http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2014; 28(3): 267–269 ! 2014 Informa UK Ltd. DOI: 10.3109/13561820.2013.872089
SHORT REPORT
Exploring new healthcare professionals’ roles through interprofessional education Yanika Kowitlawakul1, Jeanette Ignacio1, Manjari Lahiri2, See Meng Khoo2, Wentao Zhou1 and Derek Soon2 1
Alice Lee Centre for Nursing Studies, National University of Singapore/National University Health System, Singapore and 2Yong Loo Lin School of Medicine, National University of Singapore/National University Health System, Singapore Abstract
Keywords
This article presents findings from a simulation-based interprofessional education (IPE) program involving trainee advanced practice nurses (APNs) and internal medicine residents (IMRs) based in Singapore. Trainee APNs and IMRs participated in a semester-long series of high-fidelity simulations of medical emergencies. Learners’ attitudes toward the IPE intervention were assessed using validated Likert scaled surveys and written comments. Overall satisfaction was high among learners, with strongly positive attitudes toward teamwork, collaboration and patient centredness. Of most interest, written comments highlight the utility of IPE in defining the professional scope and boundaries of APNs. Comments from both professions observed that participation in the IPE scenarios greatly aided their understanding of the scope and role of APN’s practice within the health care team. This aspect of IPE may find further application in other similarly novel roles in healthcare.
Interdisciplinary, interprofessional education, mixed methods, roles, teamwork History Received 2 October 2013 Revised 15 November 2013 Accepted 2 December 2013 Published online 9 January 2014
Introduction
Methods APNs and IMRs underwent a semester-long series of four IPE simulation sessions utilizing simulated patients. The scenarios selected (myocardial infarction, atrial fibrillation, congestive cardiac failure and acute asthma) encompassed commonly encountered emergencies within the APN core syllabus. Each session catered to three groups consisting of faculty members from nursing and medicine, five trainee APNs and one or two IMRs. The participants in the simulation were blinded to the diagnosis, except in the first session. Trainee APNs attended all four sessions, whereas IMRs attended a single session each.
Correspondence: Yanika Kowitlawakul, Alice Lee Centre for Nursing Studies, National University of Singapore/National University Health System, Level 2, Block MD11, 10 Medical Drive, Singapore 117597, Singapore. E-mail: [email protected]
The study received requisite Institutional Review Board approval. Validated 5-Likert scaled surveys and open-ended questions were used to gauge learner experience. The two surveys used were; (1) ‘‘Readiness for Inter-Professional Learning Scale’’ (RIPLS; Reid, Bruce, Allstaff, & McLernon, 2006) administered before and after the IPE intervention, and (2) ‘‘Satisfaction with Simulation Experience Scale’’ (SSES; Levett-Jones et al., 2011) following the intervention. The questions in RIPLS were divided into three sub-categories: (1) teamwork and collaboration, (2) patient centredness and (3) professional identity. Due to small sample size and non-normality of the data, non-parametric statistical methods were adopted. Answers to open-ended questions were analyzed with Colaizzi’s method (Streubert Speziale & Carpenter, 2003) which involved extraction, organization and categorization of statement meanings.
20 14
Advanced practice nurses (APNs) are a relatively new addition to healthcare in Singapore. They assume a unique, semi-autonomous role, helping to meet the growing demands of complex, chronic disease burden. Their relative novelty means that in many places, a lack of consensual definition in APN job scope continues to besiege the profession (Soine, Errico, Redmond, & Sprow, 2013). This often translates to marked variation in acceptance and deployment of APNs. As part of our APN course, we developed and ran an interprofessional education (IPE) program to foster collaborative partnership between internal medicine residents (IMR) and student APNs in simulated ward settings. In this article, we report its reception based on Likert scaled surveys, and novel insights into IPE afforded by written feedback.
