The interprofessional learning experience: Findings from a qualitative study based in an outpatient setting

Clinical interprofessional education has traditionally taken place in hospital wards, but much diagnosis and treatment have shifted to the outpatient setting. The logical consequence is to shift more students’ clinical placements from the “bedside” to outpatient settings. However, it is unclear how we ensure that this shift maximises learning. The purpose of this article is to understand the authentic learning experience in an interprofessional outpatient clinic setting. We performed an exploratory case study with interviews of four nursing students, 13 medical students, and six staff members who worked in an interprofessional outpatient orthopaedic clinic from March 2015 to January 2016. The interviews were transcribed and analysed using systematic text condensation. The students’ self-reported learning experience in this outpatient clinic was characterised by direct patient contact and by authentic, interprofessional, task-based learning, and a preference for indirect supervision when conducting uncomplicated patient consultations. The supervisors intended to create this interprofessional outpatient clinic experience by having a clear teaching approach based on adult learning principles in a safe and challenging learning environment. The shift to the outpatient setting was strongly and practically supported by the management. This study indicates that student learning can be shifted to the outpatient clinic setting if there is supportive management and dedicated supervisors who establish a challenging yet safe interprofessional learning environment.     

The team builder: the role of nurses facilitating interprofessional student teams at a Swedish clinical training ward

Interprofessional education (IPE) is an educational strategy attracting increased interest as a method to train future health care professionals. One example of IPE is the clinical training ward, where students from different health care professions practice together. At these wards the students work in teams with the support of facilitators. The professional composition of the team of facilitators usually corresponds to that of the students. However, previous studies have revealed that nurse facilitators are often in the majority, responsible for student nurses' profession specific facilitation as well as interprofessional team orientated facilitation. The objective of this study was to describe how nurses act when facilitating interprofessional student teams at a clinical training ward. The research design was ethnography and data were collected through participant observations and interviews. The analysis revealed the four strategies used when facilitating teams of interprofessional students to enhance collaborative work and professional understanding. The nurse facilitator as a team builder is a new and exciting role for nurses taking on the responsibility of facilitating interprofessional student teams. Future research needs to explore how facilitating nurses balance profession specific and team oriented facilitating within the environment of an interprofessional learning context.     

Interprofessional education in a student-led emergency department: A realist evaluation

ABSTRACT

This article reports a realist evaluation undertaken to identify factors that facilitated or hindered the successful implementation of interprofessional clinical training for undergraduate students in an emergency department. A realist evaluation provides a framework for understanding how the context and underlying mechanisms affect the outcome patterns of an intervention. The researchers gathered both qualitative and quantitative data from internal documents, semi-structured interviews, observations, and questionnaires to study what worked, for whom, and under what circumstances in this specific interprofessional setting. The study participants were medical, nursing, and physiotherapy students, their supervisors, and two members of the emergency department’s management staff. The data analysis indicated that the emergency ward provided an excellent environment for interprofessional education (IPE), as attested by the students, supervisors, and the clinical managers. An essential prerequisite is that the students have obtained adequate skills to work independently. Exemplary conditions for IPE to work well in an emergency department demand the continuity of effective and encouraging supervision throughout the training period and supervisors who are knowledgeable about developing a team.     

The development of a model of education for casual academic staff who support nursing students in practice

Nursing is predominantly a practice based profession where clinical placement for pre-registration nursing students is a significant component of their programme, as this is pivotal in achieving work readiness of the graduate registered nurse. It is therefore important to ensure nursing students have high quality clinical placements that are supervised by well-prepared experienced registered nurses. This paper discusses one component of the reconnaissance phase of a wider action research project being undertaken in a metropolitan university in NSW, Australia seeking to enhance the development and support of casual academic staff known as clinical supervisors who support students in clinical placement. The outcomes attributed to this project are the development of a participation model which has resulted in a collaborative partnership between the university and clinical supervisors and secondly, the embedding of solution focused ways of working and practice development into the program. The information from the reconnaissance phase of this project confirms the need for further research into the implementation of the participatory model to ensure that future education and support process are developed through collaboration.     

