Development of a scale to measure shared problem-solving and decision-making in mental healthcare.

OBJECTIVES: The aim of this study was to create a measure of collaborative processes between healthcare team members, patients, and carers. METHODS: A shared decision-making scale was developed using a qualitative research derived model and refined using Rasch and factor analysis. The scale was used by staff in the hospital for four consecutive years (n = 152, 121, 119 and 121) and by two independent patients' and carers' samples (n = 223 and 236). RESULTS: Respondents had difficulty determining what constituted a decision and the scale was redeveloped after first use in patients and carers. The initial focus on shared decision-making was changed to shared problem-solving. Two factors were found in the first staff sample: shared problem-solving and shared decision-making. The structure was confirmed on the second patients' and carers' sample and an independent staff sample consisting of the first data-points for the last three years. The shared problem-solving and decision-making scale (SPSDM) demonstrated evidence of convergent and divergent validity, internal consistency, measurement invariance on longitudinal data and sensitivity to change. CONCLUSIONS: Shared problem-solving was easier to measure than shared decision-making in this context. PRACTICE IMPLICATIONS: Shared problem-solving is an important component of collaboration, as well as shared decision-making.

From expert to advanced clinical practitioner and beyond.

This article considers the potential development of advanced clinical practitioners (ACPs) and consultant practitioners, beyond the 'expert' status as defined by Pat Benner in 1984. The suggested Derby Model: 7 Levels of Practice Advancement, adapted from Benner's From Novice to Expert, recognises Health Education England's four pillars of advanced practice and how they can be implemented and enhanced within these senior roles, and what that means in a 21st century healthcare system.

Evaluation of the Psychometric Properties of PainChek® in UK Aged Care Residents with advanced dementia.

BACKGROUND: The aim of this study was to further validate PainChek®, an electronic pain assessment instrument, with a population living with dementia in a UK care home. METHOD: This study utilised a correlational design to evaluate the psychometric properties of PainChek® when compared to the Abbey Pain Scale (APS). Blinded paired pain assessments were completed at rest and immediately post-movement by a researcher and a nurse. A total of 22 participants with a diagnosis of moderate-to-severe dementia and a painful condition were recruited using opportunity sampling. RESULTS: Overall, 302 paired assessments were collected for 22 participants. Out of these 179 were conducted during rest and 123 were immediately post-movement. The results demonstrated a positive significant correlation between overall PainChek® pain scores and overall APS pain scores (r = 0.818, N = 302, p < .001, one-tailed), satisfactory internal consistency (α = 0.810), moderate single measure intraclass correlation (ICC = 0.680) and substantial inter-rater agreement (κ = 0.719). CONCLUSIONS: PainChek® has demonstrated to be a valid and reliable instrument to assess the presence and severity of pain in people with moderate-to-severe dementia living in aged care.

Mental health shame, self-compassion and sleep in UK nursing students: Complete mediation of self-compassion in sleep and mental health.

AIMS: To explore relationships between mental health problems, mental health shame, self-compassion and average length of sleep in UK nursing students. The increasing mental health problems in nursing students may be related to a strong sense of shame they experience for having a mental health problem. Self-compassion has been identified as a protective factor for mental health and shame in other student populations. Further, studies highlight the importance of sleep relating to mental health. DESIGN: A cross-sectional design. METHODS: A convenient sampling of 182 nursing students at a university in the East Midlands completed a paper-based questionnaire regarding these four constructs, from February to April 2019. Correlation, regression and mediation analyses were conducted. RESULTS: Mental health problems were positively related to shame and negatively related to self-compassion and sleep. Mental health shame positively predicted and self-compassion negatively predicted mental health problems: sleep was not a significant predictor of mental health problems. Lastly, self-compassion completely mediated the impacts of sleep on mental health problems (negative relationship between mental health problems and sleep was fully explained by self-compassion). CONCLUSION: The importance of self-compassion was highlighted as it can reduce mental health problems and shame. Self-compassion can protect nursing students from mental distress when they are sleep deprived. IMPACT: Nurses and nursing students are required to work irregular hours (e.g. COVID-19) and mental distress can cause serious consequences in clinical practice. Our findings suggest that nurturing self-compassion can protect their mental health and the negative impacts of sleep deprivation on mental health.

Governance options for effective interprofessional education: Exposing the gap between education and healthcare services.

