Preparing healthcare students who participate in interprofessional education for interprofessional collaboration: A constructivist grounded theory study protocol

This article presents a qualitative research protocol to explore and understand the interprofessional collaboration (IPC) preparation process implemented by clinical tutors and students of different professions involved in interprofessional education (IPE).

Many studies have shown that IPE initiatives improve students’ understanding of the roles and responsibilities of other professionals. This improves students’ attitudes towards other professions, facilitating mutual respect, and IPC. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams. This is a constructivist grounded theory (GT) study, which will involve data collection through in-depth semi-structured interviews (to 9–15 students and 6–9 clinical tutors), participant observations, and the analysis of documentation. After analysing, coding, integrating, and comparing the data if necessary, a second round of interviews could be conducted to explore any particularly interesting aspects or clarify any issues. This will then be followed by focused and theoretical coding. Qualitative data analysis will be conducted with the support of NVivo 10 software (Victoria, Australia). A better conceptual understanding will help to understand if IPE experiences have contributed to the acquisition of competencies considered important for IPC, and if they have facilitated the development of teamwork attitudes.     

Perspectives of healthcare practitioners: An exploration of interprofessional communication using electronic medical records

Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners’ experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record, and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one’s notes. Limitations in technology—including limited computer availability, documentation complexity, and sluggish sign-in processes—also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardised electronic medical record use across professions at the optimal level to support communication and patient care.     

Continuing professional development for interprofessional teams supporting patients in healthcare decision making

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients’ needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients’ and professionals’ values and preferences. This requires collaboration among professionals and with patients and their family caregivers. Continuing professional development is urgently needed to help healthcare professionals acquire the knowledge, skills, and attitudes necessary to create and sustain a culture of collaboration. We describe a model that can be used to design, implement, and evaluate continuing education curricula in interprofessional shared decision making and decision support. This model aligns curricular goals, objectives, educational strategies, and evaluation instruments and strategies with desired learning and organizational outcomes. Educational leaders and researchers can institutionalize such curricula by linking them with quality improvement and patient safety initiatives.     

A critical realist model of complexity for interprofessional working

This paper presents a theoretical model of complexity for considering issues relevant to interprofessional working. The need for such a model is introduced with reference to the literature on collaboration and integration in health and social care, particularly in children's services. It is argued that interprofessional working is often seen as a response to complexity, but that current models fail to build an appreciation of complex causality into their approach to addressing needs through targeted interventions. The alternative offered here is a critical realist model based on Bhaskar's domains of reality, focusing on the implications of open systems, complex causality and contingency. These ideas are used to examine some of the issues and dilemmas typically encountered by interprofessional networks in coming together to work on complex cases.     

Cognitive Aids for Role Definition (CARD) to improve interprofessional team crisis resource management: An exploratory study

This study aimed to assess the perceived value of the Cognitive Aids for Role Definition (CARD) protocol for simulated intraoperative cardiac arrests. Sixteen interprofessional operating room teams completed three consecutive simulated intraoperative cardiac arrest scenarios: current standard, no CARD; CARD, no CARD teaching; and CARD, didactic teaching. Each team participated in a focus group interview immediately following the third scenario; data were transcribed verbatim and qualitatively analysed. After 6 months, participants formed eight new teams randomised to two groups (CARD or no CARD) and completed a retention intraoperative cardiac arrest simulation scenario. All simulation sessions were video recorded and expert raters assessed team performance. Qualitative analysis of the 16 focus group interviews revealed 3 thematic dimensions: role definition in crisis management; logistical issues; and the “real life” applicability of CARD. Members of the interprofessional team perceived CARD very positively. Exploratory quantitative analysis found no significant differences in team performance with or without CARD (p > 0.05). In conclusion, qualitative data suggest that the CARD protocol clarifies roles and team coordination during interprofessional crisis management and has the potential to improve the team performance. The concept of a self-organising team with defined roles is promising for patient safety.     

