Interprofessional learning for nursing students in practice periods: problems to overcome and possibilities for uniprofessional campuses

There is an urgent need for educational institutions to prepare students for collaborative practices in health care in the years to come. Facilitation of interprofessional learning (IPL) can be challenging for small campuses with few healthcare and social care education programmes. The aim of this study was to identify hindrances to, and opportunities for accessible interprofessional learning, for nursing students in a uniprofessional learning environment on the Norwegian West coast. Three focus group interviews were conducted with the following groups: nursing teachers, a hospital rehabilitation team and informants from a municipal home rehabilitation team. The data were analysed by hermeneutical phenomenological method. The following four main themes emerged the following: the tradition for interprofessional learning is not yet well established, IPL in the context of existing teams is better than IPL with other students, there is an urgent need to strengthen and adjust professional responsibilities and roles, and there is a need for communication to overcome hindrances to IPL.     

Best practice interprofessional stroke care collaboration and simulation: The student perspective

Interprofessional practice (IPP) is the accepted standard of care for clients following a stroke. A brief, embedded and evidence-based IPP team simulation was designed to address stroke care knowledge and IPP competencies for students within limited curriculum space. Each team was required to construct a collaborative care plan for their patient during the simulation and submit the care plan for evaluation of best practice stroke care knowledge and implementation with evidence of interprofessional collaboration (IPC). A total of 302 students (274 on-site, 28 by distance technology) representing four professions comprised of 55 teams took part in this experience. Post-simulation, voluntary and anonymous programme evaluations were completed using the standardised interprofessional collaborative competency assessment scale (ICCAS) and open-ended free-text responses to five questions. There was a significant improvement for all pre–post ratings on the ICCAS regardless of profession or previous interprofessional experience. Additionally, the open-ended responses indicated perceived changes to role clarification, communication, and teamwork. The combined interpretation of the programme evaluation results supports interprofessional team simulation as an effective and efficient learning experience for students regardless of previous interprofessional experience, and demonstrated positive changes in stroke best-practice knowledge and IPC competencies.     

“Oh why didn't I take more notice?” Professionals' views and perceptions of pre-qualifying preparation for interprofessional working in practice

It is widely assumed that interprofessional learning (IPL) impacts positively on interprofessional working (IPW) in health and social care. However, there is no clear evidence that pre-qualifying IPL improves service delivery. The direct effect of pre-qualifying IPL on IPW and service delivery is difficult to demonstrate; researchers must rely on professionals' self-report in this regard. This paper presents findings from a qualitative study in which semi-structured interviews were used to collect individuals' views and perceptions about pre-qualifying IPL as preparation for practice. Two groups of participants came from four health and social care professions: adult nursing, midwifery, physiotherapy and social work. One group had experienced a substantial pre-qualifying IPL initiative, while the other group had not. Useful insights were gained from comparing the views and perceptions of individuals from these two groups. The total sample comprised 29 practitioners: 19 were educated on interprofessional curricula and 10 on traditional uniprofessional curricula. Thematic data analysis produced findings about pre-qualifying education as preparation for IPW. These findings suggest that pre-qualifying IPL can prepare individuals to work effectively as qualified professionals with colleagues from other disciplines and that effective IPW impacts positively on service delivery.     

Australian health reforms: enhancing interprofessional practice and competency within the health workforce

Abstract

Underpinned by increasing healthcare complexity and ongoing pressures to control the cost of healthcare, governments are increasingly calling for improved health service delivery models. A public policy paradigm of partnership-based, collaborative interprofessional working is central to revised models of health service delivery. Collaborative activity and service re-design do not occur by chance. They are complex and multi-faceted. Increasingly, calls for collaborative style health service re-design activities are being translated to a need to agree on a clear set of interprofessional competencies and develop a culture of interprofessional practice (IPP) across the sector. This report summarizes the requirements for developing a culture of interprofessional practice within the context of Australian healthcare reforms. It also highlights the role of well-developed interprofessional competency frameworks to support envisaged changes in practice. The report expands the discussion in this area by referring to the work of two other nations with prior developments in interprofessional workplace development and reform.     

