Transcript Achieving Collaborative Competence through

Achieving Collaborative Competence through
Interprofessional Education
Lessons learned from Joint Training in Learning
Disability Nursing and Social Work
Why Interprofessional Education?
• Complex practice making different professions
mutually dependent
• Holistic approaches
• Failures in communication
• Policies requiring integrated working
• Singular disciplines, training and identities
• Knowledge for collaborative practice
Jointly trained practitioners – a different
professional perspective
• Expected to integrate two discourses into their
practice
• Experienced the tensions and conflicts of a new
‘hybrid’ worker
• Occupying ‘thirdspace’ (Beattie, 2003)
• Experienced dual socialisation
Dual Socialisation in a Joint Training
Programme
• practice placements in both health and social
services
• practice supervision from both nurses and
social workers
• lecturers from both disciplines
• learning the ‘language’ of nursing and social
work
• shared learning with other nurses and/or social
workers
• two different codes of practice
• assessed against integrated learning outcomes
Collaboration and
Collaborative Competence
Collaboration:
• Involves different degrees of proximity in time or space
and different levels of complexity eg.
• May be concurrent and co-located –people working
physically together on the same task at the same time in
the same place
• May be sequential – a series of steps to provide
seamless care (eg. acute trust works with Social Services
to discharge an older patient)
• May be virtual (eg researchers working with
practitioners/organisations to improve services)
(Meads and Ashcroft, 2005)
Professional Competence
Barr (1998) distinguishes between:
Common Competencies – those held in common
between all professions – part of the rationale for joint
training
Complementary Competencies – those that distinguish
one profession from another – also part of the rationale
for joint training
Collaborative Competencies – those necessary to work
effectively with others – the evidence suggests that joint
training develops them
Collaborative Competencies
• Communication
• Understanding roles
• Respecting /valuing other professions
/networking
• Managing change and conflict
• Working together
• Acceptance
• Developing and supporting each other
• Facilitating Teamwork
(Barr, 1998)
Boundary Talk – Research with jointly
trained practitioners
• Postal survey of ex students (n =47) from 5
universities in England
• Semi-structured interviews with 25 self
selecting respondents
• Information from Course Leaders
• Ethical Approval through the Institute of
Education
• Grounded Theory methodology
Prepared for Interprofessional Practice?
40
30
20
10
0
well prepared well prepared insuff. Either insuff. Social
social issues health issues
insuff.
Nursing
How was Collaborative Competence
expressed by respondents?
‘we were looking at two cultures weren’t we?
We were trying to assimilate two cultures
into one person and we were being taught
by two cultures and there were significant
differences between mornings and
afternoons in terms of the culture of the
lesson and the content of the lesson’. (Int
04)
respecting, valuing other professions
managing competing discourses (Barnet, 1997)
Transcultural Understanding
‘I think the placements also helped.
I mean I did two placements in hospitals,
one in a mental health residential home,
one in a learning disability day centre,
and again, you experience different
cultures’. (Int 04)
Understanding roles, networking
Breadth of Knowledge (Sims, 2008)
Cultural Competence
‘When they do a multi-agency assessment of a family
of a child (in health) and they feed back to the family
they call it a case conference, but obviously within
social services a case conference is a child
protection matter, so they have different language
and different things mean different things within their
role – so working across the two you can put
people’s minds at ease because you understand the
language that they are on about and talk in terms that
they are comfortable with’ (Int 20)
Communication
Cultural competence – openness, respect and
willingness to learn (O’Hagan, 2001)
Constructing practice differently
‘being able to recognise and see that
different people might look at (practice)
slightly differently and you need to take
that into account and work with that,
not try to resist it or defend against it or
kick against it really’. (Int 23)
Valuing other professions
Learning how other professions construct understandings
of problems (Barrett and Keeping, 2005)
Confidence and Conflict
‘I think I feel relatively confident in getting a
consensus on a care plan. I feel more able to
identify and challenge members of the
support network who may be trying to
bluster their way into having their own say,
when it does not appear to be what the
consensus had identified as in the clients’
best interests’. (Int 12)
Managing Conflict
Confidence – in own role and skills (Barrett and
Keeping 2005)
Challenging Boundaries
‘I have actually sometimes been told off for
acting too much like a social worker – that’s
a social worker’s role! Why did you make
that referral? The social worker should have
made it. And I say –well, it is a piece of
paper half a page long, it takes two and a
half minutes and I have the link!’. (Int 08)
Acceptance – tolerating differences
Street Level Bureaucracy (Means & Smith,1994)
Elegant challenging (Thompson, 2006)
Negotiating Boundaries
‘I was told by the social worker that
I always have to have nurse present…
and I thought – I can do this! It’s no big
deal. I can ask these questions and I
can make a referral to the psychiatrist.