Interprofessional learning for pre-qualification health care students: an outcomes-based evaluation

Within health, it is widely acknowledged that a collaborative, team-oriented approach to care is required to ensure patient safety and quality of service delivery. A pre-qualification interprofessional learning experience should provide an ideal opportunity for students to gain the necessary knowledge, skills and attitudes to enable them to work as part of a patient-centred interprofessional team. In this article we report a multidimensional evaluation of a pre-qualification interprofessional learning (IPL) program. The program brings together senior year students from various health care professions on clinical placement in the same service area of a hospital to take part in shared, structured learning experiences centred on interprofessional teamwork. We used a combination of qualitative and quantitative methods to evaluate the IPL program. Results indicate that students' understanding of the roles of other team members was enhanced, and students and supervisors perceived the program to be of value for student learning. Measured changes in attitude were limited. Unexpected findings emerged in relation to role responsibilities within teams and attitudes towards doctors. We conclude that such programs have the potential to expand students' understanding of the contributions made by other professionals/colleagues to effective patient care, although challenges persist in overcoming pre-existing role stereotypes.     

Utilization of research methodology in designing and developing an interdisciplinary course in ethics

Within health, it is widely acknowledged that a collaborative, team-oriented approach to care is required to ensure patient safety and quality of service delivery. A pre-qualification interprofessional learning experience should provide an ideal opportunity for students to gain the necessary knowledge, skills and attitudes to enable them to work as part of a patient-centred interprofessional team. In this article we report a multidimensional evaluation of a pre-qualification interprofessional learning (IPL) program. The program brings together senior year students from various health care professions on clinical placement in the same service area of a hospital to take part in shared, structured learning experiences centred on interprofessional teamwork. We used a combination of qualitative and quantitative methods to evaluate the IPL program. Results indicate that students' understanding of the roles of other team members was enhanced, and students and supervisors perceived the program to be of value for student learning. Measured changes in attitude were limited. Unexpected findings emerged in relation to role responsibilities within teams and attitudes towards doctors. We conclude that such programs have the potential to expand students' understanding of the contributions made by other professionals/colleagues to effective patient care, although challenges persist in overcoming pre-existing role stereotypes.     

Interprofessional student groups using patient documentation to facilitate interprofessional collaboration in clinical practice – A field study

BackgroundThis article explores and provides insights into how students learn interprofessional collaboration in a clinical placement. This topic is of interest for stakeholders in health services and education and for the research field of interprofessional education.ObjectivesHow patient documentation facilitates collaboration in interprofessional student groups is explored.DesignThis study uses qualitative research with an ethnographic design.SettingsThis research studies interprofessional education at a Norwegian university.ParticipantsThree student groups that participated in a two-week interprofessional clinical placement in a geriatric rehabilitation ward were studied, which comprised students of medicine, nursing, occupational therapy and physiotherapy.MethodsData were generated through observational studies and informal conversations with the students in interprofessional placement and consists of written field notes and transcribed audio-recorded conversations. The analysis drew on concepts from practice theory related to the social practices of learning.ResultsThe students creatively and dynamically used a narrative note in the electronic patient record system in the ward to create an overview of care and ensure continuity of care for the patients for whom they were responsible. By using the narrative note in the record, the students aimed to develop a comprehensive understanding of their patients' clinical situations and care needs. When new information was entered in the note, information already written by individual students and student pairs was reviewed by all students, revised and mutually refined. As a result, multidimensional representations of the patients' health statuses and care needs emerged, including how the patients responded to the students' suggested interventions.ConclusionsPatient documentation can be a tool for stimulating interprofessional collaboration when students are allowed to organize patient care independently. We suggest that students' natural meaning-seeking capability is a hidden resource that can be exploited in interprofessional education.     

Student engagement in interprofessional working in practice placement settings

Aim. To investigate the nature of student engagement in interprofessional interaction while on placement. Background. Due to continuing emphasis on improving interprofessional collaboration, UK educational establishments are required to offer prequalifying health and social care students interprofessional education in order that they acquire relevant competencies. However, few formal interprofessional education initiatives occur in practice settings and little is known about prequalifying students’ non‐formal learning about interprofessional issues while on placement. Design. From 2003–2005 an English Faculty of Health and Social Care conducted a qualitative study to explore opportunities for interprofessional learning and working available to students in practice placement settings. Methods. Case studies were conducted in a coronary care ward, a medical ward for older patients, a maternity unit, a paediatric unit, an integrated community learning disabilities team and a residential facility for adults with challenging behaviour. Gaining access was complex, due to variable student timetables and UK research governance requirements. Sites were therefore selected according to geographical area and timing of student placements. Details of interprofessional interaction (formal and informal) were observed and recorded. Interviews were conducted with a convenience sample of 20 practitioners and 15 students. Data were analysed thematically. Results. Student experience varied considerably. Contributing factors included the influence of doctors and differing professional cultures; mentors’ support for student engagement in interprofessional working; and individual students’ confidence levels. Most sites were managed by nurses and some senior nurses were proactive in involving students interprofessionally. However, many students lacked systematic support for interprofessional engagement. Conclusions. Students lack parity of experience concerning interprofessional activity on placement. Where they do not have systematic support, their engagement depends mainly on their own confidence. Relevance to clinical practice. Senior nurses are ideally placed to promote environments where students can develop interprofessional competencies through systematic interprofessional engagement.     

