Inside the black box – an inter-professional education session on how to teach clinical reasoning in others

Mrs Tameeka Robertson1

1Northern Health, Epping, Australia

Background: Northern Health Clinical Educators are often asked to teach clinical reasoning (CR) to their students or learners but receive very little formal training on how.  Clinical reasoning is often thought as complex and difficult to teach with little available allied health specific evidence to guide this process. A needs analysis indicated staff wanted to learn more about this topic.

An inter-professional education program titled ‘Teaching Clinical Reasoning in others’ was developed by the Allied Health Education team and due to its success expanded to nursing and medical staff.

A program was developed to facilitate participants to unpack the process of problem solving from their experience and reflect on this in relation to the journey from novice to expert.  The program requires active involvement and sharing of learning and experiences to benefit the group learning

Method: The education program was developed from a synthesis of literature on clinical reasoning across disciplines, via expert consultation and via participant engagement in the learning process.

Results: 31 participants have attended from allied health, medicine and nursing.   Evaluation data highlighted increased knowledge and confidence from participants in understanding and teaching clinical reasoning.  Qualitative comments highlight the benefit of the inter-professional nature, the importance of thinking about how to teach and self-reflection.

Discussion: This program has highlighted the need for health professionals to undertake explicit training in clinical reasoning and explicit self –reflection regarding their own thinking and problem solving.  We need to invest in the training and support of our clinical educators to ensure we have quality graduates of the future.  This presentation will provide ideas on how to teach clinical reasoning relevant to your context.


Biography:

I am an Occupational Therapist by background who has been working in public health for the last 12 years.  I have always enjoyed teaching and educating others which led me to complete a Masters in Health Science with electives focusing on teaching and learning.  My current role at Northern Health as the Allied Health Clinical Schools Co-ordinator and Education leader means that I have the opportunity to teach Allied Health staff and students fundamental skills that will shape the future work force.  Clinical Reasoning is a topic i find fascinating and have really enjoyed exploring this area.

Strengthening interprofessional culture across health professional education and the workplace – the Interprofessional Twilight Challenge

Mrs Kathryn Vick1, Ms Nicole Shaw1,2, Ms Sherryn Evans2

1Barwon Health, Clinical Education & Training, Geelong, Australia, 2Deakin University, Faculty of Health, Geelong, Australia

The Interprofessional Twilight Challenge (ITC), an initiative between Barwon Health (BH) and Deakin University (DU) which began in 2017, was conceived to improve interprofessional collaboration (IPC). BH and DU share a commitment to developing effective IPC in the healthcare workforce to improve workplace culture, practice and achieve best outcomes for healthcare consumers(1). Staff from both organisations had past experiences of national team events which, whilst very valuable, represented limited opportunities for participation at scale and required a level of pre-event preparation that acted as a disincentive for busy health professionals to participate. An opportunity arose for staff from BH and DU to develop an event that would overcome these issues.

Although conceptually the ITC was sparked by other team events, it is innovative in its adaptation to the health service setting and its partnership approach including the institution-level reach, varied composition of teams, and elimination of pre-event work for participants.

In the ITC, twelve teams comprising students, academics, health professionals or clinical educators, compete in six problem-solving activities based on a case study to demonstrate mastery in IPC skills. The activities are judged against a rubric based on the Canadian Interprofessional Health Collaborative (CIHC) Framework. The team with the highest score is declared the winner.

138 individuals have competed in the event. Collation of feedback (n = 92) revealed 95% of respondents agreed the ITC increased awareness of the key competency domains of IPC and created an authentic learning experience promoting IPC. All respondents (100%) agreed the ITC enabled interprofessional learning in a fun and engaging manner, whilst 90% agreed it showcased a collaborative partnership between BH and DU.

Evaluation has demonstrated the ITC provides a learning experience which is helping to strengthen interprofessional culture. With organisational support from BH and DU, it is programmed as an ongoing annual event.

