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Preparing nursing students for interprofessional learning

Article · June 2014

DOI: 10.5959/eimj.v6i2.238

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 ORIGINAL ARTICLE
Volume 6 Issue 2 2014
DOI: 10.5959/eimj.v6i2.238
www.eduimed.com

Preparing nursing students for interprofessional learning

Jalina Karim1, Nabishah Mohamad1, John H.V. Gilbert2, Ismail Saibon1, Subahan T.Mohd
Meerah3, Hamidah Hassan1, Harlina Halizah Siraj1.,
1
Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur,
2
College of Health Disciplines, University of British Columbia, 3Faculty of Education, Universiti Kebangsaan,
Bangi, Selangor.

ARTICLE INFO ABSTRACT

Received : 24/10/2013
Accepted : 10/03/2014 Introduction: Teaching strategies for nursing students need to be varied to
Published : 01/06/2014 prepare them for their future practice, and to increase their confidence levels
in order to ensure that they deliver high quality care to patients.
KEYWORD Interprofessional learning (IPL) is a way to develop health professional
Interprofessional learning teams in that it facilitates collaboration by having health professional
Nursing student students learn with, from and about each other’s roles and responsibilities in
Collaboration the provision of patient care. At present, nurses are unable to learn together
Learning process with other health professional students during their clinical posting, because
Student perception of professional barriers. Objective: To explore nursing students’ knowledge
and perception of interprofessional learning. Authors developed a grading
system named the Discrepancy-Agreement. Method: This paper presents
the results of a focus group discussion with nursing students (n= 8). A semi
structured guide was used that focused on knowledge, experiences and
benefit related to IPL. Result: Data were analysed, from which four major
themes emerged: 1) Learning with, from and about other health
professionals; 2) Communication skills; 3) Teamwork; and 4) Preparation
of future practice Conclusion: The results of this study suggest IPL as an
educational strategy should be introduced to nursing students in order to
extend their understanding of the roles and responsibilities of other health
professionals and to provide them with opportunities to work
collaboratively with other health professionals.

© Medical Education Department, School of Medical Sciences, Universiti Sains Malaysia. All rights reserved.
CORRESPONDING AUTHOR: Jalina Karim, MSN, BNSc, SCM, SRN, Department of Nursing, Faculty of
Medicine, University Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latiff, Cheras 54000,
Kuala Lumpur. Email: jalinakarim@hotmail.com

Introduction depends on the motivation and creativity which

are used to enhance the process of students
Education of health professionals should use a learning. As stated in the CAIPE definition: “IPE
variety of appropriate teaching and learning occurs when two or more professions learn with,
strategies in order to help students achieve from and about each other to improve
learning outcomes that include appropriate collaboration and the quality of care” (2, 3).
knowledge, psychomotor skills, and professional
attitudes (1). A variety of teaching strategies will IPL is now an essential part of health
prepare students to practice successfully in real professional education and has been introduced
working environment. The quality of learning in many countries (3). In order to deliver

