Week 6 Lecture on Health Professionals & Interprofessional Collaborative PDF

Health Professionals & Interprofessional Collaborative NURS 3001 B Week 6  Agenda ✓Online Class via zoom. Link provided on eclass. ✓Scholarly Paper, Group Presentations. ✓Roles and Structure: Regulated Nursing in Canada. ✓Interprofessio...

Health Professionals & Interprofessional Collaborative NURS 3001 B Week 6  Agenda ✓Online Class via zoom. Link provided on eclass. ✓Scholarly Paper, 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? Who delivers health care and where it is delivered are undergoing continual change Health care in Canada is provided by a wide variety of health care providers: Conventional (or mainstream) medical practitioners Those who practice complementary and alternative medicine Informal workers: Volunteers of community organizations Friends and family members Copyright © 2020 by Elsevier, Inc. All Rights Reserved.  Regulated Nursing in Canada Roles and Structures: Regulated Nursing in Canada 4 designations across Canada 1) Registered/Licensed Practical Nurse (RPN/LPN) 2) Registered Psychiatric Nurse (RPN) 3) Registered Nurse (RN) 4) Nurse Practitioners or Registered Nurse, Extended Class in Ontario [NP/RN(EC)] Need for better role clarity and addressing historical power structures that impeded interprofessional and intraprofessional collaboration  Registered/Licensed Practical Nurses ❖Registered Practical Nurses in Ontario (rest is LPN) ❖Make up 29% of regulated nursing workforce ❖Role first established in late 1930s ❖Manitoba was first to require registration in 1946 ❖Education – Diploma ❖Registration Examination – Canadian Practical Nurses Registration Examination (except Quebec); in 2022 Ontario and BC will move to Regulatory Exam – Practical Nurse Jurisprudence – required in Alberta, Manitoba, Ontario, NB, NS (Almost, 2021) Registered Psychiatric Nurses Only in Manitoba, Saskatchewan, Alberta, BC, and Yukon Makes up 1.4% of regulated nursing workforce First established during WWII (early 1940s) Saskatchewan to first require registration in 1948 Education – Baccalaureate or Diploma Registration Examination – Registered Psychiatric Nurses of Canada Examination (if in Yukon, must go to other provinces for examination) Jurisprudence – not required (Almost, 2021) Registered Nurse In all provinces and territories Makes up 68% of regulated nursing workforce First nurses in Canada were Indigenous healers Manitoba was first to require registration in 1913 Education – Baccalaureate (Quebec – has both BScN and Diploma) Registration Examination – NCLEX except in Quebec Jurisprudence – BC, Alberta, Ontario, NB, NS, PEI Nurse Practitioner/Registered Nurse, Extended Class In all provinces and territories Makes up 1.4% of regulated nursing workforce 1890s expanded roles in norther and remote communities in Canada 1997 Ontario and BC first to legislate nurse practitioners’ authority and scope of practice Education – Masters Registration Examination – PHC, Paediatrics, and Adult (Except Quebec) Jurisprudence – Ontario, NS (Almost, 2021)  Interprofessional Collaboration Socialization Role clarification Access to prevention, promotion, management Right - Provider, time, place Patient safety Respect knowledge, skills, perspectives Identifying appropriateness Support patient care needs (Astle & Duggleby, 2017; CNA, 2019; RNAO, 2013; Parse, 2015) Intraprofessional vs Interprofessional Intraprofessional Nurses only Interprofessional Multiple health care providers Interdisciplinary Across disciplines - not necessarily health care ie, sociology, engineering, IT, Law (Almost, 2021; CNA, 2019; RNAO, 2013; Parse, 2015)  Care provided where ?. Practice settings include: Hospitals Residential care facilities Rehabilitation centres Community care facilities Hospices A variety of clinics, offices Primary care settings Home Inpatient hospitalization rates in acute care hospitals (per 100 000 population) in Canadian provinces and territories, age- and sex-standardized, 2010–2011 and 2017–2018 Source: Marchildon, GP. Allin, S. Merkur, S. (2021). Health Systems in Transition: Canada, (3rd Edition).  Number of selected imaging technologies per million population by province, 2017 Source: Marchildon, GP. Allin, S. Merkur, S. (2021). Health Systems in Transition: Canada, (3rd Edition).  ICT Development Index (IDI) levels based on 11 indicators, level and rank, in Canada and selected countries, 2010 and 2017 Source: Marchildon, GP. Allin, S. Merkur, S. (2021). Health Systems in Transition: Canada, (3rd Edition).  