EFFECT INTERPROFESSIONAL EDUCATION MODEL ON TEAM WORK AND COLLABORATION ATTITUDES OF NURSES STUDENTS IN THE INTENSIVE CARE UNIT OF HOSPITAL

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1 EFFECT INTERPROFESSIONAL EDUCATION MODEL ON TEAM WORK AND COLLABORATION ATTITUDES OF NURSES STUDENTS IN THE INTENSIVE CARE UNIT OF HOSPITAL (Pengaruh Model Pendidikan Interprofessional Tim Kerja Dan Sikap Kerja Sama Mahasiswa Perawat Di Unit Perawatan Intensif Rumah Sakit) Eny Kusmiran, Istianah, Lisbet Octovia Manalu. PSIK Sekolah Tinggi Ilmu Kesehatan Rajawali Bandung Jl Rajawali Barat No 38 Bandung Jawa Barat 40184, Telp (022) ABSTRAK Pendahuluan: kebijakan International merekomendasikan Interprofesional Pendidikan (IPE) untuk meningkatkan praktek interprofessional Dalam upaya untuk meningkatkan praktek perawat profesional, IPE adalah strategi membentuk perilaku profesional perawat dalam kerja tim dan kolaborasi antara profesional kesehatan lainnya, terutama dokter dalam perawatan kritis. Tujuan untuk mengetahui pengaruh model IPE kerja tim dan kolaborasi dari sikap mahasiswa keperawatan di unit perawatan intensif Rumah Sakit. Metode: Penelitian ini dilakukan dengan Rancangan kuasi-eksperimental. Jumlah 30 subyek ( intervensi dan kelompok kontrol) oleh random sampling. intervensi terdiri dari: 1) pretest 2) pemberian modul pendidikan interprofessional materi pada mata pelajaran keperawatan kritis selama 2 minggu, 2) posttest. tes t berpasangan digunakan untuk menentukan dampak dari Pendidikan interprofessional. Kemerdekaan t-test digunakan untuk mengetahui pengaruh perbedaan Pendidikan interprofessional. Instrumen yang digunakan adalah Sikap terhadap Kesehatan interprofessional Tim Timbangan untuk mengukur sikap kerja tim dan Interprofesional Kolaborasi Timbangan untuk mengukur sikap kolaborasi. Hasil: Ada tarif perbedaan kerja tim dan sikap kolaborasi perawat sebelum dan sesudah pada kelompok intervensi. Ada werenot tarif perbedaan kerja tim dan sikap kolaborasi perawat sebelum dan sesudah pada kelompok kontrol. Ada nilai perbedaan sikap kerja tim dan kolaborasi antara intervensi dan kelompok kontrol. Diskusi: Memberikan modul IPE untuk perawat umumnya dianggap menjadi strategi penting untuk meningkatkan kerja tim dan sikap kolaborasi pada siswa perawat di unit perawatan intensif rumah sakit. Kata kunci: Interprofessional Pendidikan, kerja tim, kolaborasi, mahasiswa perawat ABSTRACT Introducction: International policy recommends Interprofesional Education (IPE) to improve the practice of interprofessional In an effort to improve the practice of professional nurses, the IPE is the strategy of forming professional conduct of nurses in team work and collaboration between other health professionals, especially doctors in critical care. Objective to identify the effect of IPE model of team work and collaboration of the attitudes of nursing students in an intensive care unit of Hospital. Methods: This study was conducted with The quasi-experimental design. The number of 30 subjects ( intervention and control group) by random sampling. The intervention consisted of: 1) pretest 2) the provision of material interprofessional education modules on subjects of critical nursing for 2 weeks, 2) posttest. Paired t tests were used to determine the effects of interprofessional Education. Independence t-test were used to determine the difference effect of interprofessional Education. The instrument used was The Attitudes towards interprofessional Health Care Teams Scales to measure the attitude of teamwork and Interprofesional Collaboration Scales to measure the attitude of collaboration. Results: There were differences rates of team work and collaboration attitudes of nurses before and after on intervention group. There werenot differences rates of team work and collaboration attitudes of nurses before and after on control group. There were differences scores of the attitude of team work and collaboration between the intervention and control groups. Discussion: Giving IPE modules for nurses are commonly regarded to be an essential strategy for improving team work and collaboration attitudes on nurses student at intensive care unit of hospital. Keywords: Interprofessional Education, team work, collaboration, nurses student INTRODUCTION International policy recommends Interprofesional Education (IPE) to improve the practice of interprofessional (Craddoch et al., 2013). Health service system, nurse and doctor partnership, as the executor team has an important role in the patient care. An effective teamwork is supported by education level and professional attitude, with mutual respect ability and contribution of each profession in treating patients (Cullen, Fraser, & Symond, 2003). This professional 1

