http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(3): 258–259 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2014.942779

SHORT REPORT

Partnering to provide simulated learning to address Interprofessional Education Collaborative core competencies Judy I. Murphy1 and Jayashree Nimmagadda2 1

Department of Nursing and 2Department of Social Work, Rhode Island College, Providence, RI, USA

Abstract

Keywords

Learning to effectively communicate and work with other professionals requires skill, yet interprofessional education is often not included in the undergraduate healthcare provider curriculum. Simulation is an effective pedagogy to bring students from multiple professions together for learning. This article describes a pilot study where nursing and social work students learned together in a simulated learning activity, which was evaluated to by the Readiness for Interprofessional Learning Scale (RIPLS). The RIPLS was used before and after the simulated activity to determine if this form of education impacted students’ perceptions of readiness to learn together. Students from both professions improved in their RIPLS scores. Students were also asked to identify their interprofessional strengths and challenges before and after the simulation. Changes were identified in qualitative data where reports of strengths and challenges indicated learning and growth had occurred. In conclusion, this pilot study suggests that interprofessional simulation can be an effective method to integrate Interprofessional Education Collaborative core competencies into the curriculum.

Collaboration, communication, interprofessional education, mixed methods, professional competence

Introduction Interprofessional Education Collaborative (IPEC, 2011), a group of professional organizations from nursing, medicine, pharmacy, public health, osteopathic medicine and dentistry developed 38 core competencies for interprofessional collaborative practice. This collaborative identified four domains that are essential for effective collaboration. The domains are: values and ethics, roles and responsibilities, teams and teamwork, and interprofessional communication. For effective teamwork and patient-centered care, IPEC proposed that students should be engaged in education to help them achieve these competencies. The objective of this pilot was to explore how interprofessional simulations (IPS) affected nursing and social work students’ readiness for interprofessional learning and their perception of interprofessional strengths and challenges. Nursing and social worker (SW) educators collaborated to revise existing simulations to incorporate SW and interprofessional components. Four simulations were developed and implemented. Each simulation addressed several competencies in the four domains. Professional actors played the role of the family member who presented an ethical dilemma. The nursing students had not worked with professional actors in simulation prior to this time and did not know in advance how the actor would respond. Students were oriented to the simulation, interprofessional education and each profession’s code of ethics. One simulation that addressed several competencies in the values and ethics domain presents a scenario where an elderly

Correspondence: Dr Judy I. Murphy, PhD, Department of Nursing, Rhode Island College, Providence, RI 02908, USA. E-mail: [email protected]

History Received 31 December 2013 Revised 4 May 2014 Accepted 5 July 2014 Published online 30 July 2014

female (high-fidelity mannequin) with a history of mild dementia is admitted with a urinary infection. Students received a poor end of shift report. An error was made and discovered by an irate family member. Nursing students are expected to call the SW students, identify and disclose the error, apologize without placing blame, utilize SW and identify resources to prevent errors in the future. In the debriefing SW and nursing faculty collaboratively facilitated a reflective discussion with all students focused on the IPEC core competencies and processed the realities of healthcare outcome as a team. All simulations were collaboratively debriefed in the same way immediately following the simulation. The other three simulations included: an asthmatic who had a same sex partner in the room asking many questions, a patient who coded with his distraught wife in the room interfering with care and a homeless man without a pulse (who does not recover) accompanied by his drug addicted friend.

Methods The study employed a pre-/post-quasi-experimental design using the Readiness for Interprofessional Learning Scale (RIPLS) (McFadyen, Webster, Maclaren, & O’Neil, 2010). This survey also included a series of open-ended questions that asked students to identify strengths and challenges connected to their interprofessional learning. All senior nursing students and graduate SW students were invited to participate. Data collection Data were compared in the aggregate by profession. Fortythree nursing students and 45 SW students volunteered and completed the RIPLS, an 18-item questionnaire made up of three

Simulations addressing IPEC core competencies

DOI: 10.3109/13561820.2014.942779

Table I. Mean of RIPLS subscales by profession at pre- and post-test. Teamwork and collaboration Profession

Pre-test Post-test

Nursing Social work

4.08 4.28

a

4.56 4.53a

Sense of professional identity Pre-test 4.19 3.75

Post-test a

4.29 4.47a

Patient centeredness Pre-test Post-test 4.32 4.28

4.36a 4.32a

a

p50.05.

