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ATTITUDES OF HEALTHCARE FACULTY TOWARD INTERPROFESSIONAL

EDUCATION AND INTERPROFESSIONAL

HEALTHCARE TEAMS

A Dissertation

Presented to

the

Faculty

of the

School of Nursing

Widener University

In Partial Fulfillment

of the Requirements

for

the Degree

Doctor of Philosophy

by

Maria Olenick

School of

Nursing

August

2012



UMI Number: 3533655

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WidenerUniversity

School of Nursing

Title

of

Dissertation:

Attitudes of Healthcare Faculty Toward

Interprofessional Education and Interprofessional

Healthcare

Teams

Author:

Maria

Olenick

Approved by:

Dr, Lois R

Allen,

chair

Dr.

Lynn

Kelley

Dr.

Thomas Young

Dr.

Barbara

Patterson

Dr. G. Jean Klein

Date:

August

2012

Submitted

in

partial fulfillment

of

the requirements

for the degree of

Doctor

of hilosophy



Copyright by

Maria

Olenick

2012



Dedication

To

Kayla and Sofia,

you

have inspired me to achieve

great

things so that

I

may

be

a

role

model to you to

achieve even greater

things. Dream

big, work hard, make

your

own

opportunities,

take risks, and remember to always

do

whatever makes you happiest.

I

love you.

iv



Acknowledgments

I

wish to extend

my

sincere appreciation and acknowledge those who have

assisted, guided,

and supported me throughout this dissertation.

To my

family,

particularly

my

parents,

I

am deeply grateful

for everything you

have done

for

me

from

your

consistent

words

of

encouragement, to your

help with loaning me

tuition to sustain

my

work. I could not have done this

without

you.

To

my brother P.J., who claims to be the smarter one of

the

two

of

us, I am deeply

grateful

for

the

relationship

we have. Most people

are

not

as

lucky

to

have parentsor

a

brother who

loves

them as much

as I

know

I am

loved

by

you.

To Kayla

and

Sofia,

of

all I

have accomplished so

far

in my

life, you are

truly my

greatest accomplishments. There has been no greater inspiration

than

the looks

in your

eyes.

To my husband,

Chris,

thank you for having the courage to move us

to

paradise

where I was able

to

finish

out

this dissertation as I looked out

at

palm trees.

This

dissertation

has been

a long,

arduous journey with

a final bonus of forever

living among

the tropical breezes and warm ocean waters.

To my dissertation committee,

my

chair Dr. Lois Allen,

Dr. Tom

Young, and

Dr.

Lynn Kelly, I am deeply grateful

for

the countless hours

you

have offered your expertise.

Your constant guidance, support,encouragement, patience, insight, and wisdom have

seen

me

through the

past few years. Dr.

Lois Allen, you

were

the first faculty

member

I

met

at Widener.

Although you probably

haven't

known it,

from

that

first day

forward

I

have considered you a role model

and mentor

to my doctoral work. Your dedication to

v



students, your kindness, and the unbelievable

way

you transitioned me from being

frightened

of

statistics to understanding and loving quantitative research has been

amazing.

And finally, to my classmates and colleagues and those I met throughout

my

Widener years, thank you

for

the friendships.

We

have had great

fun.

I

have

met

such

an

interesting

mix of people. I am

lucky

to

have

made so

many valuable

connections

with

so many great nurses and nurse educators.

vi



Abstract

Quality healthcare

is

affected by how well healthcare professionals work together and

may also be influenced by attitudes toward interprofessional healthcare teams. Problems

with

interprofessional communication can have

a

negative influence on patient care and

services.

The

literature documents evidence of the negative impact of interprofessional

communication problems on patient care issues, includingdelays in patient care, wasted

staff time, and serious adverse patient consequences. Due to the negative impact on

patient care

and

services

that

interprofessional tensions can create, improved

collaboration,

improved

communication,

and

team building have been advocated.

This descriptive correlational and comparative

study

explored healthcare faculty

(HCF) attitudes toward interprofessional education

(EPE)

and interprofessional healthcare

teams

(IPHCT), HCF perceptions of subjective

norms

(SN), the influence

of SNs on

HCF

intent to engage

in

IPE, and HCF intent to engage in IPE.

In

addition, differences among

seven disciplines

of HCF

attitudes toward IPE and IPHCT and intent

to engage

in IPE

were explored.

The

conceptual basis

for

this study was the Theory

of

Reasoned Action

(TRA) by Fishbein and Ajzen,

first

published in 1975. TRA explains the

links

among

attitudes,

SNs, intention,

and

behavior

and provided

an

approach

for examining

healthcare

faculty intentions

to

engage in

IPE.

Schools

that offer accredited baccalaureate and/or higher degree programs in

nursing, medicine, pharmacy, physical therapy, occupational therapy, physician assistant,

and/or

social

work were

identified. Stratified

random sampling was used

to ensure

that

the

population surveyed was

representative of the

target population.

The actual sample

vii



for

this

study included a total

of 439

healthcare faculty from the seven healthcare

professions nationwide.

Data

collection methods included

a

Demographic

Data Form

and two research

instruments

to

measure attitudes toward IPE and attitudes toward IPHCT. Subjective

norms

were measured

using

two single item, continuous, 7-point magnitude rating scales.

Intent to

Engage

in BPE was measured using

a

single item, continuous, 10-point,

magnitude rating scale.

Statistical methods used to analyze

and

interpret the data

included

descriptive statistics, stepwise multiple

regression, and multifactorial

analysis of

variance.

Research questions, findings, additional analyses, implications for nursing,

conclusions,

generalizability, and recommendations for future research were discussed.

This study contributes

to the body

of

knowledge

for

nursing and

six other

healthcare

disciplines concerning IPE. Nurses responded favorably regarding their attitudes toward

IPE and IPHCT. IPE has the potential to influence

patient

quality of care and lead to

better working

relationships

with

other healthcare

providers.

viii



Table of Contents

Page

Dedication iv

Acknowledgements

v

Abstract vii

Table of

Contents

ix

List

of

Tables

xv

List of Figures xvii

List

of

Appendices xviii

Chapter1

1

Background 1

Aims of

the

Study

11

Research Questions

11

Theoretical Basis of

the Study 12

Theory of

Reasoned Action

12

Application of the Theory of

Reasoned

Action

16

Definitions

of

Terms

18

Assumptions

of the Study 20

ix



Significance of Study 20

Nursing Education 21

Nursing Research and Science 23

Nursing Practice 24

Chapter Summary 27

Chapter II 29

Literature Review 29

Gaps

in

Existing Knowledge 29

Interprofessional Education 30

Definitions of Interprofessional Education

30

Interprofessional Education Research

37

Interprofessional Healthcare Teams 47

Summary of Interprofessional Education and Interprofessional Healthcare Teams

Literature 53

Theoretical Literature 55

Fishbein and Ajzen's Theory of Reasoned Action

Theory of Reasoned

Action

Research

55

56



Page

Theory

of

Reasoned Action, Interprofessional Education and Interprofessional

Healthcare

Teams

62

Summary of

Theoretical Literature

62

Faculty and Interprofessional Education and Interprofessional Healthcare

Teams 63

Summary

of

Faculty and Interprofessional Education and Interprofessional Healthcare

Teams

66

Chapter Summary 66

Chapter in

68

Methodology

68

Research Design

68

Sample Selection

and

Size

69

Selection of Healthcare

Faculty

69

Instrumentation 81

Demographic Data

Form

81

Attitudes Toward Interprofessional Education 82

Attitudes Toward Interprofessional Healthcare Teams

84

Subjective

Norms

85

Intent

to Engage

in

IPE 88

xi



Page

Data Collection 89

Procedures for Data Collection 89

Protection of

Human

Subjects

92

Risks 93

Benefits

93

Costs

and Compensation

93

Confidentiality 94

Alternatives

and

Right to

Withdraw

94

Delimitations 94

Data Analysis 94

Missing Data 95

Descriptive Statistics 95

Chapter Summary 97

Chapter

IV

99

Findings 99

Research Questions 99

Research Questions One, Two,

and

Three 99

Research Question

Four 103

xii



Page

Research Question Five 104

Additional Analyses 105

Statistically Significant Additional Findings 106

Non-Significant Additional Findings 110

Positive Factors Influencing Engagement in IPE

110

Negative Factors Influencing Engagement in IPE 112

Category Reduction 113

HCF

Percentages

of Positive and

Negative Factors Reported

115

Chapter Summary 115

Chapter V 117

Discussion, Implications, Conclusions, and Recommendations 117

Discussion

of

Research Findings

117

Research Question One,

Two,

and Three 117

Discussion of Research

Question

Findings

126

Additional Analyses 126

Significant Findings 126

Non-Significant Findings.. 129

xiii



Page

Discussion

of

Positive and Negative Factors that Influence HCF Engagement

in

IPE

131

Positive

and

Negative

Factors Discussion 134

Methodological Issues

135

Generalizability of

the Findings

137

Conclusions

of

the Study 137

Nursing Implications 139

Contribution to Nursing Education

139

Contribution to

Nursing Research and

Science 143

Contribution to Nursing Practice 145

. Recommendations for Future Research 147

Chapter

Summary

147

References 149

xiv



List of

Tables

Page

Table

1

Number

of

Health Discipline Programs per Census

Bureau

Regions

and

Type of

Program and Number Randomly Selected

for

Study

71

Table

2

Frequencies and Percentages

of Sample

Characteristics

75

Table

3

Descriptive Statisticsof Sample Age

and Experience

78

Table

4 Cronbach Alpha Reliability Coefficients of Attitudes Toward EPE and IPHCT

82

Table

5

Descriptive Statistics

of Attitudes

Toward

IPE,

Attitudes

Toward

IPHCT,

Subjective Norms, and Intent to Engage in IPE

100

Table

6

Pearson Correlations of

Attitudes with

Intent to Engage in EPE

103

Table 7 Stepwise Multiple Regression of Health Care Faculty Attitudes Toward IPE,

Attitudes Toward IPHCT and Intent to Engage

in IPE 104

Table

8

MANOVA Comparing

7

Disciplines

of

Health

Care Faculty on Attitudes

Toward IPE

and

Attitudes Toward IPHCT 105

Table 9

Pearson

Correlations of Subjective

Norms

for

Faculty

Colleagues and

Subjective

Norms for School'sAdministrators

with

Intent

to Engage in

IPE

.. 106

Table

10

Stepwise Multiple Regression of Health Care Faculty Attitudes Toward IPE,

Attitudes Toward

EPHCT,

Subjective Norms for Faculty Colleagues,

Subjective Norms for School'sAdministrators and Intent to Engage in IPE.... 107

Table

11

Results

of

f-Test Analyses Comparing Groups

from

Demographic Variables

on the Research Variables

108

Table

12

15 Initial Categories of Positive Factors

Influencing

Engagement

in IPE

Ill

xv



Page

Table 13 17 Initial Categories

of

Negative Factors Influencing Engagement in

EPE....

112

Table 14 Percentage of Positive Factors and Negative Factors Influencing Intent to

Engage in IPE Reported by Each HCF

Group

115

xvi



List of

Figures

Page

Figure 1. Model

of

TRA 17

Figure 2. Application

of

TRA to current study

18

Figure 3. Interdisciplinary Care: Disciplines interact but still separately accountable....

35

Figure 4. Multidisciplinary Care: Disciplines stand alone 36

Figure

5.

Interprofessional Care: Disciplines

are

interlocked and work in concert

with one another

37

Figure

6.

Revised application

of the

TRA model

based on

study

findings

128

xvii



List of

Appendices

Page

Appendix A: Letter of Explanation 169

Appendix

B: Demographic

Data

172

Appendix C: Attitudes Toward IPE 175

Appendix D: Attitudes

Toward

Interprofessional Health Care Teams 177

Appendix E: Institutional Review Board Approval 179

Appendix F: Examples of Positive IPE Quotes of Initial 26 Categories 180

Appendix

G:

Examples

of

Negative IPE Quotes

of

Initial 26 Categories 182

xviii



1

Chapter I

Background

Quality healthcare is

affected

by how well healthcare

professionals work together

and may

also

be influenced by attitudes

toward

interprofessional education (IPE) and

interprofessional healthcare teams (IPHCT).

"Various

professions are often in collision

and largely ignorant

of

the practices

of

each

other"

(Gilbert, 2008, p. S12). Problems

with interprofessional communication

can have

a negative influence on patient care and

services. Williams et

al. (2007) documented

the

negative

impact of

interprofessional

communication problems on patient care issues including delays

in

patient care,

wasted

staff time,

and

serious

adverse patient

consequences. Rosenstein

and

O'Daniel (2006)

found that disruptive behaviors that affect healthcare

teams

negatively

may lead

to poor

quality patient outcomes and adverse events for patients.

Due to the negative impact on

patient care and services that interprofessional tensions can create, improved

collaboration,

improved communication, and team building

have

been advocated.

Interprofessional teams improve patient safety and quality of care (Lingard, Espin, Evans,

& Ha

wry uck,

2004).

The goals of this study were to investigate healthcare faculty (HCF) attitudes

toward interprofessional education (IPE)

and

interprofessional healthcare teams (IPHCT)

and HCF intent

to

engage in IPE.

The

contribution

of

attitudes and subjective

norms, as

conceptualized

in

the Theory of

Reasoned Action (TRA) (Fishbein

&

Ajzen, 1975) in

predicting

intention to implement DPE,

was also

investigated. Olenick,

Allen, and

Smego

(2010a) stated that IPE

is

an andragogical interactive experiential learning and



2

socialization process. An extensive literature search and concept analysis by this

researcher revealed that IPE occurs

when

two

or

more members

of

a healthcare team,

who participate in either

patient

assessment

and/or management,

learn with, from, and

about each other as they collaboratively focus on patient-centered care

and achieving

optimal

health

outcomes. In IPE,

knowledge

and value

sharing

occur

within

and across

disciplines.

IPE was first identified as an essential healthcare education element in 1978 by

the World Health

Organization (WHO). In 1984, WHO

recommended

that healthcare

professional students

engage

in shared learning to improve their

skills

in

solving

complex

health

and

social care problems

and

deliver healthcare

based on

common values,

knowledge,

and

skills.

In

1988, WHO

assessed

IPE

efforts, identified IPE gaps,

identified IPE organizations, identified

research

contributions

to

IPE and initiated

development

of

a

conceptual framework in a multiprofessional education report. More

recently,

WHO

announced

the

launch

of its

study

group

on

DPE

and

collaborative

practice

consisting of

25

experts on education, practice, and policy from around the

world

(Yan,

Gilbert, & Hoffman,

2007) and in 2010 published the WHO Framework for

Action on

Interprofessional Education and Collaboration. Therefore, IPE

is

not

a

new concept to

healthcare professionals. However,

it

is a

topic

of

recent

interest

and

extensive

discussion

and

debate because it

prepares

healthcare

professions

to

work

in dynamic,

challenging, contemporary health systems where

mutual respect

and collaborative care

contribute to improving patient outcomes (Wilcock, Janes, & Chambers, 2009). As such,



3

IPE stands as an alternative to more traditional hierarchical models of both healthcare

professional

education and healthcare delivery.

The

Institute

of

Medicine (IOM) issued a report entitled To err is

human:

Building a safer healthcare system (Committee on

Quality

Healthcare in America

and

Institute of Medicine [Committee],

1999).

This report indicated

that as

many as 98,000

preventable

deaths occur per year.

Lack

of

interprofessional

collaboration

and effective

communication

are

attributed to these preventable errors

that

cause more

death than

motor

vehicle

accidents,

breast

cancer,

and AIDS. In 1999, the

committee recommended

that those who work in interprofessional teams should be

trained

in interprofessional

teams.

Two later reports concluded that all healthcare student education should focus on

patient-centered care, which is

promoted

by IPE. The

first

report, Crossing the quality

chasm: A new

health system

for the

21

st

century

(Committee on Quality Healthcare in

America and Institute

of

Medicine [Committee],

2001),

recommended that all healthcare

professional

students should receive education

and training in

interdisciplinary

teams

related

to interdisciplinary care.

The second report, Health professions education:

A

bridge

to quality care (Greiner & Knebel, 2003), listed five competencies that

concern

all

healthcare disciplines: (a) provide patient-centered care, (b)

work

in interdisciplinary

teams, (c) employ evidence based practice, (d) apply quality improvement, and (e) utilize

informatics. The

IOM, based on these

two

reports that

reflect 10 years of literature

review

and workshops to identify concerns and develop strategies

to

improve

patient

care, concluded that healthcare professionals

must

deliver competent patient-centered



4

care in interdisciplinary teams and identified IPE as an essential element in the education

of

healthcare professionals.

The

most

recent IOM report, The

future

of nursing:

Leading

change, advancing

health (Robert

Wood Johnson Foundation Initiative

on

the

Future of

Nursing,

at the

Institute of Medicine [IOM], 2010) calls for and

specifically

cites interprofessional

collaboration for nursing.

This vision

of

the future

of

healthcare in the U.S. defines

interprofessional

collaboration

as the

norm.

The IOM states the role of nurses

is

to

design and implement early and continuous BPE

through

collaborative classroom and

clinical

opportunities.

IPE can only be

achieved

through committed collaborative

partnerships across professions. Collaborative cultures in

this IOM

vision

are

vital in

sustaining

and continuing

improvements in

quality

of care.

Lingard et

al.

(2004) focused on daily

practice

interactions rather than ideal

or

abstract notions

of

teamwork. They studied interprofessional tensions related to

commodities,

perceptions, and

team rules that

threaten

quality healthcare

in

hospital

settings.

Ownership (of constructs and commodities such

as

knowledge, skills,

equipment,

and territory) and

trade (of concrete

items

such as

equipment and resources

and also of abstract items

such

as

respect, goodwill, and knowledge) are barriers

to

effective medical teams. They

found

that mutual support and shared goals are more

likely to contribute

to

effective medical teams because they minimize competition and

contest. Acknowledging tensions enables teams to anticipate reactions and deflect

obstructions

so

that more

effective

teams may emerge.



5

Despite IOM directives,

WHO

recommendations, and current literature, most

healthcare professional students in the United States (U.S.) do

not

receive specific

education

about being

a

member of

a

collaborative team.

In

the U.S.,

education of

healthcare

professional students continues

to

be discipline specific and continues in

a silo

approach

at most educational

institutions (Hammick,

Freeth, Koppel,

Reeves, & Barr,

2007;

Hyer, Fairchild, Abraham, Mezey, &Fulmer, 2000). In this silo approach, health

professions are

isolated within

their

own

disciplines, or

intellectual

walls, living

within

their

own departments, professional

associations,

professional journals, and

belief

systems (Gilbert, 2008).

It

is

not

clear

in

the

literature as to

why health

professions

continue

to be isolated within their own disciplines and remain

in

their silo or discipline-

specific

approach

to educating their students.

Accrediting bodies

for

nursing,

including the

National League

for

Nursing

Accreditation Commission (NLNAC, 2012) and the Commission on Collegiate Nursing

Education

(CCNE, 2012), and

other healthcare

profession education programs

currently

require evidence of IPE curriculum integration and expectations for healthcare

professionals to function in effective teams. IPE

is

relatively new to nursing and

other

health profession curricula since nursing did not respond initially to the

2001

and 2003

IOM reports. While the published accreditation

criteria

timeline

of

change

is

not

documented

in the

literature, the current versions of

accreditation include

IPE language.

Many nursing and other healthcare faculty have not been educated this way, and

healthcare

faculty attitudes toward

EPE,

interprofessional (IP) teams and

IP

learning in

academic settings are largely unexplored. Literature regarding faculty attitudes and



6

familiarity with IPE

is

lacking, with most available IPE literature originating from

Europe

or

Canada. U.S.-based IPE literature is lacking. The degree

to

which the lack

of

U.S. IPE literature and

the

abundance

of

foreign

IPE

literature

is

related

to

differences in

the

healthcare delivery systems,

privatized

physician driven

in

the

U.S.

versus socialized,

or universal, healthcare

in

Europe and

Canada, is unknown. The degree to

which

U.S.

developing literature may be similar ordifferent

from

the existing abundance

of

foreign

literature is

also

unknown at

this

time

and

will become clearer

as

more U.S.

research

and

literature becomes available.

The accrediting bodies

implementing

IPE standards

provide

social

pressures

for

healthcare educational programs to provide

evidence

that they have implemented and

are

continuing to implement IPE consistently.

These social

pressures are

one source of

motivation behind

the

recent resurgence

of IPE discussion and

debate.

For example,

in

the discipline

of

nursing, NLNAC (2010) and the CCNE (2010) have both stated that

nursing

education

programs must provide

evidence of

interprofessional

collaboration

in

interprofessional teams and during patient

care

activities.

The American Association

of

Colleges of Nursing (AACN) stated

that

one of the essentials for baccalaureatedegree

nursing graduates

is

interprofessional communication and collaboration

for

improving

patient

health outcomes (AACN, 2009).

Association of

American

Medical Colleges (AAMC)

president,

Dr. Darrell Kirch,

stated

that

interprofessional

education and

practice

has been designated

as a

key strategic

area that will

be vital to the culture

of

physicians (AAMC, 2008). Kirch also

recommended that simulation center inventories should be shared by health professional



7

education

programs (AAMC, 2008)

since

simulation centers are

an

appropriate place

to

integrate healthcare professional students and create interprofessional learning

experiences.

