Inclusive early childhood education and care: a longitudinal study into the growth of interprofessional collaboration

ABSTRACT

Inclusive early childhood education and care (ECEC) requires interprofessional collaboration between professionals with diverse professional backgrounds. Following developments in human services, there is a growing interest in the role of interprofessional teams in community-based settings for young children. In a three-year longitudinal study, we investigated interprofessional collaboration (IPC) between staff from childcare, education and youth care. At the individual level, a survey was used for the analysis of IPC competences. At the network level, we investigated professional relationships between individuals using social network analysis. Results of a multilevel mixed linear model showed an increase in interdependence and reflection on process of individual staff, followed by the progressive development of perceived team performance. Smaller networks with higher density and professionals’ centrality predicted more positive perceptions of inclusive ECEC. We discuss our findings in the context of growing interest in interprofessional teams in ECEC.     

Clients as mediators of interprofessional collaboration in mental health services in Iran

Interprofessional collaboration (IPC) has long been identified as a way of providing optimal mental health services (MHS). It is important, therefore, to identify and facilitate factors driving IPC. This paper presents health professionals' experiences and perceptions regarding the clients' role as a driving factor for IPC in MHS in an Iranian context. Health professionals included nurses, physicians (general physicians and medical specialists), psychologists and consultants. Qualitative methods were employed in the form of in-depth individual interviews and focus groups to collect data from 24 professionals and 4 clients. Data analysis generated four key themes: “Clients as axis of IPC”, “Seamless services as a common incentive for IPC”, “Clients as a common interprofessional linkage” and “Clients as a driving force to achieve IPC”. From the professionals' perspective, it was found that clients had a mediating role in their collaborative relationships and practices. These findings are discussed in relation to the interprofessional literature. This paper goes on to argue that professionals need to be aware of and be trained about how to manage, as well as benefit from, the clients' fundamental role in IPC.     

A comparison of student attitudes and perceptions before and after an introductory interprofessional education experience

Abstract

There is increasing acknowledgement that interprofessional education (IPE) holds promise for preparing health professionals as collaborative-ready practitioners. The effects of IPE on learning outcomes are critical in determining the value of such programs. Attitudes are recognized as a significant element in developing behaviors. This study was designed to determine attitudes and perceptions of students toward collaborative learning in an interprofessional context. Three hundred and five students completed a questionnaire regarding attitudes and perceptions toward interprofessional collaboration before and after an introductory IPE course. Also 202 graduating health professional students without IPE completed the same questionnaire. The questionnaire included questions from the University of West England Interprofessional Questionnaire (UWE IQ) and Readiness for Interprofessional Learning Scale (RIPLS). Independent samples t-tests revealed significant positive changes before and after the IPE course for UWEIQ IP-Learning subscale (p?=?0.012) and RIPLS (p?=?0.05). This study provides some evidence that students who participate in an introductory IPE course early in their professional preparation not only keep positive attitudes toward interprofessional learning, but improve them. As a result, they are expected to be more engaged in learning this important knowledge that should help them to become interprofessional collaborative-ready practitioners.     

Nurse–physician collaboration in an academic medical centre: The influence of organisational and individual factors

Ineffective physician–nurse collaboration has been recognised to adversely impact patient and organisational outcomes, and some studies suggest an underlying factor may be that nurses and physicians have different perceptions of interprofessional collaboration (IPC). The objectives of this study were to evaluate for a difference in the perception of IPC between physicians and nurses and to explore potential contributing factors at the individual and organisational levels to any observed difference. Data including measures of perceptions of IPC were collected from a convenience sample of resident physicians (n = 47), attending physicians (n = 18), and nurses (n = 54) providing care for internal medicine patients in a large tertiary care academic medical centre. Regression analysis revealed significantly lower perceptions of IPC scores for nurses in comparison to the scores of both the resident and attending physician groups (p = .0001 for both). Although demographic and workload factors also differed by profession, only profession and workload remained significant in regression analysis. Given the known relationships between effective physician–nurse collaboration and superior patient and organisational outcomes, better defining the individual and organisational predictors of IPC scores may support development of more effective interventions targeting improvements in IPC.     

Practice educators’ attitudes and perspectives of interprofessional collaboration and interprofessional practice learning for students: A mixed-methods case study

ABSTRACT

Interprofessional collaboration (IPC) is important for the delivery of effective integrated health and social care systems. Interprofessional practice learning (IPPL) enables students to learn to work together within a relevant context and prepare for future IPC. While there is some evidence that negative attitudes impact on IPC and interprofessional education, there is a dearth of research on health and social work professionals’ attitudes and perspectives of IPC and IPPL opportunities for students. A mixed-methods case study was used to investigate practice educators’ attitudes and perspectives of IPC and IPPL for their students. Results showed that attitudes were positive and that mainly meso- and macro-level factors, as opposed to the micro level, impacted on the implementation of IPC and IPPL for students’ learning in practice settings. IPC was perceived to be best enabled by effective communication, established teams, IPPL for staff, and shared processes and policies. Close working proximity to other professionals encouraged informal communication and positive interprofessional relationships. Motivation and resources were perceived as enablers of IPPL, but there were often missed opportunities for IPPL. These findings suggest that further work is required to identify systems for improving IPC and to enhance IPPL opportunities for students learning within practice settings.     

