Working Together with Adults: An Implantation, Interprofessional Education in Geriatric Care

By Fitriana¹, ABT Randita², Dr. Kambey³, and AS Lestari⁴

¹Community and Family Medicine Department Faculty of Medicine, Public Health and Nursing Universitas GadjahMada, Indonesia, This email address is being protected from spambots. You need JavaScript enabled to view it.
²Medical Education Department, Faculty of Medicine Universitas Sebelas Maret, Indonesia
³Department of International Cooperation for Medical Education, School of International Health, The University of Tokyo, Japan
⁴Depati Hamzah General Hospital, Pangkalpinang, Bangka Belitung Indonesia

Summary

The older population is increasing in developed and developing countries. The growing elderly population will produce positive and negative effects. High elderly populations will be a national burden if the elderly suffer with health problems. The aging population has high demands of comprehensive care. Effective team-based health care through inter-professional collaboration among health care providers is important to face the complexity of health problems in the elderly to improve the quality of care and patient outcomes. Interprofessional collaborative practices should be initiated in undergraduate phases through Interprofessional Education (IPE). This study uses a qualitative approach to explore the effectiveness of IPE in geriatric care through a short course of IPE program. The study shows that there were several advantages of the course of IPE learning in geriatric care from students’ perspectives. The students were able to demonstrate collaboration in assessment, planning, and intervention for improving elderly health. The students can improve their communication skills among health care students from other professions. However, there were challenges of IPE implementation in geriatric care.

Background

Over the time, composition of the elderly population is increasing in developed and developing countries due to decreasing fertility and mortality and higher life expectancy, which changes the structure of the population (Kementerian Kesehatan Republik Indonesia, 2017). Worldwide, the population of elderly people reached 962 milion in 2017, that is more than twice as large as 382 milion in 1980. The number of older people is expected to reach 2,1 billion in 2050 which indicate that there will be more older people than adolescents and youth (Department of Economic and Social Affairs United Nation, 2017). In Indonesia, the population of the elderly in 2017 is 9.03 percent of the whole population and by 2020 it is predicted at more than 27 million. This situation shows that Indonesia is one of the country’s with an aging population (Kementerian Kesehatan Republik Indonesia, 2017).

Yogyakarta is one of the provinces in Indonesia with the highest number of elderly people. The high number of the elderly population in the future will produce positive and negative effects. The positive impact will be in the health condition, activity, and productivity of the elderly. High elderly population will become a national burden if elderly suffer from health problems that will cause increasing health costs, decreasing productivity, and increasing disability (Kementerian Kesehatan Republik Indonesia, 2017). The elderly will suffer with physiological changes due to aging in all organ systems (Aalami et al.,  2003). The psychological changes also will occur in the elderly (American Psychological Association, 2016). Maintaining health in the aging population is importance to the well being of individuals and helping to reduce the burden of medical services (Nigam et al. 2012). 

The aging population also has high demand of comprehensive care (Tsakitzidis et al., 2016). Effective team-based health care through inter-professional collaboration among health care providers is important to face the complexity of health problems in the elderly to improve their quality of care and patient outcomes. Interprofessional collaborative practice (IPCP) is a valuable service priority in health care service. World Health Organization (WHO) defines collaborative practice as different health professionals who work together when delivering services.

The IPCP should be initiated in undergraduate phases through interprofessional education (IPE) to prepare healthcare providers who are knowledgeable and skillful in providing and demonstrating health care collaboration especially in elderly care. The Institute of Medicine (IOM) has issued guidance that all health care student education should focus on patient-centered care (Institute of Medicine, 2001). This study aims to explore the effectiveness of IPE programs in geriatric care.

Methods

This program is short course or elective program by registration that will be implemented in a geriatric ward for a week. The learning methods were developed through case-based group discussion and bed side teaching. The participants performed comprehensive assessments, sharing of data, formulated diagnosis, development of holistic care plans, and implementation through an interprofessional team.

