Interprofessional Teamwork
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The document discusses various health models and critiques the limitations of the biomedical model, emphasizing the importance of incorporating interprofessional teamwork in health education and practice. It highlights the International Classification of Functioning, Disability and Health (ICF) as a framework to foster collaboration and improve patient outcomes by considering both biological and psychosocial factors. The document emphasizes the need for a shift towards comprehensive, team-based approaches in healthcare training and service delivery to address complex health challenges effectively.
Interprofessional Teamwork
- 1. INTERPROFESSIONAL TEAMWORK Introducing ICF into education models, clinical practice & research Olaf Kraus de Camargo @DevPeds Stefanus Snyman @StefanusSnyman
- 4. • Lay concepts • Scientific concepts • The biomedical model • The psychosomatic model • The stress-coping model • The behavioural model • The socioeconomic model • The risk-factors-model • The socio-epidemiological model • The bio-psycho-social model Sozialmedizin – Grundlagen und Praxis 5. Auflage, HeikoWaller Models of Disease and Disability
- 5. RudolfVirchow • 1821 - 1902 • Pathologist • described the cellular basis for diseases • one of the founders of modern medicine
- 6. • Every disease has its specific cause • Every disease is characterized by a specific lesion (cells, tissue, mechanical or biochemical processes) • Diseases have typical external signs (symptoms) and therefore can be recognized by scientifically trained professionals (physicians) • Diseases have a describable and predictable course and usually get worse without medical intervention. The Biomedical Model
- 7. • Exclusively biologically oriented, thus only reflecting a part of the causes (e.g.: risk factors & myocardial infarct) • Is of limited value for overcoming/fighting diseases in the population (e.g.: tuberculosis, COVID-19) • Is centred on the individual and has a curative orientation (neglects prevention, psycho-social determinants of disease) • Stabilizes the dominance of the physicians in the Health Care System and leads to a medicalization of society Critique of the Biomedical Model
- 8. RudolfVirchow • 1848 (27 years old) • Typhus epidemic in Upper Silesia • one of the founders of social medicine • „medicine is a social science“ • sewer system in Berlin • initiated the building of public hospitals • fought for the creation of public health care • Journal “Medical Reform” • Democrat
- 9. Taylor, R., & Rieger,A. (1984). RudolfVirchow on the typhus epidemic in Upper Silesia: an introduction and translation. Sociology of Health and Illness, 6(2), 201-217. https://onlinelibrary.wiley.com/doi/pdf/10.1111/1467-9566.ep10778374 1849 Themes: Health Professions Education needs Change
- 10. Themes: Health Professions Education needs Change • “The medical schools have failed to teach students and doctors a comprehensive approach to medicine, and that the sciences of sociology and psychology are equal in importance to physiology, biochemistry and anatomy, and that the practice of community medicine and prevention is as important as hospital medicine.” Williams, H. (1974). PERSPECTIVES IN MEDICAL PRACTICE AND EDUCATION. Australian Paediatric Journal, 10(Supplement Number 3), 32–34. 1974 Biomedicine is not enough!
- 11. Themes: Goals of Health Professions Education • “The M.D. graduate is expected to identify, define, and solve problems related to human health by examining the underlying biologic, social, and behavioural mechanisms involved.” • “By using this technique, it is hoped that the students are made aware of the complex and challenging problems of man as an individual within society before they are wooed by the intellectually intriguing problems in structure and function of man's component parts.” Sweeney, G. D., & Mitchell, D. L. M. (1975). An Introduction to the Study of Medicine: Phase I of the McMaster M.D. Program. Journal of Medical Education, 50, 70–77. 1975 Try Problem-Based-Learning!
- 12. Themes: Health Professions Education still needs Change • “…health care has become so complex. Skills are so specialized. Collaboration is not a nice-to-have, it’s a must-have. And, therefore, we’re moving toward team-based approaches.” Reimagining health care education – Stanford Medicine X. Available at https://medicinex.stanford.edu/2017/04/17/reimagining-health-care- education/. 2017 • “Interprofessional, interdisciplinary, team-based collaboration is essential to the future of our functioning health care system.And we can’t get there if we’re not learning and teaching together.” • “Lastly, we’re shifting the model because there’s a whole generation of new tools — digital health, data that’s coming in and empowering the end user to take control and to be more collaborative.And we’re realizing that costs have become so out of control that the old model of paternalistic medicine, of hierarchal medicine, is unsustainable. It doesn’t work.We have to create a model of engagement where people want to participate, and want to engage, so that there’s buy-in and personal responsibility”
- 14. InterprofessionalTeamwork • Evidence: Improved patient outcomes • Philosophy: It’s the right thing to do • Catalyst: For change
- 23. “Healthcare is a team sport, currently being played by individuals”
- 25. Person- centred service Communication Team functioning Role clarification Collaborative leadership Conflict resolution Reflection CLIENT SAFETY & QUALITY COLLABORATIVE PRACTICE Interprofessional Competencies
- 27. ICF – International Classification of Functioning, Disability and Health (WHO, 2001)
- 28. • Lay concepts • Scientific concepts • The biomedical model • The psychosomatic model • The stress-coping model • The behavioural model • The socioeconomic model • The risk-factors-model • The socio-epidemiological model • The bio-psycho-social model Sozialmedizin – Grundlagen und Praxis 5. Auflage, HeikoWaller Models of Disease and Disability
