Outline
Working together in multidisciplinary as well as multi-agency is an issue that has been discussed and debated extensively over the last four decades, especially in healthcare management. This is largely an effort to address the issue of service failures, lack of clinical effectiveness and efficiency, and the growing economic burden of the government (Wallin, Boström, Wikblad & Ewald 2003, p.510).
The shift in the mental illness from acute to chronic requires different health and social care skills to be put in place in the care delivery to eliminate such problems as boundary infringements, a lack of understanding of roles of each person, limited communication as well as poorly coordinated work (Burns & Grove 2005, p. 65). The paper reviews literature in collaborative care, focusing the critiquing the research findings with the help of the PICO format.
Introduction
Working together in multidisciplinary as well as multi-agency settings is a much-explored phenomenon in modern nursing (Beitz & Heinzer 2000, p. 230). It is an issue that has been discussed and debated extensively over the last four decades, to address the issue of service failures, lack of clinical effectiveness and efficiency, and the growing economic burden of the government (Wallin, Boström, Wikblad & Ewald 2003, p.510).
In the 1990s, the social and healthcare professionals began to work more and more closely together in the context of community care and home care (Beitz & Heinzer 2000, p. 233, Wallin et al. 2003, p.513) It is thus worth noting that “collaboration” has a crucial part to play in how multi-professional care is executed and developed. Considering Allan, Bryan, Clawson, & Smith (2005, p.461) definition of collaboration is based on sharing of power and responsibility where the actual aim is to exchange information based on equity and reciprocity to increase knowledge, understanding, and skills.
Although the practice can be developed by the collaboration between the health experts working, complementing, and expanding upon their expertise, the process is normally designed with the client as the center of attention in the whole system (Caelli, Downe, & Caelli 2003, p. 178)
The more complex concept has been on the healthcare professionals in the sub-field of mental healthcare. As per the definition given above, it is logical to note that the care is focused on an effort to improve the client’s well-being; a process that would require that the client is in a position to give a contribution before, during, and after the care process. However, considering the client’s mental health condition, it would be a tall order to assume that the patient would be of sound mind to give an informative opinion (Gerrish & Clayton 2004, p.116).
It has been revealed that the absence of a shared view between the healthcare providers and the patient tends to hamper efforts at appropriate healthcare provision (Bull & Roberts 2004, p. 573). Furthermore, the shift of the burden of mental illness from acute to chronic requires different health and social care skills to be put in place in the care delivery to eliminate such problems as boundary infringements, a lack of understanding of roles of each person, limited communication as well as poorly coordinated work (Burns & Grove 2005, p. 65). This paper provides a critical literature review of the existing practices with the help of the PICO format for analysis.
Research questions
PICO format will be applied in the design of the question to be addressed.
- Patients: these are the patients who are mentally ill;
- Intervention: the intervention is to use evidence-based intervention practices applied by mental health professionals to boost their educational skills.
- Comparison: inter-professional education will be compared with the separate learning processes for the mental health professionals; clinical health and the social health professionals
- Outcome: to come up with a well-structured and evidence-based approach to improve collaborative care skills of the mental health professionals.
Literature Review
Morey (2002, p. 53) study: to evaluate the effectiveness of a program to improve collaborative behavior of emergency department staff physicians, nurses, technicians, and clerks. It was a control before and after the study. United States hospitals provided all the emergency departments for the study. The intervention entailed an emergency team that coordinated education courses and implemented formal teamwork structures and processes; and a pair of physician-nurs, each from the emergency department was actively involved in the curriculum development and implementation (Morey 2002, p. 54).
With the component of eight hours of instruction per day, the format is composed of lectures, behaviors discussions, practical exercises, and video segment discussions (Morey 2002, p. 61). Teamwork implementation involved forming teams by shift and delivering care in a team structure (p.61). Nine hospital emergency departments self-selected either to receive the inter-professional education (IPE) intervention (684 clinicians from six emergency departments) or to act as a control (374 clinicians from three emergency departments) (Morey 2002, p. 64). Data were collected at two four-month intervals following the training (Morey 2002, p. 65).
