Jenn Salfi
RN,
Jen Mohaupt RN,
Dianne Allen RN,
Denise Inouye RN,
Donna Rawlin RN,
Chris Patterson NP,
Susan Tam
RN,
PhD
PhD (student)
PhD (student)
MScN
PhD (student)
MSc
BScN
McMaster University
Conestoga College
Conestoga College
Mohawk College
Mohawk College
McMaster University
Hamilton Public Health
Prepared for NERU, 2011.
“occurs when two or more professions learn with, from and
about each other in order to improve collaboration and the
quality of care”
(CAIPE, 2002)
WHO (2010): IPE is an essential step in preparing a
“collaborative practice-ready”
workforce
CIHC (2010): IPE...key to building effective health care
teams; improving the experience and
outcomes of patients
HFO (2010):
IPE...build the foundation upon which key
interprofessional care activities can be
implemented & sustained
Current Status of IPE (Canada):
Elective IPE courses & projects
Compulsory IPE course
Rural Palliative Care Program
Compulsory IP Learning Modules
Compulsory & Elective Courses
Elective & Compulsory IP activities
(UBC)
(U of A)
(U of O)
(Dalhousie)
(Memorial)
(McMaster)
(Ho et al., 2008).
Why is it so difficult?
-Complex; time consuming
-Incompatible clinical; timetables; curriculum schedules
-Lack of faculty interest & expertise in IPE
*Disproportionate # of students across programs
*Students distributed across sites
*Controversy of IPE at the undergraduate level
*Combining separate IPE frameworks
Level 1 Strategy: Intra- professional Education & the
Foundation of Group Skills
Level 2 Strategy: Introduction to IPC/IPE &
Exposure to the Health Care Team
Level 3 Strategy: Interprofessional Collaboration
Level 4 Strategy: Becoming an Effective Member of
the Health Care Team
Integration of IP Competencies in Pre-Licensure (B.Sc.N) Curriculum (Adapted from HFO, 2010))
SKILLS & BEHAVIOURS:
Level 4:
Becoming an Effective Member of the Health Care Team
IP Competency: Contributes to the overall effectiveness of a health care team).
Level 3:
Interprofessional Collaboration
(IP Competency: Collaborates with other health science students or health care
professionals).
KNOWLEDGE:
Level 2:
Introduction to Interprofessional Education (IPE) &
Collaboration (IPC); Exposure to the Health Care Team
(IP Competency: Knows scope of practice of other health care professionals, &
knows when & how to involve other professionals in patient care).
Level 1:
Intraprofessional Education; Foundation of Group Skills
(IP Competency: Knows and can articulate own professional role &
responsibilities; knows about group roles and functions).
Miller’s Levels of Competence (1990)
Entry to Pre-Licensure Program
Competencies across four year (four levels) B.Sc.N. program
-
-
Introduces students to IPC; team-based literature
Introduces students to IP issues
Opportunity to achieve ¾ of the required IPE
competencies (McMaster)
Opportunity to collaborate with others
(professionals/students)
Reference to the CNO (2009) Entry to Practice
Competencies
Mandatory Readings:
1. CIHC (2010)
2. Suter et al (2009)
Engage in IPC
1. Must involve > 2 professions (student; professional)
2. Must be interactive (immersion level)
Scholarly Paper
1. IP Issue
2. Background Information; Impact of Issue
3. Professional Development r/t issue
4. Strategies (skills, knowledge & behaviours)
To assess what students are learning about
interprofessional collaboration (IPC), after completing
the Interprofessional Issues Assignment.
Are we preparing our students for effective
interprofessional collaborative practice?
Embedded mixed method study design
Quantitative component: Will monitor general changes in
attitudes and perceptions re: IPC
Qualitative component: Will add “meaning” & elaborate
on what the students are learning from the assignment
Quantitative:
Does the Interprofessional Issues Assignment have an effect on Level
4 students’ perceptions and attitudes regarding interprofessional
collaboration?
Qualitative:
How do Level 4 B.Sc.N students experience the Interprofessional
Issues Assignment?
Overall Question for Mixed Methods study:
What is the impact of the IP Issues Assignment, in developing
attitudes and knowledge required for interprofessional
collaborative practice among Level 4 B.Sc.N students?
-4 demographic questions ( age, gender, stream, site)
-Questionnaire: before/after completion of IP Issues
Assignment (Weeks 2, 10)
-Questionnaire: Interdisciplinary Education Perception Scale
(IEPS) (McFadyen et al., 2007)
-Administered within PBL groups; by “student leaders”
Sample: n=268 (pre/post matches) - 77%
-Avg. age = 24 yrs (20-57)
-Gender = 92% Female; 8% Male
-Streams = 77% Basic
= 14% Practitioner (Post RN; RPN)
= 9% Accelerated
-Distribution:
Conestoga site (23%)
Mohawk site (38%)
McMaster site (39%)
Statistical Package for Social Sciences (SPSS)
Paired sample t-tests: Changes in IEPS scores
before/after assignment?
ANOVA: Differences between age, gender, stream & site?
