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Healthcare is moving toward a workforce
that emphasizes teamwork competencies
and working in teams of providers to
optimally meet patient healthcare needs.
To be prepared for the realities of
on-going care delivery changes,
health professions education is changing
to include a greater focus on
inter-professional education,
preparing all health profession students
to deliberately work together
in order to build a better quality, more
efficient and safer healthcare system.
In 2011 the Core Competencies for
Interprofessional Collaborative Practice
were released and are being widely used
as the basis for interprofessional
education.
This video is the first in a series of
four videos designed to introduce
preceptor students and faculty to the
core competencies for interprofessional
collaborative practice.
These core competencies were developed
by an expert panel made up of six
health professions.
All of the interprofessional competencies
discussed in these videos are
directly based on the core competencies
for inteprofessional collaborative
practice report, which is available
for free on the internet for download
and is referenced at the end of the video.
This video uses a patient scenario to
illustrate the foundational components
of the first competency - values and
ethics for interprofessional practice.
This competency centers on working from
a base of shared values,
and mutual respect with individuals
of other health professions
to deliver patient and population
centered care.
Shared interprofessional ethics is an
important part of this competency
and needs to be applied to delivering
collaborative care.
For example, how do we handle
confidentiality inherent in the
patient-practitioner relationship
in the context to delivering
team-based collaborative care.
At the end of this training video,
you'll be asked to answer a short
series of questions about the first
interprofessional collaborative practice
competency.
These questions will help you monitor
your mastery of the competency presented.
Let's get started.
This patient scenario video centers around
a patient who has decided with
her healthcare team to stop chemotherapy,
choosing to move to a totally palliative
care approach.
Her daughter who lives out of town
is not supportive of the decision.
Her daughter is visiting her mother
for the purpose of reversing
her mother's decision and resuming
chemotherapy.
Let's meet our actors.
Meet Ella, a 78-year-old
Caucasian female with diabetes
who's been receiving treatment at the
infusion center that is associated
with an oncology practice.
She lives independently at home.
She was diagnosed with breast cancer
four years ago,
underwent a mastectomy, radiation,
and chemotherapy,
and did quite well.
Two years ago she developed metastasis
to her lungs.
Ella has an interprofessional
collaborative team
who's been working with her for two years.
Ella has decided in collaboration with her
team to stop further cancer treatments
and transition to palliative care only
and symptom management and control.
She's relying on her Christian beliefs
for additional comfort,
wanting to be able to enjoy as much
quality of life as she can,
free from the distressing side effects
of chemotherapy.
Meet Karen, Ella's daughter,
who lives out of state and has not been
available to participate in the
interprofessional team meetings
involving her mother's care.
Karen has just arrived for a short visit
with her mom.
She has recently been told about
her mother's decision to transition
to a palliative care approach.
Karen is not happy.
She's worried about her mother
and wants to change her mind.
Meet Jose,
Ella's clinical nurse specialist.
Clinical nurse specialists are advanced
practice nurses who may have
prescriptive privileges and are experts
in a specialty area.
Jose is an oncology clinical nurse
specialist who works specifically with
patients who have cancer,
helping her manage symptoms.
Jose has worked closely with Ella
for over two years in the out-patient
setting to ensure that she can stay
at home where she wants to be.
Meet Andrea, the oncology social worker.
Oncology social workers are Masters
prepared mental health clinicians
who have obtained a clinical license.
Typically they have received advanced
training in psycho-social oncology
and may also be certified as an oncology
social worker.
Andrea is both a licensed social worker
and has certification in
oncology social work.
Meet Dr. Young.
She's in an assistant
professor in the department of oncology.
She trained in internal medicine for her
residency and then completed a three-year
fellowship in oncology,
specializing in breast cancer.
She has been a practicing oncologist
for 10 years, and has been caring for Ella
for four year since she was diagnosed
with her cancer.
Meet Dr. Lee.
Dr. Lee is a board certified
oncology pharmacist with experience
in palliative care.
A pharmacist certified in oncology has
extensive training and experience
in this specialty practice, and has
successfully met all qualifications
for board certification.
Dr. Lee specializes in managing the
medication treatment plan
for patients with malignant diseases.
>> My understanding from our last
team meeting is that Ella has made
the decision to transition to palliative
care only and does not want to receive
any further chemo.
We will need to focus her care solely
on pain and symptom management,
comfort and psycho-social care.
