Occupational Therapy

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Occupational Therapy

Introduction

Inter-professional education (IPE) involves students from various professions in the health care and the social care fields, studying together either during all their training or just part of their training (Greiner 2003). The main aim of inter-professional training is enhancing and cultivating a practice, where students collaborate to provide excellent patient-centred health care. In this case, students both interact and learn from students, who are in the other professions, or learn with students in the other professions. This research paper will study and analyze how the undergraduate inter-professional education affects the inter-professional working, particularly, in the field of clinical medicine after graduation. The fields include nursing, medicine, child care, midwifery, dietetics, physicians, pharmacists, and the social workers. The paper will analyze the positives and the negatives of this mode of study and come up with conclusions. The scope of the discussion will touch on the effect of the inter-professional education and how it can improve the patients’ medical conditions, such as the extent of the patient complications, mortality rates in the older people, how long the patient stays in the hospital, mortality rates in the infants, and readmission. The other areas of discussion will be on how the study mode can cause trouble to the clinicians and the patients in the places of work. The paper will also discuss the recommendations for any effective inter-professional working. To evaluate the effects of inter-professional education, the research will involve an analysis of different literature on occupational therapy and come up with recommendations. Some of the benefits of inter-profession are.

Change in the attitudes and the perception of the student.

The undergraduate inter-professional studies enhance the way clinical students perceive their colleagues in the other fields, which do not relate to the clinical matters. The graduates can appreciate the work of the other professionals such as the teachers on matters related to health issues and counselling. Workers from the other professions can contribute a lot to the care and treatment of various ailments, especially the less serious ones and also giving first aids. Non- clinical professionals can give counselling services, attend to women when giving birth, take care and manage patients at home and assist in case of emergencies like during accidents. The interaction of the clinical and the other students during their study helps to diversify the medical and the nursing skills to the students, whether they are studying medical related courses or not (Atwal & Jones 2009). The skills assist the students after graduation to offer different health services and assist the clinicians in caring for the patients without any controversies from the clinicians. A study done to investigate the change in the attitudes of the participants of some collaboration pairs (Physician-social, Physician-Nurse, Nurse-Social worker showed that there was a positive change in the three pairs of collaboration (Greiner 2003). There was an improvement in the communication and interaction among the three professionals, which helped to have teamwork in the provision of health services to their patients.

Changes in the service delivery

The interaction of different students brings about positive impacts on the service delivery and the development of the health organizations. For instance, there will be good management of the child health registers, health records, planning and auditing of the health records (Barr 2002). There will be discipline in the medical and the non-medical team in the health organizations, which brings about teamwork. The IPE programme can lead to the improvement in different fields such as the palliative care, physiotherapy, and the child care, due to the interaction between different professionals during their undergraduate study. A study involving the mental service users in the inter-professional service showed that the service users’ teachings were more effective than the professional way of teaching (Barr 2002). The service users provided a real demonstration of the importance of the inter-professional method of training by incorporating various disciplines.

Knowledge and understanding

The IPE programme can lead to an increased understanding and knowledge of the professions and how they influence the health care, such as how to share information regarding the care and the treatment of various ailments. The understanding of each others’ role by the students during their study helps them to appreciate and respect the other professionals’ role in the health matters after graduation. This is the time when the students start applying the knowledge learnt in school to treat and give health services to the patients. Inter-professional education is an effective method to address the views about the learners’ stereotypes and the roles of the other professionals. The other virtues the learners get from the interaction among different professionals are the strengths, the responsibilities, and the limitations experienced by the other professionals, such as the pharmacists, the nurses, or the physicians. A study carried to increase the HIV/AIDS awareness showed that inter-professional education was an effective mode of study, as all the professionals could carry out the campaigns on the attitude change as a team (Fraser & Greenhalgh 2001).

Effect in the behaviour and professional practice

Some of the impacts of the IPE are creation of a multi-disciplined team of professionals, which can appreciate every ones contribution without unnecessary personal criticisms (Leatheard & Leister 2004). The team of both the clinicians and the other professionals can maintain a good communication and understand one another at the place of work, and know their personalities. It is possible to have an improved leadership and work as a team in providing health services without overloading some professionals with responsibilities. There will be an improved health care to the service receivers, through a good networking and incorporation of wide disciplines, and co-operation between different teams to get services to the remote areas. The team work by the health service providers helps to improve the quality of the care they give to their patients, and the team meetings help in improving communication among the health service providers. Working as a team also helps the health professionals to balance their services for both the family care givers and the other patients. The other advantage of teamwork is that it helps the health providers understand and appreciate the work of the other professionals in the health sector.

