Interprofessional attitudes amongst undergraduate students in the health professions: a longitudinal questionnaire survey

Background

Interprofessional education (IPE) introduced at the beginning of pre-registration training for healthcare professionals attempts to prevent the formation of negative interprofessional attitudes which may hamper future interprofessional collaboration. However, the potential for IPE depends, to some extent, on the readiness of healthcare students to learn together.

Objectives

To measure changes in readiness for interprofessional learning, professional identification, and amount of contact between students of different professional groups; and to examine the influence of professional group, student characteristics and an IPE course on these scores over time.

Design

Annual longitudinal panel questionnaire survey at four time-points of pre-registration students (n = 1683) drawn from eight healthcare groups from three higher education institutions (HEIs) in the UK.

Results

The strength of professional identity in all professional groups was high on entry to university but it declined significantly over time for some disciplines. Similarly students’ readiness for interprofessional learning was high at entry but declined significantly over time for all groups, with the exception of nursing students. A small but significant positive relationship between professional identity and readiness for interprofessional learning was maintained over time. There was very minimal contact between students from different disciplines during their professional education programme. Students who reported gaining the least from an IPE course suffered the most dramatic drop in their readiness for interprofessional learning in the following and subsequent years; however, these students also had the lowest expectations of an IPE course on entry to their programme of study.

Conclusion

The findings provide support for introducing IPE at the start of the healthcare students’ professional education to capitalise on students’ readiness for interprofessional learning and professional identities, which appear to be well formed from the start. However, this study suggests that students who enter with negative attitudes towards interprofessional learning may gain the least from IPE courses and that an unrewarding experience of such courses may further reinforce their negative attitudes.     

E-Learning with virtual teammates: A novel approach to interprofessional education

Abstract

The Institute of Medicine identified interprofessional education (IPE) as a key innovation for achieving the triple aim of better care, better outcomes, and reduced healthcare costs. Yet, a shortage of qualified faculty and difficulty with aligning learners’ schedules often prevent sustainable and scalable IPE. A virtual IPE intervention was developed to circumvent these barriers and compared to a blended-learning IPE intervention. We used a pre-test and post-test design with two comparison interventions to test the effects of these IPE interventions on changes in teamwork knowledge, skills, and attitudes. The interventions were delivered to pre-licensure learners at a large, metropolitan medical and a nursing school. We used one-sample and independent-sample t-tests to analyze data from 220 learners who received the blended-learning intervention in 2011 and 540 learners who received the virtual learning intervention in 2012. The students in the blended-learning intervention did not significantly (p?<?0.05) outperform the students in the virtual learning intervention for any of the measured outcomes, except for medical students’ attitudes around team value. Virtual IPE learning is an effective, scalable, and sustainable solution for imparting foundational teamwork knowledge in health profession students.     

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

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

Beginning the process of teamwork: Design,implementation and evaluation of an inter-professional education intervention for first year undergraduate students

An evidence-based interprofessional educational (IPE) intervention involving first year undergraduate students studying medicine, nursing, physiotherapy and occupational therapy was piloted at the University of Liverpool. Campbell's phased approach and Complexity Theory guided development of the intervention and its evaluation. The intervention included a staff-training programme, e-learning materials and interprofessional team working skills workshops. A multi method study design was used to evaluate outcomes and the processes by which the outcomes had transpired. The first year cohort of students (n?=?442) was invited to attend the pilots. Fifty-four per cent (n?=?237) opted to attend. Findings showed that the intervention promoted theoretical learning about team working. It enabled the students to learn with and from each other (p?<?0.001), it significantly raised awareness about collaborative practice (p?<?0.05), and its link to improving the effectiveness of care delivery (p?<?0.01). The qualitative data showed that it served to increase students' confidence in their own professional identity and helped them to value difference making them better prepared for clinical placement. The findings support the need to start IPE early in students' training before professional doctrines have been built into their learning. As a result of the findings, the intervention has become compulsory for students to attend and the project has evolved to include trained service users/carers as co-facilitators of the workshops. It is also working on strengthening e-learning by integrating the generic materials into the curricula of all courses. Alongside this, strategies are being explored for interprofessional learning in practice.     

