Health Care Delivery Models and Nursing Practice

ORIGINAL ARTICLE

Teaching and learning activities to educate nursing students for interprofessional collaboration: A scoping review Natalie L. Murdoch, Sheila Epp, and Jeanette Vinek

School of Nursing, University of British Columbia—Okanagan Campus, Kelowna, British Columbia, Canada

ABSTRACT To prepare new graduates with the knowledge, skills, and attitudes to engage in effective interprofes- sional collaboration (IPC) in practice, healthcare professional programmes need to ensure their curricu- lum provides opportunities for interprofessional education (IPE) and IPC. To strengthen IPE within an undergraduate curriculum and meet the professional requirements set out by regulatory bodies to prepare new graduate nurses to achieve IPC competencies, a curriculum initiative was developed to expand IPE across the four years of the Baccalaureate of Science in Nursing (BSN) programme. The purpose of this scoping review was to identify published teaching-learning activities in undergraduate nursing programmes to inform the development and integration of IPE curricula. The literature included was identified by searching the following electronic databases: EMBASE and EBSCO (CINAHL, Medline, Education Research Complete, ERIC). The search was limited to articles with abstracts published between 2008 and 2016 in the English language. All ten studies that met inclusion criteria reported students’ perceived interprofessional education as valuable in facilitating their achievement of IPC competencies. Interprofessional education is an approach for preparing nursing students with knowledge, skills, and attitudes to achieve IPC competencies and therefore, urgently needs to become more prevalent in nursing curricula. Educators can use a variety of IPE teaching-learning activities to support students’ achievement of IPC competencies in order to prepare new practitioners to engage in effective IPC in a variety of healthcare milieus. Nurse educators are encouraged to intentionally integrate learning opportunities into current and future undergraduate nursing education to prepare collaborative ready graduate nurses.

ARTICLE HISTORY Received 11 June 2016 Revised 6 June 2017 Accepted 14 July 2017

KEY WORDS Interprofessional collaboration; interprofessional education; nursing students; pre- qualifying/pre-licensure; professional competence; scoping review

Introduction

To prepare new graduates with the knowledge, skills, and attitudes to engage in effective interprofessional collaboration in practice, healthcare professional programmes need to ensure curriculum provides opportunities for interprofessional educa- tion (IPE) and collaboration. The Canadian Interprofessional Health Collaborative (CIHC) defines interprofessional colla- boration as “a partnership between a team of health providers and a client in a participatory, collaborative, and coordinated approach to shared decision-making around health and social issues” (CIHC, 2010, p. 28). The CIHC (2010) definition of IPE was used to inform this work. Educators can use IPE teaching- learning activities to support students’ achievement of inter- professional collaborative (IPC) competencies in order to pre- pare new practitioners to engage in effective interprofessional collaboration in a variety of healthcare milieus (Abu-Rish et al., 2012; Bilodeau et al., 2010; D’Amour, Ferrada-Videla, San Martin Rodriguez, & Beaulieu, 2005; Fortugno, Chandra, Espin, & Gucciardi, 2013; Reeves et al., 2016).

To strengthen IPE within curriculum, and meet profes- sional requirements set out by national and provincial regu- latory bodies to prepare new graduate nurses to achieve IPC competencies, a curriculum initiative was developed to

expand IPE across the four years of a Baccalaureate of Science in Nursing (BSN) programme at a university in Western Canada. The purpose of this scoping review was to identify published IPE teaching-learning activities in under- graduate nursing programmes to inform the development and integration of IPE curricula. The findings from this review will be discussed in relation to informing curriculum devel- opment to facilitate students’ achievement of interprofessional collaborative (IPC) competencies to effectively engage in interprofessional collaborative practice upon graduation.

Background

IPE within healthcare professional programmes has been of interest internationally for some time and continues to be an expectation within curriculum (Institute of Medicine (IOM), 2015; Lapkin, Levett-Jones, & Gilligan, 2013; Szasz, 1969). However, it was not until the 1990’s that the first IPE course was offered at a university in Canada (Charles, Bainbridge, & Gilbert 2010). The World Health Organisation (WHO) advo- cates for healthcare professional students to engage in IPE to facilitate and support meeting IPC competencies (WHO, 2010). The Canadian nursing literature demonstrates weak analysis of

CONTACT Natalie L. Murdoch [email protected] School of Nursing, University of British Columbia—Okanagan Campus, 1147 Research Rd - ARTS Building 140, Kelowna, BC V1V 1V7, Canada. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ijic

JOURNAL OF INTERPROFESSIONAL CARE 2017, VOL. 31, NO. 6, 744–753 https://doi.org/10.1080/13561820.2017.1356807

© 2017 Taylor & Francis

the role and impact IPE plays in nursing education (Grant et al., 2016; Reeves, 2016). Today, only 16 of the 91 universities/col- leges in Canada offering nursing programmes have a documen- ted, structured IPE component (Canadian Association of Schools of Nursing, 2013).

Outcome or competency focused curricula have gained popularity as one method of implementing IPE (Barr, Koppel, Reeves, Hammick, & Freeth, 2005). Critics of competency- based education contend that competency does not equate with competence (Talbot, 2004; Reeves, 2012). However, com- petency–based interprofessional frameworks can support edu- cators with facilitating student achievement of mindfully chosen and contextualized interprofessional competencies. (Thistlethwaite et al., 2014). In addition, competency-based frameworks support learners to understand the learning process and differentiate matters of importance, while applying and integrating concepts in their learning journey (CIHC, 2010). Currently, educators can choose from one of four published interprofessional competency frameworks to inform the devel- opment of IPE in their curricula (Thistlethwaite et al., 2014). The CIHC’s (2010) A National Interprofessional Competency Framework was developed nationally and recognized across Canada as a useful tool to inform curriculum development. The framework identifies six competency domains which are applicable to students in a variety of practice settings: interpro- fessional communication, patient/client/family/community centred care, role identification, team functioning, collaborative leadership, and interprofessional conflict resolution (CIHC, 2010). The oldest of the other three published frameworks is The Interprofessional Capability Framework, published in the United Kingdom (Walsh, Gordon, Marshall, Wilson, & Hunt, 2005), which includes four competency domains. The Core Competencies for Interprofessional Collaborative Practice frame- work published in the United States (Interprofessional Education Collaborative Expert Panel, 2011) includes four core competency domains and was developed by a process informed by Canadian Interprofessional Health Collaborative (CIHC) (2010) and the Framework for Action on Interprofessional Education and Collaborative Practice (WHO, 2010). Lastly, the Interprofessional Capability Framework, devel- oped in Australia (Brewer & Jones, 2013) was built on the interprofessional frameworks from the United Kingdom, Canada, and the United States and includes five competency domains. CIHC’s (2010) framework was used to inform this review. The CIHC (2010) framework offers an easy to follow approach to guide both teachers and students as they engage in learning to achieve interprofessional competencies. In addition, the Canadian context is reflected in CIHC’s framework.

