Pediatric Psychologists’ Collaboration in a National Pediatric Obesity Initiative: A Case Study in Interprofessional Collaboration

Health Care reform calls for collaborative team-based care; psychologists must therefore strengthen their competencies for work in interprofessional clinical care settings. Toward that end, a group of psychologists participated with physicians, dieticians, physical activity specialists, nurses, and others in a national interprofessional workgroup focused on pediatric obesity. The interprofessional group was designed to identify areas in need of national advocacy, key assessment and treatment concerns, and gaps in internal policies and procedures in children’s hospitals. This article provides a case report of psychologists’ roles and experience in this workgroup, and focuses on factors that underlie successful collaboration among diverse health professionals, as well as potential barriers to success. The participating psychologists developed a working model for collaboration with other disciplines. Additionally, they formed a Psychology Subcommittee to identify and address discipline-specific issues regarding collaborative practice in pediatric psychology. Lessons learned in this interprofessional collaborative undertaking have relevance for future collaborative endeavors.     

Healthcare Chaplains’ Perspectives on Nurse–Chaplain Collaboration: An Online Survey

The collaboration between nurses and chaplains is essential to provide spiritual support in healthcare institutions. Given challenges in collaboration exist between these disciplines, this study sought to further understand the nature of the chaplain–nurse relationship. Data obtained from an online survey of members of the Association of Professional Chaplains (N = 266) provide a quantified and nuanced picture of how chaplains perceive nurse collaboration and provision of spiritual care. This study not only provides evidence that can inform chaplain and nurse practice, but also an instrument for measuring perceptions about collaboration to provide spiritual care.

     

Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.     

Spiritual Care in the ICU: Perspectives of Dutch Intensivists,ICU Nurses,and Spiritual Caregivers

Since there are no scientific data available about the role of spiritual care (SC) in Dutch ICUs, the goal of this quantitative study was twofold: first, to map the role of SC as a part of daily adult ICU care in The Netherlands from the perspective of intensivists, ICU nurses, and spiritual caregivers and second, to identify similarities and differences among these three perspectives. This study is the quantitative part of a mixed methods approach. To conduct empirical quantitative cohort research, separate digital questionnaires were sent to three different participant groups in Dutch ICUs, namely intensivists, ICU nurses, and spiritual caregivers working in academic and general hospitals and one specialist oncology hospital. Overall, 487 participants of 85 hospitals (99 intensivists, 290 ICU nurses, and 98 spiritual caregivers) responded. The majority of all respondents (>70%) considered the positive effects of SC provision to patients and relatives: contribution to mental well-being, processing and channeling of emotions, and increased patient and family satisfaction. The three disciplines diverged in their perceptions of how SC is currently evolving in terms of information, assessment, and provision. Nationwide, SC is not implemented in daily ICU care. The majority of respondents, however, attached great importance to interdisciplinary collaboration. In their view SC contributes positively to the well-being of patients and relatives in the ICU. Further qualitative research into how patients and relatives experience SC in the ICU is required in order to implement and standardize SC as a scientifically based integral part of daily ICU care.     

Intimate Partner Violence (IPV) and Neurological Outcomes: A Review for Practitioners

ABSTRACT

Thirty-eight million women will experience intimate partner violence (IPV) during the course of their lifetime. Many of these women will experience brain injuries as a result of IPV and may not seek medical attention. Several types of practitioners who work with IPV survivors consistently, e.g., first responders, advocates, and clinicians, may be unfamiliar with brain functioning, screening, assessment, and treatment. This article reviews the dual traumas of IPV and TBI, the impact on neurological processes and symptomatology, and short and long-term outcomes. Recommendations for screening, intervention, interprofessional collaboration, and research are outlined.     

