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Dr. Katherine Hinderer Department of Nursing “Bridging the Gap: Inter-professional Partnerships to Support Practice-ready Healthcare Graduates”
Salisbury University Research Day & Innovation Showcase 2016
Dr. Katherine Hinderer • Bridging the Gaps: Inter-professional Partnerships to Support Practice-ready Healthcare Graduates
Dr. Clifton Griffin, Dean of Graduate Studies and Research
Our next speaker is Dr. Katherine Hinderer, Department of Nursing. She is going to talk about “Bridging the Gaps: Inter-professional Partnerships to Support Practice-ready Healthcare Graduates.”
Dr. Katherine Hinderer, Ph.D., RN, CCRN, Associate Professor of Nursing
Thank you. I just want to say thank you to Dean Olmstead for inviting me to speak for the Henson School of Science, it was really an honor to be able to talk about this work that we’ve done and this is truly a labor of love for the people who are on the committee. It’s not really just me, it’s a whole group of people who made this happen.
So, I’m going to tell you a little bit of a story about how we’ve developed a committee, a group of individuals, who’ve come together to try to really promote good inter-professional practice within our educational environment and then hopefully to spread that out into the community as well.
I’m going to start with a little bit of background for those of you that maybe aren’t familiar with inter-professional practice and education and also let you know a little bit about the history of where we are and where we are right now with the state of the science and, in particular, in regard to healthcare education research. We’re also going to talk about the development of our inter-institutional, inter-professional committee, which is a collaborative partnership between Salisbury University and University of Maryland Eastern Shore. And then we’ll talk a little bit about our future directions for where we’re going with our education and research.
So, the World Health Organization has defined both inter-professional practice and inter-professional education. And one of the things, because we’re educators, I really want you to think about is inter-professional education is talking about students who are from healthcare disciplines, but it’s more than just students sitting in a classroom and learning together who represent different disciplines. It’s really more about students learning from one another and about one another and also with one another all at the same time. So, it’s more than just kind of sitting there and absorbing, they’re really engaging with one another. And what we hope will happen is that when you go out into practice, you’re going to work with healthcare providers in a professional environment where we’re taking care of individuals to try to promote best, optimal care.
Both the Institute of Medicine, which is now called the National Academy of Medicine – but, interestingly enough all of these references are still listed as Institute of Medicine references; if you go searching, I would search Institute of Medicine as well – and the World Health Organization are really promoting and in support of IPE and IPP and there’s a lot of reasons for this, but one of the most important is that our landscapes of healthcare and health education are continuously changing. We want our education to be reflective of practice, and we want to really promote a culture of safety where we have good patient outcomes. So, there’s a lot of reasons why we’re interested in inter-professional education. One of the reasons for us in academics, of course, is our accrediting bodies are really encouraging us to move in this direction, which for those of us who like IPE and are excited about IPE, it makes us happy because it then becomes a part of the everyday conversation. It’s also geared toward promoting health and also reducing cost, which interestingly enough has not been researched as much as you would think.
The first report I want to talk to you about was a report that came out just this year based on a meeting at the Institute of Medicine talking about “Envisioning the Future of Health Professions Education.” And some of the really important things that came out of this report are that we, as educators in the health education professions, can’t really anticipate where the health system is going. It’s very hard to say based on economics, maybe the current political environment, technology, where things are going. This report speaks to things like pandemics, like Ebola, that nobody could ever have predicated would have wiped out entire health systems in countries like Africa. We also need to be a little bit more proactive instead of reactive; so, that means we need to be thinking forward instead of reacting to things as they occur. One of the most important things here is that we need to engage our students in lifelong learning, which we all would like to say that we do teach that already, but it’s even more important for the healthcare professionals because our environment changes so quickly.
One of the things that’s really interesting that came out of this report, which we also actually found in a study we did with our faculty on this campus and UMES, is that faculty are not very comfortable with the concept of IPE, meaning they don’t really have the expertise to teach it. We were all brought up in very siloed, very traditional professional programs, and so, it is sort of outside of our comfort zone to have to, kind of, interact and work in these inter-professional environments, and they’re not always comfortable.
Some of the benefits, I think – and we really need to continue to look at these – are really some of the cost reduction and educational gains that can come out of IPE. We really can help to decrease duplication of efforts in terms of coursework, in terms of resource utilization. We all know resources are precious. Healthcare education is extremely expensive, so if there are ways we can find to work together to help educate our students, that’s even better.
