University of Vermont

College of Nursing and Health Sciences Launches Innovative Training in Interprofessional Care

Mary Val Palumbo
With support from a new HRSC grant, Mary Val Palumbo, associate professor of nursing, is innovating change in healthcare for the elderly, training interprofessional groups of students to develop holistic patient plans. (Photo: Sally McCay)

Cathy Jones, age 76, who lives alone in her home in Hardwick, is having problems with pain, weight loss and depression following a total knee replacement. A former teacher, she loves gardening and church activities, but both have become difficult to manage. Four pages of notes detail her past and present medical history as well as social factors that impact her health.

Mrs. Jones, as it happens, is not a real person but an invented case for interprofessional study developed by a graduate student in nursing. The designed patient’s complex range of issues, particularly common in the real-world elderly population, suggest that a team approach might efficiently and cost-effectively help resolve her issues.

And so, one by one, students from across healthcare disciplines begin popping up on Mary Val Palumbo’s computer screen to participate in a webinar where they’ll discuss how to achieve the stated goals for Cathy Jones: “to support safe but independent living at home by preventing falls, stopping weight loss, treating depression/cognitive impairment.”

This webinar is one of 12, each with a unique case, run this fall by Palumbo, associate professor of nursing and director of the AHEC Nursing Workforce, Research, Planning and Development initiative. It’s the first in an increasingly sophisticated training plan funded by a three-year, $620,477 grant from the Health Resources and Services Administration to help elders with multiple chronic conditions through interprofessional practice (IPP), including experts from pharmacy, nutrition, medicine, physical therapy, social work and nursing.

This approach to patient care is becoming a model in many states, including Vermont’s Blueprint for Health, an initiative aimed at providing seamless, effective, preventative health services, with a move towards outcome-based remuneration rather than traditional fee-for-service. But training and implementation is tricky.

“We’re really not doing such a great job working together – or teaching our students how to work together,” says Palumbo, “and the reason why is it’s nearly impossible to get everybody together, physically in the room.” It’s particularly problematic for practitioners in rural areas, but Palumbo, with help from a program implemented at Duke University, hopes to change that.

Vital signs

In the coming months Palumbo and her colleagues will be developing a far more sophisticated training tool, DIVE, a designed interprofessional practice in a virtual environment that will be implemented in fall of 2014. Rather than using their computer’s webcams, students will select avatars and sit around a virtual conference table, and they’ll have a chance to observe the elder avatar being examined by a colleague. Practitioners in different disciplines, Palumbo notes, have different styles of asking questions, which can be highly informative.

In the new case, students will be studying a Korean elder to further explore issues of diversity and cultural sensitivity in complex care. Hyun-soon Choi, an 84-year-old female, has a detailed eight-page case history which includes sections not just relating to her seven chronic conditions, from diabetes to osteoarthritis, but also to matters such as activity-exercise and sleep-rest patterns, her role-relationship pattern and coping-stress-tolerance pattern. Students are informed that older Koreans may attribute illnesses to a failure to fulfill spiritual obligations or having offended folk spirits. All of it will be fodder for fostering professionalism and communication skills both between providers and patients and among practitioners of different disciplines.

In the third year of the grant the plan is to have nurse practitioners working in rural clinical settings choose actual, highly complicated patients to discuss in the webinar format. Based on the work developing an IPP plan for Mrs. Jones, if participant’s skills progress accordingly over time, the format is promising.

“The students (who are surveyed after the conference) are loving it,” says Patricia Prelock, dean of the College of Nursing and Health Sciences, “and the learning seems highly provocative.”

Not only is everyone expected to contribute to the discussion of care, each is assigned a role – the nurse practitioner is necessarily the facilitator, but there is also a recorder to keep minutes, a timekeeper to make sure the group keeps to the agenda, a jargon buster to call for clarification if field-specific terms are used and a keeper of the rudder if the conversation strays, among others. All come to the table as equals.

The interdependency both of problems and solutions is clear in the Jones’ case. In the conversation over weight loss, the nutrition major points out that helping the patient get to a community center for meals could also help with socialization, possibly easing depression and adding motivation to eat. There is a good discussion about medications that can lead to dizziness, an issue of concern to the physical therapist.

The social worker brings results of her investigation of local transportation options – and, getting creative about lifting the avid gardener’s spirits, suggests, if she can’t tend a perennial bed, maybe a pot of flowers could add a bright spot. In just 90 minutes, professionals from six fields have traded insights and expertise that can be put into action to enhance a life. They prove the power of ending the isolation.