6 - 2 - Interprofessional - Approach - Dementia

Using
an Interprofessional
Approach to Demen5a Care
Elizabeth (Ibby) Tanner, PhD, RN
Associate Professor
Johns Hopkins University
School of Nursing, School of Medicine, Division of
Geriatric Medicine and Gerontology
Using an Interprofessional
Elizabeth (Ibby) Tanner, PhD, RN
Associate Professor
Johns Hopkins University
School of Nursing, School of Medicine, Division of
Geriatric Medicine and Gerontology
Objec5ves
•  Summarize the benefits of using an inter-‐
professional team approach to demen5a care
•  Iden5fy key components to the collabora5ve
process
•  Describe the members and roles of the
interdisciplinary demen5a care team
What are interdisciplinary teams?
“Interdisciplinary teams are groups of allied
health care professional that work together
closely and communicate frequently to
op5mize pa5ent care; each team member
contributes unique knowledge, s5ll sets and
experiences to support and augment the en5re
team.”
•  Besning, K (2005) Collabora5on in health care. Advance for Occupa5onal Therapy
Prac55oners, 21 (22), 40-‐43.
Benefits of Interprofessional Approach
•  More effec5ve coordina5on among team
members
‒ Effec5ve assessment of pa5ents needs
‒ Enhanced problem solving and development of
plan
‒ Efficient coordina5on of health care resources
•  Enhanced quality of pa5ent care outcomes
‒ Reduced clinical error
‒ Becer transi5ons of care
hcp://www.youtube.com/watch?v=3EWhshW9F5w
•  Improved pa5ent sa5sfac5on

•  Increased provider sa5sfac5on
The Interprofessional Approach
•  We are accustomed to crea5ng our own discipline
specific care plans and implemen5ng them in
isola5on of other team members
•  This approach is crea5ng a “culture change” in
geriatric demen5a health care
•  Guidelines:
–  Core Competencies for Interprofessional Collabora5ve
Prac5ce (2011)
hcp://www.aacn.nche.edu/educa5on-‐resources/ipecreport.pdf
–  TeamSTEPPS®: AHRQ Na5onal Implementa5on
hcp://teamstepps.ahrq.gov/

Who needs an interdisciplinary team?
•  Pa5ents with demen5a typically have complex
medical, psychological and social needs.
•  Teams are more effec5ve in assessing pa5ent
needs and crea5ng a comprehensive plan than
when each professional works alone.
•  Family caregivers also benefit since their
strengths and needs can be incorporated into
the plan of care.
What is interprofessional collabora5ve
prac5ce?
•  “When mul5ple health workers from different
professional backgrounds work together with
pa5ents, families, [caregivers] … to deliver the
highest quality care.” (WHO, 2010)
•  Ac5ve listening and problem solving take
place between team members
•  Openness to new knowledge
•  Involves coopera5on, collabora5on,
coordina5on
Using an Interprofessional Family
Collabora've Approach Tradi'onal Approach
Rapport and empathy: demonstrate interest Direc5ve: focuses narrowly on limited aspects
and concern for caregiver and care recipient of care
Listens when caregiver speaks Discourages caregiver conversa5on when not

directly related to professional’s goals
Promotes caregiver’s comfort. Indicates Does not pay adequate acen5on to easing the
concern for caregiver’s problems burden of care
Uses communica5on strategies Makes communica5on errors

Uses lay terms Communicates using technical language that is
difficult for the caregiver to understand
Uses affirming body language Uses body language, conveying lack of interest
and support
Source: Toth-‐Cohen, S., Lipsic, R., Vause Earland, T. & Gitlin, L. (2005). Collabora5on as a Core Principle and
Method for Working with Families in the Home. In L. Gitlin & M. Corcoran (Eds). Occupa5onal Therapy and
Demen5a Care: The Home Environment for Individuals and Families. Bethesda, MD: AOTA Press (p. 94)
Demen5a-‐Specific Interprofessional Competencies
1.  Describe roles and responsibili5es clearly to other professionals &
caregiver.
2.  Recognize and observe the constraints of competencies, roles and
responsibili5es for one’s own discipline.
3.  Demonstrate respect and knowledge of the unique contribu5ons,
responsibili5es and competence of each interprofessional team
member, including caregiver.
4.  Demonstrate knowledge of the con5nuum of professional and
support services required for quality comprehensive demen5a
care.
5.  Effec5vely collaborate as an interprofessional team member to
assess, treat and care for persons with demen5a and their families.
6.  Demonstrate knowledge of when, where and from whom
demen5a pa5ents and families may obtain care and treatment.
Source: Oandaaan, I., D'Amour, D., Zwarenstein, M., Barker, K., Purden, M., & Beaulieu, M.D (2004)
Interdisciplinary educa0on for collabora0ve, pa0ent-‐centered prac0ce: Research and findings report Ocowa: Health
Canada
Interprofessional Team
Physical
Therapy
Physician
Assistant Geriatrician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Die5cian Occupa5onal
Chaplain Therapist
Physical
Therapies
Physician
Assistant Geriatrician Nurse -‐
Provide personal care, and assist
Family
Member
in ac5vi5es of daily living. Manage
Primary Care
(caregiver)
illness related symptoms. Perform
Physician
prescribed treatments and give