Methods

Arksey and O’Malley’s (2007) scoping review framework was the methodology chosen to achieve the project’s goal. A scoping review is a rigorous and transparent approach used to identify evidence pertaining to a broader topic resulting in the identification and summarisation of key concepts. It is a process used to identify all relevant literature regardless of study design. The five steps of a scoping review include: identifying the research question, identifying relevant studies,

study selection, charting the data and collating, and summar- ising and reporting the results (Arksey & O’Malley, 2007). This review was limited to studies that included BSN students, as the goal of this review was to inform curriculum develop- ment for a four-year BSN programme.

Searching and screening processes

To identify relevant literature for inclusion in this review, the following electronic databases were searched: EMBASE and EBSCO (CINAHL, Medline, Education Research Complete, ERIC). To identify current teaching-learning approaches to IPE utilised by educators, the search was limited to articles with abstracts published between 2008 and October 2016 in the English language. This time frame was chosen as it followed the introduction of the CIHC in 2006, and the inflow of funding from Health Canada directed towards interprofessional initiatives (CIHC, 2010). The search terms included: interpro- fession* or interdisciplin* or multidisciplin* and nurs* and education and student. The search yielded 276 articles.

Primary screening of the articles included reviewing the titles and abstracts to identify whether the abstract, introduc- tion, and/or author information contained Canadian content. The screening resulted in the identification of 46 articles with the potential to be included in the review. The articles were then read in their entirety and reviewed against the predeter- mined inclusion criteria: primary studies; Canadian context; interprofessional education; undergraduate education; and pre-licensure BSN students.

Of those 46 articles, 36 were excluded for the following reasons: were discussion or theoretical papers, lacked a dis- tinct focus on IPE, or did not focus on undergraduate stu- dents, resulting in 10 studies accepted for the review (Figure 1).

Analysis

The teaching-learning activities of the included papers were reviewed for their ability to facilitate students’ achievement of the six competency domains outlined in CIHC (2010) and for potential integration in various years of a BSN programme. The impact of the teaching-learning activity was assessed using the modified Kirkpatrick Model of Educational Outcomes for Interprofessional Education (Freeth, Hammick, Reeves, Koppel, & Barr, 2005). (Table 1).

Each of the IPE teaching-learning activities in the included papers were categorised using the Educating Nurses for Interprofessional Practice (ENIPP) Pathway. The ENIPP pathway is a modified version of McMaster University’s Description of Interprofessional Education Activities and Competencies (McMaster University, 2007). The ENIPP Pathway depicts a scaffolding framework that can be used by educators to guide the most appropriate placement of IPE teaching-learning activities throughout a four-year degree. The pathway includes three levels of stu- dent education related to interprofessional practice, where each level builds on the previous. The pathway’s three levels begin with “exposure”. At the exposure level, students take

JOURNAL OF INTERPROFESSIONAL CARE 745

an observational role to gain awareness of the roles, respon- sibilities, and relationships of other healthcare providers. The second level is “experience”, where students participate in interprofessional practice. The third and final level is “engagement”; at this level, students utilise interprofessional practice knowledge and skills to actively engage in and contribute, as members of interprofessional teams.

Results

This scoping review aimed to identify published teaching- learning activities in undergraduate nursing programmes to inform the development and integration of IPE curricula. The 10 studies included in this review comprised evaluations of a variety of IPE teaching-learning activities and reported stu- dents perceived IPE as valuable in facilitating achievement of IPC competencies. (Table 2).

Interprofessional competencies

All of the studies included in this review reported learning objec- tives that were related to the development of interprofessional collaborative competencies. None of the studies reported the use of an interprofessional competency framework as a foundation to the development of the curriculum and/or teaching-learning activities. However, all of the studies measured student percep- tions of achieving one or more IPC competencies. The primary focus was most frequently on interprofessional collaboration and team functioning (Bilidoeau et al., 2010; Dobson et al., 2009; Fortugno et al., 2013; Meffe, Moravac, & Espin, 2012; Racine, Proctor, & Jewell, 2012; Takahashi, Brissette, & Thorstad, 2010). Four studies focused on attitude and knowledge development in relation to role identification of interprofessional team members (Atack, Parker, Rocchi, Maher, & Dryden, 2009; Basran et al., 2014; Meffe et al., 2012; Mohaupt et al., 2012), with three studies focusing further on knowledge development of the roles of the interprofessional team (Dobson et al., 2009; Lait, Suter, Arthur, & Deutschlander, 2011; Takahashi et al., 2010).

Timing of IPE teaching and learning activities

The majority (n = 8) of studies included upper level nursing students and students from all levels of other healthcare professional programmes. Two of the studies did not report the education level of students participating (Bilodeau et al., 2010; Takahashi et al., 2010).

Setting

The IPE activities took place in a variety of settings. The majority of studies (n = 7) took place in the practice environ- ment in either an acute care or community setting, such as a rural inpatient rehabilitation unit, rural and tertiary acute care units, and a pediatric outpatient clinic. Other settings used for the remaining three studies included: a simulation lab, a secondary school, and an undergraduate classroom (Table 2).

Type of IPE teaching-learning activity

Each of the teaching-learning activities included in the studies comprised a preparatory element followed by an experiential element. A variety of teaching-learning activities provided the opportunity for IPE and collaboration with other healthcare pro- viders. Nursing students either learned side-by-side with other healthcare professional students, or were immersed in real-world practice with healthcare providers (Basran et al., 2014; Fortugno et al., 2013; Meffe et al., 2012; Racine et al., 2012; Takahashi et al., 2010). In four studies, nursing students experienced interprofes- sional collaboration through high-fidelity simulation, case studies, and small group discussion (Atack et al., 2009; Bilodeau et al., 2010; Dobson et al., 2009; Mohaupt et al., 2012). All interprofes- sional teaching-learning activities in the included studies had an interactive element (Table 3).

