Changing the channel: a qualitative analysis of an innovative video intervention to explore resident attitudes towards interprofessional collaboration on a Geriatric Medicine Unit.

Background: Medical learners develop a more positive attitude toward Interprofessional Collaboration (IPC) following Interprofessional Education (IPE) programs. However, IPE is not standardized, and the most effective teaching tool is unclear. The purpose of our study was to develop an IPE teaching tool for medical residents during an inpatient geriatric medicine rotation at an academic hospital, evaluate and explore the impact of the program on resident attitudes towards teamwork, and identify barriers and facilitators to interprofessional collaboration. Methods: An innovative video was developed which simulated a common IPC scenario. Near the start of the rotation, learners watched the video then participated in a facilitated discussion around principles of IPE, using the Canadian Interprofessional Health Collaborative (CIHC) framework, which highlights interprofessional communication, patient-centered care, role clarification, team functioning, collaborative leadership, and interprofessional conflict resolution. At the end of their four-week rotation, focus groups were conducted to explore resident attitudes towards IPE. The Theoretical Domain Framework (TDF) was used for qualitative analysis. Results: Data from 23 participants in five focus groups were analyzed using the TDF framework. Residents were able to identify barriers and facilitators to IPC in five TDF domains: environmental context and resources, social/professional role and identity, knowledge, social influences, and skills. Their observations correlated with the CIHC framework. Conclusion: The use of a scripted video and facilitated group discussion gave insights into residents' attitudes, perceived barriers, and facilitators towards IPC on a geriatric medicine unit. Future research could explore the use of this video intervention in other hospital services where team-based care is important.

Contexte: Les apprenants en médecine développent une attitude plus positive à l'égard de la collaboration interprofessionnelle (CIP) après avoir suivi un programme de formation interprofessionnelle (FIP). Toutefois, la FIP n'est pas standardisée et on ne sait pas quel outil d'enseignement est le plus efficace. Le but de notre étude était d'élaborer un outil de FIP pour les résidents en stage de gériatrie dans un hôpital universitaire, d'évaluer et d'explorer les effets du programme sur les attitudes des résidents à l'égard du travail d'équipe, et de recenser les facteurs qui entravent ou facilitent la collaboration interprofessionnelle. Méthodes: Une capsule vidéo innovante simulant un scénario courant de CIP a été créée. Au début de leur stage de résidence, les apprenants ont regardé la capsule et participé à une discussion animée sur les principes de la CIP, conformément au référentiel du Consortium pancanadien pour l'interprofessionnalisme en santé (CPIS), qui prône notamment la communication interprofessionnelle, les soins centrés sur le patient, la clarification des rôles, le fonctionnement de l'équipe, le leadership collaboratif et la résolution des conflits interprofessionnels. À la fin de leur stage de quatre semaines, des groupes de discussion ont été organisés pour explorer les attitudes des résidents à l'égard de la CIP. Un cadre de domaines théoriques (Theoretical Domains Framework) a été appliqué pour réaliser l'analyse qualitative. Conclusion: Au moyen d'une capsule scénarisée et d'une discussion de groupe dirigée, nous avons pu cerner les attitudes des résidents d'une unité de gériatrie par rapport à la CIP ainsi que leurs perceptions quant aux facteurs qui peuvent l'entraver ou la faciliter. Des travaux futurs pourraient explorer le recours à cette formule d'enseignement de la CIP dans d'autres services hospitaliers où les soins en équipe sont importants.

Selecting an interprofessional education model for a tertiary health care setting.

The World Health Organization describes interprofessional education (IPE) and collaboration as necessary components of all health professionals' education - in curriculum and in practice. However, no standard framework exists to guide healthcare settings in developing or selecting an IPE model that meets the learning needs of licensed practitioners in practice and that suits the unique needs of their setting. Initially, a broad review of the grey literature (organizational websites, government documents and published books) and healthcare databases was undertaken for existing IPE models. Subsequently, database searches of published papers using Scopus, Scholars Portal and Medline was undertaken. Through this search process five IPE models were identified in the literature. This paper attempts to: briefly outline the five different models of IPE that are presently offered in the literature; and illustrate how a healthcare setting can select the IPE model within their context using Reeves' seven key trends in developing IPE. In presenting these results, the paper contributes to the interprofessional literature by offering an overview of possible IPE models that can be used to inform the implementation or modification of interprofessional practices in a tertiary healthcare setting.