Results Thirty-six out of 45 (80%) eligible learners participated in the intervention. These consisted of 15 out of 15 eligible trainee APNs and 21 out of 30 eligible first-year IMRs. Two IMRs did not complete the pre-test surveys, but participated in the rest of the study. Overall satisfaction was high among participants, ranging from 3 to 5 (median ¼ 4.21). The scores were not significantly different by age, gender, race or profession (p40.5). Both professions returned strongly positive baseline attitudes toward teamwork and collaboration and patient-centredness (scores of greater than 4 in both professions in both domains). IPE improved scores on teamwork and collaboration (4.38 versus 4.23 for trainee APNs and 4.77 versus 4.61 for IMRs), achieving statistical significance among IMRs (p ¼ 0.03). Both professions scored similarly in response to statements pertaining to professional identity (median pre-intervention scores of 2.80 and
268
Y. Kowitlawakul et al.
J Interprof Care, 2014; 28(3): 267–269
Table I. Results from open-ended questions. Category
Description
Significant statements
Collaboration
Participants reported enjoyment in collaborative practice. Both trainee APNs and IMRs valued the comments and feedback that they received during the sessions.
Simulation management
Both trainee APNs and IMRs offered a number of suggestions to improve the simulation experience, including increasing the number of IPE sessions, improving the realism and variety of simulation scenarios, and imposing a more formal structure to the briefings. It was also noted that the simulation provided them the opportunity to apply their knowledge in practice.
Role definition
A number of comments from IMRs reported that the IPE session led to a better understanding of the APN’s roles and scope of practice. Comments from trainee APNs indicated a parallel process of self-discovery, in particular the value of actualization and operationalizing their learned skills in an interprofessional setting, and the opportunity to learn from their fellow professionals.
‘‘Good experience with teamwork and very enjoyable’’ (R).a ‘‘The IPE program really benefits me in learning experience’’ (N). ‘‘The team of doctors we had were wonderful . . . always encouraging with his comments on APN’’ (N). ‘‘Able to share perspectives and constructive criticisms’’ (R). ‘‘Learn from other professionals and communication within team’’ (N). ‘‘I’m fully support inter-professional work’’(R). ‘‘I feel more sessions should be held . . . and should have more of such scenarios’’ (R). ‘‘Try to have varied case scenario in different clinical setting’’ (N). ‘‘Prime participants to be more serious to optimize team . . . and better briefing’’ (R). ‘‘To brief the participants clearly before each session . . .. be more structure and learning objectives need to be clear to learner . . .’’ (N). ‘‘Please adjust the volume of the audio system’’ (R). ‘‘Great simulation . . . A good refresher on management of acute medical scenarios’’ (R). ‘‘It provides opportunity for students to apply what we learn in tutorial to the clinical’’ (N). ‘‘I have opportunity to interact with different health professionals and better understand the defined job scope of an APN’’ (R). ‘‘It’s valuable to collaborate with APN trainees who have a unique role in the health care team’’ (R). ‘‘. . .. to enhance interaction between APNs and doctors in caring for a patient’’ (R). ‘‘I believe APNs will be a valuable resource to the healthcare in Singapore’’ (R). ‘‘It provides an opportunity for me to reflect and relook my own clinical ability’’ (N). ‘‘Ability to integrate knowledge and skills into actual clinical scenario and learn from other professionals’’ (N). ‘‘A more interactive session with doctors relating patient’s management of care would be beneficial’’ (N).
Open-ended questions were: (1) any comments you want to share regarding your experience with the IPE program? (2) What is the most valuable aspect of the IPE simulation? (3) What suggestions do you have for improving the IPE program? and (4) How could the IPE simulation be improved? a R ¼ Internal Medicine Resident, N ¼ Trainee APN.
2.60 for trainee APNs and IMRs respectively, p ¼ 0.85). IPE intervention did not influence these scores (p ¼ 0.44). Twenty-seven (10 trainee APNs and 17 IMRs) participants responded to the open-ended questions. Three main categories of response were identified: collaboration, simulation management and role definition. Table I contains the participants’ responses in their original words, categorized and summarized using the Colaizzi’s method.