The other great thing about working in an IPE environment is that we really do learn to appreciate one another and value what other professions are bringing to the table. So, where do we need to go? Well, obviously, we need to do a better job of linking education to practice, and we haven’t done a fantastic job linking outcomes from our students to the bigger outcomes, like the patient care outcomes. What does this IPE course mean in terms of long-term patient outcomes? What does it mean for a health system? What kind of economic impact does it have? Those are things we still really need to do a better job with.
This report also really recommended that we engage patients’ families and our communities, not only in our education, which we do do to some sense, but actually in the planning of our education and in the development or re-development of our respective curricula.
So, again, we really don’t have the best empirical foundation for IPE. We know that in practice –definitely teamwork and physicians, nurses, respiratory therapists, physical therapists, social workers – all of those people working together, there have been studies to show that that improves patient outcomes. But, there haven’t been a lot of studies and there have been no large, robust scale studies to show that what we do on an educational level has a long-term impact on patient care in the health system.
We also need to look at how can we engage our health system partners, not just acute care, because health care is moving so much into the community, but how can we engage all our health system partners in what we do?
I don’t want to spend a whole lot of time on this, but there is a new model that’s been developed. But, there are components of things that this particular work group really encouraged us to look at when we’re trying to plan research studies, so really looking at the entire learning curriculum. What role does IPE play in both our formal education – whether it’s undergraduate or graduate – and in our professional development after we’re out and practicing in the real world? How does what we do impact health systems and health outcomes? And, then, also what kind of factors help us to do a good job with IPE? And what kind of factors are really inhibiting us from doing what we need to do? Do we have a culture, even within our own health professions – and sometimes the answer is no – that supports IPE? Do we have policies in place to help us? Do we the support that we need within our institutions to make this happen?
So, I’m going to shift gears just a little bit and talk to you about what we’ve done here because this is really exciting; we’re actually starting in our fifth year of our committee. So, this committee started in 2012. It’s a collaborative effort between the Health Professions programs at Salisbury University and the University of Maryland Eastern Shore. We attended this national conference called the IPEC Institute, and as a part of attending this conference, we were able to really develop the foundation for this committee. We really worked our first year to develop this really strong mission statement, and we really are interested, obviously, in educating our students and having our students working and learning together, but also meeting the needs of our respective home organization’s communities that we serve. So, this just gives you a little bit of a flavor of the professions that we currently have on our committee. I would say we’re always growing and expanding, so there’s probably room for more on the list, but here at SU we do have nursing, respiratory therapy, social work, med-lab science and athletic training. And then at UMES, again, lots of different types of professions: physical therapy, pharmacy, rehabilitation, dietetics and then we have a liaison to their internal committee.
So, we’ve really taken a multi-faceted approach to IPE within our own departments. I think it was exciting, I was sort of sitting in my office the other day and heard some colleagues talking about “We have to incorporate this IPE activity into our course,” and it’s like wow, it’s really became a part of our culture that we really want to get our students engaged with other students and with students within this institution and at others.
We’ve also done a really good job lately, I think, trying to connect with our partners within the community and I’ll talk a little bit about that in a few minutes. A few of the examples of activities that we’ve done to help promote IPE for our students are we’ve looked at things like the care of geriatrics, we’ve worked in community health settings together, we’ve done some end-of-life work, also mental health and addictions, and poverty. So, it’s really important, and this is where things sometimes get sticky, but it’s really important for us to be able to cultivate and maintain these relationships that we have established or are developing. You have relationships, of course, within your own department, which sometimes can be contentious as we all know. But, then also within your own institution as well, and then between the two institutions. We’re all coming from different disciplines, so we all have a little bit of a different philosophy. We all sometimes have different priorities at times, but I think we’ve actually done a good job, at least on the committee, dealing with some of our conflicts and coming to some resolution.
We also have started to really maintain and cultivate these community health relationships and relationships with our partners in the community as well. This picture is an example of some of our undergraduate nursing students with the graduate-level pharmacy and physical therapy students; they went on a boat trip out to Smith Island, and we did some preventative health teaching and promotion with those residents there. This picture shows, actually the students went to the dock because there were people were working and they couldn’t come to us, so we went to them, and I remember the pharmacy faculty coming to me and saying “Wow, your students really know how to interact and speak to people!” And I said, “Well, that’s a big part of what we do.” And he’s like, “My pharmacy students need work on that, so let’s come up with a way to get them to work together.”
