Interprofessional education: merging nursing, midwifery and CAM Maggie Netherwood and Ruth Derham
Key words: Interprofessional education ■ Complementary and alternative medicine ■ Nursing ■ Midwifery
S
ince the NHS Plan (Department of Health, 2000) outlined the need for greater interprofessional working in the UK, research into interprofessional education (IPE) has happened apace. The success of IPE led Barr (2000: 19) to conclude that: ‘IPE enhances personal and professional confidence, promotes mutual understanding between professions, facilitates intra- and interprofessional communication and encourages reflective practice’. IPE is regarded as the educational ingredient most likely to bring about a more holistic healthcare service (Frenk et al, 2010; Derbyshire and Machin, 2011). To date, policy and research have focused solely on IPE within conventional health care. Complementary and alternative medicine (CAM) is ‘health-related therapies and Maggie Netherwood, Senior Lecturer, Health and Life Sciences, Oxford Brookes University; Ruth Derham, Licensed Homeopath, Purton, Wiltshire Accepted for publication: June 2014
740
Study aim To ascertain the value of bringing together undergraduate students from nursing, midwifery and CAM to determine what they could learn from each other.
Method Although the study used a mixed-methods approach, this paper uses the collected qualitative data that addressed the following question: ■■ What can undergraduate students of conventional and CAM healthcare learn from each other through IPE?
© 2014 MA Healthcare Ltd
Abstract
Aim: To ascertain the value of bringing together undergraduate students from nursing, midwifery, and complementary and alternative medicine (CAM) to determine what they could learn from each other. Background: Interprofessional education (IPE) is a growing field promoting interaction between professional groups, collaborative working and quality of health. In conventional health, IPE has a role to play in undergraduate education. No studies have been undertaken to investigate the integration of CAM students and conventional undergraduate healthcare students. Method: In a mixed-method study, in 2010, a sample of third-year students enrolled on adult nursing, midwifery, homeopathy and complementary therapies degree courses took part in two workshops and a focus-group discussion. Findings: Six themes were identified from qualitative data analysis: interaction; breaking down prejudices; knowledge of self; knowledge of others; common aims; and organisational limitations. Conclusion: The common aim of patient-centred care allowed students to recognise the benefits of a more integrated health system.
disciplines that are not considered to be part of mainstream medical or nursing care’ (Buchan et al, 2012: 672). At no point has there been any suggestion that CAM practitioners should be aware of the role of nurses and midwives or vice versa—despite the fact that there are particular areas, such as palliative care, where CAM and conventional professionals work alongside each other (NHS Careers, 2010). With a growing number of people choosing to use CAM in the UK and globally (Van der Riet et al, 2011; Buchan et al, 2012), it is arguable that all the reasons for promoting interprofessional working in the conventional realm will ultimately apply to CAM. Thomas and Coleman (2004) reported that 10% of the UK population have used CAM in any one year and 18% after recommendation by a health professional. Buchan et al (2012) found that 80% of nurses (n=531) used CAM and 71% would find education about CAM useful when talking to patients. Other surveys found that although 83% of primary care workers reported referring patients to CAM (Van Haselen et al, 2004), more than half of patients still chose not to disclose the fact that they use CAM to their GP (Thomas and Coleman 2004), mostly due to perceived disapproval (Robinson and McGrail, 2004). The potential breakdown in continuity of care that this non-disclosure engenders is what led Shaw et al (2008: 163) to call for a greater ‘atmosphere of openness and trust’. Studies involving post-qualifying interprofessional working found that increased knowledge and understanding of each other’s practices has led to greater mutual respect, increased referral rates (Smith et al, 2004) and has prevented the patient having to play the role of mediator between professionals (Soklaridis et al, 2009). However, Laurenson et al (2006) identified a lack of knowledge about CAM within pre-registration nursing students and recommended integration of CAM education into curricula. As there is limited research in this particular area, this study explored the role of undergraduate IPE with CAM and conventional students.
