How interprofessional collaborative practice can help dismantle systemic racism

A call to action for disrupting microaggressions, improving interprofessional collaboration, and optimizing outcomes: Nurse leaders have a role

BACKGROUND

Microaggressions are pervasive in clinical and academic environments, often unnoticed by those unaware of the privileges and power dynamics tied to socially constructed hierarchies. These subtle manifestations of bias and prejudice are typically directed toward historically marginalized individuals and groups (HMIGs), contributing to a toxic culture that undermines interprofessional communication, collaboration, and healthcare delivery.

PURPOSE

This article aims to explore the concept of microaggressions and their impact on healthcare environments. It provides strategies to address microaggressions through education, self-reflection, and interventions at both individual and organizational levels, emphasizing the role of nurse leaders in fostering inclusivity and optimizing outcomes.

METHODS

A brief review of the literature was conducted to define microaggressions and their types-microassaults, insults, invalidations, and environmental microaggressions. Strategies and frameworks for addressing microaggressions were evaluated, focusing on the roles of victims, perpetrators, and bystanders in promoting inclusivity and dismantling hierarchies.

DISCUSSION

Microaggressions negatively affect workplace culture, interprofessional collaboration, and healthcare outcomes, perpetuating inequities. Strategies to address these include fostering education and self-reflection, creating organizational policies for inclusivity, and empowering nurse leaders to take active roles in mitigating microaggressions. Frameworks encourage all stakeholders to act, supporting a culture of equity and effective communication.

CONCLUSION

Dismantling hierarchies and promoting inclusive communication are essential for reducing bias, improving healthcare outcomes, and ensuring equity. Nurse leaders play a pivotal role in addressing microaggressions and fostering collaboration, ultimately contributing to a more inclusive and equitable healthcare system.

Needs Assessment of Residents and Nurses for Interprofessional Cross-Cultural Curriculum

BACKGROUND

Clinicians must learn to care for patients from different cultures. They must also work in teams for optimal outcomes. Few studies have analysed the intersection of cross-cultural care and interprofessional education. We completed a needs assessment to determine what paediatric residents and nurses view as essential cross-cultural components.

METHODS

We led a sequential mixed-methods study of residents and nurses at an urban tertiary care centre. We administered the 'Residency Training in Cross Cultural Care' instrument. Survey results informed focus group interview guide development. Thematic analysis of qualitative data was conducted following the five stages to qualitative research framework.

FINDINGS

Thirty-five residents (70%) and 46 nurses (66%) completed the survey. Five residents and six nurses attended a focus group. Five themes resulted: 1) lack of clinician diversity and cross-cultural training, 2) effective cross-cultural care not always delivered, 3) multiple challenges for delivery of effective cross-cultural care, 4) call to action for enhanced cross-cultural education and 5) different cross-cultural educational needs between nurses and residents.

DISCUSSION

Residents and nurses conveyed that meaningful cross-cultural care education is imperative, lacking, and must offer skills to improve patient care. They call for a robust cross-cultural curriculum that is up to date and teaches about intersectionality.

CONCLUSION

We have used this data to implement interprofessional interventions to meet their unique learning needs and enhance upstander skills by using facilitated discussions of techniques, case studies and role plays. Ultimately, teaching all clinicians to care for patients of other cultures may lead to more equitable care.

Interprofessional Collaborative Practice: Importance Across Populations and Settings

This AOTA Position Statement describes how occupational therapy practitioners work as part of an interprofessional collaborative practice in various settings, including, but not limited to, hospitals, skilled nursing facilities, school systems, and community agencies.

In their own words: Perspectives of IPV survivors on obtaining support within the healthcare system

BACKGROUND

Almost half of all women in the US experience intimate partner violence (IPV) in their lifetime. The US Preventive Services Task Force recommends IPV screening paired with intervention for women of reproductive age. We aim to understand clinical practices and policies that are beneficial, detrimental, or insufficient to support survivors of IPV in a safety-net healthcare system.

METHODS

We sampled 45 women who were 18-64 years old, had experienced IPV within the prior year and were patients in the San Francisco Health Network. We conducted in-depth, semi-structured interviews to elicit their perspectives on disclosing IPV and obtaining support within the healthcare system. We analyzed our data using thematic analysis and grounded theory practices informed by ecological systems theory.

