Interprofessional Collaboration between Occupational Therapists and Nurses
Ainsleigh Noyce
Honorable Mention
WRTG A213: Writing and the Sciences
Dr. Sheri Ann Denison
Jennifer Langley came to America when she was 13 and graduated from the Hutchison High School in Fairbanks; she is currently studying to earn her BS in Nursing. She wants to be a registered nurse and maybe a nurse practitioner one day. She works as a CNA at an assisted living home and loves family and friends. On her free time, she loves watching movies and going to the gym.
Ainsleigh Noyce is a born Alaskan and spends her summers hiking, fishing, and wearing the heck out of her Xtratuffs. After graduating from Matsu Middle College School for high school she has continued to pursue an education through Matsu College. Over the past 2 years, she has worked alongside a local OT clinic in their equine-assisted occupational therapy program and has fallen in love with the work. With this in mind, she wants to continue her education to become a licensed OT with a specialty in equine therapy.
Abstract
This literature review examines interprofessional collaboration between nurses and occupational therapists. Interprofessional collaboration may enhance the treatment of medical issues in the future. The literature review focuses on interprofessional education, satisfaction among patients and healthcare professionals, enhancing the care of patients, and challenges of interprofessional collaboration. Interprofessional education improves self-competence and practice among workers. Collaboration brings meaningfulness by sharing an individual's knowledge to benefit both the professionals and their patients. Though there are challenges such as time management and miscommunication, it enhances the care of patients by focusing on common goals. Besides these components, this literature review will also discuss the improvements needed, such as the United States' need to incorporate more interprofessional collaboration and educational programs.Interprofessional Collaboration between Occupational Therapists and Nurses
The healthcare field is full of different professions specializing in patients' physical and psychological issues. As medical research and treatment plans advance, the need for interprofessional collaboration is at an all-time high. The World Health Organization, which was foundational in defining interprofessional collaboration, states that "Collaborative healthcare practice occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, careers, and communities to deliver the highest quality of care across healthcare practice Green & Johnson, 2015, p.4). This literature review discusses the importance of interprofessional collaboration between nursing professionals and occupational therapists, focusing on the importance of interprofessional education, the effects on satisfaction among patients and health professionals, the enhancement of care due to interprofessional collaboration, and the challenges that are often dealt with during the collaboration.Role of Occupational Therapists
Occupational therapy became a mainstream career in the early 1910s. William Rush Dunton, Jr, M.D, is known as the father of occupational therapy (CBD College, 2017, para. 2). As a psychiatrist and educator, Dunton published his first work on occupational therapy. Dunton believed that the body's healing could be occupied by completing purposeful activities, also known as "daily occupations" (CBD College, 2017, para. 2). Occupational therapy, by definition, is described as "scientific, evidence-based on skilled treatment that helps individuals achieve independence in all facets of their lives" (Goodwin University, 2021, para. 2). While occupational therapy is mainly thought of as a physician-led treatment plan, the creative career field has strong roots in mind-body awareness and connection (Goodwin University, 2021, para 2). Occupational therapists create treatment plans using everyday activities and exercises that work on employability, self-esteem, and strength to better the everyday lives of their patients. Occupational therapists must have a master's in occupational therapy but can continue onto a doctoral degree. Today there are approximately 104,500 registered occupational therapists in the United States (U.S. Bureau of Labor Statistics, 2020).Role of Registered Nurse
According to the Bureau of Labor Statistics (2021), registered nurses usually work directly with patients and often interact with patients the most. They assess patients' conditions, record symptoms, provide medications, and collaborate with different professions to provide the best quality care possible. Depending on the specialty nurses have, they work with different health professionals such as doctors, occupational therapists, and certified nursing assistants. Today, according to the University of St. Augustine (2021) nursing statics page, there are just under 4.2 million registered nurses in the United States, 950,000 LPNs/LVNs, and 325,000 nurse practitioners (University of St. Augustine for Health Sciences, 2021). A more significant number of nurses involved in the field and the high projected growth of a nursing job is crucial since it will increase the availability of interprofessional collaboration and the development of more interprofessional education programs.Interprofessional Education
