Jackie Loversidge, PhD, RNC-AWHC Assistant Professor of Clinical Nursing The Ohio State University College of Nursing

Jackie Loversidge, PhD, RNC-AWHC Assistant Professor of Clinical Nursing The Ohio State University College of Nursing

Examine strategies for overcoming barriers to interprofessional collaboration: The faculty point of view Strategies that emerged from the research Themes related to environmental & organizational culture Themes related to studentcentered challenges Themes related to creating powerful experiences

Data on Errors, Q&S, & Call for Directions in Health Care: Includes Interprofessional Collaboration Directions in Health Professions Education: Includes Interprofessional Education QSEN: Incorporating Q&S Recommendations into the fabric of Nursing Education Currently being emulated in some Medical Education Programs Why such a challenge to play together in the sandbox? What are faculty perceptions?

Silo education provides little or no opportunity for: makings of common ground and; beginnings of cross-professions understanding More of the literature focuses on licensed practitioners than students Faculty are the experts charged with educating students, however they continue to be the least frequently surveyed

Collaboration & Cooperation theories applied to interprofessional teams Including Game Theory High performance teams & HROs Reports & Initiatives on IP Health Professions Education Directions in interprofessional education & collaborative learning Medical & Nursing education: differences relevant to collaboration Undergrad vs. grad in prelicensure programs Systematic Reviews (Level V Evidence) Cochrane Review Simultaneous JET review

Very little research from faculty point of view (only 4 at time of proposal) Few qualitative studies Call for more qualitative study to underpin higher levels of evidence Collaborative learning environments involving prelicensure nursing education and medical education

How do medical school and nursing school faculty describe the experiences that enable medical and nursing students to learn how to work collaboratively in interprofessional teams? To what degree to faculty perceive that students are achieving outcomes related to interprofessional teamwork and collaboration, based on current relevant accreditation standards/competencies? What factors do faculty perceive as hindering the development of these competencies? How could hindering factors be overcome to remove barriers to collaboration?

Sampling Site selection: 3 large Midwestern institutions Data collection Semi-structured interviews Digitally audio-recorded and professionally transcribed Field notes/research journal Document analysis Participant selection: Intensity/purposive sampling 5 each nursing & medical faculty Inclusion criteria Sample size: Total of 32 interviews 17 nursing faculty 15 medical faculty Data analysis NVivo 9 (QSR International) Continuous data analysis and reduction 3 rounds of coding Trustworthiness Member checks Peer debriefing Reflexive journaling Soundness Triangulation of questions Triangulation of data through use of document review Thick description Search for disconfirming evidence Bracketing/clarification of researcher bias

Environments & Cultures Image source: vcu.edu Student-centered Themes

Clusters Subthemes Strategies Positive Influences on Student Perceptions of IP Collaboration Q&S driven environment Org culture values collaboration Specialized stable teams Shared core values related to excellence in patient care Expose students to Q&S culture where & when appropriate Student experiences alongside specialized stable teams The conundrum specialized stable team often high-level, e.g. solid organ transplant, palliative care, OR Negative Influences on Student Perceptions of IP Collaboration Enculturation Civility issues/conflict Poor role examples Students fearful of or intimidated by other profession Debrief students exposed to incivility/poor role examples Address incivility in whatever way is appropriate

Positive influences on Student Perceptions of IPC Shared Core Values... They teach their nurses to be real patient advocates and it s okay to go toe to toe with a physician if that s going to be in the best interest of the patient... I ve seen some of the most amazing interactions occur where they re willing to put themselves out there for the benefit of the patient... they come looking for you when you it the floor... You want to try to promote and foster... that open dialogue... with all your medical team. Medical Faculty Negative Influences on Student Perceptions of IPC Students fearful of or intimidated by other profession (Nursing students during simulation) when they first start the interprofessional simulation with the medical students... They ll start out & the debriefing thing I was really scared because I thought you were going to be really threatening to me and be mean basically. They saw the collaboration. So they ll talk a little bit about how doctors expect nurses just to do what they want, and they yell. Then, but they said it wasn t like that. However, I also have the medical students speak up as to how they re treated on the units when they re trying to get information on a patient, and how nurses are not very nice to them. How they are often afraid to speak up to the nurses because they know they re not going to be helpful, and be actually nasty to them. Nursing Faculty

Clusters Subthemes Strategies Academic medical center structures & logistics Programs in silos Minimal opportunity for student connection Scheduling Competition for scarce resources Saturated curriculum Expansive class size Creative scheduling by committed faculty partners Commitment between academic leaders to make resource sharing work Structural curriculum design challenges Organizational culture Curriculum & pedagogical challenges Interprofessional content in the formal curriculum (is, or is not) Matching student mastery level Matching student maturity level Organizational culture & intertia Perceived value of soft content Integration of interprofessional competencies into program outcomes, making it a curriculum requirement (overcomes the stodgy quotient ) Use NLNAC standards & criteria/aacn Essentials as leverage Creative pedagogy and facilitation can overcome the mastery/maturity conundrum Committed leadership Inclusion of required content into the IP exercises

Clusters Subthemes Strategies Faculty Engagement, Competency & Development Building inter-faculty communication & relationships Faculty engagement & development Faculty perceptions of value of interprofessional education Develop inter-faculty relationships around common ground Clinical interests Research interests Faculty Resources Faculty workload & reimbursement Creating faculty incentives Engage part-time clinical faculty in the curriculum

Theme Clusters Subthemes Strategies External Drivers Accreditation supports & drives curricular change Funding a vehicle for collaboration External press as driver Curricular reform Use of national models Leadership & faculty use these to advantage

Themes Clusters Subthemes Strategies Curricular methods & pedagogy Authentic experiential learning Faculty facilitated pedagogies Structured methods Collaborative methods Authentic experience Spontaneous teachable moments Mentoring & role modeling Student debriefing Narrative reflection Evaluating student competency Simulated learning experiences Teaching communication Collaboration around common ground Peer learning Engaging other profession in teaching students Be vigilant & make use of authentic experiences & spontaneous teachable moments Take students & faculty out of comfort zones & away from typical clinical environments when possible Not everyone is a natural mentor help your colleagues learn to become extraordinary mentors Always, always, always debrief, even if you can t do it right away Use creative methods to help students process, e.g. narrative reflection Develop & use competencies Embed them into curriculum; hold faculty accountable for using them Make communication techniques meaningful, e.g. SBAR Engage professional colleagues

Themes Clusters Subthemes Strategies Student roles and role understanding Student role identity & comfort Student understanding & expectations of other health professions roles Team building in medical & nursing students Teach students what other professions do invite them to your house Shared experiences when possible, e.g. international or other out of comfort zone experiences Create opportunities meaningful to your students & others** ** the challenge finding common ground

Use national standards and press as leverage You can change: Your student s experience One student at a time Become an extraordinary mentor Mentor your colleagues help one another in the journey to become better mentors Make the most of authentic experiences Process!!! Debrief, debrief, debrief! Develop relationships with colleagues from other professions Bring your students along when you have those conversations or meetings (your students watch and learn!)

Contact Information: Jackie Loversidge, PhD, RNC-AWHC Assistant Professor of Clinical Nursing Director, Transformational Learning Academy in Nursing & Health The Ohio State University College of Nursing loversidge.1@osu.edu http:www.tlace.osu.edu