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Occupational Therapy Programme : Student Handbook Year 1 - Level 1 September 2004 – June 2005

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Occupational Therapy Programme : Student Handbook Year 1 - Level 1 September 2004 – June 2005 EXPLORING THE IMPACT OF INTERPROFESSIONAL TAUGHT MODULES AND PLACEMENT EXPERIENCE ON THE DEVELOPMENT OF PROFESSIONAL IDENTITY AND UNDERSTANDING OF ROLES IN FIRST YEAR MENTAL HEALTH STUDENTS By TERESA HEWITT-MORAN A thesis submitted to The University of Birmingham For the degree of SOCIAL SCIENCE DOCTORATE 41863 words (excluding text boxes) Text box words = 12,988 Institute of Applied Social Studies School of Social Policy The University of Birmingham 2010 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT Mental health services are under continuous pressure to develop multidisciplinary service models in response to government policy. Mental health professionals, however, continue to be trained in isolation with little preparation for working within a multidisciplinary environment. This thesis explored the development of professional identification amongst nine students in their first year of qualifying training. It focussed on their understanding of their role and the roles of other mental health professionals, specifically nursing, social work and occupational therapy. It also focused on the impact of interprofessional education (IPE) and work-based placements. The research undertaken in this thesis was framed by a social constructionist approach and utilised semi-structured interview data collection methods, discourse analysis and the analysis of course syllabii to explore student experiences. The findings indicate that there may be benefits that can be achieved through IPE regarding enabling students to understand their professional roles within the broader context of health and social care. IPE can offer a means of preparing social work, nursing and OT students for the multidisciplinary team environments that they will be required to work within should they choose to work in mental health services. This thesis suggests that the impact of placement experiences within the first year of study on identity and knowledge of own roles and those of other professions, whether in MDTs or uni-disciplinary teams is significant. These findings indicate that consideration should be given by education providers to the weight and significance of the first practice based experiences, as a potent learning and development experience that can shape professional identity and understanding. DEDICATION For my husband Martin and our daughters Alexandra and Christina, who arrived during the journey, have inspired me along the way and bring joy and happiness to each and every day. ACKNOWLEDGEMENTS I am indebted to my supervisors Professor Ann Davis and Ric Bowl for providing challenge, insight, support and encouragement throughout the process of writing this thesis. Particular thanks to Ann for supporting me throughout the last eight eventful years. Their efforts have been tireless and to both I am very grateful. I would like to express my gratitude to my parents Mary and Seamus for nurturing my dreams and aspirations and providing a constant source of support and motivation. Completion of this thesis whilst working full time has proven to be a challenge and has required work to be undertaken most evenings. This would not have been sustainable without the patience and understanding demonstrated by my husband Martin. His enduring belief in my abilities has been unshakeable, and for that I am very thankful. TABLE OF CONTENTS Page no Introduction 1 Chapter 1. Literature review Part 1 The impact of the multidisciplinary team model on professional roles 6 Part 2 Professional identity, socialisation and Interprofessional Education 27 Table 1 Literature Review Flow Chart 49 Chapter 2. Methodology 51 Theoretical perspective 53 Social constructionist Perspective 54 Discourse analysis 58 Research design 59 Methods 61 Chapter 3. Findings 3.1 Review of professional course syllabuses for Occupational Therapy, 80 Social Work and Nursing for year 2004/05 (Table 2) 84 3.2 Discourse analysis of interview data 87 (figures 1 – 149) Chapter 4. Discussion Discussion of themes relating to the two research questions with reference to 167 literature cited in literature review Figure 150; theoretical framework 169 Appendices A. Interview schedule 196 B. Wolverhampton University Nursing Syllabus 2004/05 200 C. Coventry University Occupational Therapy Syllabus 2004/05 207 D. Wolverhampton University Social Work Syllabus 2004/05 214 E. Information for participants/ invitation to participate 248 F. Participant consent form 252 G. Participant information 253 H. Permission letter to universities 255 I. Ethics committee approval 258 J. Interview transcripts 259 References 390 CHAPTER 1. LITERATURE REVIEW 1.1 The impact of the multidisciplinary team model on professional roles This chapter is divided into two parts. The first part provides a context for the research by reviewing selected policies in England that have shaped the current multiprofessional configuration of mental health service delivery models. The literature review focused on the period from the early 1990s to 2004 when the establishment of new Multi-disciplinary Team (MDT) models introduced by the National Service Framework (NSF) for Mental Health (1999) target implementation period had been completed. Literature from before and after the policy implementation time period is included in order to encapsulate the views and perceptions of the perceived impact of the changes before, during and following the introduction of the MDT models. These policies are reviewed alongside selected literature that drew on the impact and experiences of the changes from a professional’s perspective. The second part of 1.1 then reviews literature that explored the impact of these developments on the perceptions of roles within multidisciplinary teams in addition to any perceived threats to professional identity. The second part of the chapter (1.2) reviews literature exploring the impact of socialisation and interprofessional education on professional identity, understanding of role and those of other professions. Definitions of interprofessional and multiprofessional education and practice It is widely understood in the literature that the prefixes of inter-and multi-are used interchangeably when referring to professional practice and education (McAllin, 2001). This section seeks to give an overview of the variation in terminology used in reference to the provision of education to more than one group of professionals, and the definitions of teams that consists of more than one professional. Miller (2001) defines interprofessional education 1 (IPE) as different professions learning about topics of mutual interest, rather than about each others’ roles. Clifton et al (2006) define these shared learning opportunities as multiprofessional education. They argue that the term interprofessional education describes where professionals learn from and about each other, with the expressed aim of improving the delivery of care to individuals. Freeth et al (2006) suggest that the interactive nature of IPE goes a step further, in enabling the participants to generate new perspectives and ways of understanding between professions. This lack of clarity in the definition of IPE extends throughout policy and research (Sharland et al, 2007). Barr et al (2005) define IPE as ‘Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ (p11) Barr et al's definition has become the most accepted definition across disciplines. The focus is on the intended outcome of the process, to enhance collaboration between professionals, in contrast to multidisciplinary education which simply brings different professions together in the classroom. In constructing a working definition of IPE in relation to this study, I synthesise the definitions of Barr et al (2005) and Freeth et al (2006). My working definition of IPE is occasions where professionals learn with, from and about each other, and in doing so develop their understanding of how professionals can collaborate in practice. The confusion relating to IPE terminology translates into the practice setting. The terms multidisciplinary and interdisciplinary are often used interchangeably in the literature reviewed here. However, in discussing professional roles within mental health teams the difference is significant. Within a multidisciplinary team only one person, such as the care co- 2 ordinator within the Care Programme Approach or the psychiatrist, makes decisions about interventions or treatment. There will be opportunities for each discipline to feed in to the care planning process, through individual consultation or team case discussions. The potential advantages of the multidisciplinary approach of bringing different disciplines together are not maximised in this situation. Finding a workable way of combining the input of the range of disciplines into a common decision-making process produces an interdisciplinary team. A team functioning in an interdisciplinary model would enable the utilisation
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