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.     

Interprofessional collaboration: development of a tool to enhance knowledge translation

Abstract

Purpose: Interprofessional collaboration (IPC) is a complex and multidimensional process in which different professionals work together to positively impact health care. In order to enhance the knowledge translation and improve rehabilitation practitioners’ knowledge and skills toward IPC, it is essential to develop a comprehensive tool that illustrates how IPC should be operationalized in clinical settings. Thus, this study aims at developing, validating and assessing the usefulness of a comprehensive framework illustrating how the interactional factors should be operationalized in clinical settings to promote good collaboration. Methods: This article presents a mixed-method approach used to involve rehabilitation stakeholders (n?=?20) in the development and validation of an IPC framework according to a systematic seven-phase procedure. Results: The final framework shows five types of practices according to four components: the situation of the client and family, the intention underlying the collaboration, the interaction between practitioners, and the combining of disciplinary knowledge. Conclusion: The framework integrates the current scientific knowledge and clinical experience regarding the conceptualization of IPC. It is considered as a relevant and useful KT tool to enhance IPC knowledge for various stakeholders, especially in the rehabilitation field. This comprehensive and contextualized framework could be used in undergraduate and continuing education initiatives.

• Implications for Rehabilitation

• The framework developed integrates the current scientific knowledge and clinical experience regarding the conceptualization of interprofessional collaboration (IPC) that is relevant to the rehabilitation field.

• It could be used in undergraduate and continuing education initiatives to help learners understand the multidimensional and dynamic nature of IPC.

• It could be useful to support practitioners and managers from the rehabilitation field in their efforts to optimize collaborative practice within their organization.

     

Leadership characteristics for interprofessional collaboration in China

AimTo explore the perceptions of health professionals and educators regarding the characteristics of leadership that they believed were required for successful interprofessional education and interprofessional collaboration initiatives in China.BackgroundLeadership is a key competency in the successful implementation of any collaborative initiative in healthcare. However, there are few studies about leadership characteristics how these facilitate interprofessional collaboration in health care, especially in China.MethodsData for this secondary analysis came from a qualitative study of Interprofessional Team Development in China. Grounded theory methods were used to analyze fifteen semi-structured interviews from the original study.FindingsThe three leadership characteristics extracted that facilitated interprofessional collaboration were: 1) serving as a role model of Junzi (according to Confucianism the idea person); 2) initiating and maintaining collaboration; and 3) showing benevolence to all team members during interprofessional collaboration. One overarching category that surfaced throughout the interviews was that leaders who behaved in ways congruent with typical Chinese cultural expectations for leadership would be most effective.ConclusionThis study describes the characteristics of leadership for interprofessional collaboration, providing directions for training and cultivation of healthcare professionals and workers so that they are better prepared for and work more effectively in interprofessional collaborative practice.     

Understanding interprofessional relationships by the use of contact theory

The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students’ understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students’ perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allport's (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allport's theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs.     

Clients as mediators of interprofessional collaboration in mental health services in Iran

Interprofessional collaboration (IPC) has long been identified as a way of providing optimal mental health services (MHS). It is important, therefore, to identify and facilitate factors driving IPC. This paper presents health professionals' experiences and perceptions regarding the clients' role as a driving factor for IPC in MHS in an Iranian context. Health professionals included nurses, physicians (general physicians and medical specialists), psychologists and consultants. Qualitative methods were employed in the form of in-depth individual interviews and focus groups to collect data from 24 professionals and 4 clients. Data analysis generated four key themes: "Clients as axis of IPC", "Seamless services as a common incentive for IPC", "Clients as a common interprofessional linkage" and "Clients as a driving force to achieve IPC". From the professionals' perspective, it was found that clients had a mediating role in their collaborative relationships and practices. These findings are discussed in relation to the interprofessional literature. This paper goes on to argue that professionals need to be aware of and be trained about how to manage, as well as benefit from, the clients' fundamental role in IPC.     

Improving interprofessional collaboration in a community setting: Relationships with burnout,engagement and service quality

The main purpose of this study was, firstly, to evaluate the effect of an intervention aimed at improving interprofessional collaboration and service quality, and secondly, to examine if collaboration could predict burnout, engagement and service quality among human service professionals working with children and adolescents. The intervention included the establishment of local interprofessional teams and offering courses. The sample was recruited from six different small municipalities in Northern Norway (N = 93) and a comparison group from four similar municipalities (N = 58). Participation in the project increased the level of collaboration in the intervention group significantly (Hedges' g = 0.36), but not the perceived level of service quality. Hierarchical regression analyses were used to test a model for predicting burnout, engagement and perceived service quality using work-related factors, including collaboration as predictors. Both burnout and engagement were predicted by job demands and resources after controlling for demographic variables and participation in the project. Service quality was mostly predicted by collaboration. Increasing collaboration seems possible by introducing practice-based changes; however, this intervention did not have the desired effect on perceived service quality.     

