Question 1.1 Critique and discuss the strategies in the readings to facilitate team building. Include in your answer how these strategies apply to a team that you are, have been a participating member of, or have observed.
In reviewing the 2 strategies offered in the readings by Krasner and Harris there is an apparent difference in facilitation and motivation. In the approach explored by Harris the plan was decided and implemented. While participants were open and willing to participate, individual goals influenced the implementation. The motivation to connect with outside Health Allies was limited. “The interviews with GPs suggested that there seemed to be little incentive (both tangible and non-tangible) to change the ‘culture’ from working independently as a primary health care service provider to part of a team in multidisciplinary care in chronic disease management.” This approach speaks to the silos we see in community health care.
Implementation is the responsibility of the individual stakeholders which leads to individual agency reform with little communication among partners. “Our intervention facilitators, who used a tailored approach in each practice, were also constrained by priorities of the general practice staff which tended to be inwardly focused.” This model lacks a stage where all stakeholders and participants meet to develop relationships with one another; to discuss and collaborate on the project, to connect them with other teams and to share concerns and challenges, within an environment free of criticism and judgement. In Ontario the SELHIN works with our community to deliver health care to patients. As a stakeholder partner at the table I see this first hand. Partners are competitors at the table and Home and Community Care is more of an employer than a partner.
Collaborations become a competition of who can deliver the best care model from their own internal resources and processes versus using an interdisciplinary model to connect allied health to provide optimal care for patients. The focus is internal modifications instead of external communications. “Their PDSA cycles often focused first on establishing register and recall systems, patient education services or expanding activities (such as regular staff meetings) within the practice.” This model is common in this area of health care. Recent discussions have involved creating care coordination positions to be the communicator between primary care, nursing and allied health. The Care Coordinator may be an effective way to begin implementation however for sustainability stakeholders must develop methods to communicate with each other ongoing.
The model discussed by Krasner speaks to the motivation that the Team link study did not address and that the current Home and Community Care model overlooks, developing a community of practice focused on wound care to improve patient outcomes. “The concept of a community of practice (CoP) refers to the process of social learning that occurs when people who have a common interest in some subject or problem collaborate over an extended period to share ideas, find solutions, and build innovations.” As previously noted the competitive business of health care often causes the oversight of individuals or groups who focus on wound care who are committed to Continuing Professional Development. “This is also referred to as situational learning because it is determined by practice and problems with patient care.” The stakeholders meeting at the table are often not the practioners working in the field and therefore their goal of planning differs. The development of the interdisciplinary team model becomes clouded by agency ego and profitability.
Home and Community
Care encourages agencies to develop these relationships with provider partners with no monetary motivation to do so nor does Home and Community Care reimburse established wound care practioners in the community beyond contracted agency. When examining the strategies discussed by Krasner and Harris they both offer models to create interdisciplinary teams.
In the area of Home and Community
Care the strengths of these strategies can be used together to create an interdisciplinary model. The LHIN has the ability to set the plan in place and push for implementation. Identifying that communication between agencies and motivation need to be established. Scanning the environment and identifying existing Communities of Practice and then engaging these communities to help implement the planning will assist to create safe collaboration and learning spaces. Utilizing the existing experts in our community will bridge gaps in knowledge and create relationships between allied health professionals working in wound care. By analyzing the implementation and outcomes of both strategies a new support, strategic plan can be developed to improves patient care in the community setting.
Question 1.2 (i) Appraise and discuss the concepts and principles of adult learning by comparing and contrasting at least 2 theories. The Schon theory of adult learning and the Kolb theory describe similar concepts. Both theories express the need for an “experience” or “surprise” to occur that begins the learning cycle. They both describe a reflection on action or experience that helps to formulate a response via problem solving- Schon references this as an “experiment” while Kolb expresses it as “integrating our reflection”. Both of these theories then look at bringing that gain knowledge into our memory to be applied in future cases. The theories differ in that Schon looks at the point of problem solving as an experimental process that has uncertainty, learning via experience, which requires reflection to determine what worked best and what gaps or errors occurred. Kolbs theory speaks more to an investigative reflection to determine how the “experience” may have come to be in combination with reflecting on our own existing knowledge. The Schon theory speaks to me as a learning process that may emerge in more acute situations, when time is limited or events happen unexpectedly- therefore are a “surprise”. The Kolb theory speaks to me as being a critical thinking approach when more time and information is available. I agree that evaluation of the interventions and outcomes translate learning into knowledge that is then used in future cases.