The Liaison Committee on Medical Education (LCME) stated medical education

programs must integrate the Accreditation Council

for Graduate

Medical Education

(ACGME) competencies into curricula (LCME, 2009).

ACGME competencies include

interpersonal communication skills that

result in the

effective exchange of

information

and

collaboration

with patients, their

families,

and

other

health

professionals

and work

effectively in a team

as a

leaderor member (ACGME, 2009).

The

ACGME

competencies

also

include

systems-based practice where

students

must

demonstrate use

of

resources

effectively

including

other

healthcare professional

contributions.

The Commission on

Accreditation in Physical

Therapy Education (CAPTE, 2010)

values interdisciplinary scholarship, interdisciplinary care involvement, and

communication. The Council on

Social

Work Education (CSWE, 2010) acknowledges

the

importance of

human

relationships and

promotes

interprofessional and

interdisciplinary collaboration.

The

Accreditation Review

Commission on

Education

for

the Physician Assistant (ARC-PA, 2010) promotes interprofessional education and

practice

and

expects

physician

assistant students to engage in interprofessional team

environments.

The

Accreditation Council

for

Occupational Therapy Education (ACOTE,

2010) does

not

refer specifically to interprofessional, interdisciplinary, or

multidisciplinary education or practice within their education program accreditation



8

standards; however, they do

refer

to preparation

of

occupational therapy students for the

role

of

professional

within

emerging healthcare environments.

The

Accreditation Council

for

Pharmacy Education (ACPE, 2010) stressed

interprofessional teamwork and learning throughout their guidelines. Other initiatives

involved with the development and incorporation

of

IPE into educational and practice

arenas include the Interprofessional Education

for Collaborative Patient Centered

Practice (IECPCP), the

United Kingdom

(U.K.) National

Health

Services (NHS) Choices,

and

The Association for

Prevention Teaching

and

Research

(APTR).

The

IECPCP has

formulated and developed IPE policies, formed the Canadian Interprofessional Health

Collaborative

(CIHC), developed EPE

learning projects,

and conducted

IPE research

(IECPCP, 2009).

NHS has developed

The

Center

for

Interprofessional e-Learning

(CIPeL, 2011).

The American Interprofessional Health Collaborative (AIHC) first

began

in 2007.

It is the first and only interprofessional collaborative in the U.S. (AIHC,

2011).

Globally,

additional initiatives include: the Nordic Interprofessional Network (NIPNET), which

includes Denmark, Finland,

Norway, and Sweden

(NIPNET,

2011); the National Health

Sciences

Students'

Association (NaHSSA),

a

Canadian-based student association

started

in 2005 (NaHSSA, 2011); the

International Association

for

IPE and

Collaborative

Practice (InterEd),

which was

conceived

in

Canada

and

considers itself a

worldwide

voice

for IPE (InterEd, 2011);

the

European IPE Network (EIPEN) which is

a

partnership

among Greece, Finland, Hungary, Poland, Sweden,and the U.K. started in 2004 (EIPEN,

2011); and the Australian Interprofessional Practice and Education Network (AIPPEN),



9

which

includes

health professional educators

from

Australia and

New

Zealand

and

was

started in 2006 (AIPPEN, 2011).

A synthesis of the IPE literature and

research

suggests many benefits of IPE.

In

a

synthesis

of

the literature resulting in

a

concept analysis, Olenick et al. (2010a) identified

several

of

IPE's proposed benefits including negotiation,

conflict

management, shared

decision

making,

highly integrated teams,

patient-centered

care, improved

communication, mutual trust and respect, and relinquishment of

healthcare

professional

stereotypes. IPE

aims

to

eliminate

segmented education

among

healthcare professionals,

and facilitate relinquishment

of

hierarchies, misperceptions,

and

miscommunications

amongst healthcare professionals. IPE legitimizes

a

holistic approach

where

healthcare

professionals

recognize

one

another's

contributions to patient care.

It deconstructs

preconceived, inaccurate stereotyping

and

rebuilds

accurate

identities

and

knowledge for

appropriate utilization

of

all healthcare professional resources.

The

literature

also

proposes

a

number of positive outcomes

of IPE,

including: IP

learning, negotiation, leadership,

personal

growth, lifelong learning, relinquishment of

stereotypes, information exchange,conflict management, cohesion, shared decision

making, interprofessionality, improved self-esteem and confidence in professional role,

highly integrated teams, collaborative practice, patient-centered care, improved quality

of

care, improved

competence,

improved communication,

mutual trust and respect,

and

improved understanding

of

healthcare professional roles between and

among

healthcare

professionals (Olenick et

al.,

2010a).

It is

important to note, however, that empirical

evidence to support these

actual

outcomes of IPE is lacking. The literature does not



10

identify any negative outcomes

of

engaging in BPE. However, the literature mentions

barriers to engagingin

BPE.

A Cochrane Review was done on the topic

of

interprofessional collaboration, one

proposed benefit

of

IPE.

The objective

was to determine the

effect of

interprofessional

collaboration on patient

care outcomes. There

were only

five articles that

met the

inclusion

criteria for this review

since

there has been very little

research

done

in this area.

The review revealed

that

improved

patient-centered

outcomes may result

from

effective

and highly-integrated teams (Zwarenstein, Goldman, & Reeves, 2009).

The time it takes to implement

DPE

depends on the degree to which it is to be

integrated. IPE

may

be simply integrated into a student experienceor a course or it may

be

integrated

into a

curricular structure, which

may

involve

a

process

over

several

years.

IPE

implementation time

frames

may vary

from

school to school. In

this study,

the

researcher explored faculty intent to engage in IPE

within

three years. The rationale for

the

three-year

time frame

was determined based on an

estimate of the time it

may

take

some

schools

to

implement anticipated

IPE

curricular changes

since curricular

changes

require planning and

approvals.

Schools

in

the U.S. that have designated centers

for

IPE

include

the University

of

Washington, the University of Minnesota, Thomas Jefferson University, St. Louis

University, and

Creighton University. There is

only

one

regional model

of IPE in

the

U.S. This

regional

model was founded

by

The

Commonwealth

Medical College in

Scranton, Pennsylvania

and

is

a

cooperative effort

of

18 colleges and

universities in

northeastern Pennsylvania that

create

experiences for the many different

types of



11

healthcare disciplines from all of the participating colleges and universities in the model

(Olenick

et

al., 2010b).

Aims of the Study

The

aims

of

this study were to explore:

1) Healthcare faculty (HCF) attitudes toward IPEand IPHCT;

2)

HCF

perceptions

of subjective norms' influence on HCF intent toengage in IPE;

3)

HCF intent to engage

in

IPE;

4)

Differences

among types

of

healthcare

faculty

in

attitudes toward

IPE and

IPHCT

and intent to engage

in

IPE.

Research Questions

Research questions for this study were:

1) What

are healthcare faculty attitudes toward interprofessional education and

interprofessional healthcare teams?

2)

What are the subjective norms that influence

healthcare

faculty intent to engage

in

interprofessional education?

3) What are healthcare faculty intentions regarding engaging in interprofessional

education?

4) What

are

the relationships among healthcare faculty attitudes

toward

interprofessional

education,

interprofessional healthcare teams, and

intent to

engage in interprofessional education?

5) What are the differences

in

attitudes

toward interprofessional

education and

interprofessional healthcare teams,

and

intent to engage in

interprofessional



12

education among healthcare faculty

from

various professional healthcare

programs?

Theoretical Basis of the Study

The Theory of Reasoned Action (TRA) by Fishbein and

Ajzen

(1975) served as

the theoretical basis

for this

study.

TRA,

which predicts behavioral intent and originated

within the field of social psychology, was chosen rather than

a

nursing theory because

it

appeals to a wider professional audience, which will facilitate disseminating this

particular study, since it concerns

several disciplines, including but

not

limited to nursing.

This

study was not

about

health or client

and

client care; it was

about

the education of

healthcare

professionals.

TRA is a general

theory that

has more

common ground

among

the

various

HCF

included in this study.

TRA is

most applicable to measurement

of

attitudes.

TRA has very strong, compelling, predictive use (Hartwick & Warsaw, 1988).

TRA

authors specifically identify that

the

theory was developed to

explain

behavioral

intentions rather

than

carrying out intentions (Hartwick

&

Warsaw). TRA was also

chosen over the Theory of Planned Behavior (TPB) (Ajzen, 1991),

which

purports to

predict actual behavior.

TPB implies

self-efficacy,

control,

and

a notion

that

one

person

can control something. TPB was not applicable to this study since

this researcher

did not

measure perceived behavioral control or actual behavior.

Theory

of

Reasoned

Action

Theory of Reasoned Action

(TRA)

by Fishbein

and

Ajzen, first published in

1975, provided an approach

for examining

healthcare faculty intentions to

engage

in

IPE.



13

The

theory

was

first designed to predict voluntary behaviors

such

as

consumer

behaviors

and behaviors that linked a person's goal intentions and behavior intentions,

such

as

with

weight

loss.

Intentions lead to behaviors whether they are

voluntary or not since

it

is

now

accepted that there

is a

degree of uncertainty that applies to all goals even if intentions are

clear (Sheppard, Hartwick, & Warshaw, 1988). When BPE is viewed within TRA, HCF

attitudes

and social pressures are assumed to

affect

HCF intentions

to deliver EPE

to

healthcare professional students.

TRA explains the

links among attitudes,

intention,

and behavior.

The

three

main

components of TRA are attitudes (AT), subjective norms (SN), and behavioral intentions

(BI).

The

combination of attitudes and subjective

norms

predicts behavioral intentions.

TRA

has been found

to

predict

intentions

and

behaviors well

(Sheppard

et al., 1988).

There is

no feedback

or

extraneous influences between AT and SN

in

prediction

of

intention, but it is the sum

of

these that influence and predict behavioral intent.

TRA

research

(O'Keefe,

1990) has shown that

attitude is a much

stronger and more accurate

predictor

of

behavior intent than subjective norms. Therefore,

although

SNs are

useful in

TRA, attitudes are

proposed

to have a

more

significant

influence on

behavior intentions.

TRA

proposes that there

are

situations that limit the influence

of

attitude on

behavior. For example, if

a

person

has

a

very strong desire to engage in IPE but does not

have the support

to

do so, then the person

may

not

actually engage

in IPE,

despite having

a significant

positive attitude and intention to

engage

in

DPE.

TRA more

explicitly

explains

behavioral

intention,

rather

than action

or

actual behavior.

Fishbein

and Ajzen

(1975) identify

that

TRA

was developed to

explain behavioral

intentions rather

than carry



14

out intentions. TRA

has

very compelling

predictive

use; however, potential

limitations

and issues exist

when

TRA is expanded beyond prediction

of

intentions to determine

actual

behavior or

goal attainment (Sheppard et al., 1988).

This

study

measured

intent

only

and

did not measure

behavior.

Fishbein and Ajzen (1975) defined attitude as a

"person's

location on

a

dimension

of

affect

or evaluation"

(p.

53). Attitudes

are developed

based

on

the strength

of a

person's beliefs

and on positive or

negative

personal feelings about

performing a

behavior.

In

TRA,

belief is "location on a probability dimension

that

links

an

object and

an attribute" (p. 53). Beliefs and feelings are

based

on a person's

perception

of how

important

or unimportant

something

is. Strength of

beliefs and

feelings may change

according to

the

internal and external influences that affect them. Therefore, attitudes

may

change

based on changes in beliefs and feelings. Attitudes

can

change over time

so

all measures using this

theoretical

model must occur at the same time.

Subjective

norms

are

the perceived social pressures to perform

a

behavior (Ajzen

& Madden, 1986). "Normative

beliefs

and

motivation to comply lead to normative

pressures. The totality

of

these normative pressures may be termed subjective norm"

(Fishbein

& Ajzen, 1975, p. 16). Normative beliefs are what a

person

thinks

others

want

or expect them to do.

Motivation

to comply

is

a person's assessment of

how

important it

is to them to do what others want

or

expect them

to

do. Subjective

norms

are a

person's

perception of what someone

of

influence wants them to

do.

Subjective norms consist of

both internal and external

influences. Internal

influences include skills,

abilities,

information,

and

emotions. External influences

include

situational or

environmental



15

factors such as any conditions that contribute to the way

a

person acts or reacts (e.g.,

information acquisition, disposition,

and

physical and social surroundings).

Intentions

are

dimensionsof probability that link

a

person's intentions to action.

Behaviors

are "observable acts"

(Fishbein

&

Ajzen, 1975, p. 13). Behavioral intentions

are guided by attitudes

and

subjective

norms. Intentions

are not to be thought of as exact

determinants of future behavior.

Imperfect knowledge

of future behavior exists. TRA

describes

factors

that may affect future behavior, even with the best of intentions.

According to TRA,

behavioral intention

predicts

behavior but does

not directly cause it to

occur since behavior may be affected by three factors, volitional control, consideration of

the relationship

between

attitudes

and behavior at

the same level, and change in attitudes

over

time.

Volitional control, people's control over

their

own behavior, is the first factor that

affects behavior. For example, faculty

may

want to engage in IPE but other disciplines at

their

institution

may not

be

interested in participating;

therefore, the faculty

interested

in

IPE may

perceive that

they

do

not

have control over the situation. The second factor that

affects behavior

is that attitudes and behavior must

be considered at the same

level. For

example, if faculty

intend to fully

engage in

IPE, then they

may

not be satisfied with

only

involving one other discipline

to

share

one

lecture. IPE is an experiential, learning, and

socialization process; therefore,

lecture

alone does not meet

the

standard

of the

definition

of IPE and

is

not at the level of

IPE

as it

is

defined. The third factor that affects behavior

is

that

attitudes

may

change over time so

that behavioral

intention and behavior must be

considered at the

same

time for the data to be accurate.

For example, after one year,



16

one's

attitude toward IPE may change and now the faculty

member

who did

not

intend to

engage in IPE

now

intends to engage in IPE educational activities. TRA proposes an

interactive

process

wherein the

acquisition

of new information may change a person's

attitudes,

perceptions

of subjective

norms,

or intentions

(Fishbein

& Ajzen, 1975). The

relationships among attitudes, subjective norms,

and behavioral intentions

are

presented

in

Figure

1.

Main

TRA concepts are presented

in bolded

boxes and sub concepts are

presented in boxes with thin lines.

Application

of the Theory of Reasoned Action.

Variables

in this study

represented constructs

of

TRA theory. When IPE was viewed

within TRA,

healthcare

faculty attitudes

and

subjective

norms were positioned to affect healthcare

faculty

intentions

and

ultimately behavior to engage

in

IPE

in

the

education

of healthcare

professional

students.

Attitudes

toward

IPE, attitudes

toward

IPHCT, and perceptions

of

subjective

norms were measured in this study since they were unknown factors in the prediction of

IPE implementation.

Faculty intentions to engage

in

IPE were proposed

to be a

result

of

the combined influence of attitude toward IPE, attitudes toward IPHCT, and subjective

norms

about

IPE.

In

this study,

intention to engage in IPE was postulated

to

be based on attitudes

toward

IP

concepts and the

perception

of subjective norms. This study examined various

healthcare

professional faculty attitudes toward IPE

and

IPHCT. Data collected

revealed

how likely

HCF

were to

engage

in IPE

over

the next

three years.

IPE implementation



17

Internal

and

External

Influences

Beliefs and

Feelings

Attitudes

Behavioral

Intentions

Subjective

Norms

Internal

and

External

Influences

Relationship

between

attitudes

and

behavior

I *

Change in

attitudes

over time

Volitional

Control

Figure 1.Model

of

TRA.

intentions and

subsequent

behavior may be

a function of

healthcare

faculty attitudes

toward IPE

and

IPHCT in

combination with

subjective

norms related

to engaging

in

IPE.

Application

of TRA to this

study

is

presented

in Figure 2. This

study focused

on

HCF

attitudes toward

IPE

and

EPHCT,

IPE

subjective

norms, and

intent to engage

in

IPE.

However, actual

engagement

in

DPE

was not measured.

The study variables are



18

Attitudes

Toward IPE

and IPHCT

Intent to

engage in

IPE

IPE

Subjective

Norms

Figure

2. Application

of TRA to current study.

represented in Figure 2 where the combination of attitudes toward IPE, attitudes

toward

IPHCT, and IPE subjective norms predict intentions to engage in IPE.

Definitions of

Terms

Interprofessional education

(IPE) is

an andragogical, interactive, experiential

learning, and socialization

process

that occurs when

two

or more members of a healthcare

team, who participate in either patient assessment

and/or

management, learn with, from,

and about each other as they collaboratively focus

on

patient centered

care

and achieving

optimal health outcomes (Olenick

et

al., 2010a).

Interprofessional

health care teams (IPHCT) are groups of health professionals

from

at

least two or more different disciplines or

professions

who share a common

purpose

and work together collaboratively and interdependently to serve

a

specific



19

patient/client population and achieve the

team's

and

organization's

goals and objectives

(Curran

et

al., 2008).

Attitude

is

a state of mind or disposition (Oxford Dictionary, 2009). Attitudes are

a "person's location on a dimension of affect or evaluation"

(Fishbein

& Ajzen, 1975, p.

53).

Attitudes

toward

IPE are faculty's

feelings

and beliefs about IPE. Attitudes

toward IPE

were

measured

by

total scores on

the

Attitudes Toward IPE (AT-IPE)

instrument,

adapted

by

Curran et

al.

(2008).

Attitudes

toward

IPHCT are faculty's feelings

and

beliefs

about

IPHCT.

Attitudes

toward

BPHCT

were measured by total

scores on

the Attitudes Toward

IPHCT

(AT-IPHCT),

adapted by Curran et

al. (2008).

Subjective norms are the HCF perceptions of the extent

to

which

they believe

their faculty colleagues and

school's

administrators think that faculty should

or

should

not

engage in

EPE.

Subjective

norms

were

measured using

two

single

item, continuous,

7-point magnitude rating scales developed by the researcher.

Intent

to

engage in IPE

is

HCF's determination to act

on

and involve

oneself

in

IPE. Intent to engage in IPE was measured on

a

researcher developed single item 10-

point Likert scale of

HCF

intent to engageor continue

to

engage in IPE over the next

three

years.

Healthcare

faculty are teachers who hold an academic

appointment

within a

particular health discipline school or department, or those

members

of administration,

having academic rank in an educational institution in a healthcare discipline.

HCF

are



20

members

of

specific healthcare disciplines that formally participate in the instruction,

design

of

instruction,

or

implementation

of

instruction

of


students.

In this

study,

healthcare faculty

include

the disciplines

of

nursing (NU),

medicine

(MD), pharmacy (PH),

physical

therapy (PT), occupational

therapy

(OT),

physician assistant (PA), and social work (SW). HCF

self-identified as members of

the

disciplines listed above by responding

to

Question

5 on the

Demographic

Data

Form.

Assumptions

of the

Study

Assumptions

of this

study were that:

1. Faculty self-reports will

be

accurate reflections

of

their attitudes toward IPE and

IPHCT.

2. Faculty understand the definition

of IPE as

presented

to

them

in this

study.

Significance of

Study

IPE intentions and effectiveengagement in IPE are influenced by attitudes toward

IPE, attitudes toward IPHCT, and subjective norms. Negative attitudes toward

IPE and

IPHCT present barriers

to

IPE's effective implementation (Curran

et al.,

2007b). Prior

research

on

IPE has been conducted primarily with students and IPE outcomes. There

is

very little research

done

on faculty in relation

to

IPE.

In

practice, traditional role and

territoriality issues still

exist

among healthcare providers (Curran et al.). With

development

of

new and extended professional

roles

such as the doctor

of

nursing

practice (DNP) and

the possibility

that pharmacists will have prescriptive authority,

effective IP collaboration,

established through

IPE,

may diminish negative attitudes and

stereotypes and promote

a

focus on effective working relationships for

optimal

patient-



21

focused

care

through facilitation and optimization of collaborative

patient

care

and

safety

(Zwarenstein et al., 2009).

Several

authors have highlighted

the

need

for

faculty development in the area of

IPE (Castro et

al.,

1994;

Freeth et

al., 2003). Over the past decade, WHO,

along with

various professional healthcare organizations, has recommended IPE faculty

development.

However, to date, faculty development in IPE

is still

lacking (Hoet

al.,

2008). If

faculty do

not receive support and development in the area of IPE, and if their

attitudes

toward IPE are not fully known,

IPE

may not be implemented

effectively. It is

unknown if IPE is currently not

being

implemented effectively because

HCF

are

uncomfortable with it or because they

are

not sufficiently knowledgeable to incorporate

it

effectively. Traditional methods

of silo

approaches

to

health discipline education are

likely to

continue

if

HCF

do not incorporate IPE appropriately (Curran et

al.,

2007).

HCF may remain isolated within territorial silos without IPE.

Nursing

Education

Traditionally, nurses have learned ontologic elements from nursing instructors

and

were socialized

exclusively

into one defining

role

(Clark,

2006).