- Females showed significant increases (p=0.00)
- Males did not show any significant difference
(? due to small sample (<25))
-
Significant increases basic stream (p=0.00)
No significant differences noted in the other streams
(? due to smaller sample sizes)
Key findings:
- Conestoga site: disagreed MORE after completing the
assignment (p=0.00) (esp. in C & A)
- Mohawk site: difference only in C & A (p=0.05)
-
McMaster site students – no difference before/after
Surprise finding:
1) Differences in baseline scores (pre-assignment)
Perceived level of Competency & Autonomy:
Conestoga & McMaster – difference of 5.4 points
Perceived Need for IPC/Cooperation:
No difference b/w site scores (pre or post)
Perception of Actual Cooperation:
Conestoga & McMaster – difference of 3 points
Perception of
Competency & Autonomy
(of Nurses)
Difference : Pre-Assignment
(5.4 point difference)
Post Assignment
(2 points)
12
Perception of Actual Cooperation
(occurring in the clinical setting)
10
8
Conestoga
Difference : Pre-Assignment
(3 point difference)
Post Assignment
(no difference)
6
Mohawk
McMaster
4
2
0
Pre-Assignment Scores
Post Assignment Scores
-
3 focus groups (total of 14 students)
-
Semi-structured interviews
(3 questions; audio-taped; notes)
-
2 investigators per focus groups
(one recording notes; one asking the questions)
-
PI not involved in focus groups
Convenience; Criterion sampling procedures:
students from each site
- students representing the basic stream (7)
- students representing the practitioner streams (5)
- students representing the accelerated stream (2)
- same inclusion/exclusion criteria as quantitative phase
-
Distribution: Conestoga site (n=6)
Mohawk site (n=2)
McMaster site (n=6)
To strengthen the data:
Data Source Triangulation: participants from different sites;
streams; audiotapes, notes; scholarly papers
Investigator Triangulation: 6 co-investigators collecting
notes; analyzing data
Method Triangulation: findings from the qualitative data
will be compared to quantitiative (to see if statistical
trends are supported by qualitative themes)(Creswell,
2008).
Data entered, and partially processed and validated using
NVIVO software (research staff)
Once analysis is completed, investigator triangulation
(research team)
NERU 2011:
Quick content analysis (investigator notes; scholarly papers)
and partial analysis generated from NVIVO
Coding Scheme:
A) Feedback re: IP Issues Assignment
(Readings; IP Experience; Scholarly Paper)
B) Learning/Lack of Learning
C) IPE “Wish List”
D) Preparation for Collaborative Practice?
Readings:
- Suter article (13); CIHC (4)
- Compliance: 11/14
IP Experience:
- Clinical experiences (7)
- IPE student experiences (5 )
- Compliance: 11/14
“ ... I wouldn’t have even realized that was an issue during my
interprofessional experience if it wasn’t for the previous
readings that were mandatory. So that was really helpful.”
Scholarly Paper: (5 or more comments)
-
Don’t make IP experience mandatory
Recommend 2 papers (IPC; IP Issues)
All criteria of paper effective
Appreciation for “real” assignment
Timing of due date
More structure in grading scheme
Keep the assignment in the program (unanimous)!
-
“Common sense” is not so common
“.... this assignment made me aware that it (interprofessional
collaboration) doesn’t always work out ...and prepared me
for that possibility.”
“ it (interprofessional collaboration) is more than just
different professions coming together”
“ this assignment showed me that research and actual
practice don’t always mesh”
Increased awareness of
- RN role; other professional roles
- IP conflict (MD/RN relationship) - effects on patient care;
patient safety
- competencies/ strategies required for IPC
- current deficiencies in BScN program (silo; lack of IPE)
“nurses like to lie low”
“avoid conflict”
“they do not have the tools to address conflict”
“they are not assertive enough with others (professionals)”
-All three sites – IP PBL classes
-Need more/want more IPE events/experiences
-Get credit for attending IPE events/experiences
-Make attendance at IPE events mandatory (every term;
level)
-Easier access (r/t registration for events)
“it would be helpful to have students from other disciplines in
our PBL groups but not until after second year. That way
nurses (student nurses) would get a good understanding of
their own roles before learning about the roles of others. “
- Role clarity
- Effective Communication
- Conflict management
- Collaboration
- Shared Decision-making
“The beginning of wisdom is the definition of terms”
- Socrates
“Now I do not feel alone…”
“We’re all in this together”
“Motivates me to collaborate”
“Keeps it (IPC) on my mind when I’m at (clinical)
placement and work”
- Timing of post questionnaire (after 3.5 hr class)
-
Recruitment for qualitative phase (students from Basic
stream at Mohawk; only 1 Post RN)
-
Inability to standardize the training of the Level 4 tutors
(in IPE)
Quantitative Data:
1) Post test scores higher than pre test scores
(more disagreement with statements in the IEPS)
2) Baseline Perceptions (pre test scores)
(diff. of 5.4 points - Conestoga & McMaster)
Qualitative Data:
1) Feedback: Positive
2) Learning Occurred
3) Students want more!
Are my quantitative findings so different
from most IPE initiatives?
Majority of IPE initiatives
Voluntary
Not evaluated
Pre/post test done same day
Primarily students involved
Fun
Safe
IP Issues Assignment
Mandatory
Evaluated
10 weeks b/w pre & post tests
IP experiences in clinical placements
(professionals; reality-based)
Nature of the assignment – “Issues”
“The more I learn, the more I realize I don’t know”
-Albert Einstein
Reality Check:
“Common sense is not so common”
-Voltaire
Profession of Nursing:
CNO National Competencies & Clinical Observation
-IPE throughout curriculum (mandatory)
-Extra curricular IPE (credit)
-Level 4 IPE focus – clinical setting (real)
-
Continue to create & evaluate IPE initiatives –
Are we preparing our students for interprofessional
collaboration?
-
Research across BScN Programs
-
Mixed Methods