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Nurse Education Today 36 (2016) 348353

Nurse Education Today 36 (2016) 348 – 353 Contents lists available at ScienceDirect Nurse Education Today

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/nedt

Education Today journal homepage: www.elsevier.com/nedt Capturing readiness to learn and collaboration as explored

Capturing readiness to learn and collaboration as explored with an interprofessional simulation scenario: A mixed-methods research study

Kelly L. Rossler a , , Laura P. Kimble b , 1

a Louise Herrington School of Nursing of Baylor University, 3700 Worth Street, Dallas, TX 75246, USA

b Piedmont Healthcare Endowed Chair in Nursing, Georgia Baptist College of Nursing of Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA

3001 Mercer University Drive, Atlanta, GA 30341, USA article info Article history: Accepted 21 August 2015

article info

Article history:

Accepted 21 August 2015

Keywords:

Simulation Interprofessional education Collaboration Readiness to learn Pre-licensure Mixed-methods

summary

Background: Didactic lecture does not lend itself to teaching interprofessional collaboration. High-delity human patient simulation with a focus on clinical situations/scenarios is highly conducive to interprofessional education. Consequently, a need for research supporting the incorporation of interprofessional education with high-delity patient simulation based technology exists. Objectives: The purpose of this study was to explore readiness for interprofessional learning and collaboration among pre-licensure health professions students participating in an interprofessional education human patient simulation experience. Methods: Using a mixed methods convergent parallel design, a sample of 53 pre-licensure health professions stu- dents enrolled in nursing, respiratory therapy, health administration, and physical therapy programs within a college of health professions participated in high-delity human patient simulation experiences. Perceptions of interprofessional learning and collaboration were measured with the revised Readiness for Interprofessional Learning Scale (RIPLS) and the Health Professional Collaboration Scale (HPCS). Focus groups were conducted during the simulation post-brieng to obtain qualitative data. Statistical analysis included non-parametric, infer- ential statistics. Qualitative data were analyzed using a phenomenological approach. Results: Pre- and post-RIPLS demonstrated pre-licensure health professions students reported signicantly more positive attitudes about readiness for interprofessional learning post-simulation in the areas of team work and collaboration, negative professional identity, and positive professional identity. Post-simulation HPCS revealed pre-licensure nursing and health administration groups reported greater health collaboration during simulation than physical therapy students. Qualitative analysis yielded three themes: exposure to experiential learning,” “acquisition of interactional relationships,and presence of chronology in role preparation.Quantitative and qualitative data converged around the nding that physical therapy students had less positive perceptions of the experience because they viewed physical therapy practice as occurring one-on-one rather than in groups. Conclusion: Findings support that pre-licensure students are ready to engage in interprofessional education through exposure to an experiential format such as high-delity human patient simulation. © 2015 Elsevier Ltd. All rights reserved.

Didactic lecture formats continue to be the conventional medium used in educating undergraduate health professions students (Baneld et al., 2012; Smith et al., 2012); however, the growing com- plexity of health care warrants the need to effectively engage with all members of the health care team. Educators must nd better ways to prepare students for professional practice. Interprofessional col- laboration supports nursing stude nts making the transition to pro- fessional practice by gaining greater competency in engaging with the health care team, which has the potential to yield better patient outcomes ( American Association of Colleges of Nursing , 2008 , p. 22;

Corresponding author. Tel.: +1 214 818 7981 (Ofce); fax: +1 214 820 3375. E-mail addresses: Kelly_Rossler@baylor.edu (K.L. Rossler), Kimble_LP@Mercer.edu (L.P. Kimble).

1 Tel.: +1 678 547 6781 (Ofce); fax: +1 678 547 6777.

http://dx.doi.org/10.1016/j.nedt.2015.08.018

0260-6917/© 2015 Elsevier Ltd. All rights reserved.

Stein-Parbury & Liaschenko, 2007 ). However, the didactic lecture does not lend itself to teaching interprofessional collaboration. High-delity human patient simulation with a focus on clinical situations/scenarios is highly conducive to interprofessional education. Consequently, a need for research supporting the incorporation of interprofessional ed- ucation with high- delity patient simulation based technology has been identied by multiple researchers, interprofessional collaborative partners, and practice initiatives (Institute for Healthcare Improvement, 2012 ; Interprofessional Education Collaborative Expert Panel, 2011 ; Patel et al., 2012; Titzer et al., 2011). A student enrolled in any type of health professions program of study needs to successfully complete program-speci c requirements as well as gain a license or other re- quired documentation to enter into the professional practice setting. When enrolled in individual programs of study, these pre-licensure stu- dents are not guaranteed exposure to interprofessional or collaborative

K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348353

349

education pertaining to other practice disciplines. The purpose of this mixed-methods study was to explore readiness for interprofessional learning and collaboration among pre-licensure health professions stu- dents participating in an interprofessional education human patient simulation experience. Specically, the research questions were:

1. Do perceptions of readiness to learn among pre-licensure students enrolled in a health professions program of study change following an interprofessional education simulation experience?