2 Jurnal INJEC Vol. 1 No. 2 Desember 2016: attitude is formed professional education and supported by practise environment that allows the interprofessional collaboration. The experience of team work among professions and interprofessional relationship is very low in each profession learning process, therefore the curriculum of IPE enables students to have interaction experience in working and collaboration with other health interprofessions. This Interprofessional Education is widely applied in higher education curriculum of health profession (Wilhelmson, 2011), however this education model has not been widely applied in Indonesia, especially in nursing. Team work ability in team and collaboration with other health professions is one of the competencies that must be possessed by nursing students, therefore this IPE model is righteously applied in the curriculum of nursing education, as recommended by WHO (2010) that there are a lot of benefits provided by the implementation of this IPE. Based on the above backgrounds, the researcher was interested to study about The effect of Interprofessional Education (IPE) model to the team work attitude and collaboration of nursing students in the intensive care unit of hospital. The purpose of this study is to identify the effect of Interprofessional Education model to the team work and collaboration attitude of nursing students in the intensive care unit of hospital. The theoritical benefit of this study result is the basis for nursing education curriculum in Indonesia and other health professions education in general, in implementing IPE in the curriculum especially in critical nursing learning outcomes. The practical benefit of this study result is the basis for learning method change in order to improve the capability of nursing students during his/her practice by implementing IPE. In addition, this research result is also used as the basic info in improving the nursing education research by impelemting IPE in other learning outcomes in order to improve the quality of nursing profession. Literature Study Interprofessional Education Interprofessional education (IPE) is an application of adult learning which interactive, group-based, allowing collaboration practise and mutual understanding of any involved profession (Barr, 2001). IPE based learning process is an education process which involves two or more health profession so the interaction among these professions can encourage knowledge transfer and establish a mutual appreciation of each competence in teamwork and collaboration among professions (Colyer et al., 2005). Some studies show that the effect of IPE improved the satisfaction of students and teamwork (Curran, 2010). In addition, according to Pollard (2008) in the interprofessional relation, exposed to IPE students were more confident and had the ability for better communication other than non-exposed to IPE students. The characteristic of learning process in the IPE curriculum allows for knowledge transfer, interaction among students through practicum activity, allows students to give feedback to each competence. Learning process uses role play model and laboratory practise. This represent teamwork condition and collaboration among health professions. It is expected that through this learning process every student has partnership, so they support each other and improve other shortage (Barr, 2001). Nursing education is a professional education which oriented to science, technology and society, so it is expected that it can keep up the current development and used in the development of students learning experience. According to (Nursalam 20), profession education concept consist of science and technology mastery, natural problem solving, attitude, behaviour and professional capability, independent learning as well as community learning, so the change of learning method in higher education of nursing is expected to improve the competency of professional 116