Patient-provider care goal concordance: implications for palliative care decisions

Objective: Goal-concordant care is an important feature of high quality medical treatment. Patients’ care goals may focus on curative and/or palliative outcomes. Patients rarely communicate their care goals, and providers’ predictions of patient goals are often inaccurate, corresponding most closely to their own treatment goals. This projection of own goals onto patients introduces the potential for bias, leading to goal-discordant care.

Design and Main Outcomes: We examined goal discordance using data from a U.S. sample of healthcare providers (N?=?492) recruited online in 2017 using GfK Knowledge Panel. Providers reported their perceptions of their patients’ care goals (curative relative to palliative), their own care goals if they were to become ill, and their willingness to deliver palliative care.

Results: For 28% of providers, their own care goals differed from their patients’. Providers were more likely to prioritise palliative care (relative to curative) in their own goals than in their predictions about patients’ goals. Providers were more willing to deliver palliative care when their own goals prioritised more palliative relative to curative care, but their perceptions of patient goals were unassociated with willingness to provide it.

Conclusions: Efforts to improve goal communication and reduce projection biases among providers may facilitate goal-concordant care.     

From “Longshot” to “Fantasy”: Obligations to Pediatric Patients and Families When Last-Ditch Medical Efforts Fail

Clinicians at quaternary centers see part of their mission as providing hope when others cannot. They tend to see sicker patients with more complex disease processes. Part of this mission is offering longshot treatment modalities that are unlikely to achieve their stated goal, but conceivably could. When patients embark on such a treatment plan, it may fail. Often treatment toward an initial goal continues beyond the point at which such a goal is feasible. We explore the progression of care from longshot to fantasy using two pediatric cases. This progression may be differentiated into four distinct stages of care related to the potential of achieving the initial goals of care. Physicians are often ill prepared for the progression of treatments from a longshot hope to an unfeasible and, therefore, typically unjustified intervention. We present a structured approach to guide clinicians at referral institutions where these situations may be common. The transition of care from “longshot” to “fantasy” is an inherent part of quaternary care for the sickest of patients that has been underexplored. Physicians are often poorly equipped to approach that transition. We advocate this approach to the shift from longshot to fantasy with the belief that such a structured method will have multiple benefits, including: reduced suffering for the patient; decreased emotional burden on patient and family; decreased provider moral distress; increased likelihood of seeking high quality palliative care earlier; and provision of honest and straightforward information to patients and their families.     

Changing dominance in mixed profession groups: putting theory into practice

An extended professional identity theory is proposed to enhance interprofessional collaboration. The purpose of this study is to investigate whether comparative feedback on interprofessional interaction can decrease the degree of profession-based dominance and general dominance in mixed profession groups. This observational study comprised a randomized double-blind pretest-posttest control group design with 19 mixed profession groups (10 intervention and nine control groups, each with three dental and three dental hygiene students). All groups received reflective feedback during two consecutive two hour team development meetings. Intervention groups also received comparative feedback. Profession-based dominance concerned the sum of three observation items (conversational turn-taking, dominance and contributing ideas) with a three-point scale: ?1 = dental dominance, 0 = no dominance, +1 = dental hygiene dominance. Polychoric correlations confirmed positive associations with the latent trait and an unidimensional underlying structure. Observation items were internally consistent (α > .70). General dominance concerned the sum of absolute values of observation items with a minimum value of zero (no dominance) and the maximum value of three (strong dominance). A two-way factorial ANOVA was performed. The results revealed a significant interaction effect with regard to general dominance, F(1,17) = 6.630, p = 0.020 and large effect size (partial eta squared = 0.28). Comparative feedback on interprofessional interaction decreases general dominance in mixed profession groups.     

The Benefits of Interprofessional Collaboration for a Pharmacist and Family Therapist

Abstract

Medical family therapists (MedFTs) and pharmacists in the context of interdisciplinary collaboration will be discussed. In an effort to build and reflect on their own professional experiences, recognizing the need to address wellbeing from a multitude of perspectives, and with the goals of improving access to care by identifying potential partnership opportunities between the two professions, the authors synthesized findings from pertinent articles using Medline and PsycInfo. This paper will illuminate the precise roles of MedFTs and pharmacists, how they fit into the interdisciplinary healthcare team, and anticipated facilitators and barriers in this undertaking to enhance patient care.     

