From, With and About

By Courtney Jones Mitchell from the Carolina Nursing Magazine

Meg Zomorodi, PhD, RNL, CNL, associate professor at the nursing school, is Carolina’s first Assistant Provost for Interprofessional Education and Practice, leading the Office for Interprofessional Education and Practice to solidify University-wide commitment to breaking down the barriers between schools and units and allowing innovation to become fundamental for a healthier North Carolina. Not only will this help schools meet accreditation requirements in interprofessional education, also known as IPE, but it also establishes Carolina as a leading-edge example for universities across the country. Under Zomorodi, a multidisciplinary group of faculty across schools and units will infuse current curriculums with practices that engage students with different interests in interactive learning and collaborative environments, sending more practice-ready students into the workforce after graduation.

In health care systems, many such collaborative initiatives are led by physicians, says Zomorodi. She was humbled – and thrilled – to be chosen for the role she feels like she was born to do. “Nursing is naturally interprofessional, and this school has been leading in interprofessional education for years,” says Zomorodi. “Nurses have to work well with everyone to care for their patients, so we have a unique skillset that makes us great leaders of interdisciplinary teams. We know firsthand that the minute it becomes about ‘somebody’ instead of the patient, it’s not going to work.”

A Light on the Hill

The University’s health affairs schools are set along the southern corridor of Carolina’s campus, lining either side of Columbia Street up the hill from main campus. Schools of nursing, medicine, dentistry, public health, pharmacy, and social work had been established throughout the last half century to live out the University’s missions of teaching, research and public service. Though the buildings create natural silos, the clinics where Carolina students first practice their skills are supporting the same, shared goal – the health of North Carolina’s people.

“Though they are learning in different schools, in Meg Zomorodi is Carolina’s first Assistant Provost for Interprofessional Education 6 practice those walls come down,” said Zomorodi.

And, she says, if our students-turned-providers aren’t well-practiced in that scenario, the need to collaborate quickly can catch them off guard. In that event, it is the patient who suffers. A 2018 study from researchers at Johns Hopkins University School of Medicine identified medical errors as the third leading cause of death in the U.S., right behind heart disease and cancer. A common precursor to medical error, says Zomorodi, is insufficient communication, which can lead to preventable misunderstandings or incomplete transmissions of information that compromise a patient’s safety.

By the World Health Organization’s definition, IPE occurs when two or more professions learn from, with, and about each other to develop a successful collaboration that improves health outcomes. Putting those students together in classes and clinics begins to break down those barriers and naturally disrupts preconceived ideas about who does-what in a patient-care setting, an internalized hierarchy of health care providers who each focus on a different part of a patient’s story.

“Each of us, based on our experiences, will walk into a room and see something different. If we go to visit a patient in his home, an occupational therapy student is going to notice if there is a missing rubber tip on his cane. A pharmacy student may inspect prescription bottles and find a drug interaction, and a nutrition student is going to take note of the empty refrigerator. And, if we do this together, these students will pick up on the questions they didn’t think to ask – and it will make them better.”

Zomorodi gives an example: “For instance, the nursing student is frustrated because the patient has missed several appointments when the clinic has done so much to manage their disease process. He wonders, does she just not care about her health? But, the occupational therapy student engages in a deeper dialogue with the patient and finds the full story: she is afraid to walk down her steps for fear of falling. The social work student then uses his connections in the Department of Aging to get a free repairman to come and build her a ramp so she can walk down her stairs without fear of falling.”

They also have a deeper appreciation for other members of the healthcare field, something that will help them build relationships throughout their careers, said Zomorodi. They will have already seen that, without it, the collaboration can’t reach its full potential.

Zomorodi leads these experiences as part of UNC’s Rural Interprofessional Health Initiative (RIPHI), established in 2017 with a $1.5 million award to the School of Medicine from the William R. Kenan, Jr. Charitable Trust, which provides interprofessional clinical experiences for health professions students in rural areas of the state to the benefit of their educations and our state’s underserved communities.

Students spend the fall semester paired with students outside their fields training in quality improvement methods to solve real-world problems in rural communities that partner with RIPHI. They pitch their possible solutions, borne out of the evidence collected in the first semester, to the clinics and spend the spring semester initiating them in patient-care settings.

“I’m a nurse, and I’m with nurses all day – in a group I’m more likely to go stand by nurses. But, imagine you have a class with someone from a different profession, and a year later you see them on the patient floor. Suddenly, this might be the person you gravitate toward.”

Brandi Robinson is a master’s degree student at the School of Nursing who has been a nurse at UNC Hospitals for six years. Her interprofessional experiences in Zomorodi’s class have opened her eyes to what other professions bring to the table, and now she looks forward to calling on her colleagues for help because it optimizes the care for her patient. Nurses spend more facetime with the patient than any other provider. But it can be daunting when you feel like so much is riding on your shoulders alone, she said.