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.     

Physiotherapy new graduate self-efficacy and readiness for interprofessional collaboration: a mixed methods study

ABSTRACT

Effective interprofessional collaboration is a required competency for all health professionals including physiotherapists. Little is known about new graduate physiotherapists’ self-efficacy and readiness for interprofessional collaboration. A sequential mixed-methods design was used to examine and explore (a) new graduate self-efficacy and (b) new graduate perception of the role and influence of curricular activities on their readiness for interprofessional collaboration. New graduate physiotherapists completed a self-efficacy measure based on the Interprofessional Care Core Competencies Global Rating Scales, and semi-structured interviews were undertaken and subjected to framework analysis. 150 surveys were completed (response rate 91%). Less than one quarter of all participants agreed or strongly agreed that they were confident in relation to all interprofessional competencies. New graduates attributed their self-efficacy to being directly exposed to interprofessional collaboration in a clinical setting during their placement year. The results demonstrate that new graduate physiotherapists have high self-efficacy communicating with other professionals and understanding their roles, however they have low self-efficacy with interprofessional conflict resolution and providing feedback to others. This study has implications for supporting new graduates in practice, and for preparing physiotherapy students for interprofessional collaboration.     

Interprofessional collaboration and diabetes care in Switzerland: A mixed-methods study

To face the increasing prevalence of diabetes in Switzerland, a cantonal programme has been implemented. One of its goals is to promote collaborative approaches among healthcare professionals (HCPs). The objectives of the current study were to examine HCPs’ perceptions about the collaboration they experience in diabetes care and to determine whether perceptions differed among professional groups. A mixed-methods study was conducted. First, a total of 332 HCPs comprising diabetes specialists and non-specialists participated by completing a questionnaire on interprofessional collaboration. Focus groups were then led in order to deepen the understanding and complement the interpretation of quantitative results. Quantitative results showed a perception of a moderate level of collaboration. Mean scores for specialists were systematically worse than those of non-specialists and more prominently in the “level of conflict dimension,” which means that specialists generally perceived a lower level of collaboration and a higher level of possible conflict associated with it. Qualitative results highlighted the vagueness in role definition and emphasised a form of reluctance by general physicians to collaborate with specialists, as the physicians felt that they were losing their responsibilities. The findings suggest that it is not the need to collaborate that encourages HCPs involved in collaborative schemes to desire or to know how to successfully initiate, promote, or conduct interprofessional collaboration. This study highlights the important perceptions about collaboration that could be taken into account when planning future collaborative programmes.     

Developing interprofessional communication skills for pharmacists to improve their ability to collaborate with other professions

Successful communication between health professionals is a prerequisite for collaborative practice. Clinical pharmacists completed a learning and practice module introducing them to a framework for successful interprofessional communication (IPC) in the course of their postgraduate studies. A face-to-face discussion of a contemporary clinical topic with a health professional was then scheduled, mainly with junior doctors, in their practice setting. An exploratory case study methodology was employed to investigate pharmacists’ written reflections on their experience applying their newly acquired IPC skills. Thematic analysis of reflections developed five categories relating to interprofessional collaboration, learning, and education. Themes describing pharmacists’ preconceptions about the health professional and scheduled interprofessional encounter, how it allowed them to learn about doctors’ and other health professionals’ practice and build collaborative relationships were identified. Reflections also elaborated that applying the communication framework and strengthening of collaboration created opportunities for IPE, with added observations about these increasing potential impact on patient care and change of practice. Analysis of anonymous feedback provided by the health professionals yielded similar themes and was integrated for triangulation. Applying successful IPC skills in healthcare settings may increase interprofessional collaboration and create practice models which facilitate interprofessional learning in health profession programmes.     

Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care

Lack of nurse?physician collaboration in wound care may result in prolonged healing times for patients. In order to facilitate future professional collaboration, undergraduate learning activities in interprofessional education (IPE) have been proposed. The aim of this study was to investigate nursing and medical students’ attitudes and perceptions towards each other’s future professions and interprofessional collaboration in wound care. Nursing and medical students took part in an interprofessional learning activity about wound care. Data were collected using the Jefferson Scale of Attitudes towards Physician?Nurse Collaboration questionnaire to student groups before and after an IPE activity (pooled n = 221). Focus groups were conducted to deepen the knowledge about students’ attitudes and perceptions. The results showed high scores on the attitude scale (mean 53.2, possible maximum = 60) both before and after IPE, indicating positive attitudes towards nurse?physician collaboration. Nursing students scored higher than medical students both pre-IPE (p < 0.001) and post-IPE (p = 0.006). However, no difference on scale scores could be identified between pre- and post-IPE. The following themes emerged in the analysis of focus group discussions: “Approaching patient care from different perspectives,” “Need for collaboration and clear professional roles in practice,” “Structures hindering future collaboration,” and “IPE as a tool for professional practice and roles.” The shared learning activity provided insights into the other profession’s competence. This kind of learning activity may increase future interprofessional collaboration, and thus, improve wound care.