This

insular

approach

may leave

nurses

largely

unprepared

to function

in

collaborative

teams

(Zwarenstein et

al., 2009).

The literature speaks to

IPE as

essential to

health professional

education because

of

the significance

of

all consequences generated by the phenomena

such as mutual respect, collaborative practice, and understanding

of

respective roles

(Olenick

et al.,

2010a) and the focus on patient-centered

care

with optimal health

outcomes (Curran et al., 2007;

Hammick

et al., 2007; Wilcock et al., 2009).



22

Nursing education must evolve to meet accrediting body expectations by

incorporating

EPE

into existing curricular structures (Committee, 2001; Greiner

&

Knebel,

2003). It is important to

study

healthcare

professional

faculty

attitudes

toward

IPE

and

IPHCT

and

the

influences, or subjective norms, that affect intentions to

engage

in IPE.

Many

nursing faculty have

never

been educated in an interprofessional

environment and have

not

practiced in one, thus they may be uncomfortable with

interprofessional collaboration. Also, their perspective may be limited to that

of

their

own discipline's context. Health professional faculty and

current

practicing professionals

are products

of an educational system

whose approach

to teaching

and learning has

been

limited in terms

of silos

of specific ontologic discipline education (Curran et al., 2007).

In addition, there may be little direct

benefit

to faculty for

exerting effort to

implement

effective

IPE.

In addition to the increased workload

of IPE

integration, there may be

little university administrative support or recognition associated with IPE implementation

(Gilbert, 2005).

Within TRA's conceptual framework, knowledge of faculty attitudes

is

essential

for

predicting whether

or not

faculty will implement IPE.

Currently, there are no specific recommendations regarding

when

or how IPE

should be incorporated into health professions education, including nursing programs.

However, Hoffman and

Harnish

(2007)

and

Tunstall et al. (2003)

recommended that

IP

learning take

place

early on at the undergraduate

health

professions educational level

before negative stereotypical images, negative socialization, and

professional

prejudice

develop.

DPE,

early on in nursing and other health professions education, has the

potential

to

lead

to positive attitudes, improved confidence,

better

valuing

of

other



23

professionals and can leave

a

lasting impression that promotes

collaborative

practice in

students' professional lives after graduation (Hoffman & Harnish). This is significant

to

nursing education, since nurses have long dealt with professional inequities in their role

as healthcare providers.

IPE was first

introduced

in 1978 by WHO. IOM

reports support

its

implementation. In 1998, Barr identified IPE as arguably overdue. It is

now

2012,

and

IPE has

still

not been

effectively

implemented

in

nursing.

This

study is important

because

it

explores

HCF

attitudes toward IPE and IPHCT, the subjective norms

associated with

engaging

in IPE,

and

their intentions to engage in IPE in

the

U.S..

Nursing

Research and Science

Research on

the topic of

IPE

will

contribute

to overall clarity, consistency,

and

understanding of IPE among educators, professionals,

and

researchers. Research is a

way

to discover, explain, and gather information about IPE and faculty attitudes that affect its

implementation. Determining faculty attitudes toward IPE

and

IPHCT, and identifying

subjective norms that influence behavioral intent may be the

first step

in understanding

behavioral intentions for

effective

IPE delivery.

IPE studies will lead to more effective

delivery and evaluation of EPE, therefore, improving IPE outcomes.

IPE education, research, and practice

may

contribute

to

development

of

IPE

nursing knowledge.

Carper (1978)

described ways

of

knowing in nursing

as empiric,

aesthetic, personal,

and

moral knowing.

IPE

empiric knowing is generated

through

research, evidence-based practice,

and

dissemination of

IPE

research. This study is

significant

because expansion of

knowledge

of

IPE,

HCF attitudes

toward

IPE and



24

IPHCT, and

the

subjective norms that influence intention to engage in EPE

are

essential in

nursing as

a

result

of

IOM recommendations and accrediting

body

standards.

It

is

also

essential since

much

of the

available

literature suggests

that

IPE may contribute to

improved

patient

outcomes,

although research

needs to be done to validate this claim, the

existing body

of

literature

is

largely anecdotal.

IPE is

aesthetic

in

nature. Aesthetic knowing is

content

that cannot

be

taught

because

it is expressive,

not formal or

descriptive

(Carper, 1978).

In IPE, learning occurs

through

experiences, "This

approach

to education suggests

that

the insights and skills

acquired by the participants in an interprofessional experience are the learning itself'

(Clark, 2006,

p.

580). IPE's experiential learning component is a holistic adaptive

learning process. In IPE, intuition

and

experience

are part

of the art of collaboration in

nursing practice. IPE

is

social and collaborative in nature, which contributes to personal

knowing or encountering experiences

in

nursing (Carper).

IPE also has a large component

of

moral knowing or fundamental judgments of

right and wrong (Carper, 1978). In IPE, values and decisions are shared and respected

within and between

disciplines.

IPE

is

very different from

the

traditional method

of

learning ontological

elements from

an instructor and being socialized

exclusively into

one

defining role

(Clark,

2006).

Nursing

Practice

EPE

has

the

potential

to

influence patient safety, quality of

care,

and health

systems

improvement issues for

patients

(Ladden,

Bednash,

Stevens, & Moore,

2006).

Interprofessional collaboration among healthcare professionals improves patient



25

satisfaction (Reeves et al., 2009). Presently, there are issues in nursing and medicine,

such as workforce shortages, contributing to the lack

of

collaborative practice, lack

of

patient-centered

care, and

lack

of knowledge related to professional roles

in

healthcare.

Through IPE, learners can

gain

negotiation skills, leadership

skills,

teamwork skills, and

improved communication skills.

They can

become better

able

and more prepared to

exchange knowledge and information, share

decision

making, manage conflict,

and

provide patient-centered care through a better understanding

of

respective roles (Olenick

et

al., 2010a). Evidence also

suggests that IPE learners have improved

self-esteem, self-

confidence, and competence in practice (Oandasan

&

Reeves, 2005).

Nurses'

emotions and

attitudes

affect their ability

to

work

effectively

in

interprofessional teams (Miller, Reeves, Zwarenstein, Beales, Kenaszchuk,

&

Conn,

2008). Longstanding emotions toward previous non-optimal relationships with

physicians and other healthcare providers and lack

of

appreciation

of

nursing's

contribution

to

optimal patient

care

must

be

managed before the reluctance

of

nurses to

participate in interprofessional teams can be improved (Miller et al., 2008).

Negative

emotions or attitudes

toward

previous non-optimal relationships

may

be contributing to

IPE barriers.

Understanding healthcare faculty attitudes

toward

IPE, attitudes toward

IPHCT, and

the subjective

norms that influence intentions to

engage

in EPE

is

important

since these factors may affect their ability

to

work in teams effectively and implement

IPE

effectively.

IPE may counteract negative stereotypic images (Tunstall-Pedoe, Rink,

&

Hilton,

2003). Nurses have been negatively stereotyped as hand-maidens to physicians, angels,



26

battle axes, sexy,

saucy, kinky, and naughty

(Ferns &

Chojnacka,

2005;Jinks,

2004;

O'Dowd,

1998). This raises very important issues regarding how nursing is exploited

in

the media

and entertainment

industries. It also

raises very important

issues

regarding

how nursing students perceive their own role and how other healthcare students perceive

nursing

students.

Decentering

the

healthcare environment,

through

interdisciplinary

development, could assist nursing in recognizing the unique qualities, strengths, and

contributions

nursing

brings to healthcare and

research

(McBride, 2010). IPE

may

assist

nursing in overcoming frustrations and realities regarding the external locus of control

(social,

political, and

economic

forces)

inequities

and

hierarchies that

have, for

so

long,

overshadowed

nursing's

professional

status.

IPE, early on in nursing education, may

eliminate the

barriers nursing

has faced

in

achieving well respected, equitable

professional

status

in

the

healthcare team.

IPE may foster mutual respect and mutual trust among healthcare professionals,

may

improve

quality

of care,

and

can

make healthcare teams cohesive

by

relinquishing

stereotypes

(Olenick

et al.,

2010a).

Lifelong learning and personal growth

are also

benefits

orconsequences

of DPE. The

most desired consequences

of

IPE, however,

are

collaborative practice

and

patient-centered care. Understanding how IPE influences

healthcare professionals' ability

to

work together effectively has tremendous significance

since

collaboration

and

highly integrated teamwork are

essential to

patient safety and

quality

of care

(Olenick

et al., 2010a; Greiner &

Knebel,

2003).



27

Chapter Summary

In

the current state

of

healthcare crisis in the U.S., IPE is particularly timely.

Through effective incorporation of IPE into health

professional education

curriculum and

professional

settings, optimal

patient-centered

outcomes

as

a

result

of

truly collaborative,

integrated teams addresses

the problems with

fragmentation in

healthcare

delivery and

separation among healthcare professionals.

IPE may reduce

segmented

education

between healthcare professionals, therefore relinquishing the hierarchies, misperceptions,

and miscommunications.

It

can legitimize

a

holistic approach where healthcare

professionals recognize

one another's

contributions

to

patient

care. It

can deconstruct

preconceived inaccurate stereotyping and rebuilds accurate identities

and

knowledge for

appropriate

utilization

of

all healthcare

professional resources.

This

study

is

also particularly timely

since

nursing accreditation bodies and other

accrediting bodies for healthcare professional education

now

require evidence

of

IPE

curriculum integration.

In

addition

to the IOM, accrediting

bodies

and organizations

concerned about health professional education

are

the powerful forces behind the push

for IPE. These entities have

the

capabilityof requiring evidence of

structured

DPE

activity

and

monitoring

for

collaborative

practice. IP collaboration contributes to

improved healthcare and patient outcomes (Zwarenstein et al., 2009).

IPE is

still not common

in

healthcare professional programs in the U.S. Very

little

research has been

done on

faculty in relation to IPE. Most

of

the IPE research that

has been done relates to students and has demonstrated the benefits of IPE

to

patient

safety, quality of care, and professional practice. Studying faculty attitudes toward IPE



28

and IPHCT,

subjective

norms, and intent to

engage

in IPE,

within the

Theory

of

Reasoned Action (TRA)

provided

insight into the prediction

of

faculty behaviors or their

intent to engage in IPE into their courses and

curricular structures. Within

the

model of

TRA, the combination

of

faculty attitudes and subjective norms predicts intentions to

engage in IPE. IPE

research

will contribute to the effective delivery of and engagement

in IPE.



29

Chapter II

Literature Review

The aims

of

this study were

to explore

healthcare

faculty

(HCF) attitudes

toward

IPE and interprofessional healthcare teams

(IPHCT), HCF

perceptions

of

subjective

norms' (SN) influence on HCF

intent

to

engage in IPE,

HCF

intent to engage in

IPE

within three years, and

differences

among

types

of HCF attitudes

toward

IPE

and IPHCT

and intent to engage in IPE. A review

of the

literature concerning the concepts

of

IPE

and DPHCT,

Fishbein

and

Ajzen's

Theory

of Reasoned Action (TRA) (1975)

and faculty

attitudes towards IPE and IPHCT

is

presented.

The literature reviewed was primarily from the journal

that

focuses on IPE, the

Journal of Interprofessional Care (JIPC). Literature was also reviewed

from

the

disciplines

of nursing, medicine, pharmacy, allied health,

social

work, and health

professional education. Pubmed, CINAHL, ERIC, Scopus, and Ovid online searches

were

supplemented

with

a manual

search and

ancestry

methods.

Searches

included the

keywords: interprofessional, interprofessional education, interprofessional

practice,

interprofessional learning, interprofessional healthcare teams and faculty attitudes

towards IPE and

IP

healthcare teams. In

addition,

the

writings

of

Fishbein and

Ajzen

and

related TRA literature were searched.

Searches included years

1990

to

2011.

Gaps in

Existing

Knowledge

This

literature review

presented

some

challenges for the researcher.

The

combination of computer-based, manual,

and

ancestry

search

methods

revealed

that

empirical literature

is

lacking in many

of

the topic areas concerning IPE.

In addition,



30

some of

the

available

empirically-based literature reviewed were found

to offer

too

little

details or useful information. Therefore, some studies were included in this literature

review

that

were not exceptionally

well

done.

Interprofessional

Education

Definitions

of

Interprofessional

Education

A comprehensive literature review

of

this complex concept revealed that there

are

several different interpretations, overlapping terminologies, interchangeable terms and

a

lack of uniformity of a definition

for

IPE.

This general lack

of

clarity contributes to

misunderstandings of IPE and creates barriers to optimal BPE implementation. There

are

no definitions

of

IPE in the English dictionary or encyclopedia. There are no dictionary

or encyclopedia definitions for interprofessional or interprofessionality. Education

is

defined

by

Merriam-Webster

(2008) as

the

action

or

process

of

knowledge development.

When IPE was searched online, search sites returned only healthcare and

healthcare education related materials and information.

The

World Health Organization

(WHO) (2010) stated that EPE "occurs

when

two

or

more professionals

learn

about, from

and with

each other

to

enable

effective

collaboration

and

improve

health

outcomes" (p.

13).

The Center for

Advancement

of

IPE (CAIPE,

2002) defined

interprofessional

education

as a

teaching and

learning

process that

fosters collaborative

work and

improves

quality of care

between

two or

more professions.

It

occurs when students learn with,

from,

and about

one another. This definition

has

been adopted by the Canadian

Interprofessional Health Collaborative (CIHC, 2008). The CIHC

added

that BPE occurs



31

when health care professionals learn collaboratively within and across disciplines to

acquire knowledge, skills,

and

values

needed

for working in healthcare teams.

The Interprofessional Education for Collaborative Patient Centered Practice

(EECPCP, 2008) defined IPE as learning together to promote collaboration. They stated

there are three components to IPE including: 1. socialize healthcare professionals to work

together; 2.

develop

mutual understanding and respect

for various disciplines,

and;

3.

impart collaborative practice competencies.

Clark

(1993)

defined IPE as students learning together as

a

team. Integration is

characterized by interdisciplinary contributions. Implementing IPE in the education

of

health professions' students

prepares

them to

work

together more effectively.

Clark

(2006) proposed utilization

of

theory to

guide

IPE research

and

recognized that most

IPE

research is

anecdotal,

descriptive,

and missing usage

of

theoretical

frameworks.

Clark

(2006) identified that contemporary healthcare systems require health professionals to

work

in highly integrated teams.

Barr (1998)

did not explicitly define IPE. Instead, he

suggested

competencies to

describe IPE. He noted

how

relationships are strengthened as professionals begin to

understand

their own roles and the roles of others, which eliminates stereotypes and

generates mutual trust.

Barr

described IPE

as a

rewarding

experience

that improves

collaborative

practice

and may be

transferred

to other members of the healthcare team.

The

competencies suggested by Barr were further described by Mitchell, Harvey, and

Rolls (1998)

as

having been derived from

England's National

Occupational Standards in

Professional Education.

They are

based

on "key roles"

that

speak to developing



32

professionalism,

developing research, developing

relationships, promoting

effective

communication,

prioritizing

values that promote the

rights,

responsibilities and diversity

of

others, becoming

a

reflective practitioner, optimizing

physical

and social health,

patient empowerment, ongoing assessment,

and

care

planning.

D'Amour

and Oandasan (2005) described IPE as an intervention for achieving

interprofessionality. Interprofessionality

seeks to

achieve

a

cohesive, less fragmented

system of care where

healthcare

providers

practice in

an integrated fashion. The

authors

clearly differentiated interprofessionality from interdisciplinarity and proposed that

interprofessionality

is a

new concept defined as

"the

development

of a cohesive

practice

between professionals from

different

disciplines. It

is the process by which professionals

reflect

on

and

develop

ways

of practicing

that

provides

an integrated and

cohesive

answer

to the

needs of the client/family/population"

(D'Amour

& Oandasan,

p.

9). IPE

is a

transparent blend of disciplines coming together

with

shared goals.

In

contrast,

they

described interdisciplinarity as

"a sum of

organized knowledge, and

the emergence of

numerous

disciplines"

that

"has

resulted

in an

artificial division

of

knowledge that

does

not match

the needs of the researchers" who investigate IPE

(D'Amour

& Oandasan,

p.

9).

Reeves et al. (2008) defined

IPE

as

"any

type

of

educational training, teaching

or

learning session in

which

two

or

more health

and

(

social care professions

are

learning

interactively" (Reeveset al., p. 5). They described

IPE's

purpose as working

collaboratively

to

take

care of

patients effectively.



33

As evidenced through

identification

of country source

or

origin

of most

of

the IPE

literature,

BPE

is

much more

accepted

and widespread in

Canada

and

the

United

Kingdom

(UK)

than it is

in

the United States (U.S.) although

the

literature does not provide any

explanation

as

to

why

this

would be so.

In the U.S.

there are

currently

five

Centers

for

IPE including

the University of

Washington in Seattle, University

of

Minnesota in

Minneapolis,

Thomas Jefferson

in Philadelphia, Saint

Louis

University in Missouri, and

Creighton University in

Omaha, Nebraska. There is only one regional model of

Interprofessional Education in the U.S.. This regional model, located in northeast

Pennsylvania,

is a

cooperative effort of

16

colleges and universities that

form

the

Northeast

Pennsylvania Interprofessional Education

Coalition

(NEPAIPEC)

founded

by

The

Commonwealth Medical College.

Many authors do

not

define IPE in their research articles.

Of

the authors who do

utilize

a

definition in

their

article, whether

reporting

findings from empirical data or

presenting

descriptive or

anecdotal

information,

most

use the

Canadian

CAIPE or CIHC

definitions. In some

BPE

exercises described

in

the literature, students

from various

healthcare disciplines

are

immersed

in a

learning scenario in

a profession other than their

own. In

this

way, they learn through

their

interactions from one another,

through a

decentered approach where they

see

and

experience

patient care cases through the lenses

of other professions

so as

to become aware of

viewpoints other

than

their

own (Westburg,

Adams, Thiede, Stratton, & Bumgardner, 2006). Students working through IPE cases

together in this sense

break

down communication barriers and facilitate acquisition of



34

knowledge about other

professional

roles (Westburg et al.). Disequilibrium

and

shared

inquiry enhance learning (Conceicao & Taylor, 2007)..

There are two relatively

new

journals that focus on EPE.

The

Journal

of

Research

in Interprofessional

Education

(JRDPE) has

adopted

the

CAIPE definition

of

IPE.

The

Journal of Interprofessional Care

(JIPC)

does not describe or refer to a preferred

definition.

The

concepts

most

closely related

to

IPE include interdisciplinary education

and multidisciplinary education. Merriam-Webster (2008) defined interdisciplinary as

the involvement of

two

or

more disciplines that share information and decisions together.

However, the disciplines implement education separately and are separately accountable.

Interdisciplinary

education

lacks

a

clear

process and coordination

of education of the

disciplines since although

the disciplines practice

and

share together they

are not

truly

collaborative

and integrated

with priority focus on a patient (Olenick et al., 2010a).

Multidisciplinary is defined as

a

"co-existence"

of

several disciplines meaning

they may work side by side but without much interaction (Merriam-Webster, 2008).

"Shared learning" is

another term that

is

sometimes incorrectly used

to

mean IPE.

There

is

no definition found

for

this concept; however,

it

implies that students learn together but

it does

not specify the manner in which teaching/learning happens.

Figures 3

and

4 illustrate representations of

interdisciplinary and

multidisciplinary

approaches to health care. These terms are

related

to, but different from,

interprofessional care. In an interdisciplinary representation (Figure 3), there

is

interaction

between professions

but

no

evidence of

shared

values or shared knowledge.



35

Nursing

atient

1

^ Medicine

Social

Work

Pharmacy

Figure

3.

Interdisciplinary

Care: Disciplines interact but still

separately accountable.

There is no evidence that the care is necessarily patient centered

and

each circlestands

alone, meaning it is separately accountable.

In a multidisciplinary

representation

(Figure 4), again each circle stands alone,

meaning separate accountability. There

is

no sharing between disciplines in

multidisciplinary practice. Disciplines are interacting

with

the

patient but

not

with

one

another.

IPE involves two or

more

professions. Therefore, the literature does not speak

exclusively

to one

profession or another. Currently, most

of

the literature on IPE comes

from a

medical

education

perspective.

Referring to Figure

5,

in IPE, the circles are

interlocked, including

an

interlocking with

the

patient

circle.

Circles do

not

stand alone.

There are

shared values, shared knowledge, and shared decision making. All disciplines



36

Nursing

4

^ P a t i e n t ^

^

e d k l n e ^

Pharmacy

Figure

4.Multidisciplinary

Care: Disciplines

stand alone.

work

in

concert with one another.

The

patient has the largest, middle

circle

because all

care

is

patient centered. IPE is a transparent

blend

of disciplines coming

together

with

shared goals.

A comprehensive literature review of IPE revealed that

there are

several different

interpretations, overlapping terminologies, interchangeable terms,

and

a general lack of

uniformity of a definition and conceptual clarity for

IPE.

