Learning from students: Facilitators’ learning in interprofessional placements

Few studies have examined experiences and learning from the viewpoint of interprofessional facilitators of student placements, and limited research has investigated this learning enacted across traditional service boundaries or between health and education practitioners. This study aimed to address these gaps by exploring perceptions about the learning and experiences of Early Childhood Educators (ECEs) who facilitated placements in childcare settings for speech-language pathology students from a health professional background. Lave and Wenger’s theory of Legitimate Peripheral Participation was utilised to design and interpret this study. Seven ECEs from two childcare centres and four Centre Directors participated in focus groups and individual semi structured interviews respectively. Thematic analysis revealed five themes that described how the ECEs came to accept the students as legitimate members of their practice community, and how this subsequently facilitated the ECEs’ learning. The themes of power described in previous studies that explored status and hierarchical differences between facilitators and students from differing professions were not identified in this study. This absence of observed power differential, in addition to the embedded nature of the placement design, and the students’ participation in the ECEs’ everyday activities and routines contributed to the ECEs’ positive interprofessional learning.     

Are care workers appropriate mentors for nursing students in residential aged care?

Background

The aged care sector is increasingly dominated by a less-qualified workforce at a time of increasing prevalence of complex health concerns, such as dementia. An Australian program to develop teaching aged care facilities is being undertaken to build the sector’s capacity and provide nursing students with positive experiences of engaging with vulnerable clients. This research aimed to examine care staff potential to facilitate nursing student engagement with clinically relevant knowledge in the performance of hygiene care in a residential aged care facility.

Methods

This study was designed as an action research study. A cycle of reflection, planning, action, and evaluation is described to illustrate the carer mentor capacity to engage with and contribute to the learning of nursing students. Participants were second year student nurses (n = 10) on a four-week placement in a Tasmanian aged care facility in 2013 and their nurse/carer mentors (n = 17). Mentors participated in six action research meetings, and nursing students engaged in a parallel series of four feedback meetings during the placement.

Results

At the beginning of the placement, nursing students exhibited a disregard for the clinical value of care provision. Students considered provision of hygiene care, in particular, the preserve of care workers and an inappropriate training exercise in the context of an undergraduate nursing qualification. To assist students to make links between core nursing competencies and hygiene care as well as to engender respect for their role within the aged care facility, carer mentors developed the Carer Assessment and Reporting Guide. Once implemented during the final weeks of the placement, the Guide improved student perceptions of resident hygiene care (reframed as assessment) and the role of facility care workers, as well as reinforcing carer self-esteem.

Conclusion

Hygiene care is replete with nursing competencies that are valuable for undergraduate learners, including assessments of skin integrity, mobility, cognitive function, bowels and urine, and basic hygiene. Nurse education programs should strive to address student misconceptions about care work in facilities to account for population level increases in care needs.

     

Australian nursing students’ clinical experiences in residential aged care: Reports from nurse academics

BackgroundNurses are the largest group of registered healthcare professionals and are fundamental to delivering health and aged care in Australia.AimTo explore how nursing students report clinical experiences when caring for older people as part of a larger study investigating how care of the older person content is included in Australian undergraduate nursing curricula.MethodsA population sample of all Australian nursing schools that offered a Bachelor of Nursing degree (n = 35) in 2019. Nurse academics involved in curriculum development or delivery were recruited. A telephone-assisted survey was used, and qualitative content analysis undertaken.ResultsAll schools of nursing participated in the survey, representing a response rate of 100%. The acute care focus of nursing curricula meant clinical experiences for nursing students related to older person's care commonly occurred in residential aged care facilities in the first year of the degree. Student reports of these experiences varied, with a majority of respondents reporting mixed or negative feedback associated with a lack of preparation and inadequate supervision.ConclusionsThis study highlights the: significance of the timing of nursing students’ clinical placements in residential aged care; the selection of appropriate care homes; and the need for the right clinical teaching staff who can supervise high quality learning experiences for students.     