2. Are there differences among health professions pre-licensure stu- dents in perceptions of readiness to learn and collaboration following an interprofessional education simulation experience?

3. What are the pre-licensure health professions student partici- pants perceptions of the interprofe ssional education simulation experience?

4. To what extent do the quantitative and qualitative results converge?

Interprofessional Education and Readiness to Learn with Simulation Technology

Interprofessional education (IPE) is increasingly recognized as a necessary tool in transforming the education of health care professionals ( Frank & Chen, 2010; Institute of Medicine, 2010; King et al., 2012). Specically, interdisciplinary collaboration is identied as a necessity for improving patient outcomes through competency in performance of clinical skills and patient safety initiatives. An ability to effectively collaborate among health care disciplines in the areas of communication, role identi cation, team working skills, and con ict resolution are critical components of practice for health care profes- sionals (Poore et al., 2014). Demands from hospital systems for novices entering the health care professions to think critically as fully engaged members of the health care team has led to the need for alternative teaching strategies in health care education (Gore & Schuessler, 2013; McLaughlin, 2010; Norman, 2012; Wellard & Heggen, 2010; Wolfgram & Quinn, 2012; Yanhua & Watson, 2011). Interprofessional education collaborative experiences taught in the educational setting help pre- licensure students to enter the health care setting better prepared to engage in an interdisciplinary environment (Thibault, 2011). Creating substantial interprofessional collaborative educational ex- periences within colleges of health professions is challenging. Over the past 10 years, research has demonstrated that interprofessional educa- tion can be implemented within nursing education with high- delity human patient simulators. Institutional barriers to interprofessional ed- ucation have been identi ed as workplace infrastructure, location, teaching in silos, turf protection, issues with mutual respect, and lack of administrative support and funding (Gore et al., 2012, p. e128). However, student-focused barriers to interprofessional education have not been thoroughly investigated. Specically, readiness of both pre- licensure and practicing health care professionals to engage in interpro- fessional education formats. Academic programs exploring the potential to cross curricular boundaries to develop collaborative teaching experiences would need to examine readiness of the student to engage in such activities. Readi- ness, also associated with competence, can vary for every student learn- er ( Bandali et al., 2012 ). Critical elements of readiness have been identied as psychomotor skills specic to discipline, core competency skills, and reective practice. Even when these critical elements are ad- dressed, student preparedness and readiness to engage in IPE activities can be impacted by knowledge and attitudes toward this type of learn- ing platform (Lamb & Shraiky, 2013). If a student is not ready to engage in IPE, then interactions essential for meaningful collaboration to take place may be lost. Faculty need to consider how to create an interprofes- sional learning environment promoting characteristics of relationships among professional groups, teamwork, role identication, and a benet to personal growth, professional practice, and patients. Exploration of the readiness to learn and understanding of how high-delity patient

simulation as a teaching methodology can positively enhance interpro- fessional collaboration among pre-licensure health professions students enrolled in their unique programs of study is necessary.

Theoretical Framework

David A. Kolb offered his experiential learning theory as a new ap- proach incorporating a holistic integrative perspective on learning that combines experience, perception, cognition, and behaviorto de-

ne the nature of what constitutes experiential learning (1984, p. 21). Learning involves human adaptation whereby knowledge is created through the transformation of experience ( Kolb, 1984 , p. 38). The learning process consists of (a) adaptation rather than content;

(b) knowledge transformation which was continuously recreated, not

acquired; and (c) learning. During experiential learning, knowledge is transformed from an encounter with an experience. A learner trans- forms from the knowledge gained and from participating in the learning experience set in an environment conducive to learning. Educating with simulation has offered the capability to promote learning by opening up cognitive processes of students of various learn- ing styles through sociocultural dialogue during communal lived expe- riences in a safe learning environment (Jeffries, 2007). Simulation also aligns with theories based on constructivism. Interprofessional educa- tion affords students from different professions the capacity to come to- gether to learn not only about, but from one another in an active and collaborative manner. Kolbs experiential learning theory supports an active process for interprofessional education whereby those engaged in the process work with one another to gain knowledge of individual health care roles. A learner participating in a simulation activity involv- ing interprofessional education can immerse themselves during the simulation, reect on transactions which occurred during the simula- tion experience from multiple perspectives, and integrate knowledge gained to transform their own practices.