Interprofessional education is essential for effective interprofessional collaboration and is proven through many studies. It is often incorporated into the programs for students pursuing their careers in health care. Interprofessional education allows students to learn about other health professionals and enhance future collaborative care (Thistlethwaite, 2012). Yu et al. (2020) performed a study in South Korea to confirm the effectiveness of interprofessional education among students in the medical field and nursing by providing them a scenario and encouraging them to work together as a team. This study indicated improved awareness and self competency in interprofessional practice afterward, leading to the positive perception of interprofessional collaboration. Interprofessional education is extremely crucial because it eliminates the possible barrier when collaborating with other professions, as well. Loy et al. (2015) interviewed nurses and occupational therapists in an acute care setting performed by students from the Dominican University of California to explore barriers when working together. The interviews revealed that occupational therapists expressed barriers because of nurses' lack of knowledge about their occupation. Nurses were confused because they could not distinguish between physical and occupational therapists and were unaware of their roles. Furthermore, occupational therapists explained that there would be less conflict if they were educated about their jobs, leading to more effective collaborative care for the patients. Interprofessional education can reduce the difficulty of working together and increase understanding of each other's professions.Although there are factors that require attention on why interprofessional education has issues, one of the possible issues is the lack of educational funding. Casto and Julia (1994) describe in their book titled "Commission on Interprofessional Education and Practice" stating "Without adequate institutional support (funding), Interprofessional education has neither integrity nor continuity," which means that without funding and support from university systems, interprofessional education has no merit (p.100). However, with support from universities, students will be socialized and be able to work with other individuals; this also will have a lasting influence on students' attitudes towards collaborative work. The interprofessional education programs integrate benefits students, creating teaching opportunities for educators. Educators and faculty members play a beneficial role in a student's educational career, emphasizing their role and developing their sense of self-identity as members of their profession (Casto & Julia, 1994, p. 98).
Job and Patient Satisfaction
Interprofessional collaboration leads to satisfaction among both healthcare professionals and patients. Interprofessional collaboration increases satisfaction by having shared goals to improve patients' conditions, enhancing patient satisfaction by providing the best care possible. Espinoza et al. (2018) performed a study in Chile to find a connection between job satisfaction and interprofessional collaboration. Several variables were analyzed, such as the interaction between team members and the length of time worked together. Shared goals and patient-centered care were the most significant variables for job satisfaction and communication, which increased their understanding of their capabilities and limits. The role of the designated leader is also crucial for effective communication among team members. The leader acts as a communication center and increases the likelihood of effective communication between members. Original research done in Denmark by Burau et al. (2017) emphasized the link related to job and patient satisfaction which consisted of different professions, including nurses and occupational therapists working on stroke rehabilitation. The nurses and occupational therapists all positively regarded working together; one individual added they felt a sense of "meaningfulness" that the patient agreed with also since the care was so effective. de Hann (2020) also mentioned that the rehabilitation team learned that contributing to the skills and knowledge of each profession created a beneficial outcome for the patients and gave them opportunities to engage in functional activities (para. 4).Enhanced Care
Interprofessional collaboration can enhance patient care. The most crucial benefit of interprofessional collaboration is the improvement of patient outcomes, which is why interprofessional collaboration began. Gutavasson et al. (2021) performed a study in Papua New Guinea, a country with severe poverty that often leads to fatal diseases like tuberculosis and respiratory infections. Gutavasson's study was performed on a volunteer medical ship, including different health professions, but only eleven nurses from seven different countries were interviewed while performing interprofessional collaboration. Since Papua New Guinea has rough terrain due to frequent earthquakes, the medical ship had to be used to make it easier for people to access. Most nurses revealed the want to give the best quality of healthcare, regardless of circumstances, motivated healthcare professionals to work as a team and, therefore, successfully give patient-centered care. Robberts (2020), an occupational therapist who works in a community hospital, added that what she calls a "mediator" creates plans on how the patient should be treated and works with the nurses to make a better plan of "attack" for her patients' ailments (p.18). Loy et al. (2015) also agree how collaboration between occupational therapists and nurses improves patient care. Both professions ensure the patient's conditions are assessed thoroughly so that when they are performing care, patients are not feeling pain or are uncomfortable. Thompson (2017) mentions that since nurses are more involved in self-care for patients, occupational therapists can schedule a time with nurses and incorporate self activities, mainly working on rehabilitation and physiological issues, making a more comfortable environment for the patients (para. 5).Challenges
