Dentry, Terri Louise (2021) Seeing more than we saw before: the lived experience of interprofessional practice. PhD thesis, Victoria University.

Abstract

This research provides an in-depth exploration of the experience of practitioners and clients utilising an interprofessional practice approach within a community health care setting with clients who have complex chronic care needs. An interprofessional approach has been demonstrated to have enhanced outcomes for clients who have complex chronic conditions. However, interprofessional practice approaches are not well defined in the literature. Therefore, understanding how practitioners and clients co-design healthcare using an interprofessional practice approach requires detailed research within particular healthcare settings. A focus on the management of clients from refugee and asylum seeker background with chronic pain offered a valuable context for this study. An interpretative phenomenological analysis (IPA) was chosen to support the participants' illumination of lived experience in their interactions with each other. Interviews were conducted with nine practitioners and nine clients. To determine the data's trustworthiness, journaling, member checking, external auditing, and reflexivity were used, all of which align with the IPA approach. The analysis revealed four themes within the practitioners’ experience and three themes within the clients’ experience. The first theme to emerge from the practitioner interviews, ‘My place within the team', illuminated that the interprofessional approach was a natural extension of the values within this community health setting. A strong team focus allowed most members to feel immersed in the interprofessional team. However, some practitioners felt aggrieved by those in the team who did not become as immersed as they did in the interprofessional activities. They demarcated these practitioners as being on the team's periphery. The second theme, 'Consolidating understanding', highlighted how an interprofessional approach initially caused some anxiety due to a fear of the unknown; however, with experience confidence was gained in the teams shared roles and mutual trust developed. The third theme, 'Coping with an interprofessional approach', highlighted areas of moral discomfort in the way practitioners reflected on their experience. This discomfort included coping with difficult conversations and using resistance as a protective mechanism. The impact of moral discomfort on the practitioners was reduced by the development of trust and respect which in turn led to the practitioner’s willingness to seek each other out for input into client care with an open approach. The fourth theme, 'Finding the balance for the client's benefit', highlighted the practitioner's concerns regarding the ethical and moral considerations of an interprofessional approach in this care setting, balanced with the approach's benefits compared to usual care. Analysis of the clients’ experience of an interprofessional approach was limited due to language barriers. However, three themes were revealed: 'The person behind the pain' that included feelings of uncertainty and holistic needs to be healed, 'Opening up to others' that included learning to put trust in a team, and 'Ready to move on' that separated clients into those who were now owing their pain and those who did not move forward. This study's findings provide useful information about the practical applications of interprofessional practice in a community health care setting that is deficient in the literature. The clinical implications relate to training and processes required to ensure effective interprofessional practice in this setting. The practitioners may have benefitted from additional training, particularly experiential training in applying an nterprofessional approach in practice. Tailored training to their care setting could help overcome the initial anxiety of the unknown and help prepare them for coping with difficult discussions in areas outside their professional practice.

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