Methodology

Design

In this QUAN and QUAL type of methodology, both strands of the quantitative and qualitative processes occurred concurrently and were prioritized equally (Creswell & Plano-Clark, 2011). For the quantitative data, an exploratory, descriptive design was used to explore the readi- ness of pre-licensure health professions students to participate in an in- terprofessional simulation, examine if readiness to learn changed after the simulation experience, and evaluate the effectiveness of the simula- tion experience as a teaching modality. Qualitative data were collected and analyzed using a descriptive phenomenological approach. The focus of the analysis was on describ- ing the meaning of the experience from the perspective of the health professionsstudents (Giorgi, 2009). Phenomenology provided a mech- anism to examine the howand whatof the individual study partic- ipantsexperiences of participating in an interprofessional simulation scenario ( Creswell, 2007 ). Quantitative and qualitative ndings were merged to address the mixed-methods question.

Setting and Sample

The setting for the research was the simulation laboratory in a col- lege of health professions located in the Southeastern United States. A non-probability, convenience purposive sampling method was used to recruit an interprofessional sample (N = 53) of pre-licensure health professions students. All participants met the following inclusion/exclu- sion criteria: (1) enrolled in a health professions program of study;

(2)

having the ability to comprehend, read, and write in English;

(3)

and being greater than 18 years of age. Students were excluded

from participation if they had previously participated in an

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K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348353

interprofessional student learning simulation or multidisciplinary role play scenario.

Data Collection Quantitative Strand

All participants completed a demographic data form and two quan- titative self-report instruments: the revised Readiness for Interprofes- sional Learning Scale [RIPLS, ( McFadyen et al., 2005)], and the Health Professional Collaboration Scale [HPCS, (Reese et al, 2010)].

Readiness for Interprofessional Learning Scale

The revised RIPLS was used to measure readiness for interprofes- sional learning. It consists of 19 items on a ve-point Likert scale re- sponse format yielding four subscales for which reliability data are available (McFadyen et al., 2005). The subscales are teamwork and col- laboration with a Cronbachs alpha value of 0.88, negative professional identity with a Cronbach s alpha value of 0.76, positive professional identity with a Cronbachs alpha value of 0.81, and roles and responsibil- ities with a Cronbach s alpha value of 0.43. Cronbach s alphas for the total RIPLS have been reported as 0.84 and 0.89. For each subscale, higher scores indicate more positive attitudes about interprofessional education (McFadyen et al., 2006).

Health Professional Collaboration Scale

The HPCS measured perceptions of collaboration during the simula- tion experience (Resse et al, 2010). This instrument consists of 12 items with a ve-point Likert scale response format. Internal consistency reli- ability of 0.95 was reported by Reese et al. (2010). The possible range of scores is 1260 with higher scores indicating more positive perceptions of collaboration.

Demographic Form

A demographic form collected data about the age, gender, individual program of enrollment, and semester of enrollment of the study participants.

Interprofessional High-delity Patient Simulation Scenario

The investigator developed a high-delity patient simulation scenar- io translated from a geriatric role play case study already identied as appropriate for interprofessional use for pre-licensure students. The pa- tient simulation scenario and participant assigned roles were reviewed for accuracy and validity with experienced interprofessional committee faculty members from the disciplines of nursing, respiratory therapy, health care administration, and physical therapy. The scenario involved a 68-year-old widow admitted into the hospital setting with complex health care issues to include an acute ankle sprain, high blood pressure, dementia, chronic cough, and osteoporosis. Socio-economic challenges presented in the scenario included living alone in a two-story building on a limited income, social isolation, and a daughter who lived out of town. During the pre-brieng and through the simulation, participants were provided access to a comprehensive medical chart complete with current physical exam, physician order sets specic to each disci- pline, laboratory values, arterial blood gas data, pulmonary function test results, and an ankle x-ray. The simulated patient interacted with the study participants verbally via pre-recorded scripted responses.

Procedures

Prior to the initiation of the study, approval was obtained by the In- stitutional Review Board. Participants were recruited during fall of their rst or second year of study via face-to-face overview of the study dur- ing classroom time, distribution of yers, and via-e-mail. Participants in

each interprofessional group were provided a 10-minute pre-brieng with an introduction to the study to include operational denitions, sce- nario objectives, and their discipline-speci c roles in the scripted sce- nario. Participants were provided a packet containing the pre-brieng materials and numerically coded study instruments in paper/pencil for- mat. All participants completed the demographic data form and RIPLS pre-simulation. The investigator facilitated the 20-minute high-delity patient simulation from a computer control panel located in the simula- tion laboratory. Student roles included a primary and/or secondary nurse, a respiratory therapist, health care administrator, and physical therapist. Fifteen simulations with interprofessional student groups were conducted. The investigator attempted to have two participants from nursing and one participant each from respiratory therapy, physi- cal therapy, and health care administration for each simulation group experience. However, because of scheduling conicts, it was not possi- ble to have the targeted interprofessional representation in all groups. All 15 groups included representation from nursing, and a total of 4 groups had representation from all disciplines. The post-simulation RIPLS and HPCS were administered upon completion of the simulation scenario.