Case-based interprofessional learning for undergraduate healthcare professionals in the clinical setting

Interprofessional learning (IPL) within the healthcare setting has well documented positive outcomes for patients, yet it is not widely offered at the undergraduate level, particularly in a clinical setting. We set up case-based teaching scenarios involving a real patient, aimed at small groups of four students representing two or more healthcare professions. The aim of the sessions was to give students a greater awareness of the roles of all the different healthcare professions involved in patient care in a hospital setting. Weekly sessions were offered on six wards covering different clinical specialties. Three hundred and twenty-nine undergraduate students from different healthcare professions (nursing, medicine, pharmacy, midwifery, physician associate, physiotherapy, occupational therapy, speech, and language therapy) each attended one IPL session during the current academic year. Students were given an evaluation sheet at the end of each session to be filled out anonymously. Forty per cent of the students reported experiencing interprofessional case-based learning for the first time. Over 90% of students agreed or strongly agreed with a list of statements promoting the advantages and benefits of case-based IPL for undergraduate students and many of them requested more sessions. Seventy per cent of all respondents stated they would alter their future professional behaviour as a result of this session. We propose to introduce the sessions into the undergraduate curriculum across all healthcare related professions.     

Expanding pharmacy roles and the interprofessional experience in primary healthcare: A qualitative study

The pharmacist role is undergoing significant changes which are reshaping the way primary healthcare is delivered throughout England. Due to increased physician workload and focus on primary healthcare, the pharmacist role has expanded to provide enhanced patient services, integrating into general practice (GP) settings and working more closely as a member of the healthcare team. However, the experiences of pharmacists and team members are yet to be explored. The proposed study aims to explore the experiences, thoughts, and perceptions of a purposive sample of pharmacists, physicians, and nurses working in 10 GP clinics throughout the southeast of England. Interprofessional relationships, power dynamics, changing professional roles, and barriers and facilitators to the integration of the pharmacist role will be explored. An exploratory multiple case study design will be used to investigate interprofessional experiences within and between clinics. In-depth interviews will be completed with each participant. A thematic analysis will identify themes and patterns from the interview data. Results are expected to produce recommendations to help facilitate the integration of pharmacists in their new role and will have implications for interprofessional collaboration and interprofessional education which are important for delivering safe and effective care.     

Every team needs a coach: Training for interprofessional clinical placements

Despite growing awareness of the benefits of interprofessional education and interprofessional collaboration (IPC), understanding how teams successfully transition to IPC is limited. Student exposure to interprofessional teams fosters the learners’ integration and application of classroom-based interprofessional theory to practice. A further benefit might be reinforcing the value of IPC to members of the mentoring team and strengthening their IPC. The research question for this study was: Does training in IPC and clinical team facilitation and mentorship of pre-licensure learners during interprofessional clinical placements improve the mentoring teams’ collaborative working relationships compared to control teams? Statistical analyses included repeated time analysis multivariate analysis of variance (MANOVA). Teams on four clinical units participated in the project. Impact on intervention teams pre- versus post-interprofessional clinical placement was modest with only the Cost of Team score of the Attitudes Towards Healthcare Team Scale improving relative to controls (p = 0.059) although reflective evaluations by intervention team members noted many perceived benefits of interprofessional clinical placements. The significantly higher group scores for control teams (geriatric and palliative care) on three of four subscales of the Assessment of Interprofessional Team Collaboration Scale underscore our need to better understand the unique features within geriatric and palliative care settings that foster superior IPC and to recognise that the transition to IPC likely requires a more diverse intervention than the interprofessional clinical placement experience implemented in this study. More recently, it is encouraging to see the development of innovative tools that use an evidence-based, multi-dimensional approach to support teams in their transition to IPC.     

A team approach to an undergraduate interprofessional communication course

Interprofessional communication is a team-taught upper-level undergraduate course for Nursing and Health Sciences students. In addition to teaching fundamental communication skills, this course weaves interprofessional competencies into weekly learning activities and assignments. The utilization of the principles and practices of team-based learning in the classroom enhances the attainment and practice of communication and interprofessional collaboration skills. Lessons learned from conducting informal course evaluations and delivering the course multiple times are presented.     

