Emergency on Campus: Attitudes of Interprofessional Healthcare Students in a Simulated Patient Care Experience

Monday, 30 October 2017

Briyana L. M. Morrell, MSN1
Rebecca Ann Cartledge, MSN1
Jennifer Nicole Carmack, MSN, RN1
Kathleen Elizabeth Hetzler, DNP1
Stephanie R. Kemery, MSN1
Shannon Marie Moore, MSN1
Alison M. Nichols, OTD2
Jane Toon, DNP1
Craig A. Voll Jr., PhD3
Elizabeth S. Moore, PhD4
(1)School of Nursing, University of Indianapolis, Indianapolis, IN, USA
(2)School of Occupational Therapy, University of Indianapolis, Indianapolis, IN, USA
(3)Athletic Training Department, University of Indianapolis, Indianapolis, IN, USA
(4)School of Nursing and College of Health Science​​, University of Indianapolis, Indianapolis, IN, USA

Problem: It is unclear what the attitudes of Nursing, Athletic Training, and Occupational Therapy students are before and after an interprofessional simulation.

Purpose: The purpose of this study was to explore student attitudes and perceptions toward other professions and interprofessional collaboration after their participation in an interprofessional simulation. Baseline and post-simulation perceptions were measured using the Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JSATIC) and attitudes and perceptions were further explored post-simulation using focus groups and semi-structured interviews.

Literature Review: Interprofessional Education (IPE) is defined as happening when “two or more professions learn with, from and about each other to improve collaboration and the quality of care” (Centre for the Advancement of Interprofessional Education, 2002) and has been widely utilized over the last 20 years (Lachmann, Ponzer, Johansson, Benson, & Karlgren, 2013). Healthcare simulation has advanced in conjunction with technology and healthcare education and can provide a number of advantages to student learning, including the provision of a likeness to clinical practice, the opportunity to change conditions, and more relevant feedback for students (Palaganas, Epps, & Raemer, 2014). The goal of IPE collaboration is to educate students to work together toward the goal of providing optimal healthcare (Pardue, 2013). The World Health Organization (WHO) has stated there is sufficient evidence showing that IPE in the clinical setting promotes effective patient care (Lachmann et al., 2013). It is universally accepted that providing comprehensive quality healthcare is an ideal, if not the primary tenet, of all healthcare disciplines. Comprehensive services include teamwork, coordination, and cooperation among healthcare professionals. It is hoped that through the promotion of interprofessional collaboration, an increased awareness of what other healthcare professions bring to a situation will be gained, ultimately leading to the provision of high quality patient-centered care.

Methods: A mixed methods convergence design was utilized. Results from the quantitative data were used to guide the focus group discussions. A convenience sample of 77 students from courses in nursing (BSN), athletic training (AT), and occupational therapy (OT) participated in or served as a bystander an interprofessional simulation. Of the 77 students, 32 (BSN = 10, AT = 18, OT = 4) completed the JSATIC pre-intervention and post-intervention. Pre-intervention and post-intervention scores (total score, working relationship domain, and accountability domain) were compared for the total sample and by student group (BSN, AT, OT). In addition, pre-scores and post-scores for the student groups were compared. The scenario enacted with a simulated patient was a spinal cord injury that began on the football field and ended in the university’s simulation hospital. All students who participated in the scenario were debriefed about the simulation as a group. A subset of 13 students participated in one of two interprofessional focus groups. Guided questions were adapted from the Interprofessional Attitudes Scale.

Results: There was there was a significant increase in working relationship scores (p = .003) after the simulation; however, there was not a significant change in JSATIC total scores (p = .074) or accountability scores (p = .946). When the scores were separated by student group, the BSN and AT groups had similar findings, with both having a significant increase in working relationship scores (p = .028 and p = .030, respectively). The Cohen’s d effect size was calculated for the change from pre-simulation and post-simulation which showed a medium effect for the overall Jefferson scale (d=.46), a negligible effect for the Accountability subscale (d=.02), and a large effect for the Working Relationship subscale (d=.79). The OT group did not have a significant change in any of the outcome scores (p > .05). When the pre-intervention scores were compared among the three groups, it was found that the AT student total scores and accountability scores at both pre-intervention and post-intervention were significantly lower than those of the BSN students and also significantly lower at pre-intervention compared to the OT students. There was not a significant difference in pre-intervention or post-intervention working relationship scores among the students groups, nor was there a significant difference in any of the outcome scores pre-intervention or post-intervention between the BSN and OT students. Despite the difference in scores pre-intervention, there was not a significant difference in the amount of change that occurred between the student groups after the simulation for any of the outcome scores. The focus group comments revealed four themes: collaboration, communication, respect, and knowledge. It was also discovered that themes from the students’ comments related to the interprofessional core competencies: values/ethics, roles/responsibilities, interprofessional communication, and teams/teamwork (Interprofessional Education Collaborative, 2016).

Discussion: The quantitative and qualitative results will describe the impact of an interprofessional simulation on students’ attitudes toward other professions and interprofessional collaboration.

Limitations: This study involved one simulation at one university; therefore it may lack generalizability. In addition, there was only one Occupational Therapy student represented in the focus groups, so the perspective of other Occupational Therapy students was not captured. The number of Occupational Therapy students represented in quantitative data was also smaller than the number of Nursing or Athletic Training students, which may have contributed to the non-significance of results.

Significance to Nursing: Interprofessional collaboration is an expectation of nurses; however, more research is needed to understand the impact of various educational strategies on interprofessional collaborative competencies. This study presents the results of an interprofessional simulation and its impact on interprofessional attitudes and understanding of interprofessional competencies. Future research should be done to determine the impact of a simulation that includes more professions and sites. Longitudinal studies should be done to determine the impact of interprofessional education in the academic setting on interprofessional collaboration in the practice setting.