Discussion To the best of our knowledge, this report is the first to describe an IPE program focused on APN-IMR interaction at the postgraduate level in a simulated ward setting. It complements a recent publication describing a similar IPE program in the primary care setting (Hanyok, Walton-Moss, Tanner, Stewart, & Becker, 2013). Whereas Hanyok and colleagues explored interprofessional relationships and conflict resolution, our study focused on APN-IMR synergy during medical emergencies. The survey findings reflected improvement in attitudes toward teamwork and collaboration. Such a positive reception to the IPE program is in agreement with the strongly positive responses to the SSES and open-ended questions, the latter frequently reflecting strong engagement with the program. On the strength of such feedback, plans are in place to expand and continue the program in the future. Participants strongly reported benefit from collaborative learning, citing the opportunities for collaborative practice and mutual learning as key strengths of the program. Participants’ comments on simulation management emphasized the need for
explicitly stating the learning objectives during each session. It was felt that learning objectives were required to ground and direct the learning, particularly in the setting of learner diversity. The comments from IMRs and trainee APNs pertaining to job definition become especially pertinent. The co-placement of both professions in simulated emergencies galvanized a working synergy, establishing domains of practice and professional boundaries in a non-threatening environment. Within this setting, the APNs role underwent a dramatic and evolving elucidation that was evident to participants: nurse, resident and facilitator. This phenomenon points to a hitherto under-explored utility of IPE, which is that IPE can help define the scope of new or ambiguous professional roles, and help to functionally integrate novel jobs within existing health care frameworks. The use of IPE in this role need not be confined to nursing, but can be explored in the wider healthcare community, in the operating theatre, or in the country practice. APNs are a relatively recent addition to the Singapore healthcare framework. Consequently, a degree of ambiguity still surrounds the APN’s role and manner of deployment. In this, Singapore is not unique. Recent publications describe a lack of uniformity and clarity in the job scope of APNs in the United States (Iglehart, 2013). Iglehart argued for better clarification of the role of APNs and explore expansion of APN roles to take on defined clinical duties; a view welcomed by APNs, but not all physicians. Surveys reveal considerable interprofessional differences in perceptions of APNs and their function (Soine et al., 2013). Clearly, the role of the APNs is in need of further clarification. Extending this line of thought would see the application of IPE simulation modules in establishing and rehearsing
DOI: 10.3109/13561820.2013.872089
protocols in novel interprofessional specialist treatment teams and putative interprofessional administered therapy. Our study is somewhat limited by its modest size and inequality of exposure. Nonetheless, these do not detract from the main finding of the study, which points to hitherto under-explored role of IPE in defining novel professional roles within the healthcare setting.
Declaration of interest This work was funded by the Innovation and Creativity in Education (NICE) Fund, National University Health System, Singapore. The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.
References Hanyok, L.A., Walton-Moss, B., Tanner, E., Stewart, R.W., & Becker, K. (2013). Effects of a graduate-level interprofessional education program
Exploring new healthcare professionals roles
269
on adult nurse practitioner student and internal medicine resident physician attitudes towards interprofessional care. Journal of Interprofessional Care, 27, 526–528. Iglehart, J.K. (2013). Expanding the role of advanced nurse practitioners risks and rewards. New England Journal of Medicine, 368, 1935–1941. Levett-Jones, T., McCoy, M., Lapkin, S., Noble, D., Hoffman, K., Dempsey, J., Arthur, C., & Roche, J. (2011). The development and psychometric testing of the satisfaction with simulation experience scale. Nurse Education Today, 31, 705–710. Reid, R., Bruce, D., Allstaff, K., & McLernon, D. (2006). Validating the readiness for interprofessional learning scale (RIPLS) in the postgraduate context: Are health care professionals ready for IPL? Medical Education, 40, 415–422. Soine, L.A., Errico, K.M., Redmond, C.L., & Sprow, S.M. (2013). What do faculty physicians know about nurse practitioner practice? Journal of Nurse Practitioners, 9, 93–98. Streubert Speziale, H.J., & Carpenter, D.R. (2003). Qualitative research in nursing: Advancing the humanistic imperative (2nd ed.). New York: Lippincott Williams & Wilkins.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
