Inter-professional collaborative practice CBM + Oxford

Question 1

List 6 Canadian Interprofessional Health Collaborative (CIHC) Competencies for Interprofessional Colloborative Practice

Answer 1

1. Role clarification
2. Team functioning
3. Patient centred care
4. Collaborative leadership
5. Interprofessional communication
6. Interprofessional conflict resolution

Question 2

List the domains of potential suffering / issues associated with illness/bereavement for a patient and their family.

Answer 2

• Main
  
  • Physical (disease management)
  • Psychological (Loss/grief)
  • Social/cultural (practical issues)
  • Spiritual (End of life issues)

Question 3

Which 2 CanMEDS roles are in the forefront of inter-professional care?

Answer 3

• Collaborator
• Communicator

Question 4

How do you define a team?

Answer 4

• one or more members
• working toward one or more common goals
• has defined communication processes
• some interdependency
• members have mutual respect, trust and commitment

Question 5

List x differences between multidisciplinary and interdisciplinary teams

Answer 5

Multidiscplinary teams

• one or more care providers from different professions or different discplines within a profession.
• Each separately assesses the situation and works with patient/family to achieve the goals.
• Each provides their own expertise, one person makes treatment decisions.
• Cooperate and coordinate care strategies while each stays committed to their own profession.

Interdisciplinary teams

• care providers from different disciplines or professions
• AND the patient and/or family
• exchange knowledge, expertise, to achieve common goals and consensus.
• Shared decision making
• Shared expertise

Question 6

List and describe the stages or processes of

team development

Answer 6

• FORMING
  
  • enthusiasm, anxiety
  • Need direction to ID goals
• STORMING
  
  • conflicts arise, self-oriented behaviour
  • role confusion
  • need conflict management
• NORMING
  
  • collaboration
  • greater team cohesiveness
• PERFORMING
  
  • high performance with innovative energy
  • leadership is shared between members
• ADJOURNING
  
  • as team members leave/are replaced, team may revert to its earlier stages
  • work on smooth transition

Question 7

List x benefits of using a team approach in palliative medicine

Answer 7

1. Multiple resources = creative solutions
2. Shared responsibility = less caregiver burnout
3. Greater likelihood that all patient and family needs will be identified and addressed
4. Enhanced support for better communication
5. Seamless consistent care experience
6. Greater understanding and respect for unique skills and perspectives of various disciplines
7. Greater job satisfaction if staff feel valued and included.
8. Possible reduced hospitalization time and costs
9. Possible reduced unanticipated admissions.

Question 8

What are some challenges of team work which may affect palliative care?

Answer 8

• individuals each have cognitive map
• can look at same situation not see the same thing
• have to learn to appreciate others’ maps
• Role ambiguity or role conflicts
• Situation awareness
  
  • Engestrom’s knotworking theory
  • all team members drawn together in a knot around common health situation related to patient’s needs
  • Knot is at centre of team’s relationships
  • as issues change, the threads of each member’s contributions are picked up or dropped as needed.
  • need to respect other’s competencies
  • assess needs and complexity of the knot
  • assess demands on each member, patient and family

Question 9

List x other care professionals you might involve in a hospital (or community) setting on the palliative care team.

Answer 9

• patient /family member
• physician
• nurse
• social worker
• spiritual care
• administrative support
• psychology
• OT
• PT
• dietitian
• pharmacy
• recreation therapy
• music therapy/ art therapy

Question 10

What are come challenges to virtual collaborative care?

Answer 10

• concerns re: privacy
• concerns re: confidentiality
• difficulty appreciating nuances in perspective
• limited time
• no clear leadership
• few opportunities to work on process
• need high situation awareness
• need well developed collaborative competencies

Question 11

Who are the members of a team?

Answer 11

• 5-15 people (20 max)
• Core members (full time) governed by team policy
• Associate members (can be part time or intermittent), not governed by policy or managed by team leader

Question 12

Fill in the table of characteristics of effective teamwork

Answer 12

Question 13

What is the role of the team leader?

Answer 13

• management
• professional challenges
• motivation
• policy
• keep purpose and goals
• build committment
• build confidence
• strengthen mix and skill level
• manage external relations / obstacles
• do real work
• create opportunity for others

Question 14

List x characteristics of an effective team

Answer 14

• communication
  
  • physical proximity, meetings
• cohesion
  
  • feeling of belonging, shared enjoyment, pride, good feedback
• mutual respect
• goals
• purpose
• leadership

Question 15

Describe the modern hospice movement

Answer 15

• St Christopher’s Hospice in London
• Created by Dame Cicely Saunders
• 1967
• Multi professional team work to relieve total suffering was cornerstone

Question 16

Where was the first inpatient palliative care unit?

Answer 16

• Dr. Balfour Mount (surgeon)
• Establish first PCU at Royal VIctoria Hospital in Montreal
• 1975

Question 17

Describe types /settings of teams in palliative care

Answer 17

1. Specialized PCU
2. Hospice teams
3. Extended interdisciplinary medical team (ortho, ID, anesthesia, oncology, urology, GI, psychiatry)
4. Nursing homes
5. Palliative care consult team - hospital
6. Palliative care consult team - community

Question 18

List goals of a palliative care consult team

Answer 18

• work alongside hospital admitting team
• advise on symptom control
• support relatives in difficult decisions and grief
• Educate staff in palliative care
• liaise with hospice and home care

Question 19

Describe how a hospital palliative care consult team might provide consultation

Answer 19

• Advice and guidance to professionals without direct contact with the patient
• Single visit for assessment and advice
• Short term interventions with patients and families for specific problems
• Ongoing contact for multiple, complex problems

Question 20

What three domains should teams be evaluated in?