Question 1.2 (ii) Using the Lowe article and/or your personal experiences, illustrate how to integrate these principles to change your personal learning, practice culture or patient care outcomes.Evaluating my own personal learning I feel that it is important to seek out situations that provide an opportunity to learn. In order to find new challenges and experiences we have to be confident in our current knowledge and be willing to learn. These situations have become fewer as I transitioned to a Manager. I would like to spend more time with patients, to assess new cases, to collaborate on care plans and to build the foundation of my knowledge.In home care nurses can become very routine and begin to focus more on the assigned task instead of the assigned person. There are examples of this is our agencies caseload. There is a need for adequate time and appropriate workload as well as need for motivation to pursue education. There is comfort in working with the things we know. It is also less responsibility to transfer care to a primary health provider.As a leader in a community organization I think that learning opportunities that are utilize in the aforementioned theories. Time is one of the biggest constraints nursing faces which minimizes the reflection period and limits the use of collaboration to design better plans for patients. Our agency has tried to increase access to supports for nurses in patients to help support critical thinking and implementation however the reflection and evaluation phase requires attention. Nursing continuity needs to be stabilized to allow the opportunity for nurses to evaluate and reflect to learn from their community experience.
Question 1.3 Describe the strategies needed to develop a successful educational program in wound care. Relate each of these strategies/steps to a proposed program or an existing program example from your practice. There are 5 stages outlined in Baranoski’s article that are needed to develop a successful educational program. The first step is The “Learning Needs Assessment”. This step is often not done at my current agency. The education programs are often determined by the agency leaders or are programs that were developed years, even decades, prior. The importance of this assessment is to determine what the learner already knows and what the learner identifies that they do not know. Educational gaps can also be determined by unmet KPI’s or outcomes in the work environment. Assessment eliminates assumption. I have been to education sessions where it was assumed nurses did not know how to use the provided documentation application when the real issue was that nurses were not making the documentation apriority. This information gathering can narrow down the content of the educational session to create a targeted and useful program.
This assessment also helps the presenter understand the “target audience”. The second step of planning is determining who will be attending and learning from the education session. Identification of different levels of knowledge and need assists programs to be designed for different employees. At my agency the wound care champion nurses have a different knowledge base than a field nurse therefore a session on the basics of wound care may not be beneficial for the champion nurse. Education that is below the level of your target audience can cause disengagement and a lack of participation in future sessions.
Once a needs assessment is completed and the target audience identified the next stage is to develop a meaningful program, “The next step is to translate the information into appropriate goals, objectives, topics, and content.”. The development of the program is driven by the objectives. Baranoski states that “objectives need to be specific, clear, measurable, and a benefit to the learner, institution, or professional practice.” These objectives should be shared with those who are intending to participate so there is a clear understanding of the purpose of the session. The content of the session is developed in order to meet the desired objectives. Education sessions are often done in short In-services for the nurses at my agency. There is not a clear set of objectives and often more content than what is manageable to present/learn in a short period. Questions and experiences tend to side track away from learning objectives, which may indicate the content is not meeting the learning needs or that the structure of the learning session is not being followed.
The presenter and presentation methods are integral in creating an education session that is effective. A presenter needs to be an accepted expert in the area that they are presenting. Nurses at my agency do not engage with educators who are not known to them or that do not present credible information. In the area of wound care they have shown skepticism towards product vendors and often question their wound care knowledge and challenge product biases. The presentation method also has to engage and intrigue the audience. In-services and short sessions at our agency are better received with hands on materials and active audience participation. After the education session is complete the evaluation is critical. “An evaluation provides the planner and/or committee with the opportunity to see the strengths and weaknesses of the program. It also allows them to improve their developmental skills for future endeavours. Most importantly, it provides the answer to the question, “Were objectives met?”.” The feedback determines the effectiveness of the program and evaluates the delivery of the content. It determines if the content met the goals of the session.
The evaluation notes help the presenter to redevelop the session, to make changes and highlight the strong points to create a better program for the next presentation. The education session at our agency have not been evaluated in quite some time. The content and presenters have remained constant over time and may require a refresh. An evaluation of the programs would be helpful for both the presenters and the agency. The promotion of education programs is the final listed step of the process, but begins before content is completely developed. The promotion of an education session is needed to generate interest and excitement of staff/attendees. The more engaged people are the more apt they are to attend the session. Working in the community sector it is a challenge to engage nurses to commit to sessions until they know their working schedule for that particular day.
Looking at Baranoski’s article and comparing it to the current education system has shown many areas that are available for improvement. As the Manager at my agency I want to ensure my employees have access to meaningful education programs that enhance their practice. Working through the outlines steps/stages to develop new programs would benefit our agency and create more sustainable education plans. Working forward I think that completing an assessment of our staff and the goals we want to achieve will help change how and what education we provide. The lack of a staged system for education planning is evident in our workplace. Working on using this framework will immediately improve education sessions.