Benefits to the patients or the service receivers

When the students study together, there is a lot of improvement in the quality of the services offered to the service users. For example, there can be improvement in the quality of the care given to various categories of patients, such as those with heart diseases either at home or in the hospital (Miller, Marnie, & Ross 2001). The integration can improve the way the service receivers adhere to the medical instructions, especially those involving the physical and the mental health. Some of these cases are manageable at home, and the inter-professional study helps the non medical practitioners to offer health services to the patients away from the hospital wards. There is a change of attitude by the older service receivers, on the way they view their caregivers as they come from different professions, hence, can offer excellent services. The other benefits to the patients can be improvement in the catheter care, nutrition, and the home based care. Inter-professional studies lead to inter-disciplinary teams, which provide excellent care for the old and the other patients hence assists the physicians to achieve their goals of treatment. A study on the mortality rates of the patients receiving treatment from the collaboration between the nurses and the doctors, found out that there was a significant reduction in the death rates of patients (Leatheard & Leister 2004). The interdisciplinary role decreases the rate of readmission as compared to where there is no teamwork. For teamwork to be effective there must be open communication, clear work schedule for all the members, a good and flexible process of decision making, and a proper definition of the goals. When the medical practitioners provide their services as a team, the patients are less likely to complain about poor services, since the teamwork improves the quality of the services they give to the patients. These patients also receive good care after their discharge than the patients, who receive care from the single persons.

Building a culture of mutual respect and knowledge

Inter-professional education enhances the knowledge attained by the learners and influences their performance after graduation. The interaction of the learners from various disciplines helps in sharing of the skills and knowledge, which in turn contributes to a positive performance in the work stations. The collaboration of students belonging to different disciplines creates a culture where the learners appreciate each other and respect each other’s discipline. Respect cuts across the qualifications for the entrance to the training college, the stereotyping of the professions, the level of the experience, and the degree attainable. Due to interaction during discussion and course work, students can relate well and have regard for each other, which in turn helps them to work as a team when they complete school and start working. A study carried out to investigate the collaborative behaviour of occupational therapy and the health students, showed that during their collaborative training, there was some mutual respect between them and their colleagues. This mutual respect enabled them to learn and interact freely and appreciate one another in their core duties (Leatheard & Leister 2004).

Setbacks to the Inter-Professional Collaboration

Unfavourable environment for the professionals.

Some professionals might not adapt well to the method of education where they learn together with the clinicians. For instance, social students might find it difficult to cope well in the same environment with the medical or the nursing students. In their field of work after graduation some may find it difficult to work with the others, which brings down the teamwork of the health employees. If this happens, the patients receive poor health services due to the collaboration challenges. The environment of study may provide a good atmosphere for some professionals like the physicians and deny the other group a similar environment. In this case, the affected groups cannot perform well in their duties after their graduation, compared to their possible performance, if there was no inter-professional collaboration during their study. In a study that incorporated the service users in the same class with the professionals, results showed that that some of the professionals were not comfortable since there were some issues they could not discuss freely with their clients. Some of the service users, who are mentally handicapped, can be difficult to argue with, as they might become irritated and aggressive to deal with (Oandasan & Reeves 2005). In this case, it is very difficult to integrate and learn in the same environment. Similarly, with the service users as the trainers, it will be difficult to debate and conclude without causing a stir to them, since they suffer from mental challenges.

The professionals’ lack of confidence in teamwork.

It is possible that some of the groups in the inter-professional program could lack some focus in education and training in the health professional. For example, the nurses can lack confidence to perform the roles associated with the doctors, which can lead to poor services to the patients. In a study on inter-disciplines between nursing and social work, there was a significant improvement, on how professionals appreciated their work. However, the study showed that for the cases involving such disciplines like nursing and physicians, there were difficulties in the integration of their services in their workstations (Oandasan & Reeves 2005).

Teamwork challenges

One of the challenges of working as a team is that there is a possibility of time wastage, especially during the team meetings and during the inter-disciplinary plans for caring for the patients. For the health caregivers to provide excellent services, they need to hold meetings to deliberate on the course of every action they have to undertake (Oandasan & Reeves 2005). Such meetings are lengthy and may waste a lot of time for the other activities. Disagreements might occur during the decision-making leading to delay of health services to the patients. In some cases, there could be provision of poor services, especially when the management keeps on altering the duties of the health workers in a health center or hospital. The reason is that, most of the professionals have to translate from one discipline to another, which hinders specialization. Specialization leads to high quality services due to the experience earned by the health professional by doing the same kind of a job.

