Readiness of ward for implementation inter professional education in Universitas Sumatera Utara Hospital

Nurhidayah, Rika Endah; Revi, Hasmela
doi:10.1016/j.enfcli.2021.04.011
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Universitas Sumatera Utara &#40;USU&#41; Hospital&#44; is a teaching hospital managed by the Universitas Sumatera Utara which focuses on patient care&#44; education and research&#46; At the end of 2018&#44; an Inter Professional Education &#40;IPE&#41; was implemented which involved students from several health faculties at USU namely students of medical&#44; nursing&#44; pharmacy&#44; public health&#44; psychology and dentistry&#46; These activities were carried out directly on patients guided by the doctor in charge and several lecturers who represented each profession involved&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In 2019&#44; a study on Inter Professional Education was carried out involving three faculties at USU&#44; namely medical&#44; nursing and pharmacy&#46; The faculty of dentistry was not involved because the professional education of students was carried out directly at the dental and oral hospital which they already had&#46; Meanwhile&#44; the psychology faculty was not re-involved because there was no student professional education at USU Hospital&#46; Therefore&#44; in this study&#44; students from three faculties worked with a team to solve patient cases&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thistlethwaite<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> explained that IPE may be applied in both educational and work environments&#44; where the Collaboration between professions in the work environment is known as Inter Professional Collaboration &#40;IPC&#41;&#46; Furthermore&#44; study<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> by Permata et al&#46;&#44; discovered that students&#8217; understanding of other health professions were good but professional teamwork was still inadequate&#44; which occurred due to the minimal interaction between different professions&#46; In addition&#44; based on the phenomena in the field supported by several studies&#44; the researchers continued to analyze the readiness of the ward participate in implementation of IPE&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study design was a qualitative phenomenology which aimed to explore the readiness of the ward to implement IPE&#46; The participants were all 9 head nurses at the USU Hospital&#46; The research instruments were questions related to the implementation of IPE&#46; Data were collected by means of Focus Group Discussion &#40;FGD&#41; after obtaining approval from the university research ethics committee No&#46;149&#47;KEP&#47;USU&#47;2020&#44; and the results were analyzed through several stages&#44; namely reduction&#44; presentation and conclusion&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0025" class="elsevierStylePara elsevierViewall">Based on the FGD analysis&#44; three themes were discovered from this study&#44; namely the interaction between professions&#44; the achievement of competencies and IPE barriers with the first theme been the interaction between professions&#46; From the results of the FGD it was discovered that interaction between students of the three professions were almost non-existent&#44; this was reflected in the following conversation&#58;</p><p id="par0030" class="elsevierStylePara elsevierViewall">&#8220;The medical students only came to the ward at the same time as specialist medical student&#44; when visiting patients&#8221;&#46; &#40;R5&#41;</p><p id="par0035" class="elsevierStylePara elsevierViewall">&#8220;Students of pharmacy&#44; nursing and medical almost never interacted&#59; they seemed to focus on achieving their respective competencies&#46;&#8221; &#40;R2&#41;</p><p id="par0040" class="elsevierStylePara elsevierViewall">&#8220;Medical students only interacted with nurses in the room to deliver practical schedules on the first day of the nursing room&#8221;&#46; &#40;R1&#41;</p><p id="par0045" class="elsevierStylePara elsevierViewall">&#8220;Medical students had almost no interaction with room nurses&#59; they usually went directly with the specialist medical students&#8221;&#46; &#40;R3&#41;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This showed that the interaction and communication between students from the three different professions had not occurred&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The second theme was about the achievement of competencies that were demanded from the faculties of each profession which were far different&#44; such as the following FGD results&#58;</p><p id="par0060" class="elsevierStylePara elsevierViewall">&#8220;Only nursing students interacted with nurses in the room to achieve their competence&#8221;&#46; &#40;R5&#41;</p><p id="par0065" class="elsevierStylePara elsevierViewall">&#8220;Medical students do not seem to think that nurses existed because they preferred to follow the specialist medical students and depend on them&#8221;&#46; &#40;R9&#41;</p><p id="par0070" class="elsevierStylePara elsevierViewall">&#8220;In the operating room&#44; each student of the three professions met a supervisor to discuss competencies that need to be achieved&#8221; &#40;R1&#41;</p><p id="par0075" class="elsevierStylePara elsevierViewall">This