treatments and give medica5ons
Geriatric
Psychiatrist
with kSocial
nowledge
Worker of ac5ons,
interac5ons, and polypharmacy
Pa5ent
and issues. Provide milieu for
Family therapeu5c communica5on and
Nurse coping Psychologist
strategies. Advocate for
pa5ents. Teach families,
caregivers and pa5ents. Develop
care plan in collabora5on with
Nurse Pharmacist
Prac55oner interprofessional team members
and access various resources
Die5cian Occupa5onal available for pa5ents.
Chaplain Therapist
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical Nurse prac''oner – (NP) Provide
Therapies
Physician
uncomplicated ongoing health care
and collaborate with physicians and
Family
other disciplines to develop plan of
Primary Care
Member
(caregiver) care. Provide educa5onal sessions to
Physician
staff about caring for person with

demen5a. Provide counseling
Geriatric sessions Social or Wforker
acilitate support groups
Psychiatrist
for family members. Prescrip5ve
Pa5ent privileges
in some states.
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Geriatrician
Physical Therapist -‐ Assistant
Provide interven5ons such as educa5on and

training to both the person with demen5a
Family
Primary Care
Member
and the caregivers to maximize ADLs, (caregiver) Physician
func5on and mobility, promote a safe

environment, and to reduce risk of injuries
and falls. Work effec5vely with the
Geriatric
interdisciplinary team, to support
Psychiatrist the Social Worker
highest acainable quality of life for the Pa5ent

person with demen5a and the caregivers. and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
(caregiver) Physician
Geriatric
Psychiatrist Social Worker
Pa5ent
and Primary care physician -‐
Family
Recogni5on of change in cogni5ve func5on;
Nurse rou5ne diagnos5c evalua5on, counseling of
Psychologist
pa5ent and family, imitate and or monitor

medical therapy. Refer to specialized medical
health professions and community resources
Nurse and provide longitudinal support for pa5ent
Pharmacist
Prac55oner
and family.
Chaplain Therapist
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member
(caregiver)
Geriatrician
Primary Care
Physician
-‐
Provide expert evalua5on, diagnosis
and management of unusual or
complex demen5a presenta5ons;
Geriatric special eSocial xper5se
Worker
in managing behavior
Psychiatrist
al symptoms and co morbid illness;
Pa5ent expert in community resources home
and care and residen5al care sevngs.
Family
Ongoing support for pt/family.
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Pa5ent
and
Family
Nurse Psychologist
Social worker -‐

Conduct comprehensive, strengths-‐based assessment of
individual and caregiver to develop care plan. Link to community
Nurse Pharmacist
Prac55oner resources to
address unmet needs. Coordinate community care with hospital
and nursing facility discharge planners. Provide case
Occupa5onal
management.
Die5cian
Chaplain Educate Therapist
and counsel throughout disease process.
Advocacy ac5vi5es per need. Establish and facilitate client and
caregiver support groups.
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner Psychologist -‐ Perform neuropsychological assessments
for mild cogni5ve impairment or demen5a. Provide
psychotherapy & group therapy. Provide end-‐of-‐ life
counseling. Therapist
Chaplain
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Pa5ent
and
Family
Nurse Psychologist
Pharmacist -‐ Op5mize

pharmacotherapeu5c regiment to reduce Pharmacist
Nurse
or eliminate demen5a causing drugs.
Prac55oner
Recommend therapeu5c op5ons and

monitor for adverse effects. Provide
medica5on related informa5on pa5ent
Chaplain and Therapist
caregiver. Provide assistance for improving

medical adherence.
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Pa5ent
and
Family
Nurse Psychologist
Occupa'onal Therapist -‐ Evaluate