The role of goal adjustment in symptoms of depression,anxiety and fatigue in cancer patients receiving psychosocial care: A longitudinal study

Objective: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety and fatigue. Goal adjustment was conceptualised as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals).

Design: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions.

Main Outcome Measures: Goal adjustment, symptoms of depression, anxiety and fatigue.

Results: At group level, patients reported small increases in goal disengagement (d = .22) but no significant change in goal reengagement (d = .09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% reported an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue.

Conclusion: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.     

Quality Improvement in Health Care: The Role of Psychologists and Psychology

Quality Improvement (QI) is a health care interprofessional team activity wherein psychology as a field and individual psychologists in health care settings can and should adopt a more robust presence. The current article makes the argument for why psychology’s participation in QI is good for health care, is good for our profession, and is the right thing to do for the patients and families we serve. It reviews the varied ways individual psychologists and our profession can integrate quality processes and improve health care through: (1) our approach to our daily work; (2) our roles on health care teams and involvement in organizational initiatives; (3) opportunities for teaching and scholarship; and (4) system redesign and advocacy within our health care organizations and health care environment.     

A family-based approach to adult mental disorders

Recent research studies have provided strong support for a collaborative approach between families and mental health services in the clinical management of major mental disorders. A comprehensive approach to adult mental health care that employs cognitive-behavioural family therapy as the basis for clinical assessment and treatment is described. This model emphasizes home-based intervention, collaboration with primary care, targeted specific interventions, achievement of the personal goals of index patients and their family members, long-term rehabilitation, and assessment of benefits and costs.     

THE CHALLENGE TO MENTAL HEALTH SERVICES IN THE 1980s

Robert W. Gibson MD, is interviewed concerning the potential impact of restricted funding for mental health services in the 1980s, particularly as this applies to the practice of occupational therapy. Topics covered include the decreasing length of inpatient hospitalization; the possibility of a shifting emphasis lo the treatmcnt of the severely and chronically ill; increasing utilization of rehabilitative services; and suggestions to facilitate greater interprofessional collaboration. Thc establishment of measurable outcomes for continued or improved reimbursement of occupational therapy services is stressed, and the potential for multiprofession group practices as a cost-effective approach to reduced business and industry health care costs is suggested.     

The efficacy of a pilot pediatric cognitive remediation summer program to prepare for transition of care

This study assessed the efficacy of a time-sensitive cognitive remediation summer program (CRSP) that provided patients and their families with tools to help mitigate neurocognitive deficits and promote independence to foster precursor transition of medical care skills. A total of 38 participants (aged 9–15) were included in one of the CRSPs offered yearly from 2013 to 2016. A longitudinal design was employed and at each evaluation time point, one week before start of the CRSP (pre-testing) and within three weeks after the end of the program (post-testing)), participants were administered measures of executive functioning in addition to parent ratings of behavior, executive functioning, and adaptive skills (Year 1–Year 4). In Year 4, additional measures were collected, including parenting style and parent engagement and involvement in the program. Results from Year 1 to Year 4 (n = 35) demonstrated that participants in the CRSP showed significant improvement on neuropsychological testing in sustained and selective attention, planning, and cognitive flexibility. Robust changes in parent ratings of adaptive functioning from pre- to post-treatment were also found. Specific to Year 4 (n = 13), results revealed that participants showed improvement in levels of independence with at least one of the individualized goals focused on during the program. This study provided a systematic method to gauge the levels of instruction necessary to reach goals, a crucial tool in skill-teaching. Overall, our study provides evidence for the efficacy of the CRSP and validates a feasible intervention that can be integrated into standard of care for pediatric medical populations.     