Data Collection Qualitative Strand

Data collection for the qualitative strand occurred within the context of a 30-minute debrie ng session for each of the simulation groups. Focus group interviewing was conducted during each group debrieng to obtain data about participantsperceptions of the interprofessional profession education high- delity simulation. Focus group data were collected using methods recommended by Creswell and Plano-Clark (2011) . The focus group format permitted data to be collected from multiple interprofessional viewpoints in an ef cient amount of time (Polit & Beck, 2012). The focus group interviews were audio taped and transcribed verbatim.

Results

Table 1 summarizes the demographic characteristics of the sample. Approximately 50% of the sample was nursing students with similar percentages of respiratory therapy, health administration, and physical therapy students. Prior to analysis, data were examined for missing values. Minimal missing data were noted. Nominal and ordinal data were examined with frequencies and percentages. Interval/ratio data were examined

Table 1 Sample demographic characteristics (N = 53).

Characteristic

n

%

Age in years

 

18

27

32

60.4

28

37

12

22.6

38

47

05

09.5

48

57

04

07.5

Gender Female Male Program of enrollment Nursing RT HA PT Semester of Enrollment 1st semester junior 2nd semester junior 1st semester senior Fall 1st year semester Fall 2nd year semester Missing

45

84.9

08

15.1

25

47.2

10

18.9

10

18.9

8

15.0

20

37.7

14

26.4

11

20.8

04

07.5

03

05.7

01

01.9

Note: RT = respiratory therapy, HA = health administration, PT = physical therapy.

K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348353

351

with measures of central tendency, and normality assessment was con- ducted. Subscale scores for the RIPLS demonstrated non-normal distri- butions. Consequently, non-parametric statistical analyses were conducted to address the quantitative study questions. Internal consis- tency reliability of each study instrument was examined using Cronbach s alpha. Cronbach s alpha was acceptable for all RIPLS sub- scales except roles and responsibilities, which had low reliability for both pre-simulation and post-simulation. To address the rst quantitative research question, a Wilcoxon signed rank test was used to examine change over time in the RIPLS from prior to and post the simulation scenario experience. Table 2 pro- vides descriptive statistics demonstrating change in perceptions of readiness for interprofessional learning pre- and post-simulation. Pre- licensure health professions students reported signi cantly more positive attitudes about readiness for interprofessional learning post-simulation in the areas of team work and collaboration (Z = 3.7,

p b .001), negative professional identity (Z = 3.4, p = .001), and posi-

tive professional identity (Z = 4.4, p b .001). Readiness for professional learning in the area of roles and responsibilities (Z = .008, p = .99)

was unchanged. To address the second quantitative research question, a Kruskal Wallis test, the non-parametric equivalent of a one-way ANOVA, was used to test for differences among the four different pre-licensure health professions groups on the post-simulation RIPLS and HPCS scores. Table 3 summarizes these comparisons. The health professions student groups demonstrated statistically signi cant differences in the RIPLS subscale of negative professional identity and health professional col- laboration. Post hoc analysis with Mann Whitney U revealed pre- licensure nursing and health administration groups reported signi - cantly more positive attitudes about readiness for interprofessional education and greater health collaboration during simulation than physical therapy students. The respiratory therapy groups were not sig- nicantly different from any other health profession groups. The qualitative research question about perceptions of the interpro- fessional simulation experience was addressed with the focus interview data. Data were analyzed using a three-step phenomenological process of naive reading, structural analysis, and interpretations ( Creswell, 2013 ). Verbatim transcriptions of the qualitative data were collected via audiotape. Data were organized by student study groups, and codes were developed. Subsequent exploration of the transcripts and identied codes led to the discovery of meaningful patterns related to the true essence of the phenomena ( Creswell, 2013 ). Analysis of the qualitative data concluded with interpretations expressed in three themes: exposure to experiential learning,” “acquisition of interaction-

al relationships,and presence of chronology in role preparation.Each

of the themes will be discussed individually.

