Health and social care professionals’ attitudes to interprofessional working and interprofessional education: A literature review

The healthcare setting is a rich learning environment for students to experience interprofessional working (IPW) and interprofessional education (IPE). However, opportunities for IPE are limited, and student experiences of effective IPW are varied. This raises the question of how IPW and IPE are valued by health or social care professionals. A search of the literature was carried out to identify studies of health and social care staff attitudes to IPW and IPE. This review provides a summary of the main factors found to influence attitudes and the strengths and limitations of these studies. Professional background and prior IPE experience were identified as the influencing factors for which there is most evidence. The main limitations of the studies accessed included a focus on the value of IPE for staff, as opposed to students, and a limited number of studies considering the relationship between attitudes to IPW and the value placed on IPE. It is important that health and social care professionals lead by example by working collaboratively and providing students with opportunities for IPE. Identifying the variables influencing attitudes to IPW and IPE may assist in improving IPW and experiences of IPE for students learning in the healthcare setting.     

Understanding healthcare professionals’ self-efficacy to resolve interprofessional conflict

Conflict within interprofessional healthcare teams, when not effectively resolved, has been linked to detrimental consequences; however, effective conflict resolution has been shown to enhance team performance, increase patient safety, and improve patient outcomes. Alarmingly, knowledge of healthcare professionals’ ability to resolve conflict has been limited, largely due to the challenges that arise when researchers attempt to observe a conflict occurring in real time. Research literature has identified three central components that seem to influence healthcare professional’s perceived ability to resolve conflict: communication competence, problem-solving ability, and conflict resolution education and training. The purpose of this study was to investigate the impact of communication competence, problem-solving ability, and conflict resolution education and training on healthcare professionals’ perceived ability to resolve conflicts. This study employed a cross-sectional survey design. Multiple regression analyses demonstrated that two of the three central components—conflict resolution education and training and communication competence—were found to be statistically significant predictors of healthcare professionals’ perceived ability to resolve conflict. Implications include a call to action for clinicians and academicians to recognize the importance of communication competence and conflict resolution education and training as a vital area in interprofessional pre- and post-licensure education and collaborative practice.     

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.     

An investigation of “agreement” in the context of interprofessional discussion online: A “netiquette” of interprofessional learning?

This article suggests that “agreement” is a predominant feature of online discussions amongst undergraduate health and social care professionals, which is an area of concern. The context for the research is an online interprofessional learning pathway completed by ～2,800 students each year. The concept of agreement, how and why it is reached and what it indicates in an online interprofessional group is examined. The underpinning educational rationale for instigating online interprofessional dialogue was the potential to provide a powerful interface for bringing together students across a wide range of professional groups, which is necessary to promote interprofessional learning. Discourse analysis was used to analyze digital texts of interaction in online forums. The discussion forum discourse shows evidence of increased interprofessional knowledge and understanding, as well as capacity for interprofessional dialogue. Discussions were largely characterized by agreement, although some disagreement was evident. These findings support previous research in online dialogue. However, they are interpreted in an interprofessional context as constituting a specific type of “netiquette” in relation to the participants and their identification with professional discourses and to the learning activities that shaped discussions. The research has significance for teachers, researchers, and practitioners involved in promoting interprofessional learning through online discussion forums.     

An investigation of "agreement" in the context of interprofessional discussion online: a "netiquette" of interprofessional learning?

This article suggests that "agreement" is a predominant feature of online discussions amongst undergraduate health and social care professionals, which is an area of concern. The context for the research is an online interprofessional learning pathway completed by ~2,800 students each year. The concept of agreement, how and why it is reached and what it indicates in an online interprofessional group is examined. The underpinning educational rationale for instigating online interprofessional dialogue was the potential to provide a powerful interface for bringing together students across a wide range of professional groups, which is necessary to promote interprofessional learning. Discourse analysis was used to analyze digital texts of interaction in online forums. The discussion forum discourse shows evidence of increased interprofessional knowledge and understanding, as well as capacity for interprofessional dialogue. Discussions were largely characterized by agreement, although some disagreement was evident. These findings support previous research in online dialogue. However, they are interpreted in an interprofessional context as constituting a specific type of "netiquette" in relation to the participants and their identification with professional discourses and to the learning activities that shaped discussions. The research has significance for teachers, researchers, and practitioners involved in promoting interprofessional learning through online discussion forums.     

Early interprofessional interactions: does student age matter?

In this mixed-method evaluation we report on student responses to an introductory interprofessional learning event, accessed by ten professions within six months of commencing their chosen professional curricula. Of 898 students, 754 (84%) completed pre and post course questionnaires, and 81 took part in uni-professional focus groups. Student responses were compared with those of 14 facilitators. Younger students entering straight from school achieved more learning outcomes and were more positive about the learning than older students (e.g., undergraduate medics, range p = 0.001-0.011; graduate medics, range p = 0.001-0.819). Mature entrants valued interprofessional education, but preferred to interact with students of a similar age demanding a more challenging and relevant set of learning resources, sensitive to their prior life experience. Positive and negative stereotyping was differently constructed between younger and older students. The views of facilitators endorsed the lack of engagement of mature learners compared to their younger counterparts. The study highlights the need to consider age when bringing together large numbers of different professions for their first taste of interprofessional education.     

