Interprofessional Education and Practice

Interprofessional education refers to the process through which several professionals from different disciplines learn with, from and about each other’s practice (Centre for Advancement of

Interprofessional Education, 2002; Orchard & Bainbridge, 2010; Stone, 2009). Its main goal is to prepare professionals for collaborative and relationship-centred health care practice resulting in optimal health outcomes. Collaboration itself requires some clarification; in health care the term implies “collective action based on trust and good will towards a common purpose” (D'Amour, Ferrada-Videla, San Martin Rodriguez, & Beaulieu, 2005, p. 116).

The concept of an interprofessional approach to family health care is not new. In the early 1950s, the University of Washington’s Child Health Centre offered common student experiences in disciplines including medicine, nursing, psychiatry, social work, nutrition, psychology, dentistry, dental hygiene and medical technology to promote a family-focused education within a primary health care

framework (Baldwin, 2007). Interprofessional practice emerged from a shift to more efficient health care delivery, particularly community-based client care, and the development of advanced practice nursing (Gunn, 2016). The interprofessional reform developed in response to workforce shortages and quality and safety issues. Collaboration between key stakeholders, including those in the health system, government and health education, and professional bodies who were more likely to resist the change, was identified in the literature as essential to the success of the reform (Travaglia, Nugus, Greenfield, Westbrook, & Braithwaite, 2011). Teamwork, where team members are willing to work together and share a common goal, was proposed as a second essential element of success (D'Amour & Oandasan, 2005).

The term ‘multidisciplinary’ was used until the mid-1970s when the term ‘interprofessional’ became more popular, especially in relation to clinical practice. Both terms have been used interchangeably in

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the literature (Baldwin, 2007, p. 34) although D’Amour and Oandasan (2005) argued that the two concepts were clearly distinct. Interdisciplinarity, they proposed, arose from concerns about fragmented disciplinary knowledge and was established as a mean of supporting early interaction, solidarity and interdisciplinary communication. In contrast, the concept of interprofessionality was a response to the alarming fragmentation of health care practice that resulted from silo-like divided professional responsibilities. Kuipers, Ehrlich and Brownie (2014) argued strongly that

interprofessional practice was a necessary response to the increasing complexity in health care and the ensuing demand for a more flexible, dynamic, collaborative and highly skilled workforce.

In 2010 the WHO released its Framework for Action on Interprofessional Education and

Collaborative Practice which had been produced by the Health Professions Networks Nursing and

Midwifery Office within the Department of Human Resources for Health (WHO, 2010). The aim of the framework was to support the development of a “collaborative practice-ready health workforce underpinned by key principles of primary health care” (2010, pp. 13-14). The report highlighted six essential interprofessional learning domains: teamwork; roles and responsibilities; communication; learning and critical reflection; relationships with, and recognition of the needs of the client; and ethical practice.

2.5.1 The Interprofessional Debate

Interprofessional education has been hailed as a valuable and do-able solution to current difficulties in delivering efficient and effective services to population groups experiencing complex health issues. Nevertheless some have called for caution in regard to the potential blurring of the discrete

disciplinary focus of professional curricula to support collaborative practice. This issue is regarded as particularly pertinent when dominant and powerful disciplines such as medicine are included in the educational approach (Brooks & Brown, 2002; Gunn, 2016). Pumar Mandez, Armayor, Navarlaz and Wakefield (2007) investigated potential benefits of interprofessional education within Spain’s health and social workforce. The researchers shared similar concerns about the potential risks of professional rivalry, role confusion, loss of professional identity and dilution of specialty curriculum content. They added a warning about the resource-intensive process of the educational reform when reduction of health costs was identified as a priority.

Several theoretical frameworks supporting the development of dynamic interprofessional collaboration in education and practice have been proposed (Burton et al., 2010; D'Amour et al., 2005; Orchard & Bainbridge, 2010; The Interprofessional Curriculum Renewal Consortium, 2014). Most of these address the process of interprofessional collaboration from a broad perspective of effective, safe and sustainable health care delivery. Tucker, Strange, Moules and O’hagan (2002) reported on the UK interprofessional framework developed to inform education and training of those working with children and young people in the UK. Their review highlighted three essential elements

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identified by the researchers involved in the framework’s development. These were: the adoption of interventions governed by an ecological approach that recognises the contextual environment

impacting on the child’s development and welfare needs; the importance of research skills that would evidence best practice; and the need for reflective practice underpinned by emotional intelligence and the development of critical thinking to enable students to take calculated risks (pp. 312-314).