FINDINGS

We identified four themes regarding factors that impeded or facilitated discussing and addressing IPV across interpersonal and systemic levels relating to relationship-building, respect, autonomy and resources. (1) Interpersonal barriers included insufficient attention to relationship-building, lack of respect or concern for survivor circumstances, and feeling pressured to disclose IPV or to comply with clinicians' recommended interventions. (2) Interpersonal facilitators consisted of patient-centered IPV inquiry, attentive listening, strength-based counseling and transparency regarding confidentiality. (3) Systemic barriers such as visit time limitations, clinician turn-over and feared loss of autonomy from involvement of governmental systems leading to separation from children or harm to partners, negatively affected interpersonal dynamics. (4) Systemic facilitators involved provision of resources through IPV universal education, on-site access to IPV services, and community partnerships.

CONCLUSIONS

Women experiencing IPV in our study reported that relationship-building, respect, autonomy, and IPV-related resources were essential components to providing support, promoting safety, and enabling healing in the healthcare setting. Successful trauma-informed transformation of healthcare systems must optimize interpersonal and systemic factors that improve survivor wellbeing while eliminating barriers.

Trust Development Between Speech-Language Pathologists and Laryngologists: A Thematic Analysis

OBJECTIVES

Speech-language pathologists (SLPs) and laryngologists often work closely in interdisciplinary settings evaluating and treating patients with voice, swallowing, and airway disorders. This collaboration is integral to providing optimum patient care. We theorize that trust is an essential component of this relationship and contributes to effective patient care and professional satisfaction. There is currently no literature that explores the development and role of trust in this unique interprofessional relationship. We aim to explore the SLP and laryngologist interprofessional relationship and the development and role of trust in that relationship.

STUDY DESIGN

Qualitative Realist Thematic Analysis.

METHODS

Thematic analysis of semistructured qualitative interviews was performed to explore the relationship between SLPs and laryngologists. Through purposive sampling from November 2022-January 2023, we recruited SLPs (n = 10) and laryngologists (n = 10) from 12 centers with varying years of practice, practice setting (academic or private), geographic location, and team structures.

RESULTS

Trust between SLPs and laryngologists is comprised of confidence in (1) ability (clinical judgment, technical skill), (2) benevolence, and (3) integrity. Trust formation is enhanced by frequency and quality of communication, physical proximity, and reduction of practical barriers (scheduling, billing, departmental structure). Role negotiation was not identified as a factor. The presence of all three components of trust contributes to job satisfaction, perceptions of patient experience and care outcomes, and the willingness to collaborate in academic areas beyond clinical care.

CONCLUSIONS

All three elements (ability, benevolence, integrity) must be present for trust in an interprofessional relationship between SLPs and laryngologists, and formation of trust is facilitated by robust communication, physical proximity, and reduction of practical barriers to collaboration. The lack of these elements and lack of trust between the two professions can negatively impact collaboration, job satisfaction, and patient care outcomes, contributing to inefficiencies in patient care.

The Birth Bundle Project: A Rainier Valley Midwifery-led Collaborative Care Initiative Offering Patients and Providers a Paradigm Shift to Impact Health Equity

Innovative midwifery-led collaborative care models have the potential to build on grassroots approaches to make transformative change within systems that work with families. Rainier Valley Midwives operates the Bundle Birth Project, a successful program that serves communities who are at higher risk for poor birth outcomes and face barriers to adequate medical, prenatal, and postpartum care, including Black, Indigenous, and persons of color. This project offers wraparound perinatal care services to provide a missing community of support to traditionally marginalized families before, during, and after birth while also bridging the gaps between midwives and physicians who attend births in different settings. By strengthening and formalizing the relationships between different types of perinatal providers including community-based doulas and lactation support professionals, this midwifery-led initiative improves the continuity and quality of care available to families including immigrant, refugee, and families of color in south Seattle, Washington.

Social work involvement on student interprofessional teams: a qualitative investigation

Social workers on interprofessional teams help highlight the mental health aspects of wellness and alert teams to potential social barriers to care. Social work students have been valued in new interprofessional education (IPE) initiatives across the United States; however, researchers have shown that social work practitioners often feel outside of and not valued by interprofessional teams. Social work student reflections were analyzed as research data to explore experiences on student IPE teams. This was an inductive, qualitative study informed by literary analysis methods, reading for power dynamics and implicit bias. This analysis uncovered social work students holding on to stereotypes of other professions as well as detrimental stereotypes of their own profession. Displays of respect for social work and early opportunities for successful advocacy allowed social work students to feel confident in their role and encouraged participation. This study considers how social work participation can be encouraged on interprofessional student teams.

What Works in Collaboration? Identifying Key Ingredients to Improve Service Delivery in Schools

PURPOSE

This survey study examined factors that may influence interprofessional collaboration in schools to support children with oral and written language impairments, namely, knowledge, collaborative beliefs and practices, and resources.

METHOD

A survey was conducted across 319 school-based professionals, in a partnering public school district, to examine these constructs within the context of each individual participant's professional role.