Electronic Database Search (n=314)

EMBASE (n=67)

EBSCO (CINAHL, Medline, Education Research Complete, ERIC) (n=247)

Papers moved forward after primary screening (n=27)

Primary screening Papers Excluded

(n=287)

Final papers included in Review (n=10)

Secondary Screening

Papers Excluded (n=17)

Figure 1. Overview of the literature search and article selection.

Table 1. Modified Kirkpatrick’s Model of Educational Outcomes for Interprofessional Education.

Criteria Description of Criteria

Level 1: Reaction Learners’ views on the learning experience and its interprofessional nature.

Level 2a: Modification of perceptions & attitudes

Changes in reciprocal attitudes or perceptions between participant groups. Changes in perception or attitude towards the value and/or use of team approaches to caring for a specific client group.

Level 2b: Acquisition of knowledge & skills

Including knowledge and skills linked to interprofessional collaboration.

Level 3: Behavioural change

Identifies individuals’ transfer of interprofessional learning to their practice setting and their changed professional practice.

Level 4a: Change in organisational practice

Wider changes in the organisation and delivery of care.

Level 4b: Benefits to patients/clients

Improvements in health or well-being of patients/clients.

746 N. L. MURDOCH ET AL.

Ta b le

2. C h ar ac te ri st ic s of

in cl ud

ed st ud

ie s.

A ut h or /

Ye ar

A im

of St ud

y D es ig n

Sa m p le

IP E te ac h in g -l ea rn in g

ac ti vi ti es

O ut co m e m ea su re m en t to ol s

M ai n fin

d in g s re la te d to

IP E

A ta ck et al .

(2 00 9)

To ex am

in e ch an g e in

d is as te r

m an ag em

en t co m p et en cy

an d

in te rp ro fe ss io n al

at ti tu d es

af te r

st ud

en ts

co m p le te d th e on

lin e co ur se

an d si m ul at io n .

D es ig n : Pr e- /p os t- te st

ev al ua ti on

Sa m p le : 3r d ye ar

n ur si n g st ud

en ts

(n = 6)

2n d ye ar

p ar am

ed ic in e st ud

en ts

(n = 8)

2n d ye ar

so ci al

se rv ic e w or ke r

st ud

en ts

(n = 13 ) 2n d ye ar

p h ar m ac y

te ch n ic ia n st ud

en ts

(n = 2)

3r d ye ar

m ed ic in e st ud

en t (n

= 1)

re sp ir at or y

th er ap is t st ud

en t (n

= 1)

2n d ye ar

p ol ic e

st ud

en t (n

= 1)

1s t ye ar

m ed ic al

ra d ia ti on

st ud

en t (n

= 1)

O n lin e in te rp ro fe ss io n al

co ur se

in d is as te r m an ag em

en t an d em

er g en cy

p re p ar ed n es s si m ul at io n

Q u an

ti ta ti ve : Re se ar ch er

ad ap te d Li ke rt

sc al e su rv ey

b as ed

on Ry an ,C am

p b el la n d

Br ig h am

(1 99 9) .

Re se ar ch er

ad ap te d Re ad in es s fo r

In te rp ro fe ss io n al Le ar n in g Sc al e (R IP LS ),

Pa rs el l & Bl ig h (1 99 9)

O p en

-e n d ed

q u es ti o n s: Re se ar ch er

d ev el op

ed op

en -e n d ed

q ue st io n su rv ey

b as ed

on Ry an , C am

p b el l an d Br ig h am

(1 99 9)

Q u an

ti ta ti ve : O ve ra ll re su lt s w er e

st at is ti ca lly

si g n ifi ca n t (p

= 0. 00 9) .

St at is ti ca lly

si g n ifi ca n t im p ro ve m en t (p

va lu es

n ot

p ro vi d ed ) in

su b sc al es :

te am

w or k an d co lla b or at io n an d

p ro fe ss io n al

re sp on

si b ili ty .

O p en

-e n d ed

q u es ti o n s: Fo ur

m aj or

su b -t h em

es w er e id en ti fie d : 1.

Im p ro ve d re ad in es s fo r p ra ct ic e d ur in g

a d is as te r; 2.

A w ak en in g to

in te rp ro fe ss io n al

p ra ct ic e; 3.

In si g h t

in to

th e cl ie n t p er sp ec ti ve ; 4.

D ev el op

m en t of

n ew

in te n ti on

s, n ew

ac ti vi ti es

Ba sr an ,

et al .

(2 01 4)

D es cr ib e th e ev al ua ti on

of th e

U n iv er si ty

of Sa sk at ch ew

an ’s

Lo n g it ud

in al

El d er ly Pe rs on

Sh ad ow

in g

(L EP S)

p ro je ct , an

in te rp ro fe ss io n al

se n io r m en to ri n g p ro g ra m m e in te n d ed

to im p ro ve

h ea lt h sc ie n ce

st ud

en ts ’

at ti tu d es

to w ar d ol d er

ad ul ts an d ot h er

h ea lt h ca re

p ro vi d er s.

D es ig n : Pr e- /p os t- te st

ev al ua ti on

Sa m p le : 3r d ye ar

n ur si n g st ud

en ts

(n = 22 ) 1s t ye ar

m ed ic in e st ud

en ts

(n = 30 ) 1s t ye ar

p h ar m ac y st ud

en ts

(n = 12 ) 1s t ye ar

p h ys io th er ap y st ud

en ts

(n = 46 ) 2n d ye ar

n ut ri ti on

st ud

en ts

(n = 20 ) 4t h ye ar

so ci al

w or k p ar tn er

w it h co m m un

it y- d w el lin g ol d er

ad ul ts

(n = n ot

p ro vi d ed )

Se n io r M en to rs h ip

Pr og

ra m m e –

Lo n g it ud

in al El d er ly Pe rs on

Sh ad ow

in g

Pr og

ra m m e

Q u an

ti ta ti ve : In te rp ro fe ss io n al Ed uc at io n

Pe rc ep ti on

Sc al e (IE PS ) su rv ey

(L ue ch t,

M ad es en , Ta ug

h er , & Pe tt er so n , 19 90 )

Q u al it at iv e:

Fo cu s g ro up

us in g

re se ar ch er

d ev el op

ed in te rv ie w

g ui d e

Q u an

ti ta ti ve : N o si g n ifi ca n t ch an g e

on an y of

th e IE PS

su b sc al es . 85 – 96 %

st ud

en ts

re p or te d h ig h le ve ls of

sa ti sf ac ti on

w it h LE PS .S tu d en ts ag re ed

th at

p ar ti ci p at in g in

LE PS

im p ro ve d

th ei r kn ow

le d g e of

g er ia tr ic s,

in te rp ro fe ss io n al

te am

w or k, ro le s/

re sp on

si b ili ti es

of ot h er

h ea lt h ca re

p ro vi d er s.