British Journal of Nursing, 2014, Vol 23, No 13
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RESEARCH During 2010, third-year students enrolled on adult nursing, midwifery, homeopathy and complementary therapies degree courses within a university were invited to participate in two workshops and a focus group discussion. Adult nursing and midwifery students were considered conventional healthcare students, and homeopathy and complementary therapy students comprised the CAM students. The demography of students attending the workshops is shown in Table 1. The second workshop was attended by the same students, apart from an additional midwife and absences by two homeopaths and one complementary therapist. The first workshop gave the opportunity to question each other’s roles as well as the usefulness of interprofessional collaboration and potential barriers to working together. In the second workshop, students used a case example to discuss treatment options for a patient and to interact within their professional roles. In the first phase of this study, students completed a questionnaire before and after the workshops to ascertain attitudes towards their individual and other professional groups, and their readiness to embrace IPE. Descriptive statistical analysis of the questionnaire results, along with comments from student evaluations, were used as a basis for a semi-structured focus group interview. The demography of students attending the focus group is shown in Table 2.
Students attending
Nurses
Midwives
Homeopaths
Complementary therapists
Workshop 1
4
1
5
1
Workshop 2
4
2
3
0
Table 2. Demography of students attending the focus group interview Students attending
Nurses
Midwives
Homeopaths
Complementary therapists
Focus group
2
2
3
0
gained greater knowledge and understanding of each other through interaction. Closer inspection of the students’ responses confirmed that everything the students either felt or demonstrated they had learnt had happened as a direct result of interaction, which enabled them to overcome doubts about whether or not they could learn from each other: ‘At first I was feeling that different professions cannot work together successfully, but once we started interchanging information … it became so enjoyable and so comfortable.’ (Homeopath 4) Interaction increased the students’ belief that IPE is an effective way of learning to work together.
Ethical considerations
Breaking down prejudices
Ethical approval was obtained from the university. Consent forms were issued to all potential participants, along with information forms and an assurance of anonymity.
Students identified lack of knowledge as a basis for assumptions and that stereotypical views of others came from a range of sources, including the media, interaction with people within their profession, and personal acquaintances. They considered personal experiences to be the most significant influence on stereotyping, and that these experiences influence professional decision-making. Part of the reason that the students suggested that IPE be introduced into the curricula of all health students from their first year was to help counteract negative stereotyping/preconceptions:
Data analysis The focus group discussions were recorded and transcribed. Thematic analysis of the data was done in accordance with the principles of inductive analysis outlined by Braun and Clarke (2006). This uses a six-stage process that involves familiarisation with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.
Results The thematic analysis identified six themes: interaction; breaking down prejudices; increased knowledge and understanding of others; increased knowledge and understanding of self; common aims; and organisational limitations. The following discussion of these themes reflects the group’s opinion that interaction through IPE helps break down prejudices through greater knowledge and understanding of self and others, allowing them to perceive common aims and similarities of purpose that unite them. That core belief is set within the perceived limitation imposed by institutional policies and logistical barriers to incorporating IPE into current curricula. © 2014 MA Healthcare Ltd
Table 1. Demography of students attending the IPE workshops
Interprofessional interaction Students identified that their perceptions of the other professions were more positive after the workshops. When questioned, the majority of students stated that they had
British Journal of Nursing, 2014, Vol 23, No 13
‘Sometimes we stereotype roles and actually finding out that what the other person does is quite different from what you perceived them to do.’ (Midwife 1) One interesting insight that emerged was that prejudices not only affect an individual’s view of that profession, but also how they expect that profession to view them: ‘They are not going to be receptive [to] this because they work in that way.’ (Homeopath 2) Where long-standing prejudices run deep, however, the challenge seems greater. For example, between nurses and midwives: ‘I think that a lot of the issues between nurses and midwives need to be trashed out at the beginning of the course, not even at the end. I really do.’ (Midwife 2) More sensitive issues were raised between the nurses and midwives than between any other group.
741
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Increased knowledge and understanding of each other was the most frequent response to the question about what had been learnt. For the student nurses and midwives, it had been important to learn about the growing evidence for CAM and the rigour of education provided by the degree programmes: ‘Knowing that [homeopathy] a degree level course and people are studying about it in detail … I would be more confident to recommend it to my patients.’ (Nurse 4) Prior to this, there was a certain amount of anxiety about coming across a patient who was using CAM.