RESULTS

Between-groups comparisons were made between special educators, general educators, paraprofessionals, and indirect educators (i.e., those whose roles do not explicitly include language-based instruction). Special educators had significantly higher levels of learning experiences and knowledge about language disorders compared to other groups. Those who engaged in the most independent learning (i.e., learning outside of pre- or in-service learning) exhibited the highest levels of knowledge. Collaborative beliefs among professionals were best predicted by access to resources and overall professional learning experiences. More positive collaborative beliefs, in turn, predicted higher rates of collaborative behaviors. Resources were predicted by a small negative relationship with years of experience and by working in specific school buildings within the district. Those with less experience in specific buildings reported more resources.

CONCLUSION

Individuals with higher levels of individual learning and positive attitudes toward collaboration may enhance the interprofessional collaborative practices of teams supporting children with language disorders.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24059178.

Importance of Interprofessional Education for Occupational Therapy

The purpose of this position statement is to provide recommendations for educators on best practices to embed interprofessional education (IPE) into today's occupational therapy curricula, whether entry level or postprofessional, to bridge academic and clinical learning environments.

A systematic meta-review of systematic reviews about interprofessional collaboration: facilitators, barriers, and outcomes

Interprofessional collaboration (IPC) is a practice model to promote healthcare quality. Since the World Health Organization highlighted the importance of IPC in 2010, a large volume of IPC-related research has been published. Multiple systematic reviews have been conducted to synthesize the literature from varying perspectives. Although systematic reviews are a compelling approach to synthesizing primary research, a systematic meta-review was needed to summarize the systematic reviews to offer information for healthcare professionals, researchers, and policymakers. This systematic meta-review was designed to synthesize the systematic reviews of IPC, emphasizing the IPC-related facilitators, barriers, and outcomes between 2010 and 2020. An electronic search for systematic reviews was performed in December 2020. The databases searched included PubMed, CINAHL, PsycINFO, and Cochrane Database of Systematic Reviews. Thirty-six systematic reviews met the inclusion criteria. Factors facilitating or impeding IPC were classified into three levels: organization, team, and individual. Major outcomes related to patients, healthcare professionals, and organizations. The facilitators, barriers, and outcomes are mutually interrelated. Highly effective collaboration is a process from relationship building to working together and collaborating. Improving IPC requires organizational, teams, and individuals' combined efforts. When highly effective collaborations occur, all stakeholders can benefit - organizations, professionals, and patients.

Becoming an anti-racist interprofessional healthcare organization: Our journey

The COVID-19 pandemic amplified the egregious disproportionate burden of disease based on race, ethnicity, and failure of organizations to address structural racism. This paper describes a journey by members of the National Academies of Practice (NAP) who came together to address diversity, equity, and inclusion (DEI). Through collaborative efforts, a virtual, interactive workshop was designed and delivered at NAP's 2021 Virtual Forum to facilitate discussions about DEI priorities across professions and to initiate a sustainable action plan toward achieving inclusive excellence. Resulting discoveries and reflections led us to the essential question: can we truly become an anti-racist interprofessional healthcare organization?

Interdisciplinarity, interprofessionality, and racial diversity in the anti-racist training of health professionals: voices and learnings

ABSTRACT This is a critical-reflective report on the experience of an elective course aimed at training health professionals in fighting racism. It was offered during the COVID-19 pandemic to undergraduate students from all the health subspecialties at the University of São Paulo. From the description and reflection on the proposed teaching and evaluation activities, we sought to recognize and learn/apprehend the contribution of the integration of knowledge (interdisciplinarity), professions (interprofessionality), and racial diversity in the teaching-learning process aimed at fighting racism. The perspectives of students, monitors, and teachers are reported. The support of guest teachers allowed this initiative to address racism and its influences on the health of black people, and the educational strategies encouraged students’ cultural production. The initiative proved to be a possibility for introducing changes in health education in favor of both comprehensive care and interprofessional collaboration in dismantling racism.

Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.

Interdisciplinaridade, interprofissionalidade e diversidade racial na formação antirracista do profissional de saúde: vozes e aprendizados

RESUMO Trata-se de relato crítico-reflexivo sobre a experiência de disciplina optativa voltada à formação de profissionais da saúde no combate ao racismo, oferecida aos estudantes de graduação da área de saúde na Universidade de São Paulo, durante a pandemia de Covid-19. A partir da descrição e da reflexão sobre as atividades de ensino e avaliação propostas, buscou-se reconhecer e apre(e)nder a contribuição da integração de saberes (interdisciplinaridade), de profissões (interprofissionalidade) e da diversidade racial no processo ensino-aprendizagem voltado ao combate ao racismo. São relatadas perspectivas de discentes, monitoras e docentes. A oferta da disciplina, com apoio de convidados, permitiu que o projeto abordasse o racismo e suas influências na saúde das pessoas negras e estimulou a produção cultural dos estudantes. A iniciativa mostrou-se uma possibilidade de introduzir mudanças na formação dos futuros profissionais de saúde em prol tanto da integralidade do cuidado quanto da colaboração interprofissional no combate ao racismo.