This lack of clarity contributes

to misunderstanding

and

creates barriers

to

optimal IPE research and implementation. A

concept analysis by this researcher resulted in

a

synthesis definition of IPE as an

andragogical interactive experiential learning and socialization process. IPE occurs

when

two

or

more members

of a

healthcare

team (who

participate in

either

patient assessment

and/or management) learn with,

from

and

about each

other as they collaboratively focus



37

Nursing

Advanced

Practice

Nurse

Medicine

Pharmacyutrition

Patient

Physical

Therapy

ocial

Work

Occupational

Therapy

Physician

Assistant

Figure

5.Interprofessional Care: Disciplines are interlocked and work in concert with

one

another.

on

patient

centered care

and achieving optimal health

outcomes.

In

IPE,

knowledge and

value

sharing occurs

within and

across disciplines

(Olenicket

al.,

2010a).

Without a clear understanding

and

consensus of what IPE is

and

how to achieve

it, fragmentation

in

the effective delivery of IPE and

between

healthcare disciplines will

continue (D'Amour &

Oandasan,

2005). Attitudes and perceptions towards others in

healthcare and authenticity

of

IPE are essential for positive interprofessional outcome

achievement (Hammick, Freeth, Koppel, Reeves,

&

Barr, 2007).

Interprofessional Education Research

Hind et

al.

(2003) described interprofessional perceptions

of

healthcare students.

They surveyed 933 students

in

the

United Kingdom

(U.K.) from

nursing,

medicine,

dietetics, pharmacy, and physiotherapy

programs. The study

was

based on

social



38

psychology theories including Allport's "contact hypothesis" which

"assumes

that

contact between members

of

different groups helps them to discover mutual similarities

and change stereotypical attitudes towards each

other"

(Hind et al., p. 2£). They used

"realistic conflict theory"

which

"suggests

that inter-group attitudes and behavior reflect

objective inter-group relationships" and"predicts that where groups hold divergent

objectives they will have hostile and discriminatory inter-group relationships, whereas

where

groups have common objectives, conciliatory behavior

between

groups

will

emerge"

(p.

22).

Hind et al. also used Social Identity Theory (SIT) and

Social

Categorization Theory (SCT) which explain inter-group discrimination (favor in group as

opposed

to

out

of

group members) and where self concept

is

based on identity

of a

member

of

the group

to

which they belong.

Hind

et al. (2003) described

their study

sample and

methodology well. First year

medical

students (n = 350),

nursing students

(n

=

390),

pharmacy

students

(n

=

102),

physiotherapy

students

(n =

67),

and dietetic

students

(n

= 24) from a university

in

the

U.K.

participated

(N = 933). The questionnaires used for this study included the

Healthcare

Stereotypes

Scale,

the

Professional Identity

Scale,

and

the

Readiness for

Interprofessional Learning Scale (RIPLS).

Significant differences

in

stereotypes between groups were

found.

Dieticians

were significantly more

likely to

rate themselves

as "good communicators"

(F = 2.54,

p <

.05) when compared

to

physiotherapists.

Doctors,

nurses,

and

pharmacists were

significantly more

likely to

rate

doctors as

"caring"

(F

=

4.62,

p <

.01)

than



39

physiotherapists

were to rate doctors

as "caring". Doctors

and pharmacists were more

likely to

rate doctors as "goodcommunicators"

than

physiotherapists were

(F

=

6.31,

p

<

.001). Pharmacists

were more

likely

to

rate themselves as "caring" (F = 11.79,

p < .001), "dedicated"

(F

= 5.96, p < .001), and "good communicators" F= 10.56,

p < .001) when

compared with doctors, dieticians,

nurses, and

physiotherapists. Nurses

did not demonstrate evidence of statistically significant differences

from

the other groups

regarding

stereotypes.

A significant difference in

professional

identity

was found,

in that

physiotherapists

had

significantly

higher

professional

identity scores than

pharmacists

(p

< .05).

Otherwise, all

of

the professional identity scores were

close and

indicated that

students

identified

with their own

professional

groups. Nurses were not

significantly

different from

the

other health professionals on scores

of professional

identify.

Significant differences were found between groups

in readiness

for interprofessional

learning. Nurses had

significantly higher readiness score

than dieticians, (p <

.01),

physiotherapists,

(p <

.001) and doctors, p

<

.001). The researchers discussed the

potential benefits

of incorporating

IPE very early

on in education so

students would

be

more

likely

to engage


collaborative

learning without

creating

barriers

between themselves and people

of

other professions.

Hind

et

al. (2003) hypothesized

a model

of

relationships

between stereotypes,

professional

identity, and readiness

for

interprofessional learning and

tested this model as

part of this study.

Hypothesis 1

predicted

there would

be

a positive relationship between

positive autostereotyping (views

held

by students in

their

own

group)

and strength

of



40

professional identity.

This

hypothesis

was

supported. Findings indicated

a

significant

low positive correlation for

the total

sample

(r

=

.22,

p

<

.001). Hypothesis

2

predicted

a

negative

relationship between positive heterostereotyping (out-group) and strength

of

professional

identity.

This

hypothesis

was not supported.

A

significant positive

correlation was found instead (r

=

.12,

p<

.02). Hypothesis

3

predicted

a

negative

relationship between strength

of

professional identity

and

readiness for interprofessional

learning.

This

hypothesis was

only supported within

the group of dietetic students

(r

= .42) and not supported for any of the other groups. Findings

for

the total sample

revealed

a significant positive correlation instead

which was

significant

(r =

.18;

p

< .001). Hypotheses

4

and

5

predicted that auto and heterostereotyping would relate to

readiness

for

interprofessional learning. These hypotheses were supported

(r =

.13;

p = 01).

Overall, the Hind

et

al. study was a very

well

done and objective in terms

of

sample,

methodology,

the

theoretical

bases, hypotheses,

and presentation

of findings.

Generalizability

of

this study

is

limited

to

the U.K. and the professions of medicine,

nursing, pharmacy, physiotherapy, and dietetics.

Westberg, Adams, Thiede,Stratton,

and

Bumgardner (2006) used standardized

patient (SP) experiences with pharmacy, medical,

and

nursing students who completed

pre and

post

IPE surveys after professional roles were

switched

mid SP session. This is

a

very limited study that was conducted in Minnesota.

Of the

48

pharmacy

students

who

participated in

the SP experience, only 26 completed

the

study survey. The

authors

did

not

discuss how many of the nursing

or

medical students completed the survey. Also,



41

there is very little information about the survey

that was

used. The researchers described

the use

of

pre-experience and post-experience surveys used in this study. Students were

asked

in

the survey to

respond,

in

four

sentences or

less,

what

they

thought

about the

professional roles in

the

scenario.

The

researchers did

not

report use of any theoretical

framework, did not reveal

what

survey was used

or

give

a

description

of

the survey, and

did

not describe

the methods used

to

collect

or

interpret the data. Medical and nursing

students

received feedback

from

faculty members

from each profession

but did

not state

that any data on

medical

or nursing students was collected or part of this study at all.

Westburg's

et

al.

(2006) study results were limited

to

one academic year and had

a

low return

of

survey instruments by pharmacy students who participated. Although the

authors concluded that students enjoyed the exercise, gained valuable experience,

indicated pharmacy students gained

a

better perspective about the

roles of

other health

professionals overall and provided

a

few student quotes, noother survey results were

revealed. Findings

were presented in narrative

form. The

researchers recognized that

they need

to continue to

collect

data

to improve

the

study's validity, reliability, and

generalizability. While this

study

was

not

methodologically strong,

it

was included in

this review since

there

are very few empirical studies on

this

topic reported in the

literature.

Lidskog, Lofmark, and Ahlstrom (2007) described perceptions

of how

student

nurses ( n

= 24),

occupational

therapy students

(n

= 16),

and

social

work

students

(n

= 5)

perceived their own roles and the roles of other health professionals on

a

geriatric ward in

Sweden.

A

qualitative,

phenomenological study was conducted. Participants

were



42

interviewed over a period of

three

weeks. Students were interviewed twice, once before

the three

week period on

the

ward

and once the week

after they

started on the ward.

Interviews were taped

and

transcribed. The analysis

was

appropriate for a

phenomenological approach.

Lidskog et

al. (2007) provided quotes

from the

student participants.

They

found

students from each of the professions in the study had great variations in their

understanding of one

another including variations in the perceptions

of one

another's

skills,

knowledge, responsibility, and values. For example, an OT student commented on

social

work

stating "I

wouldn't

say Isee them as being on a

higher plane,

but it can seem

as if they

are because

they've usually got

different

clothes from us" (p. 395).

Another

OT commented on nursing stating "they help the patients far too much". Findings

indicated there

is a

need to deepen the

students'

understanding of differences and

similarities between professions. Overall this study was well done. The purpose

of

this

study was clear

and

it

exhibited

credibility

and auditability by

citing

several

quotes

as

exemplars of the data and describing the categories that were determined.

Hoffman and Harnish

(2007)

described

the effectiveness of DPE for first year

healthcare professional students (chiropractor, nurse, nurse practitioner, occupational

therapist, pharmacist, physician, physiotherapist, and social work).

They described pre-

and post-test Likert

scale

results

for 161

subjects using

a modified Kirkpatrick's model of

educational outcomes

for

IPE. However, the researchers did not identify how

many

were

in each group of healthcare

professional

students.



43

A pre-test

survey

was administered

to students

three weeks

prior to

the

educational exercise and then administered again at conclusion

of

the exercise. The

educational exercise included an introduction to the

roles

and responsibilities

of

each

healthcare professional, a stereotyping exercise, and case studies. Study results indicated

that students

responded to

BPE

very positively and reported

"profound

changes

in

attitudes,

interests, and knowledge"

(p.

e235).

Findings indicated significant

improvement in knowledge

of

health profession roles and knowledge about health

professions

(p

<

.001),

significant improvement in knowledge about interprofessionalism

(p <

.001), an interest

in learning more about

the

different health professions

and

pursuing

a career

in various

health

professions (p

= .075),

and significant improvement in

attitudes about IPE and practice

(p

< .001).

The

researchers cited

self

reporting as

a study

limitation. They concluded

that

based on the study's results, IPE is

best

delivered very

early on in

their


education

since

skills

learned in

IPE,

such as

interpersonal

communication,

negotiation,

conflict

management, and cohesion, among

many

others,

do not need specific

discipline knowledge.

Hoffman and Harnish

concluded that it is reasonable to

integrate IPE at

a very early learner level before

stereotypical viewpoints

prevail in shaping disciplinary attitudes and before professional

prejudice

has a chance to

develop.

Wright

(2008)

conducted

a

qualitative

study,

within

one

university in England,

using

three focus groups to explore the experience of interprofessional learning in

healthcare profession students

(midwifery

n

=

45, podiatry n = 45,

and physiotherapy



44

n

=

70) in their

first

three months of school.

The researcher

utilized

a

purposive sample

and described the study as

generic

qualitative. Audio taping and transcription

were

used

to document focus group quotes and views. Quotes from the focus groups for each

of

the

themes that emerged were stated in the article. Themes included student understanding

of

IP learning,

educational

issues, feelings

of

isolation, and future practice influence.

Study conclusions included

IPE

curriculum development for shaping future practitioners

by taking

into

consideration student

comments for effective

IPE which included

interprofessional learning, required interaction and active learning, role modeling,and

a

relevant commonsense approach. Students

did

not feel as though

a

didactic lecture based

approach was helpful (Wright). The

study's

credibility

may be

compromised

due

to the

absence of sufficient methodological information including the

study

time, setting, and

context.

Curran, Sharpe, Forristall, and Flynn (2008) explored attitudes

of

health sciences

students towards IP teamwork

and IPE.

Subjects in

this study

were exclusively from

only one university, the

Memorial

University of Newfoundland

in

Newfoundland,

Canada.

All health

sciences students were invited to participate; therefore, se the sample

was not chosen randomly. Medicine

(n 95),

nursing

(n

=

762),

pharmacy (n =113),

and social work (n

=

109) students participated in the study

(N =

1179). Medicine

(M

=

3.86,

SD =

.46) and

nursing

(M

=

3.93, SD = .44) students reported less positive

attitudes towards IP

teamwork

than

pharmacy (M

=

4.05,

SD = .36)

and social work

(M = 4.06, SD = .44) students.

Nursing

(M = 4.03, SD = .46), pharmacy (M =4.07,



45

SD=

.40) and social work

(M =

4.18, S D

=

.42) students had significantly more positive

attitudes towards IPE

than

medical students

(M

=

3.70,

SD =

.59). Females and senior

undergraduates had more positive attitudes towards IP teamwork and IPE. Gender had

a

main effect (p = .001). A significant interaction (more positive attitudes

toward IPE

and

interprofessional teams)

was

found

between

gender

and

students with prior DPE

experience

(p

= .002).

Female

senior

undergraduates

with

prior IPE

experience

exhibited

more positive

attitudes than

all

other

student participants.

Curran

et al.

(2008) used two

Likert

scales, the 14-item Attitudes Toward

Interprofessional Healthcare Teams (Cronbach's alpha of .83), and the 14-item Attitudes

Toward IPE (Cronbach's alpha of .91), to assess student attitudes towards

IP

teamwork

and IPE.

This study

is

generalizable only to

Memorial University

of

Newfoundland,

Canada and only to medicine, nursing,

pharmacy and

social

work health

science students.

This study was methodologically sound,

with

a large sample size, statisticsand findings

were clearly presented, including explicit

validity

and reliability information

for the

instruments

that

were used.

Salamonson, Everett, Koch, Wilson, and Davidson (2009) described first

year

nursing (n = 565) and medical

students'

(n

= 100)

motivation strategies

for

learning using

the self report Motivated Strategies for Learning Questionnaire (MSLQ) in

a

comparative

survey design in a

university

in Australia. The researchers

discussed how

differences

in

motivation

and

learning may affect

IPE

success. Nurses in the study were significantly

older

(M

=

24, SD =

8.1)

than the

medical

students

(M =

19.4, SD =4.1,

p

< .001). Also,

there

were many more

females

in the

nursing

student

group

(82%) compared to the



46

medical

student group (56%) in

the

study. In

addition,

65%

of nurses

were employed

during the semester versus

only

44%

of medical

students.

In

the

Salamonson et al. (2009) study,

nurses

scored

higher

in extrinsic goal

orientation (p

<

.001). Extrinsic

goal

orientation

is

the

motivation

for

good

grades and

avoidance of external threats

that affect

completion of a course

regardless

of a student's

interest

in the course topic.

Medical students scored higher

in all

the

other four

learning

strategies including

peer

learning (p

=

.003), help seeking

(p =

.008), critical thinking

(p =

.058), and

study

environment management

(p

<

.001).

Medical students in

the

study

also demonstrated significantly higher (p < .001) grade point averages (GPA) overall. It

is

unclear

how

the researchers concluded that success

of

IPE programs may

be

influenced

by students'

motivational

and

learning strategies. The medical students in this

study

were

taught

using problem

based learning (PBL) which is a

teaching

methodology

driven

by

challenging, studentcentered, collaborative groups where students take responsibility for

their learning and teachers are simply facilitators and observers. PBL

is

known to foster

development

of communication,

problem solving, and

self direction. The nursing

students

in

this study were not

taught

using PBL which could explain the differences in

the

MSLQ

scores.

Also, the researchers did not address how MSLQ scores specifically

affect IPE

and

did not address the

potential

effect of age, gender,

or

employment status

on the study variables. Therefore, this study provided only weak evidence to support the

claim

that nurses

were less

motivated learners, which affects successful

IPE programs.

Overall, this

study

was not methodologically strong.

The

study sample was

not

well balanced in

its

representation

of

the

two

groups and the types

of

education methods



47

differed

markedly between the two groups. These two factors could have accounted for

the difference in MSLQ scores. Age, gender, employment status, and the fact that

nursing students did not receive PBL suggest

the

study findings must

be

interpreted

with

caution and

may not

be generalizable.

Interprofessional Healthcare Teams

Morey

et

al. (2002) evaluated the

effectivenessof P

teams

on collaborative

behavior of physicians,

nurses,

technicians, and clerks

in nine

emergency departments

in

the US.

The

study was a multicenter, quasi-experimental,

untreatedcontrol

group

pre

test,

post-test translational research

design using crew

resource management

(CRM)

behavioral principles

from

aviation.

Previous

literature has supported that

CRM

in

aviation and emergency departments share many similar characteristics that exist within

very stressful, complex high stakes environments. The intervention

to

the treatment

group of hospitals (n =

6)

was

a teamwork implementation program where staff coached

and mentored teamwork behaviors

of emergency

department

staff during

normal working

hours. An

aviation

oriented

teamwork

model

was used over

four months and is available

as an

appendix

of

the article

with a complete

description

of the intervention.

There were

three participating

hospitals in

the

control group.

The purpose

of

Morey's et al. (2002) study was to evaluate effectiveness of the

teamwork intervention

by assessing measures of teamwork

behaviors,

attitudes

and

opinions,

and

emergency

department

performance. The

researchers

created

their

own

survey

instrument that incorporated

questions from 14survey

instruments

they

identified

that were used to assess the three measures (teamwork behaviors, attitudes and opinions,



48

and emergency

department performance) on 3

separate occasions (5

months apart).

The

article completely describes

how

the survey was constructed

and what was

included for

each item.

The

researchers reported acceptable validity and reliability statistics for the

survey

they

created.

There was a

significant improvement in teamwork

in

the experimental

groups

following the teamwork

program

training (p = .012). Team behavior, in the area of team

dimension,

improved significantly in the experimental group (p

=

.002). Attitudes

and

opinions, in the areas

of

staff attitudes toward teamwork (p = .047) and staff perceptions

of

support (p

=

.40) improved significantly. Also, in the experimental group, the

witnessed clinical error rate decreased from 30.9% to 4.4% (p= .039).

This

error rate

decrease

was

important because

of

its significance

for

patient care and safety. For

example, some

of

the types

of

errors that were recorded

as

part

of

this study included: a

patient with

a blood pressure of

149/106

that was

never reported

by nurse

and/or

technicians to

the

physician and

a

blood pressure was

never

rechecked, a trauma patient

who was receiving oxygen

by mask and

that mask was not connected to

an

oxygen flow

meter, and

a

patient

with

chest pain who had an EKG

and

rhythm

strip

completed

by a

technician who placed both items in the patient chart but then left the

patient

unobserved

for

25 minutes without

notification

given of patient

arrival

to the physician

or

the nurse.

Morey

et

al.

(2002)

demonstrated that

interprofessional teams can

have a

significant impact

on

patient care and outcomes. The

study was supported

by U.S. Army

Research and very well

done.

The methodology, analysis, and

description

of findings

were clearly stated, including the use of many tables

and

appendices. The findings

are



49

generalizable

to

both

military and

civilian healthcare

teams

in

teaching

hospitals

or

community hospitals.

Cooper, Spencer-Dawe, and McLean (2005) used

a

triangulation research design

to assess year one

undergraduate

students in medicine

(n = 285), nursing (n = 50),

occupational therapy (n

= 55) and physiotherapy (n =

52).

The

study

was

based

on

Complexity Theory. The Readiness for

P

Learning Questionnaires (RIPLS)

and a

multi-

disciplinary lecture were

administered

to all subjects. Groups were

separated

into either

the intervention group, who received IPE interventions

with the standard

curricula, or the

non-intervention group, who received only the standard curricula.

The

intervention

group specifically received

a

staff training program, e-learning materials,

and

interprofessional

team

workshops.

A RIPLS

was administered again to each

group.

Cooper's et al.

(2005)

quantitative analysis revealed that participants in

the

intervention group

in their

study were significantly more likely

than

participants in the

control group

to:

understand need

for

positive relationships

between healthcare

professionals F=

8.9, p

<.01),

reject

the principle

of

learning

within their

own

disciplinary boundaries

(F = 25.5, p <

.001),

and

ready

to

share their

expertise through

team based

approaches to learning

F =

8.2,

p< .01).

Qualitative analysis

revealed IPE

interventions improved student confidence in

their

professional identity and

improved

their

ability

to

value

differences

between

professions.

Overall, the study (Cooper

et

al., 2005) was well done. The purpose

of

the study

was clear

and

the authors utilized the RIPLS instrument

which

has documented

validity

and

reliability

in

the literature.

This

study also used

a

theoretical framework to evaluate



50

the complex interventions carried out between the intervention group and the control

group

which

added credibility

to

the research.

Baxter and Markle-Reid (2009) studied an interprofessional approach to the

management of elderly patients who

were

at risk for falls. The qualitative study

described the experiences of two interprofessional

teams

consisting of community case

managers

(n = 2),

physiotherapists

(n

=

2),occupational therapists

(n = 2),

registered

nurses

(n = 2),

and a dietician

(n =

1)

from four community

agencies

who

were involved

in a nine month collaboration. Data regarding the facilitators and barriers

to

teamwork

were also

collected.

The

researchers conducted

four focus

groups and collected data

at

six

months

and

at

nine months.

Baxter and Markle-Reid (2009) reported their design study as an exploratory

descriptive design. Focus

groups were

taped

and

transcribed

for

accuracy. A computer

software program was used to manage

and

analyze the data. Themes that emerged from

the Baxter and Markle-Reid study were team capacity, practitioner competencies,

perceived outcomes, support, and time. Team capacity or working

toward

optimal

patient

care

as the common

goal

was influenced

by

professional roles, understanding and

appreciating

one

another's

roles,

and the working environment or climate of the team.