Exposure to Experiential Learning

Within the focus groups, students emphasized how simulation of- fered a safe environment where students could interact with students from other disciplines in a short period of time. Specically, a PT student spoke of how I liked the concept of simulation to get people familiar with what everybody does. A nursing student verbalized how

simulation allowed for “…a bunch of pieces of little puzzles coming to- getherand a RT student commented “…exciting, being the rst time being around the patient just interacting …” during the simulation. Most students were positive about the simulator providing feedback and realistic, real-time interaction. However, not all health professions had the same perception. This was particularly true of PT students who viewed their interactions with patients and other health profes- sions as occurring more one-on-one. One PT student remarked, a PT

it

might have one other person in the room with them at the time

wouldnt be ve people in the room trying to assess.Student percep- tions were consistent with current literature promoting simulation as

a means to enhance student learning in a safe and realistic educational environment ( Roche et al., 2012; Seybert et al., 2012 ; Wo gram & Quinn, 2012).

Acquisition of Interactional Relationships

Participants wanted to acquire interactional relationships through communication and appreciation of other disciplines. The IPE simula- tion helped them gain the communication skills that we would need to develop. One student stated, I think the point is learning how to communicate with one another and we just kind of winged it.Students consistently expressed the desire to learn to communicate effectively during a patient care situation and on an interprofessional basis. The scenario made one cognizant of the fact that they did not share a com- mon language. A health administration student expressed how it was like talking Greek to me. I was just hearing Greek. These comments reected the absence in universality of vocabulary among professions. One student stated how he/she wanted to see what the different pro-

fessions do

being to being. Another nursing student remarked,

it's good in nursing to get to know all the people in the different roles what they do and to form relationships.Students recognized that in- terprofessional interactions were often rare in the educational setting, with one student stating, you dont interact exactly one-on-one with each other before youre actually in a clinical setting.

Presence of Chronology in Role Preparation

The third qualitative theme focused on studentsperceptions of role preparation and how this preparation evolved over time on an individ- ual basis as each student progressed within their program of study. A nursing student reported how pulling information from past semesters

helped during the simulation experience. A respiratory therapy student reported how it was my rst year and everything and they're seniorsto communicate feeling unprepared to enter into the learning opportu- nity with students who had progressed farther in their program of study. A nursing student expressed how the simulation scared me in

a way because

I really dont know how other professions work and

how I am supposed to work togetherprior to even knowing all aspects of the nurses role. I m a brand new baby somethingand it was my year and everything and they re seniors were used to communicate feeling unprepared to enter into the learning opportunity based on pro- gression of their program of study and learning role boundaries.

Table 2 Pre-simulation to post-simulation change in readiness for interprofessional learning subscales (N = 53).

 

Pre-simulation

 

Post-simulation

 

M (SD)

Median

M (SD)

Median

RIPLS Teamwork and collaboration Negative professional identity Positive professional identity Roles and responsibilities

41.4

(3.4)

42.00

42.8

(2.8)

44.00

⁎⁎

13.5

(1.8)

15.00

14.2

(1.2)

15.00

⁎⁎

18.1

(1.8)

19.00

19.2

(1.3)

20.00

⁎⁎

11.4

(2.0)

11.00

11.4

(2.1)

12.00

Note. RIPLS = Readiness for Interprofessional Learning Scale. ⁎⁎ Statistically signicant change from pre-simulation to post-simulation using Wilcoxin signed rank test.

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K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348353

Table 3 Comparisons of health professions groups on readiness to learn and collaboration following a high-delity patient simulation.

 

Nursing (N = 25)

Respiratory therapy ( N = 10)

Health administration ( N = 10)

Physical therapy (N = 8)

Test

statistic

Variable

Mean rank

Mean rank

Mean rank

Mean rank

X 2

p value

RIPLS subscales Teamwork and cooperation Negative professional identity Positive professional identity Roles and responsibilities HPCS

28.22

29.20

29.60

17.19

4.28

0.23

30.18

a

29.45

28.60

a

12.00

b

11.60

0.01

27.82

26.75

32.30

18.13

5.32

0.15

28.98

24.85

22.00

29.75

1.97

0.58

29.62

a

21.79

29.55

a

10.81

b

11.42

0.01

Note. RIPLS = Readiness for Interprofessional Learning Scale; HPCS = Health Professional Collaboration Scale. Mean ranks with differing superscripts signicantly differed at p b .05.

The mixed-methods question focused on convergence of the quanti- tative and qualitative ndings. Quantitative and qualitative data were examined and similarities and differences were identied (Creswell & Plano-Clark, 2011). The signicant increase in readiness for interprofes- sional learning observed in the quantitative data was supported by the qualitative themes revealing students' views that the experience pro- vided a realistic environment for communicating and collaborating with students from other professions. The quantitative data also re- vealed that physical therapy students had less positive attitudes about interprofessional learning than nursing and health administration stu- dents. The qualitative provided insight into this nding as physical ther- apy students expressed that the scenario was not necessarily consistent with physical therapy practice which they perceived to occur one-on- one with patients and other health care professionals.