3 Effect Interprofessional Education Model on Team Work (Eny Kusmiran, dkk.) nursing. This interprofessional education (IPE) is one of the study in the development of nursing study program curriculum. Framework Interprofessional Education IPE concept is a process in preparing collaboration practise that support health services so it can improve health outcomes. Collaboration practise occurs in service environment that involve several people with different profession background. IPE implementation phase consist of: preparation of IPE-based curriculum, identification of lectures amd students for the role play, teamwork practise, and work performance as a team. The domain of IPE implementation consist of: teamwork, role models and responsibility, communication, learning and reflection, interconnection and identification of patients need, and ethics. while, in the Curriculum Renewal for Interprofessional Education in Health published by The Australian Governmant Officer for Learning and Teaching (2014) it was explained that IPE-based education process consist of interprofessional learning (IPL) activity and Figure 1. Framework Interprofessional Education From WHO (2010). Knowing how to go on Inform Making sense of experience Theorising Make sense of Practising Embodying theory Figure 2. Model Practice as Embadied Theory. Source: Helme (2004), with reference to Gadamer s hermeneutic circle (Gadamer 1989) and Ison, Blackmore et al., 2003 (dalam Colyer, 2005) 117

4 Jurnal INJEC Vol. 1 No. 2 Desember 2016: interprofessional practice (IPP). In this process, the role of tutor also determines its success, so tutor should understand the purpose of learning (Sharpe, 2009). Team Work Attitude Attitude, according to Hodges (2012) had more to do with feelings, and individual reactions to incidents in the surrounding. Attitude is also a disposition to react positively (favorably) or negatively (unfavorably) to certain objects. Teamwork is an act that can be conducted by a group as a team to achieve goals (Boller, 2005). The activities in this collaboration consist of: mutual help and sharing of expertise, sharing of information to support each other, so it can encourage a relationship that can improve the communication; to give positive feedbacks that can smooth the process or outcomes; to receive suggestion from others to improve self capability; to conduct group decision for team s problem solving, to give ideas and mutual trust. The attitude of teamwork is the willingness of individuals to conduct team work and active communication within the team. Active has a meaning to give suggestion and encourage each other to achieve team s goals. The main components of attitude formation according to (Notoadmodjo 2011) are: religion or belief, idea, and concept of attitude; emotional life or evaluation of people to an object; as well as tendency to act. Some research suggested that IPEbased education curriculum encouraged to the establishment of attitude and readiness of students to work with a team which consist of several health professioncs, such as Mandy et al. (2004), Regmi (2010), and Wilhelmson (2011). Based on the social identity theory, students who have a positif look to their group and other groups showed a positive interprofessional learning result too. The implication is that the IPE process encourage a positive attitude of students in the readiness for teamwork. Collaboration Attitude Collaboration is a complex and multidimensional activity, involving nurses, doctors, and other profession who work together to provide services to individual patients, families, and communities (Cox, 2010). Futhermore, according to Curran (2007), collaboration in nursing is a process that focues on patients with two or more interactions of professions to share knowledge, skills, and decision making in patient care. There are several factors that able to increase the practise of collaboration, such as: attitudes, knowledge, skills, and organizational factors. An effective communication is the key of collaboration success (Laming, 2003, in Cox, 2010), in addition, an effective inter professional collaboration can improve teamwork, working satisfaction, and reduce patients level of pain. Nurse student Education Interprofessional Education Learning Outcomes Competency Knowledge Attitude Skills Interprofessional Learning Interprofessional Practice Figure 3. The Formation Process of student s Competency. 118