2.5.2 Nursing Perspective

Despite a plethora of literature on the importance of collaborative practice and shared learning in the field of early childhood, specific research on nurses’ perspectives on interprofessional education and practice was scant. Psaila, Schmied, Fowler and Kruske (2014b) explored the nature and extent of collaboration at the transition of care between midwives and CFH nurses in Australia. This followed an earlier descriptive study (Homer et al., 2009) that identified a duplication of service delivery complicated by the concurrent implementation of multiple transition-of-care models and a lack of formal mechanisms to promote collaboration and communication between midwives and CFH nurses. In the Psaila et al. study (2014b), participants agreed that professional collaboration was built on good communication and relationships in which common vision, goals and understanding of each other’s roles and responsibilities were essential. They commented, however, that it took time to establish and was difficult to sustain without organisational endorsement, which was often lacking. Although 1753 midwives and CFH nurses participated in Phase 2 of the study, it only examined the provision of universal health services during the short transition period from maternity services to CFH nursing care. One significant finding from both studies was the alarming fragmentation and duplication of care resulting from service models that lacked a mechanism for collaboration.

In Sweden, where antenatal and postnatal care is delivered by two distinct, separately managed services, Barimani and Hylander (2012) explored strategies used by midwives and child healthcare nurses18 _{(CHN) to improve continuity of care for pregnant women and new mothers. The study}

involved two series of interviews with 20 clinicians and 21 mothers conducted one year apart, prior to and following the implementation of the continuity of care strategy. It also involved participant observation and documentary analysis. The data were collected from two distinct workplaces, a medical centre and a family centre. While much smaller than the Australian study, the use of in-depth interviews allowed clinicians to reflect on issues and barriers to continuity of care. It also had the benefit of examining continuity from the perspective of staff and mothers. The study’s findings demonstrated that, while midwives and nurses implemented joint action in the family centre, staff in the medical centre had a vision of the strategies they should implement but were unable to initiate

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collaboration through joint action. Implemented joint action by midwives and nurses was identified by the researchers as a key element of success of the chain of care through the perinatal period.

The interprofessional education and practice debate has been ongoing for more than a decade and has promoted better understanding of complex health issues and more cohesive, integrated models of healthcare practice. Progress, however, is slow and there are few documented examples of

successfully implemented strategies. Several frameworks for guiding interprofessional education and practice are available internationally, but the review of literature indicates a failure to translate theory into practice. It has been suggested that this poor outcome may result from lack of organisational leadership and political will (D'Amour & Oandasan, 2005).

2.6 Conclusion

A comprehensive review of the literature brought clarity to key concepts central to the care of families with complex needs. These included maltreatment, adversity, risk, vulnerability and resilience, all of which help to contextualise the role of CFH nurses in promoting the health, wellbeing and safety of children and their parents. This chapter also reported on the various studies that supported the development and implementation of evidence-based service models, with particular focus on the public health model that underpins the practice of nurses caring for families with

complex needs. The discussion identified key elements of those services that were essential for optimal outcomes, including collaborative, integrated practice and strengths-based, family-centred, child-focused approaches.

The literature review provided strong evidence for urgent reforms in the areas of early childhood and child protection. It identified CFH nurses as key players in the implementation of those reforms. However, based on the review above several gaps were identified. While there was abundant literature around nursing competence, little evidence was found on the roles and competency requirements of CFH nurses working with families with complex needs during the perinatal period. Several Australian studies indicated that even though a significant practice paradigm change from traditional, short clinic-based interventions to sustained home visiting was advocated, nurses struggled to meet the new expectations placed on them. While professional expertise, particularly in the area of targeted

interventions that can prevent intergenerational transfer of vulnerabilities, was seen as essential, few studies had explored the indicated level of nurses’ preparedness to assume this complex role. Finally, despite findings of consistently poor communication between fragmented services and limited sharing of information between maternity and community services, research into interprofessional education and practice was scant. Evidence of high-quality collaborative practice and shared learning in the field of CFH could not be identified.

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The findings from the literature review and the identified gaps in knowledge assisted with the formulation of specific research questions and the choice of mixed method design.

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