524279
research-article2014
NSQXXX10.1177/0894318414524279Nursing Science QuarterlyFawcett / Essays on Nursing Science
Essays on Nursing Science
Thoughts About Interprofessional Education
Nursing Science Quarterly 2014, Vol. 27(2) 178–179 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414524279 nsq.sagepub.com
Jacqueline Fawcett, RN; PhD; FAAN1
Abstract This essay is about two views of interprofessional education. One view emphasizes the coming together of students of various healthcare areas to learn about each other’s roles and role activities. The other view focuses on the meaning of “inter” as the blurring of boundaries among healthcare areas with the potential of loss of distinct roles and role activities and evolution to a single healthcare profession. Keywords education, interprofessional, nursing This essay is an extension of my essay about multidisciplinary, interdisciplinary, and transdisciplinary research (Fawcett, 2013). In that essay, I concluded that “until nurse researchers authoritatively and enthusiastically embrace nursing discipline-specific knowledge. . . they should emphasize single-discipline nursing research” (p. 378). In this essay, I share two views of interprofessional education (IPE) and question which view is more conducive to advancing nursing practice and high quality patient care. Since the late 1960s, “the need for … IPE has been identified as a necessary precursor to effective team functioning and [high] quality care” (Disch, 2013, p. 3). Enthusiasm for IPE is so pervasive that many faculties in many nursing programs in the United States and other countries are competing for federal and foundation grants to support diverse approaches to IPE without questioning its meanings and the implications of meanings. I have identified two views of IPE that reflect two meanings. One view, admittedly the most typical, is that IPE is formal courses, clinical experiences, and/or workshops that involve students from more than one area of healthcare learning about the roles and role activities of each area (Centre for Advancement of Interprofessional Education, n.d.). The most frequently mentioned areas for IPE are the professional discipline of nursing and the trade of medicine. Other areas that also may be included in IPE are nutrition, occupational therapy, physical therapy, respiratory therapy, social work, psychology, sociology, architecture, engineering, and interior design. The goal of this view of IPE is team-based collaborative practice that is purported to enhance the quality of patient care. Core competencies identified by the Interprofessional Education Collaborative (IPEC) Expert Panel (2011) as required to attain that goal are that students from various
areas of healthcare (a) work together to establish and maintain “a climate of mutual respect and shared values” (p. 19); (b) use knowledge of the roles of each area of healthcare “to appropriately assess and address the health care needs of the patients and populations served” (p. 21); (c) communicate “in a responsive and responsible manner that supports a team approach to maintaining health and treatment of disease” (p. 23); (d) “apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable” (p. 25). Perhaps the main implication of the first view of IPE is that the members of each area of healthcare have distinct roles and role activities that do not overlap as they engage in collaborative practice. However, as Taylor (2012) pointed out, “collaboration … is useful only if it is true collaboration” (p. 65). Choi and Pak (2008) underscored the importance of true collaboration when they noted that “The more disparate the [areas of healthcare], the more different the perspectives [of members of each healthcare area], which leads to a greater chance of success in tackling a complex problem” (p. E43). Another view of IPE focuses on the meaning of interprofessional. Extrapolating from Choi and Pak’s (2006) description of interdisciplinary research, IPE can be defined as “an integrative and reciprocally interactive approach that actualizes a synthesis of diverse disciplinary perspectives leading to a new level of thinking about … a topic or even a new discipline” (Fawcett, 2013, p. 376). In this view of IPE, the boundaries of knowledge needed for practice in each area of healthcare are blurred, which leads to blurring or elimination of distinctive of roles and role activities. 1
Professor, Department of Nursing, University of Massachusetts Boston
Downloaded from nsq.sagepub.com at UCSF LIBRARY & CKM on April 27, 2015
179
Fawcett / Essays on Nursing Science Although this view of IPE is not usually found in the literature, the potential for its becoming the dominant view exists unless the voices of the members of each healthcare area are clearly heard and respected and unless the distinctive knowledge of each area is used to identify the roles and guide the role activities of its members. For example, McCloskey and Maas (1998) cautioned “against the [melding], molding, and further concealing of the professional identity of nursing that is being mistakenly encouraged by some persons and groups” (p. 157). They went on to point out that “some nurses are abandoning [nursing] discipline-specific successes because they have been led to believe that a [nursing] disciplinary focus is not consistent with an interdisciplinary approach” (p. 157). Continuing, McCloskey and Maas (1998) maintained that if nurses reject a nursing discipline-specific approach, “patient care will suffer from loss of the nursing perspective and the accountability of nurses for their interventions” (p. 157). McCloskey and Maas’ statements may be generalized to the members of each area of healthcare. Perhaps the main implication of the second view of IPE is that roles and role activities of members of various healthcare areas are not distinct to the end that a single area of healthcare emerges. Thus, IPE could evolve into one educational program for preparation for all areas of healthcare. Nagle (1999), for example, cautioned that “We may soon find ourselves in a situation of generic health science education. Health care systems will be serviced by a hierarchy of generic care providers identified by their educational preparation in the natural and social sciences and their ability to perform technical skills of varying complexity” (p. 80). She went on to identify four levels of generic care providers. Care Provider I has the training to provide custodial care, bathe, ambulate, administer medications, monitor vital signs, intake and output, and intravenous infusions. Care Provider II has the training to provide physiotherapy and respiratory therapy treatments, minor invasive procedures, and dressing changes. Care Provider III performs the more complex procedures and prescribes and interprets diagnostic and treatment interventions. Specialization and expertise is developed on the basis of the medical model, for example, pediatrics, obstetrics, and surgical subspecialties. The Care Provider at the highest level of technical competency is the surgical interventionist who has mastered the most complex of technical procedures and devices. (Nagle, 1999, p. 80)
A question that arises from both views of IPE is, which is the best way to operationalize the creation of “expert teams of health care providers who will transform health and health care … together” (Disch, 2013, p. 4). I encourage readers to share their preferred view of IPE and their ideas about the best way to advance nursing practice and ensure the highest quality of healthcare for all people worldwide. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this column.