Lack of respect among the inter-professionals

The greatest hindrance to the effectiveness of the inter-professional education is lack of mutual respect for the professionals. Lack of respect will hinder collaboration of the parties since the groups cannot sit and have an effective discussion concerning their areas of occupation. The possible cause of this lack of respect for collaborators are the education level, in which, the students involved, are at different grades in terms of their education level. Those at the higher grade can despise the ones that are at the lower grade. This gap can lead to lack of understanding, especially during discussions or when offering medical services to patients. The other cause of lack of respect is the differences in the experience levels of the professionals, where some could be ahead of the others. The other issue that can lead to lack of respect is the level of the degree under study, in which case those studying in the higher degree level can despise those pursuing a lower degree. For example, a study involving the occupational therapy students and the health students showed that there was lack of respect between the two groups at the initial stages of their study. The collaborators later worked on their differences to overcome the vice and continued with their learning (Freeth, Hammick, Koppel, Reeves, & Barrs 2003). The course of the lack of respect was because the occupational therapist students viewed themselves as the weaker professionals

Limitations of time and schedule

There is always a limitation in the time and the schedule for the different students participating in the inter-professional education. This issue will pose challenges in future after the students graduate, because of lack of effective preparation during their study time. Different learners could be having more lessions of study than the others could, which brings about difficulties in their modes of study.

Other limitations

The other limitations to inter-professional education could be due to limited understanding of the contents in the other disciplines, such as in the field of medicine and nursing. Lack of understanding of the contents can cause difficulties to the learners, which can reflect in their careers after the completion of their course. The degree level can also create difficulties to the inter-professional educators, in which some degree programs take longer than the others (Freeth, Hammick, Koppel, Reeves, & Barr 2003).. In this case, those whose degrees take a shorter time are at a disadvantage. The skills obtained might be inadequate after the students graduate to serve in the clinical matters.

Recommendations

More research

One of the recommendations of the IPE is that more research is necessary to find out whether the system is effective to deliver good quality collaborative services in the primary care of the patients (Oandasan & Reeves 2005). The effect of a good primary care is an improved clinical outcome, patient care, and the service delivery to different categories of the service receivers. Another research should be on the best IPE approaches to help in achieving the positive outcomes after the students leave the learning institutions. The research should offer clear guidelines on the best criterion of incorporating students in the IPE, so that their interrelationship brings about good discipline, good relationship, high quality services, and effective communication during their working periods. Evaluation should include more research on the collaborative practices with long term sustainability, and not just for a short time such as the end of the school or the completion of a project.

The role of educators and policy makers

The policy-makers and the educators should join hands and come up with the best approaches to initiate and run the IPE project, so that only the best initiative on the primary care receive the highest attention. The policy makers should ensure that enough resources in terms of finance, literature, and infrastructural materials are available to support the IPE program in the work places. If the resources are not enough the project has very high chances of failure of the project.

There should be inter-professional education and a collaborative patient-centred practice

There must be a lot of education on the meaning of IPE to raise awareness on the collaborative practice that is self-centred. The education should focus more on the models used in IPE, the models of practice, which is collaborative, the barriers of IPE, how to promote IPE, and issues on the team building. The program should explain the beliefs, knowledge, and the skills acquired in the IPE and the collaborative patient-centred practice (Brady 2013). The teaching should aim at changing the attitudes of the people, organizations, and the stakeholders, so that they work as a team.

Improvement in teaching and learning

More is required for the IPE program to peak and run with fewer challenges, such as addressing the challenges that limit the effective of the IPE and the collaborative patient-centred servicesl (Steinert 2005). The teachings should offer advice to the participants to appreciate their learning environment and adapt to the curriculum, interactive lecturing, teaching that is case-based, small group teaching, evaluation and the feedback.

Effective leadership and organizational change

To promote an effective productive education, there must be adequate changes in the leadership and management, the behavior of the organization, conflict management, and negations, which will foster collaboration and cooperation of the inter-professional participants

Initiatives to develop the faculty.