SHORT REPORT
Exploring new healthcare professionals’ roles through interprofessional education Yanika Kowitlawakul1, Jeanette Ignacio1, Manjari Lahiri2, See Meng Khoo2, Wentao Zhou1 and Derek Soon2 1
Alice Lee Centre for Nursing Studies, National University of Singapore/National University Health System, Singapore and 2Yong Loo Lin School of Medicine, National University of Singapore/National University Health System, Singapore Abstract
Keywords
This article presents findings from a simulation-based interprofessional education (IPE) program involving trainee advanced practice nurses (APNs) and internal medicine residents (IMRs) based in Singapore. Trainee APNs and IMRs participated in a semester-long series of high-fidelity simulations of medical emergencies. Learners’ attitudes toward the IPE intervention were assessed using validated Likert scaled surveys and written comments. Overall satisfaction was high among learners, with strongly positive attitudes toward teamwork, collaboration and patient centredness. Of most interest, written comments highlight the utility of IPE in defining the professional scope and boundaries of APNs. Comments from both professions observed that participation in the IPE scenarios greatly aided their understanding of the scope and role of APN’s practice within the health care team. This aspect of IPE may find further application in other similarly novel roles in healthcare.
Interdisciplinary, interprofessional education, mixed methods, roles, teamwork History Received 2 October 2013 Revised 15 November 2013 Accepted 2 December 2013 Published online 9 January 2014
Introduction
Methods APNs and IMRs underwent a semester-long series of four IPE simulation sessions utilizing simulated patients. The scenarios selected (myocardial infarction, atrial fibrillation, congestive cardiac failure and acute asthma) encompassed commonly encountered emergencies within the APN core syllabus. Each session catered to three groups consisting of faculty members from nursing and medicine, five trainee APNs and one or two IMRs. The participants in the simulation were blinded to the diagnosis, except in the first session. Trainee APNs attended all four sessions, whereas IMRs attended a single session each.
Correspondence: Yanika Kowitlawakul, Alice Lee Centre for Nursing Studies, National University of Singapore/National University Health System, Level 2, Block MD11, 10 Medical Drive, Singapore 117597, Singapore. E-mail: [email protected]
The study received requisite Institutional Review Board approval. Validated 5-Likert scaled surveys and open-ended questions were used to gauge learner experience. The two surveys used were; (1) ‘‘Readiness for Inter-Professional Learning Scale’’ (RIPLS; Reid, Bruce, Allstaff, & McLernon, 2006) administered before and after the IPE intervention, and (2) ‘‘Satisfaction with Simulation Experience Scale’’ (SSES; Levett-Jones et al., 2011) following the intervention. The questions in RIPLS were divided into three sub-categories: (1) teamwork and collaboration, (2) patient centredness and (3) professional identity. Due to small sample size and non-normality of the data, non-parametric statistical methods were adopted. Answers to open-ended questions were analyzed with Colaizzi’s method (Streubert Speziale & Carpenter, 2003) which involved extraction, organization and categorization of statement meanings.
20 14
Advanced practice nurses (APNs) are a relatively new addition to healthcare in Singapore. They assume a unique, semi-autonomous role, helping to meet the growing demands of complex, chronic disease burden. Their relative novelty means that in many places, a lack of consensual definition in APN job scope continues to besiege the profession (Soine, Errico, Redmond, & Sprow, 2013). This often translates to marked variation in acceptance and deployment of APNs. As part of our APN course, we developed and ran an interprofessional education (IPE) program to foster collaborative partnership between internal medicine residents (IMR) and student APNs in simulated ward settings. In this article, we report its reception based on Likert scaled surveys, and novel insights into IPE afforded by written feedback.
