Jackie Loversidge, PhD, RNC-AWHC Assistant Professor of ...€¦ · Interprofessional Collaboration Directions in Health Professions Education: Includes Interprofessional Education

Jackie Loversidge, PhD, RNC-AWHC Assistant Professor of Clinical Nursing

The Ohio State University College of Nursing

Examine strategies for overcoming barriers to interprofessional collaboration:

The faculty point of view

Strategies that emerged from the research ◦ Themes related to

environmental & organizational culture

◦ Themes related to student-centered challenges

◦ Themes related to creating powerful experiences

Copyright Jacqueline M. Loversidge 2013

Data on Errors, Q&S, & Call for Directions in Health Care: Includes Interprofessional Collaboration

Directions in Health Professions Education: Includes Interprofessional Education Why such a challenge to

play together in “the sandbox?” What are faculty perceptions?

QSEN: Incorporating Q&S Recommendations into the fabric of Nursing Education Currently being emulated in some Medical Education Programs


Silo education provides little or no opportunity for:

◦ makings of common ground and;

◦ beginnings of cross-professions understanding

More of the literature focuses on licensed practitioners than students

Faculty are the experts charged with educating students, however they continue to be the least frequently surveyed

Copyright Jacqueline M.

Loversidge 2013

Collaboration & Cooperation theories applied to interprofessional teams ◦ Including Game Theory

High performance teams & HROs Reports & Initiatives on IP Health Professions Education Directions in interprofessional education & collaborative learning Medical & Nursing education: differences relevant to

collaboration ◦ Undergrad vs. grad in prelicensure programs

Systematic Reviews (Level V Evidence) ◦ Cochrane Review ◦ Simultaneous JET review


Very little research from faculty point of view • (only 4 at time of proposal)

Few qualitative studies • Call for more qualitative study to underpin higher levels of

evidence

Collaborative learning environments involving prelicensure nursing education and medical education


How do medical school and nursing school faculty describe the experiences that enable medical and nursing students to learn how to work collaboratively in interprofessional teams?

To what degree to faculty perceive that students are achieving outcomes related to interprofessional teamwork and collaboration, based on current relevant accreditation standards/competencies?

What factors do faculty perceive as hindering the

development of these competencies? How could hindering factors be overcome to remove

barriers to collaboration?


Sampling

Site selection:

◦ 3 large Midwestern institutions

Participant selection:

◦ Intensity/purposive sampling –

◦ 5 each nursing & medical faculty

◦ Inclusion criteria

Sample size:

◦ Total of 32 interviews

17 nursing faculty

15 medical faculty

Data collection Semi-structured interviews Digitally audio-recorded and professionally

transcribed Field notes/research journal Document analysis

Data analysis NVivo 9 (QSR International) Continuous data analysis and reduction

◦ 3 rounds of coding

Trustworthiness Member checks Peer debriefing Reflexive journaling

Soundness Triangulation of questions Triangulation of data through use of

document review Thick description Search for disconfirming evidence Bracketing/clarification of researcher bias


Environments & Cultures Image source: vcu.edu

Student-centered Themes


Clusters Subthemes Strategies

Positive Influences on Student Perceptions of IP Collaboration

•Q&S driven environment •Org culture values collaboration •Specialized stable teams •Shared core values related to excellence in patient care

•Expose students to Q&S culture where & when appropriate •Student experiences alongside specialized stable teams

•The conundrum – specialized stable team often high-level, e.g. solid organ transplant, palliative care, OR

Negative Influences on Student Perceptions of IP Collaboration

•Enculturation •Civility issues/conflict •Poor role examples •Students fearful of or intimidated by other profession

•Debrief students exposed to incivility/poor role examples •Address incivility in whatever way is appropriate


Positive influences on Student Perceptions of IPC

Negative Influences on Student Perceptions of IPC

Shared Core Values

“. . . They teach their nurses to be real patient advocates and it’s okay to go toe to toe with a physician if that’s going to be in the best interest of the patient . . . I’ve seen some of the most amazing interactions occur where they’re willing to put themselves out there for the benefit of the patient . . . they come looking for you when you it the floor. . . You want to try to promote and foster . . . that open dialogue . . . with all your medical team.”