A pilot interprofessional program to promote oral health and wellness in Appalachian children

In a first of its kind authentic clinical interprofessional education (IPE) experience, University of Kentucky (UK) health profession students joined dental students to implement a pilot program to promote oral health and wellness with children living in underserved Appalachian communities. Known as hCATS (Health Colleges Advancing Team Skills) to Appalachia, a total of 113 students participated in interprofessional teams of 48 health profession students paired with 65 dentistry students to provide health services. Although the UK College of Dentistry has provided sealant services (tooth decay prevention) to elementary school children for several decades in eastern Kentucky counties, funding through the UK Women and Philanthropy Network allowed services to expand to include general health screening and age-appropriate education on oral health, nutrition, exercise, and prevention of substance abuse. The UK Center for Interprofessional Health Education (CIHE) coordinated the efforts for students from the colleges of Communication and Information Sciences, Health Sciences, Nursing, Pharmacy, Public Health, and Social Work. In addition to the clinical experience in the elementary schools, nursing and other health profession students explored the health resources of the communities visited and reflected on their experience in collaborative practice that the program was designed to encourage. The authors noted positive outcomes with interprofessional education competencies, although more structure for collaboration is required to ensure students who work with other professions in an authentic clinical setting can gain early relevant practice in, and experience the benefits of, collaborative patient care.     

Evaluation of an interprofessional practice placement in a UK in-patient palliative care unit

This paper reports on undergraduate students' evaluation of a new hospice-based interprofessional practice placement (IPP) that took place in the voluntary sector from 2008 to 2009. Ward-based interprofessional training has been successfully demonstrated in a range of clinical environments. However, the multidisciplinary setting within a hospice in-patient unit offered a new opportunity for interprofessional learning. The development and delivery of the IPP initiative is described, whereby multidisciplinary groups of 12 students provided hands-on care for a selected group of patients, under the supervision of trained health care professionals. The placement was positively evaluated and students reported an increased understanding of both their own role and that of other professionals in the team. The evaluation also suggests that additional learning opportunities were provided by the in-patient palliative care unit. The results of this evaluation suggest that the in-patient unit of a hospice caring for patients with life-limiting illness provides a suitable environment to demonstrate and learn about interprofessional practice.     

Fluctuations in the emotional intelligence of therapy students during clinical placements: Implication for educators,supervisors, and students

This study investigated the changes in emotional intelligence (EI) of occupational therapy, physiotherapy, and speech pathology students (therapy students). Clinical placements have multiple benefits including the development of interprofessional skills, enhancing practice skills and interpersonal skills. Higher EI competencies have been shown to have a positive impact on patient outcomes, teamwork skills, dealing with stress, and patient satisfaction. Data for this study were collected at two time points: before third-year therapy students commenced extended clinical placements (T1 with 261 students) and approximately 7 months later after students had completed one or more clinical placements (T2 with 109 students). EI was measured using the Emotional Quotient Inventory 2.0 (EQ-i^2.0). Only one EI score, assertiveness, demonstrated a significant decline. No EI score showed a significant increase. A third or more of the students showed increases of five points or more in self-actualisation, emotional expression, independence, reality testing and optimism. However, of concern were the five EI scores where therapy students’ EI scores decreased by more than five points: assertiveness (where 38% of students declined), problem solving (37%), impulse control (35%), self-actualisation (35%), and stress tolerance (33%). With EI scores declining for some students during clinical placements, there are implications for clinical supervisors and interprofessional facilitators as clinical performance may decline concurrently. There is a range of potential reasons that clinical placements could negatively influence the EI competencies of a therapy student, including poor clinical supervision, conflict between a student, and supervisor and failing a clinical placement. The research suggests that interprofessional facilitators and university educators might consider students undertaking EI tests before clinical placements.     