Key trends in interprofessional research: A macrosociological analysis from 1970 to 2010

The field of interprofessional research has grown both in size and in importance since the 1970s. In this paper, we use a macrosociological approach and a Bourdieusian theoretical framework to investigate this growth and the changing nature of the field's research. We investigate publication trends at the aggregate (field) level, using an original dataset of 100 488 interprofessional-related articles published between 1970 and 2010 and recorded in the PubMed database. Articles were coded using a list of 638 codes that were then analyzed thematically and longitudinally. Our results are presented in two main sections. Initially, we consider the growth and reach of the interprofessional field. Second, we explore the five different trends (“terminological issues”, “rising management rhetoric”, “expansion of psychometrics”, “shift from individualism to collectivism” and “emerging issues”) that emerged out of our thematic analysis of publications over time. These findings are discussed in the light of Bourdieu's framework to provide an indication of what we argue is a growing legitimacy of the field of interprofessional research as a scholarly domain in its own right.     

A critical examination of the role of appreciative inquiry within an interprofessional education initiative

Appreciative inquiry (AI) is a relatively new approach to initiating or managing organizational change that is associated with the ‘positiveness’ movement in psychology and its offshoot positive organizational scholarship. Rather than dwelling upon problems related to change, AI encourages individuals to adopt a positive, constructive approach to managing change. In recent years, AI has been used to initiate change across a broad range of public and private sector organizations. In this article, we report findings from a subset of 50 interviews gathered in a wider study of interprofessional education (IPE) in which AI was employed as a change agent for implementing IPE in a number of health care institutions in a North American setting. A multiple case study approach. (Yin, 2002) was employed in the wider study and semi-structured interviews were undertaken with participants both before their IPE programs and directly afterwards to obtain a detailed understanding of their expectations and experiences of IPE. Interviews were analyzed in an inductive thematic manner in order to produce key emergent themes from each of the IPE programs. A process of re-analysis provided a set of themes which offered an understanding of the role of AI within this IPE initiative. Our findings identify a strong resonance and fit for AI both among the health and social care professionals who participated in this initiative. Numerous individuals commented on the enthusiasm and energy AI engendered, while praising its ability to enhance their working lives and interprofessional relationships. Yet a number of difficulties were also reported. These focused on problems with the translation of the AI process into achievable structural level (e.g. professional, cultural) changes. Based on these findings, the article goes on to argue that the use of AI can overlook a number of structural factors, which will ultimately limit its ability to actually secure meaningful and lasting change within health care.     

Developing interprofessional education online: An ecological systems theory analysis

This article relates the findings of a discourse analysis of an online asynchronous interprofessional learning initiative involving two UK universities. The impact of the initiative is traced over three intensive periods of online interaction, each of several-weeks duration occurring over a three-year period, through an analysis of a random sample of discussion forum threads. The corpus of rich data drawn from the forums is interpreted using ecological systems theory, which highlights the complexity of interaction of individual, social and cultural elements. Ecological systems theory adopts a life course approach to understand how development occurs through processes of progressively more complex reciprocal interaction between people and their environment. This lens provides a novel approach for analysis and interpretation of findings with respect to the impact of pre-registration interprofessional education and the interaction between the individual and their social and cultural contexts as they progress through 3/4 years of their programmes. Development is mapped over time (the chronosystem) to highlight the complexity of interaction across microsystems (individual), mesosystems (curriculum and institutional/care settings), exosystems (community/wider local context), and macrosystems (national context and culture). This article illustrates the intricacies of students’ interprofessional development over time and the interactive effects of social ecological components in terms of professional knowledge and understanding, wider appreciation of health and social care culture and identity work. The implications for contemporary pre-registration interprofessional education and the usefulness and applicability of ecological systems theory for future research and development are considered.     

Observing of interprofessional collaboration in simulation: A socio-material approach

Simulation exercises are becoming more common as an educational feature of the undergraduate training of health professionals. Not all students participate in these activities, but are assigned as observers of the actual simulation. This article presents a study that explored how social-material arrangements for observation of interprofessional collaboration in a simulated situation are enacted and how these observations are thematised and made relevant for learning. The empirical data consisted of 18 standardised video recordings of medical and nursing students observing their peer students simulate. Practice theory is used to show how observation is embodied, relational, and situated in social-material relations. The findings show two emerging ways of enacting observation—proximate observation and distant observation. The enactments are characterised by different socio-material arrangements concerning the location where the simulation took place and its material set-up as well as embodied “doings” and “relatings” between the observing students and instructors. The observing students are participating in a passive, normative position as an audience and as judges of what is correct professional behaviour.     