Do multidisciplinary integrated care pathways improve interprofessional collaboration?

This paper reports on the evaluation stage of an action research project on interprofessional collaboration in discharge planning. Findings from interviews with health care professionals working in the acute sector had revealed concerns about discharge planning and multidisciplinary teamwork. In the United Kingdom the National Health Service (NHS) Plan has reinforced the need for an integrated approach to health care. Effective health care integration requires effective communication, teamwork and the commitment to deliver integrated care. Integrated documentation is a key strategy for enhancing interprofessional collaboration and reducing the isolation of professionals, and has been successfully implemented in a range of health care settings. Presented with the concerns about the collaborative process in discharge planning, an action research strategy was chosen to bring about change in an orthopaedic ward in one London teaching hospital. This paper will evaluate the implementation of an integrated care pathway with fractured neck of femurs in one London teaching hospital. Care pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The emphasis will be on understanding whether integrated care pathways enhance and develop interprofessional collaboration and enable effective information access and flow across the professions and the organization. The criteria for evaluation, forming the hypotheses of the study, were that interprofessional nonverbal and verbal communication would be enhanced and that interprofesisonal collaboration would increase. Methods of evaluation used were: (i) stakeholder interviews, (ii) interprofessional audit and (iii) analysis of the variances from the integrated care pathway. The evaluation revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were enhanced. Furthermore, key factors in discharge delays appeared to be organizational rather than professional.     

Instruments measuring interprofessional collaboration in healthcare – a scoping review

ABSTRACT

Worldwide there is growing understanding of the importance of interprofessional collaboration in providing well-functioning healthcare. However, little is known about how interprofessional collaboration can be measured between different health-care professionals. In this review, we aim to fill this gap, by identifying and analyzing the existing instruments measuring interprofessional collaboration in healthcare. A scoping review design was applied. A systematic literature search of two electronic databases, Medline (PubMed) and CINAHL, was conducted in 03/2018. The search yielded 1020 studies, of which 35 were selected for the review. The data were analyzed by content analysis. In total, 29 instruments measuring interprofessional collaboration were found. Interprofessional collaboration was measured predominantly between nurses and physicians with different instruments in various health-care settings. Psychometric testing was unsystematic, focusing predominantly on construct and content validity and internal consistency, thus further validation studies with comprehensive testing are suggested. The results of this review can be used to select instruments measuring interprofessional collaboration in practice or research. Future research is needed to strengthen the evidence of reliability and validity of these instruments.     

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.     

Can one eat collaboration? Menus as metaphors of interprofessional collaboration

The turn of the century has seen a sudden upsurge in publications and initiatives around the development of interprofessional collaboration in Japan. In Japanese, the term 'team-treatment' is generally used to mean interprofessional collaboration, but hitherto there have been no generally accepted definitions and conceptualizations of the term, nor are there guidelines as to how it may be implemented in practice. In order to facilitate understanding of the different modes of interprofessional collaboration and issues in practice, we introduced the use of menus as metaphors for interprofessional collaboration in a class of first year students of nursing. There were two 90-minute classes available for exploring this topic. Through the use of a metaphor the students demonstrated they were able to conceptualize interprofessional collaboration, identify the value of nurses working together with other professionals and issues involved in making team-treatment work. The purpose of this paper is to share the experience of using metaphors as a teaching/learning strategy, including reflection on the successes and some limitations of what, for us, was an interesting educational innovation.     

Developing interprofessional education in the pre-registration curricula: mission impossible?

Interprofessional education has long been cited in health and social care policy as a remedy to improve many of the problems faced by the National Health Service (NHS) around co-ordination and collaboration of staff. More recently, this form of education has been acknowledged as having a key role in delivering the government’s modernisation agenda to produce a more ‘flexible’ workforce. Given the large number of logistical problems connected to developing interprofessional education before registration, this type of activity more often occurs after registration. It is interesting, therefore, to note that pre-registration interprofessional education has recently been hailed by NHS policy as a primary method for enhancing collaboration. However, these policy documents have both contributed to the conceptual confusion in this area and also overlooked the range of factors (educational, organisational and cultural) connected with implementing and sustaining this type of education in the pre-registration sector. In posing the question, ‘pre-registration interprofessional education: mission impossible?’ this paper examines the cultural, organisational and educational factors that affect the development of this activity. It also considers attempts to build an evidence-base for interprofessional education. This paper finally outlines how the implementation of interprofessional practice-based placements can be an achievable goal for the pre-registration curricula.