Increased knowledge and understanding: self Less discussed within the literature is the potential for students to learn more about their own profession through interaction with others. Here, the lessons learned took various forms. In one case it was comparison of their own role in the light of new understanding about the role of others: ‘Getting to know what other people do, then you get to know that, oh my god, we are working a lot harder than them!’ (Nurse 2) And in another case, it was a reflection on their role and that of their profession in the light of interprofessional working: ‘As much as I would want to be autonomous and assertive … actually, when you look at it, there are so many restrictions and guidelines that you can’t always do what you want.’ (Midwife 2)
Common aims The increased knowledge and understanding of their own and others’ roles led all students to feel united by a common aim, despite the differences in their approach to health care: ‘It became very clear very quickly that we all have something we can interact with and use to help the people we are committed to.’ (Midwife 2) ‘We are all working towards the same aim, we all care about the health of people, and so we are likeminded already.’ (Homeopath 1) This sense of unity was the key that allowed the students to form new interprofessional groups, embark on casework together, and reflects a desire to work together, motivated by a patient-centred vision.
Organisational limitations There was, however, one outcome that has come through strongly: namely, the nature of organisational limitations to interprofessional working. ‘If you had these case studies and the opportunities to have similar groups with a couple of people from nursing and a couple of people from homeopathy … but the logistics of it, I don’t know how it would ever work…’ (Midwife 2)
742
In addition to acknowledging some of the logistical barriers for taking IPE into university curricula, the students acknowledged that the emphasis on a medical orthodoxy and a free healthcare system with limited CAM options would be a huge barrier to working together: ‘[The medical profession] is driven by the pharmaceutical companies who don’t want homeopathy or complementary therapies to be too up and coming.’ (Homeopath 2)
Discussion This study aimed to ascertain the value of bringing together undergraduate students from conventional and CAM degree courses. The design of the research did not allow for generalisations about the usefulness of IPE to other undergraduate students. But it did allow conclusions to be drawn as to the usefulness of IPE to these students and gives the reader the option of applying this to other groups (Lincoln and Guba, 2000). Interaction was identified as key to success in breaking down prejudices and developing common aims. The question of whether IPE can make a difference to prejudices is still debated within the literature. But with conventional and CAM students, the findings of this research suggest that it can. One reason may be that prejudices between the CAM and conventional professionals represented here are actually less deep-rooted than might be perceived. However, the mutual stereotyping between nurses and midwives seemed more embedded and challenging. Social identity theory (Tajfel and Turner, 1986) states that individuals identify with their own group and actually behave according to the stereotypical views that other groups apply to them when they come into contact. In this case, the midwife assumed a dominant position in the second workshop as care coordinator for the case-study patient, and the nurses took a more subservient role. Perhaps IPE at undergraduate level can allow potential conflicts and prejudices to emerge and be expressed openly, discussed, witnessed and reflected on (Barr et al, 2005). Previous research (Curran at al, 2010; Laurenson et al, 2012) reported benefits similar to the findings of this study: a greater awareness of a range of approaches to health care; the opportunity to develop collegiality with professionals outside their own field of medicine; increased professional competence from broadening their learning beyond their own field of medicine; and increased confidence in communicating with a range of health professionals. This study also confirms previous findings that IPE is achievable and desirable with undergraduate students without having a detrimental effect on their professional identity (Goelen et al, 2006). The difference here is that previous studies involved students from only a conventional healthcare background. Though only likely to work together in particular areas of health, the students could appreciate benefits specific to interaction between CAM and conventional disciplines. Like Laurenson et al (2006) and Lumague et al (2006), these students identified advantages for patients, such as a greater openness between professionals in different fields of healthcare. This encourages disclosure by patients, allows
© 2014 MA Healthcare Ltd
Increased knowledge and understanding: others
British Journal of Nursing, 2014, Vol 23, No 13
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.113.111.210 on October 27, 2015. For personal use only. No other uses without permission. . All rights reserved.
RESEARCH for greater continuity of care, and more choice for patients through having professionals that are able to discuss a range of healthcare options (Willison, 2008).