A conceptual treadmill: the need for 'middle ground' in clinical decision making theory in nursing

This paper explores the two predominant theoretical approaches to the process of nurse decision making prevalent within the nursing research literature: systematic-positivistic approaches as exemplified by information processing theory, and the intuitive-humanistic approach of Patricia Benner. The two approaches' strengths and weaknesses are explored and as a result a third theoretical stance is proffered: the idea of a cognitive continuum. According to this approach the systematic and intuitive theoretical camps occupy polar positions at either end of a continuum as opposed to separate theoretical planes. The methodological and professional benefits of adopting such a stance are also briefly outlined.     

Cognitive Continuum Theory in nursing decision-making

AIM: The purpose of this paper is to analyse and evaluate Cognitive Continuum Theory and to provide evidence for its relevance to nurses' decision-making. BACKGROUND: It is critical that theories used in nursing are evaluated to provide an understanding of their aims, concepts and usefulness. With the advent of evidence-based care, theories on decision-making have acquired increased significance. METHOD: The criteria identified by Fawcett's framework has been used to analyse and evaluate Hammond's Cognitive Continuum Theory. Findings. There is empirical evidence to support many of the concepts and propositions of Cognitive Continuum Theory. The theory has been applied to the decision-making process of many professionals, including medical practitioners and nurses. Existing evidence suggests that Cognitive Continuum Theory can provide the framework to explain decision-making in nursing. CONCLUSION: Cognitive Continuum Theory has the potential to make major contributions towards understanding the decision-making process of nurses in the clinical environment. Knowledge of the theory in nursing practice has become crucial.     

Collaboration: A critical exploration of the care continuum

The purpose of this research was to explore the concept of collaboration within a specific healthcare context and to include the perspectives of healthcare users, a position largely lacking in previous studies. In applying a critical theoretical approach, the focus was on, as an exemplar, mothers with newborn babies who had spent more than 48 hr in a special care nursery. Semistructured interviews were undertaken with child health nurses, midwives and mothers. The three key theoretical findings on collaboration generated in the study point to layers of meanings around identity, knowledge and institutions of care. Findings from the interview data analysis were further examined through the lens of key policy documents. The research outcomes indicate that the concept of collaboration serves an important function in healthcare in obscuring the complexities and ambiguities that characterise the care continuum. The study concludes the need for a more critical approach to the assumptions that underlie the language of collaboration and the implications for practice in healthcare.     

The role of interprofessional collaboration for intimate partner violence in psychiatric care: A research and development project

In Finland, policy requirements have demanded providers to work collaboratively together with regard to intimate partner violence (IPV). This research and development project seeks to identify efficient tools for stopping IPV. The project included staff training to recognize and respond to IPV, the development of a research-based guideline for use in the care situations of victims and perpetrators and the integration of the guideline into practices and staff development. Networking was developed during the project through interprofessional and multiagency collaboration, whereas appraisal information was collected at different stages of the process. This paper focuses on the issues of interprofessional collaboration, and uses psychiatric care as an example. There is some evidence that interprofessional interventions reduce the cost of patient care and improve the quality of IPV services. That is why it is important to discuss these issues and solve possible problems arising in interprofessional patient care.     

A conceptual review of interprofessional expertise in child safeguarding

It is increasingly accepted that practitioners across a range of professional fields must work together in order to promote children’s welfare and protect them from harm. However, it has also become apparent that interprofessional working is a challenging area of practice that cannot simply be prescribed through protocols and procedures, nor acquired as a set of technical competences. This article develops the concept of interprofessional expertise in order to explain how practitioners become more proficient at working with others to manage complex child welfare issues. Key principles are outlined with reference to relevant theoretical frameworks, including models of skill acquisition. The article concludes by discussing some potential implications for future research and contemporary developments in child safeguarding practice.