Julie Poore IPE Transcript

Welcome to the Indiana University School of Nursing Interprofessional Collaborative Practice in Education Podcast Series. This podcast series was supported by grant funding from the Health Resources and Services Administration under the U.S. Department of Health and Human Services. The goal of this podcast series is to provide ideas and information to individuals interested in implementing interprofessional education or collaborative practice initiatives in their practice or educational setting.

Interprofessional health education, or IPE, is on the minds of educators around the country as a top priority for health-profession curriculum revision and clinical experiences in order to prepare students to work in an ever-changing healthcare arena. At the Indiana School of Nursing in Indianapolis and Bloomington, Indiana, curriculum change and grant-funded programs have moved interprofessional education initatives forward in recent years with positive results. As those who are doing similar work can attest, planning and implementing interprofessional experiences in coursework and in clinical settings is not without its challenges whether it is identifying appropriate practice sites, scheduling experiences with various professional programs, ensuring that the experiences are valuable or just getting the right people in the room from the start. Dr. Julie Poore is an assistant clinical professor at the IU School of Nursing and has spearheaded many of the interprofessional initiatives as the lead faculty for the interprofessional practice course which was implemented in 2015.

Dr. Poore spoke with us about a few of the clinical experiences that have been created in the last year or two to supplement the coursework. We started by asking Dr. Poore about the gap they were trying to fill by including IPE in the curriculum.

[Poore] Well, our nursing students were graduating from the program with the expectation by some of our clinical partners that they knew how to practice and function as a member of an interprofessional team, and we realized that they weren't receiving much opportunity during their clinical experiences to interact with other professionals. They were getting a great experience being with the nurses in a unit, but they didn't ever have an opportunity to really call a physician or speak with OT or PT or respiratory therapy. So, we saw this as a real gap that we had in our curriculum and we were getting ready to undergo a curriculum revision and we thought that was the perfect opportunity for us to implement some interprofessional opportunities within the new curriculum.

[CPDLL] One of the first sites that Dr. Poore identified as a good fit for interprofessional clinical experiences was the IU Student Outreach Clinic, which utilized volunteer students from a variety of professions including medicine, dentistry, occupational therapy, physical therapy, social work, law, pharmacy, optometry, and public health. Getting involved at the clinical took some time, observation, and research but was well worth the effort in the end.

[Poore] We spent the entire summer going to the clinic. We met with patients. We met with students from the other professions because we really weren't sure what nursing could add. Our medical students there were already doing health histories and they were doing vital signs, which is many times what people think that nursing students might do in a clinic setting. So, as a result we knew that we needed to come in with another idea. And realizing that nursing is far beyond health histories and vital signs, we determined that we could provide some patient navigation services. So, our nursing students go through the patient experience with them from the minute they check in until the minute they leave the clinic. Um, they take notes for the patient throughout their interactions with the other partners. The students then can learn what educational needs those patients might have. So, one of our primary roles is providing patient education.

[CPDLL] Collaborating with other professions on development of health education materials and implementation of education also became a priority starting with dentistry.

[Poore] Dental is actually at a location two blocks away from us because they have to have their dental chairs and their equipment. So, we do send students down there to work with the dental students but one of the great collaborative things we did last semester was some of the dental students and nursing students got together and created an oral health education pamphlet, and then they did oral health education at both locations. So, they did their education down at the clinic where they're treating the dental patients in the morning at 9 o'clock then they came down to the IUSOC at 10:30 and they did the same educational inservice for the patients that were there. So, that has been a great opportunity.

We did some education on sleep, rest, and hygiene with our occupational therapy students. We've been doing some  smoking cessation work with both occupational therapy and our pharmacy students at the clinic. So, that is one of the probably primary areas that we've really worked with the other professions and that's where we've been encouraging our students to really reach out because I think it gives them, um, not only the opportunity to work together on those materials, but to again see where they can complement each others' services.

[CPDLL] An additional interprofessional initiative the nursing students took the lead on is use of a screening tool that assesses the needs of the patients who come to the clinic and can be used by all the professions during the patient visit.

[Poore] That screening tool is done by nursing students and in a team with physical therapy and occupational therapy. So, they form a three-man team and they do a screenings for the patients. The screening has questions that would refer a patient to all of the other partners within the clinic. So, there are specialized areas that focus on each one of the other health professionals. This way we're making sure the patients receive all of the services they need that we have available and we're also collaborating with one another on how our care may overlap or ways we can complement one another.

[CPDLL] In addition to the community-based experience, the team wanted the students to have an acute care experience with an interprofessional focus. Dr. Poore reached out to an educator who worked on the trauma unit at a local hospital to find out if the collaboration would be possible. The team met with the director of trauma services and the director of education over a two- to three-month period to figure out guidelines for the experience and to clarify goals and objectives for the students. After the different professions were brought into the conversation to organize the clinical experience. Dr. Poore described for us how the nursing students work with the different professions on this unit.