Recommendations The authors regard this research as an initial study that shows the value of IPE between CAM and conventional healthcare students. Through encouraging communication and greater understanding of each other’s practices, IPE can enhance the respect that health professionals have for each other (Barr et al, 2005; Derbyshire and Machin, 2011). However, this potential needs to be recognised outside the confines of this individual study. Further studies are needed to confirm the conclusion that, although full integration may be a long way off, mutual respect would go some way in uniting a fragmented health system and thereby improving continuity of patient care—enabling everyone to offer the seamless service to which all aspire. It is unrealistic to suggest academic institutions invest time and energy in integrative IPE as a result of this research alone. However, research is needed with other groups of CAM and conventional students to demonstrate the consistent usefulness of integrated IPE across a broad spectrum of disciplines.
Conclusion Although this was the first study to undertake IPE between CAM and conventional healthcare students, it is still a revelation to find so many common themes with IPE of conventional students alone. This study has found that IPE enables students to gain an increased awareness of each other’s skills and roles as a result of interacting with other professional groups. At undergraduate level, IPE is about the challenging of preconceptions and the changing of attitudes towards other professional groups. This study has shown that there is the potential in IPE to challenge prejudices, both against distinct professions and against diverse approaches to health, thereby engendering a more open-minded approach to health care and a more seamless service for patients. BJN Conflict of interest: none
© 2014 MA Healthcare Ltd
Barr H (2000) Interprofessional Education: 1997–2000. A Review. UK Central Council of Nursing, Midwifery and Health Visiting, London Barr H, Freeth D, Hammick M, Koppel I, Reeves S (2005) The Evidence Base and Recommendations for Interprofessional Education in Health and Social Care. http:// www.swap.ac.uk/docs/barr_05.pdf (accessed 27 June 2014) Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2): 77–101 Buchan S, Shakeel M, Trinidade A, Buchan D, Ah-See K (2012) The use of complementary and alternative medicine by nurses. Br J Nurs 21(11): 672–4, 676 Curran V, Sharpe D, Flynn K, Button P (2010) A longitudinal study of the effect of an interprofessional education curriculum on student satisfaction and attitudes towards interprofessional teamwork and education. J Interprof Care 24(1): 41–52. doi: 10.3109/13561820903011927. Department of Health (2000) The NHS Plan. DH, London.
KEY POINTS n Research
has identified a range of benefits from interprofessional education (IPE) for nurses and other health professionals but no studies have investigated the benefits of IPE with groups of undergraduate conventional and complementary and alternative medicine (CAM) professionals
n CAM
use is increasing although patients may not tell health professionals about their use of CAM and this can lead to fragmented care
n This
study found that IPE with student nurses, midwives, homeopaths and complementary therapy students led to greater interaction, knowledge and challenging of prejudices between professional groups
n Inter-professional
education resulted in openness to a more holistic approach to health, which allows for greater continuity of care and increased choice for patients
Derbyshire J, Machin A (2011) Learning to work collaboratively: nurses’ views of their pre-registration interprofessional education and its impact on practice. Nurse Educ Pract 11(4): 239–44 Frenk J, Chen L, Bhutta Z, et al (2010) Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 376(9756): 1923–2010 Goelen G, De Clercq G, Huyghens L, Kerckhofs E (2006) Measuring the effect of interprofessional problem-based learning on the attitudes of undergraduate health care students. Med Educ 40(6): 555–61 Laurenson M, MacDonald J, McCready T, Stimpson A (2006) Student nurses’ knowledge and attitudes toward CAM therapies. Br J Nurs 15(11): 612–15 Laurenson M, Heath T, Gribbin S (2012) Intervention in health care teams and working relationships. J Healthc Leadersh 4: 117–26 Lincoln Y, Guba E (2000) The only generalisation is: there is no generalisation. In: Gomm R, Hammersley M, Foster P, eds. Case Study Method. Sage Publications, London Lumague M, Morgan A, Mak D, et al (2006) Interprofessional education: the student perspective. J Interprof Care 20(3): 246–53 NHS Careers (2010) NHS careers in details: wider healthcare team: complementary and alternative medicine (CAM). http://tinyurl.com/ovkuwpg (27 June 2014) Robinson A, McGrail M (2004) Disclosure of CAM use to medical practitioners: a review of qualititative and quantitative studies. Complement Ther Med 12(2–3): 90–8 Shaw A, Noble A, Salisbury C, Sharp D, Thompson E, Peters T (2008) Predictors of complementary therapy use among asthma patients: results of a primary care survey. Health Soc Care Community 16(2): 155–64. doi: 10.1111/j.13652524.2007.00738.x. Smith M, Green B, Haas M, Liao J (2004) First report on a US project analyzing chiropractic and medical interprofessional relationships. J Interprof Care 18(3): 320–1 Soklaridis S, Kelner M, Love R, Cassidy J (2009) Integrative health care in a hospital setting: communication patterns between CAM and biomedical practitioners. J Interprof Care 23(6): 655–67 Tajfel H, Turner J (1986) The social identity theory of inter-group behaviour. In: Worchel S, Austin L, eds. Psychology of Intergroup Relations. Nelson-Hall, Chicago Thomas K, Coleman P (2004) Use of complementary or alternative medicine in a general population in Great Britain: results from the national omnibus survey. J Public Health (Oxf) 26(2): 152–7 Van der Riet P, Francis L, Levett-Jones T (2011) Complementary therapies in healthcare: Design, implementation and evaluation of an elective course for undergraduate students. Nurse Educ Pract 11(2): 146–52. doi: 10.1016/j. nepr.2010.10.002. Van Haselen R, Reiber U, Nickel I, Jakob A, Fisher P (2004) Providing complementary and alternative medicine in primary care: the primary care workers’ perspective. Complement Ther Med 12(1): 6–16 Willison K (2008) Advancing integrative medicine through interprofessional education. Health Sociol Rev 17(4): 342–52
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Key words: Interprofessional education ■ Complementary and alternative medicine ■ Nursing ■ Midwifery
S
ince the NHS Plan (Department of Health, 2000) outlined the need for greater interprofessional working in the UK, research into interprofessional education (IPE) has happened apace. The success of IPE led Barr (2000: 19) to conclude that: ‘IPE enhances personal and professional confidence, promotes mutual understanding between professions, facilitates intra- and interprofessional communication and encourages reflective practice’. IPE is regarded as the educational ingredient most likely to bring about a more holistic healthcare service (Frenk et al, 2010; Derbyshire and Machin, 2011). To date, policy and research have focused solely on IPE within conventional health care. Complementary and alternative medicine (CAM) is ‘health-related therapies and Maggie Netherwood, Senior Lecturer, Health and Life Sciences, Oxford Brookes University; Ruth Derham, Licensed Homeopath, Purton, Wiltshire Accepted for publication: June 2014
740
Study aim To ascertain the value of bringing together undergraduate students from nursing, midwifery and CAM to determine what they could learn from each other.
Method Although the study used a mixed-methods approach, this paper uses the collected qualitative data that addressed the following question: ■■ What can undergraduate students of conventional and CAM healthcare learn from each other through IPE?
© 2014 MA Healthcare Ltd
Abstract
Aim: To ascertain the value of bringing together undergraduate students from nursing, midwifery, and complementary and alternative medicine (CAM) to determine what they could learn from each other. Background: Interprofessional education (IPE) is a growing field promoting interaction between professional groups, collaborative working and quality of health. In conventional health, IPE has a role to play in undergraduate education. No studies have been undertaken to investigate the integration of CAM students and conventional undergraduate healthcare students. Method: In a mixed-method study, in 2010, a sample of third-year students enrolled on adult nursing, midwifery, homeopathy and complementary therapies degree courses took part in two workshops and a focus-group discussion. Findings: Six themes were identified from qualitative data analysis: interaction; breaking down prejudices; knowledge of self; knowledge of others; common aims; and organisational limitations. Conclusion: The common aim of patient-centred care allowed students to recognise the benefits of a more integrated health system.
