Achieving Collaborative Competence through Interprofessional Education

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Achieving Collaborative Competence through
Interprofessional Education

• Lessons learned from Joint Training in Learning
  Disability Nursing and Social Work

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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

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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

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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

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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)

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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

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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)

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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

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Prepared for Interprofessional Practice?
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How was Collaborative Competence expressed by
respondents?

• we were looking at two cultures werent 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)

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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)
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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 peoples 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 (OHagan, 2001)

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Constructing practice differently

• Valuing other professions
• Learning how other professions construct
  understandings of problems (Barrett and Keeping,
  2005)

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)
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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)

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Challenging Boundaries

• I have actually sometimes been told off for
  acting too much like a social worker thats a
  social workers 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)

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Negotiating Boundaries

I was told by the social worker that I always
have to have nurse present and I thought I can
do this! Its no big deal. I can ask these
questions and I can make a referral to the
psychiatrist. No you cant do it, said the
social worker. (Int 06)
Managing conflict Role/boundary negotiation
(Barrett and Keeping 2005)
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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

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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 manageonce
  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)

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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 517 Scrutinising the evidence of
  multidisciplinary working (in teams, networks,
  systems)

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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!

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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
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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

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• 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.
• OHagan, K. (2001). Cultural Competence in the
  Caring Professions. London Jessica Kingsley

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• 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.

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Collaborative Competencies (Barr, 1998 for
information)

• Describe ones roles and responsibilities clearly
  to other professions and discharge them to the
  satisfaction of those others
• Recognise and observe the constraints of ones
  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 ones 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

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• 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)