Funding The author received no financial support for the research, authorship, and/or publication of this column.
References Centre for Advancement of Interprofessional Education (n.d.). http://caipe.org.uk/ Choi, B. C. K., & Pak, A. W. P. (2006). Multidisciplinarity, interdisciplinarity, and transdisciplinary in health research, services, education and policy: 1. Definitions, 1-objectives, and evidence of effectiveness. Clinical and Investigative Medicine, 29, 351-364. Choi, B. C. K., & Pak, A. W. P. (2008). Multidisciplinarity, interdisciplinarity, and transdisciplinary in health research, services, education and policy: 3. Discipline, inter-discipline distance, and selection of discipline. Clinical and Investigative Medicine, 31(1), E41-E48. Disch, J. (2013). Interprofessional education and collaborative practice. Nursing Outlook, 61, 3-4. Fawcett, J. (2013). Thoughts about multidisciplinary, interdisciplinary, and transdisciplinary research. Nursing Science Quarterly, 26,376-379. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Retrieved from https://www.aamc. org/download/186750/data/core_competencies.pdf. McCloskey, J. C., & Maas, M. (1998). Interdisciplinary team: The nursing perspective is essential. Nursing Outlook, 46, 157-163. Nagle, L. M. (1999). A matter of extinction or distinction. Western Journal of Nursing Research, 21, 71-82. Taylor, S. G. (2012). Moving forward: Ramblings of a genuine antique nurse. Self-Care, Dependent-Care & Nursing, 19(1), 60-65.
Downloaded from nsq.sagepub.com at UCSF LIBRARY & CKM on April 27, 2015
research-article2014
NSQXXX10.1177/0894318414524279Nursing Science QuarterlyFawcett / Essays on Nursing Science
Essays on Nursing Science
Thoughts About Interprofessional Education
Nursing Science Quarterly 2014, Vol. 27(2) 178–179 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318414524279 nsq.sagepub.com
Jacqueline Fawcett, RN; PhD; FAAN1
Abstract This essay is about two views of interprofessional education. One view emphasizes the coming together of students of various healthcare areas to learn about each other’s roles and role activities. The other view focuses on the meaning of “inter” as the blurring of boundaries among healthcare areas with the potential of loss of distinct roles and role activities and evolution to a single healthcare profession. Keywords education, interprofessional, nursing This essay is an extension of my essay about multidisciplinary, interdisciplinary, and transdisciplinary research (Fawcett, 2013). In that essay, I concluded that “until nurse researchers authoritatively and enthusiastically embrace nursing discipline-specific knowledge. . . they should emphasize single-discipline nursing research” (p. 378). In this essay, I share two views of interprofessional education (IPE) and question which view is more conducive to advancing nursing practice and high quality patient care. Since the late 1960s, “the need for … IPE has been identified as a necessary precursor to effective team functioning and [high] quality care” (Disch, 2013, p. 3). Enthusiasm for IPE is so pervasive that many faculties in many nursing programs in the United States and other countries are competing for federal and foundation grants to support diverse approaches to IPE without questioning its meanings and the implications of meanings. I have identified two views of IPE that reflect two meanings. One view, admittedly the most typical, is that IPE is formal courses, clinical experiences, and/or workshops that involve students from more than one area of healthcare learning about the roles and role activities of each area (Centre for Advancement of Interprofessional Education, n.d.). The most frequently mentioned areas for IPE are the professional discipline of nursing and the trade of medicine. Other areas that also may be included in IPE are nutrition, occupational therapy, physical therapy, respiratory therapy, social work, psychology, sociology, architecture, engineering, and interior design. The goal of this view of IPE is team-based collaborative practice that is purported to enhance the quality of patient care. Core competencies identified by the Interprofessional Education Collaborative (IPEC) Expert Panel (2011) as required to attain that goal are that students from various
areas of healthcare (a) work together to establish and maintain “a climate of mutual respect and shared values” (p. 19); (b) use knowledge of the roles of each area of healthcare “to appropriately assess and address the health care needs of the patients and populations served” (p. 21); (c) communicate “in a responsive and responsible manner that supports a team approach to maintaining health and treatment of disease” (p. 23); (d) “apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient/population-centered care that is safe, timely, efficient, effective, and equitable” (p. 25). Perhaps the main implication of the first view of IPE is that the members of each area of healthcare have distinct roles and role activities that do not overlap as they engage in collaborative practice. However, as Taylor (2012) pointed out, “collaboration … is useful only if it is true collaboration” (p. 65). Choi and Pak (2008) underscored the importance of true collaboration when they noted that “The more disparate the [areas of healthcare], the more different the perspectives [of members of each healthcare area], which leads to a greater chance of success in tackling a complex problem” (p. E43). Another view of IPE focuses on the meaning of interprofessional. Extrapolating from Choi and Pak’s (2006) description of interdisciplinary research, IPE can be defined as “an integrative and reciprocally interactive approach that actualizes a synthesis of diverse disciplinary perspectives leading to a new level of thinking about … a topic or even a new discipline” (Fawcett, 2013, p. 376). In this view of IPE, the boundaries of knowledge needed for practice in each area of healthcare are blurred, which leads to blurring or elimination of distinctive of roles and role activities. 1