Q u al it at iv e:

LE PS

p ro g ra m m e h ad

a si g n ifi ca n tl y p os it iv e im p ac t on

st ud

en ts ’a tt it ud

es to w ar d ol d er

ad ul ts .

Bi lo d ea u

et al .

(2 01 0) .

D es cr ib e p ar ti ci p an ts ’ p er ce p ti on

s co n ce rn in g th ei r in vo lv em

en t in

an IP E

an d th ei r kn ow

le d g e of

th e b en ef it s of

In te rp ro fe ss io n al Ed uc at io n fo r

C ol la b or at iv e Pa ti en t ce n tr ed

Pr ac ti ce

(IE C PC

P) In it ia ti ve .

D es ig n : Pr e- /p os t- te st

ev al ua ti on

Sa m p le : Re si d en ts /

tr ai n ee s an d p ro fe ss io n al s fr om

th e

fo llo w in g p ro fe ss io n s: n ur si n g ,

p h ar m ac y, ki n es io lo g y, n ut ri ti on

, oc cu p at io n al

th er ap y, p sy ch ol og

y, m ed ic in e, p h ys io th er ap y, co m m un

it y

h ea lt h p ro je ct

d ir ec to rs (n

= 4)

ex ec ut iv e te am

m em

b er s (n

= 6)

*N ot e: sa m p le

si ze

is d iff er en t fo r ea ch

co m p on

en t of

th e IE C PC

P in it ia ti ve .

*y ea r of

st ud

y n ot

re p or te d

D es ig n ed

an d im p le m en te d an

In te rp ro fe ss io n al Ed uc at io n fo r

C ol la b or at iv e Pa ti en t ce n tr ed

Pr ac ti ce

(IE C PC

P) In it ia ti ve

(a s p ar t of

st ud

en t

p re ce p to rs h ip ). Fo ur

co m p on

en ts of

th e

p ro g ra m m e in cl ud

e: 1. In it ia lt ra in in g ;2 .

Pr ac ti ca l tr ai n in g in

p ri m ar y ca re ; 3.

C on

ti n ui n g Ed uc at io n ; 4.

C om

m un

ic at io n an d in fo rm

at io n

te ch n ol og

ie s in

su p p or t of

IP E

Q u an

ti ta ti ve : Re se ar ch er

d ev el op

ed se lf-

ad m in is te re d q ue st io n n ai re s us in g 5 p oi n t

Li ke rt -t yp e sc al e q ue st io n s

Q u al it at iv e:

Se m i- st ru ct ur ed

in te rv ie w s us in g

re se ar ch er

d ev el op

ed op

en -e n d ed

q ue st io n s

Q u an

ti ta ti ve :

C o m p o n en

t 1:

St at is ti ca lly

si g n ifi ca n t

im p ro ve m en t in

st ud

en ts ’ p er ce p ti on

s of

th ei r kn ow

le d g e of

th e b en ef it s of

IE C PC

P b ef or e an d af te r IP E co ur se s

(p < 0. 05 ).

C o m p o n en

t 2:

St at is ti ca lly

si g n ifi ca n t

d iff er en ce

in p er ce iv ed

im p ro ve m en ts

to kn ow

le d g e of

IP C PC

P b en ef it s

am on

g re si d en ts /t ra in ee s. N o

st at is ti ca lly

si g n ifi ca n t d iff er en ce

in p er ce iv ed

im p ro ve m en ts to

kn ow

le d g e

of IP C PC

P b en ef it s am

on g

p ro fe ss io n al s.

C o m p o n en

t 3:

86 .1 %

p al lia ti ve

ca re

te am

p ar ti ci p an ts , 86 .5 %

p ri va te

p ra ct ic e se tt in g p ar ti ci p an ts , 78 .9 %

h ea lt h an d so ci al

se rv ic es

ce n tr e

p ar ti ci p an ts

ag re ed

th e le ar n in g

ac ti vi ti es

al lo w ed

th em

to le ar n w it h ,

fr om

an d ab ou

t ea ch

ot h er .

C o m p o n en

t 4:

N ot

re p or te d

Q u al it at iv e:

N ot

re p or te d

(C o n ti n u ed

)

JOURNAL OF INTERPROFESSIONAL CARE 747

Ta b le

2. (C on

ti n ue d ).

A ut h or /

Ye ar

A im

of St ud

y D es ig n

Sa m p le

IP E te ac h in g -l ea rn in g

ac ti vi ti es

O ut co m e m ea su re m en t to ol s

M ai n fin

d in g s re la te d to

IP E

D ob

so n

et al .

(2 00 9)

To d ev el op

an d ev al ua te

a cl as sr oo m -

b as ed

cu rr ic ul um

d es ig n ed

to p ro m ot e

in te rp ro fe ss io n al

co m p et en ci es

am on

g st ud

en ts

fr om

va ri ou

s h ea lt h

p ro fe ss io n s to

w or k to g et h er

on sy st em

- b as ed

p ro b le m s us in g q ua lit y

im p ro ve m en t m et h od

s an d to ol s to

im p ro ve

p at ie n t- ce n tr ed

ca re .

D es ig n Pr e- /p os t- te st

ev al ua ti on

Sa m p le : 2n d an d 4t h ye ar

n ur si n g

st ud

en ts

(n = 85 ) 2n d ye ar

n ut ri ti on

st ud

en ts

(n = 26 ) 3r d ye ar

p h ar m ac y

st ud

en ts

(n = 82 ) 3r d ye ar

p h ys ic al

th er ap y st ud

en ts

(n = 30 )

Re se ar ch er

d ev el op

ed q ua lit y

im p ro ve m en t ca se

st ud

y in vo lv in g

el d er ly p at ie n ts in

tr an si ti on

fr om

ac ut e

ca re

to co m m un

it y ca re .