Prior experience of interprofessional learning enhances undergraduate nursing and healthcare students' professional identity and attitudes to teamwork

BackgroundHow willing are today's medical, nursing and other healthcare students to undertake some of their studies as shared learning? There is a lack of evidence of students' views by discipline despite this being a priority task for higher education sectors. This study explored the views of nursing, midwifery, nursing-emergency health (paramedic), medical, physiotherapy and nutrition–dietetics students.MethodsSenior undergraduate students from six disciplines at one university completed the Readiness for Interprofessional Learning Scale prior to participating in interprofessional clinical learning modules.ResultsFor 741 students, the highest ranked response was agreement about a need for teamwork (mean 4.42 of 5 points). Nursing students held significantly more positive attitudes towards Teamwork/Collaboration, and were more positive about Professional Identity than medical students (p < .001). Midwifery and nursing-emergency-health students rejected uncertainty about Roles/Responsibilities compared with medical students (p < .001). One-third of all students who had prior experience of interprofessional learning held more positive attitudes in each of four attitude domains (p < .05).ConclusionOverall, students' attitudes towards interprofessional learning were positive and all student groups were willing to engage in learning interprofessionally. Early introduction of IPL is recommended. Further studies should explore the trajectory of students' attitudes throughout the university degree.     

Evaluation of a caregiver education program to support memory and communication in dementia: a controlled pretest-posttest study with nursing home staff

Background

There is a need for simple multimedia training programs designed to upskill the dementia care workforce. A DVD-based training program entitled RECAPS and MESSAGE has been designed to provide caregivers with strategies to support memory and communication in people with dementia.

Objectives

The aims of this study were: (1) to evaluate the effects of the RECAPS and MESSAGE training on knowledge of support strategies, and caregiver satisfaction, in nursing home care staff, and (2) to evaluate staff opinion of the training.

Design

A multi-centre controlled pretest–posttest trial was conducted between June 2009 and January 2010, with baseline, immediately post-training and 3-month follow-up assessment.

Setting

Four nursing homes in Queensland, Australia.

Participants

All care staff were invited to participate. Of the 68 participants who entered the study, 52 (37 training participants and 15 controls) completed outcome measures at baseline and 3-month follow-up. 63.5% of participants were nursing assistants, 25% were qualified nurses and 11.5% were recreational/activities officers.

Methods

The training and control groups were compared on the following outcomes: (1) knowledge of memory and communication support strategies, and (2) caregiver satisfaction. In the training group, the immediate effects of training on knowledge, and the effects of role (nurse, nursing assistant, recreational staff) on both outcome measures, were also examined. Staff opinion of the training was assessed immediately post-training and at 3-month follow-up.

Results

The training group showed a significant improvement in knowledge of support strategies from baseline to immediately post-training (p = 0.001). Comparison of the training and control groups revealed a significant increase in knowledge for the training group (p = 0.011), but not for the control group (p = 0.33), between baseline and 3-month follow-up. Examination of caregiver satisfaction by care staff role in the training group revealed that only the qualified nurses showed higher levels of caregiver satisfaction at 3-month follow-up (p = 0.013). Staff rated the training positively both for usefulness and applicability.

Conclusion

The RECAPS and MESSAGE training improved nursing home care staff's knowledge of support strategies for memory and communication, and gains were maintained at 3-month follow-up. Moreover, the training was well received by staff.     

Decreased small dense LDL levels in Gilbert's syndrome

Objective

To investigate the role of small dense low density lipoprotein cholesterol (sd-LDL-C) in the mechanism of decreased incidence of cardiovascular disease in Gilbert's syndrome (GS).

Design and methods

sd-LDL-C, ox-LDL, and high sensitive C reactive protein (hs-CRP) levels were investigated in subjects with GS (n = 42) and compared to healthy controls (n = 52).