(1) World Health Organisation. (2010). Framework for action on interprofessional education & collaborative practice.  Retrieved from http://www.who.int/hrh/nursing_midwifery/en/


Biography: To be confirmed

Taking an interprofessional approach to improving nutrition for older people in hospital

Dr Adrienne Young1,2, Dr Merrilyn  Banks1, Dr Alison Mudge3, Ms Prue McRae3

1Nutrition and Dietetics, Royal Brisbane And Women’s Hospital, Herston, Australia, 2School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia, 3Internal Medicine, Royal Brisbane and Women’s Hospital, Herston, Australia

Malnutrition and poor dietary intake remains a significant problem for older hospital patients. The complexity of hospital mealtimes and nutrition care necessitates an interdisciplinary approach to improvement. This study monitored nutritional intake of older inpatients (65+ years) over a ten-year period as foodservice and mealtime interventions were progressively implemented into routine practice in a large metropolitan Queensland hospital. Hospital and ward-level interventions were implemented from 2009-2014. These included facilitated implementation of ‘assisted mealtimes’ (by nursing, allied health, and medical, as part of the Eat Walk Engage program), and proactive provision of high protein/energy (HPHE) meals and mid-meals. Allied health assistants supported these interventions. Data were collected on 386 medical inpatients admitted in 2007-08 (n=129, 80±8y, 49% male), 2009 (n=139, 80±8y, 45% male), 2013-14 (n=52, 82±8y, 44% male) and 2017 (n=66, 82±8y, 50% male). Energy and protein intake were calculated from visual plate waste of all meals and mid-meals on Day 4-7 of admission; these were compared to patient requirements. One-way ANOVA and χ2 tests were used to compare cohorts. Nutritional intakes of participants have significantly increased over time (energy: 5073±1850kJ, 5403±2252kJ, 5989±2614kJ, 5954± 2179kJ, p=0.014; protein: 48±19g, 50±21g, 57±26g, 58±24g, p=0.002). The proportion of patients with inadequate energy and protein intakes has also decreased (intake<resting energy expenditure: 59.7%, 53.2%, 44.2%, 34.8%, p<0.001; intake<1g/kg protein: 85.3%, 75.5%, 73.1%, 63.6%, p=0.007). Provision of HPHE diets and mealtime assistance have improved (HPHE: 20.2%, 56.1%, 84.6%, 89.4%, p<0.001; assistance where required: 58.1%, 86.4%, 100%, 85.7%, p<0.001). This ten-year study highlights the importance of continuous quality improvement and interdisciplinary and system-level nutrition care strategies such as mealtime assistance and foodservice improvements to achieve improved intakes of older inpatients. Factors important in creating sustainable change included use of implementation frameworks, multidisciplinary implementation team, assistant workforce, and making small, sequential changes.


Biography:

Dr Adrienne Young is an Accredited Practicing Dietitian, and is currently Principal Research Fellow, Allied Health Professions at the Royal Brisbane and Women’s Hospital. Her PhD research on improving nutritional intake of older medical inpatients has been of interest nationally and internationally, with Adrienne awarded the Health Practitioner Researcher of the Year at the Royal Brisbane and Women’s Hospital research symposium in 2018, and New Researcher Award at the International Congress of Dietetics in 2012. Adrienne has continued to research in the area of malnutrition in older people, with recent work also focused on workforce development to prepare allied health professionals to translate research into their practice.

Lets do better together: Training for health professionals on transgender and gender diverse affirmative practice in a hospital context

Andrew Wale-corey1, Simone Sheridan1

1The Royal Melbourne Hospital, Parkville, Australia

Background: A recent Australian study found that Transgender and Gender Diverse (TGD) patients experience high rates of discrimination when accessing mainstream healthcare services.  A lack of knowledge of TGD issues and insensitive questioning were the most common forms of reported discrimination (Department of Health, 2014).  Research suggests that the TGD population experience poorer physical and mental health outcomes due to stigma and social exclusion (Department of Health, 2014). Improving the provision of TGD affirmative health care may contribute to decreased health disparities and assist in creating safe and accessible health care for TGD people.