Trends in Health Care Delivery In 2014, Statistics Canada reported that 4.5 million Canadians did not have a family physician To address the issue, all regions are experimenting with different ways to deliver primary care: Patient’s Medical Home (PMH) Interprofessional collaboration Community-based care Copyright © 2020 by Elsevier, Inc. All Rights Reserved. Categories of Health Care Providers Conventional health care providers include: Physicians, nurse practitioners, midwives, nurses, dentists Allied health professionals include Dental hygienists, dietitians, optometrists, psychologists Complementary and alternative practitioners include: Indigenous healers, naturopathic doctors, massage therapists Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 17  Conventional Medicine Conventional medicine is frequently referred to as orthodox, mainstream, traditional, or Western medicine. Conventional health care practitioners diagnose health problems; treat prediagnosed health problems; and render technical, therapeutic, or supportive care with scientifically proven therapies, medication, and surgery. Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 18  Alternative Medicine Critics of alternative medicine believe that treatments should be scientifically proven before they are used (also called an evidence-informed or evidence- based approach). A significant number of Canadians use CAM at some point in their lives. This may be due to many factors, including: ▪ disillusionment with conventional treatment ▪ difficulty getting appointments with their doctor ▪ cultural influences and belief systems that contradict mainstream medicine ▪ information available on the Internet ▪ many more people are actively participating in their own health care and treatment options. Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 19 Regulation of Health Care Professions Educational standards Provincial and territorial examinations Practitioner’s scope of practice, which outlines skills, acts, and services the practitioner is able to perform competently and safely Curbing of individual’s practice if standards are not met Formal complaints process for the public Complaints investigation and follow-up Title protection Competence and quality assurance Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 20  Performing Controlled Acts Controlled acts, if not performed by a qualified practitioner, may result in harm to a patient Controlled acts are identified by the Regulated Health Professions Act (RHA) or the equivalent in each jurisdiction Examples of controlled acts include Giving an injection Setting or casting a fracture Passing a nasogastric tube Prescribing a medication Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 21  Exceptions Most provinces and territories allow controlled acts to be performed by competent yet unregulated individuals, including ▪ A person with appropriate training providing first aid or assistance in an emergency ▪ Students learning to perform an act under the supervision of a qualified person ▪ A person, such as a caregiver, trained to perform an act (e.g., giving injections to a person with diabetes) ▪ An appropriate person designated to perform an act in accordance with a religion Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 22  Delegated Acts (1 of 2) A delegated act by definition is the means by which a regulated health professional (authorized to perform the delegated act) transfers legal authority or permits another person to carry out a controlled act they are otherwise unauthorized to do (procedures that are not controlled acts do not require delegation) Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 23 Delegated Acts (2 of 2) Although guidelines and protocols for delegation of medical acts vary across Canada, in general the delegated act must be clearly defined and supervised accordingly The delegating health care professional, the delegate, the facility, or environment in which the act is performed share responsibility for the act Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 24 Nonregulated Professions and Occupations People who work within nonregulated occupations do not have federal or provincial legislations governing their occupations. Like regulated professions, many nonregulated occupations have professional organizations or bodies that award certification when a person completes a set of written or practical examinations or both Copyright © 2020 by Elsevier, Inc. All Rights Reserved. 25 Interprofessional Practice & Education: What is the Evidence? 