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.     

“Refreshed…reinforced…reflective”: A qualitative exploration of interprofessional education facilitators’ own interprofessional learning and collaborative practice

While there is extensive research examining the outcomes of interprofessional education (IPE) for students, minimal research has investigated how facilitating student learning influences the facilitators themselves. This exploratory case study aimed to explore whether and how facilitating IPE influences facilitators’ own collaborative practice attitudes, knowledge, and workplace behaviours. Sixteen facilitators of an online pre-licensure IPE unit for an Australian university participated in semi-structured telephone interviews. Inductive thematic analysis revealed three emergent themes and associated subthemes characterising participants’ reflexivity as IPE facilitators: interprofessional learning; professional behaviour change; and collaborative practice expertise. Participants experienced interprofessional learning in their role as facilitators, improving their understanding of other professionals’ roles, theoretical and empirical knowledge underlying collaborative practice, and the use and value of online communication. Participants also reported having changed several professional behaviours, including improved interprofessional collaboration with colleagues, a change in care plan focus, a less didactic approach to supervising students and staff, and greater enthusiasm impressing the value of collaborative practice on placement students. Participants reported having acquired their prior interprofessional collaboration expertise via professional experience rather than formal learning opportunities and believed access to formal IPE as learners would aid their continuing professional development. Overall, the outcomes of the IPE experience extended past the intended audience of the student learners and positively impacted on the facilitators as well.     

Interdisciplinary and interprofessional education: what are the key issues and considerations for the future?

The identification of key issues and considerations for interdisciplinary and interprofessional education are explored. Both benefits and barriers to interprofessional education are discussed. The concept of simulation is reviewed relative to interprofessional education primarily as a catalyst for implementation of collaboration. The promise of interprofessional education and outcome studies direct where the future is headed.     

All together now? Staff views and experiences of a pre-qualifying interprofessional curriculum

An interprofessional pre-qualifying curriculum for health and social care professionals was introduced at an English university in September 2000. This study explored the experiences of academic staff from a range of professional backgrounds involved in this interprofessional initiative. Data were collected via questionnaires, individual interviews and focus groups and were analysed using Interpretative Phenomenological Analysis. Sixty-one questionnaires were returned out of a possible two hundred (response rate 30.5%); twenty-nine respondents participated in interviews and focus groups. Four main themes emerged from the data: (i) Huge: Size does matter; (ii) Isolation: Together but separate; (iii) Facilitation: Anything but easy; and (iv) Faculty: Do we walk the talk? The study found a cross-Faculty commitment to interprofessional education, but revealed considerable difficulties for those staff responsible for the management and delivery of the curriculum. The vast scale, the complex nature of interprofessional education delivery, the logistics and organizational challenges created significant difficulties for staff, who could at times feel overwhelmed and isolated. Attitudinal barriers to interprofessional education were identified, although the interprofessional curriculum had enhanced interprofessional working within the Faculty. In order to optimize the success of interprofessional education, the significant challenges that exist for academic staff must be addressed, and ownership by staff enabled.     

A scoping review to understand “leadership” in interprofessional education and practice

This scoping study examined how “leadership” is referred to and used in interprofessional education and practice. A total of 114 refereed articles were reviewed to determine how leadership is defined, conceptualised, and theorised. The review also examined what capabilities were identified for effective interprofessional leadership. The majority of papers were empirical studies undertaken by researchers based in North America. The majority of articles did not refer to a specific leadership approach, nor did they define, describe, or theorise leadership. Moreover, “leadership” capabilities were rarely identified. Articles generally focused on health practitioners and educators or students as leaders with little exploration of leadership at higher levels (e.g. executive, accrediting bodies, government). This review indicates the need for a more critical examination of interprofessional leadership and the capabilities required to lead the changes required in both education and practice settings. The goal of this article is to stimulate discussion and more sophisticated, shared understandings of interprofessional leadership for the professions. Recommendations for future research are required in both education and practice settings.     

Multiprofessional working, interprofessional learning and primary care: a way forward?

Across all sectors of health and social care there is a growing need for collaboration between professionals, agencies, providers and above all with the people they seek to serve.The significant challenge is how to create, within the existing and future workforce, the capability to work in multi professional teams capable of effective collaboration.The intention of this paper is to explore the implications that multi- or more specifically inter-professional learning may have for collaboration within primary care. As part of this, the state of the current evidence base regarding this form of learning will be explored. However, just as this way of learning is but one element in a wider picture of health care, so the focus will also include the implications for a workforce relevant to future primary care.     

The impact of interprofessional collaboration on nurses’ satisfaction and comfort with intranasal fentanyl

BackgroundHealthcare providers’ beliefs and comfort with analgesics can impact medication decisions. Interprofessional educational interventions (IPE) improve medication delivery processes ultimately resulting in better patient care. The purpose of this study was to determine the impact on nurses’ satisfaction and comfort with administering intranasal fentanyl for pediatric pain management in the Emergency Department (ED) before and following IPE.MethodsA protocol for administering intranasal fentanyl for children age 1–15 years with acute pain was introduced to the ED Nursing staff by an educational session conducted by a clinical pharmacist. Nurses’ level of satisfaction and comfort was surveyed prior to and following IPE. Compliance with patient monitoring was determined by chart review.ResultsEighty percentage of the nurses were very satisfied with the analgesic effect of intranasal fentanyl but barriers for its use included personal comfort, nurse monitoring time and age appropriateness. Most nurses felt comfortable administering intranasal fentanyl but showed increased comfort with intravenous morphine (83% versus 98%, p < 0.05). Benefits cited by nurses included having a pharmacist available in the ED to assist in the delivery of intranasal fentanyl.ConclusionThe use of IPE facilitated knowledge sharing to improve nurses’ comfort with administering analgesic medication and the quality of patient care services.     

