Nursing, Medical Students Partner on Interdisciplinary Care to Needy

We know that interdisciplinary care is in patients' best interests. We also know it can be hard for professionals from various healthcare disciplines to work together.

Physicians, nurses, physical therapists, and all the other professions that participate in patient care are educated in very different ways. It can be difficult for each group to understand where the others are coming from. It's no surprise that sometimes interdisciplinary care does not go as smoothly as patients—or providers—would like.

Which is why an innovative program at Florida International University is attempting to teach providers how to work together, while at the same time benefiting the local community, in a program called Green Family NeighborhoodHELP™. The university is partnering students from multiple healthcare disciplines in an outreach project to bring healthcare to families in local communities.

A medical student and a nursing student will pair up to visit one or two uninsured or underinsured families in local neighborhoods. The students will work with those families to identify health and social needs, and bring in students from disciplines such as social work as needed.

Sharon Pontious, interim dean and professor at the College of Nursing & Health Sciences at FIU explains that a first or second year medical student will partner with a junior or senior nursing student from the bachelor of science nursing program. The students will visit the families regularly and follow them over an extended period of time. When medical students reach their third year, they will continue to follow the families, but partner with an advanced practice nursing student, such as someone a nurse practitioner.

"All of these families have agreed to be teaching families," says Pontious. "In addition to that, in every neighborhood there are an equivalent number of families who will act as control families and will not have students visiting them."

The university will gather data throughout the four years spent with the families to determine whether students make a difference. Pontious says they will monitor such things as what services were provided and how the health status of the family changes.

The students participated in a seminar together last year, but this is the first year for the NeighborhoodHELP program.

"We already know that the medical students and nursing students have learned from each other about what their roles are and they have communicated what their real roles are," says Pontious. "As students come into the program, they have certain beliefs in their head about what their role will be. As they begin to work together, they find out their roles are different than what they thought they would be."

Pontious explains that medical students, for example, might assume their role is to come in and diagnose the patients, prescribe medication, and so on. But with the involvement of other disciplines, they can learn to look at the patient as a whole, considering the societal factors of care, such as whether patients have the financial means to afford the medications prescribed.

This point is reinforced by Tina Jacomino, a home health aide trainer with United HomeCare Services, who will be presenting a training session to the students before the program kicks off. Jacomino is an RN with years of experience working with patients in home care. She says the dynamics of working with patients in their own homes is quite different from a hospital or office setting.

"It's a very different attitude from patients and families when you come to see them in their home as opposed to an office," says Jacomino. "You're in that patient's comfort zone. In the hospital, the patient feels like the stranger. Now, we feel like the stranger."

Jacomino says students will have to learn how to feel out the situation. "You need to assess the location, everything around you in a holistic way. Is the home safe? If there is no air, does that mean they don't have the finances for their utilities? You can see the dynamics of the family. It's very different and interesting and you can gather a lot more information that is useful in aiding the person in their needs."

The medical and nursing students who visit families will be able to bring in students from other disciplines as necessary, including social work, physical therapy, or even law or public health to help meet the family's needs.

Pontious explains that the program will get students comfortable with working with many professionals and that such collaboration will be expected in their professional lives.

"I think that both sets of students will be much more comfortable with working with nurses or physicians or other health providers," she says. "They will have learned to communicate with each other positively."

For example, Pontious says medical students are trained to talk in bullets and concentrate on bottom line information. In contract, nurses describe everything about the patient, concentrating on bigger picture issues. The students are learning together that sometimes you need to talk in bullets, other times you need to bring in detail and consider such things as psycho-social issues. These methods will help you get to the care that will be most positive and most accepted by patients.

A final benefit of the program is that it will help students learn about and gain new understanding of patients' living conditions.

"All of these families they are visiting are form vulnerable populations," says Pontious, "who typically do not have access to healthcare, they don't have insurance. We expect these students to have a very deep personal conviction about how to work with people in their communities and from their cultural and life perspective."

Pontious believes they will be better healthcare providers for it. "Instead of just talking about interdisciplinary care, these students have experienced it," she says. "They will go into their future positions expecting to continue it."