constructs: teamwork and collaboration, patient centeredness and sense of professional identity (McFadyen et al., 2010) via Survey MonkeyÕ. The post-test response rate for nursing students and SW students was 48.8 and 57.7%, respectively. Analysis A non-parametric test, one-sample Kolmogorov–Smirnov test, was run for each of the items on the RIPLS scale. Students’ responses to perceived strengths and challenges related to interprofessional learning pre- and post-IPS was analyzed by content analysis. This approach was used to code and theme responses. Summative content analysis was used to determine the frequency of themes. The PI and co-PI independently compared their themes with the research assistants and reached 100% consensus. Ethical considerations The study received approval from the Institutional Research Ethics Committee.

Results Both student groups showed a significant change in attitudes toward interprofessional learning in that attitudes became significantly more positive after the simulations (p50.05) (Table I). Themes identified from the open-ended questions include communication, ability to work as a team, attitudes, listening skills and leadership skills. A unique strength of interprofessional learning identified by nursing students was patient-centered care, while only SW students identified cultural competence, ability to work in a high-stress environment and compassion. On post-test both nursing and SW students identified new strengths such as reflective listening and open-mindedness for the SW role. The most frequently reported challenge by both groups on pre-test was interprofessional role uncertainty, while at post-test this challenge was reduced by over two-thirds.

Discussion In the past, measures of IPE have focused on program evaluation, satisfaction, confidence, team collaboration and perception of others’ roles (Youngblood, Zinkan, Tofil, & White, 2012; Zhang, Thompson, & Miller, 2011). Using a simulation that presented and evaluated an ethical challenge was not found in a systematic review (Gough, Hellaby, Jones, & MacKinnon, 2012), thus this pilot explores new territory.

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Consistent with other research, nursing students’ report of delegation and communication skill increased as a result of IPS (Gough et al., 2012). While a reduction in reported strengths suggests diminished teamwork and communication, it is the researchers’ perspective that these simulations led students to be more reflective and acknowledge how little teamwork skills they possessed and were able to execute. After reflection, what they initially had identified as strengths were now reported as challenges. These findings suggest the value of using IPS with nursing and SW students. Indeed, the study found that a full day of IPS activities promoted readiness for interprofessional learning as well as positive changes in collaboration, communication and professional identity. Further research to evaluate student learning and efficacy by matching individual pre- to post-responses using a tool that addresses all 38 competencies is needed. In relation to study limitations, this analysis is susceptible to Type II errors because of a post-test loss of responses. A Type II error is when the researcher accepts the research hypothesis that there is a significant difference in scores of RIPLS after these simulations, which is false. Those that responded to the post-test may not have been representative of the sample, thus although the data indicates a significant difference pre- to post-test, this may not be true. In addition, although the response rate was high for a survey, it was lower than desired. Our inability to match the individual responses pre- to post-IPS is another limitation of this work. In summary, interprofessional faculty collaboration yielded substantial returns for students and faculty. IPS proved to be a useful pedagogy to meet IPEC core competencies. Integrating interprofessional education in professional schools has tremendous potential for mentoring a new generation of healthcare workers who have clarity and appreciation for each profession’s roles.

Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

References Gough, S., Hellaby, M., Jones, N., & MacKinnon, R. (2012). A review of undergraduate interprofessional simulation-based education (IPSE). Collegian, 19, 153–170. Interprofessional Education Collaborative (IPEC). (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Retrieved from http://www.aacn.nche.edu/education-resources/ ipecreport.pdf McFadyen, A.K., Webster, V.S., Maclaren, W.M., & O’Neil, M.A. (2010). Interprofessional attitudes and perceptions: Results from a longitudinal controlled trial of pre-registration health and social care students in Scotland. Journal of Interprofessional Care, 24, 549–564. Youngblood, A.Q., Zinkan, J.L., Tofil, N.M., & White, M.L. (2012). Multidisciplinary simulation in pediatric critical care: The death of a child. Critical Care Nurse, 32, 55–61. Zhang, C., Thompson, S., & Miller, C. (2011). A review of simulationbased interprofessional education. Clinical Simulation in Nursing, 7, 117–126.

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Partnering to provide simulated learning to address Interprofessional Education Collaborative core competencies.

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