Results Thirty-six out of 45 (80%) eligible learners participated in the intervention. These consisted of 15 out of 15 eligible trainee APNs and 21 out of 30 eligible first-year IMRs. Two IMRs did not complete the pre-test surveys, but participated in the rest of the study. Overall satisfaction was high among participants, ranging from 3 to 5 (median ¼ 4.21). The scores were not significantly different by age, gender, race or profession (p40.5). Both professions returned strongly positive baseline attitudes toward teamwork and collaboration and patient-centredness (scores of greater than 4 in both professions in both domains). IPE improved scores on teamwork and collaboration (4.38 versus 4.23 for trainee APNs and 4.77 versus 4.61 for IMRs), achieving statistical significance among IMRs (p ¼ 0.03). Both professions scored similarly in response to statements pertaining to professional identity (median pre-intervention scores of 2.80 and
268
Y. Kowitlawakul et al.
J Interprof Care, 2014; 28(3): 267–269
Table I. Results from open-ended questions. Category
Description
Significant statements
Collaboration
Participants reported enjoyment in collaborative practice. Both trainee APNs and IMRs valued the comments and feedback that they received during the sessions.
Simulation management
Both trainee APNs and IMRs offered a number of suggestions to improve the simulation experience, including increasing the number of IPE sessions, improving the realism and variety of simulation scenarios, and imposing a more formal structure to the briefings. It was also noted that the simulation provided them the opportunity to apply their knowledge in practice.
Role definition
A number of comments from IMRs reported that the IPE session led to a better understanding of the APN’s roles and scope of practice. Comments from trainee APNs indicated a parallel process of self-discovery, in particular the value of actualization and operationalizing their learned skills in an interprofessional setting, and the opportunity to learn from their fellow professionals.
‘‘Good experience with teamwork and very enjoyable’’ (R).a ‘‘The IPE program really benefits me in learning experience’’ (N). ‘‘The team of doctors we had were wonderful . . . always encouraging with his comments on APN’’ (N). ‘‘Able to share perspectives and constructive criticisms’’ (R). ‘‘Learn from other professionals and communication within team’’ (N). ‘‘I’m fully support inter-professional work’’(R). ‘‘I feel more sessions should be held . . . and should have more of such scenarios’’ (R). ‘‘Try to have varied case scenario in different clinical setting’’ (N). ‘‘Prime participants to be more serious to optimize team . . . and better briefing’’ (R). ‘‘To brief the participants clearly before each session . . .. be more structure and learning objectives need to be clear to learner . . .’’ (N). ‘‘Please adjust the volume of the audio system’’ (R). ‘‘Great simulation . . . A good refresher on management of acute medical scenarios’’ (R). ‘‘It provides opportunity for students to apply what we learn in tutorial to the clinical’’ (N). ‘‘I have opportunity to interact with different health professionals and better understand the defined job scope of an APN’’ (R). ‘‘It’s valuable to collaborate with APN trainees who have a unique role in the health care team’’ (R). ‘‘. . .. to enhance interaction between APNs and doctors in caring for a patient’’ (R). ‘‘I believe APNs will be a valuable resource to the healthcare in Singapore’’ (R). ‘‘It provides an opportunity for me to reflect and relook my own clinical ability’’ (N). ‘‘Ability to integrate knowledge and skills into actual clinical scenario and learn from other professionals’’ (N). ‘‘A more interactive session with doctors relating patient’s management of care would be beneficial’’ (N).
Open-ended questions were: (1) any comments you want to share regarding your experience with the IPE program? (2) What is the most valuable aspect of the IPE simulation? (3) What suggestions do you have for improving the IPE program? and (4) How could the IPE simulation be improved? a R ¼ Internal Medicine Resident, N ¼ Trainee APN.
2.60 for trainee APNs and IMRs respectively, p ¼ 0.85). IPE intervention did not influence these scores (p ¼ 0.44). Twenty-seven (10 trainee APNs and 17 IMRs) participants responded to the open-ended questions. Three main categories of response were identified: collaboration, simulation management and role definition. Table I contains the participants’ responses in their original words, categorized and summarized using the Colaizzi’s method.