Answer 20

• Structure
  
  • job descriptions, systems for referral, feedback, symptom assessment tools
• Processes
  
  • # referrals, referral time, time expenditure, urse of sx ass tools
  • Communication and documentation (records, d/c summaries)
  • Internal processes (team functioning, performance)
• Outcomes
  
  • changing practice, improved symptom control, patient/family satisfaction…

Question 21

Miller’s Pyramid Model of Assessment (teaching)

Answer 21

1. Knows (MCQ)
2. Knows how - matching questions, portfolio
3. Shows how - OSCI, simulated patient assessment
4. Does - feedback, direct observation,

Question 22

Benefits of certification in hospice and PC nursing

Answer 22

• proven competency
• access to national network of experienced nurses
• demonstrated commitment to practice
• dedication to professional development
• asset to employer

Question 23

Benefits of having palliative care nurses

Answer 23

• improved care
• better symptom control
• better patient outcomes
• QOL
• cost effective

Question 24

“Occupation” in occupational therapy

Answer 24

• Self care / ADLS, iADLS
• Productivity
• Leisure

Question 25

Core skills in Occupational therapy

Answer 25

• collaboration with patient
• assessment of function, potential, limitations, ability, needs
• enablement
• problem solving
• activity as a therapeutic tool
• group activities
• environmental adaptation

Question 26

Equipment and Aids: Bed transfers

Answer 26

• back rests
• mattress lifter
• leg lifter
• blocks to raise bed height
• sliding sheets
• hospital bed
• hoists and slings

Question 27

Equipment: Toilet transfers

Answer 27

• varying height toilet seats
• frames
• grab rails
• commode
• urinals

Question 28

Equipment : Bath and shower aids

Answer 28

• Bathboards
• Bath seats
• hydraulics for lifting
• grab rails
• shower seats

Question 29

Equipment: chair transfers

Answer 29

• blocks to raise chairs
• high back
• firm armrests
• riser recliners to assit to sit/stand

Question 30

Equipment : Car transfers

Answer 30

• sliding boards

Question 31

Equipment : mobility aids and stairs

Answer 31

• Walkers
• wheelchairs
• motorized scooters
• PT

Stairs:

• handrails
• stairlifts
• elevators

Question 32

Equipment: meal aids

Answer 32

• jar openers
• non slip mats
• specialized cutlery

Question 33

OT: Management of cognitive impairment

Answer 33

• observation during functional activities
• assessment for deficits
• safety assesment

Question 34

OT Skills: What is required for indepedence in ADLS?

Answer 34

• motor skills
• sensory skills
• cognition
• intrapersonal skills
• interpersonal skills
• self maintenance (toileting, dressing, feeding)
• productivity (working, shopping, cooking)
• Leisure activities

Question 35

Goals of music therapy

Answer 35

• supportive validation, enhance contemplation
• increased self awareness and self discovery
• symptom relief and relaxation
• connectedness
• aesthetic and spiritual experience
• support expression of grief and bereavement

Question 36

Roles of the dietician

Answer 36

• treating altered taste and smell
  
  • avoid food aversions
• treating oral thrush and ulcerations
  
  • alters taste- cold fluids, oral hygiene
• treating nausea and vomiting
  
  • meds, small freq meals, fluids after meals (not with).
• treating dysphagia
  
  • pureed foods, supplements, PEG
• respiratory distress/aspiration
  
  • pre medicate before meals, loose clothes, relaxaton, small meals
• early satiety
  
  • small meals freq, po consumption when feels well
• altered bowel function
  
  • constipation or diarrhea
  • pancreatic enzymes
  • increase fibre
• fatigue/lethargy
  
  • eat when feel well, avoid foods that need ++ chewing
• reduced saliva and consistency:
  
  • artificial saliva, gel, gum, candy, oral hygiene

Question 37

SLP : Common communication issues in Pall Care

Answer 37

• Dysphasia (understanding or using spoken language)
• Dysarthria (motor weakness)
• Dyspraxia (difficulty forming sounds, words)
• Dysphonia (vocal impairment)

Question 38

SLP interventions for communication

Answer 38

• augmentation
• alternative communication
• paper, picture charts, tablet, typing with auditory output

Question 39

Art therapy : goals of therapy

Answer 39

• creative attitude
• increased sense of control
• communication of mental/emotional state
• wider range of expression
• increased insight into patient behaviour
• release of emotions
• increased self esteem and efficacy
• positive coping
• reduction in symptoms
• QOL

Question 40

Pharmacy in palliative care : Roles

Answer 40

• appropriateness of medication orders
• Right patient, right drug, right time
• counselling and education for patients
• ensuring patients understand and follow directions
• compounding non standard formulations
• consider financial concerns
• ensure safe and legal disposal of meds after death
• effective communication with regulatory and licencign agencies

Question 41

Rehab in palliative care : roles

Answer 41

• short targeted rehab, often no functional improvement
• goals can be focused on caregiver training re: safety and independence
• exercise regimes
• education positioning
• skin integrity
• pain control
• continence / elimination

Question 42

When should you refer to palliative rehab services?

Answer 42

• new difficulty with IADLS
• decrease in mobility
• frail, ill, disabled
• recent hospitalization
• sig change in status
• symptoms interfering with function