“Understanding where you're coming from”: Discovering an [inter]professional identity through becoming a peer facilitator

Peer facilitation offers an innovative and effective means of promoting interprofessional learning (IPL) between health and social care students. This paper highlights the benefits that peer facilitators themselves experience from involvement in assisting junior colleagues to engage with IPL in an online context. The setting for the inquiry is an online interprofessional learning pathway shared by two higher education institutions in the UK. Insights have been developed over a 3-year period through collaborative inquiry with 41 peer facilitators, academic tutors and the students who benefitted from their input. This paper which focuses on peer facilitators' application data, interview data and written reflections explores the instrumental, cognitive and personal gains experienced. However, more fundamentally, theorizing findings in relation to identity theory we substantiate the claim that the role provides opportunity for testing and refining important aspects of both professional and interprofessional identities.     

Crucial Conversations: An interprofessional learning opportunity for senior healthcare students

Clinical errors due to human mistakes are estimated to result in 400,000 preventable deaths per year. Strategies to improve patient safety often rely on healthcare workers’ ability to speak up with concerns. This becomes difficult during critical decision-making as a result of conflicting opinions and power differentials, themes underrepresented in many interprofessional initiatives. These elements are prominent in our interprofessional initiative, namely Crucial Conversations. We sought to evaluate this initiative as an interprofessional learning (IPL) opportunity for pre-licensure senior healthcare students, as a way to foster interprofessional collaboration, and as a method of empowering students to vocalise their concerns. The attributes of this IPL opportunity were evaluated using the Points for Interprofessional Education Score (PIPES). The University of the West of England Interprofessional Questionnaire was administered before and after the course to assess changes in attitudes towards IPL, relationships, interactions, and teamwork. Crucial Conversations strongly attained the principles of interprofessional education on the PIPES instrument. A total of 38 volunteers completed the 16 hours of training: 15 (39%) medical rehabilitation, 10 (26%) medicine, 7 (18%) pharmacy, 5 (13%) nursing, and 1 (2%) dentistry. Baseline attitude scores were positive for three of the four subscales, all of which improved post-intervention. Interprofessional interactions remained negative possibly due to the lack of IPL opportunities along the learning continuum, the hidden curriculum, as well as the stereotyping and hierarchical structures in today’s healthcare environment preventing students from maximising the techniques learned by use of this interprofessional initiative.     

Interprofessional education for delirium care: a systematic review

Abstract

Recent delirium prevention and treatment guidelines recommend the use of an interprofessional team trained and competent in delirium care. We conducted a systematic review to identify the evidence for the value of interprofessional delirium education programs on learning outcomes. We searched several databases and the grey literature. Studies describing an education intervention, involving two or more healthcare professions and reporting on at least one learning outcome as classified by Kirkpatrick’s evaluation framework were included in this review. Ten out of 633 abstracts reviewed met the study inclusion criteria. Several studies reported on more than one learning outcome. Two studies focused on learner reactions to interprofessional delirium education; three studies focused on learning outcomes (e.g. delirium knowledge); six studies focused on learner behavior in practice; and six studies reported on learning results (e.g. patient outcomes), mainly changes in delirium rates post-intervention. Studies reporting changes in patient outcomes following the delirium education intervention used an interprofessional practice (IPP) intervention in combination with interprofessional education (IPE). Our review of the limited evidence suggests that IPE programs may influence team and patient outcomes in delirium care. More systematic studies of the effectiveness of interprofessional delirium education interventions are needed.     

Examining the interface between interprofessional practice and education: Lessons learned from Norway for promoting teamwork

Promoting teamwork in health and social care requires an understanding of the interface between interprofessional practice (IPP) and interprofessional education (IPE). A study with two parts, one qualitative and one quantitative, examined this interface in Norway. The first used focus groups to assess IPP rewards, barriers, and facilitating factors among practitioners in clinical settings. The second utilized an online survey to measure IPE attitudes, barriers, and facilitating factors among senior administrators in the educational system. Results of Part 1 indicate that providers report many intrinsic rewards of IPP; however, the more extrinsic impacts of collaborative practice on patient care need to be emphasized to system managers. Results of Part 2 suggest strong general support by academic deans and directors for IPE, though addressing specific potential barriers to its implementation has become increasingly important. Overall, bridging the IPP–IPE gap requires educating leaders in both settings about the resources needed for teamwork, linking clinical and educational settings through continuing professional development, and generally advocating more effectively for both IPP and IPE.     