CONTEXT: The increase in interprofessional models of collaborative practice and identification of health services as interprofessional organisations, sits somewhat awkwardly with traditional governance systems for both health services and educational institutions. Whereas health services have a primary focus on assuring competence and safety for health care practice, educational institutions have a primary focus on assuring academic standards within specific qualifications. Bridging the gap between these two systems with a workable option has proven challenging, especially in relation to interprofessional education (IPE). OBJECTIVES: Given the need to ensure 'work ready' graduates within a more interprofessional and collaborative workforce, it is important to review the quality assurance governance models that are in place and to consider which of these existing governance systems, if either, is the more appropriate model for enabling and supporting IPE. METHODS: This paper describes current issues in relation to governance for quality assurance, summarises the current state of research in the field and discusses potential governance options moving forward. CONCLUSION: Given that existing governance models are not meeting the challenges of IPE, there is a need to achieve greater alignment between the academic and health service governing systems.

Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi study.

BACKGROUND: There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia. METHODS: In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers. RESULTS: The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute). CONCLUSIONS: This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792.

Barriers and enablers to collaboration in the mental health system in Sabah, Malaysia: towards a theory of collaboration.

BACKGROUND: The systems that help people with mental disorders in Malaysia include hospitals, primary care, traditional and religious systems, schools and colleges, employers, families and other community members. AIMS: To better understand collaboration between and within these systems and create a theoretical framework for system development. METHOD: A total of 26 focus groups and 27 individual interviews were undertaken with patients, carers, psychiatric hospital staff, primary care and district hospital staff, religious and traditional healers, community leaders, non-governmental organisation workers, and school and college counsellors. Grounded theory methods were used to analyse the data and create a theory of collaboration. RESULTS: Three themes both defined and enabled collaboration: (a) collaborative behaviours; (b) motivation towards a common goal or value; and (c) autonomy. Three other enablers of collaboration were identified: (d) relatedness (for example trusting, understanding and caring about the other); (e) resources (competence, time, physical resources and opportunities); and (f) motivation for collaboration (weighing up the personal costs versus benefits of acting collaboratively). CONCLUSIONS: The first three themes provided a definition of collaboration in this context: 'two or more parties working together towards a common goal or value, while maintaining autonomy'. The main barriers to collaboration were lack of autonomy, relatedness, motivation and resources, together with the potential cost of acting collaboratively without reciprocation. Finding ways to change these structural, cultural and organisational features is likely to improve collaboration in this system and improve access to care and outcomes for patients.

Repositioning interprofessional education from the margins to the centre of Australian health professional education - what is required?

Objective This paper examines the implementation and implications of four development and research initiatives, collectively titled the Curriculum Renewal Studies program (CRS), occurring over a 6-year period ending in 2015 and focusing on interprofessional education (IPE) within Australian pre-registration health professional education. Methods The CRS was developed as an action-focused and participatory program of studies. This research and development program used a mixed-methods approach. Structured survey, interviews and extensive documentary analyses were supplemented by semi-structured interviews, focus groups, large group consultations and consensus building methods. Narrative accounts of participants' experiences and an approach to the future development of Australian IPE were developed. Results Detailed accounts of existing Australian IPE curricula and educational activity were developed. These accounts were published and used in several settings to support curriculum and national workforce development. Reflective activities engaging with the findings facilitated the development of a national approach to the future development of Australian IPE - a national approach focused on coordinated and collective governance and development. Conclusion This paper outlines the design of an innovative approach to national IPE governance and development. It explores how ideas drawn from sociocultural theories were used to guide the choice of methods and to enrich data analysis. Finally, the paper reflects on the implications of CRS findings for health professional education, workforce development and the future of Australian IPE. What is known about the topic? IPE to enable the achievement of interprofessional and collaborative practice capabilities is widely accepted and promoted. However, many problems exist in embedding and sustaining IPE as a system-wide element of health professional education. How these implementation problems can be successfully addressed is a health service and education development priority. What does this paper add? The paper presents a summary of how Australian IPE was conceptualised, developed and delivered across 26 universities during the period of the four CRS studies. It points to strengths and limitations of existing IPE. An innovative approach to the future development of Australian IPE is presented. The importance of sociocultural factors in the development of practitioner identity and practice development is identified. What are the implications for practitioners? The findings of the CRS program present a challenging view of current Australian IPE activity and what will be required to meet industry and health workforce expectations related to the development of an Australian interprofessional- and collaborative-practice-capable workforce. Although the directions identified pose considerable challenges for the higher education and health sectors, they also provide a consensus-based approach to the future development of Australian IPE. As such they can be used as a blueprint for national development.

Reactions to symptoms of mental disorder and help seeking in Sabah, Malaysia.

BACKGROUND: A better understanding is needed about how people make decisions about help seeking. MATERIALS: Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members. DISCUSSION: Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment. CONCLUSION: Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.

Interprofessional competencies: the poor cousin to clinical skills?

This article was migrated. The article was marked as recommended. The purpose of this paper is to clarify what work-based IPE is, challenge some common misconceptions about its values in clinical settings and highlight tools that will assist with its implementation in such settings.

Introducing the individual Teamwork Observation and Feedback Tool (iTOFT): Development and description of a new interprofessional teamwork measure.