Practitioner competencies were influenced by

face to

face communication which

improved camaraderie and collaboration. Perceived outcomes were influenced by

increased trust from the

patient

and the

patient's family

and focusing on

the

team

approach

to

patient

centered care

rather than the

falls. Support

was influenced

by the

organization being supportive

of

the team approach and allowing time through

reduced



51

workload

and

added

resources

for

an interprofessional approach.

The

researchers

clearly

documented the methods

they

followed in data collection, management, and

interpretation in this

well

designed and implemented study.

Dobson

et

al.

(2009) evaluated the use

of a

quality improvement teaching

strategy

on interprofessional collaboration among healthcare professional students

at

a college in

Canada.

Using

a pre-test/post-test design, the researchers collected data

from a

total of

223 healthcare professional students. Study subjects included nursing (n = 85), nutrition

(n

=

26), pharmacy (n

= 82),

and

physical

therapy

(n =

30).

Of

the

223

subjects, 134

completed both pre-test and post-test

self

reflection tool that

had

16 items on

a

7-point

Likert scale and 132 complete both pre-test and post-test group process tools that

consisted

of

nine

items

on

a

7-point Likert scale.

The self reflection tool

assessed

knowledge, beliefs, and attitudes towards interprofessional teams.

The quality improvement teaching strategy consisted

of

2 sessions. Session 1

reviewed quality

improvement (QI) concepts, analyzed

health

system data and explored

possibilities for areas of improvement. Session 2

reviewed

change ideas, plans, and

characteristics of effective teams. In

addition

to

the

sessions,

there was

a

group

assignment

that correlated with each session, for a

total

of 2

group

assignments, one for

each

session.

Significant increases p <

05) were

found

between

pre

and post

self reflection

scores

for

12

of

the

16 items on

the

self

reflection tool

completed by 134

subjects.

Statistics were

computed for

the 134 subjects and

not

separated by

discipline or groups.

The

most

significantly different scores fell under the component areas

of professional



52

roles,

team conflict, and

decision

making. The researchers

concluded that

using a

quality

improvement process

as

a teaching strategy

is a feasible,

rational, effective

approach

to

enhancing interprofessional experiences for students

(Dobson et

al.,

2009).

However,

all

students did

not receive the

same

intervention and there were

differences

in

the

numbers

of

professional

students from

the various

disciplines that

participated,

which

may

limit

generalizability. Nursing and pharmacy students received two terms of group sessions

and

group assignments. Physical therapy students received only term

one

group

session

and

assignment and nutrition students

received

only term two session and assignment.

For those

reasons, the study

results must be

interpreted with caution.

Hall

et al.

(2009) studied

a

health

professional team

approach to quality

improvement over two years. They

conducted

four half day quality improvement (QI)

sessions

once a month for

five months

with participants who

were integrated into QI

teams at

an

academic health center. The QI

teams received

QI training and expert QI

mentoring.

Experimental group

study subjects,

who participated in the QI sessions,

consisted

of

fourth year medical students

(n =

30) and other health professionals (n

= 56) from

disciplines including nursing,

pharmacy,

laboratory

technicians,

health

administration,

information technology,

and

medical education.

Subjects

attributed their

successful

completion of the quality improvement

projects

to the interprofessional design

of

the

teams.

Hall et al. (2009)

evaluated written

feedback

regarding quality improvement

from

study subjects and collected data on a quality improvement knowledge application tool.



53

A

control

group consisted of

28

medical students who

did

not participate in

the QI

sessions.

In

the Hall's et al. (2009) study,48 of

the

86experimental group study subjects

completed the validated 5-item, Likert scale QI Knowledge Application tool that assessed

QI

aim,

intervention

and

measurement with values ranging

from

1 (lowest

score

possible)

to 5 (highest score

possible) that

assessed

action

based

improvement

interprofessional

teams.

Action

based

improvement teams

are quality improvement

teams

that

focus

specifically

on identified clinical problems

within the

teams.

There

was

a

significant

difference (p < .0001)

between participating students (M

=

10.86) and

control

group

(M = 5.73) students for

the year 2006-2007 and for

the

year 2007-2008

for

participating

students (M

=

8.7) and control group (M = 5.08,

p <

.0005). There

was

also a significant

difference between pre-course

(M

=

4.88)

and

post-course (M = 8.7) participating

students

(p

< .001).

In Hall's et al. (2009) study, medical students comprised one-third

of

the

experimental

group while

all

participants in

the

control

group

were medical

students.

The study

may

be

improved

by the

addition

of

other

types of

health

discipline students.

This

was

a

limitation identified by the authors.

Summary of

Interprofessional

Education

and

Interprofessional

Healthcare Teams Literature

The literature

review

of IPE

revealed

that

there

are several

different

interpretations, overlapping terminologies, interchangeable terms,

and

a general

lack

of

uniformity of a definition and conceptual clarity for IPE. Many researchers do not define



54

IPE in

their studies, which contributes

to a

lack

of

clarity

and creates barriers to optimal

IPE research and implementation.

Based

on

the current literature and

a

concept analysis on DPE, IPE

is an

andragogical interactive experiential

learning

and socialization process.

IPE occurs when

two

or

more members

of a

healthcare team (who participate in either patient assessment

and/or management) learn with, from

and

about each other as they collaboratively focus

on

patient centered

care and

achieving

optimal

health

outcomes.

In IPE, knowledge and

value sharing occurs within and across

disciplines

(Olenick

et

al., 2010a).

This

clearly

stated definition, used in this research study,

was

synthesized

based

on the common

elements

of

all the

available

definitions in the literature.

IPE research describes healthcare profession

students'

perceptions and

perspectives about

IPE,

relationships

among

and between

different types of healthcare

profession students, readiness for interprofessional learning, the effectiveness

of

IPE, IPE

experiences and attitudes toward IPE. IPHCT research describes collaborative behavior,

effectiveness

of

teamwork interventions, relationships between healthcare professions,

interprofessional approaches

to

patients and

team

approaches

to

quality improvement.

IPE and IPHCT literature continues to expand due to

new

interest in this topic and

how it

concerns

education of

healthcare professionals, quality

of care,

and patient safety.

The

IPE and IPHCT literature support the benefitsof IPE including relinquishment of

stereotypes,

highly

integrated teams, collaborative

practice, patient

centered care,

and

improved understanding

of

healthcare professional roles

among

other benefits. EPE



55

research on

students and IPHCT

research on healthcare

professionals continues to grow

and develop.

Theoretical Literature

Fishbein and Ajzen s

Theory

of Reasoned Action

The

Theory

of

Reasoned Action (TRA) by Fishbein and

Ajzen

(1975) served as

the

theoretical basis for

this study.

While most of the published

literature

on 1PE is

atheoretical, other social psychology theories have been used in previous DPE research.

However, the

other theories were

generally applied to

IPE

research on students, not

faculty, and

primarily

concerned

group

behaviors within IPE, not

attitudes

toward IPE.

TRA

proposes

that

the


norms predicts

behavioral

intentions.

Therefore, TRA was

deemed

to

be

most

appropriate for

the purpose

of

this

study.

The Theory

of Reasoned

Action (TRA) provides a framework for understanding

and predicting behaviors (Fishbein & Ajzen, 1975). In TRA,

people's

attitudes are

determined by their beliefs. Life experiences help to form beliefs about other

people,

events, circumstances, objects, and

actions.

A

person's

beliefs

and

therefore, their

attitudes also,

are

subject

to

change

and

are

dynamic

in

nature

depending on influences,

experiences, and the strength of the beliefs. Attitude is

formed

by a person's beliefs

toward

an object, action or event and that object, action, or event's consequences. The

number of beliefs a person has regarding an object, action or event may also

influence

their attitude

(Fishbein

&

Ajzen).

Attitudes are conscious choices made by

an

individual

toward

something

based

on personal evaluation

of

the

outcome.



56

Beliefs are influenced by a

person's

observations and other

information

a

person

processes (Fishbein & Ajzen, 1975).

In

TRA,

when

people have

positive

beliefs and

positive

attitudes toward a

behavior, they

are

more likely to

have

strong intentions to

perform

that behavior.

Reinforcement

of

beliefs, positive

or

negative, strengthens

attitudes.

Subjective

norms, or perceived expectations to perform

a

behavior (Fishbein &

Ajzen,

1975), also

influence

a

person's

behavioral

intentions. Subjective

norms

are

influenced by a

person's

motivation to comply with perceived expectations. Ultimately,

intentions

are

determined by the combination

of

attitudes

and

subjective norms.

Subjective norms provide

social motivation

to

comply

with

intentions and carry through

on behavior performance.

Both

attitudes and subjective norms should be considered

when predicting

intentions and behaviors.

This

research

study

explored attitudes,

subjective norms, and intent

to

engage in IPE.

According to TRA, intentions predict behavior. Behaviors are elicited based on

the strength of the intentions that precede them. Intentions

are

strongor weak depending

on the

attitudes

and subjective norms that precede them. Favorable attitudes correlate

positively with intentions that become behaviors (Fishbein

&

Ajzen, 1975).

Theory of

Reasoned

Action Research

The

Theory of

Reasoned

Action (Fishbein

&

Ajzen, 1975) was developed within

the

field

of social

psychology and

has

been used

primarily

for

research

regarding

consumer behaviors. However,

it

has been found useful to explain attitudes and



57

behavioral intentions in healthcare research as well. Research literature

based

on TRA

was searched and reviewed.

Levin

(1999) studied predictors

of

healthcare

workers'

glove

use when

a potential

for exposure to

blood

existed. She examined three theoretical

models in an

effort to

compare which of the three best predicted glove use behavior. In

a

random sample

of

nurses (n

=

247) and laboratory workers (n

=

280), subjects were selected using telephone

area codes

for

Chicago and

its

surrounding area and included those nurses

(N=

104,499)

with an active nursing

license

in

Illinois and

those laboratory

workers

(N = 8,499)

who

were certified through the American Society

of

Clinical Pathologists' Board of Registry.

The

minimum required sample size for this study was 450.

The

final sample included

527 nurses and laboratory workers.

Levin (1999) hypothesized that the Theory

of

Planned Behavior (TPB) would

explain glove use

by

nurses and laboratory workers more effectively

than

the Theory

of

Reasoned Action (TRA). Levin administered

a

26-item questionnaire to subjects and

concluded that TRA

explained 70%

of

glove

use

behavior

in the

study. TRA was found

to better

fit

and

explain

prediction

of

behavior

than TPB. The study

did

not

support

use

of TPB, which

is

an extension of the TRA

model.

Predictive capability of attitudes

affecting behavior was significant in this study (p = .03).

Russell et al. (2003) described

medication

taking beliefs

of

renal transplant

patients, using

the

TRA framework. The qualitative descriptive study compared a

purposive sample (N = 16) of older patients,

more than

50

years

old, (n =

8)

to

younger

patients, aged 18 to

49

years old, (n = 8) in a renal

transplant

program in

Missouri.

An



58

interview guide was utilized to collect demographic information and answers to specific

questions. Interviews were audio

taped

and transcribed, contributing tocredibility and

auditability in this

well

done study. Data were coded for themes and group comparisons.

Russell

et al.

found

that both the younger

and the older patients

held similar

beliefs that

led to

their medication compliance.

Beliefs that

led to

improved

compliance for

medication

taking behaviors

included planning

ahead, organization, cues to help them

remember, remembering the

donor who

provided their kidney transplant and

not

wanting

a

life

of

dialysis. Both groups

indicated

improved compliance

when

a

subjective norm

such

as

support from family was

present.

Young,

Horton, and Davidhizar (2005) applied TRA toa study of

nurses'

(N =

52)

attitudes and beliefs about pain assessment

and management.

The

researchers

explored attitudes

in relation

to

nursing

education

and

experience. Participants

completed an open ended attitudes and beliefs questionnaire. The overall attitude scores

ranged from negative 6

to positive

28

with

a

mean

of 8.3 for

use

of pain

assessment

tools.

No additional

statistics

were presented.

The

researchers

concluded that education had a

positive

impact

on pain assessment tool usage and outcomes and

that positive

attitudes

toward

pain

assessment were related

to

increased

education. Young

et al.

did

not

disclose

the study design type

or

specific methodology

or

statistical analyses

used, and

there was

no

discussion

of the

validity

and

reliability

of the

instrument used to

collect the

data.

Also,

a

convenience sample

of

nurses from one Midwest community hospital

unit

limits

the usability and generalizability

of

the

study's

findings.



59

Based on the TRA framework, Marco et al. (2006) examined intensive care

nurses' beliefs and attitudes towards the effect

of open

visiting on patients, family, and

nurses.

The sample consisted of

females nurses only

(N = 46) from a 16

bed medical-

surgical intensive care

unit (ICU) in Navarra,

Spain.

A descriptive

correlational

design

was

used. The researchers presented a

diagram and description of

how TRA

applied to

their study and how they intended

to

describe

nurses'

beliefs and attitudes

toward

open

visiting

policies in the ICU.

Marco et al. (2006) concluded that beliefs about visiting were positive and found

a significant, positive correlation

between beliefs

and attitudes about the

open visiting

policy

(

r =

.52,

p <

.0001). Every nurse surveyed indicated

that

an open visiting policy

increased family

satisfaction

with

the ICU

patient

stay.

The

results section

of

this article

had several

quotes from the

nurse participants that provided

examples and

insight into

their

thoughts regarding open visiting policies in

ICU

settings which contribute to the

study's

auditability. All

nurses'

quotes presented in the article were positive comments

regarding open

visiting policy. Marco et

al.

did

not

discuss the research findings in

relation

to the TRA

framework

or describe how

beliefs and attitudes may potentially

affect open visiting policy. Failure to relate the findings to the theory

is a

weakness and

limitation

of

the study.

The

extent to which Spanish culture influenced the

nurses'

attitudes and limits

the

study's generalizability to other cultures

is

a concern.

A meta-analysis by Wallace, Paulson, Lord, and Bond (2005) strongly supported

Fishbein

and Ajzen's

(1975) theory

that

attitudes predict behavioral intentions and

behaviors.

This

meta-analysis included

797

studies completed between 1937 and 2003.



60

The

purpose of the meta-analysis was to quantify the overall magnitude

of

the

relationship

between

attitudes and behavior,

based on

statistically combining the sample

sizes, significance

levels, and

effect

sizes of the

various

studies. The sample of 797

studies included those specifically based on the TRA model and studies not based on

TRA.

Findings indicated that situational constraints, such

as

perceived social pressure,

moderated the relationship between attitudes and behavior. Within

TRA,

social pressure

is referred

to

as

subjective

norms. When behaviors were thought to

be desirable,

normatively appropriate,

or

politically correct, people tended to perform the behavior

whether or not they had a positive personal attitude

toward it.

Attitudes predicted

behavior better when there were weak social pressures surrounding

a

situation and few

obstacles or

constraints a

person

had

to

overcome. Attitudes also

predicted

behavior

better

when

people felt they were

in

control and free

to

make their own decision.

Social

pressures

and level of difficulty

significantly

predicted

an

attitude-behavior

relationship correlation

of .41

(p

< .01)

when social pressures and level

of

difficulty

were

at

mean level. Social

pressures

and level of

difficulty were

rated

on

9-point scales

ranging from no social pressure to very socially pressured and not at all difficult to very

difficult. When social pressures and level

of

difficulty rose to

one

standard deviation

above

the

mean,

the attitude-behavior

correlation dropped

to .30(p

<

.01).

Wallace's et al. (2005) meta-analysis

was methodologically

sound.

A

total

of 797

studies were

included

in the sample. Although this meta-analysis speaks primarily

to

the

relationship between attitudes and behavior, within TRA the combination

of

attitudes

and



61

subjective

norms

lead

to intention

which then

leads to

behavior.

Therefore, although

all

studies

used

in

this

analysis

were not

TRA

model based, they did support

the TRA

framework

indicating that

attitudes and subjective norms predict behavioral intentions

and behaviors.

Within TRA,

intentions

are proposed to be the strongest

predictors

of behavior.

Webb and Sheeran

(2006) quantified

the

degree

to which

changes in intention

led

to

changes in

behavior.

Their meta-analysis of 47

studies,

conducted between 1981 and

2003, of intention and

behavior

changes

revealed

that a medium to large change in

intention (d = .66) led to

a

small to medium changes

in

behavior (d =

.36).

Webb and Sheeran (2006) described the

methodology,

statistical analysis, and

findings

in

this meta-analysis. Although the 47 studies in this

meta-analysis

included

studies

based

on

TRA,

the

meta-analysis

also

included studies

based on several other

models

of

attitude-behavior relations. Overall, this meta-analysis

was well

done

and

supported

the

TRA

theoretical

proposition that intentions are

the strongest

predictive

indicators

of

behavior.

Sheppard, Hartwick,

and

Warshaw (1988) conducted

two separate

meta-analyses

based on 87 articles that used attitudes and subjective norms to predict intentions and 87

articles that used intentions to predict behavior.

All

articles

used in

these

meta-analyses

were based on research conducted between 1960

and

1985. The mean correlation

for

studies

that

explored

attitudes and

subjective norms to predict

intentions

was .66

and

statistically significant (p = .001), and the mean correlation for studies that explored

intentions

to predict behaviors was

.53

and statistically significant

(p = .01).



62

In addition

to

these findings, Sheppard

et

al. (1988)

determined

that TRA, even

when

used beyond

its

intended

conditions, managed

to maintain

its strong predictive

utility.

TRA's

intended conditions

do

not include choices and was originally designed

to

determine single

behaviors only. Sheppard

et al. referred to

TRA

as a compelling and

coherent

model.

These two

meta-analyses were

clearly

presented.

All studies included

were

listed

in

table form, the methodology was explicit,

and

findings

were

very

thoroughly described.

Theory of Reasoned Action, Interprofessional Education

and Interprofessional

Healthcare

Teams

There was no literature found where TRA was used in conjunction

with

IPE

or

IPHCT.

In

fact,

most of the IPE and

other interprofessional studies

did

not

utilize

a

theoretical framework.

This review

indicates there

is a

significant

gap in the

IPE and

interprofessional literature

using

theoretical frameworks. There is significant opportunity

and need

to

study

IPE and

IPHCT

with a theoretical

framework.

Summary of Theoretical Literature

The

TRA conceptual

framework (Fishbein

&

Ajzen, 1975) was

discussed

in this

chapter. Relationships

between TRA

concepts of attitudes,

subjective

norms,

intentions,

and behaviors were presented. TRA literature proposes that the Theory

of

Reasoned

Action explains

intentions and behaviors. There is an enormous gap in EPE literature

overall

with

regard to utilizing conceptual frameworks to guide IPE research. There

were

no published studies found

where

IPE research utilized TRA

as a

framework.

In fact,

most

of the IPE

research

did not use a

theoretical

framework.



63

There

were four meta-analyses included in this literature review that support

TRA. Wallace et al. (2005) found significant attitude-behavior correlations. Webb

and

Sheeran (2006)

determined

intentions are the

strongest predictors

of behavior.

Lastly,

Sheppard et al.

(1988)

performed

two meta-analyses that determined TRA

is a

strong

predictive

model

even when used

beyond its intended conditions.

The TRA

literature presented in this review was

used as a

guide

for

this research

and

to assess the

utility

of

TRA for use in

this

study. TRA

explains

how attitudes

and

subjective norms predict intentions and behaviors.

The

model specifies

a

methodical

approach

to

prediction

of

intentions and behavior which strengthens the model's

applicability for use as the theoretical underpinnings of this research.

Faculty and Interprofessional Education

and

Interprofessional

Healthcare Teams

A

literature

search

for articles

on

faculty attitudes

toward

IPE

and

IP teams

yielded

only

one study by Curran, Sharpe, and Forristall (2007b). The purpose of

this

study

was

to examine

faculty

attitudes

towards

IPE and IP

teamwork. Healthcare faculty

in medicine, nursing, pharmacy, and social

work

at Memorial University of

Newfoundland, St. John's,

Newfoundland,

Canada(N =194;

medicine

n =

106, nursing

n

=

64, pharmacy

n

=

10, and

social work n

0)

responded to three Likert scale surveys.

The

three

surveys

that were used included

the

14-item Attitudes Toward Interprofessional

Healthcare Teams scale (Cronbach's alpha of .88), the 15-item Attitudes Toward

Interprofessional Education scale

(Cronbach's alpha of

.92), and

the

13-item Attitudes

Toward Interprofessional Learning scale (Cronbach's alpha of .81).

Response rate was

63%.



64

Research instruments, procedures, sample, and analysis were clearly described.

The researchers computed

a

one-way

ANOVA

and post hoc comparisons

using

the

Scheffe test. Curran et

al.

(2007b)

reported

the mean attitude scores for

physician

faculty

were significantly lower (p <

.05)

than nursing faculty on all three scales.

Faculty

who

had

prior

experience with

EPE reported significantly higher mean scores than those

with

no experience (p = .01)

and

females reported

significantly

higher mean scores (p

<

.01).

Therefore, healthcare

discipline,

experiencewith IPE, and gender

significantly

influenced

attitudes toward IPE,

IP

teams, and IP learning.

