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Journal of Interprofessional Care

ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: https://www.tandfonline.com/loi/ijic20

Determining the effectiveness of an interprofessional educational intervention for teamwork competencies among nursing, physical therapy, and pharmacy students

Lee Ann Waltz

To cite this article: Lee Ann Waltz (2019): Determining the effectiveness of an interprofessional educational intervention for teamwork competencies among nursing, physical therapy, and pharmacy students, Journal of Interprofessional Care, DOI: 10.1080/13561820.2019.1682531

To link to this article: https://doi.org/10.1080/13561820.2019.1682531

Published online: 07 Nov 2019.

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SHORT REPORT

Determining the effectiveness of an interprofessional educational intervention for teamwork competencies among nursing, physical therapy, and pharmacy students Lee Ann Waltz

School of Nursing and Health Professions, University of the Incarnate Word, San Antonio, TX, USA

ABSTRACT Interprofessional education is recognized widely as an essential component to improving patient outcomes but little progress has beenmade toward understanding the impact of specific educational interventions on interprofessional competencies. The purpose of this study was to evaluate the effectiveness of a case study exercise aimed at improving students’ teamwork competencies. A pre and posttest design was used to evaluate the effectiveness of two approaches to an educational intervention. The treatment group com- bined nursing, physical therapy, and pharmacy students; the control group involved only nursing students. The Team Skills Scale (TSS) was used tomeasure interprofessional teamwork competencies and open-ended questions were used to elicit students’ views. Mean pretest scores were similar for both the treatment and control groups. Following the intervention, posttest TSS scores were significantly higher for both the treatment group and control groups. However, posttest scores for the treatment group were significantly higher than the control group (mean score change 19.2 for treatment group versus 10.0 for control group), indicating that the face-to-face interaction between students of different professions had a greater impact. Themes that emerged from the open-ended questions support the quantitative findings, indicating that the intervention was useful for improving teamwork competencies.

ARTICLE HISTORY Received 18 July 2018 Revised 18 September 2019 Accepted 14 October 2019

KEYWORDS Interprofessional education; teamwork; communication; collaboration; quantitative method

Introduction

In the 2013 report Transforming and Scaling Up Health Professionals’ Education and Training, the World Health Organization emphasized that teamwork has increasingly become the standard in today’s health settings, resulting in the need for all health professionals to effectively collaborate across disciplines. To enter the workforce armed with the skills necessary for this model of practice, interprofessional education (IPE) must be considered as a means of improving health care members understanding of each other’s roles, and developing collaborative attitudes and behaviors (WorldHealthOrganization, 2013).Despitewidespread recognition of the need for IPE in academic settings, amultitude of barriers inhibit progress including a lack of partners within insti- tutions willing to engage in an interprofessional agenda, a need for faculty development in IPE, and scheduling conflicts (Interprofessional Education Collaborative, 2011). As educators have struggled to overcome these barriers, a growing number of research studies have been conducted to discover the bestmethods for conducting IPE. While initial research demonstrates that IPE improves communication and teamwork, more studies are neces- sary to guide healthcare educators on the value of specific educa- tional activities. The purpose of this study was to evaluate the efficacy of two approaches to an educational intervention aimed at improving students’ interprofessional teamwork competencies.

Methods

The study employed a quasi-experimental, pre and posttest design. Convenience and purposive sampling was used to recruit

baccalaureate nursing, doctoral physical therapy (PT), and doc- toral pharmacy students from a private university in the south- west region of the United States. Nursing students were recruited from a Community Health Nursing, a requisite senior level course. PT and pharmacy students were recruited to participate in the study by the physical therapy and pharmacy faculty and institutionally approved flyers.