Bridging the “system's” gap between interprofessional care and patient safety: Sociological insights

This paper is based on the premise that a systemic approach is the crucial link between patient safety and interprofessional care. It is argued that there has been little concern with regard to the need for a critical assessment and development of a systems' theoretical model able to envisage the broad approach of delivery of health care that patient safety initiatives require. Based on a medical sociology approach, the paper analyzes four forces that threaten a well sustained development of research and problem-solving strategic proposals that are to be derived from the intersection of patient safety and interprofessional care, namely: (i) the absence of explicit theoretical models in empirical research work in both fields; (ii) the a-critical acceptance of an ideologically limited biomedical paradigm in the actual systemic definitions of the clinical model; (iii) a fragmentation of the underlying system concept that is unable to include all of the actors of the system; and, (iv) the need to go beyond the non-maleficence principle and include the remaining three bioethical principles in medical care. The paper concludes with the proposal of developing theoretically grounded empirical interprofessional research that allows the crucial inclusion of social sciences in the systemic approach.     

Evaluation of interprofessional relational coordination and patients’ perception of care in outpatient oncology teams

ABSTRACT

This pilot study was designed to measure teamwork and the relationship of teamwork to patient perceptions of care among 63 members of 12 oncology teams at a Cancer Centre in the Midwest. Lack of teamwork in cancer care can result in serious clinical errors, fragmentation of care, and poor quality of care. Many oncology team members, highly skilled in clinical care, are not trained to work effectively as members of a care team. The research team administered the Relational Coordination survey to core oncology team members—medical oncologists, nurse coordinators, and clinical secretaries—to measure seven dimensions of team skills (four relating to communication [frequency, timeliness, accuracy, and problem solving] and three relating to relationship [shared goals, shared knowledge, and mutual respect]) averaged to create a Relational Coordination Index. The results indicated that among the team member roles, nurse coordinator relational coordination indices were the strongest and most positively correlated with patient perception of care. Statistically significant correlations were intra-nurse coordinator relational coordination indices and two patient perception of care factors (information and education and patient’s preferences). All other nurse coordinator intra-role as well as inter-role correlations were also positively correlated, although not statistically significant.     

Measuring changes in pharmacy and nursing students’ perceptions following an interprofessional high-fidelity simulation experience

The purpose of this study was to evaluate the effects of interprofessional high-fidelity simulation-based learning (SBL) on third-year pharmacy and senior nursing students’ perceptions of interprofessional care. Students participated in an interprofessional high-fidelity SBL experience consisting of two hospital-based scenarios followed by a debriefing. The “Student Perceptions of Interprofessional Clinical Education–Revised” (SPICE-R) instrument was administered pre- and post-SBL. The “Student Satisfaction and Self-Confidence in Learning” (SSSCL) instrument, which uses a 5-point Likert scale, was administered post-SBL. A total of 104 (78%) pharmacy and 93 (77%) nursing students completed both the pre- and post-survey instruments. Baseline differences between pharmacy and nursing students included number of clinical hours completed [200 (190–240) vs. 210 (209–210); p < 0.001] and previous/current experiencing working directly with other healthcare professionals [71 (53%) vs. 88 (73%); p < 0.001]. Median score increases were observed for all SPICE-R items (p < 0.01) for pharmacy students and nine of ten SPICE-R items (p < 0.01) for nursing students. All students rated both the experience and their confidence highly on the SSSCL; however, nursing scores were higher than pharmacy scores for 7 of 13 items (p < 0.05). An interprofessional high-fidelity SBL experience increased pharmacy and nursing students’ perceptions of interprofessional care.     

What fosters or prevents interprofessional teamworking in primary and community care? A literature review

BACKGROUND: The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved. OBJECTIVES: This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century. DESIGN: A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods. FINDINGS: Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed. CONCLUSIONS: These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision.     

Factors influencing secondary care pharmacist and nurse independent prescribers’ clinical reasoning: An interprofessional analysis

In the United Kingdom, pharmacist and nurse independent prescribers are responsible for both the clinical assessment of and prescribing for patients. Prescribing is a complex skill that entails the application of knowledge, skills, and clinical reasoning to arrive at a clinically appropriate decision. Decision-making is influenced and informed by many factors. This study, the first of its kind, explores what factors influence pharmacist and nurse independent prescribers during the process of clinical reasoning. A think-aloud methodology immediately followed by a semi-structured interview was conducted with 11 active nurse and 10 pharmacist independent prescribers working in secondary care. Each participant was presented with validated clinical vignettes for the think-aloud stage. Participants chose the clinical therapeutic areas for the vignettes, based on their self-perceived competencies. Data were audio-recorded, transcribed verbatim, and a constant-comparative approach was used for analysis. Influences on clinical reasoning were broadly categorised into themes: social interaction, intrinsic, and contextual factors. These themes showed that intrinsic, sociocultural, and contextual aspects heavily influenced the clinical reasoning processes of prescribers. For example, prescribers were aware of treatment pathways, but chose to refer patient cases to avoid making the final prescribing decision. Exploration of this behaviour in the interviews revealed that previous experience and attitudes such as confidence and cautiousness associated with responsibility were strong influencers within the decision-making process. In addition, strengthening the professional identity of prescribers could be achieved through collaborative work with interprofessional healthcare teams to orient their professional practice from within the profession. Findings from this study can be used to inform the education, training, and practice of independent prescribers to improve healthcare services by improving their professional and interprofessional development.