The individual Teamwork Observation and Feedback Tool (iTOFT) was devised by a consortium of seven universities in recognition of the need for a means of observing and giving feedback to individual learners undertaking an interprofessional teamwork task. It was developed through a literature review of the existing teamwork assessment tools, a discussion of accreditation standards for the health professions, Delphi consultation and field-testing with an emphasis on its feasibility and acceptability for formative assessment. There are two versions: the Basic tool is for use with students who have little clinical teamwork experience and lists 11 observable behaviours under two headings: 'shared decision making' and 'working in a team'. The Advanced version is for senior students and junior health professionals and has 10 observable behaviours under four headings: 'shared decision making', 'working in a team', 'leadership', and 'patient safety'. Both versions include a comprehensive scale and item descriptors. Further testing is required to focus on its validity and educational impact.

Looking to the future: Framing the implementation of interprofessional education and practice with scenario planning.

BACKGROUND: Adapting to interprofessional education and practice requires a change of perspective for many health professionals. We aimed to explore the potential of scenario planning to bridge the understanding gap and framing strategic planning for interprofessional education (IPE) and practice (IPP), as well as to implement innovative techniques and technology for large-group scenario planning. METHODS: A full-day scenario planning workshop incorporating innovative methodology was designed and offered to participants. The 71 participants included academics from nine universities, as well as service providers, government, students and consumer organisations. The outcomes were evaluated by statistical and thematic analysis of a mixed method survey questionnaire. RESULTS: The scenario planning method resulted in a positive response as a means of collaboratively exploring current knowledge and broadening entrenched attitudes. It was perceived to be an effective instrument for framing strategy for the implementation of IPE/IPP, with 81 percent of respondents to a post-workshop survey indicating they would consider using scenario planning in their own organisations. DISCUSSION: The scenario planning method can be used by tertiary academic institutions as a strategy in developing, implementing and embedding IPE, and for the enculturation of IPP in practice settings.

Interprofessional education for first year psychology students: career plans, perceived relevance and attitudes.

Undergraduate psychology students have been largely excluded from interprofessional education (IPE) initiatives. In contrast to many health professions, undergraduate psychology students do not engage in work placements as part of their degree, and many enter careers outside the health care context. However, the collaborative skills gained through an IPE experience may well be beneficial to students who work in this wider context. This research examines whether undergraduate psychology students' views of IPE vary according to their planned career directions, and if so, whether the perceived relevance of IPE mediates the relationships. A sample of 188 Australian university undergraduate psychology students completed an online questionnaire following completion of a first-year IPE health sciences program. Path analysis indicated that psychology students' attitudes towards IPE are associated with both professional identification and practitioner orientation, fully mediated through the perceived relevance of IPE to future career and study plans. Stronger professional identification and practitioner orientation were associated with greater perceived relevance and more positive and less negative attitudes towards IPE. Placing a stronger emphasis on the generalizability of IP skills taught may increase students' awareness of the relevance outside of the health context, reducing disengagement of students planning alternative careers.

Promoting collaborative dementia care via online interprofessional education.

AIM: This study aimed to develop, implement and evaluate an online interprofessional education (IPE) dementia case study for health science students. The IPE initiative aimed to develop collaborative interprofessional capabilities and client-centred mindsets that underpin high-quality dementia care. METHOD: A mixed methods research design was used to assess students' values, attitudes and learning outcomes using an interprofessional socialization and valuing scale (ISVS) completed pre and post the online case study and via thematic analysis of free text responses. RESULTS: Students' ISVS scores improved significantly following online participation, and the qualitative results support a shift towards interprofessional collaboration and client-centred care. CONCLUSIONS: This online IPE case study was successful in developing the collaborative mindsets and interprofessional capabilities required by a future workforce to meet the complex, client-centred needs of people living with dementia.

Competencies and frameworks in interprofessional education: a comparative analysis.

Health professionals need preparation and support to work in collaborative practice teams, a requirement brought about by an aging population and increases in chronic and complex diseases. Therefore, health professions education has seen the introduction of interprofessional education (IPE) competency frameworks to provide a common lens through which disciplines can understand, describe, and implement team-based practices. Whilst an admirable aim, often this has resulted in more confusion with the introduction of varying definitions about similar constructs, particularly in relation to what IPE actually means.The authors explore the nature of the terms competency and framework, while critically appraising the concept of competency frameworks and competency-based education. They distinguish between competencies for health professions that are profession specific, those that are generic, and those that may be achieved only through IPE. Four IPE frameworks are compared to consider their similarities and differences, which ultimately influence how IPE is implemented. They are the Interprofessional Capability Framework (United Kingdom), the National Interprofessional Competency Framework (Canada), the Core Competencies for Interprofessional Collaborative Practice (United States), and the Curtin University Interprofessional Capability Framework (Australia).The authors highlight the need for further discussion about establishing a common language, strengthening ways in which academic environments work with practice environments, and improving the assessment of interprofessional competencies and teamwork, including the development of assessment tools for collaborative practice. They also argue that for IPE frameworks to be genuinely useful, they need to augment existing curricula by emphasizing outcomes that might be attained only through interprofessional activity.