Discussion To the best of our knowledge, this report is the first to describe an IPE program focused on APN-IMR interaction at the postgraduate level in a simulated ward setting. It complements a recent publication describing a similar IPE program in the primary care setting (Hanyok, Walton-Moss, Tanner, Stewart, & Becker, 2013). Whereas Hanyok and colleagues explored interprofessional relationships and conflict resolution, our study focused on APN-IMR synergy during medical emergencies. The survey findings reflected improvement in attitudes toward teamwork and collaboration. Such a positive reception to the IPE program is in agreement with the strongly positive responses to the SSES and open-ended questions, the latter frequently reflecting strong engagement with the program. On the strength of such feedback, plans are in place to expand and continue the program in the future. Participants strongly reported benefit from collaborative learning, citing the opportunities for collaborative practice and mutual learning as key strengths of the program. Participants’ comments on simulation management emphasized the need for
explicitly stating the learning objectives during each session. It was felt that learning objectives were required to ground and direct the learning, particularly in the setting of learner diversity. The comments from IMRs and trainee APNs pertaining to job definition become especially pertinent. The co-placement of both professions in simulated emergencies galvanized a working synergy, establishing domains of practice and professional boundaries in a non-threatening environment. Within this setting, the APNs role underwent a dramatic and evolving elucidation that was evident to participants: nurse, resident and facilitator. This phenomenon points to a hitherto under-explored utility of IPE, which is that IPE can help define the scope of new or ambiguous professional roles, and help to functionally integrate novel jobs within existing health care frameworks. The use of IPE in this role need not be confined to nursing, but can be explored in the wider healthcare community, in the operating theatre, or in the country practice. APNs are a relatively recent addition to the Singapore healthcare framework. Consequently, a degree of ambiguity still surrounds the APN’s role and manner of deployment. In this, Singapore is not unique. Recent publications describe a lack of uniformity and clarity in the job scope of APNs in the United States (Iglehart, 2013). Iglehart argued for better clarification of the role of APNs and explore expansion of APN roles to take on defined clinical duties; a view welcomed by APNs, but not all physicians. Surveys reveal considerable interprofessional differences in perceptions of APNs and their function (Soine et al., 2013). Clearly, the role of the APNs is in need of further clarification. Extending this line of thought would see the application of IPE simulation modules in establishing and rehearsing
DOI: 10.3109/13561820.2013.872089
protocols in novel interprofessional specialist treatment teams and putative interprofessional administered therapy. Our study is somewhat limited by its modest size and inequality of exposure. Nonetheless, these do not detract from the main finding of the study, which points to hitherto under-explored role of IPE in defining novel professional roles within the healthcare setting.
Declaration of interest This work was funded by the Innovation and Creativity in Education (NICE) Fund, National University Health System, Singapore. The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.
References Hanyok, L.A., Walton-Moss, B., Tanner, E., Stewart, R.W., & Becker, K. (2013). Effects of a graduate-level interprofessional education program
Exploring new healthcare professionals roles
269
on adult nurse practitioner student and internal medicine resident physician attitudes towards interprofessional care. Journal of Interprofessional Care, 27, 526–528. Iglehart, J.K. (2013). Expanding the role of advanced nurse practitioners risks and rewards. New England Journal of Medicine, 368, 1935–1941. Levett-Jones, T., McCoy, M., Lapkin, S., Noble, D., Hoffman, K., Dempsey, J., Arthur, C., & Roche, J. (2011). The development and psychometric testing of the satisfaction with simulation experience scale. Nurse Education Today, 31, 705–710. Reid, R., Bruce, D., Allstaff, K., & McLernon, D. (2006). Validating the readiness for interprofessional learning scale (RIPLS) in the postgraduate context: Are health care professionals ready for IPL? Medical Education, 40, 415–422. Soine, L.A., Errico, K.M., Redmond, C.L., & Sprow, S.M. (2013). What do faculty physicians know about nurse practitioner practice? Journal of Nurse Practitioners, 9, 93–98. Streubert Speziale, H.J., & Carpenter, D.R. (2003). Qualitative research in nursing: Advancing the humanistic imperative (2nd ed.). New York: Lippincott Williams & Wilkins.
Copyright of Journal of Interprofessional Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
