A substantial body of literature asserts the importance of incorporating interprofessional education into the curriculum of human service professions to enhance the provision of high-quality health and social care through improved communication, effective use of resources, and increase of knowledge exchange (Barnsteiner et al., 2007; Johnson et al., 2017; Lam et al., 2013). However, interprofessional education between healthcare and non-healthcare disciplines has not been well documented in the literature (Lee et al., 2018). There are commonalities shared in human services professions such as Nursing and Early Childhood Education (Jenaro et al., 2007). This study aims to explore the potential of expanding interprofessional education to nursing and early childhood education trainees by: a) examining the pattern of anxiety in a sample of nursing and early childhood education students; b) exploring the extent of collaboration between the two disciplines from students’ perspective. Two specific research questions were asked: 1. Do learners from Nursing and Early Childhood Studies (ECS) experience similar amount of stress associated with skills performance? 2. How do they perceive as potential areas for collaborative learning?
Methods:
A multi-method, pilot study was conducted at one university in the Province of Ontario, Canada. Students enrolled in their final (4th) year of the undergraduate Nursing and Early Childhood Studies programs were recruited for two concurrent activities: a) completing a one-time study survey (N=131) that assessed the levels of anxiety, experience with clinical or field work experience and areas of collaboration between the two disciplines; b) physiological measure of salivary cortisol level was measured in students of each program (N=42) at three time points: 1. before an anxiety-producing event of skills performance; 2. after skills performance; 3. before performing a non-anxiety producing event (such as daily routine), approximately at the same time of day as #1. The skills performance for nursing participants was simulation; and leading a newly designed musical activity was for early childhood studies participants. This study was approved by the university’s research ethics board.
Study variables examined in this study were: anxiety (state and trait anxiety), perception of inviting behaviour exhibited by clinical instructor or faculty, clinical environment that triggers anxiety, perception of collaboration between nurses and early childhood educators, and demographics (e.g., age, gender, prior experiences in performing similar tasks).
For anxiety, a combination of physiologic and self-report measures were used to assess this construct. Participants’ cortisol level were obtained from a saliva sample. The level of salivary cortisol correlates with serum cortisol level which is an indicator of stress (Fisher & Cleare, 2017).
A self-report measure of State-Trait Anxiety Inventory (STAI) (40 items) was used to assess state and trait anxiety. Both STAI and saliva cortisol levels have been used in studies of young adults (Misra & McKean, 2000; Takai et al., 2004).
In addition to the STAI, participants were asked to rate their perceived level of anxiety associated with some common tasks during practicum or practice (e.g., speaking with patients / students; conducting physical assessment). For nursing participants, this was assessed via the clinical experience assessment form (Kleehammer et al., 1990) (16 items). For ECS participants, an equivalent measure was developed and pilot tested.
The intent of collecting perception of inviting behaviour from mentors and instructors, and demographic data is to establish concurrent validity as these have been reported to be associated with skills performance and clinician’s anxiety (Chapell et al., 2005; Cook, 2005).
For perception of inviting behaviour, Ripley’s clinical teaching survey (CTS) was used (Ripley, 1986) (44 items).
Lastly, perceived collaboration between ECS and Nursing was assessed using items developed by the investigators based on relevant literature, such as dealing with mental health issues, assessment of developmental milestones in this population.
Self-reported survey measures were analysed using descriptive statistics and Multivariate Analysis of Variance (MANOVA) to compare differences between Nursing and ECS participants. Physiological measures of salivary cortisol level was examined using descriptive statistics and repeated measure analysis of variance (repeated measure ANOVA) to compare differences between the two groups before and after skills performance. Significance level was set at 0.05 (2-tailed).
Results:
Participants were predominantly female (88.2% in Nursing and 97.4% in ECS), between the age 18 and 24 (83.9% in Nursing; 97.4% in ECS) for both professions. A majority of participants had some relevant experience from courses and practicum (61.3% in Nursing and 63.1% in ECS).
For the physiological assessment of stress, repeated measure ANOVA analysis revealed significant main effect of time on salivary cortisol level [F(2,34)=16.69, p<0.001] and interaction (professional x time) [F(2,34)=7.89, p<0.01]. Follow-up simple effect analysis showed significantly higher cortisol level prior to performance in only Nursing students [F(2,63)=17.29, p<0.001]. No significant differences were noted for the three measurement times in ECS students [F(2,55)=2.50, p=0.091]. Comparison between Nursing and ECS students showed significantly higher cortisol level in nursing students prior to performance at time 1 [F(1,41)=19.93, p<0.001], no differences were noted between the two groups after performance [time 2: F(1,42)=0.76, p=0.39] [time 3: F(1,35)=0.62, p=0.44].
For the self-report measures, MANOVA showed no significant differences in STAI ratings (both state and trait anxiety). Additionally, Nursing students rated higher levels of CEAF [F(1,128)=12.40, p<0.001], CTS [F(1,128)=5.01, p<0.05], CTS Professional subscale [F(1,128)=10.04, p<0.01] and SAOM course subscale [F(1,128)=7.80, p<0.01] than ECS students.
For perceived potentials for collaboration, majority of nursing participants ranked developmental milestone assessment to be an area of collaboration (81.7%), followed by ensuring healthy and safe environment for this population (77.4%), hygiene and infection control (63.4%), dealing with mental health issues (59.1%), teaching and counseling on nutrition (58.1%).
Most ECS participants ranked hygiene and infection control (78.9%) as a potential area of collaboration, followed by dealing with mental health issues (73.7%), teaching or counseling on nutrition (68.4%), ensuring healthy and safe environment (65.8%), developmental milestone assessment (50%).
Conclusion:
This is the first study that explored the potentials of introducing collaborative learning for Nursing and ECS students. Results from this study suggested that students in Nursing and ECS are similar in demographics (i.e., predominately enter the professional program from high school, of female gender, had some practical experience). They also had similar ratings of trait and state anxiety. However, Nursing students experienced significantly higher level of stress prior to performing clinical skills. There also appeared to be discrepancies between the two groups with regards to the perception of how they may collaborate: An area that is identified by the most nursing participants as collaborative was one that was identified by the least ECS participants. Future research should examine the feasibility of implementing joint activities for these two groups of learners.
Most human service professional education take place in silos, resulting in undervaluing or misunderstanding each others’ roles and contributions (Barnsteiner et al., 2007). The current findings can inform future research on interprofessional education beyond the conventional disciplines to foster further competencies. For instance, using current blueprint in integrating interprofessional curriculum (Pardue, 2015) to include learners from early childhood studies. An increase in awareness will bridge the gap in understanding each profession’s roles (Paige et al., 2014). Future interprofessional initiatives can also target coping strategies to prevent burnout in human service professions (Harker et al., 2016).
* Please note some references are older than five years because: a) they are seminal work; b) more recent literature cannot be obtained; or c) they are the only instruments available to assess specific study variables.*