Evaluation of nurses' perceptions on providing patient decision support with cardiopulmonary resuscitation.

The decision whether to receive cardiopulmonary resuscitation (CPR) is a decision in which the personal values of the patient must be considered along with information about the risks and benefits of the treatment. A decision aid can be used to provide patient decision support to a patient who is seriously ill and needs to consider CPR options. The goal of this project was to identify the barriers and facilitators to using a CPR decision aid, through evaluating nursing perceptions on providing patient decision support. Using a needs assessment, it was determined that implementing a patient decision aid for CPR status in the Acute Monitor Area (AMA) of The Ottawa Hospital would be an excellent quality improvement project. The nurses who chose to participate were given an education session regarding patient decision support. Questionnaires were distributed to evaluate their views of patient decision support and decision aids before and after the education session and implementation of the CPR decision aid. Questionnaire results did not indicate a significant change between before or after education session and decision aid implementation. Qualitative reports did indicate that nurses generally have positive attitudes toward patient decision support and decision aids. The nurses identified specific barriers and facilitators in their commentaries. This clinically relevant data supports the idea that patient decision support should be integrated into daily nursing practice.

Evaluation of a natural health product decision aid: a tool for middle aged women considering menopausal symptom relief.

OBJECTIVE: To evaluate the effectiveness of a self-administered decision aid for menopausal women facing decisions about natural health products. STUDY DESIGN: This pre-/post-test study included peri- or post-menopausal women, aged 45-64 considering the use of a natural health product for management of menopausal symptoms. They were recruited from a Women's Health Center. OUTCOME MEASURES: The primary outcome was decisional conflict and secondary outcomes included knowledge, strength of values, and decision preference. RESULTS: Of 24 women, the typical participant was 50-64 years of age, Caucasian, married, and well educated. Compared to baseline, after using the decision aid, women's total decisional conflict was reduced from 63% to 24% (p<0.001) and knowledge improved from 76% to 87% (p=0.001). Of the 24 women, 10 were unsure of their choice at baseline and 3-post use of the decision aid (p=0.015). There was a trend for women preferring natural health products (n=12) to be more likely to rate the non-chemical aspect as important and the cost of the natural health product as less important; women who preferred not to take natural health products (n=3) rated the non-chemical aspect as less important and the costs as more important. CONCLUSIONS: The natural health product decision aid improved the quality of decisions by enhancing knowledge and reducing decisional conflict. As well, women were more likely to make a choice that was consistent with their values.

Decision coaching to support shared decision making: a framework, evidence, and implications for nursing practice, education, and policy.

BACKGROUND: Patients with values-sensitive health decisions frequently experience decisional conflict and require support. Decision coaching shows promise but little is known about the fit within the therapeutic relationship and factors influencing implementation of decision coaching in practice. AIMS: To offer an evidence-based decision coaching framework and explore implications for competency development and environmental infrastructures needed to facilitate client-centered decision coaching. METHODS: A review of the evidence and our experience supporting the development of a framework for decision coach-mediated shared decision making that outlines the roles of the primary practitioner, the patient, and decision coach for achieving high-quality health decisions. IMPLICATIONS: Competence in providing decision coaching requires knowledge and skill building at both pre- and post-licensure levels. Practice environments, regulatory bodies, educational systems, and professional and accreditation organizations are vital to successful integration of decision coaching skills into practice. Practical, visible, accessible, evidence-based, and equitably enforced regulations and policies endorsing patients' decision support interventions are essential. CONCLUSIONS: Enhancing nurses' coaching skills for supporting patients and their families in decision making can be fostered through interventions aimed at the nurses, educational systems, and regulatory organizations. Further research and pragmatic evaluation are needed to better support the acquisition and implementation of decision coaching for all types of health decisions. APPLICATION TO NURSING PRACTICE: The framework indicates the practitioner's role in diagnosing the problem, providing options, and screening for decisional conflict. Decision coaching involves assessing factors influencing patients' decisional conflict, providing support to address decisional needs, monitoring progress in decision making, and screening for factors influencing implementation. Informed patients share their values and preferences shaped by their personal situation.