Professor, Department of Nursing, University of Massachusetts Boston
Downloaded from nsq.sagepub.com at UCSF LIBRARY & CKM on April 27, 2015
179
Fawcett / Essays on Nursing Science Although this view of IPE is not usually found in the literature, the potential for its becoming the dominant view exists unless the voices of the members of each healthcare area are clearly heard and respected and unless the distinctive knowledge of each area is used to identify the roles and guide the role activities of its members. For example, McCloskey and Maas (1998) cautioned “against the [melding], molding, and further concealing of the professional identity of nursing that is being mistakenly encouraged by some persons and groups” (p. 157). They went on to point out that “some nurses are abandoning [nursing] discipline-specific successes because they have been led to believe that a [nursing] disciplinary focus is not consistent with an interdisciplinary approach” (p. 157). Continuing, McCloskey and Maas (1998) maintained that if nurses reject a nursing discipline-specific approach, “patient care will suffer from loss of the nursing perspective and the accountability of nurses for their interventions” (p. 157). McCloskey and Maas’ statements may be generalized to the members of each area of healthcare. Perhaps the main implication of the second view of IPE is that roles and role activities of members of various healthcare areas are not distinct to the end that a single area of healthcare emerges. Thus, IPE could evolve into one educational program for preparation for all areas of healthcare. Nagle (1999), for example, cautioned that “We may soon find ourselves in a situation of generic health science education. Health care systems will be serviced by a hierarchy of generic care providers identified by their educational preparation in the natural and social sciences and their ability to perform technical skills of varying complexity” (p. 80). She went on to identify four levels of generic care providers. Care Provider I has the training to provide custodial care, bathe, ambulate, administer medications, monitor vital signs, intake and output, and intravenous infusions. Care Provider II has the training to provide physiotherapy and respiratory therapy treatments, minor invasive procedures, and dressing changes. Care Provider III performs the more complex procedures and prescribes and interprets diagnostic and treatment interventions. Specialization and expertise is developed on the basis of the medical model, for example, pediatrics, obstetrics, and surgical subspecialties. The Care Provider at the highest level of technical competency is the surgical interventionist who has mastered the most complex of technical procedures and devices. (Nagle, 1999, p. 80)
A question that arises from both views of IPE is, which is the best way to operationalize the creation of “expert teams of health care providers who will transform health and health care … together” (Disch, 2013, p. 4). I encourage readers to share their preferred view of IPE and their ideas about the best way to advance nursing practice and ensure the highest quality of healthcare for all people worldwide. Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this column.
Funding The author received no financial support for the research, authorship, and/or publication of this column.
References Centre for Advancement of Interprofessional Education (n.d.). http://caipe.org.uk/ Choi, B. C. K., & Pak, A. W. P. (2006). Multidisciplinarity, interdisciplinarity, and transdisciplinary in health research, services, education and policy: 1. Definitions, 1-objectives, and evidence of effectiveness. Clinical and Investigative Medicine, 29, 351-364. Choi, B. C. K., & Pak, A. W. P. (2008). Multidisciplinarity, interdisciplinarity, and transdisciplinary in health research, services, education and policy: 3. Discipline, inter-discipline distance, and selection of discipline. Clinical and Investigative Medicine, 31(1), E41-E48. Disch, J. (2013). Interprofessional education and collaborative practice. Nursing Outlook, 61, 3-4. Fawcett, J. (2013). Thoughts about multidisciplinary, interdisciplinary, and transdisciplinary research. Nursing Science Quarterly, 26,376-379. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Retrieved from https://www.aamc. org/download/186750/data/core_competencies.pdf. McCloskey, J. C., & Maas, M. (1998). Interdisciplinary team: The nursing perspective is essential. Nursing Outlook, 46, 157-163. Nagle, L. M. (1999). A matter of extinction or distinction. Western Journal of Nursing Research, 21, 71-82. Taylor, S. G. (2012). Moving forward: Ramblings of a genuine antique nurse. Self-Care, Dependent-Care & Nursing, 19(1), 60-65.
Downloaded from nsq.sagepub.com at UCSF LIBRARY & CKM on April 27, 2015