disciplines that are not considered to be part of mainstream medical or nursing care’ (Buchan et al, 2012: 672). At no point has there been any suggestion that CAM practitioners should be aware of the role of nurses and midwives or vice versa—despite the fact that there are particular areas, such as palliative care, where CAM and conventional professionals work alongside each other (NHS Careers, 2010). With a growing number of people choosing to use CAM in the UK and globally (Van der Riet et al, 2011; Buchan et al, 2012), it is arguable that all the reasons for promoting interprofessional working in the conventional realm will ultimately apply to CAM. Thomas and Coleman (2004) reported that 10% of the UK population have used CAM in any one year and 18% after recommendation by a health professional. Buchan et al (2012) found that 80% of nurses (n=531) used CAM and 71% would find education about CAM useful when talking to patients. Other surveys found that although 83% of primary care workers reported referring patients to CAM (Van Haselen et al, 2004), more than half of patients still chose not to disclose the fact that they use CAM to their GP (Thomas and Coleman 2004), mostly due to perceived disapproval (Robinson and McGrail, 2004). The potential breakdown in continuity of care that this non-disclosure engenders is what led Shaw et al (2008: 163) to call for a greater ‘atmosphere of openness and trust’. Studies involving post-qualifying interprofessional working found that increased knowledge and understanding of each other’s practices has led to greater mutual respect, increased referral rates (Smith et al, 2004) and has prevented the patient having to play the role of mediator between professionals (Soklaridis et al, 2009). However, Laurenson et al (2006) identified a lack of knowledge about CAM within pre-registration nursing students and recommended integration of CAM education into curricula. As there is limited research in this particular area, this study explored the role of undergraduate IPE with CAM and conventional students.
British Journal of Nursing, 2014, Vol 23, No 13
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.113.111.210 on October 27, 2015. For personal use only. No other uses without permission. . All rights reserved.
RESEARCH During 2010, third-year students enrolled on adult nursing, midwifery, homeopathy and complementary therapies degree courses within a university were invited to participate in two workshops and a focus group discussion. Adult nursing and midwifery students were considered conventional healthcare students, and homeopathy and complementary therapy students comprised the CAM students. The demography of students attending the workshops is shown in Table 1. The second workshop was attended by the same students, apart from an additional midwife and absences by two homeopaths and one complementary therapist. The first workshop gave the opportunity to question each other’s roles as well as the usefulness of interprofessional collaboration and potential barriers to working together. In the second workshop, students used a case example to discuss treatment options for a patient and to interact within their professional roles. In the first phase of this study, students completed a questionnaire before and after the workshops to ascertain attitudes towards their individual and other professional groups, and their readiness to embrace IPE. Descriptive statistical analysis of the questionnaire results, along with comments from student evaluations, were used as a basis for a semi-structured focus group interview. The demography of students attending the focus group is shown in Table 2.
Students attending
Nurses
Midwives
Homeopaths
Complementary therapists
Workshop 1
4
1
5
1
Workshop 2
4
2
3
0
Table 2. Demography of students attending the focus group interview Students attending
Nurses
Midwives
Homeopaths
Complementary therapists
Focus group
2
2
3
0
gained greater knowledge and understanding of each other through interaction. Closer inspection of the students’ responses confirmed that everything the students either felt or demonstrated they had learnt had happened as a direct result of interaction, which enabled them to overcome doubts about whether or not they could learn from each other: ‘At first I was feeling that different professions cannot work together successfully, but once we started interchanging information … it became so enjoyable and so comfortable.’ (Homeopath 4) Interaction increased the students’ belief that IPE is an effective way of learning to work together.
Ethical considerations
Breaking down prejudices
Ethical approval was obtained from the university. Consent forms were issued to all potential participants, along with information forms and an assurance of anonymity.
Students identified lack of knowledge as a basis for assumptions and that stereotypical views of others came from a range of sources, including the media, interaction with people within their profession, and personal acquaintances. They considered personal experiences to be the most significant influence on stereotyping, and that these experiences influence professional decision-making. Part of the reason that the students suggested that IPE be introduced into the curricula of all health students from their first year was to help counteract negative stereotyping/preconceptions:
Data analysis The focus group discussions were recorded and transcribed. Thematic analysis of the data was done in accordance with the principles of inductive analysis outlined by Braun and Clarke (2006). This uses a six-stage process that involves familiarisation with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.