Education in Medicine Journal (ISSN 2180-1932) © www.eduimed.com | e27

effective health care services, interprofessional thereby providing rich data (13). Our focus
collaboration should be introduced to students group comprised eight third year nursing
during their pre-registration/licensure studies (5, students at UKMMC. The intention of the focus
6) which will prepare them to work group was to gather as many responses from the
collaboratively after they graduate (3). IPL is a participants, as possible (14). A semi- structured
way to facilitate collaboration among health guide was used during the session, which
professional teams, and will help nursing focused on: 1) the knowledge, experiences and
students learn with, from and about other health benefit that could be learned together, and 2) the
professionals, to achieve this goal. possible timing of IPL during pre-
registration/licensing years. Discussions lasted
IPL addresses various factors that are common in between 45 minutes and one hour. Data captured
practice, such as, team based patient care and the narrative voices from participants during the
collaborative practice (6). It is inappropriate for session. Prior ethical approval was obtained from
members of a health care team to work the institutional ethical committee. Information
independently if their goal is high quality care. It sheets were provided and informed consent
is therefore a necessary that each team member obtained prior to focus group discussion.
learns to work together in order to achieve Participants were assured of confidentiality.
patient oriented goals (7,8). To ensure nursing
students collaborate with other health Method of Analysis
professionals, they must be provided with active Using thematic analysis focus group discussions
educational and learning opportunities to were analysed manually, in four stages:
improve their understanding of other health 1. Transcription of the discussion was carried
professionals (9). out by the researcher. Transcribing
familiarized her with the entire text of the
Currently, nursing students are taught to focus on focus group discussions.
their specific professional roles (10) and are 2. Following familiarization with the texts, the
unable to learn together during their clinical researcher carefully read the transcriptions,
training due to professional boundaries imposed, line by line, and performed content analysis
for example, by scopes of practice, regulation . The content analysis described what she
and accreditation. There is a clear need to make had interpreted in the texts.
innovations in teaching, especially during 3. The content analyses were then grouped
clinical training, in order to prepare future nurses together into themes.
for collaborative practice with other health 4. Four major themes were derived from this
professionals (11). grouping. The major themes best describe
nursing students’ knowledge and perception
The objective of this study was to identify the of IPL. Texts were shared with a colleague
readiness for IPL among nursing students, with to check for accuracy of transcription.
the ultimate aim of providing useful information
for curriculum change, and development. Results

Method Data were analysed and yielded the following

four themes about knowledge and perception of
We conducted this study using focus group IPL:
discussions. According to Lapan (12), a focus  Learning with, from and about other
group is an interview with multiple informants health professionals,
(five to ten participants) the aim of which is to  Communication skills,
gather in depth information about specific topics  Teamwork,
set out in a series of focused questions. During  Future preparation.
discussion, participants are able to share their
ideas and understanding on the topic discussed,

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Learning with, from and about other health Teamwork
professionals was agreed on by a majority of Teamwork was another important issue agreed
participants. One commented: on by a majority of the participants ‘We need to
have teamwork with students from other
‘I agree that we should learn together with other professionals’. One commented that ‘we need the
professions… for example, we should learn skills teamwork in order to deliver a quality of care to
on suction to the patient together with the patient.’ (Student 4)
physiotherapy students… so that we can share
information etc.’ (Student 1) The future preparation
Participants made some specific suggestions
Another student, concerning future preparation as a strategy that
could help to develop IPL. For example,
‘… we can learn together, we would not feel 1. An issue raised by a number of participants
awkward to share ideas, therefore, there is no related to the number of students per group.
gap with the medical students.’ (Student 2) The hope was expressed that the number of
participants in a group should not be too
‘No overlap roles because everybody can large, and that there should be equality
participate and knows their roles during the between the numbers of students from each
patient managemen.t’ (Student 3) profession.
2. There was concern that IPL should not be
‘We can learn through this experience, it can dominated by certain program. ‘Need to
prepare us to work together in the have an equal chance to other professions
future.’(Student 8) involved, therefore, we can discuss the
patient management easily.’ (Student 7)
The students tried to defend their roles as did 3. Equality was raised by some of the
mention by one of them, ‘We can learn together, participants, especially in terms of
however, some of the professions still thinking assessment; ‘have to make sure that if an
that we have to follow orders and no autonomy assessment is needed, the students from
during patient management.’ (Student 3) other professions have to do the same, so
that everybody has to be responsible.’
Communication skills (Student 3)
Most participants mentioned that communication 4. A majority of focus group participants were
with other professions is important; however, favourably inclined to having topics
they were not given a chance to communicate discussed that related to their clinical
during patient management, as illustrate by the training in order for them to practice in
comment of one participant; delivering a quality care to patients; ‘the
topic must relate to clinical placement’.
‘At the moment we are not taught to 5. Some individuals mentioned that there was
communicate with other professions, it depends a, ‘Need (for) a trained facilitator in the
on our own initiative...’(Student 4) learning session and from other health
professional disciplines.’ (Student 4 and 5)
As indicated above, most of the health 6. A majority of discussants agreed on
professional education takes place within their exposure early to IPL. One participant said:
programmes and the curricula did not emphasize ‘It is good to expose us early to other
on interaction with other health care professions professions, therefore, we will understand
(15) . better about other professions’. In contrast,
there was one participant disagreed that the
One participant emphasized that; ‘At last patient students should be exposed as early as year
will suffer from the miscommunication between one, as she mentioned that ‘each students
the team.’ (Student 3) must be exposed to their own profession, get