Interprofessional health education in Australia: three research projects informing curriculum renewal and development.

PURPOSE: This paper reports on three interrelated Australian studies that provide a nationally coherent and evidence-informed approach to interprofessional education (IPE). Based on findings from previous studies that IPE tends to be marginalized in mainstream health curriculum, the three studies aspired to produce a range of resources that would guide the sustainable implementation of IPE across the Australian higher education sector. METHOD: Nine national universities, two peak industry bodies and a non-government organization constituted the study team. Data were gathered via a mixture of stakeholder consultations, surveys and interviews and analyzed using quantitative and qualitative methods. RESULTS & CONCLUSION: An important outcome was a curriculum renewal framework which has been used to explore the implications of the study's findings on Australian nursing. While the findings are pertinent to all health professions, nursing is well placed to take a leading role in establishing IPE as a central element of health professional education.

Evaluating an interprofessional disease state and medication management review model.

There is lack of literature data reporting an incorporation of medication management reviews in students' interprofessional education (IPE) and practice programs in aged care settings. This pilot study reports how an interprofessional disease state and medication management review program (DSMMR) was established in a residential aged care facility in Perth, Western Australia. Students from the professions of nursing, pharmacy and physiotherapy focused on a wellness check in the areas of cognition, falls and continence while integrating a medication management review. Students' attitudes were explored using a pre- and post-placement questionnaire. Students indicated positive experience with the IPE DSMMR program which also resulted in their positive attitudinal shift towards IPE and practice. These findings indicated that aged care can be a suitable setting for student interprofessional programs focusing on DSMMR.

E-learning and educational diversity.

This article discusses the nature of electronic learning (E-learning) and argues for its centrality to educational diversity and the shift from teaching to learning. It is argued that E-learning is the new wave strategy that sits comfortably with other strategies developed for the 21st century. As such it challenges the traditional 'banking concept' of education, where the teacher is seen as the font of knowledge as long as students acknowledge this and are eager to absorb the teacher's vital knowledge. The article argues that E-learning should replace what Freire (1994) calls the backing concept of education, which is at odds with other 21st century approaches such as lifelong learning, open and flexible learning and the accreditation of prior learning (APL) to name only a few. In suggesting the shift from the traditional approach to E-learning, the article acknowledges issues of quality assurance and the need to maintain not only standards of achievements but also the comparability of those standards. Strategies for developing E-learning material and maintaining standards are discussed. McKey (2000) and Salmon's (2001) model of E-learning development and management are used to show how E-learning works in practise. The article then focuses on the role of E-learning as a catalyst for educational diversity, freedom to learn and equality of opportunity. While E-learning encourages diversity it paradoxically creates programmes that are more specifically tailored to the market needs than traditionally validated programmes. This is seen as very good in terms of addressing specific needs, for instance, specific knowledge and skills for a particular market. The learners or students in that particular market will feel that their specific needs are recognized and addressed, and will thus see the E-learning programme as having relevance for them. The article concludes by asserting that adequate resources, particularly learner support, will distinguish quality or good programmes from bad ones.

The process of developing a research questionnaire to measure attitudes to shared learning.

This article discusses the process by which a questionnaire was developed specifically to measure attitude to shared learning. Over a three-year period the attitude questionnaire was developed and tested using pre-registration students who were engaged in a shared learning programme. These pre-registration students were from three professional groups, namely occupational therapy (OT), diagnostic radiography (DR), and therapeutic radiography (TR). While the study hypothesis was that shared learning would improve attitudes over the three-year period, the focus of this article is to discuss the process by which the research instrument was developed. The rationale for focusing on the process is a simple one. After a diligent literature search it was clear that there were no attitude questionnaires specific to attitude measurement in relation to shared learning. Thus without an already validated attitude to a shared learning questionnaire, it became imperative to create systematically a credible attitude measure of shared learning. The process centred on understanding how monadic scales are constructed and used to measure attitudes and perceptions of participants. Amongst a number of processes to be followed was the need also to check the reliability of the developed questionnaire. This was done using the Cronbach alpha coefficient. A Cronbach alpha coefficient of 0.7 was set as a minimum reliability requirement, which was duly satisfied. The outcome of this process was that it very useful to learn how to produce a suitable instrument to measure attitude to shared learning and to add in a small way to the range of attitude questionnaires available.