and uncertainty appear to characterise client-driven, self-management focused interprofessional teamwork for all participants. These findings indicate that students need ongoing opportunities to share explicit understandings of interprofessional teamwork and dispel assumptions, since isolated interprofessional experiences may only begin to address these temporal processes.

Cultivating interprofessional practice in New Zealand: an inter-sectorial approach to developing interprofessional education.

The World Health Organization (WHO) challenges health providers to commit to and champion interprofessional education (IPE) and interprofessional collaboration (IPC), arguing that IPE promotes IPC, which in turn improves health outcomes. Providing opportunities for students to engage in IPE, which occurs when current or future practitioners learn from, with, and about one another, ensures that health providers are in line with the WHO imperative of 2010. This paper describes the process of developing and implementing an undergraduate IPE initiative within a large New Zealand district health board, Counties Manukau Health, which provides clinical placements for over 500 students annually. This initiative involved 2 half-day interprofessional workshops attended by 123 students from seven disciplines. The impact of the interprofessional learning on students' perceptions and their confidence in relation to teamwork, communication, and interprofessional interaction were evaluated. Overall, students had a positive view of interprofessional communication and teamwork, and their opinion of relationships with other professionals improved following participation in the workshops.