Medical Faculty

Students fearful of or intimidated by other profession

(Nursing students during simulation) “when they first start the interprofessional simulation with the medical students . . . They’ll start out & the debriefing thing – I was really scared because I thought you were going to be really threatening to me and be mean basically. They saw the collaboration. So they’ll talk a little bit about how doctors expect nurses just to do what they want, and they yell. Then, but they said it wasn’t like that.

However, I also have the medical students speak up as to how they’re treated on the units when they’re trying to get information on a patient, and how nurses are not very nice to them. How they are often afraid to speak up to the nurses because they know they’re not going to be helpful, and be actually nasty to them.”

Nursing Faculty



Academic medical center structures & logistics

•Programs in silos •Minimal opportunity for student connection •Scheduling •Competition for scarce resources •Saturated curriculum •Expansive class size

•Creative scheduling by committed faculty partners •Commitment between academic leaders to make resource sharing work

Structural curriculum design challenges

•Curriculum & pedagogical challenges •Interprofessional content in the formal curriculum (is, or is not) •Matching student mastery level •Matching student maturity level

•Integration of interprofessional competencies into program outcomes, making it a curriculum requirement (overcomes the “stodgy quotient”)

•Use NLNAC standards & criteria/AACN Essentials as leverage

•Creative pedagogy and facilitation can overcome the mastery/maturity conundrum

Organizational culture

•Organizational culture & intertia •Perceived value of “soft” content

•Committed leadership •Inclusion of “required content” into the IP “exercises”



Faculty Engagement, Competency & Development

•Building inter-faculty communication & relationships •Faculty engagement & development •Faculty perceptions of value of interprofessional education

•Develop inter-faculty relationships around common ground

•Clinical interests •Research interests

Faculty Resources •Faculty workload & reimbursement •Creating faculty incentives

•Engage part-time clinical faculty in the curriculum


Theme Clusters Subthemes Strategies

External Drivers •Accreditation supports & drives curricular change •Funding a vehicle for collaboration •External press as driver •Curricular reform •Use of national models

•Leadership & faculty use these to advantage


Themes Clusters Subthemes Strategies

Curricular methods & pedagogy

Authentic experiential learning Faculty facilitated pedagogies Structured methods Collaborative methods

•Authentic experience •Spontaneous teachable moments •Mentoring & role modeling •Student debriefing •Narrative reflection •Evaluating student competency •Simulated learning experiences •Teaching communication •Collaboration around common ground •Peer learning •Engaging other profession in teaching students

•Be vigilant & make use of authentic experiences & spontaneous teachable moments

•Take students & faculty out of comfort zones & away from typical clinical environments when possible

•Not everyone is a natural mentor – help your colleagues learn to become extraordinary mentors •Always, always, always debrief, even if you can’t do it right away •Use creative methods to help students process, e.g. narrative reflection •Develop & use competencies

•Embed them into curriculum; hold faculty accountable for using them

•Make communication techniques meaningful, e.g. SBAR •Engage professional colleagues


Themes Clusters Subthemes Strategies

Student roles and role understanding

•Student role identity & comfort •Student understanding & expectations of other health professions roles •Team building in medical & nursing students

•Teach students what other professions do – invite them to “your house”

•Shared experiences when possible, e.g. international or other “out of comfort zone” experiences

•Create opportunities meaningful to your students & others** ** the challenge – finding common ground


Use national standards and “press” as

leverage You can change:

◦ Your student’s experience ◦ One student at a time

Become an extraordinary mentor ◦ Mentor your colleagues – help one another

in the journey to become better mentors

Make the most of authentic experiences ◦ Process!!!

Debrief, debrief, debrief! Develop relationships with

colleagues from other professions ◦ Bring your students along when you have

those conversations or meetings (your students watch and learn!)


Contact Information:

Jackie Loversidge, PhD, RNC-AWHC

Assistant Professor of Clinical Nursing

Director, Transformational Learning Academy in Nursing & Health

The Ohio State University

College of Nursing

[email protected]

http:www.tlace.osu.edu

Copyright Jacqueline M.

Loversidge 2013

mailto:[email protected]

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Jackie Loversidge, PhD, RNC-AWHC Assistant Professor of ...€¦ · Interprofessional Collaboration Directions in Health Professions Education: Includes Interprofessional Education