No you can’t do it, said the social worker’.
(Int 06)
Managing conflict
Role/boundary negotiation (Barrett and Keeping 2005)
Facilitating Interprofessional Working
‘I got social services to come and sit in the
meetings and that worked really well, so we
were already joint working and integrated
before we were told to integrate. I initiated
that, and that was because of the joint
training I think’. (Int 25)
Developing/supporting one another
Managing Collaboration
‘All the time you are in your comfort zone
you are less likely to learn, whereas if you
are faced with those difficulties, you know,
and quite often they are operational
logistical difficulties, you have to try and
manage……once you become qualified it is
a real mistake to retreat into the comfy arms
of those professional bodies’. (Int 23)
Working Together
Professional Adulthood (Barrett and Keeping 2005)
Lessons which can be learned
• Broadening the socialisation of social work
students
• Ensuring contrasting / diverse placements
• Involving other professionals in the assessment
of students
• Drawing on different discourses and knowledge
(eg. nursing, health)
• Establishing contact opportunities with students
from other disciplines – joint tasks?
• Placement contracts - IP learning opportunities
• Key Role 5:17 Scrutinising the evidence of
multidisciplinary working (in teams, networks,
systems)
Final Thoughts
• Workers are needed in the crucial space between
disciplines (Bernstein, 2000)
• They need a professional habitus which goes beyond
a single discipline (Bourdieu,1998)
• Collaboration involves celebrating definitional
uncertainty (Beattie, 2003) rather than being
overwhelmed by it
• Social workers need the ability to tread lightly on
shifting professional sands!
The Challenge
Do you think that interprofessional
experiences can help social work students
to develop collaborative practice?
If so, how can singular social work
programmes best achieve this?
Dave Sims
University of Greenwich
Sources
• Barnett R. (1997). Higher Education: A Critical
Business. Buckingham: Open University Press.
• Barr H. (1998). ‘Competent to Collaborate: towards a
competency-based model for inter-professional
education’. Journal of Interprofessional Care, 12 (2),
181-187.
• Barrett G. and Keeping C. (2005). ‘The Process
Required for Effective Interprofessional Working’, in
Barrett G., Sellman D. and Thomas J. (eds.)
Interprofessional Working in Health and Social Care.
Basingstoke: Palgrave Macmillan.
• Beattie A. (2003). ‘Journeys into thirdspace? Health
Alliances and the challenges of border crossing’, in
Leathard A. (ed.) Interprofessional Collaboration.
From Policy to Practice in Health and Social Care,
Hove: Brunner-Routledge
• Bernstein B. (2000). Pedagogy, Symbolic Control and
Identity. Theory, Research, Critique. Revised Edition.
Lanham: Rowman and Littlefield (USA). Bourdieu P.
(1998). Practical Reason. On the Theory of Action.
Cambridge: Polity Press.
• Department of Health. (2002). Requirements for
Social Work Training. London, DH.
• Means, R and Smith, R. (1994). Community Care
Policy and Practice. Basingstoke. Macmillan.
• O’Hagan, K. (2001). Cultural Competence in the
Caring Professions. London: Jessica Kingsley
• Quality Assurance Agency for Higher Education.
2008. Social Work Subject Benchmark Statement.
Gloucester, QAA.
• Sims, D (2008) The Role of Joint Training in
Practitioner Development for Learning Disability
Services in the International Journal of the
Interdisciplinary Social Sciences. Vol 2, Issue 5. pp
207-214.
• Thompson, N. 2006. People Problems. Basingstoke.
Palgrave Macmillan.
Collaborative Competencies
(Barr, 1998 – for information)
•
Describe one’s roles and responsibilities clearly to other
professions and discharge them to the satisfaction of those
others
•
Recognise and observe the constraints of one’s role,
responsibilities and competence yet perceive needs in a wider
context
•
Recognise and respect the roles, responsibilities and
competence of other professions in relation to one’s own,
knowing when, where and how to involve those others through
agreed channels
•
Work with other professions to review services, effect change,
improve standards, solve problems, and resolve conflict in the
provision of care and treatment
•
Work with other professions to assess, plan, provide and
review care for individual patients and support carers
•
Tolerate differences, misunderstandings, ambiguities,
shortcomings and unilateral change in another profession
•
Enter into interdependent relationships, teaching and
sustaining other professions and learning from and being
sustained by those other professions
•
Facilitate interprofessional case conferences, meetings, team
working and networking
Barr (1998)