IPE to IPC:

University of the Philippines Experiences and Lessons

JOSEFINA A. TUAZON, RN, MN, DrPH University of the Philippines Manila

EAFONS Convenor & Executive Committee

What I hope to cover …

Interprofessional Collaboration (IPC) for safe and quality patient care

Overview of Interprofessional Collaborative Practice Competencies (IPEC 2016 update)

Univ of the Philippines Manila on IPE and devt of a community-based program

Challenges for Nursing, Nursing Education on IPE

Multiple health workers from different professional backgrounds providing comprehensive health services working with patients, their families, caregivers and communities to deliver the highest

quality of care across settings.

Framework for Action on Interprofessional Education & Collaborative Practice WHO, 2010

“… the process of developing and maintaining

effective working relationships with learners,

practitioners, patients/clients/families and

communities to enable optimal health outcomes.

Elements of collaboration include respect, trust, shared decision-making, and partnerships.”

Canadian Interprofessional Health Collaborative, 2010

“Occasion when 2 or more professionals learn with, from and about one another to facilitate collaboration in practice” (CAIPE,1997, p. 3)

IPE involves educators and learners from 2 or more health professions and their foundational disciplines who jointly create and foster a collaborative learning environment (CAIPE, GITT, IOM)

Positively influence the attitudes and perceptions of students by reducing negative stereotypes to help overcome barriers to collaboration

Common curricula in education can result in the development of common concepts, values, perspectives and language, which, in turn will provide a frame of reference for collaborative practice

Source: Perez, A. IPE:Transforming Care through Teamwork, ASU

Core Competencies for Interprofessional

Collaborative Practice: 2016 Update

• Inteprofessional Collaboration as a single

domain with 4 competencies and sub-

competencies

Competency 1 Work with individuals of other professions to maintain a climate of mutual respect and shared values. (Values/Ethics for Interprofessional Practice)

Competency 2 Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations. (Roles/Responsibilities)

Competency 3 (Interprofessional Communication)

Communicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.

Competency 4 (Teams and Teamwork)

Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.

IPE Competencies

Values & Ethics for Interprofessional Practice Roles & responsibilities Interprofessional Communication Teams and teamwork

Other Needed Competencies Population Health, including social

determinants Patient-center decision-making Evidence-based decision-making Cost-effective practices Quality improvement and safe practice Stewardship Systems Thinking

Desired Principles of Interprofessional Competencies

Sensitive to the systems context/applicable across practice settings

Applicable across professions

Stated in language common and meaningful across the professions

Outcome driven

April 9, 1948 - first university-based BSN in the Philippines and Asia

Late 1960s – early 1970s : diploma and certificate nursing programs phased out; single entry for practice at BSN

1955 – Masters Program

1979 – first PhD Nursing in Asia-Pacific

1989 – WHO Collaborating Center, first in the Region, 7th in the world

1996 – Philippine CHED Center of Excellence in Nursing Education

University of the Philippines Manila

College of Nursing (UPCN)

UPCN (Philippines)

Elective IPE courses & projects (senior year)

Compulsory IPE course (none)

Compulsory IP Learning Modules (none)

Community Health Devt Program (senior year)

Work as a team with Medicine, Nutrition, Dentistry, Public Health etc

Half semester (8 weeks)

Community immersion (students live in the community)

UPCN (Philippines)

2nd year – Introduction to Health Team; foundations course; clinical rotation in hospital and community

3rd year – Mostly intraprofessional, communicate and coordinate with members of the health team

4th year – More interprofessional, work with the team

Current Educational Reforms (Philippines)

Transforming higher education programs to Outcomes-based curriculum (OBE)

Aug 2018 - UP and UPCN BSN OBE curriculum

UP General Education courses revised also; will cater more to students from various degree programs enrolling together which is a BIG step (Note: this ws done in the past where students enrol in common courses)

Learn Learn Learn with, about

With about and from each other

Common Discussion Senior year: intensive

Courses on Health community experience

Team (2 months)

G.E. & Basic Classroom Project-based (CHDP)

courses Clinical ex- Joint immersion in one

periences community

Community Health Development Program (CHDP) of UP Manila: Facilitators

Shared vision

Political will, full support of leadership (Chancellor level)

Intensive consultation and planning with colleges involved, initially by Medicine, Phyiscal Therapy, Nursing, Nutrition

Funding and administrative support

Community Health Development Program (CHDP) of UP Manila: Challenges

The biggest challenge was “lack of role clarity” while at the same time, achieve common and collaborative competencies

Each discipline had its own program already; how to merge this into one shared program

The main question was: what and how do we do things that we “cannot achieve alone” and do “better together”?

Challenges for nurses, nursing education,

and IPE

Idea of TEAM WORK is not new …

The idea of “team work” and “team approach” is not a new idea … but it has not been fully implemented to achieve the best possiple care

Nursing education is highly focused on “working as … and with a team”; it is included in the terminal competencies of the Philippine BSN curriculum

“Team work” cannot happen if various members of the team do not have the same mind set and respect for each member’s competencies

Know one’s own role and those of team members

Communicate team roles and responsibilities

Engage diverse healthcare professionals to meet the needs of patients

Use the full scope of knowledge, skills, and abilities of available health professionals and health care workers to provide safe, timely, efficient, effective, and equitable care

Use respectful health care practices

Norm tends to be hierarchical …

In Asia particularly, the traditional hierarchical

structure with the Doctor as leader of the team.

In IPC, the MD is not the automatic leader; this

requires a major paradigm shift for the MD and the

nurses as well

Requires an “empowering” milieu or climate in

health care institutions and the way we educate our

students

Modeling and providing actual experience will

be key

Why is IPE so difficult??? -Complex; time consuming

-Incompatible clinical; timetables; curriculum schedules

-Lack of faculty interest & expertise in IPE

*Disproportionate # of students across programs

*Students distributed across sites

*Controversy of IPE at the undergraduate level

*Combining separate IPE frameworks

For Programs and Curriculum to be RELEVANT AND RESPONSIVE! For safe and quality health care

Institutional policy on IPE

Plan for improving quality of education

Faculty who are DYNAMIC and OPEN to IPE

Continuous institutional capacity-building

– Influencing developments in nursing, nursing education & curriculum

–Promoting professional developments in our countries and the Region amidst the pull of global demand & movement of people

–an opportunity rather than a problem

Way Forward ...

… through IPE