Teaching Teamwork

"Teaching Teamwork" headline from ForwardNursing magazine Fall/Winter 2016
by Jennifer Garrett, photography by Alexander André

Millie is lying in bed, and four University of Wisconsin students—two nursing, two occupational therapy—are tending to her. One nursing student asks about her diet.

Do you eat any fruits or vegetables?
Yes, Millie responds. She does. She usually buys canned produce because it lasts longer. She especially loves fruit cocktail.

The nursing student is satisfied with the answer and makes a note to talk about sugar intake. Then an OT student chimes in.

How do you open the can?
“I start with a can opener,” Millie answers, “but sometimes I have trouble getting it all the way around because of my arthritis.”

So what do you do then?
“I jab at it with a knife,” she says.

It was an important moment.

“That single exchange nailed the objective of this exercise and underscored the value of interprofessional education,” says School of Nursing Clinical Professor Paula Jarzemsky, MS, RN.

The exercise was a simulation in the School of Nursing’s Center for Technology-Enhanced Nursing, or CTEN, which is outfitted with an apartment designed to help students practice home health visits. Millie is the manikin voiced by different instructors behind a two-way mirror who prompt students with comments designed to drive home learning objectives. In this case, the goal was to help nursing students recognize the unique and valuable input that OT students bring to home health visits and vice versa.

And it worked.

“In the debrief, the OT student said she would never have asked about Millie’s diet, and the nursing student said she would never have asked how Millie opened the can of fruit cocktail,” Jarzemsky says. “Both pieces of information were crucial because they exposed a real safety risk, and neither student would have discovered it without the other.”

Nursing faculty members Paula Woywod, Kari Hirvela and Barbara J. King, along with Debbie Bebeau, a clinical assistant professor in the UW–Madison Occupational Therapy Program, developed the simulation last summer with a Bader Foundation grant. Interprofessional educational experiences like this one are growing more common as scientific evidence points to the benefits of improved communication and collaboration among members of healthcare teams.

Jarzemsky originally grew interested in interprofessional collaborations nearly a decade ago. She heard from colleagues in practice that new nurses often struggled with determining their roles and responsibilities with respect to other providers. They eventually figured out how to work alongside each other but not necessarily together.

That was not a surprise. At that time, future nurses learned primarily with other future nurses. Physical therapy students learned with other physical therapy students. While some students from different disciplines interacted in programs and projects outside the classroom, most of their formal learning occurred in discrete silos.

Jarzemsky reached out to Bebeau to explore the possibility of teaching students together in an exercise designed to clarify roles and, as in the apartment simulation with Millie, show how collaboration could lead to better outcomes for patients. Bebeau thought it was a great idea from the start.

“I didn’t have any interprofessional education as a student,” Bebeau says. “My first job was in a level-one trauma center, and we operated minute to minute. That was my first experience working directly with nurses, and it took me a while to learn how we came together, where we overlap, where we didn’t and how we view patients and situations with different lenses.”

Bebeau credits Jarzemsky for spearheading many interprofessional learning opportunities for UW health professions students. “She has been a real igniter and she’s still going,” Bebeau says. “Just today we found two more places where we could intersect.”

Jarzemsky and Bebeau also work together every autumn at a fall-prevention workshop that brings together UW–Madison nursing, OT, physical therapy and pharmacy students to provide free screenings for older adults. Nursing students take blood pressures and conduct vision tests. The OT students conduct home safety assessments. Pharmacy students look for
drug interactions that might lead to dizziness, and PT students assess mobility. Results are tabulated to generate a fall-risk score at the end.

The project also provides a valuable community service with real impact. A follow-up survey conducted a month after the event reveals that 77% of participants had initiated their individualized action plans. Jarzemsky says a 25% implementation
rate is typical. “We need to do more research, but we believe the interprofessional nature of the workshop contributes to that high initiation rate,” she says. “Those improved outcomes really speak to the value of this kind of learning.”

That is a big part of what motivates Jarzemsky to identify and offer other interprofessional learning opportunities. Another of her favorites involves second-year nursing and third-year pharmacy students working together to respond when a patient’s condition deteriorates. The scenario takes place in the CTEN hospital suite and calls for medication reconciliation,
anticoagulation therapy and discharge teaching—all situations that require pharmacists and nurses to work closely together in real life.

“The pharmacy students, who typically have had less exposure to clinical settings, see that it is the nurses who recognize and respond when a patient’s condition changes,” Jarzemsky says. “Nursing students begin to appreciate the value of their experience, and that’s a real boost for them. They see that they’ve come a long way in just a year.”

Jarzemsky says that while coursework explores the roles of other health professionals, some insights into how they practice together come only from interaction. And those insights, she notes, are important not only for the health professionals but also for the patients. Research has shown that when providers break down perceived hierarchies and function well as a team, they deliver better care. That improves patient satisfaction and outcomes.

Indeed, it is widely accepted that highly collaborative interprofessional practice is good for patients. In 2001 the Institute of Medicine called on academic institutions to begin teaching health professionals to work more collaboratively because of evidence pointing to increased healthcare quality and safety. Eight years later, six national health profession education associations, including the American Association of Colleges of Nursing, formed the Interprofessional Education Collaborative (IPEC) and promulgated standards and core competencies for interprofessional education. Funders, too, such as the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services, frequently look for interprofessional collaboration during research and discovery.

The UW–Madison School of Nursing identified the expansion of interprofessional education as one of its strategic initiatives for 2016–2020, and it will be home to the new UW Center for Interprofessional Practice and Education. Led by School of Pharmacy Dean Emerita Jeanette Roberts, CIPE will foster and facilitate interprofessional learning opportunities for students and professionals.

“The stars and moon are aligning,” Jarzemsky says. “I hate to think of it as a stick, because once people start doing these activities, they realize there’s a more of a carrot at the end. It is valuable, and some of these concepts are hard to teach in any other way. And, it really is a lot of fun to work with people from other disciplines.”