5 Effect Interprofessional Education Model on Team Work (Eny Kusmiran, dkk.) METHOD This research was a quantitative research with an experimental quasi design with pre-test and post-test to identify the effect of Interprofessional Education model to the team work and collaboration attitude of nursing students in the intensive care unit of hospital. The population of this research was all nursing students in STIKES Rajawali at the final grade as many as 70 people. The sample was divided into two groups: people of intervented group and people of control group. A drop out criteria was the absence student or sick during the practical period of critical nursing subject. Team work attitude instrument used The Attitudes towards Interprofessional Health Care Teams Scale and collaboration attitude used Interprofessional Collaboration Scale. The scale of questions used Likert scale (1 = strongly disagree, 2 = disagree, 3 = doubt, 4 = agree, 5 = strongly agree). RESULTS The results study were conducted through two phases. The first phase was the development of critical nursing module with IPE approach. The development and preparation of module was based on the identification of IPE material needs and assessment to lectures and perceivers as well as literature study such as a referral from Interprofesional Working in Acut Care (IWAC) by Holland (2003) in March April The second phase was the implementation of critical nursing module material provision with IPE approach in June The provision of IPE module about critical nursing with experimental quasi approach was conducted to nursing students as control and nursing students as treatment. The implementation of critical nursing module material provision was conducted for two weeks in June The assessment was conducted a week before the implementation of IPE module provision about critical nursing module to intervented group and standard material to control group. The evaluation was conducted after the implementation of Table 2 Collaboration atttitude between intervention and control group Collaboration attitude n ±s.d. Intervention group Collaboration atttitude before intervention Collaboration atttitude after intervention Control group Collaboration atttitude before intervention Collaboration atttitude after intervention *paired-t-test 73,2 ± 5,3 77,3 ± 3,2 71,1 ± 8,9 76,6 ± 4,7 difference ± s.d. CI95% 4,1 ± 4,4 1,7 6,6 0,003 5,5 ± 11,5 0,8 11,9 0,083 p Table 3 difference changes of mean scores of team work and collaboration attitude between intervention and control group No Variables Intervention Control 1 Team work attitude Standard Deviation 2 Collaboration attitude Standard Deviation *independence t-test 7,0 4,3 4,1 4,2 4,4 8,1 5,7 11,3 Difference CI95% 2,6 2,3 7,5 0,285 1,6 4,9 8,2 0,614 p 119

6 Jurnal INJEC Vol. 1 No. 2 Desember 2016: treatment once nursing students completed their nursing profession practice for six weeks. The test results table 1 showed that there were significant differences mean teamwork attitude the student nurses before and after between intervention and control groups p < There is on table 2 showe a significant difference in the mean attitude of collaboration student nurses before and after the intervention group. There are differences between the mean attitude of the average attitude of collaboration student nurses before and after in the control group but indicated no significant difference p > The results of the table 3 shows that the average change in attitude of team work and collaboration among student nurses before and after the intervention and control groups was not significant p > DISCUSSION In this research, it can be identified that the assessment of team work attitude to nursing students in the intervented group increased towards team work attitude. The change of team work attitude showed a good quality as many as > 80, referred to the assessment of attitude perception. The change of team work attitude was also identified in the control group however its change was in sufficient limit (75 80). These results showed that IPE material provision in critical nursing improved the team work attitude of nursing students. The collaboration attitude in intervented group showed a significant change while the change of collaboration attitude in control group was not significant. However, the change of collaboration attitude has not in a good quality < 80. The model of pre-profession briefing to achieve critical nursing learning outcomes with interprofessional education approach in nursing profession program has not been widely implemented in nursing institutions. The provision of IPE module in this research was focused on the capability of nursing students to cooperate and collaborate during their practice in intensive care unit. In this research, IPE module consist of the following materials: 1) the concept of material and skills of partnership among nurses and other health workers; 2) interprofession team work, this material consist of integrated and interdiscipline learning, which conducted through study, seminars, and working in a group, 3) collaboration among nurses and doctors; 4) communication in nursing and 5) implementation of the IPE in nursing clinical practise. CONCLUTION AND RECOMMENDATION Conclusion In this study, it can be concluded that there was a significant change of team work and collaboration attitude of nursing students before and after the provision of IPE module. There was no significant difference of collaboration attitude of nursing students before and after the treatment in control group. The change of team work attitude in nursing students before and after the IPE module treatment in intervented group was higher than control group. There was no significant change of collaboration attitude in intervented group and control group. Recommendation IPE module in critical nursing can be implemented to improve the capability of nursing students for teamwork and collaboration attitude during their practice in intensive care unit, The assessment of team work and collaboration attitude of nursing students requires a minimal performance standard > 80. If the assessment has not reached the standard, a provision of material and reassessment is required. BIBLIOGRAPHY Azwar, S Sikap Manusia: Teori dan Pengukurannya. Yogyakarta: Pustaka Pelajar. Barr, H Interprofessional Education: Today, yesterday, and tomorrow Learning and theaching Support 120

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