preserved capabili5es and func5onal
performance and Nurse
determine the type of Pharmacist
assistance, compensatory strategy, and
Prac55oner
environmental modifica5on needed to

successfully & safely complete ac5vi5es.
Provide caregiver training in problem-‐ Chaplain Therapist
solving, task simplifica5on,

communica5on and stress-‐reduc5on
techniques.
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Chaplain -‐ Provide visits and ministry to pa5ents and family.
Chaplains should advise caregivers to express their feelings through
compassion, commitment, and humble entry into the culture of demen5a.
hcp://www.agis.com/Document/152/demen5a-‐ ethical-‐issues.aspx
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Pa5ent
and
Family
Nurse Psychologist
Die'cian -‐ Evaluate the nutri5onal status of pa5ents;

Nurse
work with family Pharmacist
members and medical team to
Prac55oner determine appropriate nutri5on goals for pa5ent.
Encourage independent ea5ng, educate on the
importance
Occupa5onal
of fluid intake, and provide foods that are
Die5cian
Chaplain ethnically and culturally appropriate.
Therapist
hcp://alzheimers.about.com/od/prac5calcare/a/Alz heimer_Diet.htm
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Geriatric psychiatrist -‐ Pa5ent

Expert in evalua5on and and
Family
diagnosis of full spectrum
of cogni5ve disorders Nurse Psychologist
and behavioral
manifesta5ons of
demen5a and related
psychiatric disorders. Nurse Pharmacist
Prac55oner
Recommends and
monitors medica5on
therapy, counsels pt/ Die5cian Occupa5onal
Therapist
family and coordinates Chaplain
with other providers

overall plan of care.
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Physician assistant –Under the

supervision of a physician; recogni5on of
Geriatric
change in cogni5ve func5on; rou5ne
diagnos5c evalua5on, counseling of

Pa5ent
pa5ent and family, and
ini5ate and/or monitor medical therapy. Family
Refer to specialized medical health
Nurse Psychologist
professions and community resources
and provide longitudinal support for
pa5ent and family.
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Family member of choice (caregiver) -‐
Provides insights on pa5ent’s daily rou5nes, Pa5ent
needs, abili5es, interests. Provides and
Family
informa5on on the values, beliefs, and
decisions that guide care giving
Nurse in the home . Psychologist
Share knowledge of pa5ent’s past history and

preferences; iden5fying meaningful tasks
Provide nuances of behavior and physical
states Nurse
Prac55oner
Pharmacist
of person with demen5a. Help team define

realis5c goals. Shares effec5ve strategies for
interac5ng with pa5ent Caregivers can sense Die5cian Occupa5onal
Therapist
Chaplain
how recep5ve pa5ent will be with treatment
plan.
Physical
Therapy
Physician
Family
Member Primary Care
Physician
(caregiver)
Geriatric Social
Psychiatrist Worker
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist
Physical
Therapies
Physician
Family
Member Primary Care
Geriatric
Pa5ent
and
Family
Nurse Psychologist
Nurse Pharmacist
Prac55oner
Chaplain Therapist

6 - 2 - Interprofessional - Approach - Dementia

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

6 - 2 - Interprofessional - Approach - Dementia

Uploaded by

Copyright:

Available Formats

Using

• Improved pa5ent sa5sfac5on

Listens when caregiver speaks Discourages caregiver conversa5on when not

Uses communica5on strategies Makes communica5on errors

prescribed treatments and give

staﬀ about caring for person with

Provide interven5ons such as educa5on and

func5on and mobility, promote a safe

highest acainable quality of life for the Pa5ent

pa5ent and family, imitate and or monitor

Social worker -­‐

Pharmacist -­‐ Op5mize

Recommend therapeu5c op5ons and

caregiver. Provide assistance for improving

Occupa'onal Therapist -­‐ Evaluate

environmental modiﬁca5on needed to

solving, task simpliﬁca5on,

Die'cian -­‐ Evaluate the nutri5onal status of pa5ents;

Geriatric psychiatrist -­‐ Pa5ent

with other providers

Physician assistant –Under the

diagnos5c evalua5on, counseling of

Share knowledge of pa5ent’s past history and

of person with demen5a. Help team deﬁne

You might also like

•  Improved pa5ent sa5sfac5on

Social worker -‐

Pharmacist -‐ Op5mize

Occupa'onal Therapist -‐ Evaluate

Die'cian -‐ Evaluate the nutri5onal status of pa5ents;

Geriatric psychiatrist -‐ Pa5ent