The

Curran et al. (2007b)

study is generalizable

only to Memorial University of

Newfoundland and the selected disciplines including medicine, nursing, pharmacy, and

social work.

In

addition, the

samples

of pharmacy

and social work faculty

were

too

small

to

be statistically

meaningful.

The research

instruments demonstrated

high

internal

consistency reliability and the authors

presented

the study and its findings clearly.

An

earlier

quantitative study

by

Curran et

al. (2005b)

examined attitudes

of

academic administrators towards

DPE

and

IP

teamwork in Canadian post-secondary

schools of

health

professional education.

Eighty-two senior

administrators responded

including

deans

and

directors of

various health

education programs

(medicine

n = 8,

nursing n

= 30,

pharmacy n

= 6, social work n = 17, physical

therapy

n= 9, occupational

therapy

n =12). The response rate for this study

was

46.9%.

The

researchers

did not

describe where their sample

was

from

or how

it

was

chosen. They only

stated that

the

administrators selected were from the varying programs across Canada.



65

Subjects

in

the Curran

et

al.

(2005b) study completed

a

web-based survey and

answered questions about their healthcare education

program

characteristics (student and

program types), attitudes toward interprofessional teams and

toward interprofessional

education,

and were

asked to identify

barriers

to IPE

in academic

settings.

Overall,

attitudes toward IPE and IP teamwork were positive. There were no significant

differences

among

the different types of

professionals who

participated

regarding

attitudes. The barriers to IPE and IP teamwork that were

identified most frequently

in

this

study

were schedule/calendar, rigid curriculum, turf battles, and lack of

perceived

value

of

IPE.

Other barriers mentioned included lack

of

financial resources,

lack of

administrative support, classroom

size,

faculty attitudes, student acceptance, and lack of

reward for faculty. These barriers are concerning because they may impact the successful

implementation

of

IPE and account

to

some degree for the reason healthcare discipline

students are not receiving IPE.

Barker, Bosco, and Oandasan (2005) explored factors

that

affect the

implementation

of

IPE.

This

study was done in Canada and utilized grounded theory

methodology. A sample of participants who were considered champions in

the

field of

IPE were identified and 12 interviews were completed. Discipline backgrounds

of

the

interviewees were not revealed.

The

interviews

started out

broadly but then narrowed

to

progressively

focus on concepts and

relationships

elicited. Interviews occurred one time

only.

The

researchers

audio

taped and transcribed the interviews.

Data

analysis

included

manual content analysis and the use of

computer software.

Five main

themes emerged

including

lack of consensus of

terminology regarding

IPE;

the need

for champions to



66

move

the EPE

initiative forward; the need

for

external support in the

form

of funding,

academic institutions, government,

and

accreditation bodies; sensitization

of

the effects

of

professional

culture

which

essentially

were the ontologic

elements that

were

entrenched

in

participants and found

to

be

very

difficult

to

change; and

logistics of

implementation which included

timetabling, geography, and

physical

space. The study

was

a well done,

qualitative investigation.

Summary of Faculty

and

Interprofessional

Education

and

Interprofessional

Healthcare Teams

A total

of

three relevant studies were found. All three studies were conducted and

published in Canada.

Only

one study was found concerning faculty attitudes and

interprofessional

education or

interprofessional teams. There

were no other

studies

identified

that met these specific criteria. The

literature in

the area of faculty attitudes,

IPE and IPHCT is extremely limited. The other two studies found included

a

study of

administrators

of

professional

schools,

not faculty, in relation to interprofessional

education and a study

on factors that affect the implementation

of D P E . These

few studies

indicated that there

is a

significant gap in the literature and

a

significant need and

opportunity for the study

of

faculty in relation to IPE and IPHCT.

Chapter Summary

IPE definitions, IPE research, IPHCT, TRA

and TRA research

were

presented in

this literature review. IPE

is a complex

concept

that

has different

interpretations,

overlapping terminologies, interchangeable terms, and a

general

lack of uniformity in the

literature.

This has

led

to

misunderstandings and barriers

to optimal IPE

research

and



67

implementation. The concept analysis derived definition

of

IPE (Olenick et al., 2010a)

will

provide guidance for this study.

The

IPE empirical

literature

reviewed pertained to attitudes, perceptions,

perspectives,

and

motivation

of healthcare students. The IPHCT literature focused

primarily on collaboration, collaborative behavior, readiness

for

interprofessional

learning, and interprofessional and team management

of

patients.

TRA literature reviewed

how

attitudes

and

beliefs predict behavior in clinical

situations.

Four meta-analyses were included in this

literature

review

and support the

strong predictive

nature

of TRA, the components of the model,

and

the relationships

between the components in the model. There was no literature found where TRA was

used in conjunction with IPE or IPHCT. Most

of

the IPE and IPHCT literature did not

utilize theoretical

frameworks.

Therefore, there

is

significant opportunity and

need to

study IPE and IPHCT within the context of

a

theoretical framework.

A literature search on faculty

and

IPE

and

IPHCT

revealed

only two published

studies. A significant

gap

in

the

literature regarding faculty in relation to

IPE

and IPHCT

exists. A great opportunity

exists

for future

research

in this topic area as well.



68

Chapter III

Methodology

The aims of

this study

were

to

explore

healthcare

faculty

(HCF) attitudes toward

interprofessional education (IPE) and interprofessional healthcare teams (IPHCT), to

explore

HCF

perceptions of subjective norms'

influence

on HCF intent toengage in IPE,

to

explore HCF intent

to engage in

IPE,

and to explore differences among types

of HCF

in attitudes toward IPE and IPHCT and intent to engage in EPE.

This

chapter includes a

description of the

research

design, sample,

instruments,

data

collection procedures,

and

data

analysis.

Research Design

A study design

is a

blueprint that maximizes control

over

factors that

contribute

to

the validity of a

study (Burns

& Grove, 2009). The research questions guiding this study

were:

1) What are

healthcare

faculty attitudes

toward

interprofessional education and

interprofessional healthcare

teams?

2) What are the subjective norms that influence healthcare faculty intent to engage in


3) What are

healthcare faculty

intentions

regarding

engaging


education?

4)

What are the relationships among healthcare faculty attitudes toward

interprofessional

education,

interprofessional

healthcare teams,

and

intent to

engage in

interprofessional

education?



69

5) What are the differences in attitudes toward interprofessional education and

interprofessional healthcare teams, and intent to engage

in

interprofessional

education

among healthcare

faculty from


programs?

Descriptive correlational and comparative research designs were used

in

this

study.

Descriptive designs

"identify a

phenomena

of

interest, identify variables within

the

phenomena, develop conceptual and operational definitions

of

variables and

describe

variables in

a

study

situation"

(Burns &

Grove,

2009, p. 696).

Correlational research is

a

"systematic

investigation of relationships between two or more

variables

to explain the

nature of relationships in the world and not

to examine

cause and effect" (Burns

&

Grove, p. 694). Comparative descriptive designs

"describe

differences in variables in

two

or more groups" (Burns & Grove,

p.

692).

Sample Selection and

Size

Selection

of

Healthcare Faculty

Healthcare faculty were selected via internet searches

of the

healthcare programs

of colleges and

universities

throughout the U.S. Nursing (NU), medicine (MD),

pharmacy (PH),

physical therapy

(PT), occupational therapy (OT),

physician

assistant

(PA), and social work (SW) programs were included

in the national selection of subjects.

These

particular professions were chosen because they represent nursing, medical, social,

and therapy aspects of healthcare

through

direct patient care

and management.

A

stratified, random, proportionate sampleof

10%

of programs

was

compiled and separated

according to the four U.S. census

bureau

regions (Northeast, Midwest, South,

and

West)



70

and based on availability

of

publically

available faculty email

addresses

on the

internet

on the school or healthcare education program (e.g., nursing program) website. The total

number

of

programs for each healthcare

discipline

in each region is

presented

in Table 1.

The four

U.S.

census bureau

regions (U.S.

Census Bureau,

2011) (excluding Puerto Rico)

are:

1. Northeast aine, New

Hampshire,

Vermont, Massachusetts, Rhode Island,

Connecticut, New

York, Pennsylvania,

New Jersey

2. Midwest Wisconsin, Michigan, Illinois, Indiana, Ohio, Missouri, North Dakota,

South Dakota,

Nebraska,

Kansas, Minnesota, Iowa

3. South

elaware, Maryland, District

of Columbia,

Virginia,

West

Virginia,

North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee,

Mississippi, Alabama, Oklahoma,

Texas,

Arkansas, Louisiana

4. West daho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona,

New

Mexico, Alaska, Washington, Oregon, California, Hawaii

This researcher identified nursing schools that offered baccalaureate and higher

degree programs in nursing and were accredited by

the

Commission on Collegiate

Nursing Education (CCNE)

or

the National League of Nursing Accrediting Commission

(NLNAC).

Allopathic medical schools

that

were accredited by

the Liaison

Committee on

Medical

Education (LCME),

pharmacy

schools

that were accredited

by the

Accreditation

Council

for Pharmacy Education (ACPE),

PT

schools that were

accredited

by the

Commission on Accreditation in

PT

Education

(CAPTE), OT

schools that

were

accredited by the Accrediting Council

for

OT Education (ACOTE), physician assistant



71

programs that

were accredited by the Accreditation

Review

Commission for the

Physician Assistant (ARC-PA),

and

social

work

programs that were accredited by

the

Council on Social Work

Education

(CSWE) were also identified by this researcher. Only

programs

that

offered

a

minimum of

a bachelor's

degree

or

higher in these disciplines

were included in this study.

Stratified random sampling was used to ensure that the population surveyed was

representative of the target population.

"In

stratification,

each stratus should have

numbers of subjects selected in proportion to their occurrence in the population" (Burns

& Grove, 2009,

p.

747). To achieve stratified random sampling, this researcher entered

the names of

all

the schools that are counted in

Table

1

into

an Excel spreadsheet. Once

the

spreadsheet

was created,

a

random number generator

software

program was used

to

Table 1

Number

of

Health

Discipline Programs per

Census

Bureau

Regions

and

Type

of

Program

and Number

Randomly

Selected for

Study

Type

of

Program Northeast

Midwest

South

West

Total

n

(10%) n (10%)

n

(10%) n (10%)

NU 165(17) 226(23) 264

(26)

98

(10)

753(76)

MD

31(3)

32

(3)

50

(5) 16 (2)

129(13)

PH

22

(2)

26 (3)

46(5) 23 (2)

117(12)

PT

56 (6)

58

(6) 62 (6)

28

(3)

204(21)

OT 46 (5)

40(4) 47(5) 19(2)

152(16)

PA

47(5)

34 (3)

51(5) 22

(2)

154(15)

SW

47

(5)

53 (5)

76(8)

42(4)

218(22)

Total

programs in

414

(43)

469

(47) 596 (60) 248 (25)

1727

(175)

each region



72

select 10%

of each

of the seven types

of

programs from

each of the four census

bureau

regions. Initially, a total

of

175 healthcare discipline programs were randomly selected.

From

the

175 randomly selected programs, this researcher

accessed

each

program's

website and searched

for

publically available

email

addresses

of

faculty. An

online survey using Survey

Monkey™ was

sent to

those

available

faculty

email

addresses. The email

invitation

to

participate included

a letter of explanation (Appendix

A) which explained in detail the study title,

purpose,

description, risks, benefits,

alternatives, confidentiality, termination of participation, compensation, and

researcher's

name and

contact

information with

a

link to

the

actual survey.

Study inclusion criteria were

included

in the demographic data collection portion

of the

online

survey. Only healthcare faculty who were employed in one

of

the seven

healthcare

disciplines were

included in

this

study.

Those

who

held a master's degree or

above,

who were full time, and who

had professorial rank

(full

professor,

associate

professor

or assistant

professor)

were

invited

to complete

the survey. These inclusion

criteria

were selected since it

is more probable

that

only

full time

professors with

an

advanced

degree

would have

a

voice in determiningcurriculum and opportunity related

to engaging in IPE.

It was

expected

that

the

original random selection

of

10%

of

programs

in

each

census bureau region would be sufficient to acquire the 231 subjects required for this

study.

Nursing

met

its required 33 subjects

very

early on in the datacollection but the six

other

healthcare disciplines

lagged

behind

despite this researcher following Dillman's

Tailored Method Design (TDM) (Dillman, Smyth, & Christian,

2009),

as

described

in

the



73

data collection procedure section of this chapter. Therefore, another 10%

of

all

healthcare programs, exceptnursing, were

randomly

selected and sent out for a total

of

20% of

all programs

nationwide excluding nursing which remained at

the 10% rate.

Subjects

were

not asked

on

the

demographic

data

form

which

school they were

associated with,

as a measure to maintain

confidentiality,

so there is no way to

discern

which

schools from

the

random

stratified sample

participated

and which did not.

A

total

of 5224 emails were sent out

and

a total of

451 replies

were

received

which yielded

an

8.6% response rate.

Size

and description

of the

healthcare faculty sample.

An

a

priori power

analysis determined the minimum

total sample

size of 231

was

required

for

this study.

Sample size

was

calculated using Sample

Power

version 2

(SPSS,

2004). Effect size,

significance

level,

and power

were

all considered. A medium effect

size, a

significance

level

of

.05 and

a

power

of

.80

were

used

to compute the power analysis. Effect size

takes into consideration

the

degree to which the independent variable will affect the

dependent variables.

A medium effect size was appropriate

for

this study because the

research instruments have shown both

reliability

and validity in previous studies. Also,

maturity of TRA, the theoretical basis of this

study,

contributes to the rationale for use of

a medium effect size.

A

power

of .80 is

standard and

desirable

(Burns

& Grove,

2009)

and minimizes the

chance of a Type II error

or

the

likelihood

of

accepting

a false null

hypothesis. The

number

of

variables

for each

question

was also considered.

Power

analyses were computed separately

for

each hypothesis to determine the minimum

number

of subjects required for the study.



74

When multiple regression statistical analysis

was

considered,

a

medium

effect

size

of

.13

was used in

the

power

analysis computation.

According

to Cohen (1988), a

medium effect

sizeof .13 is

appropriate for multiple regression analysis. In this multiple

regression analysis there were two predictor variables, an alpha

of

.05 and

a

power of .80.

Sample

Power

(SPSS,

2004) calculated that

a

minimum sample

of 68 subjects

would be

acceptable for this analysis.

When multivariate analysis

of

variance (MANOVA) was considered,

a

medium

effect size of .25,

an alpha

of .05

and power

of .80

for

seven

groups

were

used in the

power analysis

computation. Sample Power calculated that

a

minimum

sample of 33

subjects

per

group

was

required. Since there were

seven groups in

this analysis, a total of

231 subjects

was

the

required

minimum sample size for the

MANOVA

analysis. Given

that

the

MANOVA required more

subjects

than

the

multiple regression

analysis,

the

minimum total sample size that was sought for this study

was

231 subjects.

Description of

actual sample.

The actual sample

for this study

included 439

healthcare faculty from the seven healthcare professions nationwide. A total of 5,224

emails

were

sent out to

faculty

in

274 schools

from

the stratified random

sample of

nursing

(NU), medicine

(MD), pharmacy (PH), physical therapy (PT), occupational

therapy

(OT),

physician assistant

(PA), and social work

(SW) programs

across

the

U.S.

Details

of

the

descriptive statistics of demographic

variables

are

presented

in Tables 2

and

3.

In

Table 2, the number of responses for each

faculty group

does not always equal

the

total

number of

subjects

in the groups due to missing data.



Table 1

Frequencies

and

Percentages ofSample Characteristics

NU MD PH

PT OT PA SW

Variable

n

n n

n

n n

n

And Categories

Gender

Female

182

95.8

16 43.2 28 60.9 33 66.0

31 77.5

22

57.9

27

75.0

Male

8 4.2 21 56.8

18

39.1 17

34.0 9

22.5

16

42.1

9 25.0

Highest

degree

Bachelor's 1 2.6

Master's 57 30.2 1 2.6

1

2.2

7 14.0

11

27.5 22

59.5

3

8.3

Doctorate 132 69.8

36

94.7

45

97.8 43 86.0 29 72.5 15

40.5

33

91.7

Teach at level

Bachelor's 135 70.7 4

10.5

1

2.2

6

15.0

2

5.3

Master's 93

48.7

6 15.8

2

4.3 1

2.0 39

97.5

38

100

33

91.7

Doctorate 41

21.5 38 100 46

100

50

100

5

12.5 8

22.2

Employment status

Part-time 8 4.3 4 11.4 2

4.1 3

7.5

3 8.1 2

5.6

Full-time 178 95.7 31

88.6

46 100

47

95.9 37

92.5 34

91.9 34

94.4

Appointment status

Permanent 173

91.1

35

92.1

44

95.7

48

96.0

36

90.0

34

89.5 31

86.1

Temporary

17

8.9

3

7.9

2

4.3

2

4.0

4

10.0

4

10.5

5

13.9

(continued)



NU MD PH PT OT PA SW

(n=

191) (n

=

38) (n

=

46) (»

= 50)

(n = 40) (w =

38)

(n

=

36)

Variable

n n n n n n n

And

Categories

Faculty position

Teaching faculty 161

85.2

Administrative

faculty

28 14.8

32

4

88.9

1 1 1

38

7

84.4

15.6

42

7

85.7

14.3

30

8

78.9

21.1

24

13

64.9

35.1

30

5

85.7

14.3

Tenure appointment

Tenured 53

27.9

3 8.1 18 39.1 17

35.4

12 30.0

6 16.2 18

50.0

Tenure

track

52 27.4

3

8.1 7 15.2 9

18.8 9

22.5 4

10.8

8

22.2

Non-tenure track

85 44.7 31

83.8

21

45.7

22

45.8 19

47.5 27

73

10

27.8

Currently implementing IPE

Yes 86

45.0

27 71.1 27 58.7 37

74.0 23 57.5

29

76.3 19 52.8

No 105

55.0

11

28.9

19

41.3 13

26.0

17 42.5

9

23.7 17 47.2

Previously implemented IPE

Yes

90

47.6

24

63.2 29

63.0

31

64.6

26

65.0

28 73.7 21

58.3

No

99 52.4

14

36.8

17

37.0 17

35.4

14 35.0

10

26.3 15

41.7

Academic appointment

Full Professor

35

18.3 8 21.1 18

39.1

6

12.0

2

5.0

3

7.9

9

25.0

Associate Professor 45 23.6

9 23.7

11

23.9 19

38.0 17 42.5

10

26.3

12 33.3

Assistant Professor 95 49.7

19 50.0

14

30.4

20

40.0 10

25.0

19

50.0 9 25.0

Clinical/Instructor/

13 6.8 1

2.6 3

6.5

5

10.0

9

22.5

6

15.8

3 8.3

Lecturer

Other

3

1.6 1

2.6

2

5.0

3

8.3

(continued)



NU MD PH

PT OT PA SW

(n= 191) (n =

38)

(n = 46)

(n = 50) (n

= 40)

(n

= 38)

(n=

36)

Variable

And

Categories

n

n n

n n

n

n

Experience

with IPE

None

62 33.0

7

18.4

10

21.7

9

18.4

8

20.0 5

13.2

7 19.4

< 1

year 27 14.4

5 13.2

4

8.7

6

12.2

3

7.5

5

13.2

3 8.3

1-2 years 31

16.5

7

18.4

8 17.4

8

16.3

7

17.5

10 26.3 6

16.7

3-4 years

26

13.8

2 5.3 8

17.4

11 22.4

8 20.0

7

18.4

3

8.3

>

5 years

42 22.3 17 44.7 16 34.8

15 30.6

14

35.0

11

28.9 17 47.2

Experience

with

IPHCT

None

27 14.1 7

18.4

7

15.2

5

10.0 2 5.0

4

10.5 4 11.1

< 1 year

10

5.2 2

5.3 3

6.5

2

4.0

1 2.5

1

2.6

1

2.8

1-2 years 17

8.9

5

13.2

5 10.9 3

6.0

2

5.0

5

13.2

5

13.9

3-4 years

19 9.9

1

2.6

5

10.9

5

10.0 1

2.5

5

13.2 2 5.6

> 5

years 118 61.8

23

60.5

26

56.5

35

70.0 34

85.0 23

60.5

24

66.7



Table

2

Descriptive

Statistics

of Sample Age and Experience

Variables

NU

MD

PH

PT

OT PA

SW

(n =

191)

(n = 38)

in

=

46)

(n = 40)

U

in

= 36)

Age

Mean

54.43

49.24

46.09 48.32 49.49

49.59

51.39

SD 8.42

12.30 12.46 9.71 8.56 8.50

9.73

Range

34-81

31-73 0-52 28-68

30-65

31-67 32-69

Years

experience

as a

health professional

Mean

31.06 20.90

20.74

23.28 24.67 22.66

22.29

SD

9.14

13.04

14.46

10.82

10.10 8.29

11.05

Range

7-58 0-47 0-52

0-47

1-46 0-36

0-45

Years

experience as a

health

professional

educator

17.11

15.23

15.07 13.22

12.66

11.30

14.06

Mean

10.97

10.95 12.54

7.93 6.98

6.28 8.58

SD 2-40

2-40 1-49

1-33

1-28 1-32 2-38

Range



79

Most of the respondents

in

the

total

sample (

N =

439) were nurses (n=

191).