A Systematic Approach to Engineering Ethics Education

Engineering ethics education is a complex field characterized by dynamic topics and diverse students, which results in significant challenges for engineering ethics educators. The purpose of this paper is to introduce a systematic approach to determine what to teach and how to teach in an ethics curriculum. This is a topic that has not been adequately addressed in the engineering ethics literature. This systematic approach provides a method to: (1) develop a context-specific engineering ethics curriculum using the Delphi technique, a process-driven research method; and (2) identify appropriate delivery strategies and instructional strategies using an instructional design model. This approach considers the context-specific needs of different engineering disciplines in ethics education and leverages the collaboration of engineering professors, practicing engineers, engineering graduate students, ethics scholars, and instructional design experts. The proposed approach is most suitable for a department, a discipline/field or a professional society. The approach helps to enhance learning outcomes and to facilitate ethics education curriculum development as part of the regular engineering curriculum.     

Meaning in life and violations of beliefs and goals: reciprocal relations among individuals with congestive heart failure

Background and objectives: In the context of highly stressful experiences, violations of beliefs and goals and meaning in life may have a reciprocal relationship over time. More violations may lead to lowered meaning, whereas higher meaning may lead to lowered violations. The present study examines this relationship among congestive heart failure (CHF) patients.

Design: A cross-lagged panel design was used.

Methods: CHF patients (N?=?142) reported twice, six months apart, on their meaning in life and the extent to which CHF violates their beliefs and goals.

Results: Overall, results were consistent with a reciprocal relationship, showing that greater goal violations led to negative subsequent changes in meaning, whereas greater meaning led to favorable subsequent changes in violations of beliefs and goals.

Conclusions: Meaning in life and violations may contribute to one another, and therefore, in understanding the adjustment process, it is important to consider their interrelationship. The results are also broadly informative regarding the experience of meaning, showing that disruption of beliefs and goals may undermine meaning.     

Collegiate Coaches' Perceptions of Their Goal-Setting Practices: A Qualitative Investigation

The purpose of the present investigation was to assess the perceptions of coaches regarding the process of goal setting using a qualitative methodology. Participants were 14 NCAA collegiate coaches from the American Midwest representing both team and individual sports. All participants were head coaches and were asked to respond to the interview questions in relation to their current head coaching position. Results revealed that coaches employed goal setting extensively for both individual and team goals in practice and competition. In addition, many interesting findings regarding the process of goal setting emerged including (a) coaches tended to set short-term goals although there were some nebulous longterm goals; (b) coaches only inconsistently wrote down their goals; (c) goals were both dictated by coaches and set in collaboration with players with a focus on collaboration; (d) the primary function of goals was to provide direction and focus; (e) goal commitment was related to enjoyment/fun; (f) process, performance, and outcome goals were set but coaches focused on performance and outcome goals; and (g) physical, psychological, and time barriers impeded goal attainment. These findings are discussed in relation to the current empirical/theoretical goal-setting literature and suggestions for best practice by sport psychology researchers are offered.     

Therapeutic Relationships Re-Defined

Abstract

The therapeutic relationship has traditionally been central to occupational therapy. This study surveyed 129 practicing occupational therapists in Connecticut, concerning how they define and use the therapeutic relationship with clients in today's cost-conscious health care environment. The following four hypotheses: (1) Therapeutic relationships are related to functional outcome, (2) Definitions of therapeutic relationships include words and phrases expressed in the literature and by experts, (3) There are differences in perceptions of therapeutic relationships among pediatric, adult, and geriatric specialty subgroups, (4) Most occupational therapists learned skills in developing therapeutic relationships “on the job,” rather than during professional education, were all supported. This study reaffirms the importance of the therapeutic relationship in occupational therapy practice and provides an updated definition: A trusting connection and rapport established between therapist and client through collaboration, communication, therapist empathy and mutual understanding and respect.