Results

Age, gender and body mass index (BMI) distributions were similar between the two groups. sd-LDL-C, ox-LDL and hs-CRP levels were lower in GS than the healthy controls (p < 0.001, p < 0.001 and p = 0.001, respectively). Unconjugated bilirubin was negatively correlated with sd-LDL-C, ox-LDL and hs-CRP (r = −0.594, p < 0.001; r = −0.249, p = 0.016 and r = − 0.373, p < 0.001 respectively). In addition, sd-LDL-C was positively correlated with ox-LDL (r = 0.307, p = 0.003).

Conclusions

The findings of this preliminary study suggest that reduced sd-LDL-C, ox-LDL and hs-CRP levels may have a role in preventing atherosclerosis in subjects with GS.     

A longitudinal analysis of bibliometric and impact factor trends among the core international journals of nursing, 1977–2008

Background

Although bibliometric analysis affords significant insight into the progression and distribution of information within a particular research field, detailed longitudinal studies of this type are rare within the field of nursing.

Objectives

This study aimed to investigate, from a bibliometric perspective, the progression and trends of core international nursing journals over the longest possible time period.

Methods

A detailed bibliometric analysis was undertaken among 7 core international nursing periodicals using custom historical data sourced from the Thomson Reuters Journal Citation Reports^®.

Results

In the 32 years between 1977 and 2008, the number of citations received by these 7 journals increased over 700%. A sustained and statistically significant (p < 0.001) 3-fold increase was also observed in the average impact factor score during this period. Statistical analysis revealed that all periodicals experienced significant (p < 0.001) improvements in their impact factors over time, with gains ranging from approximately 2- to 78-fold.

Conclusions

Overall, this study provides one of the most comprehensive, longitudinal bibliometric analyses ever conducted in the field of nursing. Impressive and continual impact factor gains suggest that published nursing research is being increasingly seen, heard and cited in the international academic community.     

The effectiveness of interactive computer assisted instruction compared to videotaped instruction for teaching nurses to assess neurological function of stroke patients: A randomized controlled trial

Background

Teaching inexperienced nurses to assess neurologic function of acute ischemic stroke patients poses challenges to educators in Taiwan.

Objectives

The purpose of this study was to examine the effectiveness of two programs that teach nurses the use of the Chinese version of the National Institute of Health Stroke Scale (C-NIHSS), and to evaluate the level of learner satisfaction with these teaching programs.

Design

An experimental research design with two groups, one pre-test and two post-tests was utilized.

Setting

Six neurology and neurosurgery wards at two hospitals in southern Taiwan.

Participants

Participating nurses were stratified based on their clinical level of experience and prior training on the National Institute of Health Stroke Scale (NIHSS). They were randomly assigned to either the experimental C-NIHSS interactive computer assisted instruction (ICAI) group (n = 44) or the Instructor-led videotape learning program (IVLP) group (n = 40) to learn the C-NIHSS.

Methods

The measurement tools included the score verification unit (SVU) (score range from 0 to 45, content validity index, CVI = 0.96, percentage agreement = 84%) and the learner satisfaction scale (CVI = 0.92, Cronbach's alpha = 0.97).

Results

Both groups’ scores on the assessment of correctness significantly increased (F = 35.50, p = 0.00) after intervention. However, there was an insignificant difference between the changes in the two groups (F = 0.02, p = 0.89). After using one-way ANCOVA analysis, and adjusting for the length of experience in neurological nursing, the results showed that in the second post-test, the ICAI group's score was significantly higher than that of the IVLP group (F = 4.81, p = 0.03). There was a positive correlation between assessment correctness on the second post-test and length of experience in neurological nursing (r = 0.35, p < 0.05). It was concluded that nurses with less experience in neurological nursing, who receive ICAI will perform a better assessment of stroke patients than those who received IVLP.