Perceptions of an international interprofessional education experience: Findings from students based in Europe and North America

The globalisation of healthcare is changing the demands placed on health professionals. It requires different skills and thought processes across national borders. Thinking in an innovative manner may provide healthcare workers with some of the necessary tools to facilitate international change by increasing students’ mental flexibility and ability to apply solutions in multiple contexts. We created the International Innovation Program for health profession education students to learn about and implement the innovation process. The programme provides students the opportunity to learn in interprofessional, international teams and apply didactic knowledge to community problems using the innovation process. The purpose of this article is to describe student perceptions across 4 years of programme implementation. Through analysis of closed-ended survey data, we found that students who participated in the programme reported improvements in collaboration and teamwork, project management, interprofessional teamwork, professional growth and development, thinking in an innovative manner, research and development skills, information seeking, and willingness to work on international projects. Analysis of the open-ended questions revealed five themes: language, teamwork and collaboration, cultural awareness, innovation process, and personal growth and self-improvement. The long-term, follow-up data indicate that these attributes can be transferred into a clinical context which have implications for improved collaboration and patient care.     

A passage to interprofessional learning: the benefits to students from an educational visit to India

An educational visit was made by a group of students representing all eight professional pathways on an interprofessional learning programme in health and social care at Canterbury Christ Church University to a hospital in Kerala, India. Interprofessional clinical supervision groups were organised in order to support the students, many of whom had little experience of foreign travel, in an environment they were anticipated to find emotionally challenging. At the close of the visit, following informal observation of a degree of interprofessional learning that had not been anticipated, qualitative data were collected by means of an opportunistically administered questionnaire that yielded insights into the quality of the learning – cultural, interprofessional and personal – that had resulted. This data indicated multiple benefits, some quite unexpected, for all involved; the aim of this paper is to present and discuss these. There are significant implications for health and social care education, including the value of international visits and interprofessional clinical supervision.     

Challenges in postgraduate research supervision in nursing education: Integrative review

AimThe aim of this study was to investigate challenges associated with postgraduate research supervision in nursing education and possible implications for improvement efforts.BackgroundPostgraduate research-based programs in nursing education are particularly new compared to other professions. Anecdotal notes from nursing education stakeholders indicate that postgraduate research supervision encounters numerous challenges, with negative consequences for the nursing profession and for society.MethodIntegrative review that combines empirical and theoretical evidence was used to obtain a comprehensive picture of challenges in the supervision of postgraduate research.Data sourcesEBSCOhost; Science Direct; Google Scholar.Review methodsThe quality of included studies was appraised using the Mixed Method Appraisal Tool for quantitative, qualitative and mixed-method studies. Two reviewers extracted data and did quality appraisal.AnalysisInductive content analysis was used to analyse extracted data from included studies.ResultsSeven studies were included. Three main categories of challenges associated with (a) institutional context, (b) research supervisors, and (c) postgraduate students.DiscussionInstitutional context challenges were lack of clear guidelines for nursing schools, limited pool of appropriate research supervisors, and recruitment of many postgraduate students leading to mismatch, confusion and limited support. Research supervisors are insufficiently prepared, predominantly use traditional face-to-face method, and provide inconsistent feedback. Postgraduate students are inadequately prepared and are mostly full-time employed.ConclusionMany challenges continue to beset postgraduate research supervision in nursing discipline, with negative consequences for the quality of graduates and the quality of their research output.The implication for nursing policyTo generate useful knowledge and increase the number of motivated nursing scholars, challenges associated with postgraduate research supervision need to be addressed, with emphasis on formal training for research supervisors and development of clear guidelines for postgraduate research supervision and for recruitment of postgraduate students.     

Interprofessional education and practice guide No. 5: Interprofessional teaching for prequalification students in clinical settings

The importance of interprofessional education in health professions training is increasingly recognised through new accreditation guidelines. Clinician teachers from different professions may find themselves being asked to teach or supervise learners from multiple health professions, focusing on interprofessional dynamics, interprofessional communication, role understanding, and the values and ethics of collaboration. Clinician teachers often feel prepared to teach learners from their own profession but may feel ill prepared to teach learners from other professions. In this guide, we draw upon the collective experience from two countries: an institution from the United States with experience in guiding faculty to teach in a student-run interprofessional clinic and an institution from Canada that offers interprofessional experiences to students in community and hospital settings. This guide offers teaching advice to clinician educators in all health professions who plan to or already teach in an interprofessional clinical setting. We anticipate that clinician teachers can learn to fully engage learners from different professions, precept effectively, recognise common pitfalls, increase their confidence, reflect, and become role models to deliver effective teaching in interprofessional settings.     