The

NU

sample was

primarily

females who held their doctoral degree and taught at the

bachelor's level.

Most were employed as

full

time, permanent, teaching faculty. Less

than half

of the

nursing

sample was currently or

had previously

implemented

BPE.

The

mean age

of the

NU

sample

was

54

with

an

average

of 31 years experience as a health

professional

and an

average

of 17

years

as

a health professional

educator. The

majority

of the

NU

faculty were

tenured or on

a tenure

track

with

an

academic appointment of

assistant professor.

The MD

faculty

was

primarily male and nearly

all

held

a doctoral degree.

They

all taught at the doctoral

level.

Most were employed as

full time,

permanent, teaching

faculty

and

more

than

half of the MD faculty was currently or had previously

implemented IPE. The mean age

of

the

MD

faculty was 49with an average

of

21

years

experience

as

a

health professional and an average

of

15 years

as

a health professional

educator. The vast majority

of

MD faculty in this sample were in non-tenure track

positions with an academic appointment of assistant professor.

The

PH sample was primarily female. Nearly all pharmacists held their doctorate

and all taught at the doctoral level. All

were

full time, permanent teaching faculty. More

than half of the pharmacy

sample were

currently or

have

previously implemented IPE.

The

mean

age

of the PH

sample

was

46 with an

average

of

21 years

experience

as

a

health

professional and an average

of

15 years as

a

health

professional educator. The

majority

of PH subjects

were tenured or

on a tenure track

and

were full or

associate

professors.



80

The PT

sample

was primarily

female. Most

PT

faculty held their doctorate

and

all taught at

the

doctoral

level.

Most were full time,

permanent teaching

faculty. More

than half of the

PT

sample

were

currently

or

have previously

implemented

IPE. The

mean age of

the PT

sample was

48 with

an average

of 23 years

experience as

a

health

professional and an average of

13

years

as

a

health professional

educator. The majority

of

PT subjects

were

tenured

or

on a tenure track and were full

or

associate professors.

The OT sample was

primarily

female. Most OTs held

their

doctorate and taught

at

the

master's level.

Most were

full

time,

permanent

teaching faculty. More

than

half of

the OT sample were currently or have previously implemented BPE.

The

mean age of the

OT sample was

49 with

an average

of

25

years

experience as

a

health professional and an

average of

13

years

as a health professional educator.

OTs

in this sample were mostly

tenured

or

on a tenure track and were primarily

associate

professors.

The

PA sample was primarily female.

Most

PA faculty held

their

master's

and all

taught at the master's level. Most were full time, permanent teaching faculty. More than

half of

the

PA

sample were currently

or

have previously implemented IPE. The

mean

age of the PA sample was 50 with an average of 23 years experience as a health

professional

and an average of

11

years as a health

professional

educator. PAs

in

this

sample were predominantly

in

non-tenure

track

positions

as

assistant professors.

The SW sample was

primarily

female. Most SW faculty held

their

doctorate

and

taught at the

master's level. Most were

full

time,

permanent

teaching faculty. More than

half of

the

SW

sample were

currently or

have previously implemented IPE.

The mean

age of the

SW

sample was

51

with an average of 22 years experience as a health



81

professional and an average of 14 years

as

a health professional educator. The majority

of

SWs in

this

sample

were

tenured or on

a

tenure track and

were full or associate

professors.

Instrumentation

A

Demographic Data Form

(Appendix

B) was used to collect information for the

purpose

of

describing

study subjects and included

questions

to measure

the

variables of

subjective

norms

and intent to

engage

in IPE.

Two

research instruments that were

adapted

for

assessing faculty attitudes by

Curran et

al.

(2008)

were

used

to measure the

attitude variables. Instruments

are

discussed in detail in this section including a general

description,

validity, reliability,

and scoring. The first

instrument

was adapted by Curran

et al. from Parsell and Bligh

(1999)

and

measures

attitudes

towards

IPE (Appendix

C).

The second

instrument

was adapted by

Curran

et al. from

Heinemann,

Schmitt, and

Farrell (2002) and measures attitudes

towards

healthcare teams

(Appendix

D). Aside

from

the instruments developed

by

Curran

et al., there were no

other instruments in the

literature to measure the attitude variables. These instruments were chosen

for

use in this

study because they were designed specifically to measure faculty

attitudes toward

IPE

and

EPHCT which were the

research variables in

this

study. Table

4

presents Cronbach

alpha internal consistency reliability coefficients for the two attitude scales for each

group of

healthcare faculty.

Demographic Data Form

The Demographic Data Form

(Appendix

B) was used to collect information for

the

purpose

of

describing study subjects. Definitions

of IPE

and IPHCT were provided to



82

Table 4

Cronbach

Alpha Reliability Coefficients of

Attitudes

Toward IPE and IPHCT

Variables NU MD PH PT

OT

PA SW

(n = 191)

(n

= 38)

(n

= 46) (n = 50) (n = 40) (n = 38) (n = 36)

Attitudes

towards IPE

.92

.91 .89

.88

.90

.93 .93

Attitudes

towards .90

.90

.85

.90

.86

.88

.85

IPHCT

subjects

to

promote understanding

of these concepts. Subjects were

asked

what health

discipline they teach, characteristics

of

their academic appointment, highest degree

achieved, employment status, age,

gender,

level of

experience with IPE or

IPHCT

and

the

type

of

experience they have had, and level

of

experience as a healthcare professional and

as a healthcare educator.

Attitudes Toward Interprofessional Education

Description. The

Attitudes Toward IPE Instrument

is a

14-item Likert

scale. It

was originally developed

by

Parsell and

Bligh (1999) as

the Readiness

for

Interprofessional Learning

Scale

(RIPLS)

with a

three factor scale

composed of 19

items

designed

to measure readiness

for

multi-professional

shared

learning and measured three

factors

(team work

and collaboration nine

items,

professional identity seven

items,

and

roles

and

responsibilities three items).

The

RIPLS

was adapted by

Curran et

al.

(2007)

for

use in assessing faculty attitudes toward IPE. Curran's

first

adaptation

of

this scale

had 15 items (roles and responsibilities factor was

totally

excluded

and

one item from



83

professional

identity was

excluded

due to

not

applicable to survey population). In his

2008 study, Curran removed another item from his adapted 15 item scale on the basis

that

it

correlated poorly with the other 14 items.

When that one item was removed, the scale's

internal consistency reliability improved

from .89

to

.91

(Curran et

al.,

2008). For

the

purpose

of this study, the

instrument

that

was

used is Curran's

most

current

14-item

scale.

Validity. In

a

study by

Curran

et

al.

(2008), construct validity was established by

factor analysis

which

initially

revealed

three components consistent

with

the

original

authors' assessment.

However,

the

moderately high correlation between factors

1

and

2

(.53)

and

between factors

1 and

3 (.78) confirmed that

all three

factors

were measuring

the same general concept,

therefore,

all 14 items

were combined

into a one factor solution

yielding

a

univocal measurement instrument. The

size of

the sample in the Curran et

al.

(2008) study was 1179.

Reliability. Curran et al. (2008)explored internal consistency

reliability and

found a high Cronbach'salpha of .91. Curran's adapted scale,

which

is the scale that

was

utilized

for

this study, is composed of

14

items.

The

Attitudes Toward

EPE

Instrument

was

used in this study to measure faculty

attitudes toward IPE.

Internal

consistency reliability for the total sample

yielded

a

Cronbach's

alpha of

.91.

Cronbach's alpha

was also computed

for

faculty in each

of

the

seven

healthcare

profession groups

and demonstrated high

internal consistency reliability

for each group

with

a

range

of .88 to .93. The alpha

scores in this

study are

consistent

with the scores demonstrated by Curran et

al.

(2008) of .91 for the Attitudes

Toward IPE



84

Instrument. Ail

items

in

this instrument had positive item-to-total

correlations for

all

of

the groups, indicating that

all

items contributed positively to the instrument reliability.

Scoring.

This scale consists

of

Likert scoring that ranges

from

1 (strongly

disagree)

to

5

(strongly agree). Item number

7

on this

scale was

negatively

worded and

was reverse scored

prior

to data analysis. Responses to the 14 items

were summed

to

yield

a

total score. Total scores could range from 14 to 70 and higherscores reflected

more positive attitudes toward IPE.

Attitudes Toward Interprofessional Healthcare Teams

Description.

The

Attitudes

Toward DPHCT Instrument is

a

14 item Likert scale

adapted

by

Curran et al. (2008). It was originally developed by Heinemann

et al.

(1999)

with

27 items

(quality

of

care 14

items, costs of team

care 7 items, and physician

centrality

6 items). Curran's et al. adaptation

of

the scale excluded the physician

centrality factor (six

items)

since

it

was felt

that

this factor was

not

applicable to his study

population

due

to the limited experience

his

student subjects had in this

area.

Other

changes to

the

original tool by Curran

included removal

of 3 of the

14

quality of care

items for

a

total now

of

11 quality

of

care items and removal

of

4

of

the 7 costs

of

team

care

items.

The final version

of

the tool, that was used in

this

study, consists of 14 items.

Physician centrality remained

excluded since it

would not be applicable to

the

other six

disciplines in this research.

Validity. Three factors were identified in the original

scale by

Heinemann,

Schmitt,

and Farrell (2002), the original authors. Curran

et

al. (2008) explored

the

construct validity through factor analysis and found two main components that explained



85

34.1% and 9.8% of the

variance,

respectively

(quality

of

care

=

11

items, and

team care

=

3

items). The size

of

the sample

in

the Curran et al. (2008) study

was

1179.

Reliability. Internal consistency reliability in a study

by

Curran

et

al. (2008)

yielded

a Cronbach's

alpha

of

.83.

Curran's et al.

adapted scale and

the scale

utilized

for

this study

uses

11 items from qualityof care and 3 items from the teamcare factor for an

instrument

total

of 14

items.

The Attitudes Toward

IPHCT Instrument

was used in this

study

to measure

faculty attitudes toward IPHCT.

Internal

consistency reliability for

the

total

sample

yielded

a Cronbach's

alpha

of

.88.

Cronbach's alpha was also

computed

for faculty

in

each

of the seven

healthcare profession groups and demonstrated high internal

consistency reliability for each group

with

a range of .85 to .90. The

alpha

coefficients in

this study are higher

than

the alpha

of

Curran's et al.(2008) alpha of .83. All

items

in this

instrument had positive item-to-total correlations

for

all of the groups, indicating

that

all

items contributed

positively

to

the instrument

reliability.

Scoring. This scale consists of Likert scoring ranging from

1

(strongly disagree)

to 5 (strongly

agree).

Items number 2,

6,

and 9

were

negatively

worded

on this scale and

were reverse scored prior to

data

analysis. Responses to

the

14 items were summed to

yield a

total

score.

Total scores could range from 14 to

70

and higher scores reflected

more

positive attitudes

toward IPHCT.

Subjective

Norms

Description.

Subjective norms were measured using two single item, continuous,

7-point

magnitude

continuous

rating

scales. The first scale

stated

"My

faculty



86

colleagues think I should or should not engage in

IPE."

The second scale stated "My

school's

administrators think

I

should orshould not engage in IPE." The rating scales

ranged

from

1

(I should

not)

to 7 (Ishould).

Validity.

The single-item

measures

of subjective norms were

not

tested for

validity. No multiple-item measures currently exist for measurement

of

IPE subjective

norms so criterion and construct validity could not be assessed.

However,

several

researchers have found single-item measures

to be valid and

useful.

Woods

and

Hampson (2005) concluded

that

single-item measures

of

personality

demonstrated construct validity with convergence (r

=

.61) when compared to multiple-

item

scales.

West, Dyrbye,

Sloan, and Shanafelt (2009)

compared

single-item

measurement

for the

assessment

of

burnout against a well validated

burnout

instrument

and demonstrated

concurrent

validity

through

correlations that ranged

from

.61 to .83.

West et al. determined that the single-item measures provided meaningful information

and stratified burnout risk consistently.

DeSalvo, Fisher, Tran, Bloser,

Merrill, and Peabody

(2006)assessed the

measurement properties of two single-item health questions and determined good

concurrent

(r

=.56

and .59)

and discriminant validity (ANOVA, p

< .001).

Dollinger and

Malmquiest

reported good

validity

when they correlated single-item measures with

multiple-item

measures. Single-item

measures

in

Jordan and

Turner's

2008

study on

organization justice demonstrated concurrent validity.

Face

and content

validity

of

subjective norms single-item measures was assessed

prior

to administration of the

items.

A

total

of 10 HCF from

the health

disciplines of



87

nursing, social work, and medicine assessed the single-item measures

for

their relevance

and

determined that they measure what they intended

to

measure. Barofsky, Erickson,

and Eberhardt (2004) sought

to

determine whether single-item use may

be

substituted for

multiple-item use in their

study

of persons

with and without

diabetes. They were

unsuccessful in providing enough evidence that single-items may be consistently

substituted

for

multiple-item instruments. Hasson and Arnetz (2005) found that single-

item measures, although comparable to multiple-item measures, should not

be

considered

interchangeable. This

position

is

consistent

with

Gardner, Cummings, Dunham, and

Pierce (1998) who indicated that single-item measures are appropriate in

certain

situations,

especially when

multi-item instruments are

not

available.

In

this

research,

there were

no other

instruments available

for use for

assessment

of

IPE

subjective

norms,

therefore, substitutability

was

not an issue since no multiple-item instrument existed.

Reliability.

The single-item measures

of

subjective norms were not tested for

reliability.

This

study

collected data onone

occasion only

so

there

was no

opportunity

for

test-retest procedures.

However, several

researchers have

found

single-item measures

to be reliable and

useful.

Woods and Hampson

(2005)

concluded

that single-item

measures of

personality

demonstrated test-retest reliability. Woods

and

Hampson stated single-item measures

encourage participation because they

save

time and are easier

for participants

to engage

in. They

also

recommend a bi-polar approach when using single-item

measures. The

measurements

of

subjective norms in this study were bipolar constructs

since

they

contain contrasting descriptions

at each

end of the

Likert scale.



88

DeSalvo et

al.

(2006) concluded that single-item

measures

of

health

demonstrated

good reproducibility

and

reliability

when

administered two weeks apart

(r

=

.74).

Dollinger and Malmquist (2009)

concluded

that

single-item measures are more reliable

and

valid

than commonly thought when

they

found good to

excellent

test-retest reliability

of

single-item measurement

of

college students' alcohol use, religiosity, and social

life.

Single-item measures in Jordan and Turner's 2008

study

on organization justice

demonstrated

reliability

coefficients of .70 and above.

The

subjective norms single-items measurements in this study demonstrated

utility since

they

were very practical,

demonstrated ease

of

use, took

very little

time

to

complete, and the language and phrasing was determined to

be

clear

by

the

HCF

who

assessed the items

for

content and

face

validity.

Scoring. This scale

used

a 7-point rating scale

with

the anchor

points

identified

as 1

(I

should not) and

7 (I

should). Total scores could range from 1 to

7.

Higher scores

reflected stronger

perceptions that

faculty colleagues

and

school's administrators

believe

HCF should engage

in IPE.

Intent

to

Engage in IPE

Description.

Intent

to Engage in IPE was

measured

using a single item,

continuous, 10-point, magnitude

rating scale. Subjects

were asked how likely they

were

to engage in IPE

within the next

three years.

The

rating scale ranged from 1 (not

at

all

likely

to engage in IPE within the next 3 years) to 10 (very likely to engage in

IPE

within

the next 3

years).



89

Validity.

No

multiple-item measures currently

exist for

measurement

of intent to

engage in IPE

so

criterion and construct validity could not

be

assessed. However, a

number of researchers have found single-item measures

to

be valid and useful as

mentioned

above

under

the subjective

norms validity subheading.

Face

and content validity

of intent to engage

in IPE single-item measure

were

assessed prior

to

administration. A total

of 10

HCF from the health disciplines of

nursing, social work, and medicine assessed

the

single-item measure

for its relevance

and

determination

of

the scale measuring

what

it

was intended

to

measure.

Reliability. The single-item

measure

of

intent

to

engage in IPE was not tested

for

reliability. This study collected data

on one

occasion only so there was no opportunity

for test-retest

procedures. However,

a

number

of

researchers have found

single-item

measures

to

be reliable and useful as mentioned above

under

the subjective norms

reliability subheading.

Scoring. This

scale

consists of a

10-point, magnitude rating scale ranging

from 1

(not

at all likely to

engage

in

IPE

within the next 3 years)

to 10

(very likely to

engage

in

IPE

within the next

3

years). Total scores could

range

from

1

to 10

and

higher scores

reflected stronger likelihood

of

intent

to

engage in IPE within the next

3

years.

Data Collection

Procedures for Data Collection

Institutional Review Board (IRB) approval

was

sought and attained from Widener

University (Appendix

E).

Upon approval, an email message was sent

to

each

of

the

healthcare faculty asking them to complete an online survey.

The

Dillman Tailored



90

Design Method (TDM) was used in an attempt

to

achieve

a

predicted response rate

of

80% (Dillman

et

al., 2009).

TDM

recommends

a

"3 Contact

Strategy"

(Dillman

et

al., 2009, p. 276). When

using

an

email survey,

the

first email

introduces

the potential

study

subject

to

the

survey,

provides essential study information,

and

provides a method

for

the

subject to enter

the

survey, such as a link to the survey. The second email serves as

a

reminder and

again

provides

a

link

to

enter the survey. The third email serves as another reminder

with

the

link again, but, also includes a message about the importance of

responding

and the short

time left to complete the survey.

Timing is important

when using

the"3 ContactStrategy".

Per

Dillman

et

al.

(2009),

the

exact timing sequence for emailed

online

surveys

is

not yet known. Regular

mail surveys

are

sent out two to four weeks apart. However, email surveys have a faster

tempo because the emails arrive instantly

to

the subject inbox. Emails

may

also be more

easily forgotten or dismissed by the potential subject since emails are

not

physically

present

and

potentially laying on

a

desk or in

a

file to be found again.

For this study

the

researcher

decided that

emails

would be sent

1

week

apart. This

was

decided

to give

potential subjects time to

process

the first email before they received the second email

and then finally the last

email.

Dillman et

al.

stated that, while emails may be sent out

as

frequently as 2 to 4

times

a day, he does not recommend

this option.

The bulk of email responses came in within

48

hours

of

an email with the survey

link being sent

out.

Within

one

week, responses would start

to

dwindle

so the

timing

strategy

for

this study was appropriate. When an

email

reminder was sent

out,

over the



91

following 48 hours responses

would

come

again in

bulk

until they

began to dwindle over

a

week's

time.

HCFemployed within

the selected

10

to

20%

health discipline programs

within

the

four

census

bureau U.S. regions received

emails

with

the

online Survey Monkey™

link. The email

explained

the study's

purpose, procedures, risks and benefits,

alternatives,

costs,

compensation, confidentiality, right to

withdraw,

contact information

for

the principle investigator, and link to the online survey.

Subjects

were advised

that

they could email this

researcher

to ask any questions

they may have had and

to request

study results.

This

researcher received

a number of

emails and

one

telephone call. The email messages received were primarily requests

for

the

study

results or

statements from subjects stating they filled out the survey and offered

best

wishes

or good luck with

the

study. A few responses

were

"out of the office"

automatic replies. There

were

two emails from professor emeriti asking whether or

not

they

should participate since they are

retired but

still

actively working

with

students.

Email

replies

were sent to all inquiries, stating

that

retired

professors were

welcome to

participate in

the study since

they were

still active

with

students,

and

a

summary

of

the

study results would be sent upon

completion

of the study, at

the

end of spring

2012.

There was one call

and two emails

from

two subjects asking how the

researcher

obtained their

email

addresses. The researcher responded with

a

description

of

the

stratified

random selection process and availability

of

public availability

of University

email addresses. Both of those subjects were satisfied with the explanation and then



92

completed

the

survey. There were no email messages or

calls

that

pertained

directly to

the

survey

itself

or any issues subjects

had with particular

questions.

Subjects were

contacted initially

via

publically

available email

addresses

with the

message inviting them to participate in the study. Email reminders sent one week apart

to

non-responders. A second email

that served

as a reminder

and

included the survey link

and

all information

that was included

in the

initial invitation to participate email was

sent

out

one

week after

the initial

email to non-responders. Subjects were contacted

a

total

of

three times one

week

apart. The

survey

was closed once there were 33

minimal

responses

from

each

of

the

7 health

profession groups.

In

each email

that was sent

to

healthcare

faculty inviting them to

participate in

this study, there

was

a link to the survey completion and submission site at Survey

Monkey™. Instructions for survey completion

and

submission were

included

in the

email. A letter

of

explanation, that was part

of

the study invitation email, included

information

that

participation in the

study

is voluntary.

It

took

study subjects

approximately 20 minutes

to

complete the

total survey including

the

two research

instruments

and

the Demographic

Data

Form.

