Jackie Loversidge, PhD, RNC-AWHC Assistant Professor of ...€¦ · Interprofessional Collaboration Directions in Health Professions Education: Includes Interprofessional Education
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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
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
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?
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
Environments & Cultures Image source: vcu.edu
Student-centered Themes
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
Clusters Subthemes Strategies
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”
Copyright Jacqueline M. Loversidge 2013
Clusters Subthemes Strategies
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
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
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
Copyright Jacqueline M. Loversidge 2013
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!)
Copyright Jacqueline M. Loversidge 2013
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
loversidge.1@osu.edu
http:www.tlace.osu.edu
Copyright Jacqueline M.
Loversidge 2013
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