Objectives:  To develop, implement and evaluate a co-design education and training package with the Zoe Belle Gender Collective on affirmative language and sensitive questions for Nursing, Medical, Allied Health and Administrative staff.

Methods:  Single site cross-sectional survey measuring participants’ knowledge and confidence related to TGD experiences and affirmative practice skills.

Results: Preliminary results for 116 participants (84 nursing staff, 19 Allied Health Clinicians and 13 Medical Staff) show an increase in knowledge regarding the use of TGD safe language, importance of pronouns and asking sensitive questions to TGD patients. Furthermore, many participants identified an increase in knowledge regarding TGD experiences and inclusive/affirmative practice. The study is ongoing with a hospital wide roll out in 2019.

Significance:  Improving health professionals’ TDG knowledge and affirmative practice skills can assist in mitigating the effects of discrimination and harassment, which in turn may improve TDG health and wellbeing. This study describes a co-design, inter professional, time efficient, low-cost method to deliver education and examines its effectiveness.


Biography:

Andrew Wale-Corey is a Social Worker at the Royal Melbourne Hospital.  Andrew has clinical experience in Emergency Surgery, Trauma, Stroke, Neurology and Cardiology and a keen interest in LGBTIQA inclusive and affirmative practice.  Andrew is a member of the RMH LGBTIQA Working Party, a member of the Family Safety Advocacy Initiative, and was recently nominated for an Allied Health Respect Award for their work with LGBTIQA patients, staff, advocacy and education.

Simone Sheridan is a Clinical Nurse Educator at the Royal Melbourne Hospital.  Simone has a dedicated interest in providing safe and accessible care for all patient with a focus on the LGBTIQA community.  Simone is a key member of the RMH LGBTIQA Working Party and runs the ‘Let’s Talk about Sex’ training day. She is currently working with the Family Safety team to provide education to nursing staff with regards to Family Violence.

Standardising interprofessional graduate attributes in university health professional study programs – lessons learnt and opportunities uncovered

Mr Nathan Reeves1, Professor Gary Rogers1

1Griffith University, Gold Coast, Australia

Background: Recognising the importance of interprofessional education (IPE) in the skilling of the health workforce of the future has been a key pillar of Griffith Health Institute for the Development of Education and Scholarship (Health IDEAS) over the past decade. The World Health Organization (WHO) Framework for Action on Interprofessional Education & Collaborative Practice and the 2010 Sydney Interprofessional Declaration are at the heart of ensuring that all health professionals trained at Griffith University develop high-level capabilities in interprofessional collaboration. Griffith Health committed to implementing threshold learning outcomes and pedagogical and assessment standards, and designed mechanisms to support study programs to achieve these standards.

Method: Interprofessional leads from across health programs were consulted to develop a common set of interprofessional pedagogical and assessment standards to ensure that graduates are collaborative practice-ready. An internal IPE accreditation system was adopted where programs can demonstrate compliance with IPE standards.

Results: To date one health program has been assessed against the IPE accreditation standards. Feedback from the review panel was that the process provided sufficient flexibility to accommodate the diverse range of IPE in study programs across the health faculty, featured enough rigour to ensure that study programs meet internal and external minimum IPE standards, and provided the opportunity for reflection on IPE design and implementation. Feedback from the study program was that completing the accreditation encouraged a phased pedagogical and programmatic approach to IPE.

Discussion: Griffith Health’s commitment to health professional student education and competencies in interprofessional collaboration is supported by the development of an accreditation system for health programs. Adopting a position that all health programs that lead to a qualification for practice as a health professional should obtain IPE accreditation will produce normative interprofessional literacy in graduates across the faculty. National uptake of IPE accreditation may elevate the importance of interprofessional competency standards within discipline-specific professional accreditation bodies.