An Inter-professional Antiracist Curriculum Is Paramount to Addressing Racial Health Inequities

Legal, medical, and public health professionals have been complicit in creating and maintaining systems that drive health inequities. To ameliorate this, current and future leaders in law, medicine, and public health must learn about racism and its impact along the life course trajectory and how to engage in antiracist practice and health equity work.

Theory-Informed Clinical Practice: How Physical Therapists Can Use Fundamental Interventions to Address Social Determinants of Health

The American Physical Therapy Association's Vision Statement for the profession is guided by principles of innovation, access, equity, and advocacy, and calls on physical therapists to stretch their influence beyond the walls of the clinic and the individuals they treat. Access and equity are problems that span multiple health care professions and entities; yet, addressing social determinants of health is a paradigm shift that clinicians need continued support to achieve. This article has 2 objectives: (1) to define the Fundamental Cause Theory and the Socioecological Model within the context of physical therapy in order to promote best clinical practice, and (2) to apply the concept of "fundamental interventions" in clinical practice to mitigate the negative impact of downstream effects of social determinants of health across levels of the Socioecological Model-individual, interpersonal, institutional, community, and societal. This theoretical lens provides the conceptual framework necessary for physical therapists to think creatively about ways to change their practice in their own contexts to impact the life of individual patients and transform the movement health of society.

IMPACT

As health care providers, physical therapists have a responsibility to make every effort to meet the needs of their patients and optimize movement health in society; yet significant structural and systemic barriers often prevent patients from reaching their fullest potential. Clinicians can no longer subscribe to a narrow scope of practice focused on individual attainment of therapy goals. This Perspective discusses Fundamental Cause Theory and the Socioecological Model theoretical frameworks that can help physical therapists develop, test, and implement functional interventions to address the needs of society as a whole.

Advancing Workplace Diversity Through the Culturally Responsive Teamwork Framework

Purpose Diversification of the profession is an important element of combating racism, bias, and prejudice in the speech-language pathology workforce at national and systemic levels. However, national and systemic change needs to be combined with equipping individual speech-language pathologists to adapt to the challenges that they face to engaging in culturally responsive practice. This paper presents four interacting levels of practice within the Culturally Responsive Teamwork Framework (CRTF): (a) intrapersonal practices, (b) interpersonal practices, (c) intraprofessional practices, and (d) the interprofessional practices. Conclusion CRTF is a practical, strengths-based framework that draws on international research and expertise to expand personal and professional practice and describe critical behaviors within the workplace that can be used to promote principles of evidence-based practice and social justice, especially when working with people from nondominant cultural or linguistic groups.

Online, Asynchronous Hearing Education and Research Project for Ethnically Diverse Adolescents via Interprofessional Collaboration and Electronic Service-Learning During the COVID-19 Pandemic: A Pilot Study on the Needs and Challenges

Purpose This study discusses the creation of an online, asynchronous presentation to educate adolescents about prevention of noise-induced hearing loss (NIHL) through interprofessional collaborations and electronic service-learning (eSL) during the COVID-19 pandemic. Method The Hearing Education and Research (HEAR) presentation, which included activities and videos to educate a group of ethnically diverse adolescents (n = 100) on NIHL, was created by 11 doctor of audiology (AuD) students through online collaborations toward course-related eSL requirements. Adolescents responded to a baseline survey to assess hearing health-related behaviors prior to reviewing the presentation. A postprogram survey was administered 1 week after the presentation to assess change in knowledge and attitudes toward NIHL prevention. Online collaborations with schoolteachers helped with project implementation. Postreflection papers written by AuD students regarding the eSL activities were analyzed. Lastly, suggestions from a focus group of educators were included that highlight the role of interprofessional collaborations to enhance school-based hearing conservation opportunities. Results The HEAR presentation resulted in changes in knowledge about NIHL among the adolescents. Postreflection papers by the AuD students indicated that the eSL activity served as a high-impact pedagogical assignment, especially during the academic challenges of the pandemic. Feedback from a focus group of schoolteachers helped outline ideas for future implementation of sustainable hearing conservation programs in school settings. Conclusion The pilot data collected in this study serve as a proof of concept for future hearing conservation projects in school-based settings via interprofessional collaborations and by engaging university students via eSL.