Results The thematic analysis identified six themes: interaction; breaking down prejudices; increased knowledge and understanding of others; increased knowledge and understanding of self; common aims; and organisational limitations. The following discussion of these themes reflects the group’s opinion that interaction through IPE helps break down prejudices through greater knowledge and understanding of self and others, allowing them to perceive common aims and similarities of purpose that unite them. That core belief is set within the perceived limitation imposed by institutional policies and logistical barriers to incorporating IPE into current curricula. © 2014 MA Healthcare Ltd
Table 1. Demography of students attending the IPE workshops
Interprofessional interaction Students identified that their perceptions of the other professions were more positive after the workshops. When questioned, the majority of students stated that they had
British Journal of Nursing, 2014, Vol 23, No 13
‘Sometimes we stereotype roles and actually finding out that what the other person does is quite different from what you perceived them to do.’ (Midwife 1) One interesting insight that emerged was that prejudices not only affect an individual’s view of that profession, but also how they expect that profession to view them: ‘They are not going to be receptive [to] this because they work in that way.’ (Homeopath 2) Where long-standing prejudices run deep, however, the challenge seems greater. For example, between nurses and midwives: ‘I think that a lot of the issues between nurses and midwives need to be trashed out at the beginning of the course, not even at the end. I really do.’ (Midwife 2) More sensitive issues were raised between the nurses and midwives than between any other group.
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British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.113.111.210 on October 27, 2015. For personal use only. No other uses without permission. . All rights reserved.
Increased knowledge and understanding of each other was the most frequent response to the question about what had been learnt. For the student nurses and midwives, it had been important to learn about the growing evidence for CAM and the rigour of education provided by the degree programmes: ‘Knowing that [homeopathy] a degree level course and people are studying about it in detail … I would be more confident to recommend it to my patients.’ (Nurse 4) Prior to this, there was a certain amount of anxiety about coming across a patient who was using CAM.
Increased knowledge and understanding: self Less discussed within the literature is the potential for students to learn more about their own profession through interaction with others. Here, the lessons learned took various forms. In one case it was comparison of their own role in the light of new understanding about the role of others: ‘Getting to know what other people do, then you get to know that, oh my god, we are working a lot harder than them!’ (Nurse 2) And in another case, it was a reflection on their role and that of their profession in the light of interprofessional working: ‘As much as I would want to be autonomous and assertive … actually, when you look at it, there are so many restrictions and guidelines that you can’t always do what you want.’ (Midwife 2)
Common aims The increased knowledge and understanding of their own and others’ roles led all students to feel united by a common aim, despite the differences in their approach to health care: ‘It became very clear very quickly that we all have something we can interact with and use to help the people we are committed to.’ (Midwife 2) ‘We are all working towards the same aim, we all care about the health of people, and so we are likeminded already.’ (Homeopath 1) This sense of unity was the key that allowed the students to form new interprofessional groups, embark on casework together, and reflects a desire to work together, motivated by a patient-centred vision.
Organisational limitations There was, however, one outcome that has come through strongly: namely, the nature of organisational limitations to interprofessional working. ‘If you had these case studies and the opportunities to have similar groups with a couple of people from nursing and a couple of people from homeopathy … but the logistics of it, I don’t know how it would ever work…’ (Midwife 2)
742
In addition to acknowledging some of the logistical barriers for taking IPE into university curricula, the students acknowledged that the emphasis on a medical orthodoxy and a free healthcare system with limited CAM options would be a huge barrier to working together: ‘[The medical profession] is driven by the pharmaceutical companies who don’t want homeopathy or complementary therapies to be too up and coming.’ (Homeopath 2)
Discussion This study aimed to ascertain the value of bringing together undergraduate students from conventional and CAM degree courses. The design of the research did not allow for generalisations about the usefulness of IPE to other undergraduate students. But it did allow conclusions to be drawn as to the usefulness of IPE to these students and gives the reader the option of applying this to other groups (Lincoln and Guba, 2000). Interaction was identified as key to success in breaking down prejudices and developing common aims. The question of whether IPE can make a difference to prejudices is still debated within the literature. But with conventional and CAM students, the findings of this research suggest that it can. One reason may be that prejudices between the CAM and conventional professionals represented here are actually less deep-rooted than might be perceived. However, the mutual stereotyping