Biography:

Nathan is a senior lecturer at School of Allied Health Sciences, Griffith University and is Exercise Physiology discipline lead for inter-professional and simulated learning. Nathan has extensive experience in developing and leading intra and inter professional simulated learning events across the allied health and medical disciplines.

Facilitating organisational change to enhance rural interprofessional education: A process evaluation

Dr Priya Martin1, Associate Professor Monica Moran2, Ms Nicky Graham3, Dr Anne Hill4

1Cunningham Centre, Darling Downs Health, Toowoomba, Australia, 2Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Australia, 3Children’s Health Queensland, Brisbane, Australia, 4The University of Queensland, Brisbane, Australia

Background: Given the workforce challenges in rural Australia, there continues to be a lack of structured interprofessional education (IPE) opportunities in clinical settings. The Rural Interprofessional Education and Supervision (RIPES) model of student placement was developed and implemented in 2017-18 to address this gap. An advisory group consisting of senior state-wide health and university partners facilitated implementation of this model in two rural Queensland sites. An evaluation of the advisory group processes over the 18 months of the rollout was conducted to map the approaches used by the group to facilitate organisational change in order to implement the RIPES model.

Method: The nine-member advisory group was interprofessional and had a total of eleven teleconference meetings. Evaluative focus group discussions were held at the half-way point and after the final advisory group meeting. A focus group guide was used, consisting of nine open-ended questions and further prompts. Discussions were recorded, transcribed verbatim and data analysed using content analysis.

Results: Members acknowledged the difficulties in coordinating a diverse group and addressing the challenge of finding time that suited everyone. Members also commented on the lack of role clarity in the group initially as group members held different strategic and operational roles. However, with time, role clarity and collaborative leadership were achieved. The different expertise of members (project management, IPE evaluation, strategic leadership, placement allocation) were identified and utilised at different stages of the project to achieve successful outcomes. Leadership, sustainability, linkages, knowledge exchange, and thinking beyond uni-professional boundaries emerged as key themes.

Discussion: Leading academic and health sector partnerships, and developing and implementing innovative IPE models can be complex and challenging. Understanding the processes, barriers and enablers that leadership groups experience can inform the development of governance frameworks in order to facilitate sustainability of innovative IPE models.

Acknowledgement – RIPES advisory group members


Biography:

Nicky Graham has worked as a Speech Pathologist across a number of rural, regional and metropolitan Queensland Health facilities since 1998 and has been employed in the Statewide Speech Pathology Clinical Education and Training Program Manager position since 2011. Nicky is passionate about supporting the speech pathology profession to deliver high quality clinical education and learning pathways within the healthcare environment.

Validation of a new psychometric tool for assessing the competencies of clinical supervisors

Ms Sarah Hamilton1, Professor  Analise  O’Donovan2, Assoicate Professor Lynne  Briggs3, Dr    Maddy Slattery4

1School of Human Services and Social Work Griffith University, Brisbane , Australia, 2Dean Health Group Griffith University , Brisbane, Australia, 3School of Human Services and Social Work Griffith University , Gold Coast , Australia, 4School of Human Services and Social Work Griffith University , Brisbane , Australia