Both the treatment and control groups independently par- ticipated in a case study exercise that involved developing interprofessional care plans for a geriatric patient who has recently undergone a below the knee amputation. Prior to the study, permission was granted to use the case study titled Interdisciplinary Geriatric Assessment: Mr. Ames, which was developed by the Center for Interdisciplinary Geriatric Assessment at the University of Missouri-Columbia (Weston et al., 2012). The purpose of the case study was to promote an interprofessional approach for planning and managing treat- ment of older adults with complex medical, psychological, and social needs. A packet of information with details regarding the patient was provided to students for each stage of the case study, and included assessment information from the disci- plines of nursing, occupational therapy, physical therapy, social services, psychological services, podiatry, and respira- tory therapy. The exercise involved students developing a total of five interprofessional plans at various stages of treatment including discharge planning from the inpatient setting, an inpatient rehabilitation unit, home health services, and transi- tion back to the family and community. Upon completion of each care plan, the faculty facilitated a debriefing. The total

CONTACT Lee Ann Waltz waltz@uiwtx.edu 4301 Broadway, San Antonio, TX 78209

JOURNAL OF INTERPROFESSIONAL CARE https://doi.org/10.1080/13561820.2019.1682531

© 2019 Taylor & Francis Group, LLC

time to complete the entire exercise for both the treatment and control groups was approximately six hours in one day.

Group assignment

Nursing students were randomized to a treatment or control group. PT and pharmacy students were assigned to the treat- ment group. The treatment group consisted of 16 nursing, 6 PT, and 3 pharmacy students for a total of 25 in the group. Subjects were placed in groups of 5–6 students to collectively discuss the case study and develop the plans of care. The case study groups were comprised of five groups that contained a combination of 2–3 nursing, 1–2 PT, and 0–1 pharmacy students. The 3 phar- macy students were rotated to a different table following each round of care plan development so that by the end of the intervention, all nursing students in the treatment group had similar amounts of interaction time with the pharmacy students.

The control group consisted of 17 nursing students. The control group participated in the same exercise, and were placed in three case study groups of 5–6 students to work together and develop the interprofessional plans of care.

Data collection

Students completed the Team Skills Scale (Hepburn, Tsukuda, & Fasser, 1998) before and after the intervention to measure the effectiveness of the educational intervention in the treatment and control group. The instrument is comprised of 17 items that are rated on a 5-point scale designed to measure self-reported team skills. Summing the scores results in a range of 17 to 85, with higher scores reflecting greater estimates of team skills. A demographic data sheet was collected prior to the intervention, and open-ended questions were collected after the intervention to elicit students’ views regarding the impact of the activity.

Analysis

IBM SPSS version 22 was used to analyze demographic and Team Skills Scale (TSS) data. A paired-samples t- test was conducted to evaluate the impact of the intervention on students’ scores on the TSS. Assumptions for the use of a parametric test were assessed by a review of histograms, Q-Q plots, and Kolmogorov-Smirnov which indicated approximately normal data. Responses to open-ended ques- tions were categorized using thematic content analysis.

Ethical considerations

Prior to recruitment of participants, approval for the study was obtained from the University of Texas Medical Branch Institutional Board and the University of the Incarnate Word Institutional Review Board.

Results

Forty-two students completed the study. All students com- pleted the demographic questionnaire, the Team Skills Scale (TSS) pretest and posttest, and open-ended questions regard- ing the value of the educational intervention. Internal

consistency for the TSS was strong, with a Cronbach’s alpha of .89 for the pretest, and .94 for the posttest. Table 1 presents post hoc analysis findings for the pre and posttest scores of the TSS for the treatment and control groups. Mean change scores were higher in the treatment group (19.2) versus the control group (10.0). Using Cohen’s guidelines, a large effect size was noted for both the treatment and control groups.

In the analysis of responses to open-ended questions about the students’ views regarding the educational intervention, four themes were shared by both the treatment and control group: 1) improved understanding of other health professions roles; 2) importance of working as a team; 3) importance of communication; and 4) increased appreciation of other health professions. In the treatment group, an additional theme of increased confidence about future collaboration with other health professions was noted, which the students attributed to a positive experience of interacting with other health pro- fessions during the activity.