“I didn’t know before this class that hospital pharmacists will come do bedside consults for your patient. A pharmacist has more complete knowledge about the medications than I do, and it’s a relief to know I don’t have to worry about that by myself – I have someone on my side. On a home health visit, I was paired with a physical therapy student who noticed that a patient’s legs weren’t in the right position to support her if she stood up. It seems so simple, but it was a fall risk, and I wouldn’t have seen it. It’s better for all of us, especially that patient in our care.”

Putting It Into Practice

Zomorodi is a systems person. As a young intensive care nurse herself, she entered the other side of patient care when she visited her mother in a hospital ICU. The nurse in her knew proper protocols were followed, but the worried daughter in her could see the teamwork breaking down. To learn more about the relationship between teamwork and safety in hospitals, Zomorodi decided to go back to school. She attempted to start a master’s degree, but she quickly learned what she really needed was the School of Nursing’s PhD program.

During her training, a discussion with then-Dean Linda Cronenwett led her to the table of the Quality and Safety Education for Nurses (QSEN) project, from which the school had recently received a grant.

“I fell in love,” she said. “Here I was a nursing student, on a team with these champions of nursing and medicine working on an international level to put quality safety education in nursing.”

Zomorodi finished her PhD with a doctoral dissertation on a team-based approached to end of-life care, and she joined the faculty of the School of Nursing. She started inviting physicians from the hospital to lead the nursing students through case scenarios, so they could have classroom experience working with physicians.

“This gave our nursing students an opportunity to experience what it would be like to treat patients in collaboration with a physician. Our students would see that when a doctor asks you to repeat something, it’s not because she’s not listening to you – she has a massive case load and needs to hear your concern again. Go ahead and speak up,” she said. “It was eye opening for everyone.”

From there, Zomorodi was selected as a Josiah Macy Jr. Faculty Scholar, just one of six in the nation and one of two nurses in her cohort. The appointment gave her two years to train in developing curriculum for interprofessional education, and she found the groove that would become the root of her career. The school had already been on the forefront of IPE at Carolina, with cutting-edge patient simulation classes led by Carol Durham, EdD, RN, in partnership with the schools of medicine and pharmacy to improve quality and safety in health care. In perfect timing with her Macy scholarship, the academic deans from all the health affairs schools made a recommendation to then-Provost James Dean to establish an official presence for IPE on campus, and Zomorodi was chosen to lead a steering committee to figure out how.

The stars truly aligned, said Zomorodi, when the dean of the School of Pharmacy, Bob Blouin, became the University’s provost in 2017. Blouin had been part of the push for more IPE, and he wanted to take IPE beyond a component of accreditation to a cornerstone in the Carolina experience so that students learn team-based approaches by default and graduate ready to be change agents for the state of North Carolina. He created the office Zomorodi now leads and established a Director of IPE for each of Carolina’s schools to work toward this goal. “The delivery of high-end quality health care services demands interprofessional care,” said UNC Executive Vice Chancellor and Provost Bob Blouin, PharmD. “It is essential that we prepare our health science students and related disciplines with the knowledge and skills of a highly integrated, collaborative professional in order to support the rapid changes taking place in a performance-based care world.”

Making More Connections

Now even more barriers are broken as Zomorodi brings in schools outside health affairs, particularly Kenan Flagler Business School and the School of Education. Business students train to solve major problems, which will be beneficial in developing outcomes based initiatives that work. Zomorodi also knew, as a nurse leader and educator, getting future teachers into IPE situations would have a meaningful impact on the state’s children.

“Health and education go hand-in-hand. Taking a teacher on a home visit where there are children is powerful, because if they are in a living situation where they aren’t able to sleep well or can’t access the food, they can’t study. That teacher will have a different view of that student who falls asleep in class, and they can also use those experiences to advocate for changes to the educational system that help kids grow up healthy. It’s huge.”

Eventually she envisions IPE as a thread weaving through the whole of Carolina education as IPE practices are embedded into the existing coursework campus wide – all in the aim of providing for our state a nimble, caring workforce ready to work together for a healthier population. Students will graduate with a number of core immersive experiences simply by attending Carolina, with the option to do even more.

Personally, and professionally, Zomorodi is still learning from IPE, too.

“I’m in awe of how hard people work across campus to do the right things for their patients. I’ve learned so much from seeing how other schools teach their students and what they value,” she says. “We all have similar issues, and we’re all trying to solve them. Maybe someone over there has a solution I can try – and we can learn from, with and about each other.”