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 to know their profession before they can that IPL should be accurately assessed since it is
contribute to others.’ (Student 3) known that objective and fair assessment
motivates students to learn (7).
Discussion
From discussion in the focus groups, it was clear
The objective of this study was to identify the that there is a need for experienced facilitators to
readiness for IPL among nursing students, with facilitate IPL. Experienced and committed
the ultimate aim of providing useful information facilitators are required to be involved in IPL (7)
for curriculum change, and perception of from different disciplines (16,20). Facilitators
interprofessional learning. who are poorly prepared and unable to become a
good role models will clearly interfere with the
Nursing students appear positive and ready for success of the IPL (17).
IPL (4,15). Understanding of their own, and
other health professionals’ roles in managing The number of students and equal representation
patient care increased after students had been across programs are seen as important factors for
exposed to IPL (5). Furthermore, uniprofessional the success of IPL and both were mentioned by a
care is seen as not being as of high quality as that majority of students. IPL requires a small
provided by interprofessional teams. (8, 14). learning group (7) between 5-10 students
(22).The number of students from each
There are only a few opportunities to expose profession must be equal in order to experience
students so that they understand each other roles good interprofessional interactions (19) and
(15) and are able to collaborate with other health avoid domination by a large professional group
professionals (7). The opportunity to learn (7) .
together can break down negative feeling
towards other health professionals (17). In IPL is very challenging (20), it is a hard goal to
addition, IPL is seen to improve communication achieve (22) and needs to be very carefully
skills , professional interdependence and planned in order to avoid frictions(19) and
confidence levels (16). interprofessional conflict (7). Faculty members
play an important role in supporting IPL as role
We also found that the majority of students in models. (19). Positive learning environments,
this study perceived that it is good to expose which encourage socialization, should be
them early to IPL. Based on findings by Priest supported as students will then give their full
and Robert (18), it is essential to expose commitment to IPL (17). There will be
students early in order that they become effective challenges in designing and implementing the
collaborative team members. Early exposure is IPE (15). Good planning, designing and
seen as encouraging the development of positive preparation for the difficulties that could arise
attitudes and behaviours (19). However, it is also (18) such as scheduling, number of students and
possible that it is not good to expose students to accountability (22) will end with the success(7).
IPL too early since they may not yet be familiar Changing and developing curriculum that
with their own professional roles which might facilitates IPL is known to ensure that high
negatively impact their contribution to team quality patient care is the outcome of health
learning (7,20). professional education.

Steinert (17) argued that early exposure to IPL Conclusion

can give students chance to actively participate
in collaborative patient care and therefore In this study, responses of focus group
develop positive attitudes to working together participants showed that IPL is perceived as
with other health professionals at an early stage positive in terms of interest, acceptance and
in their education (7). In addition, the discussants understanding. This study also showed that
highlighted issues such as assessment. It is clear nursing students are ready for a curriculum that

Education in Medicine Journal (ISSN 2180-1932) © www.eduimed.com | e30

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Appendix

Semi structured questionnaire

1. How far do you feel your achievement in the

learning process?
2. Have you ever heard about Interprofessional
Learning (IPL)?
3. Do you know about IPL in general or our
faculty?
4. Do IPL been practicing in our faculty?
5. What are the advantages of IPL that you
know?
5. If there will be a new learning package that
involves the IPL, what do you aspect from this
learning package?

Education in Medicine Journal (ISSN 2180-1932) © www.eduimed.com | e32

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