Interprofessional Collaborative Practice in a Community-based Primary Care Setting
Nursing Research on the Green
Jennifer Timm, MS, RN and Amy Reitmaier Koehler, PhD, RN – Winona State University
- Background: Healthcare is currently shifting from hospital-based to community-based care. This shift is a result of expensive healthcare with poor health outcomes. Fragmentation across systems, barriers to access, and communication challenges among providers all impact the quality of healthcare in the United States (IOM, 2010). The shift to community-based care has implications for practice and academia. The development and implementation of innovative models of care in the community setting are necessary. Models of community care should aim to strengthen primary care services, utilize the full scope of the registered nurse, incorporate the advanced practice nurse further into primary care (IOM, 2010), and prepare the future workforce for working in interprofessional collaborative teams (Josiah Macy Jr. Foundation, 2016).
- Significance: National and local barriers exist in achieving the goals of strengthening primary care. The availability of an adequate supply of multifaceted clinical placements for academia is one challenge. Workforce supply of nurses prepared to practice in the primary care setting is another challenge. Finally, the needs of the community continue to grow as a result of increasing chronic disease and mental health needs (Josiah Macy Jr. Foundation, 2016).
- Purpose/objective: There are two goals for this project. The first goal is to design and set-up an interprofessional collaborative practice setting for students across disciplines to experience exposure, immersion, and to develop competence in interprofessional practice. The second goal is to assist in meeting the health priorities of the community (healthy behaviors, emotional wellbeing, health equity) through providing preventative and primary care services in a community-based primary care setting.
- Methods/project: A review of the literature has examined academic-community partnerships, interprofessional education and practice, nurse-led clinics, service-learning, and student run clinics. These are the key areas guiding the design of the model. The project will explore student growth in interprofessional practice domains according to the levels of exposure, immersion, and competence throughout the clinical experience. The population for this project is a group of interprofessional faculty and students. The project will initially target faculty and students from the Departments of Nursing, Social Work, Counselor Education, and Health and Exercise Rehabilitation Services (HERS). Further collaboration with other disciplines is desired and expected as the project progresses.
The intervention is the design and set-up of an interprofessional collaborative practice (IPCP) clinical setting within a community-based primary care setting. The IPCP will be co-developed between academia and community partners into a model of care. The model will be anchored by principles of academic-community partnership and interprofessional practice (IPP). The IPCP will provide a two-pronged approach to expanding primary preventative services. The IPCP will be providing mobile employee health outreach to employers in the Winona area. The focus is on providing preventative health and health promotion. In addition, the IPCP will be operating a weekly evening walk-in clinic within a local community-based primary care clinic. The focus is on providing preventative health, health promotion, and primary care services. Each of these mechanisms within the model will involve a triad of faculty, students, and community partner. However, the students will be leading and operationalizing the model as part of their learning experience.
The literature supports academic-practice partnerships as there is evidence to support a wide range of partners, including community-based primary care settings. In fact, experts encourage partnerships within the community setting as a result of the transition of patient care needs from the hospital setting to the community setting (American Association of Colleges of Nursing, American Organization of Nurse Executives, 2012, Josiah Macy Jr. Foundation, 2016, & National League for Nursing, NLN Board of Governors, 2015).
- Results: Pilot study to be completed in the fall 2017.
The indicators to measure success of implementing the project are multifaceted. First, students’ growth in interprofessional preparedness will be measured through selection of an IPE/IPP measurement tool and will be measured pre- and post-clinical placement. Second, the IPEC competencies will be measured through a staging of exposure, immersion, and competence. Third, the impact of the intervention as a clinical practice site will be measured through the number of students, the number of programs, and the number of clinical hours served by the experience. Finally, to measure the impact on the community, the number of patient encounters, along with the type of interventions provided, will be measured. Each of the outcomes measured will be formally reported to the Foundation following implementation. Success of the project will be measured on the three foci (student’s preparedness, clinical site effectiveness, and impact to community).
- Clinical implications: While the interprofessional collaborative practice project aims to enhance student outcomes, it also will assist in meeting the health priorities of healthy behaviors, emotional wellbeing, and health equity for the community. First, the project benefits the community partner by extending and complementing services currently provided. The clinic desires to serve more individuals and will benefit from innovative mechanisms to reach the community.
the interprofessional collaborative practice will enhance services at a community-based primary care setting. By enhancing services of community-based primary care, there is potential to meet the primary care health needs of more individuals. Community-based primary care is one mechanism to achieve the community health priorities of healthy behaviors, emotional wellbeing, and health equity. This project expects to be one part of the solution toward the community’s goals of improving overall health and wellness of its people. Lastly, the intervention will provide clinical placement opportunities for a diverse group of students. This will assist in meeting the needs for interprofessional practice clinical placement sites for several departments and disciplines.
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