Teaching and learning activities to educate nursing students for interprofessional collaboration: A scoping review

To prepare new graduates with the knowledge, skills, and attitudes to engage in effective interprofessional collaboration (IPC) in practice, healthcare professional programmes need to ensure their curriculum provides opportunities for interprofessional education (IPE) and IPC. To strengthen IPE within an undergraduate curriculum and meet the professional requirements set out by regulatory bodies to prepare new graduate nurses to achieve IPC competencies, a curriculum initiative was developed to expand IPE across the four years of the Baccalaureate of Science in Nursing (BSN) programme. The purpose of this scoping review was to identify published teaching-learning activities in undergraduate nursing programmes to inform the development and integration of IPE curricula. The literature included was identified by searching the following electronic databases: EMBASE and EBSCO (CINAHL, Medline, Education Research Complete, ERIC). The search was limited to articles with abstracts published between 2008 and 2016 in the English language. All ten studies that met inclusion criteria reported students’ perceived interprofessional education as valuable in facilitating their achievement of IPC competencies. Interprofessional education is an approach for preparing nursing students with knowledge, skills, and attitudes to achieve IPC competencies and therefore, urgently needs to become more prevalent in nursing curricula. Educators can use a variety of IPE teaching-learning activities to support students’ achievement of IPC competencies in order to prepare new practitioners to engage in effective IPC in a variety of healthcare milieus. Nurse educators are encouraged to intentionally integrate learning opportunities into current and future undergraduate nursing education to prepare collaborative ready graduate nurses.     

A strategic initiative to foster interprofessional collaboration: A case report using a men’s healthy living programme

Interprofessional collaboration (IPC) can be challenging, yet it has shown benefits for providers and patients. We examined the existing enablers and barriers to IPC at a local Community Health Center (CHC) and report on the existing types of IPC practice. We also report how implementing a men-sensitive healthy living programme united a team of health professionals/managers in attending to the needs of a population that to date had been largely underserved. A total of 16 employees were interviewed at the CHC. All respondents spoke positively of existing IPC and provided examples of existing collaborative practices. These CHC professionals (clinicians and managers) experienced greater intra- and extra-organisational collaborations as a result of experiencing a community-delivered programme. It also allowed the CHC professionals/managers to rethink the management and structure of collaborative practices and understand the needs and challenges of working with non-traditional partners (men and workplace-based managers). While our findings are context sensitive (case study design), they shed light on how uniting health professionals/managers around a challenging and non-traditional health issue (i.e., improving health in a hard-to-reach population subgroup) can strategically reduce resistance to collaborative practice development by strengthening team cohesion and fostering innovative interactions.     

The impact of interprofessional simulation on readiness for interprofessional learning in health professions students

Healthcare does not occur in a silo and yet healthcare education remains fractured into individual disciplines. This isolated curricular methodology does not represent the intricate interprofessional environment that healthcare providers are required to thrive in post-graduation. Interprofessional Education (IPE) has been identified as a crucial stratagem for creating effective collaborative healthcare teams. The purpose of this research project was to create an interprofessional education (IPE) simulation that represents the current collaborative healthcare practice environment. Medical students, Physicians Assistant's students and Nursing students from different educational institutes participated in a patient simulation using the Situation Background Assessment and Recommendation communication framework (SBAR).The design of this study was a one-group comparative, quasi-experimental, quantitative pilot study. The study employed the Readiness for Interprofessional Learning Scale (RIPLS) in a pre-and-post questionnaire to measure readiness for IPE simulation and student attitudes. Attitude toward collaboration has been found to positively influence care team collaboration, which can positively affect patient outcomes. The sample population (n=45) included the second-year associate degree nursing students, first-year medical students, and first-year physician assistant students. The results of this study indicated that the implementation and participation in an interprofessional communication simulation had a positive effect on readiness and attitudes.     

Setting a research agenda for interprofessional education and collaborative practice in the context of United States health system reform

Interprofessional education (IPE) and collaborative practice (CP) have been prolific areas of inquiry exploring research questions mostly concerned with local program and project assessment. The actual sphere of influence of this research has been limited. Often discussed separately, this article places IPE and CP in the same conceptual space. The interface of these form a nexus where new knowledge creation may be facilitated. Rigorous research on IPE in relation to CP that is relevant to and framed by health system reform in the U.S. is the ultimate research goal of the National Center for Interprofessional Practice and Education at the University of Minnesota. This paper describes the direction and scope for a focused and purposive IPECP research agenda linked to improvement in health outcomes, contextualized by health care reform in the U.S. that has provided a revitalizing energy for this area of inquiry. A research agenda articulates a focus, meaningful and robust questions, and a theory of change within which intervention outcomes are examined. Further, a research agenda identifies the practices the area of inquiry is interested in informing, and the types of study designs and analytic approaches amenable to carrying out the proposed work.     