Q u an

ti ta ti ve : 7- p oi n t Li ke rt -t yp e se lf-

re fle ct io n to ol

(C la rk ,1 99 4)

an d M cM

as te r

U n iv er si ty

d ev el op

ed 7- p oi n t Li ke rt -t yp e

q ue st io n n ai re

(J ac q ue s, 20 00 )

O p en

-e n d ed

q u es ti o n s:

O p ti on

to in cl ud

e fr ee

te xt

co m m en ts

Q u an

ti ta ti ve : Im p ro ve m en t b et w ee n

p re -/ p os t- te st

re fle ct io n sc or es

fo r

it em

s ad d re ss in g st ud

en ts ’ ab ili ty

to co m m un

ic at e an d co op

er at e w it h

ot h er s an d th ei r co m fo rt w it h an d

ab ili ty

to id en ti fy

w it h th ei r te am

(p < 0. 00 1) ; it em

s ad d re ss in g te am

co n fli ct , g ro up

d ec is io n -m

ak in g , an d

ro le

of ot h er

p ro fe ss io n al s (p

< 0. 01 ).

Po st -t es t sc or es

re fle ct ed

a h ig h le ve l

of sa ti sf ac ti on

w it h th e ex p er ie n ce . N o

si g n ifi ca n t d iff er en ce s in

th e g ro up

ev al ua ti on

sc or es

b as ed

on p ro fe ss io n al

d es ig n at io n .

Fo rt ug

n o

et al .

(2 01 3)

To ex p lo re

th e in te rp ro fe ss io n al

te am

w or k th at

oc cu rr ed

am on

g th e

un d er g ra d ua te

st ud

en ts p ar ti ci p at in g in

an in te rp ro fe ss io n al p la ce m en t.

D es ig n :D

ur in g an d p os t- te st ev al ua ti on

Sa m p le :3 rd

an d 4t h ye ar

st ud

en ts fr om

n ur si n g (n

= 1) , ch ild

an d yo ut h ca re

t (n

= 1) , ea rl y ch ild h oo d ed uc at io n

(n = 1)

n ut ri ti on

(n = 1)

se co n d ar y sc h oo l p re ce p to r (n

= 2)

Re se ar ch er

d ev el op

ed in te rp ro fe ss io n al

p la ce m en t to

d ev el op

an d im p le m en t

fo ur

h ea lt h y- liv in g m od

ul es

fo r

se co n d ar y sc h oo l st ud

en ts

Q u al it at iv e:

Fo cu s g ro up

us in g

re se ar ch er

d ev el op

ed se m i- st ru ct ur ed

to p ic g ui d e.

Q u al it at iv e:

Tw o m aj or

th em

es em

er g ed : 1.

Te am

fu n ct io n in g ; 2.

Sh ift

in p er sp ec ti ve s.

La it et

al .

(2 01 1)

To in cr ea se

in te rp ro fe ss io n al ca p ac it y in

h ea lt h p ro vi d er s an d st ud

en ts in

cl in ic al

si te s in

a p ro vi n ce

in w es te rn

C an ad a.

D es ig n : Po st -t es t ev al ua ti on

Sa m p le : 4t h ye ar

n ur si n g , p h ar m ac y,

oc cu p at io n al

th er ap y, p h ys io th er ap y,

re sp ir at or y th er ap y, sp ee ch

la n g ua g e

p at h ol og

y st ud

en ts

*T ot al

st ud

en t sa m p le

(n = 11 )

p re ce p to rs

(n = n ot

re p or te d )

In te rp ro fe ss io n al m en to ri n g in

a fin

al p re ce p to rs h ip

p ra ct ic e ex p er ie n ce

Q u al it at iv e:

Ex p lo ra to ry

g ro up

an d

in d iv id ua l se m i- st ru ct ur ed

in te rv ie w s

us in g re se ar ch er

d ev el op

ed op

en -e n d ed

q ue st io n s.

Q u al it at iv e:

Th re e th em

es em

er g ed

(t w o re la te d to

IP E) : 1.

Pr ov id er

co m m it m en t; 2.

C om

p le xi ty

of in te rp ro fe ss io n al

m en to ri n g ac ti vi ti es ;

3. St ud

en ts ’ le ar n in g ou

tc om

es .

M ef fe et al .

(2 01 2)

Ev al ua te

h ow

p ar ti ci p at io n in

an IP E

p ilo t p ro g ra m m e in

m at er n it y ca re

m ay

en h an ce

st ud

en t kn ow

le d g e, sk ill s/

at ti tu d es , an d m ay

p ro m ot e th ei r

co lla b or at iv e b eh av io ur

in th e p ra ct ic e

se tt in g .

D es ig n : Po st -t es t ev al ua ti on

Sa m p le : se n io r st ud

en ts

fr om

n ur si n g

(n = 3)

m id w ife ry

(n = 3)

m ed ic in e

(n = 3)

Si x w or ks h op

m od

ul es

an d tw o cl in ic al

sh ad ow

in g ex p er ie n ce s

Q u al it at iv e:

Se m i- st ru ct ur ed

in te rv ie w s

us in g re se ar ch

d ev el op

ed op

en -e n d ed

q ue st io n s.

Q u al it at iv e:

Fo ur

th em

es em

er g ed : 1.

Th e p ro ce ss

of re la ti on

sh ip

b ui ld in g ;2 .

Th e p ro ce ss

of es ta b lis h in g co n fid

en t

co m m un

ic at io n ; 3.

W ill in g n es s to

co lla b or at e; 4.

Pr ov id in g w om

an /

fa m ily -c en tr ed

ca re .

M oh

au p t

et al .

(2 01 2)

To ex am

in e ch an g es

in un

d er g ra d ua te

h ea lt h ca re

st ud

en ts ’ p er ce p ti on

s an d

at ti tu d es

to w ar d in te rp ro fe ss io n al

co lla b or at io n fo llo w in g th ei r

p ar ti ci p at io n in

an in te rp ro fe ss io n al

si m ul at io n p ro g ra m m e

D es ig n : Pr e- /p os t- te st

ev al ua ti on

Sa m p le : fin

al ye ar

st ud

en ts

fr om

n ur si n g (n

= 42 ) oc cu p at io n al

th er ap y/

p h ys io th er ap y as si st an t (n

= 15 )

p ar am

ed ic (n

= 16 ) p h ar m ac y te ch n ic ia n

(n = 11 )

Re se ar ch er

d ev el op

ed In te rp ro fe ss io n al

Si m ul at io n Pr og

ra m m e

Q u an

ti ta ti ve : In te rd is ci p lin ar y Ed uc at io n

Pe rc ep ti on

s Sc al e (L ue ch t, M ad se n ,

Ta ug

h er , & Pe tt er so n , 19 90 )

Q u an

ti ta ti ve : (n ur si n g st ud

en ts )

St at is ti ca lly

si g n ifi ca n t in cr ea se s in

p os it iv e at ti tu d es

fo r: C om

p et en cy

an d

au to n om

y (M

D − 0. 14 ); Pe rc ei ve d n ee d

fo r co lla b or at io n (M

D − 0. 05 );

Pe rc ep ti on

of ac tu al co lla b or at io n (M

D − 0. 14 ). N o st at is ti ca lly

si g n ifi ca n t

d iff er en ce

re p or te d fo r U n d er st an d in g

ot h er s va lu es

(M D − 0. 09 ).