- 30. A person is functioning well, if – with regard to the context in which she is living (Concept of Environmental Factors) – Her Body Functions (including the mental functions) and her Body Structures correspond to general accepted norms (Concept of Body Functions and Body Structures), She is able to perform the type of activities in the same way as a person without a health problem (Concept of Activities), She is able to develop her existence in all domains that are important to her in the same way and the same extent as it would be expected to be by a person without impairments of body functions or structures or restrictions in activities. (Concept of participation) Functioning Bio Psycho Social
- 31. Contextual factors (Environmental factors, personal factors) influence functioning: Positively (Facilitators) Therefore, it is always necessary to take into consideration the contextual factors when evaluating functioning! Negatively (Barriers) Functioning and Contextual Factors
- 32. Common Language • Professionals can communicate across disciplines • Patients can identify common needs across diagnoses - speak with one voice! • Service providers can identify populations for programs and services across diagnoses • Public Health services can identify priorities based on needs
- 33. “Laulima" Many hands working together in cooperation & harmony
- 36. 1. Mixed anxiety and depressive disorder 2. Type 2 insulin-resistant diabetes mellitus with multiple complications (renal, peripheral circulatory complications.Very painful feet – use crutches to walk) 3. Non-alcoholic fatty liver disease 4. Sleep apnoea: tiredness & day time somnolence 5. Severe Obesity (BMI = 54) 6. Glaucoma 7. Ischaemic heart diseases with angina on effort 8. Hypertensive renal disease 9. Impotence 10. Lower back and hip pain / degeneration
- 38. Mental status Sensory functions Vascular and circulatory Respiratory system Endocrine, digestive & metabolic Genito-urinary & reproductive Skin & related structures Depression;Anxiety; Suicidal Severe pain; Poor vision (glaucoma) Ischemic heart disease with hypertension; Dyspnoea & Angina Sleep apnoea Insulin-resistance Obesity, Acid reflux Hypercholesterolaemia Non-alcoholic fatty liver disease Poor kidney function Impotence Fungal infection in skin folds Neuromusculoskeletal & Movement Lower back and hip degeneration Neck disc prolapse
- 40. Learning & applying knowledge General tasks & demands Communication Mobility Self-care Domestic life Interpersonal interactions & relationships Major life areas Community, social & civic life Difficult to focus and make decisions because of his pain, depression and anxiety Difficult to carry out daily routine due to pain, difficult to walk, weakness of arms.Very anxious No problem Due to lumbar sacral and cervical pain, peripheral neuropathy and weak muscles he walks with difficulty using crutches. He cannot carry objects. Difficult to get out of bath – needs help Difficult to wash feet and put on shoes He is dependent on his wife to do domestic tasks Due to his depression he often withdraws himself; Impotence; Low self-worth He is on permanent disability. He doesn’t want to go back to work. Bitter & angry at previous employer Community work: Writing Christian devotional books raising funds to build a safe house. He appreciates prayer.
- 42. Products & technology Physical environment Support, relationships & attitudes Services, systems & policies He is moving around with crutches. Is this the most appropriate assistive devise? Will pressure socks make a difference for peripheral pain and stasis? He lives in a brick house. Good built environment. Wife good support Health professionals & employer failed him He has a medical insurance for private healthcare He receives a permanent disability pension
- 44. • Age: 55 • Gender: male • Education: Finished school • Fearful • No hope • Inferiority • Failure • Lifestyle • Christian
- 46. Downloaded >20,000 times Presented > 150 times locally & internationally Shared around the world and being translated into > 25 languages
- 47. Health Condition (e.g., CP,ASD) Function Fitness Friends Family Fun The ICF Future
- 50. Health Condition (e.g., CP,ASD) Function Fitness Friends Family Fun The ICF Future
- 52. ICF in Health Professions Education “Indeed, it is likely that health professionals well trained in the ICF are best positioned to move ICF values about functioning and disability forward by engaging the general public at large and facilitating the culture change we seek.” Bornbaum, C. C., Day,A. M. B., Izaryk, K., Morrison, S. J., Ravenek, M. J., Sleeth, L. E., & Skarakis-Doyle, E. (2014). Exploring use of the ICF in health education. Disability and Rehabilitation, 8288(April), 1–8.
- 53. ICF in Health Education • WHO advocates for the ICF’s use ‘‘in curriculum design and to raise awareness and undertake social action’’ • Many articles address the potential rather than actual implementation of the ICF • Caution against top-down approaches, which may hinder effective implementation • Securing support from organizational leaders is important Bornbaum, C. C., Day,A. M. B., Izaryk, K., Morrison, S. J., Ravenek, M. J., Sleeth, L. E., & Skarakis-Doyle, E. (2014). Exploring use of the ICF in health education. Disability and Rehabilitation, 8288(April), 1–8.
- 54. Germany: ICF in Bachelor Course for Early Intervention • In 2005, implementation of the ICF in Early Intervention Centres in Germany • Followed by workshops around the country to train professionals • Since 2007 the ICF is part of the curriculum in bachelor courses for Early Intervention Specialists Kraus de Camargo, O. (2007). Die ICF-CY als Checkliste und Dokumentationsraster in der Praxis der Frühförderung. Frühförderung Interdisziplinär, 26, 158–166.
- 55. J. Darrah, J. Loomis, P. Manns, B. Norton and L. May, Role of conceptual models in a physical therapy curriculum: application of an integrated model of theory, research, and clinical practice., Physiother. Theory Pract. 22 (2006), pp. 239–250. Canada,Alberta: Curriculum PT Four underlying concepts: 1. Importance to understand theoretical frameworks 2. Importance of client-centred practice 3. Integration of philosophy and language of ICF 4. Use evidence-based practice for clinical decisions
- 58. The power of a story
- 59. Group reflection 1. What did you learn? 2. How should this change the way you are trained? 3. How are you going to be a change agent?
- 60. Q A & Olaf Kraus de Camargo @DevPeds Stefanus Snyman @StefanusSnyman