>> Yes Ella feels that the chemotherapy
side effects prevent her from living
the life that she wants in the time that
she has left.
She's clearly stated she does not want
further treatment.
She is cognitively competent to make
this decision and is very much aware
exactly what this means.
Spiritually she feels that she's ready to
go whenever it is time to go.
Unfortunately her daughter is not
in agreement.
She arrived yesterday and did not
seem very happy with the decision.
She fears that we've given up
on her mother.
>> You know, I've had a chance to
review Ella's chemotherapeutic regimen
as well as the other medications to assess
whether any dosage adjustments
are needed to help her better tolerate
the treatment.
She's already receiving all the
medications necessary to help minimize
toxicity from the chemo.
Unfortunately she continues to experience
side effects from the treatment.
>> Dr. Lee I appreciate your assessment of
Ella's response to her chemo regimen.
Well there appears to be some concern
about Ella's decision.
Andrea have you had a chance to meet
with Ella and her daughter?
Do you think that we should have a family
conference with them?
>> I did meet with Karen, Ella's daughter
when she arrived and she was
frightened about losing her mother
and is trying to understand
how her mom came to this decision.
Because she is from out of town the
decision felt abrupt to her.
She expressed concern that we are
not doing all we can for her mom.
She's afraid that her mom is giving up.
She wants to make sure that all
treatment options have been explored.
This is very common reaction for
family members of the prospect
of losing a loved one.
I'm trying to be supportive of Karen's
concern while also being sensitive
to Ella's very personal decision.
Ella told me that when her sister was
facing losing her life from cancer
she chose to have everything done,
and she really suffered.
Ella has made it very clear that she
does not want that,
or for her family to experience that.
I think that we should have a family
conference to help facilitate
the conversation.
Let me ask Ella if that's what she wants
to do.
>> I think that's a great idea.
It appears that her daughter Karen
may not be supportive of this decision.
Asking Ella will honor her right to
direct her care.
>> Agreed, but we all need to be on the
same page prior to this family meeting.
Perhaps we should have
a team meeting first?
Let's try for two pm today.
I'll make contact with the palliative
care consult services to see if they
can join us as well.
>> You know I'll be glad to address
Karen's concerns about her mother's
chemo regimen and that toxicity issues
she's been experiencing,
despite all measures,
at the family conference.
>> Great and I will check with the
infusion center nursing staff to see
if they think there is anyone else that
should be included in this discussion.
Oh and I'll make sure everyone knows
about the 2pm planning meeting.
In addition I will make sure that
everyone knows about the agenda.
Let me make sure you are okay
with what I'm going to say.
This meeting is to discuss Ella's decision
to go to the palliative care route.
We're going to discuss what palliative
care means,
what Ella indicated she wants,
her cognitive status,
then we're going to discuss any team
members' concerns regarding this decision.
Oh, also we are proposing to meet with
Ella and Karen to ensure that they know
the team supports Ella's decision.
Does that sound right?
>> You got it.
>> Great.
>> This is a patient decision and we need
to make sure that we respect her decision
and that she can trust us
to support her decision.
Getting together and talking this out will
make our team stronger moving forward.
>> Agreed and you know perhaps this
conference will give us an opportunity
to assess both Ella's readiness and
Karen's acceptance over her
mother's medication for pain
and symptom control.
>> Yes that sounds good.
Andrea, if Ella and Karen agree
to have a family conference,
will you be willing to co-facilitate
with me?
>> I would be glad to.
I will speak with Ella and if she wants
to have the family conference,
I will talk to both Ella and Karen
to identify their concerns
and make sure that they are brought
up during the family conference.
Also, I will see if there is anybody
else they would like to have
at the conference such as another
relative or their clergy.
It is very important that we support
the family through this transition.
>> Interprofessional collaborative teams
are critically important to the success
of patient centered care.
Mutual respect, trust, respect for
diversity, and individual professional
expertise all contribute to successful
healthcare team,
where he patient is the central focus.
Let's review what we saw illustrated
in the scenario that applies
to internprofessional competency
under the values, ethics
for interprofessional practice.
This discussion reflects some of the
sub-competencies identified
by the interprofessional education
collaborative in 2011.
>> Patients and families are considered
part of the interprofessional healthcare
team, and as such they are an integral
part of this first interprofessional
competency.
For example, there are three
sub-competencies under values and ethics
for interprofessional practice
competency domain
that illustrate the role of patients and
families on the health care team.
