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Vol.:(0123456789)

Advances in Health Sciences Education

1 3

Brenda Flood

1

· Liz Smythe

1

· Clare Hocking

1

· Marion Jones

2 Received: 22 August 2018 / Accepted: 23 February 2019

© The Author(s) 2019

Abstract

Interprofessional practice is commonly discussed in the literature in terms of competen cies. In this study we move away from the theoretical notions of criteria, concepts and guidelines to adopt an ontological approach which seeks to stay as close to the lived expe rience as possible. Our research asked 12 participants from a variety of health disciplines to tell their stories of working interprofessionally. We sought to glean meaning from the lived experience. Our phenomenological hermeneutic approach and interpretation were informed by Heidegger and Gadamer. Rather than oering a thematic overview, in this article we share three stories from the research that were congruent with other stories. The rst, told by a doctor, is of a resuscitation in an emergency department. It shows how the eective working together of the interprofessional team was more than each member fol lowing a resuscitation protocol. There was ‘something" about how they worked together that made this story stand out, even though the patient died. The second story showcases how ‘who" the person is makes a dierence. This nurse makes an eort to get to know other sta as people, to nd common interests. In such a way interprofessional practice comes to ourish. The third story shows how a physiotherapist and a psychologist joined in conversation to seek innovative possibilities for a challenging situation. In such a way each built on the others expertise and were excited at the success they achieved for the patient. From these ontological accounts we have come to see that interprofessional practice our- ishes when practitioners are their authentic, caring selves. Who the person is matters.

Keywords

Competency· Interprofessional practice· Phenomenology· Health professional educationIntroduction Competencies are so pervasive in health professional education and practice that they have been dubbed one of the eld"s “most cherished ideas" (Lingard 2009
, p. 625), an idea taken

up as the cornerstone of interprofessional practice. By nature, educational institutions and * Brenda Flood

bood@aut.ac.nz 1 Faculty ofHealth andEnvironmental Sciences, Auckland University ofTechnology, Auckland,

NewZealand

2 Graduate Research School, Auckland University ofTechnology, Auckland, NewZealand

B. Flood et al.

1 3 2007
).Whileinternationalagree tencewillbecomemoreprecise(Nagelsmith 1995
;Reeveset al. 2009
).Thestandardand course"(Talbot 2004
performanceinto"basicunitaryskills"(Fernandezet al. 2012
,p.363).Thatfracturing, 2007
).Alerttothatcritique, porate"higherordercompetence"(Talbot 2004
,p.587)includingjudgement,values,emo tions,andpersonalorcharacterattributes(Fernandezet al. 2012
;Talbot 2004
).Reflecting concernsaboutwhetheritispossibletoacquireorteachthoseattributes(Fernandezet al. 2012
;Kumagai 2014
petence(Parket al. 2015
petency(BrewerandJones 2013
2010

InterprofessionalEducationCollaborative

2016
)andeducationandpracticeframeworks (Charleset al. 2010
;InstituteofMedicine 2015
;WorldHealthOrganization 2010
).Such 1998
,p.185).Recentpublications (Bainbridgeet al. 2010
;Gunaldoet al. 2017
;Reeves 2012
;Thistlethwaiteet al. 2014

Interprofessional practice: beyond competence

1 3 2001
)argues:"thinkinggets 1971a
),theessenceof enced',yetthatiswhatmatters.

Aimand purpose

deliveryisanestablishedmethodology(Gileset al. 2012
;GloverandPhilbin 2017
;Lan drumet al. 2017
;Rocha 2016
;Thomson 2016
).Approvalforthisstudywasgainedfrom

Methodology

fromourexperienceof'being'.Sheehan( 2014
),inasking"What,afterall,wasHeidegger inghowthingsareexpectedtobe(Heidegger 1962
).Insuchamannerwegoaboutina non-thinkingmode(Heidegger 1968
).Thomson( 2016
),drawingonHeidegger,pointsto whoweare"(p.849).Hetalksofthechoiceto" impose pre-establishedstandards"orto takeontheworkto" disclose (p.853,emphasisoriginal).To impose

B. Flood et al.

1 3

Method

2017
),incollaboration 2003
),in sibilities"(Smythe 2003
thatexploredcoreconceptsofoccupationaltherapy(Reedet al. 2011
),wheretheinitial

Joneset al.(

2014
professionalpractice.HeedingHeidegger's( 1962
)calltoseektogetasclosetotheprimor- tionwherenecessaryandremovingdistractingdetails(Crowtheret al. 2017
).Thisprocess 1990
).Floodworkedwiththe practice. process(Caelli 2001

Interprofessional practice: beyond competence

1 3 beforegrounded.vanManen( 2014
states: 2006
).Thus, constantlyatplay.Anoverviewofthefindingsisreportedelsewhere(Floodet al. 2019

Presentationof ?ndings

2012
duringaresuscitation.

B. Flood et al.

1 3 1971b
,p.74). letourselvesbetoldsomething"( 1971b
1 1

Recognising that we had perhaps taken our interpretation of this story beyond what was actually said we

invited comment from Amanda: “What a lovely interpretation of this story. Yes, it is very much in tune

with the lived experience. Knowing something, understanding the algorithm and then doing—putting it all

into practice in the moment with a group of diverse people is very di erent. You have captured that beauti

fully. It is an openness, it was a moment of interprofessional practice ourishing, a feeling of having come

together in a way that created something more—more than each of our competencies as you say, more than

anyone of us could have achieved on our own. We became a team ghting for this man"s life, a team making

a di erence".

Interprofessional practice: beyond competence

1 3 hesaid" ".Fromhisexperience surgeonhereflectsthatifhesays" spaceforopennesstowhateveremerges.

Heidegger(

1962
andtransformed(Gadamer1975/ 2013
;Vilhauer 2013
).Opennessinvolveskeepingthedia withregardstothesubjectmatter"(Vilhauer 2013
,p.77).Beingopenandcomporting

B. Flood et al.

1 3

Gadamer(1975/

2013
andTapp 2008
wearenolongeraswewere(Gadamer1975/ 2013
;Laverty 2003
)."He[Gadamer] (LawnandKeane 2011
2011

Interprofessional practice: beyond competence

1 3 1975/
2013
;LawnandKeane 2011
apprenticedescribedbyHeidegger( 1993a
,b),whoseabilitywiththewoodwasmorethan other.

Discussion

2001
,p.222). natureofprofessionalpractice(Kumagai 2014
).Itbecomesakintoatechnology,ameans 1993b
'team'. 2016

B. Flood et al.

1 3 "specificsituationsandcontexts"(Kumagai 2014
,p.982).Weseehowthewayweare,the awoken. 1993b
,p.325)byatechnological livein"(O'Brien 2004
straintsandconflictstheycanimpose"(Reeveset al. 2009
,p.453).Howthendowemove beyondsuchconstraintandtension?O'Brien( 2004
)interpretsHeidegger'sanswertothis 2016
)rec mand - Knowthyself - isterrifying"(p.10).Perhapsthatiswhywesettlecomfortably behindmyprofessionalpersona.

Limitationsof the study

Interprofessional practice: beyond competence

1 3

Conclusion

allofthoseandmore? arewithothers.Thisiselusive - difficulttoteachandassess.Whilewesensewhenitis

Open Access

tionalLicense( http://creat iveco mmons .org/licen ses/by/4.0/

B. Flood et al.

1 3

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Flood,B.(2017).

Toward a spirit of interprofessional practice: A hermeneutic phenomenological study http://hdl.handl e.net/10292 /10776quotesdbs_dbs48.pdfusesText_48

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