There was a statistically significant improvement in the quality of observed team behaviors between the experimental and control groups following training; and the clinical error rate also decreased significantly, from 30.9% to 4.4% in the intervention group (Morey 2002, p.66).
The other one was another control-before-and-after study by Young (2005, p. 12) to evaluate the effects of a consumer-led innovation to improve the competence of mental health practitioners working in community mental health provider organizations in the United States. The target population was psychiatrists, nurses, therapists, case managers, residential staff, mental health workers, and administrative support who were engaged in six educational components for over one year as an intervention part of PICO; the components were presentations, discussions, small groups, and role-playing techniques, and three or four full-day detailing visits to sites (Young 2005, p. 13).
Additionally, 16 hours were also spent with staff at the sites; a consumer-focused intervention was delivered by two people who are consumers of mental health services (Young 2005, p. 13).
Five organizations in two states provided the locations for the study; one organization in each state received the intervention (total of 269 mental health practitioners, 151 in intervention groups, and 118 in control groups) (Young 2005, p. 14). Data were collected at the baseline for one year. The results indicated that control group mental health practitioners in the intervention group emerged superior about teamwork, holistic approaches, education about care, rehabilitation methods, and the overall competency, in comparison to practitioners in the control group, reported significantly (Young 2005, p. 13).
Analysis
Even though the overall results of the two studies show that there are positive outcomes that are directly linked to inter-professional education (IPE), there is a lack of clarity of the IPE itself, effectiveness; the heterogeneity and the limitations in the methodology of the two studies puts in doubt the effectiveness. The objectives, the educational intervention format, the existence of other interventions, and the clinical areas, as well as settings, contributed to the heterogeneity.
The IPE component of the two studies took 8 months and one year respectively for the first and the second. Young (2005, p.16) report shows that most clinicians participated in each of the component-varied-intervention group sites. Morey (2002, p. 74) on the other hand solely focused on inter-professional teamwork in a particular context and setting, i.e. emergency department and primary care. These illustrations indicate the heterogeneity components that may have led to the insufficient result, and shows the reason why it is maybe a difficult task to put a summary on the identified key elements of successful interprofessional education.
Morey (2002) and Young (2005) are all proposing a multifaceted approach to interventions, where inter-professional education was just but one component. The other interventions were feedback measurements and consumer-focused interventions. Morey (2002, p. 78) commented on the need for a type of leadership that supports teamwork at various levels of organizations. These explicit inadequacies of rigorous designs of the methodology used coupled with insufficient qualitative data are likely to significantly affect our understanding of the effectiveness of Inter-professional education as an intervention procedure.
However, it is significant to acknowledge that inter-professional training promises to be one of the most important ways of integrating collaborative healthcare provision for mental health professionals (Dieleman, Fariis, Feeny, Johnson, Tsuyuki & Brilliant 2004, p. 6). Shared professional competencies have been under-explored about their efficacy to change practice and enable effective team working. In a study that was not highlighted here (Downie, Wynaden, McGowan, Zeeman & Ogilvie 2001, p.28).
Pillar & Solem (1999, p.31) concluded that inter-professional education can have different outcomes but one thing that has been revealed is that work-based IPE can be more effective than the university- shared learning, which results directly in changes to practice as well as the quality of life. But most observers insist that the best practice is that which marries the framework at the occupational and learning levels, where adequate curriculum planning with all the stakeholders is required (Retsas 2000, p. 600). More importantly, the complexity associated with collaborative care for mental cases needs more research and understanding to ensure a more specific patient-tailored approach is reached (Boswell & Cannon 2005, p 8).
Appendix
Methodology of Search and Search Terms
The literature search for several terms was achieved through a search of several databases, where various terms related to collaborative healthcare were the main focus, with specific areas of mental healthcare provisions. The first search was on the CINAHL database, where terms such as “collaborative nursing”, “role of the nurse in collaborative healthcare”, and “inter-professional education”. The search resulted in a wide range of results, which had to be narrowed to get specific and up-to-date relevant materials such as journals published mostly from the last 10 years. Additionally, the same search criterion was used with Google Scholar, where some relevant materials like the online material were found.
Reference List
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