Though there are many positive outcomes to interprofessional collaboration, it is not easy in practice. There are challenges regarding an interprofessional collaboration that interfere with its impact and create conflicts between professions. Guatavasson et al.'s (2021) study on a medical ship revealed that communication was the most significant barrier while working together. English was the primary language used since they were all from different countries, but it was a second language for most nurses. Due to different backgrounds with different experiences, challenges arose from adapting to new rules and being open-minded. They were used to their routines, and adjusting and accepting new rules was difficult for most nurses. According to Loy et al. (2015), nurses and occupational therapists revealed that "time" was the most significant barrier. Nurses were more "rushed," making it challenging for occupational therapists to communicate with one another. Lack of information about each other's roles became a problem, primarily because nurses were confused between physical therapists and occupational therapists. Lack of nurses' knowledge offended some occupational therapists that increased tensions between the two professions. The overlap of their roles was another barrier that interfered with interprofessional collaboration. Both professions work on activities of daily living, but their goals and purposes are significantly different. Nurses usually focus on performing the care for the patient promoting dependence, while occupational therapists' role is to have patients perform it on their own, maximizing their independence. Interprofessional collaboration can have challenges that lead to dissatisfaction; therefore, interprofessional education is vital to prevent such barriers that can be interfering.Limitations
The United States lacks education that enhances interprofessional collaboration. Compared to other countries such as Canada, interprofessional collaboration is lacking in the United States. Canada has a national framework program dedicated to the collaboration between health care professionals, "Canadian Interprofessional Health Collaborative (CIHC)," which includes domains such as role clarification, resolving conflicts, leadership, patient-centered care, and communications (CIHC, 2016, para.2). Along with the CIHC, Langlois et al. (2020) discuss how the University of Toronto has a specific Interprofessional Education Program: Integrating the client perspective, making sure new professionals who enter the working field understand their place and use their resources.There are numerous studies (see Table 1) on the effectiveness of interprofessional collaboration among healthcare professionals such as nurses and physicians, but not with nurses and occupational therapists specifically. Because of the lack of educational programs and collaborative work, the United State's healthcare system is insufficient. The United States needs to incorporate interprofessional collaboration into its standard healthcare treatments to fix this national issue.
Table 1
Studies on Interprofessional Collaboration
| Study | Description | Country | Health Profession |
| Burua et al. (2017) | Original research done in working for rehabilitation patients where 5 stroke teams and 17 interviews with different health professionals are conducted in a home setting | Denmark |
|
| Espinoza et al. (2018) | A mixed-method study of both quantitative and qualitative study in a hospital to examine job satisfaction due to interprofessional collaboration | Santiago, Chile |
|
| Gustavs-son et al. (2021) | Study done in a medical ship to examine barriers and effects of interprofessional collaboration internationally | Papua New Guinea | 11 Nurses from different countries (Australia, United Kingdom, Germany, Israel, New Zealand, Norway, and Papua New Guinea) |
| Loy et al. | An explanatory study done by students in acute care settings to examine between Nurses and Occupational Therapists | Northern California,US |
|
| Yu et al. (2020) | Pre- post-survey focusing on the significance of interprofessional education by using the ATTITUTDES, JSAPNC, and IPEC Competency | Aju, South Korea |
|
Conclusion
As illustrated, the roles of nurses and occupational therapists vary in both the framework of their jobs and their goals as caretakers. The many studies surrounding the ongoing efforts to increase the level of interprofessional collaboration provide examples of why this is such a challenge and why it is increasingly crucial for the United States, particularly to work on its interpersonal education system, which can then be applied for better collaboration. When done correctly, this method and implementation have proved to give patients adequate care and streamline the care of the variety of issues that medical professionals face in occupational therapy and nursing. In many cases, this collaboration was only achieved in a high-stress environment that forced them to work towards a common goal, but this is not ideal. Overlapped roles can become an issue; even though two caretakers may be working towards the same goal, they can actively undo each other's efforts. However, by establishing common goals and assigning specialists who can understand and work well, a better healthcare system can be established, benefitting the patients and the professional work environment.References
Burau, V., Carstensen, K., Lou, S., Kuhlmann, E. (2017). Professional groups driving change toward patient-centered care: Interprofessional working in stroke rehabilitation in Denmark. BMC Health Services Research, 17, 662. https://doi.org/10.1186/s12913-017-2603-7
Casto, R. M., & Julia, M. C. (1994). Interprofessional Care and collaborative practice. Brooks/Cole, 95-101.