[Poore] They spend the day with them, following along, learning more about the particular roles and responsibilities of that health professional. And, they have an opportunity to engage with one another as they're working with those professionals. And what I mean by that is, each day they have a team meeting that the students are able to attend. So, during that team meeting, they talk about each one of the trauma patients on the service, and they go around the table and each different professional identifies what that patient needs from their profession. Um, then the other opportunities that we may have is, for instance, we have one student with an ER physician, one student who is with the EMS on the truck, and we might have a student with a respiratory therapist in the hospital. And, we've had instances where I've gone down to the ER when the EMS personnel are bringing in a patient from the field and that nursing student is with the EMS driver and they're bringing the patient, they're giving report over to the ED physician who may be working with another one of our students, and then they have to call down the respiratory therapist to help with that case as well. So, the students are not only seeing what that individual professional that they're assigned to for the day is doing, but they're getting to see the team interaction and direct patient care.

[CPDLL] Probably not surprisingly, the students in this hospital-based clinical reported positive experiences with concrete examples of learning and application to practice.

[Poore] The students have had, um, some really great experiences. It's been very interesting to hear them at the end of the day we always have a post-conference. Um, and all of the students report out what their day was like with the different professionals. And, one student came in one day, and she said, "I never knew how much our dietitians had to calculate." She said, " I just imagined these people are figuring out what these patients' diet needs to be." She said, "I didn't even think about all the nutritional calculations. They have to have this much protein. They have to have this many carbohydrates. They have to have, you know, all of these things." And, she said, "*It takes a long time for them to just process everything for one patient." And, she said, "As a nurse, that's really going to help me because when I'm on the floor. I have this expectation that, 'why can't they get this to me quickly?'" And, one of our students actually went from this clinical experience to her critical care experience on Friday. On that Friday with her critical care nurse, she said that the nurse was complaining about the dietitians, and um, saying she was getting very frustrated because they didn't have a patient's information up to them about what the dietary restrictions were going to be. And, that student actually said, told us in post-conference that she said to the nurse, "Well, you know, this week in my interprofessional collaborative practice clinical, I was actually able to work with the dietitian, and during that clinical experience, I learned how much they actually do. Would you like me to talk to you about that?" And, fortunately in this circumstances, the nurse was really receptive and so the student was able to share what the dietitian did. And, that nurse didn't know either. So, we really love that story because a great opportunity for that student to share what she learned with somebody else.

[CPDLL] We were curious about how other health professions students might learn from having nursing students in their clinical setting. While in this particular unit, there are not often multiple professional students present, Dr. Poore did share a story about a time when there was a nursing student and another health professional student in the same area.

[Poore] One day they were rounding on a patient that had a change, uh, in neuro status and the student was with occupational therapy and there happened to be an occupational therapy student who was along with them. And, the occupational therapy student was very surprised when the nursing student spoke up questioning the change in level of consciousness of the patient. And, the OT student said, "Well, I know that we deal with cognitive function, but I didn't know that was really a concern for nursing." And, first it was very shocking for me to hear that from the student, but then I thought, "Well, if we're educating people in silos and they're really focused only on just the fact that they do that as part of their daily assessment, they may not know what a nurse does." And, I think sometimes what we really find through some of these interprofessional options is that people think they know what a nurse does because they see it on TV, and they see all these things, and they think that nurses take vital signs, and nurses change beds, and nurses give baths. But, very rarely does a nurse do that. They don't really have a clear understanding of what a nurse does. So, I think it is definitely a wonderful opportunity for the other students, and I hope that as we move forward, that's one of the changes we can make. I would love to see an interprofessional clinical opportunity where we had multiple students from multiple professions that were all working together for the entire clinical day.

[CPDLL] Students also came up with their own observations about the benefits of interprofessional experiences as one student shared with Dr. Poore.

[Poore] She felt like we should always give a consistent message to the patient. So, she used PT as an example. She said, "I saw a PT come in and they were teaching a patient how to get out of bed." And she said, "I was with the PT. So I got to see the steps, but the nurse who was actually caring for the patient that day wasn't in the room," and she said, "it made me think, 'well, how is that nurse going to tell that patient how to get out of bed later?'" And, she said, "You know, we could be sending mixed messages to our patients and what I would really like to learn from this health professional is, how can I when I'm working as a nurse on the floor, make sure that I am giving that consistent message to the patient, that we're all giving the same instruction?" And so, for me, I think that's really essential that they're walking away with.

[CPDLL] It is easy to hear Dr. Poore's passion and  excitement about having the opportunity to expose her students to so many professions and experiences, and she's seen the impact with patients at the Outreach Clinic as well.

[Poore] Patients on a weekly basis whether they need education from us or not, I love seeing them come to seek out some of the nursing student board members just to say "hi!" And, it's because those nursing students have worked with them, they've provided education with them, and they sit down and spend time and talk to them. That they never come to the clinic even if they're there just to pick up refill for medication, they never come without stopping by to say "hi" to the nursing students. So, it has just been an amazing thing to see. And, the patients hug us and thank us every day for being there. And, I think that if we get all of these health professions together before they enter practice, they are going to be much more comfortable collaborating with one another, working with one another, when they're out, um, and when they've graduated. So, I really think that this is not only a wonderful opportunity, but I think it's a necessity. I think it's the only way we're going to be able maintain adequate health care for all the people in the United States, for the most part.

[CPDLL] Well, thank you for taking the time today, and for all you do for the students. And, hopefully we'll get to talk again about some of the outcomes once you have some of that information, and we can share that with people out there who are looking to start these types of initiatives at their nursing programs or their other health profession programs.

[Poore] Absolutely! I'd be glad to talk to you. Thanks, Lisa.