18 Definitions: Interprofessional The relationship between various professions as they purposely interact to work and learn together to achieve a common goal. For example, if a patient has trouble swallowing, nurses, speech language pathologists and dietitians need to work together as a team to figure out what is wrong and how to help the patient. www.CIHC.ca  Definitions: Collaboration Involves multiple people interacting to achieve a common goal Consists of social inputs and task inputs An active and ongoing partnership between professionals and institutions with diverse backgrounds and mandates who work together to provide services A process that involves cooperation, communication, negotiation, trust, respect, and understanding to build a synergistic alliance that maximizes the contributions of each participant  Four critical elements of collaboration 1. Coordination (working to achieve shared goals) 2. Cooperation (contributing to the team, understanding and valuing the contributions of other team members) 3. Shared decision-making (relying on negotiation, communication, openness, trust, and a respectful power balance) 4. Partnerships (open, respectful relationships cultivated over time in which all members work equitably together) Definition: Interprofessional Collaborative Practice An interprofessional process of communication and decision-making that enables the separate and shared knowledge and skills of care providers to synergistically influence the client/ patient care provided. Way, Jones & Baskerville, 2001 31  Definition: Interprofessional Education Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care. CAIPE, UK Centre for Advancement of Interprofessional Collaboration, 2004 CIHC uses the term to include all such learning in academic and work based settings before and after qualification, adopting an inclusive view of "professional". Canadian Interprofessional Health Collaborative (CIHC) 32  Interprofessional Collaborative Practice: The Evidence CHSRF Synthesis 2007: Overall Key Messages High quality evidence supporting positive outcomes for patients/clients, providers & system in specialized areas (e.g. diabetes, mental health, hypertension) with interprofessional collaboration e.g. ▪ Physician/ pharmacist mgmt. hypertension with significant B/P reduction ▪ Diabetes shared care very positive feedback re service & increased confidence providing routine diabetes care in practice ▪ Case manager & PC physician collaboration for depression significant positive effects in standardized depression outcomes 33 Interprofessional Collaborative Practice: The Evidence CHSRF Synthesis 2007: Overall Key Messages Positive outcomes for patients/clients, providers & system when interprofessional collaboration fostered & supported on basis of servicing geographic populations or population health models (environmental scan/ some of literature reviews) e.g. ▪ FP physicians & clinical dieticians resulted in significant decrease in weight (50% with intense follow-up & personal diet) ▪ Some correlation (statistically significant) in team effectiveness & lower wait time appts./fewer ER visits/ higher access PHC ▪ Interprofessional services to population 15,000 with improvement satisfaction professional practice, reduction in ER use, healthier lifestyles Regulatory & legislative support not readily evident to foster & promote consistency & clarity of interprofessional collaborative partnerships & scope of practice, nor availability of physician (& other professional) remuneration models 34  Interprofessional Collaborative Practice: The Evidence Health Council of Canada: Teams in Action 2009 Evidence for interprofessional practice Canadians who have additional access to either nurse &/or other professional were: > 2.5 times more likely to report range of services that met needs 42% more likely to rate quality health care as good, very good, or excellent 46% more likely to have more knowledge of conditions 67% more likely to report know-how re preventing future problems 35  Interprofessional Collaborative Practice & Education: Conclusions Evidence to support interprofessional practice (especially for management chronic disease) Some evidence & lot of support for interprofessional practice Need to clarify understanding/ definitions re interprofessional practice & education Need for one set of interprofessional competencies for all professions Better evaluation/ research needed 36  Interprofessional Collaborative Practice & Education : Questions What is present status of Interprofessional Education? Do you feel present Interprofessional Education supports Interprofessional Practice? 37 Next Week is reading week so no class. Following week we will cover Chapter 5. Organizational Culture. Practitioners and Workplace Settings.