Discussion

The purpose of this study was to explore pre-licensure health profes- sions students' readiness for interprofessional learning and perceptions of health collaboration when participating in a high-delity human pa- tient simulation. Findings demonstrated that students had more posi- tive attitudes about interprofessional learning following simulation. Findings from this research study suggest how pre-licensure students are ready to engage in interprofessional education through exposure to an experiential format such as high-delity human patient simula- tion. They experienced interactions which can enhance communication, an appreciation for other disciplines, and the ability to contribute to the whole when providing care in practice. These ndings are consistent with prior studies where use of a standardized patient facilitated com- munication skills and promoted teamwork ( Barnett et al., 2011 ) and collaborative relationships between academia and hospital institutions ( Waxman et al., 2011 ). The importance of effective communication strategies during interprofessional collaboration ( Berg et al., 2010 ) was also supported by the qualitative data. When examining the revised RIPLS pre-simulation and post- simulation data results, there was not a signicant change in the sub- scale for roles and responsibilities. This was likely related to the low in- ternal consistency reliability of the subscale. Roles and responsibilities vary for the different health professions and the low Cronbachs alphas indicate items within this subscale were not homogenous. Findings from the HPCS around how the different health professions viewed each other with respect to interprofessional collaboration need closer examination. Findings indicated that perceptions of collaboration were different among the student groups with pre-licensure nursing and health administration students reporting greater collaboration than physical therapy students. Likewise, ndings from the RIPLS post-simulation revealed how the different health professions viewed each other in relation to negative professional identity whereby nursing and health administration students reported less negative attitudes toward learning with other health care profes- sionals than physical therapy students. While the simulation scenar- io was translated from an existing role play scenario currently

utilized for interprofessional education, the scenario might not have translated accurately for use with a high-delity human patient simulator to meet the educational needs of a physical therapy stu- dent. The negative professional identity subscale of the RIPLS con- tains questions such as I don t want to waste my time learning with other health care students and It is not necessary for under- graduate health care students to learn together ( McFadyen et al., 2005 , p.1). Physical therapy students in this study appeared to view group interactions as not consistent with current physical ther- apy practice. Bridges and colleagues reported how pre-licensure stu- dents need to understand their own professional identity while gaining an understanding of other professional's roles on the health care team ( Bridges et al., 2011 , p. 1). These physical therapy stu- dents may already have had a strong sense or knowledge of both col- laboration and professional identity which would not have changed after participating in the simulated learning experience. This aligns with ndings from Ateah et al. (2011) where physical therapy stu- dents were identi ed as having the traits of interpersonal skills and con dence as a profession prior to and post an interprofessional im- mersion experience. The logistics for implementing this study were challenging. Despite being a part of the same college of health professions and administrative support from college administration, it was difcult to schedule simula- tion sessions when all health professions could attend. Differences in class schedules and clinical rotations limited the times when health pro- fessions could be together. The study was conducted in one site by a sole investigator; consequently, ndings should be generalized with caution to other colleges of health professions. Since the predominant health professions group represented in the simulation groups were pre- licensure nursing students, it remains unclear how ndings would have differed if a greater proportion of other health professions students had been represented. The low reliability of the roles and responsibili- ties subscale of the revised RIPLS is problematic, and in future research, the items may need to be analyzed separately.

Conclusion

Findings from this research study support pre-licensure students are ready to engage in interprofessional education through exposure to an experiential format such as high- delity human patient simulation. They perceived the interprofessional interactions during the simula- tion-enhanced interprofessional communication, increased their appreciation for other disciplines, and delineated their discipline's con- tribution to the whole when providing care in practice. As pre-licensure students transition to professional practice, the ability to successfully collaborate with other disciplines will be key to assuring quality patient outcomes. A high-delity patient simulation was the conduit for the oc- currence of interactional relationships among study participants. Identi- fying the existence of readiness to learn in an interprofessional manner starts dialogue on how to best prepare students for engaging in an inter- professional learning experience with high-delity patient simulation as a teaching modality which can in turn impact entry into practice.