between nurses and midwives seemed more embedded and challenging. Social identity theory (Tajfel and Turner, 1986) states that individuals identify with their own group and actually behave according to the stereotypical views that other groups apply to them when they come into contact. In this case, the midwife assumed a dominant position in the second workshop as care coordinator for the case-study patient, and the nurses took a more subservient role. Perhaps IPE at undergraduate level can allow potential conflicts and prejudices to emerge and be expressed openly, discussed, witnessed and reflected on (Barr et al, 2005). Previous research (Curran at al, 2010; Laurenson et al, 2012) reported benefits similar to the findings of this study: a greater awareness of a range of approaches to health care; the opportunity to develop collegiality with professionals outside their own field of medicine; increased professional competence from broadening their learning beyond their own field of medicine; and increased confidence in communicating with a range of health professionals. This study also confirms previous findings that IPE is achievable and desirable with undergraduate students without having a detrimental effect on their professional identity (Goelen et al, 2006). The difference here is that previous studies involved students from only a conventional healthcare background. Though only likely to work together in particular areas of health, the students could appreciate benefits specific to interaction between CAM and conventional disciplines. Like Laurenson et al (2006) and Lumague et al (2006), these students identified advantages for patients, such as a greater openness between professionals in different fields of healthcare. This encourages disclosure by patients, allows
© 2014 MA Healthcare Ltd
Increased knowledge and understanding: others
British Journal of Nursing, 2014, Vol 23, No 13
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RESEARCH for greater continuity of care, and more choice for patients through having professionals that are able to discuss a range of healthcare options (Willison, 2008).
Recommendations The authors regard this research as an initial study that shows the value of IPE between CAM and conventional healthcare students. Through encouraging communication and greater understanding of each other’s practices, IPE can enhance the respect that health professionals have for each other (Barr et al, 2005; Derbyshire and Machin, 2011). However, this potential needs to be recognised outside the confines of this individual study. Further studies are needed to confirm the conclusion that, although full integration may be a long way off, mutual respect would go some way in uniting a fragmented health system and thereby improving continuity of patient care—enabling everyone to offer the seamless service to which all aspire. It is unrealistic to suggest academic institutions invest time and energy in integrative IPE as a result of this research alone. However, research is needed with other groups of CAM and conventional students to demonstrate the consistent usefulness of integrated IPE across a broad spectrum of disciplines.
Conclusion Although this was the first study to undertake IPE between CAM and conventional healthcare students, it is still a revelation to find so many common themes with IPE of conventional students alone. This study has found that IPE enables students to gain an increased awareness of each other’s skills and roles as a result of interacting with other professional groups. At undergraduate level, IPE is about the challenging of preconceptions and the changing of attitudes towards other professional groups. This study has shown that there is the potential in IPE to challenge prejudices, both against distinct professions and against diverse approaches to health, thereby engendering a more open-minded approach to health care and a more seamless service for patients. BJN Conflict of interest: none
© 2014 MA Healthcare Ltd
Barr H (2000) Interprofessional Education: 1997–2000. A Review. UK Central Council of Nursing, Midwifery and Health Visiting, London Barr H, Freeth D, Hammick M, Koppel I, Reeves S (2005) The Evidence Base and Recommendations for Interprofessional Education in Health and Social Care. http:// www.swap.ac.uk/docs/barr_05.pdf (accessed 27 June 2014) Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2): 77–101 Buchan S, Shakeel M, Trinidade A, Buchan D, Ah-See K (2012) The use of complementary and alternative medicine by nurses. Br J Nurs 21(11): 672–4, 676 Curran V, Sharpe D, Flynn K, Button P (2010) A longitudinal study of the effect of an interprofessional education curriculum on student satisfaction and attitudes towards interprofessional teamwork and education. J Interprof Care 24(1): 41–52. doi: 10.3109/13561820903011927. Department of Health (2000) The NHS Plan. DH, London.
KEY POINTS n Research
has identified a range of benefits from interprofessional education (IPE) for nurses and other health professionals but no studies have investigated the benefits of IPE with groups of undergraduate conventional and complementary and alternative medicine (CAM) professionals
n CAM
use is increasing although patients may not tell health professionals about their use of CAM and this can lead to fragmented care
n This
study found that IPE with student nurses, midwives, homeopaths and complementary therapy students led to greater interaction, knowledge and challenging of prejudices between professional groups
n Inter-professional
education resulted in openness to a more holistic approach to health, which allows for greater continuity of care and increased choice for patients
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