The initiative to develop the faculty should aim at bringing a change at the organizational and the individual level. The faculty should aim at addressing and changing the attitudes that can lead to the failure of the IPE and their collaboration in the provision of services to patients (Brady 2013). The faculty should also teach the collaborators and the successful IPE about inter-professional practices, which can lead to an effective service delivery. A good curriculum is necessary for the success of the IPE, which will improve the skills required in the inter-professional work.

Encouragement of teamwork

Teamwork is the key to the success of the IPE program since it helps to enhance the inter-professional education and promotes collaborative practice by the team members (Steinert 2005). The faculty should therefore, ensure that the learners work as a team in every aspect. Working as team leads to the success of the IPE program and the effective provision of healthy services.

An effective education design

The education system should incorporate all the IPE participants and should not favour or discriminate against any of the participant in the system (Steinert 2005). The faculty has the mandate to ensure that there is a proper and effective design for the provision of high quality educational and training services. Good educational principles are mandatory for any inter-professional program to operate smoothly and offer excellent services to the users.

Adoption of a good model

The model for adoption of an effective inter-professional education and training system should be appropriate for the IPE program. The best method is the dissemination model, which can be at the local level, in which a group receives training and then disseminates the information to the surrounding communities. The other method is the development and dissemination of the development materials from the faculty to assist the faculty developers and the teachers (Steinert 2005).

Target to diverse stakeholders

For an IPE to be successful the concerned parties and the facilitators should be from various disciplines and each of them should know the skills and the abilities of all the stakeholders. Different disciplines ensure that the ideas given are widely sourced and there is a variety of skills from various professionals. The faculty development should also ensure that some of the contents like learning and teaching, IPE and the collaborative patient-centred practices are excellent. The area of interest should be about the organizational change and leadership, which ensures that the IPE programs run smoothly (Brady 2013).

The drawbacks to the recommendations.

The recommendations for the success of the inter-professional education in clinical matters may not be fully successful due to various reasons. Some of the difficulties in implementing the recommendations are.

High costs of implementation

The program requires a lot of money for funding various activities like the research on the viable methods of running the program (Brady 2013). To train the participants with respect to the recommended model, the faculty will require investing a lot of funds to the system in purchasing the equipment and materials required for the implementation of the model. Incorporation of stakeholders from various disciplines will also require large amount of funding to sustain them in the system. The stakeholders require payments, learning materials, and internship, which are costly. The other recommendations like improving the quality of education, provision of enough learning resources, adoption of a good educational system, and the adoption of an effective leadership require funding, which might not be available. Financial challenges can limit the success of the inter-professional education programs in the clinical matters.

Difficulties in changing the participants’ attitudes.

One of the successes of the inter-professional work progress is the demonstration of a positive attitude towards the IPE program. In cases where the positive attitude does not exist, there are difficulties in achieving the teamwork. Teamwork is the key to any effective IPE and where it lacks, the program collapses. It can be tasking to change the workers’ attitude towards their colleagues taking the same program, which means, one has to input a lot of energy to ensure that all the inter-professionals collaborate well with one another. At their work stations there might be disagreements due to lack of team work, which leads to provision of poor services to the service receivers.

Inadequate personnel

Most of the recommendations require having enough qualified personnel to facilitate the IPE program (Steinert 2005). Since the program requires a number of facilitators to teach and monitor the health service providers in the various disciplines, there can be difficulties in getting enough of them to offer their services to inter-professional practitioners, as they require relocating in some cases. The facilitators must have the required knowledge and capability to serve the various categories of the IPE workers and monitor them during internship and at their places of work.

Conclusion

From the discussion, it is possible to note that the inter-professional education can lead to a better inter-professional working in the clinical setting, because the skills earned from the interaction of the various categories of learners contribute greatly in the way the health care givers do their work. The integration of various students during the IPE creates teamwork, knowledge, and understanding of various issues in the clinical matters, which ensures high quality services to the service receivers. There is also the change of attitudes in different professionals, which improves their confidence in the service delivery. The service receivers get high quality services from the professionals, who work as a team. However, there are various setbacks to the IPE system, where some participants may create a negative attitude towards their colleagues, which affects their performance. In some cases there is lack of respect among the inter-professionals, challenges due to lack of confidence by some inter-professionals, and the problem of the time schedule. There are a number of recommendations to improve the performance of the inter-professionals such as more research, more funding, effective leadership, adopting a good model, and diversification of the stakeholders. The limitations to the recommendations are inadequate finance, difficulties in changing the attitudes, and inadequate personnel. In any case, the undergraduate inter-professional education leads to a better inter-professional working in the clinical setting after the graduation.

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