Prospective health students’ perceptions of the pharmacist role in the interprofessional team

Negative perceptions or underdeveloped understanding of healthcare team member roles can impact the functionality of the team and stunt innovations in interprofessional practice and education. Therefore, the intent of this study was to explore the perception of pharmacists’ role on the healthcare team by future team members: prospective health professional students. The study utilised a survey to examine these perceptions in prospective health professional students (n = 34) nearing the application process to health professional school. A coding process was used to explore open-ended text responses through a line-by-line analysis and identify emerging themes regarding perception of pharmacists’ roles, responsibilities, and practice settings. Quantitative data examined perception of pharmacists by intended prospective profession, healthcare experience, and pharmacy experience. Results indicate that while prospective health professional students find pharmacists to be an important part of the healthcare team, they lack a developed understanding of pharmacists’ roles, responsibilities, and practice settings. Identifying and addressing prospective health professional students’ misperceptions surrounding pharmacists’ roles and responsibilities may encourage them to make informed career decisions and shape them into more knowledgeable future professionals with the ability to better impact patient care on interprofessional teams.     

Developing a culture of safety: Exploring students’ perceptions of errors in an interprofessional setting

Abstract

Healthcare has a long tradition of silence around mistakes that cause or have the potential to cause harm to a patient, and there is evidence that this culture may be present from the beginning of a health professional’s training. The purpose of this pilot study was to examine a team of interprofessional students’ interactions with a preceptor in a simulation environment. The debriefing explored the students’ reactions and assisted them with how to manage similar situations in the future to improve patient safety. The results showed that the students felt powerless to stop the simulated preceptor from doing harm to the patient, or to even question the preceptor’s unsafe actions. Recommendations for educators include incorporating discussions and interprofessional training about handling mistakes into the curriculum, in the context of patient safety.     

What's best? Clinical indicators of quality in residential aged care facilities

This paper reports on the views of 36 registered nurses (RNs) in Phase One of a three stage study, Quality of Care for Residents in Aged Care Facilities. Case studies were conducted in nine residential aged care facilities and data were collected from informants using semi-structured interviews, participant observation and document analysis and review. Of the 36 RNs, almost three quarters (n=26) provided care at the bedside and ten held managerial positions. Each volunteered to participate. When asked to nominate the major clinical indicators of high quality residential aged care, all 26 RNs who worked at the bedside stated that the absence of decubitis ulcers was the pre-eminent measurable factor. While five managerial RNs also mentioned low rates of pressure ulcers, only two ranked it as the most important clinical indicator of high quality care. Hydration management was the clinical indicator nominated most frequently by managerial nurses. The one indicator of equal importance to both groups, but for different reasons, was that of poly pharmacy. The differences in priorities between each group were statistically significant.     

Stakeholders’ perceptions of family-centred care in the intensive care unit: An associative group analysis

AimTo explore different stakeholders’ including nurses, health care professionals and family member’s perceptions of ideal family-centred care in an intensive care unit.Research design and methodsWe used a mixed method approach to identify perceptions of family-centred care with 60 stakeholders of equal numbers who voluntarily participated in the study. Data were collected over one month using an associative group analysis method. The responses were ranked, scored, thematically themed and weighted.SettingA 23 bed adult intensive care unit in an urban private hospital in South Africa.FindingsAccording to the stakeholders’ responses, ideal family-centred care should be built around communication based on expectations and engagement. In addition, the physical environment should allow for overall comfort and spiritual care must be incorporated.ConclusionStakeholders had similar perceptions on the main themes however; nuances of different perspectives were identified showing some of the complexities related to family-centred care. Spiritual care was highlighted by the family members, revealing the need to broaden the care perspectives of healthcare providers.     

Physicians’ perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models

Objective

To explore the barriers to and facilitators of adapting and expanding a primary care memory clinic model to integrate care of additional complex chronic geriatric conditions (heart failure, falls, chronic obstructive pulmonary disease, and frailty) into care processes with the goal of improving outcomes for seniors.

Design

Mixed-methods study using quantitative (questionnaires) and qualitative (interviews) methods.

Setting

Ontario.