(C o n ti n u ed

)

748 N. L. MURDOCH ET AL.

Educational model/learning theory

In addition to the type of teaching-learning activity, it is impor- tant to report on the use of educational models or learning theories to inform the activity. Only four out of the 10 studies described the use of educational models or learning theories to ground their teaching-learning activities. The theories used were: adult learning theory (Bilodeau et al., 2010; Meffe et al., 2012), intergroup contact theory (Mohaupt et al., 2012), and the cooperative and experiential learning theory (Racine et al., 2012).

Impact of teaching and learning activity

Using the modified Kirkpatrick’s Model of Educational Outcomes for Interprofessional Education (Freeth et al., 2005), the impact of teaching-learning activities was assessed. The highest level achieved by four studies was Level 3 (Fortugno et al., 2013; Meffe et al., 2012; Racine et al., 2012; Takahashi et al., 2010) (Table 3). This level identifies indivi- duals’ transfer of interprofessional learning to the practice setting and a change in their professional practice. The remaining six studies achieved Level 2b: Acquisition of knowledge & skills, where students linked knowledge and skills to IPC. The students in all 10 studies reported satisfac- tion with the teaching-learning activities and an increased acquisition of knowledge, skills, and development of positive attitudes related to IPC.

Level of interprofessional collaboration

All teaching-learning activities included in the 10 studies achieved the first level in the ENIPP Pathway, Exposure. The teaching-learning activities in the majority of studies (n = 7), met the second ENIPP level, Experience. The teach- ing-learning activities in the remaining three studies achieved the highest ENIPP level, Engagement (Fortugno et al., 2013; Racine et al., 2012; Takahashi et al., 2010). None of the studies, however measured changes in organisational practice or improvements in health or well-being of patients/clients as a result of students engaged in IPE and collaborative practice (Table 3).

Measurement of outcomes

All 10 studies utilised participant self-evaluation tools to determine the outcomes of IPE innovations. Self-evaluation involves a level of self-reflection which is an important ele- ment of Kolb’s (1984) experiential learning theory and serves to offer valuable information in relation to the students’ perception of an experience. Four studies utilised a validated tool specifically designed to measure interprofessional learn- ing (Atack et al., 2009; Basran et al., 2014; Mohaupt et al., 2012; Racine et al., 2012). The remaining six studies utilised non-validated tools. The study conducted by Meffe et al. (2012) was the only longitudinal study included in this review and interviewed participants at 2, 3, 6, and 12 weeks post- programme to assess retention of interprofessional knowledge and skills.Ta

b le

2. (C on

ti n ue d ).

A ut h or /

Ye ar

A im

of St ud

y D es ig n

Sa m p le

IP E te ac h in g -l ea rn in g

ac ti vi ti es

O ut co m e m ea su re m en t to ol s

M ai n fin

d in g s re la te d to

IP E

Ra ci n e

et al .

(2 01 2)

To d et er m in e w h et h er

st ud

en ts

d em

on st ra te d g re at er

re ad in es s to

w or k

in in te rp ro fe ss io n al

h ea lt h ca re

te am

s af te r p ar ti ci p at in g in

th e

In te rd is ci p lin ar y Po p ul at io n H ea lt h

Pr oj ec t.

D es ig n : Pr e- /P os t- te st ev al ua ti on

Sa m p le : fin

al ye ar

n ur si n g st ud

en ts

(n = 54 ) *m

ed ic al

st ud

en ts

(n = 28 )

*p h ys ic al

th er ap y st ud

en ts

(n = 26 )

*k in es io lo g y st ud

en ts (n

= 9)

*y ea r of

st ud

y n ot

re p or te d

Fi ve -w ee k co lla b or at iv e co m m un

it y-

b as ed

In te rd is ci p lin ar y Po p ul at io n

H ea lt h Pr oj ec t

Q u an

ti ta ti ve : 5- it em

Li ke rt -t yp e

Re ad in es s of

H ea lt h C ar e St ud

en ts

fo r

In te rp ro fe ss io n al Le ar n in g Sc al e (R IP LS )

ad ap te d fr om

Pa rs el l an d Bl ig h ’s (1 99 9)

ac ti vi ti es

(p re -/ p os t- in n ov at io n ) an d

Re se ar ch er

d ev el op

ed 5 it em

Li ke rt -t yp e

sc al e m ea su ri n g sa ti sf ac ti on

re la te d to

ac ad em

ic ac ti vi ti es

(p os t- in n ov at io n on

ly )

O p en

-e n d ed

q u es ti o n s: Re se ar ch er

d ev el op

ed op

en -e n d ed

q ue st io n s (p os t-

te st

on ly )

Q u an

ti ta ti ve : St ud

en ts

re ad in es s to

w or k in

in te rp ro fe ss io n al

te am

s d id

n ot

si g n ifi ca n tl y ch an g e ov er

th e

co ur se

of th ei r p ar ti ci p at io n of

th e

IP H P.

O p en

-e n d ed

q u es ti o n s: Re sp on

se to

q ue st io n : “T h in g s I lik e b es t” -

Pa rt ic ip at e in

te am

w or k w it h st ud

en ts

fr om

ot h er

p ro g ra m m es ; g ue st

in te rv ie w ; th e co m m un

it y p lu n g e.

Re sp on

se to

q ue st io n : “T h e th in g s I

fo un

d m os t d iff ic ul t” – Te am

-b ui ld in g

ac ti vi ty

w as

fo un

d to

b e th e m os t

ch al le n g in g .

Ta ka h as h i

et al .