Interprofessional learning in an international context: the unfamiliar as impetus for learning,also about oneself

ABSTRACT

Studying experiences of interprofessional learning (IPL) in international contexts can contribute to better understand its nature. The aim of this study was to evaluate students’ IPL in the context of a two-week study-abroad program. There were 28 health-care students from Tokyo Metropolitan University, Japan, who participated in a two-week interprofessional education program provided by Karolinska Institutet, Sweden, from 2013 to 2016. The program consisted of classroom-based activities, a literature study (since 2015) and study-visits to health-care facilities. The data were two pre-course questionnaires with open-ended questions that inquired about students’ motivation, expectations and goals, and one post-course questionnaire that inquired about their learning. A qualitative KJ-method analysis of students’ completed questionnaires revealed two understandings about the nature of IPL. Namely, the ‘unfamiliar’, presented by both interprofessional and international contexts, provided students’ with unique learning, with the international context reinforcing interprofessional learning. Secondly, developing one’s individual collaborative skills and one’s professional expertise was important aspects of their learning. International context can add value to students’ IPL by affording learning opportunities considered unique to the different socio-cultural context. IPL may also pertain to ‘learning about oneself’, in addition to ‘learning with, about and from each other’.     

Changing stress while stressing change: The role of interprofessional education in mediating stress in the introduction of a transformative technology

The introduction of a transformative technology into practice settings can affect the functioning of interprofessional teams, placing stress on interprofessional relationships, thus slowing adoption and change. This study explored the potential of an interprofessional education (IPE) approach to mediate this stress and facilitate the adoption of a transformative technology- Image Guided Radiation Therapy (IGRT). Oncologists, physicists, and therapists in radiation medicine who attended an interprofessional IGRT Education Course were interviewed about perceived benefits and stressors to IPE and to interprofessional practice (IPP) in the IGRT context. A modified grounded theory approach was used to conduct 14 interviews, with 200 minutes of interview time recorded. In introducing IGRT, participants noted interprofessional stress in understanding and adopting new technology. IPE offered common terminology, appreciation for others' knowledge, and a holistic framework for practice. Outcomes were thought to foster collaboration, efficiency, and improved professional role definition. Time constraints and power relations were noted to be residual stressors exacerbated by IPE, but were thought to be transient. IPE can thus be of benefit in the implementation of transformative technologies such as IGRT, through mediation of interprofessional stress inherent in change. Interprofessional knowledge, collaboration, and efficiency in practice facilitate the development and adoption of a new practice model.     

Interprofessional education: The student perspective

The Toronto Rehabilitation Institute (Toronto Rehab) is a current leader in the movement of interprofessional education (IPE) initiatives in Ontario, Canada. Nine students from seven different health care disciplines, including medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech language pathology participated in the second IPE clinical placement in the winter of 2005 on Toronto Rehab's Stroke inpatient unit. In an effort to increase interprofessional collaboration, improve communication skills, foster respect and enhance knowledge of the different roles each discipline plays on the health care team, these students met together over a five week period and participated in interprofessional group sessions led by different health care professional leaders from the unit. This paper discusses the students' perspectives on this IPE experience and the corresponding benefits and challenges. All participants in the study recognized the importance of interprofessional teamwork in patient care and agreed that all health care education should include opportunities enabling them to develop the skills, behaviours and attitudes needed for interprofessional collaboration.     