Participants

Family physicians currently working in primary care memory clinic teams and supporting geriatric specialists.

Methods

Family physicians currently working in memory clinic teams (n = 29) and supporting geriatric specialists (n = 9) were recruited as survey participants. Interviews were conducted with memory clinic lead physicians (n = 16). Statistical analysis was done to assess differences between family physician ratings and geriatric specialist ratings related to the capacity for managing complex chronic geriatric conditions, the role of interprofessional collaboration within primary care, and funding and staffing to support geriatric care. Results from both study methods were compared to identify common findings.

Main findings

Results indicate overall support for expanding the memory clinic model to integrate care for other complex conditions. However, the current primary care structure is challenged to support optimal management of patients with multiple comorbidities, particularly as related to limited funding and staffing resources. Structured training, interprofessional teams, and an active role of geriatric specialists within primary care were identified as important facilitators.

Conclusion

The memory clinic model, as applied to other complex chronic geriatric conditions, has the potential to build capacity for high-quality primary care, improve health outcomes, promote efficient use of health care resources, and reduce health care costs.     

Students’ perceptions of interprofessional collaboration on the care of diabetes: A qualitative study

Interprofessional education can promote healthcare professionals' competence to work in interprofessional collaboration, which is essential for the quality and safety of care. An interprofessional approach is particularly important in complex, chronic diseases like diabetes. This qualitative study evaluated changes in medical and nursing students' perceptions of interprofessional collaboration, induced by a novel interprofessional education course on diabetes care with practical elements. Data from focus-group interviews of 30 students before and after the course were analyzed by using inductive and deductive content analysis. The students’ perceptions were illustrated as Elements of Collaborative Care (e.g. Quality of professional care relationship) and Elements of Interprofessional Collaboration (e.g. Importance of communication and Valuation of collaboration). The post-course interviews added one subcategory (Need of resources) to the pre-course perceptions, and there was improvement in ten areas of self-perceived competence in performing or understanding interprofessional collaboration on diabetes care. The course improved the students' self-perceived competence and confidence in interprofessional collaboration on the care of patients with diabetes, and their understanding of interprofessional collaboration changed towards a more patient-centred and holistic perspective. The findings support further implementation of IPE with practical elements in future health professionals’ education.     

Measuring changes in pharmacy and nursing students’ perceptions following an interprofessional high-fidelity simulation experience

The purpose of this study was to evaluate the effects of interprofessional high-fidelity simulation-based learning (SBL) on third-year pharmacy and senior nursing students’ perceptions of interprofessional care. Students participated in an interprofessional high-fidelity SBL experience consisting of two hospital-based scenarios followed by a debriefing. The “Student Perceptions of Interprofessional Clinical Education–Revised” (SPICE-R) instrument was administered pre- and post-SBL. The “Student Satisfaction and Self-Confidence in Learning” (SSSCL) instrument, which uses a 5-point Likert scale, was administered post-SBL. A total of 104 (78%) pharmacy and 93 (77%) nursing students completed both the pre- and post-survey instruments. Baseline differences between pharmacy and nursing students included number of clinical hours completed [200 (190–240) vs. 210 (209–210); p < 0.001] and previous/current experiencing working directly with other healthcare professionals [71 (53%) vs. 88 (73%); p < 0.001]. Median score increases were observed for all SPICE-R items (p < 0.01) for pharmacy students and nine of ten SPICE-R items (p < 0.01) for nursing students. All students rated both the experience and their confidence highly on the SSSCL; however, nursing scores were higher than pharmacy scores for 7 of 13 items (p < 0.05). An interprofessional high-fidelity SBL experience increased pharmacy and nursing students’ perceptions of interprofessional care.     