CBD College (2017, April 13). Dr. William Rush Dunton Jr. | CBD College. CBD College. https://www.cbd.edu/2017/04/13/dr-william-rush-dunton-jr/de
Haan, K. (2020). Interprofessional education in a community hospital: Discovery and opportunity. Occupational Therapy Now, 22(4), 11-13. https://www.proquest.com/docview/2426493736?accountid=14473
Espinoza, P., Peduzzi, M., Agreli, H. F., & Sutherland, M. A. (2018). Interprofessional team member's satisfaction: A mixed-methods study of a Chilean hospital. Human Resources for Health, 16(1), 1-12. https://doi.org/10.1186/s12960-018-0290-z
Goodwin University (2021, May 14). The Origins of Occupational Therapy (OT) | Goodwin University. Goodwin University. https://www.goodwin.edu/enews/origins-of-occupational-therapy-and-mental health-practices-within-ot/
Green, B. N., & Johnson, C. D. (2015). Interprofessional collaboration in research, education, and clinical practice: Working together for a better future. The Journal of Chiropractic Education, 29(1), 1–10. https://doi.org/10.7899/JCE-14-36
Gustavsson, K., Börjesson, E., Björklund, M., & Munck, B. (2021). Interprofessional collaboration in connection with a medical ship: Nurses' experiences. Journal of Clinical Nursing, 21(23-24), 3506-3516. https://doi-org./10.1111/jocn.15853
Langlois, S., Boyle, J., & Cadavid, E. (2020). Embracing interprofessional practice:Clients partnering with students. Occupational Therapy Now, 22(4), 21-23.https://www.proquest.com/docview/2426493557?accountid=14473
Loy, B., Micheff, H., Nguyen, K., & O'Brien, V. (2015). Interprofessional collaboration between occupational therapists and nurses in an acute care setting: An exploratory study [Master’s thesis]. The Dominican University of California, San Rafael, CA.
Occupational therapists. (2021, March 31). Bls.gov. https://www.bls.gov/oes/current/oes291122.htm
Office of Interprofessional Education. (2016, September 16). Canadian Interprofessional Health Collaborative (CIHC) framework. Office of Interprofessional Education. https://www.mcgill.ca/ipeoffice/ipe-curriculum/cihc-framework
Roberts, N. (2020). Reflections of an interprofessional practice leader: The power of humility, curiosity, courageousness, and self-reflection. Occupational Therapy Now, 22(4), 17-18. https://www.proquest.com/docview/2426494109?accountid=14473
Thistlethwaite, J. (2012). Interprofessional education: A review of context, learning, and the research agenda. Medical Education, 46, 58-70. https://doi.org/10.1111/j.1365-2923.2011.04143.x
Thompson, C. (2017, November 14). Improving rehabilitation care with interdisciplinary collaboration [Web log]. https://www.rehabalternatives.com/2017/11/14/improving-rehabilitation-care-with-interdisciplinary-collaboration
University of St. Augustine for Health Sciences. (2021, September 9). 60 Key nursing statistics and trends for 2021. University of St. Augustine for Health Sciences. https://www.usa.edu/blog/nursing-statistics/
U.S. Bureau of Labor Statistics. (2021, September 8). Registered nurses: Occupational outlook handbook. U.S. Bureau of Labor Statistics. https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-2.
Yu, J., Lee, W., Kim, M., Choi, S., Lee, S., Kim, S., Jung, Y., Kwak, D., Jung, H., Lee, S., Lee, Y. J., Hyun, S. J., Kang, Y., Kim, S. M., & Lee, J. (2020). Effectiveness of simulation-based interprofessional education for medical and nursing students in South Korea: A pre-post survey. BMC Medical Education, 20(1), 476. https://doi.org/10.1186/s12909-020-02395-9