Observation of interprofessional collaboration in primary care practice: A multiple case study

Interprofessional collaboration (IPC) is known to improve and enhance care for people with complex healthcare and social care needs and is ideally anchored in primary care. Such care is complex, challenging, and often poorly undertaken. In countries such as Canada, the United Kingdom, the Netherlands, Australia, and New Zealand, primary care is provided predominantly via general practices, where groups of general practitioners and nurses typically work. Using a case study design, direct observations were made of interprofessional activity in three diverse general practices in New Zealand to determine how collaboration is achieved and maintained. Non-participant observation of health professional interaction was undertaken and recorded using field notes and video recordings. Observational data were subject to analysis prior to collection of interview data, subsequently gathered independently at each site. Case-specific themes were developed before determining cross-case themes. Cross-case themes revealed five key elements to IPC: the built environment, practice demographics and location, practice business models, shared goals, and team structure and climate. The combination of elements at each practice site indicated that strengths in one area helped offset challenges in others. The three practices (cases) collectively demonstrated the importance of an “all of practice” commitment to collaborative practice so that shared decision-making can occur.     

Every team needs a coach: Training for interprofessional clinical placements

Despite growing awareness of the benefits of interprofessional education and interprofessional collaboration (IPC), understanding how teams successfully transition to IPC is limited. Student exposure to interprofessional teams fosters the learners’ integration and application of classroom-based interprofessional theory to practice. A further benefit might be reinforcing the value of IPC to members of the mentoring team and strengthening their IPC. The research question for this study was: Does training in IPC and clinical team facilitation and mentorship of pre-licensure learners during interprofessional clinical placements improve the mentoring teams’ collaborative working relationships compared to control teams? Statistical analyses included repeated time analysis multivariate analysis of variance (MANOVA). Teams on four clinical units participated in the project. Impact on intervention teams pre- versus post-interprofessional clinical placement was modest with only the Cost of Team score of the Attitudes Towards Healthcare Team Scale improving relative to controls (p = 0.059) although reflective evaluations by intervention team members noted many perceived benefits of interprofessional clinical placements. The significantly higher group scores for control teams (geriatric and palliative care) on three of four subscales of the Assessment of Interprofessional Team Collaboration Scale underscore our need to better understand the unique features within geriatric and palliative care settings that foster superior IPC and to recognise that the transition to IPC likely requires a more diverse intervention than the interprofessional clinical placement experience implemented in this study. More recently, it is encouraging to see the development of innovative tools that use an evidence-based, multi-dimensional approach to support teams in their transition to IPC.     

Clients as mediators of interprofessional collaboration in mental health services in Iran

Interprofessional collaboration (IPC) has long been identified as a way of providing optimal mental health services (MHS). It is important, therefore, to identify and facilitate factors driving IPC. This paper presents health professionals' experiences and perceptions regarding the clients' role as a driving factor for IPC in MHS in an Iranian context. Health professionals included nurses, physicians (general physicians and medical specialists), psychologists and consultants. Qualitative methods were employed in the form of in-depth individual interviews and focus groups to collect data from 24 professionals and 4 clients. Data analysis generated four key themes: "Clients as axis of IPC", "Seamless services as a common incentive for IPC", "Clients as a common interprofessional linkage" and "Clients as a driving force to achieve IPC". From the professionals' perspective, it was found that clients had a mediating role in their collaborative relationships and practices. These findings are discussed in relation to the interprofessional literature. This paper goes on to argue that professionals need to be aware of and be trained about how to manage, as well as benefit from, the clients' fundamental role in IPC.     

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.     

A cross-institutional analysis of Australian undergraduate paramedic students’ attitudes towards interprofessional collaboration

Interprofessional collaboration (IPC) continues to gain much momentum with recognition and evidence that improved communication and collaboration between healthcare workers leads to better delivery and access to care. The objective of this study was to examine the self-reported IPC among Australian paramedic undergraduate students over two years. A two-year cross-sectional study involving undergraduate paramedic students from multiple Australian Universities was undertaken. Students’ IPC levels were measured using the Interdisciplinary Education Perception Scale (IEPS). Responses were collected from 1,264 students during the 2011 and 2012 academic years. During the study females tended to outnumber males enrolled in paramedic studies across all universities, which was consistent across 2011 and 2012 (overall, n = 748 or 59.2% and n = 516 or 40.8% for females and males, respectively). Factor results revealed mean = 23.63 (Competence/Autonomy), mean = 9.65 (Perceived need for Cooperation), and mean = 23.78 (Perception of Actual Cooperation). There were no differences in self-reported perceptions between students assessed in 2011 and 2012 for any of the three factors. The current study provides the first multi-institutional normative data for paramedic students for the IEPS within Australia. Initial findings tend to suggest that paramedic undergraduates are positive about the concept of IPC and their ability to work as part of a collaborative healthcare team.     

Interprofessional education between speech pathology and nursing programs: A collaborative e-platform curriculum approach

ABSTRACT

Interprofessional practice between nurses and speech-language pathologists (SLPs) in healthcare is essential, and it is a priority for both professions. Interprofessional education (IPE) is warranted to move forward professional partnership, and would be best served through incorporation into academic training for both disciplines. A combined synchronous and asynchronous e-platform collaborative approach that minimizes encroachment on already overcrowded clinical curricula is described. Implementation is outlined for use within a graduate-level dysphagia course for SLP students and a medical/surgical undergraduate course for nursing students. This model is flexible and lends itself for use in other courses within clinical disciplines.     

Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course

As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled “Health Care System and Health Promotion” was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students’ views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.     

Clients as mediators of interprofessional collaboration in mental health services in Iran

Interprofessional collaboration (IPC) has long been identified as a way of providing optimal mental health services (MHS). It is important, therefore, to identify and facilitate factors driving IPC. This paper presents health professionals' experiences and perceptions regarding the clients' role as a driving factor for IPC in MHS in an Iranian context. Health professionals included nurses, physicians (general physicians and medical specialists), psychologists and consultants. Qualitative methods were employed in the form of in-depth individual interviews and focus groups to collect data from 24 professionals and 4 clients. Data analysis generated four key themes: “Clients as axis of IPC”, “Seamless services as a common incentive for IPC”, “Clients as a common interprofessional linkage” and “Clients as a driving force to achieve IPC”. From the professionals' perspective, it was found that clients had a mediating role in their collaborative relationships and practices. These findings are discussed in relation to the interprofessional literature. This paper goes on to argue that professionals need to be aware of and be trained about how to manage, as well as benefit from, the clients' fundamental role in IPC.     

Analysing the cognitive rigor of interprofessional curriculum using the Depth of Knowledge framework

Interprofessional collaborative practice is widely documented as a strategy to improve quality of healthcare. To develop collaborative practitioners, educators need interprofessional curricula with proper cognitive demand and methods of delivery and assessment. The University of the Western Cape in South Africa incorporated an Interprofessional Core Courses Curriculum for all undergraduate students enrolled in the health sciences faculty. The objective of this study was to analyse the curriculum content to determine its cognitive rigor. Cognitive rigor can be measured by the quantitative content analysis method using the Depth of Knowledge (DOK) framework. This approach tests whether the rigor of instructional activities and assessments is aligned with learning outcomes. The curriculum content evaluated in this study found that assessment activities were less demanding than instructional activities and infrequently aligned with learning outcomes. This approach may be useful to other educators seeking to evaluate and plan interprofessional curriculum.     

Grounding theories of W(e)Learn: A framework for online interprofessional education

Interprofessional care (IPC) is a prerequisite for enhanced communication between healthcare team members, improved quality of care, and better outcomes for patients. A move to an IPC model requires changing the learning experiences of healthcare providers during and after their qualification program. With the rapid growth of online and blended approaches to learning, an educational framework that explains how to construct quality learning events to provide IPC is pressing. Such a framework would offer a quality standard to help educators design, develop, deliver, and evaluate online interprofessional education (IPE) programs. IPE is an extremely delicate process due to issues related to knowledge, status, power, accountability, personality traits, and culture that surround IPC. In this paper, a review of the pertinent literature that would inform the development of such a framework is presented. The review covers IPC, IPE, learning theories, and eLearning in healthcare.     

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

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

Physicians’ perceptions of the role of the dental hygienist in interprofessional collaboration: a pilot study

ABSTRACT

Shifts in healthcare models, and greater numbers of patients seeking care, has encouraged professional organizations to recommend collaborative healthcare teams. In the realm of oral health, the American Dental Hygienists’ Association (ADHA) and the Commission on Dental Accreditation (CODA) have set recommendations that interprofessional collaboration (IPC) be emphasized in the profession. The purpose of this study was to determine physicians’ perceptions of the role of the dental hygienist in IPC. A pilot study utilizing a nonprobability sampling method which included a purposive sample of 30 licensed physicians was conducted. The survey addressed: personal experiences with a dental hygienist, dental hygienists’ roles working in collaboration with physicians, experiences with IPC, benefits of working with dental hygienists, barriers, and demographics. The majority (77.7%) supported the concept that dental hygienists have the necessary education and are important in IPC. Over 77.7% indicated dental hygienists would add value to a medical practice. Time and transfer of data were identified as primary obstacles in working collaboratively with dental hygienists. Findings revealed dental hygienists have the necessary education to be valuable members of IPC teams. Future research is needed to broaden the scope of studies among dental hygienists and other members of IPC teams.     

Reflections and unprompted observations by healthcare students of an interprofessional shadowing visit

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

An interprofessional collaborative practice approach to transform heart failure care: An overview

Interprofessional collaborative practice (IPCP) approaches to health care are increasingly recognized as necessary to achieve the Triple Aim—improved health of the population, improved patient care experience, and improved affordability of care. This paper introduces and provides an overview of an interprofessional intervention to improve a healthcare team, healthcare system, and patient outcomes for hospitalized patients with heart failure. In this paper, we describe the overall project resulting from a workforce training grant and the proposed series of future papers resulting from the interprofessional intervention. Collectively, these papers will describe the results of a unique IPCP approach on team, system, and patient outcomes as well as describe and compare organizational and leadership traits that affect collaborative practice. Our hope is that the intervention approaches, evaluation results, and lessons learned described in these papers will help further the efforts to spread IPCP approaches to transforming health care.