Conclusion

The C-NIHSS ICAI teaching program contributed to better assessment correctness after adjusting for the length of experience in neurological nursing, and to some extent increased satisfaction for the participating nurses. Therefore it is worth promoting the use of ICAI for in-service education of nurses, especially for nurses with less experience in neurological nursing, in order to enhance long-term effects of learning.     

Successful learning of surgical liver anatomy in a computer-based teaching module

Aim

To analyze factors influencing the learning of surgical liver anatomy in a computer-based teaching module (TM).

Methods

Medical students in their third to fifth year of training (N \(=\) 410) participated in three randomized trials, each with a different primary hypothesis, comparing two- (2D) and three-dimensional (3D) presentation modes in a TM for surgical liver anatomy. Computed tomography images were presented according to the study and allocation group. Students had to answer eleven questions on surgical liver anatomy and four evaluative questions. Scores and time taken to answer the questions were automatically recorded. Since the three studies used the same 15 questions in the TM, a pooled analysis was performed to compare learning factors across studies.

Results

3D groups had higher scores (7.5 ± 1.7 vs. 5.6 ± 2.0; p < 0.001) and needed less time (503.5 ± 187.4 vs. 603.1 ± 246.7 s; p < 0.001) than 2D groups. Intensive training improved scores in 2D (p < 0.001). Men gave more correct answers than women, independent of presentation mode (7.2 ± 2.0 vs. 6.5 ± 2.1; p \(=\) 0.003). An overall association was found between having fun and higher scores in 11 anatomical questions (p < 0.001). In subgroup analysis, 3D groups had more fun than 2D groups (84.7 vs. 65.1 %; p < 0.001). If given the option, more students in the 2D groups (58.9 %) would have preferred a 3D presentation than students in the 3D group (35.9 %) would have preferred 2D (p  < 0.001).

Conclusion

3D was superior to 2D for learning of surgical liver anatomy. With training 2D showed similar results. Fun and gender were relevant factors for learning success.

     

Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: a randomised controlled trial

Objectives

To evaluate the impact of video-based interactive crisis resource management (CRM) training on no-flow time (NFT) and on proportions of team member verbalisations (TMV) during simulated cardiopulmonary resuscitation (CPR). Further, to investigate the link between team leader verbalisation accuracy and NFT.

Methods

The randomised controlled study was embedded in the obligatory advanced life support (ALS) course for final-year medical students. Students (176; 25.35 ± 1.03 years, 63% female) were alphabetically assigned to 44 four-person teams that were then randomly (computer-generated) assigned to either CRM intervention (n = 26), receiving interactive video-based CRM-training, or to control intervention (n = 18), receiving an additional ALS-training. Primary outcomes were NFT and proportions of TMV, which were subdivided into eight categories: four team leader verbalisations (TLV) with different accuracy levels and four follower verbalisation categories (FV). Measurements were made of all groups administering simulated adult CPR.

Results

NFT rates were significantly lower in the CRM-training group (31.4 ± 6.1% vs. 36.3 ± 6.6%, p = 0.014). Proportions of all TLV categories were higher in the CRM-training group (p < 0.001). Differences in FV were only found for one category (unsolicited information) (p = 0.012). The highest correlation with NFT was found for high accuracy TLV (direct orders) (p = 0.06).

Conclusions

The inclusion of CRM training in undergraduate medical education reduces NFT in simulated CPR and improves TLV proportions during simulated CPR. Further research will test how these results translate into clinical performance and patient outcome.     

Evaluating Undergraduate Nursing Students' Attitudes Toward Health Care Teams in the Context of an Interprofessionally-Focused Nursing Course

Background

Nursing students' attitudes related to health care teams in the context of interprofessional education (IPE) and the impact of these attitudes on IPE and future practice are not fully understood.

Quantifying off-hour emergency physician coverage of in-hospital codes: a survey of community emergency departments

Background

Community emergency physicians (EPs) are often required to respond to unstable patients outside of their department during off-hours.

Objective

The primary objective of this study was to describe the critical care responsibility of community EPs outside of their departments.

Methods

A one-page survey was mailed to emergency department (ED) directors of 10 states and Washington, DC.