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Acknowledgements

Dr. Tanya Sudia Associate Dean for Research and Scholarship Interim Graduate Program Director and Professor Louise Herrington School of Nursing of Baylor University Dr. Lisa Broussard Acadian Ambulance Endowed Professor in Nursing Hamilton Medical Center Endowed Professor in Nursing Department Head and Associate to the Dean University of Louisiana at Lafayette College of Nursing and Allied Health Professions

References

American Association of Colleges of Nursing, 2008. The Essentials of Baccalaureate Educa- tion for Professional Nursing Practice. Author, Washington, DC. Ateah, C.A., Snow, W., Wener, P., McDonald, L., Metge, C., Davis, P., Fricke, M., Ludwig, S., Anderson, J., 2011. Stereotyping as a barrier to collaboration: does interprofessional education make a difference? Nurse Educ. Today 31, 208213. http://dx.doi.org/10.

1016/j.nedt.2010.06.004.

Bandali, K.S., Craiz, R., Ziv, A., 2012. Innovations in applied health: evaluating a simulation-enhanced interprofessional curriculum. Med. Teach. 34, e176 e184.

http://dx.doi.org/10.3109/0142159X.2012.642829.

Baneld, V., Fagan, B., Janes, C., 2012. 20092012 Spacelabs innovation project award:

charting a new course in knowledge: creating life-long critical care thinkers. Dynam- ics 23, 2428.

Barnett, G.V., Hollister, L., Hall, S., 2011. Use of the standardized patient to clarify interdis- ciplinary team roles. Clin. Simul. Nurs. 7, e169e173. http://dx.doi.org/10.1016/j.ecns.

2010.01.004.

Berg, B.W., Wong, L., Vincent, D.S., 2010. Technology-enabled interprofessional education for nursing and medical students: a pilot study. J. Interprof. Care 24, 601604. http://

dx.doi.org/10.3109/13561820903373194.

Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V., Tomkowiak, J., 2011. Interprofes- sional collaboration: three best practice models of interprofessional education. Med. Educ. Online 16, 110. http://dx.doi.org/10.3402/meo.v16i0.6035. Creswell, J.W., 2007. Qualitative Inquiry & Research Design: Choosing Among Five Ap- proaches. 2nd ed. Sage Publications, Inc., Thousand Oaks, CA. Creswell, J.W., 2013. Qualitative Inquiry & Research Design: Choosing Among Five Ap- proaches. 3rd ed. Sage Publications, Inc., Thousand Oaks, CA. Creswell, J.W., Plano-Clark, V.L., 2011. Designing and Conduction Mixed Methods Re- search. 2nd ed. Sage, Los Angeles, CA. Frank, J., Chen, L.C., 2010. Health Professionals for a New Century: Transforming Educa- tion to Strengthen Health Systems in the Interdependent World. Harvard University Press, Cambridge, MA http://dx.doi.org/10.1016/S0140-6736(10)61854-5 (Retrieved from www.thelancet.com). Giorgi, A., 2009. The Descriptive Phenomenological Method in Psychology: A Modied Husserlian Approach. Duquesne University Press, Pittsburgh, PA. Gore, T., Schuessler, J.B., 2013. Simulation policy development: lessons learned. Clin. Simul. Nurs. 9, e319e322. http://dx.doi.org/10.1016/jecns.2012.04.005. Gore, T., Van Gele, P., Ravert, P., Mabire, C., 2012. A 2010 survey of the INACSL member- ship about simulation use. Clin. Simul. Nurs. 8, e125 e133. http://dx.doi.org/10.

1016/j.ecns.2012.01.002.

Institute for Healthcare Improvement, 2012. What is open school? Retrieved from http:// www.ihi.org/offerings/IHIOpenSchool/overview/Pages/default.aspx Institute of Medicine, 2010. A Summary of the February 2010 Forum on the Future of Nursing: Education. National Academies Press, Washington, D.C. (Retrieved from

http://www.iom.edu/Reports/2010).

Interprofessional Education Collaborative Expert Panel, 2011. Core Competencies for In- terprofessional Collaborative Practice: Report of an Expert Panel. Interprofessional Education Collaborative, Washington, D.C.

Jeffries, P.R. (Ed.), 2007. Simulation in Nursing Education: From Conceptualization to Evaluation. National League for Nursing, New York, NY. King, S., Greidanus, E., Major, R., Loverso, T., Kowles, A., Carbonaro., M., & Bahry, L., 2012. A corss-institutional examination of readiness for interprofessional learning. J. Interprof. Care 26, 108114. http://dx.doi.org/10.3109/13561820.2011.640758. Kolb, D.A., 1984. Experiential Learning: Experience as the Sources of Learning and Devel- opment. Prentice Hall, Upper Saddle River, N.J. Lamb, G., Shraiky, J., 2013. Designing for competence: spaces that enhance collaboration readiness in healthcare. J. Interprof. Care 27 (52), 1423. http://dx.doi.org/10.3109/

13561820.2013.791671.

