Enhancing Care of Vulnerable Populations through Development of a Holistic Model to Evaluate Interprofessional Education

Saturday, 7 November 2015

Rebecca Lee, PhD, MSN, BSN, BS, ADN, RN, PHCNS-BC, CTN-A
College of Nursing, University of Cincinnati, Cincinnati, OH, USA
Gwen Sherwood, PhD, RN, FAAN
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Carol L. Huston, DPA, MSN, RN, FAAN
School of Nursing, California State University Chico, Chico, CA, USA

Rebecca C. Lee, STTI ENFLA Scholar (2014-2015)

Leadership Project: Enhancing Care of Vulnerable Populations through Development of a Holistic Model to Evaluate Interprofessional Education


This change project was implemented as part of the Experienced Nurse Faculty Leadership Academy (ENFLA) by Rebecca C. Lee (Scholar), in collaboration with Gwen Sherwood (ENFLA Mentor) and Carol Huston (ENFLA Faculty).  The ENFLA experience was sponsored by Sigma Theta Tau International and Chamberlain College of Nursing Center for Excellence in Nursing Education.

Introduction/Background: Interprofessional teamwork and collaborative practice are key elements of efficient and productive efforts to promote health and treat patients in an increasingly complex health care system. Team-based care involves health and/or social professions that share a team or network identity and work closely together in an integrated and interdependent manner to solve problems and deliver services. Inadequate preparation of health professionals for working together, especially in interprofessional teams, has been implicated in a range of adverse outcomes, including lower provider and patient satisfaction, greater numbers of medical errors and other patient safety issues, low workforce retention, system inefficiencies resulting in higher costs, and suboptimal community engagement. Therefore, reforming health professions education in order to prepare all future health professionals for deliberatively working together through advancement of Interprofessional Education (IPE) opportunities is vital for increasing health professional’s work satisfaction as well as improving the quality and safety of health care, while ensuring patient-centeredness.

Health professions faculty have long recognized that interprofessional experiences should be geared toward meeting a set of standards and competencies. The report of the Interprofessional Education Collaborative (IPEC) Expert Panel (2011) proposed four domains of Interprofessional Collaborative Practice: Values/Ethics, Roles/Responsibilities, Interprofessional Communication, and Teams and Teamwork. Thirty-eight specific competencies further define the domains to assist educators in designing relevant learning experiences across all health care professions and promote dialogue to evaluate the fit between educationally identified core competencies for interprofessional collaborative practice needs and demands. Development of the IPEC domains and competencies were developed primarily by educators and professional societies with limited or no input from active healthcare practitioners, students, and members of the communities we serve. While there are numerous surveys to assess various aspects of IPE, educators continue to seek comprehensive assessment strategies that consider the full range of the competencies. Development of a holistic model for measuring the impact of IPE on the professional growth of health professions students during their education is needed to examine the linkage between interprofessional education and collaborative practice, as recommended by the Institute of Medicine in their 2015 report, Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes.

Purpose: The purpose of this project was to facilitate leadership development of an experienced nurse faculty member through the expansion of the skills needed to successfully lead an interprofessional team in the development of a holistic model to evaluate interprofessional education experiences for health professions students caring for vulnerable populations in a community based setting.

Methods: The first step of the project was to convene a team consisting of interprofessional colleagues from across the Academic Health Center of a large Midwestern University. This group included representatives from the Colleges of Nursing, Medicine, Pharmacy, and Allied Health. Faculty and students had partnered with a local social service agency since 2010 to hold an interprofessional self-management clinic at the agency’s community food pantry.  Despite anecdotal data related to the value of this IPE experience, no data has been collected to assess student learning outcomes. A series of collaborative forums were planned with key stakeholder groups involved with the self-management clinic to examine the IPEC domains and competencies including: (1) Health professions students; (2) Health professions faculty; and (3) Community partners including the agency and clients. Following each presentation and review of the domains and competencies, stakeholder representatives provided both written and verbal feedback regarding the existing domains and competencies, as well as suggestions for additional items needed to formulate a holistic assessment of the IPE experience. Following each of these collaborative forums, the IPE Team members met to analyze data and refine the emerging model.

Results: Collaborative forums were completed with each of the key stakeholder groups. Participants were appreciative of the opportunity to contribute to development of the model, identifying areas that they felt were important for inclusion.  As a result, a final model was created by the IPE team that expanded the original four IPEC domains to six. Faculty and students identified a fifth domain, Environment of Care, which involves actively contributing to improving the environment of care for self and other health care professionals and staff in order to increase satisfaction, enhance retention, and reduce burnout. The Community Partners, which included both representatives from the agency and community residents, identified additional competencies to be included under the Teamwork & Collaboration domain and added an additional domain, Patient Centeredness, which was determined by the group to be central to the new model.  Patient Centeredness was defined as purposefully placing the patient and his/her family at the center of the health care experience through holistic, relationship-based care delivery.

During the ENFLA experience, the scholar gained valuable self-awareness, insight, and skills which allowed her to strategically create a dynamic leadership plan to facilitate her continuous development as a member of the academy in her new role as a tenured faculty member, as well as a leader in IPE initiatives designed to enhance the care of vulnerable populations.  Self-reflection, skillfully facilitated by both the ENFLA mentor and ENFLA faculty, was a crucial component of the ongoing leadership development process, and prepared the scholar to move from relying on external definitions and indicators of successful professional development and leadership to embracing a model which includes knowledge of her own unique personal leadership qualities and style while setting leadership goals. As a result of this process, the scholar identified servant leadership as the leadership style most in keeping with her personal philosophy of nursing, and life. Thus the ENFLA experience resulted in greater knowledge of, and acceptance of self, as well as the recognition of opportunities for future leadership in advancing the care of vulnerable populations, locally, nationally, and globally.  

Conclusions: Plans are underway for future testing and refinement of the Holistic IPE Model. An IPE grant has been submitted to an external funding agency that will use the model to evaluate student learning as part of involvement with the proposed project. A master’s student in Allied Health is using the model to evaluate learning outcomes for former health professions students participating in the IHI Open School clinic. As part of her project, she will utilize cognitive interviews of students to further refine the holistic model.

Development of a nurse leader, as well as a holistic model to evaluate IPE, requires thoughtful strategic planning and partnerships. Participation in the ENFLA provides experienced nurse faculty with the opportunity to reflect on personal leadership qualities and styles, and incorporate this self-knowledge in the creation of a tailored leadership development plan under the guidance of mentors and faculty accomplished in the field of nursing leadership. Leadership skills are further refined through the planning, implementation, and evaluation of the leadership project in partnership with colleagues in our respective universities. Thus an essential element of the ENFLA leadership development process is collaboration with a supportive team whose members possess diverse perspectives and expertise who challenge the scholar to expand previous boundaries and envision future leadership potential. An African proverb states, “If you want to go fast, go alone. If you want to go far, go together.”