By Laura R. Sanchez, RN (@lsancheznp) and Helen Horvath, RN, MS, ANP (@helen_horvath)
In my experience as a nurse practitioner (NP) student at University of California, San Francisco (UCSF) I have found significant value in not simply receiving didactic interprofessional education, but in practicing it through clinical experiences. Combining didactic IPE with a yearlong clinical experience, centered around interprofessional collaboration, has been powerful. Geriatrics education at UCSF incorporates experiential interprofessional education to successfully prepare future clinicians to provide quality care to older adults. For me, it has illuminated the ways in which health professionals can come together to improve outcomes for some of the most vulnerable, frail, and complex patients.
As an Adult-Gerontology Nurse Practitioner student with a focus in geriatric home-based primary care, I participated in weekly interprofessional didactics on advanced geriatrics topics. This focused curriculum is shared by UCSF physicians as part of their geriatrics fellowship and provides a welcome opportunity for interprofessional learning. This, in conjunction with the IPE courses required by the School of Nursing, gave me a glimpse of the importance of interprofessional collaboration and communication.
At UCSF, NP students are required to complete an IPE course every quarter throughout the two-year program; this coursework is shared by students in the medical, dental, and physical therapy schools (IPEC Competency: Teamwork) and we come together several times throughout our education to role-play IPE cases. This exposes learners to the importance of other health professional roles (IPEC Competency: role & responsibility) and helps to build foundational communication skills (IPEC Competency: Communication). In addition, we learn how each other contributes to the team, highlighting the value each member contributes to the complex care of patients (IPEC Competency: Value and Ethics). However, the most valuable part of my interprofessional education has been taking what I learned in the classroom and operationalizing it in my clinical experiences.
Having seen interdisciplinary care in action through a year-long geriatric clinical rotation truly conveyed its significance in fostering quality care and improved patient outcomes. I have had the unique opportunity to dedicate a majority of my clinical hours to UCSF Care at Home, a home-based primary care program for older adults. In weekly clinical conferences, the entire team comes together with the goal of determining how to provide the best care to patients, whether that be through administrative means or consulting each other on clinically and psychosocially challenging cases. This team, composed of registered nurses, social workers, patient care coordinators, geriatricians, a psychiatrist, and nurse practitioners, models interprofessional collaboration at its finest.
The exemplar:
Ms. J, an 81-year-old retired RN who worked for over 30 years in an assisted living and skilled nursing facility, lives with advanced COPD with exacerbations and chronic lower extremity edema that often results in open wounds and cellulitis. She lives alone and has suffered social isolation during the COVID-19 pandemic. Given her complicated clinical and social picture, we sought a team-based approach to help us provide the best care possible.
- The clinic’s nursing team is in contact with Ms. J regularly and loaned her a tablet for video appointments and virtual visits with her family
- The social worker helped resolve an exorbitant ambulance charge
- The pulmonologist regularly weighs in on the appropriate course of action regarding her worsening COPD.
- Clinic physicians and NPs were consulted regarding her regarding her unrelenting lower extremity edema.
Ms. J could not possibly get all the care she needs from a sole provider; well she could but it would be incomplete care which would result in poor outcomes.
The value to learners of seeing authentic interdisciplinary collaboration and communication first-hand cannot be overstated. As a result of practicing IPE in my clinical rotations, I have personally experienced greater confidence and skill in providing interdisciplinary care and now look for opportunities to bring in other disciplines, in order to provide the best possible care for each patient. While interprofessional education courses are required for many health professions programs, interprofessional collaboration experience within clinical rotations is often an added bonus.
References
Halter, J.B., et al. (2017). Hazzard’s Geriatric Medicine and Gerontology, Seventh Edition. New York; McGraw-Hill Education Medical.
Naylor, M. D., Hirschman, K. B., Bowles, K. H., Bixby, M. B., Konick-McMahan, J., & Stephens, C. (2007). Care coordination for cognitively impaired older adults and their caregivers. Home health care services quarterly, 26(4), 57-78.
Image credit: ©stock.adobe.com/au/Monkey Business