Discussion

While pretest TSS scores reflected similar teamwork compe- tencies among students in both the treatment and control group, posttest TSS scores were significantly higher in the treatment group. Similar findings have also been noted by other researchers who detected significant improvement in subjects exposed to an IPE intervention compared to a control group (Ruebling et al., 2014; Wang, Shi, Bai, Zheng, & Zhao, 2015). While the findings reflect that the intervention resulted in the greatest benefit for students in the treatment group, the findings also suggest that the virtual input of other health professions used in the control group was also beneficial. Limitations of the study include a small sample size, and representation from only three health profes- sions within one educational institution. Although the gener- alizability of the findings is limited, the findings may be useful to other healthcare educators in planning IPE activities.

Conclusion

While the findings of this study support that face-to-face interac- tion of health care professions students maximizes confidence in interprofessional teamwork competencies, it also supports that virtual exercises involving only one health care profession can be beneficial. Therefore, when face-to-face interaction is not feasible, educational interventions that provide virtual interprofessional input should be considered as an alternative method for develop- ing teamwork competencies.

Table 1. TSS pre and posttest scores for treatment and control groups (N = 42).

Pretest mean SD

Posttest mean SD

Mean change

Mean SD

change p Effect size

Control (n = 17)

57.9 9.38 67.9 6.41 10.0 9.1 <.001 1.10

Treatment (n = 25)

57.0 6.01 76.2 7.2 19.2 8.4 <.001 2.29

Note: nursing student TSS mean pretest scores (n = 16): treatment group 57.3, control group 57.9. P values (two-tailed) based on paired t-test. Effect size computed with Cohen’s d.

2 L. A. WALTZ

Acknowledgments

I would like to express my deep gratitude to the students who partici- pated in this study, and to my dissertation committee for their support and guidance. I would also like to thank Richard E. Oliver, Ph.D., FASAHP for granting permission to use the Interdisciplinary Geriatric Assessment Case Study, and Kenneth Hepburn, PhD for granting per- mission to use the Team Skills Scale.

Declaration of Interest

The author reports no conflicts of interest. The author alone is respon- sible for the content and writing of this article.

Notes on contributor

Lee Ann Waltz PhD, RN, CNE is an Assistant Professor at the University of the Incarnate Word in San Antonio, Texas. Dr. Waltz has been a Registered Nurse since 1986 in a wide variety of health care settings. Her background in nursing includes geriatrics, mental health, medical-surgi- cal, and home health. Dr. Waltz has been teaching in the undergraduate nursing program at the University of the Incarnate Word since 2007. Her research interests include interprofessional education and collaboration, technology in education, and simulation.

References

Hepburn, K., Tsukuda, R., & Fasser, C. (1998). Team skills scale, 1996. In K. Siegler, T. Hyer, T. Fulmer, & M. Mezey (Eds.), Geriatric inter- disciplinary team training (pp. pp. 264–5). New York: Springer.

Interprofessional Education Collaborative. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Author.

Ruebling, I., Pole, D., Breitbach, A. P., Frager, A., Kettenbach, G., Westhus, N., … Carlson, J. (2014). A comparison of student attitudes and perceptions before and after an introductory interprofessional education experience. Journal of Interprofessional Care, 28(1), 23–27. doi:10.3109/13561820.2013.829421

Wang, R., Shi, N., Bai, J., Zheng, Y., & Zhao, Y. (2015). Implementation and evaluation of an interprofessional simulation-based education program for undergraduate nursing students in operating room nur- sing education: A randomized controlled trial. BMC Medical Education, 1–7. doi:10.1186/s12909-015-0400-8

Weston, D., Petterborg, L. J., Oliver, R. E., Baldwin, D. J., Dobey, T., Sanford Hargrove, M., … Reid-Arndt, S. (2012). Interdisciplinary geriatric assessment: Mr. Ames. Retrieved from http://shp.missouri. edu/vhct/CIGA_Ames/index.html

World Health Organization. (2013). Transforming and scaling up health professionals’ education and training: World health organization edu- cation guidelines 2013. Geneva, Switzerland: Author.

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