Extending conceptual understanding: How interprofessional education influences affective domain development

Interprofessional learning (IPL) can influence affective domain development of students through teaching activities that facilitate learning with, from, and about other professions. Current quantitative evidence offers limited explanation of how this learning is achieved within IPL programmes. This article tests a conceptual framework drawn from theories on IPL and affective domain development (attitudes, values, and behaviours) to explain what works for whom, when, and in what circumstances. The objectives of the study were twofold: to evaluate the impact of the IPL programme on the student’s attitudes and values, and to identify behaviour changes in clinical practice towards interprofessional working. Using an action research approach, based in practice, an IPL programme was delivered over 6 weeks. Students from five professions, nursing, radiography, physiotherapy, social work, and podiatry (n = 63), participated over the two action research cycles and in semi-structured focus groups (n = 37). The recorded personal experiences of the IPL activities on the students were examined in relation to the type of activity; impact on the affective domain of learning (attitude, value, or behaviour) and self-reported outcome on application to their practice. Modification in affective domain development was measured to identification or internalisation stage for 30 of the students. Self-reported outcomes on application to practice included direct impact on patient care, personal resilience building, improved communication, and ability to challenge practice. This article presents a conceptual framework not evident in current research, in regard to what IPL works for whom, in what circumstances, and when. IPL activities that address a personal reward or incentive and are delivered over four weeks, imitating ‘circles of care,’ that explore self-assessment, team building, and reflection can lead to sustained change in values, attitudes, and behaviours.     

Development of IMAGINE: A three-pillar student initiative to promote social accountability and interprofessional education

Abstract

This article is based on a partnership between a primary health service and a university whose shared goal was to prepare students and graduates for interprofessional practice (IPP). This collaborative process led to the development of consensus on an interprofessional capability framework. An action research methodology was adopted to study the development and progress of the partnership between university and health service providers. The initial aim was to understand their perceptions of IPP. Following this, the findings and draft capabilities were presented back to the groups. Finalisation of the capabilities took place with shared discussion and debate on how to implement them in the primary care setting. Several ideas and strategies were generated as to how to prepare effective interprofessional learning experiences for students in both environments (university and primary health care setting). Extensive stakeholder consultation from healthcare providers and educators has produced a framework, which incorporates the shared views and understandings, and can therefore be widely used in both settings. Development of a framework of capabilities for IPP, through a collaborative process, is a useful strategy for achieving agreement. Such a framework can guide curriculum for use in university and health service settings to assist incorporation of interprofessional capabilities into students’ learning and practice.     

Utilising Medicare annual wellness visits to implement interprofessional education in the primary care setting

Interprofessional education (IPE) is an important component of healthcare professional curriculum in order to optimally prepare students for their roles as part of the healthcare team. Integrating IPE activities into direct patient care in the primary care clinic setting can help improve perceptions and student understanding of other healthcare professionals’ responsibilities in this ever-evolving practice setting. This report describes the implementation of an interprofessional clinic including a variety of healthcare professionals and students in the context of the Medicare Annual Wellness Visits (AWV). Design of the clinic and general roles of the professionals in optimising preventive care are described. Student perceptions of IPE and their knowledge of other healthcare professionals were also surveyed. Student knowledge of other professionals mildly improved. Student perception of actual cooperation and interprofessional interaction statistically improved, while perception of interprofessional learning slightly worsened. Utilising Medicare AWVs can be a way for various professionals to improve IPE in the primary care setting.     

Transforming primary care: improving on the medical home model

This paper reports work from a Centre for Interprofessional Practice in a higher education institution in the UK that offers four levels of interprofessional learning (IPL) to all healthcare students. The second level (IPL2) integrates professional practice into the learning process, requiring students to shadow a qualified healthcare professional (from a different profession) for half a day. Students complete a reflective statement upon their learning experience on their return. A study was undertaken to analyse students' reflective statements in depth to see their observations and reflections on the shadowing visit. Using frame analysis, 160 reflective statements were analyzed, identifying common words and phrases used by students, which were then grouped together under six themes. Three of these related directly to the assignment: communication styles and techniques; communication between healthcare professionals and comparison of students' own and other healthcare professionals' roles. Three themes emerged from student's own interpretation of observations and reflections made during the shadowing of a different professional: attitudes toward other professions; power structures between professionals and patients and between professionals and impact of communication on patient care. Interprofessional shadowing gives students an opportunity to observe communication between healthcare professionals and patients and to reflect on broader issues surrounding collaborative working.     

