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http://hdl.handle.net/11375/23645
Title: | Development and Feasibility Testing of an Interprofessional Education to Support Collaborative Practice in Home Care for Older Adult Stroke Survivors with Multiple Chronic Conditions and their Family Caregivers |
Authors: | Bookey-Bassett, Susan E. |
Advisor: | Markle-Reid, Maureen |
Department: | Nursing |
Keywords: | interprofessional education;collaborative practice;community-based stroke rehabilitation;home care;older adults;effectiveness;feasibility |
Publication Date: | 2018 |
Abstract: | Background. Many older stroke survivors live with multiple (> 2) chronic conditions (MCC), resulting in the need for care by multiple health and social service providers from multiple organizations and sectors. Managing the physical, social and psychological needs related to stroke in addition to other chronic conditions is a complex process that is best served by an interprofessional team of health care providers working collaboratively toward common goals. Interprofessional education (IPE) has been promoted by numerous organizations as a method to enhance collaborative practice. However, many home care providers have not received formal IPE or training to support collaborative practice. Providing IPE in the home care setting is challenging because providers rarely work in a common location, often work in isolation, and spend much of their time driving to provide care to clients in their homes. Moreover, the effectiveness of IPE on collaborative practice for stroke rehabilitation in the home care setting is undetermined. New approaches to IPE for practicing health care providers working in the home care setting are needed. The purpose of this study was to examine the feasibility and acceptability of implementing a new theory-based, IPE intervention, and to explore its effects on collaborative practice in home care for older adult stroke survivors with MCC. Method. This feasibility study involved the use of both a qualitative descriptive and a quantitative (one-group repeated measures) design. The IPE intervention was developed and evaluated within the context of a larger pragmatic randomized controlled trial (RCT), which evaluated the effectiveness of the Aging Community and Health Research Unit Community Partnership Program (ACHRU-CPP). Informed by the W(e) Learn Framework for Interprofessional Education, the National Interprofessional Competency framework, and the literature, the IPE intervention consisted of four key components: (a) an initial three-hour standardized IPE training session; (b) standardized training for care coordinators; (c) collaborative practice reflective huddles; and (d) outreach visits. The primary outcome was the feasibility of the IPE intervention (enrollment rate, attrition rate, implementation barriers/facilitators). Secondary outcomes included the acceptability of the IPE intervention, the feasibility of the study methods (recruitment/retention rates and procedures, eligibility criteria, data collection and analysis methods), and potential effectiveness of the intervention based on three-month changes in collaborative practice, as measured by the Collaborative Practice Assessment Tool (CPAT) and the 19-Item Team Climate Inventory (TCI). Feasibility and acceptability outcomes were based on descriptive statistics for enrollment and attrition rate and qualitative descriptive analysis of focus group content, field notes, and evaluation of training. The potential effectiveness of the IPE intervention was explored using paired t-tests and Cohen’s d, with the results expressed using descriptive statistics and effect estimates (95% confidence intervals). Results. A total of 37 home care providers from two provider agencies and one Community Care Access Centre (CCAC) in Ontario, Canada participated in the study. Participants included registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators as well as nursing, rehabilitation and personal support worker supervisors. Participants viewed the intervention as feasible and acceptable. It was effective in improving three domains of collaborative practice as measured by the CPAT (communication/information exchange; community linkage and coordination of care; decision-making and conflict management) and one domain of collaborative practice, as measured by the TCI (task orientation) at six months post initial training. Participants perceived many benefits to the intervention, including improved communication and collaboration within their teams, enhanced role understanding, increased learning with and from each other, and increased appreciation and valuing of the expertise of all team members. Facilitators to implementing the intervention included: funding from the larger trial, support from key stakeholders including agency leadership, provision of key resources (e.g., Team Charter, sample agenda), and continuity of the care coordinators. Barriers included unanticipated delays in recruitment of older adult stroke survivor participants into the larger trial, and higher than expected attrition rates. The study methods were feasible and effective in reaching the target population. We established that the intervention could be delivered as planned. Conclusion. The results of this study provide preliminary evidence for the feasibility, acceptability and preliminary effects of the IPE intervention on collaborative practice for an interprofessional stroke-specific team in home care caring for older adult stroke survivors with MCC. The results also provide knowledge of the facilitators and barriers to successfully implementing and sustaining the intervention into home care practice. Further research is warranted to test this intervention in other chronic populations and settings. |
URI: | http://hdl.handle.net/11375/23645 |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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Bookey-Bassett_Susan_E_ Final Submission_2018July_PhD.pdf | 1.72 MB | Adobe PDF | View/Open |
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