Inclusion of interprofessional education for students in health care professions is supported through the Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative Expert Panel, 2011). Both occupational therapy (OT) and nurse practitioner (NP) students learn how to provide care for individuals with mild or major neurocognitive disorders (NCDs), which may include patient disruptive behaviors. One approach that OT students learn to use with this population is the management of those behaviors, whereas NP students may benefit from learning more about the use of nonpharmacologic approaches with the same group. For behavioral symptoms in individuals with NCD, nonpharmacologic and collaborative professional approaches were promoted by Gitlin, Kales, and Lyketsos (2012).
Goals and Objectives of the Interprofessional Collaboration Activity
OT and NP students learn the roles of the other discipline when working with older adults who have mild or major NCD. Through the discussion of cases that are focused on individuals with mild or major NCD with irritable or impulsive behaviors, students apply the principles of the Allen Cognitive Levels model (Allen et al., 2007). Using case study analysis, students identify options to decrease drug use and increase behavioral interventions for individuals with mild or major NCD.
Initially, both student groups receive information on various symptoms of mild and major NCDs, as well as common assessment and intervention approaches for their own discipline. In preparation for the interprofessional team experience, OT students receive in-depth training on the Allen Cognitive Levels, which provides a score that is representative of an individual’s functional cognition and assists with care planning (Allen et al., 2007). NP students are oriented to Allen Cognitive Levels principles by the OT faculty in one 3-hour session. In a 2-hour class session, 10 NP and 32 OT students are brought together in groups of four to five students to discuss the perceptions of each other’s roles in addressing older adult dementia care and to analyze clinical case studies involving mild and major NCDs. Students develop a plan of care, applying Allen Cognitive Levels principles to address specific strategies to reduce problematic behaviors and relieve caregiver burden in both family and supervised living settings. Case studies include individuals with the following diagnoses: mild NCD due to Alzheimer’s disease (or early-onset dementia), major NCD due to frontotemporal NCD, and major NCD with Lewy body dementia.
Data from the pre- and posttest surveys completed by the students indicated that the interprofessional experience helped to better their understanding of the role of the other profession and increased their knowledge of various ways to work with individuals with NCDs. In the majority of OT pretests, students thought that NPs assessed patient medical needs and administered medications. OT posttests showed that students held a broader view of the NP role, which included medication prescription, the ability to refer to other professions, and the ability to order cognitive assessments for patients. NP posttests indicated that their view of the role of the occupational therapist was changed from that of teaching self-care skills to assessing cognition, modifying the environment, and assisting with care planning of the patient.
The impact of the learning activity was that both student groups reported increased knowledge about the roles and responsibilities of the other discipline and increased their confidence in communicating and working with other team members. In addition, students indicated a higher likelihood of referring to the other profession in future practice. Through this exercise, three of the four core competency domains for interprofessional collaborative practice were met.
This model of interprofessional NP and OT geriatric education provides an effective educational opportunity that could help promote collaborative behavioral management and the use of non-pharmacologic approaches for individuals with mild or major NCD who exhibit irritable or impulsive behaviors.
- Allen, C.K., Austin, S.L., David, S.K., Earhart, C.A., McCraith, D.B. & Riska-Williams, L. (2007). Allen cognitive level screen-5 (ACLS-5) and Large Allen cognitive level screen-5 (LACLS-5). Retrieved from http://www.allen-cognitive-network.org/images/stories/pdf_files/web09ACLS-5Handoutpg2.pdf
- Gitlin, L.N., Kales, H.C. & Lyketsos, C.G. (2012). Managing behavioral symptoms in dementia using nonpharmacologic approaches: An overview. The Journal of the American Medical Association, 308, 2020–2029. doi:10.1001/jama.2012.36918 [CrossRef]
- Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.