A mixed-methods evaluation of an interprofessional clinical education model serving students,faculty, and the community

ABSTRACT

The clinical learning environment significantly affects students’ preparedness to enter practice. Nursing programs may struggle securing relevant clinical sites necessary for student learning and meeting accreditation standards. Programs must be creative in developing community-based experiences that facilitate students’ learning. However, authentic interprofessional practice is often missing. We evaluated how an interprofessional clinical education model provided preventive health services through a faculty-student-led clinic and delivered an effective avenue to educate health profession students while serving the community. The model was implemented as a pilot project over the course of one semester. We used mixed-methods to analyze data from pre/post-instruments and focus groups to gain a comprehensive understanding of the effect of the model on students, faculty, and the community. Student growth in interprofessional competencies, measured with the Interprofessional Education Collaborative Self-Assessment Tool and the Interprofessional Socialization and Valuing Scale, indicates significant difference pre/post-participation. Four themes were identified from the focus groups highlighting the impact of the clinical education model: interprofessional teamwork, an unorthodox learning environment, delivery of primary and secondary prevention in the community, and reaching underserved populations. This clinical education model has promising utility in providing an interprofessional clinical learning environment while serving the community.     

Are nurses recognised,prepared and supported to teach nursing students: Mixed methods study

BackgroundThe requirement for clinical teaching and supervision of undergraduate nursing students is a continual high volume, high impact essential requirement of registered nursing staff. Nurses are integral in facilitating the learning of nursing students in the practice environment to deliver quality safe care. However nurses engaged in teaching and supervising nursing students have unique challenges.ObjectiveTo understand how well recognised, prepared, and supported nurses perceive they are to teach and supervise undergraduate nursing students in the practice environment?MethodsNurses from 12 different wards of two hospitals were invited to participate in the study. A sequential mixed methods approach comprising hard-copy questionnaires, completed by 59 nurses, and six focus groups. Four feedback sessions verified findings.ResultsA low level of recognition and support for the amount of time available to nurses to teach and supervise was reported from both survey and focus group data. Four themes emerged from focus groups. Nurses recognised their role to teach and supervise students; The role in teaching and supervision was not recognised at a system level; Nurses could be more prepared to teach and supervise students; and Nurses required more support for their role in teaching and supervising students. A major challenge was the low level of support nurses perceived from the education sector in preparing students for placements. The nurses reported a disconnection of components of the student placement system, which was difficult to negotiate when undertaking this teaching and supervision role.ConclusionThe complex practice environment, where nursing student numbers are increasing and nurses have to navigate an often disconnected student placement system, requires a rethink of the precentorship or buddy one-to-one model of clinical placement. Addressing these challenges will be an essential step in protecting the interests of the public, nurses and nursing profession.     

Healthcare students as innovative partners in the development of future healthcare services: An action research approach

BackgroundHealth care systems in Norway and the western world have experienced extensive changes due to patients living longer with complex conditions that require coordinated care. A Norwegian healthcare reform has led to significant restructuring in service delivery as a devolution of services to municipalities.Action Research DesignPartners from three rural healthcare services, students from four professional programmes, and one lecturer from each of the professional programmes used a collaborative approach to obtain new knowledge through interprofessional practice. Using an action research design, the research group facilitated democratic processes through dialogues with healthcare services and students. The design is visualised as a cyclical process in which each cycle contributes to improvements, innovations, and increased understanding. A total of 32 students and 3 supervisors were interviewed before and after the clinical practice experiences. Fieldwork was conducted during three clinical periods.FindingsInterprofessional student groups formed small healthcare teams and assessed patients with chronic and long-term conditions. Students prepared and negotiated patient follow-up. The teams' responsibilities led to reflective practices that enhanced their professional knowledge. The teams achieved a new understanding of patient situations, which influenced “second opinions” for patients with complex conditions and led to innovative practices. The change in perception of patient needs led to a changed professional approach. The students' perceptions changed as they learned from and about each other and in collaboration with the health service; this led to more coordinated care of patients with complex conditions. Interprofessional learning in community settings provided a platform to improve both healthcare education and rural healthcare services.ConclusionThis research contributes to knowledge of how students' placement in interprofessional teams can enhance students learning from, with and about each other. The student teams promoted new ways of approaching and delivering complex patient treatment and care in community healthcare service. Collaborative partnerships in interprofessional learning have potential in the wider international arena as a means for practice improvement.