Results

Three hundred forty of 1169 surveys were returned. The median (interquartile range [IQR]) number of hospital and intensive care unit (ICU) beds was 145 (IQR 60–242) and 11 (IQR 6–20), respectively. Median ED annual volume and ICU admission percentage was reported to be 25 K (IQR 14–40) and 5% (IQR 2–10), respectively. Seventy-six percent of reporting institutions require EPs to leave their department and respond to medical codes on the floors after hours. In 57% of institutions, the EP was the only physician required to respond. In addition, 48% of EPs must respond to unstable patients in the ICUs after hours. Hospitals in which EPs were required to respond to medical codes and unstable ICU patients were more likely to have fewer hospital beds (137 vs. 275; p < 0.001), fewer ICU beds (12 vs. 27; p < 0.001), and have a smaller ED annual volume (24 K vs. 39 K; p < 0.001).

Conclusions

Many community EPs are responsible for covering critically ill patients outside of their ED. Further investigation is required to determine the impact on patient care.     

Development and preliminary testing of a self-rating instrument to measure self-directed learning ability of nursing students

Background

With the growing trend of preparing students for lifelong learning, the theory of self-directed learning (SDL) has been increasingly applied in the context of higher education. In order to foster lifelong learning, abilities among nursing students, faculties need to have an appropriate instrument to measure the SDL abilities of nursing students.

Objectives

The objectives of this study were to develop an instrument to measure the SDL abilities of nursing students and to test the validity and reliability of this instrument.

Methods

This study was conducted in 4 phases. In Phase 1, based on a review of the literature, the researchers developed an instrument to measure SDL. In Phase 2, two rounds of the Delphi study were conducted, to determine the content validity of the instrument. In Phase 3, a convenience sample of 1072 nursing students from two representative schools across three different types of nursing programs were recruited to test the construct validity of the Self-Directed Learning Instrument (SDLI). Finally, in Phase 4, the internal consistency and reliability of the instrument were tested.

Results

The resulting SDLI consists of 20 items across the following four domains: learning motivation, planning and implementing, self-monitoring, and interpersonal, communication. The final model in confirmatory factor analysis revealed that this 20-item SDLI indicated a good fit of the model. The value of Cronbach's α for the total scale was .916 and for the four domains were .801, .861, .785, and .765, respectively.

Conclusions

The SDLI is a valid and reliable instrument for identifying student SDL abilities. It is available to students in nursing and similar medical programs to evaluate their own SDL. This scale may also enable nursing faculty to assess students’ SDL status, design better lesson plans and curricula, and, implement appropriate teaching strategies for nursing students in order to foster the growth of lifelong learning abilities.     

Qualitative and quantitative evaluation of an interprofessional workshop between physical therapy and medical students

ABSTRACT

Interprofessional education (IPE) is an important component of medical education, preparing students for the collaboration necessary for high-quality patient care. This study aimed to compare IPE readiness in pre-qualification physical therapy (PT) and medical (MD) students before and after an interprofessional workshop and identify factors influencing the workshop’s perceived educational value. In two consecutive years, students were surveyed with the Readiness for Interprofessional Learning Scale (RIPLS) following a four-hour, case-based workshop. During the second year, students were also surveyed before the workshop and answered open-ended questions about its educational value. PT and MD students had similar mean pre-workshop RIPLS scores (83.0, SD 5.3 vs. 80.7, SD 7.9; p = .27), but post-workshop scores were higher among PT students (86.3, SD 6.5 vs. 80.3, SD 8.8; p < .001). Qualitative thematic analysis of responses to open-ended questions revealed students valued IPE within the workshop. However, MD students in particular identified improvement opportunities in workshop delivery, timing, and content. These factors undermined the perceived educational value for MD students and may have contributed to their lower post-workshop RIPLS scores. This study suggests that a brief workshop can improve readiness for IPE among pre-professional students and highlights the importance of content, delivery, and timing to IPE success.     