Across the allied health professions there is acknowledgement that access to clinical supervision is an essential prerequisite for ensuring effective service delivery. Although research in this field has expanded rapidly over the past decade, disagreement remains on the minimum. competencies and training needs of clinical supervisors. Furthermore, the psychometric tools that are currently available for assessing supervisors’ competencies in one tool, capture multiple perspectives, or have not been validated by a large and diverse workforce and/or do not require independent third-party validation. To address these gaps, our interprofessional team developed and psychometrically validated the Generic Supervision Assessment Tool (GSAT). The GSAT has 32 competency items and was designed to enable supervisors, supervisees and third-party assessors to assess the core competencies of clinical supervisors. Initially we designed the GSAT questionnaire in SurveyMonkey and sent it to multiple professionals in Australia and New Zealand. A total of 479 supervisors and 447 supervisees from 12 different professions in Australia and New Zealand completed the GSAT survey. Statistical analyses were conducted in SPSS and R statistical software, with results from factor analysis confirming that the GSAT has four competency subsets (Feedback and Reflective Practice, Supervisory Alliance, Professional Practice and Goals and Tasks). Analyses confirmed that the GSAT has strong internal and external reliability.  The second component of our research involves third party observation with assessors watching videos of a supervision session and scoring each supervisors competency against the GSAT.  Based on previous research of this nature, this stage of the research is expected to highlight differences between how supervisors, supervises and third parties evaluate supervisors’ competencies. The second stage is also expected to further demonstrate the purpose of the GSAT as a generic clinical tool which can be used to optimise supervisory reflection, identify strengths and areas for further supervisory training supports.


Biography:

Sarah Hamilton is the State-wide Allied Health Professional Practice Leader – Social Work for Mental Health and Addiction Services Queensland Health. Sarah has 20 years of experience in mental health service provision, clinical education, supervision, leadership, management, policy and research in New Zealand and Australia. Sarah has a specific interest in the areas of scope of practice, research and supervision. She is currently completing a PhD in clinical supervision competencies through the School of Human Services and Social Work at Griffith University.

Transdisciplinary Model of Care between Allied Health and Nursing in a rural sub-acute setting

Kathryn Costello1

1Boonah Hospital, Australia

Background: Rural hospitals traditionally provide communities with local medical services and sub-acute care for patients transferring back from larger hospitals. These facilities are often located closer to home for patients, however they are also frequently subject to reduced access to allied health services, which play a vital role in the delivery of optimal care. Boonah hospital, a rural site in West Moreton Health, provides rehabilitation and sub-acute services. It was identified through service analysis that skill sharing and delegation of tasks between allied health and nursing staff could increase access to appropriate care in a more timely manner, decreasing length of stay and expediating achievement of patient centred functional goals. The model aimed to provide a 24/7 approach to functional rehabilitation through optimisation of professional scope of practice.

Method: The Calderdale Framework was utilised to facilitate re-design through service and task analysis. Clinical task instructions were identified and developed to provide theoretical and practical training for staff. Chart audits were completed pre- and post-implementation, along with analysis of Pi5, Hibiscus data and staff and patient experience surveys.

Results: Preliminary data indicates that formal skill sharing and delegation practices are valued by staff and allow them to work more effectively. Optimisation of nursing staff scope of practice has enabled functional assessment and meaningful intervention in a more timely and intense manner. Implementation of Clinical Task Instructions has increased staff confidence to perform tasks and documentation reflects more meaningful assessment and comprehensive documentation skills. Further data analysis is required to determine impact on patient satisfaction, LOS and performance indicators.

Discussion: The ongoing challenge to provide effective healthcare within an environment of restricted resources requires sustainable models of care. A transdisciplinary model is proving to be successful in maintaining high standards of care while increasing efficiency within existing resources.


Biography:

Kathryn Costello is a senior physiotherapist working currently as a rural generalist at Boonah hospital. She has had experience working across the continuum of inpatient, outpatient and community services within QLD health and has a passion for rehabilitation and improving the access and quality of care to rural patients.

Development of a framework to evaluate implementation of an interprofessional education and practice organisation-wide strategy to foster integrated family centred care

Kristine Kelly1, Claire  Costello1, Tania Hobson1

1Queensland Children’s Hospital, South Brisbane, Australia

BACKGROUND – Healthcare teams are responding to complex challenges to deliver quality, safe and cost-effective healthcare by transforming traditional approaches of healthcare delivery to incorporate Interprofessional practice (IPP), underpinned by Inter-professional education (IPE) ¹²³.   To fully realise the benefits and efficiencies IPP and IPE can effect, it is imperative that healthcare services develop an organisation-wide understanding of principles of IPE and IPP¹²⁵ , thus Children’s Health Queensland Hospital and Health Services (CHQ-HSS) has developed an organisation-wide IPE/IPP strategy including an evaluation framework and workforce awareness survey (WAS) to ensure internal consistency in longitudinal evaluation.