A scoping review to improve conceptual clarity of interprofessional interventions

Interprofessional education (IPE) and interprofessional collaboration (IPC) have been identified in health education and health care as playing an important role in improving health care services and patient outcomes. Despite a growth in the amount of research in these areas, poor conceptualizations of these interprofessional activities have persisted. Given the conceptual challenges, a scoping review of the interprofessional field was undertaken to map the literature available in order to identify key concepts, theories and sources of evidence. The objective of this review was to develop a theoretically based and empirically tested understanding of IPE and IPC. A total of 104 studies met the criteria and were included for analysis. Studies were examined for their approach to conceptualization, implementation, and assessment of their interprofessional interventions. Half of the studies were used for interprofessional framework development and half for framework testing and refinement. The final framework contains three main types of interprofessional interventions: IPE; interprofessional practice; and interprofessional organization; and describes the nature of each type of intervention by stage, participants, intervention type, interprofessional objectives, and outcomes. The outcomes are delineated as intermediate, patient, and system outcomes. There was very limited use of theory in the studies, and thus theoretical aspects could not be incorporated into the framework. This study offers an initial step in mapping out the interprofessional field and outlines possible ways forward for future research and practice.     

An interprofessional health assessment program in rural amateur sport

Effective interprofessional learning (IPL) in multisectoral collaborations such as those linking health services within communities can provide an authentic experience for students and also appears to be the most effective way to achieve health changes in targeted population groups. The aim of this study was to facilitate the IPL of students at a rural university in a multisectoral health assessment programme and to promote health in players of rural amateur sport. Two rural rugby league teams took part in three pre-season health assessments conducted by general medical practitioners, practice nurses, and nursing, osteopathy, and exercise science students. The Readiness for Interprofessional Learning Scale questionnaire and a series of focus groups were used to evaluate participants’ experiences of the programme. Results indicated that students saw the benefits for patients and 93% valued the opportunity to improve interprofessional communication, problem-solving and team skills. Some students felt they needed to learn more about their own professional role before learning about others, and instances of stereotyping were identified. The programme also enabled early detection of potential health risks and referral for medical care, management of musculoskeletal conditions, and health promotion. These health assessments would be readily transferred to other multisectoral sporting settings.     

An interprofessional patient assessment involving medical and nursing students: a qualitative study

Interprofessional collaboration is fundamental to providing optimal patient care. The readiness of the team entering a framework of interprofessional collaborative practice is critical to its success. In this study, we conducted an interprofessional education (IPE) activity for medical and nursing students in an acute care setting. Over nine occasions, 21 student pairs (one nursing and one medical student per pair) jointly assessed a patient and created a list of problems and interventions to achieve the patient’s goals. Immediately after the activity, students were debriefed to gain insight into their experiences. Debriefing sessions were audiotaped and analysed using a phenomenological approach and four major themes were identified. Overall, students felt responsible for representing their profession and were initially apprehensive about the interprofessional task. Nevertheless, they identified their own shortcomings and recognized the value in their partner’s approach. These realizations promoted convergence on a shared vision to provide optimal care for patients as a team. Acknowledging and understanding these perceptions may help design better ways to improve patient care. This educational model may be utilized by others who are seeking IPE activities in acute care.     

“Acute caring” in the emergency department

The aim of this essay was to discuss the ways in which the dynamics of interprofessional communication and collaboration among healthcare providers ultimately affect patient quality of care in the acute setting. Interprofessionalism describes a care model whereby health providers use complementary skills, knowledge and competencies to provide quality care to a group of patients. These interactions are characterized by trust, respect and an understanding of each other's skill and knowledge. At its best, the interprofessional care model has made great strides in the amelioration of patient outcomes, including reduction in negative outcomes, decreased health access needs and increased patient satisfaction. However, challenges with regard to communication and implementation have translated to a steep learning curve for healthcare providers. As such, a new-found emphasis has been placed on interprofessional education for today's healthcare students with the goal of promoting a more efficient and collaborative philosophy for tomorrow's healthcare teams.