By the end of this program, healthcare students are expected to:

1. Perform a holistic elderly care assessment (involves history taking, physical examination, and other procedures if needed), plan, and intervention with interprofessional collaborative practice approach
2. Understand their own and other professionals’ roles and responsibilities within an interprofessional health care team.

Based on the four interprofessional education collaborative practices, students’ targeted interprofessional competencies are:

1. Respect the dignity and privacy of patients.
2. Respect unique cultures, values, roles/responsibilities, and expertises.
3. Engage diverse healthcare professionals.
4. Explain the roles and responsibilities.
5. Choose effective communication tools and techniques.
6. Communicate in understandable words.
7. Communicate the importance of teamwork.
8. Shared accountability to other professionals.
9. Show effective teamwork.

The participants of this program are 120 students from three study programs which include medicine, nursing, and health nutrition. The students divided into interprofessional teams which consisted of a minimum of two students from each study program. The number of participants of this study were 120 students.

At the end of this program, students assessed through qualitative approach and used self-reflection about the course of IPE in geriatric care. Research teams conducted in-depth interviews to explore students’ experience of interprofessional practice in geriatric care (Table 1). The informed consent obtained with the study participants. Data and identity of each participants was kept confidential.

Table 1. Questionnaire Prompts

Qualitative data from in-depth interviews will be recorded, transcribed, and re-checked. Inductive content analysis will be performed to identify the theme in the data. Research teams will apply a thematic analysis focused on identification of the theme using coding processes from description to interpretation. Thematic analysis will be conducted in small samples to appropriately identify, analyze, and report patterns within the data. Research teams will review the coding and assign keywords and phrases to data segments. Inductive processing will make the research team familiar with the data and better understand the experience. Comparison methods used to compare new codes with the previous ones will be used to consider conceptual similarities and differences. The research team will meet and compare the results of their analysis. The few differences will be identified and resolved through discussion to reach agreement. The final codes, categories emerged from the analysis and relationship among the categories, will be examined to generate themes (Holmes et al., 2018).

Result

Three main themes presented were identified from qualitative data analysis. Namely “IPE advantages,” “IPE challenges,” and “Suggestions for IPE in Geriatric Care Course.” Each theme has various codes that represent the respondents’ answers to the questions listed in the research instrument.

Some students pointed out that IPE learning has benefits. First, their geriatric ward visit activities would enable them to recognize various problems occurring in geriatric health based on their comprehensive assessment. Thus, they could take advantage of this situation to think about collaborative strategies to improve care for geriatric patients.

IPE learning also is seen as a beneficial activity for students. Many students reflected about the advantages of being involved in IPE learning, and this included enhancement of their communication skills. A course on IPE in geriatric care activities enabled the students to better communicate among health care students from other professions. Students also reported that they were able to increase their knowledge and behavior, which will be useful in improving their competencies. They also were able to perform holistic assessment, planning, and collaborative intervention in geriatric care.

There were some challenges in IPE learning described by the students. The challenges included overlapping of roles and responsibility especially among medical and nursing students in some cases. The student also reported that there were barriers among health care students and elderly patients in communication. 

Discussion

This qualitative study explored students’ perspectives, focusing on their perceptions of IPE learning. From the analysis of the interviews with respondents, results suggest that students positively perceive their IPE learning as it has many benefits for both students and the patients. Perceptions were also associated with challenges which must be considered.

In the IPE course, students were placed in a circumstance where they worked together as a team. This situation led to enhancement of students’ understanding about interprofessional teamwork and respect for other professions. They realized that effective communication is required to promote the health quality. Students should train more as a team because it gives them a better appreciation of other professions and shows them how to have effective communication (Keller et al., 2013; Tsang et al., 2016).

Although there are many benefits to IPE, comments from students provide evidence that one of the significant challenges is about overlapping role and someimes difficulty in communication with the patients. The other study from the Norwegian Health Care challenges of IPE implementation such as lack of collaboration between patient and providers. The different perspective about patient problems and lack of good communication also becomes a challenge in implementation of IPE (Steihaug, Johannessen, Ådnanes, & Paulsen, 2016).

