By Diane Butcher RN MN PhD(c)
Numerous inter-professional initiatives permeate the health-care landscape, outlining the need for professionals to collaborate
effectively to provide quality patient care. Little attention has been given to intra-professional relationships, where professionals within one disciplinary domain (with more than one point-of-entry to practice) collaborate to provide care. New care models are being introduced in some contexts, where baccalaureate and diploma students of a particular discipline (such as nursing, occupational therapy, dentistry, or physiotherapy) are working closely together in teams to deliver care. Questions thus arise as to how students and educators learn to work on intra-professional teams.
My dissertation work (A Methodologically Plural Exploration of Student, Nurse, and Educator Experiences with Intra-professional Collaboration) includes leading* a Joanna Briggs Institute (JBI) qualitative systematic review, exploring pre-licensure health professional student and educator experiences learning to work on intraprofessional teams. Changes in acute care contexts, including the introduction of new care models and team configurations of RNs, LPNs, and Health Care Assistants, have created role ambiguities and overlapping scopes of practice which impact nurses’ work and patient care (MacKinnon, Bruce, & Butcher, 2015a; 2015b). How are health professional students prepared for working collaboratively within these teams in shifting care contexts?
Currently, there is little research available related to changing healthcare teams and relationships to care outcomes. Further, nurses currently in practice reflect upon how there were few, if any, opportunities as students (baccalaureate and diploma) to work together or learn about each others’ roles. Therefore, this systematic review was conducted in order to explore what is currently known (as well as to identify the gaps) about how categories of students under one disciplinary domain learn to engage collaboratively to enhance patient care.
The JBI process of qualitative synthesis – meta-aggregation – includes development of a research question and peer-reviewed protocol (with specific inclusion/exclusion criteria), and comprehensively searching numerous databases for retrieving relevant published and unpublished literature. Our search revealed over 1000 articles to be screened for possible inclusion in this review. After an initial screen, 61 articles remained that required more detailed, second full-text assessment. After this subsequent screening, 12 articles remained to be critically appraised utilizing a standardized appraisal tool. After critical appraisal, seven papers remained that were
included in this systematic review.
Sixty-four unequivocal or credible findings, all of which were supported by data (participant quotes) were iteratively synthesized using posters and JBI software in order to create nine categories of findings, grouped by similar meaning. The nine categories were then further iteratively grouped into four synthesized findings: (i) contextual factors (including pedagogical approaches and timing of experiences) may influence experiences of intra-professional learning; (ii) shared learning opportunities contribute to comprehensive care planning and more efficient patient care; (iii) intra-professional learning helps to build collaborative relationships and understanding of roles; and (iv) intra-professional learning is beneficial to students; however, it also creates frustration for students.
Despite its challenges, shared learning experiences assisted students in understanding each other’s roles, develop communication and collaborative competencies, develop comprehensive care plans, provide more efficient care, and helped prepare them for their future roles as health care professionals. Various contextual elements could either hinder (hierarchies in practice, academic staff attitudes, inconsistent shared learning activities, lack of understanding or respect of roles, timing of shared experiences) or facilitate (tutor role modelling, clinical/classroom pairings, role playing) shared learning experiences. As only papers from the disciplines of occupational therapy, physiotherapy, and dentistry met the inclusion criteria for this review, further nursing research is needed to understand not only student experiences of intra-professional learning, but also how changes to care teams and models impact experiences of patients and families.
*Reviewers: Karen MacKinnon, Anne Bruce, Carol Gordon, and Clare Koning, University of Victoria
_______________
MacKinnon, K.A., Bruce, A., & Butcher, D.L. (2015). Re-designing nurses’ work: How institutional work practices perpetuate health inequities in small community hospitals. ISIH 6th International Conference: Challenging Health Inequity: A Call to Action, Palma de Mallorca, Spain, June 10-12, 2015.
MacKinnon, K.A., Bruce, A., & Butcher, D.L. (2015). Working to their full scope: Exploring changing work relationships between RNs and LPNs. Invited presentation at Island Health/University of Victoria Health Talks 2015, Victoria, BC, April 20, 2015.
From the 2016 Spring Communiqué — Knowledge Synthesis
Recent Comments