condition shows that each student who comes from a different profession has different competency achievements&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The third theme was about the barriers in implementing IPE&#44; which were the practice schedules of the three different faculties&#44; practical supervisors and levels of activity for each room&#44; as shown in the following FGD results&#58;</p><p id="par0085" class="elsevierStylePara elsevierViewall">&#8220;Medical students had never practiced at the ICU&#44; if pharmacy students had been to the ICU to check the status of a patient&#44; they usually came at 14 past and those who went to the ICU usually followed USU Hospital pharmacy officers&#8221; &#40;R7&#41;</p><p id="par0090" class="elsevierStylePara elsevierViewall">&#8220;Around 2&#8211;3 o&#8217;clock&#44; it was possible to hold IPE because indoor activities were not as busy as in the morning&#8221; &#40;R8&#41;</p><p id="par0095" class="elsevierStylePara elsevierViewall">&#8220;IPE was only carried out during practice hours if the emergency room was not crowded with patients&#44; just a suggestion should be above 10<span class="elsevierStyleHsp" style=""></span>am&#8221; &#40;R4&#41;</p><p id="par0100" class="elsevierStylePara elsevierViewall">&#8220;During practice hours&#44; it was possible to carry out IPE&#44; preferably when there was a lot of action in the room&#8221; &#40;R4&#41;</p><p id="par0105" class="elsevierStylePara elsevierViewall">From the results of the FGD&#44; it was discovered that different practice schedules were the biggest obstacle to implementing IPE in hospitals&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discuss</span><p id="par0110" class="elsevierStylePara elsevierViewall">Based on the results found 3 themes&#44; namely the interaction between professions&#44; different competency achievements and barriers in the implementation of IPE&#46; The lack of communication that has occurred between students who come from different professions because so far they have implemented professional programs only interacting and depending on their supervisors&#46; This condition is of course different from inter professional education&#44; which requires all professions to interact in dealing with every patient problem&#46; This condition should be designed from the start of the professional education program so that students will not find it difficult when carrying out interprofessonal collaborations&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Buring et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> stated that the expected results of IPE learning includes reactions&#44; modification of attitudes and perceptions&#44; additional knowledge and skills&#44; changes in attitudes&#44; changes in organizational practice and benefits for patients&#44; some experts said that IPE may be the basis for forming collaborations&#46; Furthermore&#44; Mendez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> stated that IPE is a potential medium for collaboration between health professionals by impacting basic knowledge and skills between professionals during education&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">It is important in helping to develop the concept of cooperation between existing professionals by promoting positive attitudes and behaviors between the professions involved&#46; The communication problems that were discovered in clinical practice was the overlapping work in Interprofessional teams caused by ineffective communication among team members which affected patient&#39;s outcome<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> Frenk&#46; Meanwhile&#44; the coordination of schedules with other health care professional programs and students can be a daunting task especially when territorial&#44; turf and non-optimal cooperation between disciplines exists&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The second theme is about differences in the achievement of the required competencies&#46; Basically every different profession will demand different competencies&#46; That is the reason why they need to be involved in IPE&#46; They are expected to be able to understand the importance of the existence of other professions&#44; so as to be able to appreciate the different professions in a team&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">It was discovered that the competency achievements of nursing&#44; pharmacist and medical students were very different&#44; depending on their respective stages and subjects&#46; To face the increasingly complex challenges of health needs and problems&#44; the first Institute of Medical &#40;IOM&#41; conference recommended that all health education providers be required to encourage collaboration between health professionals in the health care team<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> Antonakis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Health academics have a role and responsibility to provide education and training for its students with team-based service competencies&#46; Governments&#44; academics and policy makers need to define a clear vision of quality education and health programs&#44; collaborative practice would be created and health outcomes would increase if one or more different professionals were willing to mutually understand the roles and