‘Student-y or studious’: An exploration of students’ perceptions of parallel learning in preregistration physiotherapy education

Background/Aim: Within the United Kingdom (UK), physiotherapy preregistration training is provided at both undergraduate and postgraduate level at 17 higher education institutions (HEIs). Some course teams approach this by teaching preregistration BSc and MSc students simultaneously to meet the same learning outcomes. This is often termed “parallel learning” and it is not known how students perceive this mode of learning. The aim of the study was to explore the perceived benefits and challenges to parallel learning of preregistration BSc and MSc physiotherapy students. Methods: Students from two different UK-based HEIs participated in an exploratory qualitative research design, with data collected in focus groups of each cohort and HEI. Data were analyzed using thematic analysis. Results: Several themes arose from student perceptions of parallel learning that were sceptical: “starting over again,” “misunderstanding each other’s motivations,” “establishing knowledge hierarchies,” and “competing for space”. However, some themes emerged from students reflections on the perceived benefits of parallel learning including “healthy competition” and “learning from difference.” Conclusions: It is clear from findings that students perceive the benefits of parallel learning of mixed groups. However, to avoid perceptions that it is merely cost cutting, learning resources need to be maintained and from the outset clear explanations of the purposes should be given to students.     

Development of the ‘Intimacy and Sexuality Expression Preference’ tool for residential aged care

ObjectivesTo outline development of the Intimacy and Sexuality Expression Preference (ISEP) tool that elicits preferences for the expression of intimacy and sexuality of older people, living with and without dementia, in residential aged care.MethodsUsing two rounds of the Delphi technique involving 14 panelists, tool items were evaluated for importance, usefulness, relevancy and clarity on a 5-point Likert scale.ResultsAll tool items achieved a mean score of ≥3.4 across the four areas of evaluation with an overall average tool-level content validity index of 0.89. Instructions were deemed appropriate (M=4.6; SD=0.8), easy to understand and simple to follow (M=4.6; SD=0.6).DiscussionThe ISEP tool can improve care and support older people's expression of intimacy and sexuality from a person-centered approach. Further research into the use of the tool in ‘real’ residential aged care settings is required to establish external validity prior to implementation.     

Indonesian students’ participation in an interprofessional learning workshop

Abstract

Interprofessional learning activities, such as workshops allow students to learn from, with and about each other. This study assessed the impact on Indonesian health students’ attitudes towards interprofessional education (IPE) from participating in a workshop on medication safety. The students attended a two-day IPE workshop on medication safety. Thirty-five (48.6%) students completed pre-/post-workshop surveys using a modified Readiness for Interprofessional Learning Scale (RIPLS) survey. The post-workshop survey also had a series of open-ended questions. Students’ responses to each RIPLS statement pre-/post-workshop were compared, whilst their responses to open-ended questions in post-workshop survey were thematically analysed. Students reported positive attitudinal changes on statements of shared learning and teamwork sub-scale (Wilcoxon p value <0.05). Analysis of the open-ended questions indicated that students perceived the workshop as having improved their understanding on the importance of teamwork and communication skills. This study found that learning with other health students through an IPE workshop improved medical, nursing and pharmacy students’ attitudes towards the importance of shared learning, teamwork and communication in healthcare service.     

An Australian hospital-based student training ward delivering safe,client-centred care while developing students’ interprofessional practice capabilities

Abstract

Royal Perth Hospital, in partnership with Curtin University, established the first interprofessional student training ward in Australia, based on best practice from Europe. Evaluation of the student and client experience was undertaken. Feedback from all stakeholders was obtained regularly as a key element of the quality improvement process. An interprofessional practice program was established with six beds within a general medical ward. This provided the setting for 2- to 3-week clinical placements for students from medicine, nursing, physiotherapy, occupational therapy, social work, pharmacy, dietetics and medical imaging. Following an initial trial, the training ward began with 79 students completing a placement. An interprofessional capability framework focused on the delivery of high quality client care and effective teamwork underpins this learning experience. Quantitative outcome data showed not only an improvement in students’ attitudes towards interprofessional collaboration but also acquisition of a high level of interprofessional practice capabilities. Qualitative outcome data from students and clients was overwhelmingly positive. Suggestions for improvement were identified. This innovative learning environment facilitated the development of the students’ knowledge, skills and attitudes required for interprofessional, client centred collaborative practice. Staff reported a high level of compliance with clinical safety and quality.