Place the interest of patients and
populations at the center of
interprofessional healthcare delivery.
Work in cooperation with those who
receive care, those who provide care
and those who support the delivery
of health services.
Embrace the cultural diversity and
individual differences that characterize
patients populations and healthcare teams.
In our scenario, we see that team members
are focused on the patients wishes.
From big decisions like treatments options
and moving to palliative care,
to small decisions like whether we should
hold the family team conference
with her and her daughter.
This demonstrates how the healthcare
team is putting Ella at the center
of the care.
It also illustrates that the team is
working in cooperation
with Ella, and embracing
her individual differences,
such as her desire to avoid the suffering
she experienced when her sister
decided to have everything done
at the end of her life.
As you can see by the team discussion
Ella is in control of the decisions
about her care with the support
of her healthcare team,
rather than having her healthcare
team just tell her what to do.
Trust is critical to the effective
functioning of the healthcare team.
Trust develops over time as team
members act with integrity,
and follow through on commitments
to other members,
feel that their expertise and input
is valued, and actively participate
in the decision making.
With trust comes mutual respect.
Respect is demonstrated through
confidence that team members show
in each other, speaking positively
about one's team, fellow team members
and team decisions.
For example, there are three of the
sub-competencies under values and ethics
for interprofessional practice competency
domain that illustrate the importance
of trust and mutual respect as a
foundation for the relationships
on the healthcare team which includes
the patient and family.
Developing a trusting relationship
with patients, families, and
other members of the healthcare team.
This healthcare team has been working
with Ella for two years now,
providing adequate time and opportunity
to build trust in each other
and with Ella.
Act with honestly and integrity in
relationships with patients, families,
and other team members.
Respect the unique cultures, values,
roles, and expertise of the other
healthcare team members.
For example, in our scenario,
respect for the value and the role
of the pharmacist Dr. Lee,
is demonstrated by the physician
Dr. Young, when she indicated she
appreciates Dr. Lee's input
about the patient's medication regimen.
Another example demonstrating respect
for the contributions of other healthcare
team members expertise is when the
physician Dr. Young asked
the social worker Andrea to co-facilitate
the family conference.
Each healthcare professional
learns ethics and professionalism
from the perspective of their own
profession.
What is different in this competency
is the focus on ethics
from an interprofessional team based
perspective.
We need to think through how team
based healthcare delivery affects
our ethical decision making.
This is an emerging area of interest.
For example, there are three
sub-competencies under the values,
ethics for interprofessional practice
competency domain.
The focus on incorporating
interprofessional ethics into your
collaborative team-based practice.
Respect the dignity and privacy of
patients while also maintaining
confidentiality in the delivery of
team-based care.
Demonstrate high standards of ethical
conduct and quality of care
in one's contributions to team-based care.
Manage ethical dilemmas specific to
interprofessional patient and population
centered care situations.
The health care team is using a patient
centered approach which focuses
on supporting Ella's autonomy to make
informed decisions,
in this case moving to palliative care.
They are also maintaining confidentiality
by asking Ella if she wants a family
conference with the team rather than
any one healthcare team member
trying to explain Ella's decision to
her daughter without her input or consent.
>> Ella, Karen, we are so glad we had
a time to meet together today
and hear your concerns.
This is a difficult time and we fully
support your decision.
Karen, do you have any more questions?
>> No, I understand now
what my mom wants.
I can see how palliative care is going to
help her.
I don't necessarily agree with her but
if it is what she wants
I'm going to respect her decision,
and I'm glad that she has a team
to support her.
>> Karen we're going to be working
very closely with your mother
to help support her in this time
to help manage her symptoms and
her pain and to enhance her
quality of life.
We will working very closely with
Dr. Lee, the palliative care physician
to support you and your mom.
We are also here for you, okay?
The whole team is here to provide
whatever you need during this transition.
We are not giving up on her,
it is very important to understand that.
We are working with her to help her
experience the best quality of life
possible at this time.
We will be right here with you the
whole way and if either of you
want to meet us again, or Ella
if at any point you decide you
want to change your mind,
we'll respect that too
and we'll be ready to work with you, okay?
>> Thank you for supporting me
and helping Karen to understand my wishes
This has been a difficult time for her
and I think she knows that I just want
to enjoy the time I have left,
and to be with family and with friends.
>> For more information on the IPE
Competencies, they can be accessed
by the website on the screen.
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