Untitled Quiz

Course Information

• Course title: Health Professionals & Interprofessional Collaborative
• Course code: NURS 3001 B
• Week: 6

Agenda

• Online class via zoom (link provided on eclass)
• Scholarly paper and group presentations
• Roles and Structure: Regulated Nursing in Canada
• Interprofessional Collaboration
• Delivery of care and practice settings
• Control Acts and Delegated Acts
• Interprofessional Education

Who Delivers Healthcare?

• Continual change in who delivers healthcare and where it occurs
• Diverse providers in Canada:
• Conventional (mainstream) medical practitioners
• Practitioners of complementary and alternative medicine
• Informal workers (volunteers, community organizations, friends and family)

Roles and Structures in Canada

• Four designations across Canada:
• Registered/Licensed Practical Nurse (RPN/LPN)
• Registered Psychiatric Nurse (RPN)
• Registered Nurse (RN)
• Nurse Practitioner/Registered Nurse, Extended Class (Ontario [NP/RN(EC)])
• Need for clearer roles and addressing historical power structures that impact interprofessional and intraprofessional collaboration

Registered/Licensed Practical Nurses

• 29% of regulated nursing workforce in Ontario (rest of Canada is LPN)
• First established in late 1930s
• Manitoba first to require registration in 1946
• Education is a diploma
• In 2022, Ontario and BC will use a regulatory exam instead of the Canadian Practical Nurses Registration Exam (Quebec is an exception)
• Jurisprudence is required in Alberta, Manitoba, Ontario, NB, and NS

Registered Psychiatric Nurses

• Primarily in Manitoba, Saskatchewan, Alberta, BC, and Yukon
• Makes up 1.4% of regulated nursing workforce
• First established during WWII (early 1940s)
• Saskatchewan first required registration in 1948
• Education is a baccalaureate or diploma
• Registered Psychiatric Nurses of Canada examination is used (except in Yukon, where must go to another province)
• Jurisprudence is not required

Registered Nurse

• Found in all provinces and territories
• Makes up 68% of regulated nursing workforce
• Indigenous healers were the first nurses in Canada
• Manitoba first to require registration in 1913
• Education is a baccalaureate (Quebec also offers a diploma)
• NCLEX is used as the registration examination (except in Quebec)
• Jurisprudence is required in BC, Alberta, Ontario, NB, NS, and PEI

Nurse Practitioner/Registered Nurse, Extended Class

• Found in all provinces and territories
• Makes up 1.4% of regulated nursing workforce
• Expanded roles in the 1890s in northern/remote communities in Canada
• Ontario and BC were first to legislate nurse practitioners' authority and scope of practice in 1997
• Education is a Masters
• Registration examination is PHC, Paediatrics, and Adult (except Quebec)
• Jurisprudence required in Ontario and NS

Interprofessional Collaboration

• Socialization
• Clarification of roles
• Access to prevention, promotion, and management of health problems based on provider, time, place
• Patient safety
• Respecting different knowledge, skills, and perspectives
• Identifying appropriate interventions to meet patient needs

Intraprofessional vs Interprofessional

• Intraprofessional: nurses only
• Interprofessional: multiple health care providers across disciplines. (e.g., sociology, engineering, IT, law)

Practice Settings

• Hospitals
• Residential care facilities
• Rehabilitation centres
• Community care facilities
• Hospices
• Clinics, offices
• Primary care settings
• Home

Inpatient Hospitalization Rates (2010-2011 and 2017-2018)

• Data provided in a table by province/territory; this includes 7-year change percentage.

Imaging Technologies per Million Population (2017)

• Data in table format listing various imaging technologies per province/territory.

ICT Development Index (2010 & 2017)

• Data in table comparing Canada and other countries.

Trends in Healthcare Delivery

• In 2014, 4.5 million Canadians lacked a family physician.
• Regions are experimenting with different healthcare delivery models:
• Patient's Medical Home (PMH)
• Interprofessional collaboration
• Community-based care

Categories of Health Care Providers

• Conventional: Physicians, nurse practitioners, midwives, nurses, dentists, dental hygienists, dietitians, optometrists, psychologists
• Complementary and alternative: Indigenous healers, naturopathic doctors, massage therapists

Conventional Medicine

• Frequently referred to as orthodox, mainstream, traditional, or Western medicine.
• Practitioners diagnose health problems, and administer technical, therapeutic, or supportive care using scientifically proven therapies, medication, and surgery.

Alternative Medicine

• Critics believe treatments should be scientifically proven before use.
• Many Canadians use CAM (complementary and alternative medicine) for a variety of reasons, including: Disillusionment with conventional treatment, difficulty accessing appointments, cultural influences/beliefs, and readily available internet info.

Regulation of Health Care Professions

• Educational standards
• Provincial/territorial examinations
• Scope of practice
• Curbing practices when standards aren't met
• Formal public complaints process
• Complaints investigation and follow-up
• Title protection
• Competence and quality assurance

Performing Controlled Acts

• May cause harm to a patient if performed by an unqualified practitioner.
• Controlled acts are defined by the regulated health professions act in each jurisdiction.
• Examples: giving injections, setting or casting fractures, passing nasogastric tubes, and prescribing medication.

Exceptions to Controlled Acts

• Most provinces allow competent, unregulated individuals to perform controlled acts in specific circumstances:
• People with emergency assistance/training
• Students supervised by qualified professionals
• Individuals with specialized training (e.g., caregivers of individuals with diabetes)
• Religious practices

Delegated Acts

• Regulated health professional transfers legal authority for a controlled act.
• Procedures that are not controlled acts do not require delegation.
• Guidelines and protocols, clearly defined, and are essential across all provinces.
• Responsibility for delegated acts is shared by the delegating professional, delegate, facility, and environment.

Nonregulated Professions and Occupations

• Lack federal or provincial legislation.
• Professional organizations still award certification after completing written or practical exams.

Interprofessional Practice & Education

• Defined as occasions where professionals learn from and with each other, improving interprofessional collaboration and quality of care.
• Interprofessional health care using the term "professional" includes all professional learning in academic and work settings before and after qualification

Interprofessional Collaborative Practice: The Evidence

• Positive outcomes: patients/clients, providers, and systems when interprofessional collaboration supported. (e.g. weight loss with physician and clinical dieticians)
• Improved team effectiveness and lower wait times in many settings.
• Improving satisfaction and reducing ER use.

Interprofessional Collaborative Practice: The Evidence

Key messages to support interprofessional practice especially for management of chronic disease.

• Some evidence and support for interprofessional practice, including need to clarify definitions and understandings as well as education
• Need for competencies for all professions involved.
• Better evaluation and research needed.

Interprofessional Collaborative Practice & Education: Key Questions.

• Present status of interprofessional education
• Interprofessional education supports interprofessional practices

Next Week's Topics

• Chapter 5: Organizational Culture
• Practitioners and workplace settings.