This really gives you an overview of the kinds of things we’ve done since we’ve started our committee, and it’s really exciting to look at this and to think about all the possibilities that we have for the future. The first year we really focused on figuring out who we were, what we were doing, where we were going and did a little bit of experiences; but, each year we’ve built, we’ve been able to have more experiences, we’ve been able to develop some scholarship, we’ve presented at national and international conferences, and we’ve written a couple papers. So, we’ve really been able to grow as a committee and really, kind of, highlight the work that we’ve done.
This is another picture of our students interacting with pharmacy, physical therapy, from this campus we have respiratory therapy and nursing and this is an acute care scenario, but the students are all working together to try to work through some different patient situations – and they had a lot of fun with this. This is just this past spring. Our undergraduate nursing students and the doctor-level pharmacy students came together to work on an emergency preparedness drill at UMES that’s meeting some community health needs.
So, just to give you a little highlight of some of the work we’ve done, these are some things we’ve found when we did do faculty assessment of faculty here and at UMES who are in the health professions. Some of the things that are kind of interesting that came out of our survey were that a lot of our faculty from the different professions felt that their profession was undervalued by others. This is not surprising to me or, really probably, anyone on the committee because we know what it’s like to work in that health environment. And again, I think a lot of people don’t understand what the other professions bring to the table. But, some of the really positive things that came out of it was that the faculty really did see the value of working with other professions. They really saw the value of integrating into patient care and saw the value of working in teams. And, many of them were very interested in inter-professional education, although they felt like they didn’t have the best knowledge or comfort with teaching in an IPE environment. So, that’s really where the committee has focused the first couple years of our work is really to try to help develop our faculty, while we offer our students different opportunities.
So, in 2014, one of the key things that we wanted to address was looking at how to manage conflict. This is a big one. In health environments, conflict is very detrimental to patient outcomes. And so, we had a speaker come in and talk about conflict and you can see the faculty sat at round-tables and we talked through different scenarios; it was really great because we got to meet people from the other professions that we didn’t even, you know, really, necessarily, know. This particular event was at UMES. The event we had this past spring was here at SU. And, here we brought together our faculty members again and then academic communities – excuse me, academic members with our community partners. So, we invited people within various health organizations within the community and the hospital and had them come speak to our faculty and then also, after, interact with them, so we could come up with some ways that maybe we could integrate those types of experiences in for our students.
And then a big part of our development has also come from us, various members of the committee, being supported by the University to go to different conferences, sometimes to present scholarship and sometimes to just participate and learn more about what’s going on in the world of IPE. This summer, Dr. Vonny Brown and I went to a conference that was up at Rochester, and we were so happy to find out that what we’re doing here, little, old Eastern Shore, Salisbury University and University of Maryland Eastern Shore, is actually the same as or better than what’s going on at a lot of institutions, at least on the East Coast. So, that was pretty exciting for us.
So, we do a lot of different types of research within our committee. We do look at or what we’re planning to look at is we want to look at long-term outcomes, so we really want to measure where our students are when they come in versus where they are when they get out. And, then, we also want to look at what happens after they graduate, which we’ve kind of decided is going to be a very, much more difficult project to tackle, but I think we’re going to take it on. And then there’s a lot of subgroups of us that do other research projects on the side. Some of those have included improving end-of-life care work with our geriatric populations and community health. So, some of the places that we want to go, obviously, we want to stay consistent with what both of our home institutions want and mesh our mission with the mission of both institutions to help provide the best opportunity for students and faculty.
We also want to continue to engage with our community. I think it’s really important in the health environment to be community-minded, and our community partners are very interested in working with us. And then again, to cultivate and grow these relationships because it does take time, and like I said, sometimes, things don’t always go the way you want them to, but we want to continue to grow those relationships that we have.