AIM – To establish a consistent approach to evaluation of organisational learning related to an IPE/IPP strategy and to monitor organisational understanding of IPP/IPE by sampling the workforce of CHQ longitudinally through a phased roll out of the strategy.

METHOD – A working group of interprofessional champions from CHQ-HHS was convened.  An international partnership was formalised with the Centre for Interprofessional Education, University of Toronto. Literature reviews were conducted to inform WAS content and develop the Evaluation framework cross-referenced to organisational learning effectiveness as described by Kirkpatrick-Phillips⁴. Consultation incorporated review by CHQ representatives and international partners. A pilot awareness survey was undertaken with a sample population of workforce (clinical and non-clinical) to refine its effectiveness. Communication and distribution plan optimised workforce engagement and survey completion rates.

RESULTS & DISCUSSION – Initial data collection phase is underway for phase1/horizon1 of the strategy.  Results from this stage will be analysed & presented.  Findings from the evaluation framework and awareness survey will serve to inform future planning for targeted IPE/ IPP activity within CHQ-HHS existing and emerging workforce with the aim of improving integration of care and optimising clinical outcomes for those target populations best serviced by interprofessional models of care. Ongoing evaluation of IPE/IPP activities across horizons of implementation will be measured according to the evaluation framework.


Biography:

Kris Kelly is an Allied Health Workforce Development Officer and Co-chair of the Children’s Health Queensland  Inter-professional Working Group.  She has been involved in educating allied health students within the university context and during clinical placement  with of focus on inter-professional education in a paediatric context.  Her work has included paediatric workforce education and training also incorporating inter- professional education with emphasis on  inter professional models of care and simulation based learning  for over a decade.

Investigating multidisciplinary team management of pressure injuries in sub-acute care

Ms Alice Doring1, Ms Juliette Mahero1

1Qld Health (TPCH), Brisbane, Australia

The prevalence of pressure injuries (PI), both hospital acquired and present on admission, is a worrying concern. The 2016-2017 financial year attracted $510,000 in PI penalties at The Prince Charles Hospital alone. Evidence-based policies for the prevention and management of pressure injuries describe the benefits of a multidisciplinary team(MDT) approach1.

This project aimed to investigate MDT management of PI in the Rehabilitation and Acute Stroke (RAS) Unit at a tertiary hospital in Brisbane, QLD. A four-week prospective audit was conducted on patients who were admitted to the RAS unit with a PI(N=9) or obtained a hospital acquired pressure injury during their admission(N=0). Documentation including that at point of handover of care, discharge planning processes and communication of pressure injuries at weekly MDT meetings were audited. Clinical staff were engaged via surveys(N=13) to assess current practice and perceptions of responsibility for care.

Results showed that 12.5% of the time, PI were documented on handover to the sub-acute ward via medical admission summary. 62% of clinicians did not routinely note a PI in departmental handover processes. 66% of patients had their pressure injury documented on summary pages as per local hospital protocol. PI progress discussions at weekly MDT meetings were conducted in 3.7% of the cases (N = 9). 22% of patients were discharged with no documentation of PI healing status on medical discharge summary.

Results were presented with the MDT and a unit pressure injury week was held to improve awareness and increase education around PI care. Changes were made to local handover and case conference templates. In future, audits will be conducted annually to reassess management and address key areas for improvement.

While structured management plans for MDT PI care exist, lack of awareness, documentation and communication amongst the MDT and on transfer of care is compromising patients PI care.

References:

1)            Australian Wound Management Association. Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury. Abridged Version, AWMA; March 2012. Published by Cambridge Publishing, Osborne Park, WA.


Biography: To be confirmed

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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