This study aimed at increasing the knowledge about students’ experiences with IPE in a setting including patients with complex care needs in nursing homes. The major finding is that students are challenged on many levels when collaborating together on complex patients. For example patients with no predefined problems force the students to look at the patients from many professional angels, they experienced that they have to build relations with several participants in the learning activity to solve the patients care needs. From the discussions the students seemed to develop patient relations both as a team, and as individuals, that depended on previous team members’ actions. The various ways of collaborating as teams challenged their normal way of working as individual professionals.
This makes in line with other studies (16, 18) nursing home is an appropriate arena for an IPE activity because it provide the possibilities for students’ to experience complex patients’ situations during their education. Even if it was challenging and sometimes frustrating, their possibility to discuss difficulties with each other and the faculty enhanced their scope of the patients need and the advantages of collaboration. We argue that IPE in nursing homes facilitated the students’ scope from having a fragmented approach of the patients towards a relational and collaborative practice that improve patient care. Two recurring findings in previous studies are that IPE can strengthen students’ own professional role identity, as well as increase the understanding for other health care professionals’ work (9). Our study confirms these findings also in a nursing home setting, and by conceptualizing these categories as window and mirror learning, our study adds conceptually to the literature. Window and mirror learning are concepts found in the pedagogical literature (26–28) and are well suited to use in the context of IPE to understand how students obtain these learning outcomes in nursing homes. This learning experience could be described in terms of windows opening for new perspectives and first-hand understandings about, the other students, medicines, diseases and the patients. On one hand, the students can learn by watching other students; in this case they “open a window” for new perspectives and other ways of solving a task. On the other hand, students can learn by being challenged and confronted by the other students. They “watch themselves in the mirror” when the other students question what they do (26). Here the complex patients appear to have created a great forum for this.
IPE in nursing homes appears to create a safe forum for students to step out of their uniprofessional approach to other more collaborative practices. However, our findings suggest that how students structure their collaboration in the teams is important for their total learning experience on complex patients. For expanding current understanding of IPE in the complex health care system, we apply four types of coordination practices in our discussion (29). During a collaborative process, Vik identified four types of coordination practices that may occur (29). Even if these coordination practices are revealed from a specific context, the concept has generic features that make it useful to understand broader perspectives, as for example reach full potential of IPE in nursing homes.
We uncovered groups with a focus on establishing physical meetings throughout the whole process and having discussions for knowledge sharing. They expressed that they had achieved a different collective knowledge experience, i.e. a deeper understanding of the patient and each other, compared to than groups that did not meet more often than scheduled. Some groups appeared to have been engage more in relational collaboration practice (29). Such practice is characterized by closeness in the practice, and high level of interlocking of the various professions’ different understanding. This is achieved through many and various physical meetings and negotiations between the actors. This leads to a common understanding and recognition of each other’s contributions in the task solving process (29).
On the other hand, some of the teams had instead not engaged fully in the interprofessional collaboration. They presented uniprofessional suggestions for the complex patients’ health problems without building on their potential strengths as an interprofessional group. Such a practice is more influenced by an operational closed collaboration. For example in our course the students had the opportunity to meet each other, but not all utilized these opportunities. As a result, in such teams the actors never reach a common understanding about the task and each other, even though there are various physical meeting points, which was apparent in our results (29). Our findings, therefore indicate the importance of the physical and social organization of the teams for achieving maximum learning outcomes, and potentially also improving clinical outcomes for the patients. Therefore to achieve a successful relational collaborative IPE practice, pre-training in teamwork might be needed, i.e. beforehand introducing theoretical knowledge about other team members and inform students about how to create successfully interprofessional teams and how physical but also online software can create such platforms. Also, improvements of several administrative factors need to be considered in ensuring a relational collaborative practice experience (13, 29–30). In our study this is exemplified by the students wish for an effective patient meeting in terms of time efficiency, the need for including only one participant per profession in the group, and a better aligned time schedule. For example, Hean et al. argue that social aspects of learning, here relationship building between participants, distinguish interprofessional learning from uniprofessional learning (13). Social aspects of learning by the conflicts or negotiations between the students' different competences, roles and understanding will then help to create a mutual knowledge (or mutual understanding of each other's competences) that should form a good starting point for further interaction such as by relational collaborative practices and/or a coordinated delegation practices which is understood as physical distance, but still an mutal acceptance of the professions' different understanding. The integration could be done by e.g well-functioning Information and Communications Technology (ICT) systems (9, 13, 29).
The students expressed that the health care sector today is not characterized as interprofessional and is inclined towards distance and differentiation ie. fragmented delegation meaning that collaboration was characterized by distance and differentiation (29). When starting their professional lives, students who have experienced a practice of relational collaboration during their education might lower their threshold to confer with other professionals. By knowing each other’s limitations and strengths, physical distance will not be equivalent to a uniprofessional approach, and a coordinated delegation might be expedient (29).
One limitation might be that two moderators were involved, as two focus group took place simultaneously at one nursing home. Immediately after the first two focus group, a de-briefing session was held with the moderators and co-moderators, discussing the interview-guide. Rather than being a limitation, we experienced that the use of two moderator teams actually enriched the interviews. A strength with this study is the interprofessional research team working together, which gives a wider perspective on the analysis and interpretation of the empirical data collected.
RH and LM, who conducted one of the focus group interviews, had previously been involved in the course as educators, but they did not have a major role at the time of the data collection. KS and BK had no previous connection to the project and were enrolled to be an independent part of the data collection and analysis team. By using the already established student teams, we might have missed out negative experiences from the teamwork. On the other hand, the students seemed to be confident to express challenges regarding IPE.