Interprofessional education on complex patients in nursing homes: a focus group study

BACKGROUND

An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients' complex needs. This study describes graduate students' experiences of working practice based in interprofessional teams with complex patients' care needs in nursing homes.

METHOD

Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data.

RESULTS

Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified.

CONCLUSIONS

IPE in nursing homes facilitated the students' scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students' curricula. This could ensure that IPE is experienced more efficient by the students.

Engaging refugee families in therapy: exploring the benefits of including referring professionals in first family interviews

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Therapy with refugee families: what is a "good" conversation?

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[Psychosocial consequences of organized violence. Experiences from Latin America]

The health consequences of organized violence are well documented (increasing from many parts of the world). We review experiences reported from Latin-America based on literature, contact with human rights organizations and participation in conferences in (Santiago de) Chile and Costa Rica, with special focus on: the destructive psychosocial influence of a repressive society; the development of torture methods; the development of therapeutic methods; the serious psychological implications of "impunity". In Central America joint strategies have been developed for preventive and therapeutic work connected to the effects of war-traumas and terror. Psychiatrists and psychologists from Western countries involved in treatment of refugees in exile can mutually benefit from the experiences of colleagues who have death with the problems in countries where prosecution and oppression have taken place. Within this framework professionals are challenged to take a firm stand against human right violations.

[Psychosocial problems among refugees in Norway]

172 patients were examined and treated by the Psychosocial Team for Refugees in Norway from 1 January 1986 to 15 November 1988. The patients came from 21 countries, the majority from Iran, Chile and Vietnam. Various reactive conditions dominated the clinical picture, and 53 patients had posttraumatic stress disorder, which was the most frequently occurring single diagnosis. The patient group had been exposed to a number of overwhelming experiences and at least half had been tortured. The therapists identified separation and loss, traumatic experiences and social isolation in exile as the factors of greatest importance for the development of the patients' conditions. 46% of the patients were found to have improved at the end of the treatment.

[Clinical experiences with refugees in need of treatment. Reflections on psychosocial problems of people living in exile]

In the light of experiences from the Psychosocial Team for Refugees in Norway, the authors describe factors of importance for understanding the personal meaning of the exile. We point to the implication of different traumatic events associated with flight and exile, and to the psychosocial consequence of such traumatization. We consider this to be important basic knowledge for doctors and other health workers engaged in preventive and curative work with refugees.