Bringing World Class Nursing Care to a World Class Eye Institute through Transdisciplinary Collaboration

Monday, 9 November 2015

Robert J. Dorman, MSN, RN-BC, CCRN, C-NPT
School of Nursing, University of Rochester, Rochester, NY, USA


A compelling example of interprofessional collaboration that has been identified came from a study of “the psychological and sociocultural factors that influence the risk of Human Immunodeficiency Virus (HIV)/Sexually Transmitted Disease (STD) for married men in urban poor communities of India” (Schensul, Nastasi, and Verma, 2006, p. 96).  This interprofessional team consisted of an American anthropologist, an American psychologist, an Indian psychologist, demographers, STD epidemiologists, public health physicians, allopathic physicians, microbiologists, educators, and traditional healers and activists from the study communities.  This collaboration of both medical and social scientists is called for in a paper by Rosenfield in 1992 where she defines three different levels of disciplinary collaboration:

Multidisciplinary – in which researchers work in parallel or sequentially from a disciplinary-specific base to address common problems…

Interdisciplinary – in which researchers work jointly but still from a disciplinary-specific basis to address a common problem…

Transdisciplinary – in which researchers work jointly using a shared conceptual framework drawing together disciplinary specific theories, concepts and approaches to address a common problem. (p. 1351)

By collaborating on development of this research in a transdisciplinary method, the team used a combination of methods in forming and evaluating the project, and ultimately developing the intervention tool, which “addressed medical, psychological, and cultural factors related to men’s sexual risk” (Schensul et al, 2006, p. 102).  This team was diverse not only in terms of professional background, but also in terms of their nationality, type of institution, religion, work experience, age, gender, and socioeconomic and educational background.  Although there were several factors that were viewed as challenges (language, hierarchy, funding, common misunderstandings), other factors played into the success of the study (development of personal relationships over time, central lodging, dedication and commitment to the project, electronic communication over distances, open dialogue, professional benefits, replicability of the study components).  An intervention that will take place at the LV Prasad Eye Institute (LVPEI) illustrating the effectiveness of transdisciplinary work is a continuing education project to increase the knowledge base of the current staff, while improving the training of new staff; building collaborative relationships through joint continuing education, and allowing each discipline to through its own concepts and approaches while using the shared pyramid of care concept that has driven LVPEI to the top of the eye care world.  Surveying the staff prior to instituting this intervention, to determine their current level of transdisciplinary collaboration will be vital, as will be an exit survey at the end of the clinical teaching period.  Additional surveys regarding the transdisciplinary approach will be useful when conducted at 1 year marks for the next 3-5 years.  This will measure impact at the team level.

An additional theory that will show benefit to the transdisciplinary approach at LVPEI in India is situated learning theory.  Situated learning is a social learning approach and views learning “as a social activity situated within a particular environment or context” (Sargeant, 2009).  It was first described by Jean Lave, a social anthropologist, in 1988.  The key concept that this theory introduced was that in a situational environment, learning would be more successful.  Anderson, Reder, and Simon (1996) state that the four key concepts of situated learning are that (1) action is grounded in the situation where it occurs, (2) knowledge does not transfer between tasks, (3) abstract training is not useful, and (4) instruction must be done in a complex, social environment.  Through the construction of a simulation lab that is mocked up to be both environments common to LVPEI (operating theatre and patient care ward), practitioners of all levels will be able to practice not only clinical and technical skills, but communication and teaching skills.  Outcomes of this intervention can again be measured by surveying the staff involved prior to and following the simulation exercise, and tracking the success of their work during the actual simulation.  This will measure the impact of situated learning at the individual level.