functions of their profession and that of other health professionals&#46; Therefore&#44; IPE is an effective way to develop collaborative skills between health workers who are ready to work together to provide comprehensive care in a variety of health services Hall and Zierler&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Based on the research of Levett-Jones and Lapkin&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> the application of IPE began at the early academic stage of students&#44; before they became health professionals&#46; This was reinforced by Thibault&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> that IPE need to be implemented both at the academic and clinical practice stages with the aim of connecting the theories obtained by students during learning on campus and the practices undertaken in the field&#44; this has proven to provide many benefits for students&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">IPE occurred when students from two or more health professions learnt together&#44; from other health professions and about the roles of each health profession in improving collaboration skills and the quality of health services&#46; Furthermore&#44; it aimed produce health workers who have knowledge&#44; skills and attitudes that support collaborative practices between health professions&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> Olson and Bialocerkowski described that IPE effectiveness was affected by differences in power and curriculum placement&#46; Meanwhile&#44; Utami et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> discovered that the obstacle in implementing Interprofessional Collaborative practices at Panti Rapih Hospital was that most of the nursing staff was not equipped with sufficient knowledge about Interprofessional Education &#40;IPE&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The third theme that has been found in this research is the things that can become obstacles in implementing IPE&#46; Based on the results of the FGD&#44; it was discovered that different practice schedules were the biggest obstacle in implementing IPE in hospitals&#46; Based on the experience of head nurses&#44; accompanying students from their various different professions suggests that the ideal IPE implementation is late afternoon&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">This situation was chosen because the activity of the ward relating to administrative problems had decreased therefore&#44; the ward assisted in preparing for its implementation&#46; Furthermore&#44; the IPE approach facilitated students to learn from and about other health disciplines therefore&#44; improving their skills and creating better cooperation in an integrated work environment&#46; Unfortunately&#44; the implementation of IPE in the health colleges were still inconsistent&#44; especially the implementation in hospitals&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Nurhidayah and Revi<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> said IPE needed to be integrated into the curriculum to ensure its sustainability&#44; have its own portion and not just a trial&#46; Academically&#44; IPE assisted students in increasing specific knowledge&#44; attitudes and skills&#44; such as team problem solving&#44; health counseling and clinical skills&#46; This had the potential to increase understanding&#44; trust and mutual respect between health professions therefore&#44; enabling students to achieve collaborative competence&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0165" class="elsevierStylePara elsevierViewall">Based on the explanation above&#44; it was concluded that every room&#44; emergency unit&#44; outpatient and inpatient room were ready to facilitate the implementation of IPE at USU Hospital&#46; Therefore&#44; to anticipate the problems that arose due to the lack of interaction between different professions&#44; differences in competency attainment and other implementation barriers&#44; it was necessary to carry out special policies that facilitated all obstacles in implementing IPE&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aims to analyze the readiness of the ward participate in implementation of IPE&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A qualitative study design was used and the participants were 9 head nurses who were interviewed by using FGD technique&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The FGD results showed that there had been no communication between students from different professions namely medical&#44; nursing and pharmacy due to their different schedules and followed only the instructions of their supervisors&#46; Furthermore&#44; only the nursing students interacted with nurses in the patient&#39;s room&#44; as they followed the cycle of the room&#39;s activities&#44; while medical and pharmacy students would leave immediately after their supervisors&#46; Three themes were discovered in this study&#44; namely the interaction between professions&#44; different competency achievements and barriers in the implementation of IPE&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The ward is ready to facilitate the implementation of IPE even though there are still differences in student competency achievements&#46;</p></span>"
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