Working together: Using a unique approach to evaluate an interactive and clinic-based longitudinal interprofessional education experience with 13 professions

Interprofessional education (IPE) involving an interactive and longitudinal clinic experience at an inner-city charitable clinic from September to May 2013/2014 was evaluated. Pre-, mid-, and post-intervention data were collected from students in 13 different professions including medicine (medical and physician assistant), dentistry (dental and dental hygiene), nursing (undergraduate and clinical nurse specialist), public health, pharmacy, physical therapy, occupational therapy, nutritional sciences, speech and language pathology, and social work. To evaluate their interprofessional attitudes, students completed the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and Readiness for Interprofessional Learning Scale (RIPLS). They also completed a unique measure, healthcare professionals circles diagrams (HPCDs), that indicated student conceptualisation of a healthcare team caring for a complex patient, along with perception of their team’s progress towards meeting patient goals. Results from the T-TAQ and RIPLS scores indicated small but significant increases from pre- to post-intervention (p = 0.005 and 0.012, respectively). Analysis of the HPCDs revealed significant increases in students’ perceptions of the types of interprofessional team members, relationships, and communication between professions to provide medical care to patients (p < 0.01). Most HPCDs included pharmacists, nurses, and physicians as part of the care team at all time points. Students significantly increased their inclusion of dentistry, public health, social work, and physician assistants as members of the healthcare team from pre- to post-intervention. Implications of our data indicated the importance of IPE interventions that include not only classroom-based sessions, but actual patient care experiences within interprofessional teams. It also reinforced the importance of new and unique methods to assess IPE.     

Comparison of a computer assisted learning program to standard education tools in hospitalized heart failure patients

Background

Education, coaching and guidance of patients are important components of heart failure management.

Aim

The aim of this study was to compare a computer assisted learning (CAL) program with standard education (brochures and oral information from nurses) on knowledge and self-care in hospitalized heart failure patients. Satisfaction with the CAL program was also assessed in the intervention group.

Methods

A quasi-experimental design was used, with a convenience sample of in-hospital heart failure patients. Knowledge and self-care were measured using the Dutch Heart Failure Knowledge Scale and the European Heart Failure Self-care Behaviour Scale at hospital admission, at discharge and after a 3-month follow-up. Satisfaction with the CAL program was assessed at hospital discharge using a satisfaction questionnaire. Within and between groups, changes in knowledge and self-care over time were tested using a mixed regression model.

Results

Of 65 heart failure patients screened, 37 were included in the study: 21 in the CAL group and 16 in the usual care group. No significant differences in knowledge (p = 0.65) or self-care (p = 0.40) could be found between groups. However, both variables improved significantly over time in each study group (p<0.0001).

Conclusions

Both educational strategies increased knowledge and improved self-care. The design did not allow isolation of the effects of standard education usual care from CAL. Economic and clinical outcomes of both methods should be evaluated in further research.     

Increased plasma levels of CATS mRNA but not CATB mRNA in patients with coronary atherosclerosis

Background

We hypothesized that patients with coronary atherosclerosis have increased plasma levels of cathepsin S (CATS) and cathepsin B (CATB) mRNA, the genes that are involved in atherosclerotic plaque development and destabilization.

Methods

mRNAs were isolated from plasma of 67 patients with coronary atherosclerosis (29 with stable angina, 38 with acute coronary syndrome) and 33 healthy subjects as controls, transcribed to cDNA and quantified by real-time PCR.

Results

Plasma levels were successfully measured in all samples. Patients with coronary atherosclerosis had 2.75 times higher plasma levels of CATS mRNA than controls (median 6.10 vs. 2.22; p < 0.001). No difference was observed in CATB mRNA levels (median 5.62 vs. 6.19; p = 0.866). Patients on therapy with statins and aspirin tended to have higher plasma levels of CATS mRNA than patients without statins and aspirin (median 6.41 vs. 4.27; p = 0.028).

Conclusions

Further evaluation of plasma CATS mRNA levels in patients with coronary atherosclerosis is reasonable.