McFadyen, A.K., Webster, V., Strachan, K., Figgins, E., Brown, H., McKechnie, J., 2005. The readiness for interprofessional learning scale: a possible more stable sub-scale model for the original version of RIPLS. J. Interprof. Care 19, 595603. http://dx.doi.

org/10.1080/13561820500430157.

McFadyen, A.K., Webster, V.S., Maclaren, W.M., 2006. The test-retest reliability of a revised version of the Readiness for Interprofessional Learning Scale (RIPLS). J. Interprof. Care 20, 633639. http://dx.doi.org/10.1080/13561820600991181. McLaughlin, M.P., 2010. Medical simulation in the community college health science cur- riculum: a matrix for future implementation. Community Coll. J. Res. Pract. 34, 462476. http://dx.doi.org/10.1080/1068920903235811. Norman, J., 2012. Systematic review of the literature on simulation in nursing education. Assoc. Black Nurs. Fac. J. 24-28 (Retrieved from http://www.ncbi.nlm.nih.gov/

pubmed/22774355).

Patel, E., Nutt, S.L., Qureshi, I., Lister, S., Panesar, S.S., Carson-Stevens, A., 2012. Leading change in health-care quality with the institute for healthcare improvement open

school. Br. J. Hosp. Med. 73, 397400. Polit, D.F., Beck, C.T., 2012. Nursing Research: Generating and Assessing Evidence for Nursing Practice. 9th ed. Lippincott, Williams, & Wilkins, Philadelphia, PA. Poore, J.A., Cullen, D.L., Schaar, G.L., 2014. Simulation-based interprofessional education guided by Kolb s experiential learning theory. Clin. Simul. Nurs. 10, e241 e247.

http://dx.doi.org/10.1016/j.ecns.2014.01.004.

Reese, C.E., Jeffries, P.R., Engum, S.A., 2010. Learning together: using simulations to devel- op nursing and medical student collaboration. Nurs. Educ. Perspect. 31, 3337. Roche, J., Schoen, D., Kruzel, A., 2012. Human patient simulation versus written case stud- ies for new graduate nurses in nursing orientation: a pilot study. Clin. Simul. Nurs. X, e1e7. http://dx.doi.org/10.1016/j.ecns.2012.01.004. Seybert, A.L., Smithburger, P.L., Kobulinsky, L.R., Kane-Gill, S.L., 2012. Simulation-based learning versus problem-based learning in an acute care pharmacotherapy course. Simul. Healthc. 7, 162165. http://dx.doi.org/10.1097/SIH.0b013e31825159e3. Smith, K.V., Witt, J., Klaassen, J., Zimmerman, C., Chen, A., 2012. High-delity simulation and legal/ethical concepts: a transformational experience. Nurs. Ethics 19, 390398.

http://dx.doi.org/10.1177/0969733011423559.

Stein-Parbury, & Liaschenko, J., 2007. Understanding collaboration between nurses and physicians as knowledge at work. Am. J. Crit. Care 16, 470 477 Retrieved from www.aacn.org. Thibault, G.E., 2011. Interprofessional education: an essential strategy to accomplish the future of nursing goals. J. Nurs. Educ. 60, 313 317. http://dx.doi.org/10.3928/

01484834-20110519-03.

Titzer, J.L., Swenty, C.F., Hoehn, W.G., 2011. An interprofessional simulation promoting collaboration and problem solving among nursing and allied health professional stu- dents. Clinical Simulation in Nursing X, e1e9. http://dx.doi.org/10.1016/j.ecns.2011. 01.001 (March). Waxman, K.T., Nichols, A.A., OLeary-Kelley, C., Miller, M., 2011. The evolution of a state- wide network: the bay area simulation collaborative. Simul. Healthc. 6 (6), 345351. http://dx.doi.org/10.1097/SIH0b013e31822eaccc. Wellard, S.J., Heggen, K.M., 2010. Are laboratories useful ction? : a comparison of Norwe- gian and Australian undergraduate nursing skills laboratories. Nurs. Health Sci. 12, 3944. http://dx.doi.org/10.1111/j.1442-2018.2009.00481.x. Wolfgram, L.J.B., Quinn, A.O., 2012. Integrating simulation innovatively: evidence in teaching in nursing education. Clin. Simul. Nurs. 8, e169e175. http://dx.doi.org/10.

1016/j.ecns.2010.09.002.

Yanhua, C., Watson, R., 2011. A review of clinical competence assessment in nursing. Nurse Educ. Today 31, 832836. http://dx.doi.org/10.1016/j.nedt.2011.05.003.