Multi‐professional Learning for Nurses: Breaking the Boundaries

Citation

Clarke, D. (2002), "Multi‐professional Learning for Nurses: Breaking the Boundaries", Journal of Management in Medicine, Vol. 16 No. 1, pp. 94-96. https://doi.org/10.1108/jmm.2002.16.1.94.1

This is an interesting and timely book, in that multi‐professional and interprofessional initiatives are strongly featured in recent health policy documents as the current government seeks to effect changes in the organisation and delivery of health care in the UK. There is, however, a good deal of concern that the rhetoric of collaboration, multi‐professional and interprofessional team working, required for flexible and user focused health services, is not matched by the reality of contemporary professional practice or by the majority of current higher education provision for health care professionals. A further concern in this area is the absence of sound evidence of the benefits of multi‐professional education or multi‐professional team working in terms of improvement in patient outcomes associated with treatment and care. This book attempts to explore and examine some of the drivers for multi‐professional learning and provides examples of specific educational initiatives involving students and recently qualified staff from nursing, midwifery, medicine, physiotherapy and occupational therapy. The main aim of the book is to bring together current experience and (anticipated) future developments in multi‐professional education. The book is not simply a collection of “how to” chapters but is an attempt to provide those who are responsible for commissioning, developing and implementing changes in health care professional education, with examples of the very real challenges which must be faced if the policy rhetoric is to be matched with realistic, achievable and relevant preparation for future professional practice.

The title of the book is perhaps a little unfortunate because although two of the chapters are quite narrowly focused on the impact of multi‐professional learning on nursing, the content of the remaining chapters of the book would be suitable for a much broader audience than those involved in nurse education and practice. This is perhaps a missed opportunity and I would recommend colleagues involved in education of all health professional groups to take a look at this book because the issues which are addressed are relevant for all those who have a commitment to multi‐professional education at pre‐ and post‐registration level. The first chapter of the book examines the recent and growing profile of multi‐professional learning and the factors which are considered to have led to its current prominence in the debate about how best to prepare health care professionals for the demands of future health services. The author examines policy drivers and the limited and inconclusive research evidence related to the reality of interprofessional working which has developed in the primary care sector in England. The chapter also considers some of the sociological perspectives on the challenges to existing professional boundaries, power and authority which multi‐professional learning and working will inevitably bring. The following chapter looks at definitions and theoretical perspectives related to multi‐professional and interprofessional education. The author briefly reviews the debate about when it is most appropriate to introduce multi‐professional education, at pre‐ or post‐education level, or both. This is a theme which is commented upon throughout the remainder of the book, and although reasonable arguments are put forward for both, no clear consensus is agreed upon. A key issue picked up in this and some other chapters (see chapter 7) is what the purpose of multi‐professional learning is. Is it about health professionals’ understanding one another’s roles so that they do not engage in provision of repetitive or overlapping care, or is it about health professionals learning how to work effectively with each other so that what each health professional brings to the planning and delivery of patient care is understood, respected and valued, and most importantly, used appropriately to meet agreed patient focused goals? This is a key question and one which I think the book frequently raises but does not clearly answer.

Chapters three to seven of the book describe and in most cases evaluate specific multi‐professional educational initiatives. These range from (successful) whole programmes of education in terms of the joint programmes of social work and nursing educational preparation for professionals to work with individuals with a learning disability, to specific parts of educational programmes; for example in relation to learning about managing normal labour (midwives and medical students) or ethics (nurses and medical students). Chapter 7 is particularly interesting in that it describes the innovative, and at this time unique in the UK, development and use of an “interprofessional training ward” involving medical, nursing, physiotherapy and occupational therapy students. This is perhaps the largest multi‐professional education project discussed in the book. The detailed and multi‐method evaluation which is reported upon has real potential to contribute valuable information on the impact of multi‐professional education for health care students, the educators and the clinical staff who supervise the students in practice, the institutions which host the training, and, most importantly, the patients who receive care and treatment in this way. This pilot project clearly recognises the criticism of the lack of a sound evidence base in this area; the team managing the project appears to be working towards providing good quality evidence about the operation and evaluation of the initiative.

What the book does do well is to discuss openly and honestly the very real practical problems of designing, implementing and evaluating multi‐professional education. These problems include the timescale required for many of these initiatives, which is often very lengthy. The huge commitment of time and energy which is required to overcome practical problems of rigid timetables and inadequate teaching space is realistically examined alongside the ever present concerns related to variations in student abilities and numbers at entry to programmes. Overall the authors maintain an optimism that multi‐professional learning has an important contribution to make to the future preparation of competent health professionals. The interprofessional training ward project described in chapter 7 suggests that uni‐professional and institutional boundaries can be overcome and that the investment made by the individuals and agencies concerned was worthwhile. The chapter also hints at the large scale and strategic collaboration which will be necessary if such initiatives are to become mainstream as opposed to “beacon centre” activities.

The final chapter of the book provides a useful reminder that, whilst much can be achieved by committed individuals in this field, there must be much greater clarity about the purpose of multi‐professional learning, much greater strategic multi‐professional co‐ordination in any major revision of health professional education programmes, and a greater coming together of service and education providers if the conditions for multi‐professional practice are to become a reality as opposed to another well meaning piece of rhetoric. It is something of a surprise that the book did not make more of the major structural and ideological changes which will be needed if health professional education is to move from its largely entrenched uni‐professional approach to education and training.

It should be noted that the book is part of the Nursing Education in Practice Series edited by Professor Sally Glen, who is based at City University in London. A mix of experienced and new authors is sought for this series, and the main aim of the series is to provide clearly written and academically rigorous texts which explore and review specific contemporary issues in nursing education. As a text within this series the book would appear to meet its stated aims. The limitations of the text, i.e. its relatively superficial analysis of some of the theoretical, organisational and health policy issues, and its lack of a comparative international perspective may also be a feature of the specific series brief. However, on balance the book has a contribution to make to the growing literature on multi‐professional and interprofessional education.