Some of the other things we’re doing, some of the projects that we’ve been doing, we’re working on modifying them, either to be able to include some of the other students that hadn’t been included before or we want to do something larger scale. So, some of the things that we’re working with right now are potentially implementing some things related to poverty simulations, some other things that would touch multiple health professions at the same time. We’re also looking at ways we can integrate different coursework and curricular opportunities, and this is hard because our health professions curricula are very tight. We don’t have a lot of room for electives, we don’t have a lot of room to offer new courses, so we have to get creative in how we’re going to do this. And then again, we are always looking for ways to continue to be scholarly in what we’re doing and ways to get the word out about what we’re doing here at Salisbury University and, also, University of Maryland Eastern Shore.
So, that is the end of my presentation (audience claps).
Audience Member One
[Beginning cut off] how mindful the Baltimore campuses’ University of Maryland School of Nursing as it relates to the school of medicine and dental school and …?
Dr. Hinderer
Well, I can only speak to what I know. I obviously don’t work there, so … I know that the dean at University of Maryland Graduate School downtown, where all of the health professions programs are housed, is very much all about inter-professional education. I think they’re doing pockets of things. I don’t – I really am not aware of what types of committees they have. I do know that the Shady Grove campus, which we have a Respiratory Therapy Program there for another year, has a pretty active inter-professional committee that has nursing, pharmacy, I think social work, respiratory therapy involved as well.
Particularly, thinking about the school of medicine?
Yeah, I mean, it’s part of inter-professional education is also becoming a requirement in medical education, but I’m not really sure what they’re actively doing at this moment.
Dr. Griffin
Other questions? (gestures to another audience member)
Audience Member Two
Hi, connecting this one to the previous presentation, I’m sort of struck by the potential of IPE for General Education reform. I know Vonny pretty well, and she’s always very proud of the liberal arts, kind of, underpinnings of our Nursing Program here, and as we, kind of, blow up or expand and grow our Gen. Ed. model, think about the potential for example or how cool it would be if speech pathology, I don’t know if we have a Speech Pathology Program, but if speech pathology students taking Elsie’s course on listening and sound and all of that stuff. Have you given any thought to that yet and collaborations that we could do as we, sort of, put out offerings that might be especially powerful for nursing or pre-nursing, I guess because it’s probably going to happen in the first two years, again, because of how prescriptive the program is, but the potential for liberal arts to do so much more for our students in professional healthcare programs?
I think, absolutely, any of our programs would really be benefit from, you know, collaborations such as that. And I think we do have some of those things going on. For example, Dr. Campbell has a history in nursing course that’s also paired with the Honors Program, that also would, you know, lend itself to history. But, I absolutely think there’s so many possibilities and ways we could look at this, and I do think it’s interesting that we come from a very strong liberal arts background that we could definitely build it to incorporate those things as well. I’ve always thought it would be really cool to be able to offer our students, before they get into the program, opportunities to really think a little bit stronger about health. I know we’ve had philosophy, ethics, end-of-life course before, and I think those things would be great to revitalize, absolutely.
Any other questions?
Audience Member Three
Hi, Katie. I want to ask about, what I would call, experiential learning. All the majors at Salisbury University, that you’re talking about – respiratory therapy, nursing, community health, social work – you all have historic commitments to these sort of big clinical experiences at the end of your undergraduate careers where students are going out into the community. Well, as health has really become more community and continues to become more community based, it seems to me, just as an outside observer, that it’s getting a little messier to deal with in the clinical placements. So, as your committees work together and try to find inter-disciplinary, inter-professional ways to work together, are you talking about ways that that’s maybe backing up on your students’ terminal semester where they’re going out into the field and you have nurses that are working, maybe, maybe not, alongside social workers, who maybe or maybe not are licensed social workers, but not as nurses or nurses not as social workers? It seems like it’s getting awfully complicated, and I wonder if you’re talking about it on the experiential learning part of it.
Absolutely.
This is a great question, kind of asking what are we doing with our students because healthcare is really moving into a community-driven model, and I do think we are having conversations with each other about what we can do in community-based scenarios, like the POD drill, but actually do it with real people and one of things we really talked about at our last meeting, even, was, you know, looking at the community that we serve and where we’re sitting and how many health needs are in the community, really what ways can we take our students and impact the health of the local community even more rather than, you know, I think we’re moving away from that model where we’re just toting them off to the hospital. We don’t do that anyway, but, you know, I think more and more that’s becoming the norm rather than the exception.
Good question. Thank you.
Thank you very much (audience claps).