(2 01 0)

Pr ov id e an

op p or tu n it y fo r st ud

en ts

to a)

d ev el op

an un

d er st an d in g of

th e

ex p er ti se

th at

ea ch

p ro fe ss io n al

b ri n g s

to th e m an ag em

en t of

h ea lt h is su es , b )

le ar n an d d ev el op

cl in ic al ex p er ti se

to g et h er

an d c)

d ev el op

an un

d er st an d in g of

te am

d yn am

ic s,

co m m un

ic at io n sk ill s an d co n fli ct

re so lu ti on

w it h in

th e co n te xt

of a w el l-

fu n ct io n in g te am

.

D es ig n : Pr e- /P os t- te st ev al ua ti on

Sa m p le : n ur si n g st ud

en ts

(n = 2) ,

p h ys io th er ap y st ud

en ts

(n = 2) ,

oc cu p at io n al

th er ap y st ud

en ts

(n = 2)

*y ea r of

st ud

y n ot

re p or te d

In te rp ro fe ss io n al se ss io n s in

a st ud

en ts ’

us ua l cl in ic al p ra ct ic e p la ce m en t

(p ed ia tr ic ou

tp at ie n t d ep ar tm

en t cl in ic )

Q u al it at iv e:

Pr og

ra m m e ev al ua ti on

q ue st io n n ai re s – n on

-s p ec ifi ed

Q u al it at iv e: “R es p on

se s fr om

st ud

en ts

w er e ov er w h el m in g p os it iv e re la te d to

in cr ea se d un

d er st an d in g of

an d

re sp ec t fo r th ei r ow

n ro le s an d ro le s of

ot h er s”

(p .3 6) .

JOURNAL OF INTERPROFESSIONAL CARE 749

Discussion

The literature included in this scoping review supports the effectiveness of IPE in healthcare professional programmes for the development of IPC competencies to prepare collabora- tive-ready new graduate nurses with the knowledge, skills, and attitudes to participate effectively as members of interprofes- sional healthcare teams (Atack et al., 2009; Bilodeau et al., 2010; Dobson et al., 2009; Mohaupt et al., 2012). Participants in the studies reported having attained IPC competencies which aligned with the six competency domains outlined in (CIHC, 2010). The learning outcomes explored in all of the studies may be categorised as roles, responsibilities, and rela- tionships (Parsell & Bligh, 1998; Simmons, Wagner, & Reeves, 2016) related to IPC for effective team functioning. Overall, the review found the teaching-learning activities utilised led to an increased appreciation for, and ability to engage in, effec- tive teamwork while acquiring a greater understanding of roles, responsibilities, and relationships for effective interpro- fessional collaboration. While the self-reported data showed the development of IPC competencies, this review supports the findings of previous reviews which identified the failure to provide evidence of the sustainability of students’ achieve- ment of IPC competencies (Lapkin, Levett-Jones, & Gilligan, 2011) or IPE’s impact on health systems outcomes (Cox, Cuff, Brandt, Reeves, & Zierler, 2016; IOM 2015).

Knowing IPE is necessary for effective interprofessional collaboration in real-world practice is not enough, educators must consider the dynamic contexts in which students learn – in both the academic and practice settings (Dow, Blue, Konrad, Earnest, & Reeves, 2013). Consideration must be given to logistic and humanistic aspects when beginning the process of developing and then teaching for successful achievement of IPC competencies. Logistic factors to consider include: available resources, optimal timing in the education programme, which teaching-learning activity will achieve best results, the learning/practice environment, and the use of appropriate, validated tools assessing IPC competency achievement (d’Avry & McCrorie, 2011). Humanistic aspects include: faculty buy-in and preparedness to support student learning, use of appropriate educational models, and learning theories to inform teaching-learning activities to attend to various styles of student learning (Oandasan & Reeves, 2005), and buy-in and preparedness of healthcare

professionals in the practice setting (d’Avry & McCrorie, 2011; Thistlethwaite & Nisbet, 2011).

Identifying the competencies educators are going to focus on is the first step in the process of IPE. CIHC (2010) is a compe- tency framework educators can use to guide the implementation of interprofessional education and collaborative practice in cur- ricula. Accurately evaluating students’ achievement of IPC com- petencies is crucial in determining the effectiveness of the IPE teaching-learning approaches. Educators are encouraged to use validated tools designed to specifically measure IPC competen- cies (Curran et al., 2011). A selection of tools may be found on the following websites: https://nexusipe.org/measurement- instruments and https://www.cihc.ca/resources

Deciding when to implement IPE and offer interprofes- sional collaboration experiences must be carefully considered (Abu-Rish et al., 2012; Charles et al., 2010; Cox et al., 2016; Dillon, Noble, & Kaplan, 2009). Student perspective indicates students value early exposure to the roles of other healthcare professionals (Eccott et al., 2012). While Meffe et al. (2012) argue: “pre-licensure IPE programmes, offered at varying stages of professional development, can be effective in culti- vating collaborative behaviours provided that they are thoughtfully developed, theoretically grounded in the learning and social domains, and sustained by ongoing interprofes- sional activities with support at the individual, organisational and societal levels.” (p.187). To meet the demands of an evolving healthcare environment, nursing students need the opportunity for IPE throughout their education programme with the opportunity to continue engaging in IPE and inter- professional collaboration throughout their career (IOM, 2015).

Integrating IPE in early years of healthcare professional programmes may preclude the development of negative opi- nions of other healthcare professionals, resulting in the crea- tion of a collaborative culture. In addition, early exposure to IPE provides an extended opportunity for healthcare profes- sional students to achieve IPC competencies (Dillon et al., 2009; Eccott et al., 2012). As students move into their senior year(s) they will have developed a better sense of their profes- sional roles and responsibilities enhancing their ability to engage more effectively in interprofessional teams (Basran et al., 2014; Mohaupt et al., 2012). Even though the majority of student participants in the included studies were from upper levels of their programmes, each of the teaching-

Table 3. Impact of teaching-learning activities and ENIPP level achieved.