Conclusion

In conclusion, this study indicates several advantages of the course of IPE learning in geriatric care from students’ perspectives. Our findings show that the course of IPE in geriatric care as a learning method of IPE makes students better able to demonstrate collaboration in assessment, planning, and intervention for improving elderly health. The students also can improve their communication skills among healthcare students from other profession. However there were challenges of IPE implementation such as overlapping roles and difficulity communicating with elderly patients. 

Works Cited

American Psychological Association. 2016. Psychology and Aging. Washington: The Retirement Research Foundation American Psychological Association

American Psychological Association. 2017. Older Adults’ Health and Age-Related Changes. Washington: American Psychological Association

Interprofessional Education Collaborative Expert Panel. 2011. Core Competencies for Interprofessional Collaborative Practice. Washington DC: Interprofessional Education Collaborative.

Keller, K. B., Eggenberger, T. L., Belkowitz, J., Sarsekeyeva, M., Zito, A. R., Lynn, C. E., … Raton, B. (2013). Implementing successful interprofessional communication opportunities in health care education : a qualitative analysis. International Journal of Medical Education, 4, 253–259. doi.org/10.5116/ijme.5290.bca6

Nigam, Yamni, John Knight, Sharmila Bhattacharya, and Antony Bayer. 2012. “Physiological Changes Associated with Aging and Immobility” 2012 (ii): 2012–14. doi:10.1155/2012/468469.

Tsakitzidis, Giannoula, Olaf Timmermans, Nadine Callewaert, and Veronique Verhoeven. 2017. “Outcome Indicators on Interprofessional Collaboration Interventions for Elderly” 16 (2): 1–17.

Tsang, E. S., Cheung, C. C., Sakakibara, T., Tsang, E. S., Cheung, C. C., & Sakakibara, T. (2016). Perceptions of interprofessionalism in health professional students participating in a novel community service initiative, 1820(June). doi.org/10.3109/13561820.2015.1055717

Author Bios

Dr. Daniel Richard Kambey is a 34-year-old Scotland trained university lecturer and educational consultant from Indonesia. He is currently a research student in Japan and has four years of experience as a university lecturer, three years as a health education professional consultant, and extensive experience as a trainer for all age ranges. 

FITRIANA, MD, M.Sc.FM is  a family physician, researcher, lecturer, and an executive manager from the Faculty of Medicine, Public Health, and Nursing at the Universitas Gadjah Mada (FMPHN UGM). She serves as the head of  curriculum development of Interprofessional Education (IPE) for the Academic Health System. Fitriana's field of speciality is Community Health with a focus in Prevention and Management of Metabolic Disease, Gerontology, InterProfessional Education, Interprofessional Collaboration Practice, Biopsychosocial, Family Health, Pediatric Health, Maternal Health, and the Obstetric Community. Her work involves curing patients, preventing community health problem, research, executing community development projects, and communicating with stakeholders in Yogyakarta Indonesia. Fitriana also is the recent Montegut Scholarship Awardee for WONCA Kyoto Japan 2019. 

Amandha Boy Timor Randita, MD, M.Med.Ed is a lecturer from the Faculty of Medicine Universitas Sebelas Maret (FM UNS) and head of curriculum development of the School of Medicine. He graduated as medical doctor from FM UNS in 2012 and received his master's degree in medical education from the Faculty of Medicine Universitas Gadjah Mada in 2016. Amandha is interested in medical education such as curriculum development, Interprofessional Education (IPE), clinical teaching, and community-based education. He is actively researching and published in national and international publications.  

Ayuningtyas Satya Lestari, BSN, RN is a pediatric and neonatal nurse pracitioner in Depati Hamzah General Hospital Pangkalpinang. She also serves as a team member in the integration of academic institutions and the teaching hospital. She graduated from the School of Nursing Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada. Ayuningtyas is a researcher of Interprofessional Education (IPE), interprofessional collaboration, and nursing management improvement.