Author/Year IPE teaching-learning activity Impact of teaching-learning activity (Based on quality

assessment model of Kirkpatrick) Highest ENIPP pathway

level achieved

Atack et al. (2009) On-line simulation *2b Experience Basran, et al. (2014) Mentor programme (clinical practice) 2b Experience Bilodeau et al. (2010) Classroom lecture, small group discussion, on-

line discussion, simulation 2b Engagement

Dobson et al. (2009) Small group discussion 2b Experience Fortugno et al. (2013) Creation and delivery of modules (secondary

school setting) 3 Engagement

Lait et al. (2011) Mentor programme (clinical practice) 2b Experience Meffe et al. (2012) Clinical practice experience **3 Experience Mohaupt et al. (2012) Simulation 2b Experience Racine et al. (2012) Clinical practice experience 3 Engagement Takahashi et al. (2010) Clinical practice experience 3 Engagement

*2b – Acquisition of Knowledge and Skills **3 – Transfer of Interprofessional Learning to Practice Setting

750 N. L. MURDOCH ET AL.

learning activities included preparatory elements that exposed learners to other healthcare professional students and/or the concept of collaboration, prior to having students experience, or engage in interprofessional collaboration. This supports the notion that exposure to other healthcare professionals is a key element in IPE with the possibility of creating to a greater understanding of other healthcare professionals (Reeves, Lewin, Espin, & Zwarenstein, 2010).

Once the interprofessional competency and timing of IPE is thoughtfully decided, the environment and available resources will further inform the development of the teaching-learning activity. Developing an appropriate teaching-learning activity grounded in educational models, or learning theories (Meffe et al., 2012) is the next step. Educational models and learning theories can aid in the creation and implementation of teach- ing-learning activities (Oandasan & Reeves, 2005). Each study included in this review reported on an interprofessional teach- ing-learning activity to engage students in IPE and/or IPC. Interactive teaching-learning activities provide opportunities for students to practice interprofessional knowledge, skills, and attitudes in action with others in learning environments that are close to practice realities (Schmitt, Gilbert, Brandt, & Weinstein, 2013). Doing so, provides an opportunity to develop insight into their ability to collaborate with others which is not gained from passive experiences (Radomski & Beckett, 2011). The variety of teaching-learning activities reported in the stu- dies supports the notion that there are many ways educators can support healthcare professional students to achieve IPC competencies. However, this inconsistency continues to be identified as perpetuating the inability to measure impact (Abu-Rish et al., 2012). Grounding teaching-learning activities in educational models or learning theories has the potential to strengthen the activity while guiding the selection of appropri- ate evaluation tools (Oandasan & Reeves, 2005). In addition, educational models or learning theories can contribute to further developing educational theory related to healthcare professional education (Murdoch, Bottorff, & McCullough, 2014).

Educators are encouraged to use one of the various IPE frameworks when developing teaching-learning activities (Cox et al., 2016; Thistlethwaite et al., 2014). The ENIPP Pathway is a useful framework to guide educators as they create activities to support student learning and achievement of IPC competencies; guiding educators to scaffold IPE teach- ing-learning activities throughout a four-year degree. Scaffolding teaching-learning activities provides the opportu- nity for early exposure to other healthcare professional stu- dents with the potential of preventing the development of negative views and allowing the notion that experiencing and engaging in interprofessional practice may be more appropriate for upper level students and new graduate nurses in real-world practice (Cox et al., 2016; Eccott et al., 2012). Learning activities fitting the first level, Exposure, could be offered earlier in healthcare professional programmes provid- ing students with a longer time to achieve IPC competencies.

While this review focused on Canadian undergraduate nur- sing curricula, the results have implications for nurse educators internationally as they endeavour to facilitate student achieve- ment of knowledge, skills, and attitudes necessary to engage in

effective interprofessional collaborative practice. The findings of this review, similar to the findings of an earlier review (Abu- Rish et al., 2012), provide support for the use of multiple teaching-learning activities within IPE as effective for students’ achievement of IPC competencies. This is encouraging for nurse educators as a variety of approaches for IPE provide educators with the freedom to choose the best approach depending on the teacher’s knowledge, available resources, level of student, and the education/practice environment.

The constraints in academic and practice settings should not deter educators from developing and/or revising IPE curricula components. The logistics of organising and offering teaching-learning activities to ensure all students have the opportunity to experience and engage in interprofessional teams in real-world practice can be challenging in todays’ practice settings. Feasibility and sustainability of providing opportunities for large student cohorts to experience and engage in interprofessional collaboration may be unlikely given that educators are faced with resource constraints; whereas, organising and offering teaching-learning activities that expose students to interprofessional collaboration are less challenging and more feasible and sustainable. Therefore, all healthcare professional programmes should strive to offer students, at a minimum, the opportunity for exposure to other healthcare professional students and/or healthcare pro- viders with a focus on developing knowledge, skills, and attitudes for effective interprofessional collaborative practice. Students who have been exposed to other healthcare profes- sional students during IPE would have the pre-requisite knowledge, thereby allowing for a more nimble response to opportunities of experience and engagement in interprofes- sional collaboration when opportunities arise.

To strengthen the overall body of evidence related to inte- grating effective IPE teaching-learning activities into nursing curricula, validated assessment tools specific to measuring IPC competency attainment, beyond measuring student perceptions, would be valuable to provide healthcare programme educators with evidence of student learning (Abu-Rish et al., 2012; Cox et al., 2016; Lapkin et al., 2013; Reeves, 2016). Consideration must also be given to the recruitment of participants, as random or mandatory assignment may mitigate the potential positive perception bias held by volunteer participants (Hall & Weaver, 2001; Loiselle, Profetto-McGrath, Polit, & Tatano Beck, 2011). Lastly, the contribution of longitudinal studies could provide evidence of students’ ability to integrate IPC competencies into practice to support effective engagement in safe, interprofes- sional collaborative practice.

In regards to limitations, the studies included in the review were set in the Canadian context, this may limit the transferability of the findings. In addition, the inclusion of only Canadian studies may have resulted in missing the identification of effective IPE teaching-learning activities to facilitate students’ achievement of IPC competencies. In addition, the assessment tools used in the studies measured student perceptions. Validated tools designed to specifically measure student achievement of IPC competencies would enhance rigour and impact in IPE literature with the poten- tial to provide educators with stronger evidence of student learning.

JOURNAL OF INTERPROFESSIONAL CARE 751

Concluding comments

Nurse educators are responsible for ensuring curriculum pre- pares students to provide safe, high-quality nursing care. Curriculum development and revisions must provide learning opportunities for students to begin practice as a new graduate with the knowledge, skills, and attitudes necessary to engage as effective members of interprofessional teams. Based on the evidence presented in this scoping review, there are a variety of teaching-learning activities educators can use to support the achievement of IPC competencies. Nurse educators are encouraged to intentionally integrate IPE learning experiences into current and future nursing education to best prepare collaborative ready graduate nurses.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

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