Protection of

Human

Subjects

Informed consent

was implied

when a

subject

entered the

survey website

and

submited

a

completed survey. Subject anonymity and confidentiality were preserved

since there were

no

names attached to the online submitted surveys. Once a survey was

submitted online

there

was no way to withdraw from

the

study. Survey

Monkey™

raw

data will be

kept

for

one

year following study completion then destroyed through deletion



93

of the Survey Monkey™ account.

Offline

data

were

stored

in

a

password

protected

computer. An electronic data file was stored on a zip drive

and

kept

in

a locked cabinet

at this

researcher's

home. Printouts of

raw

data will be kept for one year following

completion of the study then destroyed by shredding. Data on the

password protected

computer will be kept for one

year

following completion of the study then deleted from

the

computer

hard

drive.

Data on zip drives will be kept indefinitely.

Survey

Monkey™ protects

user

security

by

providing unique usernames and

passwords, only enabling

session

"cookies" for the duration

of

a logged in session,

and

using

Secure Sockets

Layer (SSL) server authentication and

data

encryption.

Network

security includes firewall restrictions,

intrusion

detection, network scans

and

network

audits.

Risks.

There

were no anticipated

risks

associated with participation in

this study.

Benefits.

There were

no

anticipated direct benefits for subjects participating

in

this study.

However,

participation

in the

study may

have

encouraged

somefaculty

to

actively consider

IPE if they had not considered

it

previously. Data

from this

study will

advanced

nursing's

and other health professions' knowledge

of


IPE and IPHCT. This information may assist in the advancement

of

interprofessional

education

within health

professions.

Costs

and

Compensation.

There were no

costs

to participate

in

this study.

Subjects

did

not receive any compensation, payment, or incentives for participating

in

this study.



94

Confidentiality.

All

documents

and

information

pertaining

to this

research

study

were kept confidential in accordance

with all

applicable federal, state, and local laws and

regulations.

Data generated by

the

study

may be reviewed by

Widener University's

Institutional Review Board, which is the committee responsible for ensuring

research

subject

welfare

and rights, to assure

proper conduct

of the study

and

compliance with

university

regulations. Any

presentations

or

publications

resulting from this

research

will

not

identify schools or subjects

by name. SPSS

raw data

files

were

accessible to the

members

of the

researcher's

dissertation committee.

Alternatives and Right to Withdraw.

The alternative was to not participate in

the study. Participation in this study was voluntary. Subjects had the right

to

withdraw,

skip any

questions

or

exit the survey

at

any time without penalty. However,

once

subjects submitted the survey online, they were then

unable

to withdraw from the study.

Delimitations

One delimitation

of this

study

is

that subjects included

only those faculty with

publically

available

email

addresses

on

their school

or

education program

website.

Data Analysis

This descriptive study

was

based on

Fishbein and

Ajzen's Theory of Reasoned

Action (1975)

as

the framework

for

examining

HCF

attitudes towards

IPE,

P healthcare

teams, subjective norms that influence HCF intent to engage in IPE, relationships among

HCF attitudes

toward

IPE,

IPHCT and intent to engage in IPE and

the

differences

in

attitudes toward IPE and IPHCT among healthcare faculty from various professional

healthcare professions. The

statistical methods that were used to analyze and interpret



95

the data were descriptive statistics, stepwise multiple regression, and

one

way

multifactorial analysis

of

variance (MANOVA). Data were analyzed using SPSS

version

18.0 to

answer

the

research questions

and

test

the

hypothesis.

Missing Data

Demographic data

that

were missing

were left blank in

the raw data file.

However, if a subject failed to identify

the

health

professional

program in which they

taught,

they

were excluded because the health

profession

was necessary

for data

analysis

for the purpose of answering the research questions.

Subject

responses

that

were missing

more than 10%

(two or more questions) from either of the

attitude

instruments

were

excluded from analysis. There were

12

subjects removed for these reasons. Nine

subjects were removed because they had two

or

more questions missing

from

either

attitude instrument and three subjects were removed because they failed to

list

their

health

profession. For subjects who had only one or two questions unanswered on either

attitude instrument, the missing data was replaced

with

the subject's own mean score.


Demographic

data

were analyzed and summarized using descriptive

statistics.

Frequencies

and

percentages were used

to

describe the number

of

subjects in each

discipline,

the subjects

taught

in, age,

gender,

level

of experience with

IPE or IP

healthcare teams and the type of experience they have had, the nature of their academic

appointment and position, employment

status,

and

level of

experience as

a

healthcare

professional

and as a health professional

educator. Measures of central tendency

and

dispersion were computed to describe variability

of

the

types

of

disciplines and

whether



96

or not

the healthcare

faculty has

had

experience with

IPE

or

IPHCT and

their attitudes

toward IPE and IPHCT. Frequencies and percentages were also computed to describe

healthcare faculty experience with IPE or

EPHCT.

Research Questions One,

Two,

and Three. To

answer the

first

research

question,

"What

are

HCF attitudes toward IPE and EPHCT?", the second research

question

"What

are thesubjective norms that influence HCF intent

to

engage in

IPE?",

and the third research question,

"What

are

HCF

intentions regarding engaging in IPE

within the next three years?", descriptive statistics,

measures

of central tendency,

measures

of dispersion and

shape

of the

distribution curve

were computed.

Research Question Four. To

answer

the

fourth research question,

"What are the

relationships among

HCF

attitudes toward

IPE,

IPHCT and intent

to

engage in

IPE?"

A

stepwise multiple

regression analysis

explained the

relationships between

these

three

variables. Multiple regression serves to identify subset variables that are most

useful

for

prediction

of an outcome. In

Research Question

4,

the predictor variables

are interval

level

measures

(attitudes

toward IPE and attitudes

toward

IPHCT). The outcome

variable,

intent to engage

in IPE,

is also

an interval level measure. In

a stepwise

regression, predictor variables are entered or removed from an analysis individually so

that the researcher can determine

the

percent

of

variance explained

of

an outcome

variable based

on a

particular predictor variable (Burns &

Grove,

2009). In this analysis,

HCF attitudes

toward

IPE and attitudes

toward IPHCT were

examined for the

predictive

value of how likely each explains intent to engage in

IPE.



97

Research

Question

Five.

To answer the fifth research question, "What are the

differences

in

attitudes

toward

IPE and IPHCT among healthcare faculty from various

professional

healthcare

programs?" a

MANOVA

was computed.

A MANOVA was

chosen

for Research

Question

5

because

it

determines the differences between two

or

more

groups of a nominal

(categorical) independent variable

(IV)

on the

two

or more

interval

level

dependent variables (DVs).

In this question,

the IV is

healthcare faculty

from seven groups

of

professional healthcare programs.

The

DVs are attitudes toward

IPE

and attitudes

toward EPHCT

which

are

both

measured at the

interval

level.

Chapter Summary

The

methodology

for this descriptive

correlational

and comparative study was

presented in this chapter. A proportionate, random, stratified nationwide sample of

healthcare

faculty in seven

disciplines

in

274

health programs across

the U.S.

was

selected. Emails were sent

to

healthcare faculty from seven different selected disciplines

who were

employed

within

programs that

met the

stated inclusion

criteria.

A link

to the

Survey Monkey™ online survey of Attitudes toward EPE and

Attitudes toward

IPHCT

surveys

was emailed to study

subjects using Dillman's

TDM (Dillman

et al.,

2009)

in

an

effort

to achieve a

high

survey return rate. Demographic and research instrument

data

were collected and analyzed. Data analyses were completed

using

SPSS

version

18.0.

Anonymity and confidentiality of subjects was maintained.

A discussion

of

the instruments that were used in the study is presented.

Discussion includes a general description of the instruments including

reliability and

validity.

Data

collection

procedures

are described

in this

chapter

including

a discussion



98

of study risks, benefits, costs and compensation, confidentiality, alternatives, and

right

to

withdraw as these areas relate to Widener University

IRB

approval. Study delimitations

were addressed.



99

Chapter IV

Findings

The aims of this study

were to

explore

healthcare faculty

(HCF)

attitudes

toward

interprofessional education

(IPE)

and interprofessional

healthcare teams

(IPHCT), to

explore HCF perceptions

of

subjective norms' influence on HCF intent

to

engage in IPE,

to explore

HCF

intent to

engage in IPE, and to explore differences among types

of

HCF

in attitudes toward IPE and IPHCT and intent to

engage in

IPE. Analysis of data from

the

final sample (N = 439) is discussed, summarized, and

presented in this

chapter.

SPSS, version 18,

was

used to

compute

all statistics

for

this

study.

Research Questions

Research Questions One, Two, and Three

Descriptive

statistics,

measures

of

central tendency, measures

of

dispersion

and

shape

of

the distribution curve were computed to answer the

first

three research

questions,

"What

are HCFattitudes

toward

IPE and IPHCT?", "What are

the

subjective

norms that influence HCF intent to engage

in

IPE?"

and, "What are HCF intentions

regarding engaging in

IPE?"

Details of the statistical analysis are presented in Table

5.

Research

Question One:

Attitudes

toward IPE. Research

question

one

asked,

"What

are

HCF

attitudes toward IPE and IPHCT?" Possible scores on the Attitudes

Toward IPE

instrument

could range

from 14 to 70. Higher

scores reflected

more

positive

attitudes toward

IPE. Nearly all ranges

of

scores were above the

midpoint

of

possible

scores of 42

and had means that ranged from 60.34 to

62.92

(

SD

range

=

5.64 to 7.87)

with multiple modes (ranging

54

to

70) within

the seven healthcare faculty groups.



100

Table 5


of

Attitudes Toward IPE, Attitudes Toward IPHCT, Subjective

Norms,

and

Intent

to Engage

in

IPE

Variables NU MD PH PT OT PA

SW

n = 191) n =

38)

n== 46) n =

50)

n =

40)

n = 38) w = 36)

Attitudes

toward IPE

Possible Range

(14 to 70)

Mean

62.17 60.34

62.17 60.74

61.88

60.39

62.92

SD

6.44 7.24 5.64

5.84

5.73

7.87

6.78

Range

42-70 41-70 51-70

47-70

51-70

37-70

45-70

Skew

-.76 -.85

-.05

.10 -.19

-.85

-.72

Kurtosis

.29

.30 -1.03 -.71

-1.05

.45

.39

Attitudes

toward

IPHCT

Possible Range

(14 to

70)

Mean

56.05 55.63 56.41

54.88

55.65

55.79

58.36

SD

7.11 7.10

5.85

6.97

6.42

7.32

6.43

Range

29-70

33-69 44-70

35-70

45-70

39-70

44-70

Skew

-.21 -.64

.11

-.01

.44

-.52

-.24

Kurtosis

.65

1.84 -.50 .39

-.23

.09

.39

My faculty

colleagues

think I should

engage

in

IPE

Possible Range

(1 to 7)

Mean

5.74

5.45

5.96

5.90 5.92

6.13

6.06

SD

1.57 1.57 1.38

1.40

1.40

1.56

1.41

Range

1-7

2-7 1-7

2-7 2-7

1-7

2-7

Skew -.98 -.36

-1.40

-1.18

-1

-2.20

-1.21

Kurtosis .06 -1.37

2.04

.70

-.15

4.66

.37

(continued)



101

Variables NU MD PH PT OT PA

SW

(« =

191)

n

= 38) (» =

46)

w

=

50)

n

=

40)

n

=

38)

n

= 36)

My

school's

administrators

think

I

should

engage

in

IPE

Possible Range

(1

to 7)

Mean

5.87 5.46

6.17

6.16 5.83 6.24

6.12

SD 1.48

1.50 1.37 1.33

1.39

1.38

1.37

Range

1-7 2-7 1-7

2-7

2-7

1-7

2-7

Skew

-1.07 -.23 -1.90

-1.44 -.93

-2.07

-1.44

Kurtosis .24 -1.35 3.60 1.03 -.12 4.46 .40

Intent

to

engage

in

IPE

Possible Range

(1 to 10)

Mean

6.81 7.76 7.63

8.42

7.38 8.39

7.49

SD

3.19

2.95 2.70 2.43 3.13 2.72

3.07

Range

1-10 1-10 1-10 2-10 1-10 1-10

1-10

Skew

-.53 -1.23

-.92 -1.58 -.83 -1.77

-1.05

Kurtosis

-1.16

.33

-.13

1.39 -.73

1.90 -.34

For all seven groups, the distribution

of

scores on Attitudes Toward IPE approximated a

normal

curve indicating scores were

normally

distributed, with

skew

and kurtosis

within

the range of +/-1.00 as recommended

by

Munro (2005).

Research Question

One: Attitudes

toward IPHCT.

Possible scores on the

Attitudes Toward EPHCT instrument could range from 14 to

70.

Higher

scores reflected

more

positive attitudes toward EPHCT.

Minimum scores

for the

Attitudes

Toward

IPHCT

fell

below the midpoint of possible scores of

42 for

four

of

the seven groups and

had means that ranged

from 54.88

to 58.36 (

SD

range =

5.85 to

7.32)

with

multiple



102

modes

within

the

seven

healthcare faculty

groups.

For six of

the seven

groups, the

distribution

of

scores on Attitudes Toward IPHCT approximated a normal curve,

indicating

scores

were normally

distributed,

however,

the curve of the scores for MD

faculty

was more

peaked than

a

normal

curve, indicating less

variability

in these scores.

Research Question

Two:

Subjective norms.

Research

question two, "What are

the subjective norms that influence HCF intent to engage in

IPE?"

was analyzed using

a

7-point Likert scale. Possible scores on these items could range from 1 to 7. Higher

scores reflected greater influence of faculty colleagues

and

school's administrators on

subjects'

perceptions

of

their influence

on

engaging in IPE. The modal

score

was

consistently 7 across all

HCF

groups for

both

items

measuring

subjective norms.

Minimum scores for

whether

faculty

believed

their faculty colleagues think they

should engage

in

IPE fell below the midpoint

of

3.5

of

the possible scores and

had

means

that ranged from 5.45 to

6.13

(SD range = 1.38 to 1.57). Consistent with scores for the

first SN item,

for

five of the seven groups, the distribution of scores on SN (school's

administrators) approximated a normal curve; however, the curves of the scores for PH

and PA faculty were more peaked and negatively skewed

than a

normal

curve

indicating

there

were

more high scores than low scores.

Research

Question Three: Intent to

engage

in IPE.

Research

question three,

"What

are HCF intentions regarding engaging in IPE?" was

analyzed using

a 10-point

Likert scale. Possible scores on this instrument could range from 1 to 10. Higher scores

reflected

greater likelihood of engaging in BPE

within the next

three

years.

Mean scores

ranged from

6.81 to 8.42

(SD range

= 2.43

to 3.19). All HCF groups

had a

mode of

10



103

and 35.4% to 57.9%

of HCF stated

they are very likely

to

engage in

or continue to

engage in IPE within the

next

three

years.

Only 4.3%

to

9%

indicated

they are

not

likely

at all to engage in IPE within the next three years. For five of the seven groups, the

distribution of scores on intent to engage in EPE

approximated

a

normal

curve;

however,

the curves of

the

scores for PT

and PA

faculty were

more

peaked and negatively

skewed

than

a

normal

curve

indicating there were more

high

scores

than

low

scores.

Research Question

Four

A stepwise multiple

regression

analysis

was computed

to

answer

the

fourth

research question, "What are the relationships among HCF attitudes toward IPE, IPHCT

and

intent

to engage

in

IPE?"

An

initial

Pearson correlation

matrix

revealed

that

both

attitude variables

were

significantly,

but

weakly, related to intent toengage in

IPE

(Table

6).

Table

6

Pearson Correlations of Attitudes

with

Intent to Engage in IPE

Variables Correlated with

Intent

to

Engage

in

IPE

r

£

r_

Attitudes toward IPE

.31

<.001 9.5%

Attitudes

toward IPHCT

-23 <.001

5.3%

Multiple

regression

analysis

revealed

that attitudes toward IPE was the single best

attitude predictor

of

intent to engage in

IPE (R=

.31, p

<

.001) but only explained 9.5%

of the

variance

in intent to engage

in

IPE scores.



104

Attitudes toward DPHCT alone explained 5.3% of

the variance

in

intent

to engage

in

IPE

scores. However, attitudes toward IPE and attitudes toward

EPHCT

were

significantly related

(r

=

.75, p <.001) and shared 56.3%

of

the variance in their scores.

The

two

predictor

variables were

strongly correlated, demonstrating

multicollinearity.

Attitudes toward

IPHCT failed

to enter

the regression equation because

it did not

correlate well with and was not

a

good predictor

of

intent to engage in IPE, and was

strongly related to attitudes toward IPE.

Stepwise

multiple regression analysis did not

yield any more information than the simple Pearson correlations in this statistical

analysis.

Details of the stepwise multiple regression analysis are

presented

in Table 7.

Table

7

Stepwise Multiple

Regression of

Health Care

Faculty

Attitudes

Toward IPE,

Attitudes

Toward IPHCT and Intent to Engage in IPE

Model R

R

l

R

2

A

F

df

P

1

Attitudes toward IPE

.31

.095

.095

45.72 1,434 <.001

Research Question Five

To

answer the fifth research question,

"What

are the differences in attitudes

toward

IPE

and

IPHCT

among

healthcare faculty from


programs?"

a

MANOVA was computed.

The

seven groups

of

faculty had relatively

equal means for both instruments with

a

range of 60.34 to 62.92 for Attitudes Toward

IPE

and

a range of 54.88 to 58.36 for Attitudes Toward IPHCT.

Descriptive statistics for

the

two attitude

variables,

by

groups, were presented earlier in

Table 5.



105

Differences among the

seven

HCF groups

on attitudes

toward

IPE were

not

significant. Differences among the seven HCFgroups

on

attitudes

toward

IPHCT were

also

not.significant. These results indicated there

were no

significant differences among

the groups

of

faculty regarding attitudes toward IPE or IPHCT. Details

of

the MANOVA

analysis are presented in Table

8.

Table 8

MANOVA

Comparing 7 Disciplines of

Health

Care Faculty on Attitudes Toward IPE and

Attitudes Toward IPHCT

Variable F

df p

Attitudes

toward IPE

Attitudes

toward IPHCT

Additional Analyses

Pearson correlations, independent

t-tests,

one-way ANOVAs,

and

MANOVA

were computed to explore various relationships

and

differences with the demographic

and research variables in

the data set.

Statistically significant findings and non

significant findings, based on additional analyses

of

demographic data and research

variables, are summarized

and

presented.

In addition, positive and negative factors that influenced

HCF

engagement in IPE

were

analyzed as part of the

additional

analysis for this study. Positive and

negative

factors that

influenced

faculty engagement in IPE were analyzed

through

identification of

1.11

6, 432

.356

.98 6,432

.438



106

categories

in

faculty responses to two

open-ended

questions

on the Demographic

Data

Form. Responses for each question

were

categorized

and then

quantified through

counting

of

frequencies. The

frequency

distribution of categories

provided

an assessment

of what

factors influenced

HCF

intent

toengage

in

IPE based on how

often each

of

the

categories were cited in the

survey responses.

Statistically Significant Additional Findings

Pearson correlations revealed that scores for the two SN

variables,

"My

faculty

colleagues think I should/should not engage

in

IPE"

and

"My

school's administrators

think

I

should/should not engage in

IPE"

were significantly

related to scores on

intent to

engage

in

IPE.

Table 9

Pearson

Correlations

of Subjective

Norms for Faculty Colleagues

and Subjective

Norms

for School's Administrators with Intent

to

Engage in IPE

SN Variables Correlated with


r

£ r^_

SN faculty colleagues

.43

<.001 18.5%

SN school's administrators .52 < .001

27.0%

A

multiple regression analysis

was

computed

to

regress the

two

attitude variables

and the

two

SN

variables on intent

to engage

in IPE

scores. The

analysis revealed

that

SN school's administrators was the best predictor of and explained 26.6% of the variance

in intent to engage in IPE. Attitudes toward IPE was the next significant predictor and

added an

additional

2.7% explanation

of variance (Table

10).

Thus, a

total

of 29.3% of



107

Table 10

Stepwise Multiple Regression

of

Health Care Faculty Attitudes Toward IPE, Attitudes

Toward IPHCT, Subjective

Norms

for Faculty Colleagues, Subjective

Norms for

School's

Administrators and Intent to Engage in IPE

Model R R

l

R

2

A

F

df

P

1 Subjective Norms-

School's Administrators

.52

.266

.266 151.40

1,417

<.001

2

Attitudes toward IPE .54 .293 .027 15.96

1,416 <.001

the variance in

intent

to engage in IPE was explained

by the

linear combination

of one

SN

and

one Attitude variable (R

=

.54, p <.001). Attitudes toward IPHCT and SN faculty

colleagues failed to enter

the

equation.

Independent f-tests were computed

to

compare teaching

faculty

and

administrative

faculty scores

on the research variables attitudes toward

IPE,

attitudes

toward IPHCT,

intent

to

engage

in IPE, beliefs that faculty colleagues think

HCF

should

engage

in IPE

(SN colleagues),

and beliefs

that school's administrators

think

faculty

should engage

in IPE (SN

administrators). There were statistically significant differences

on intent to

engage in

IPE, SN colleagues, and

SN

administrators. Independent

r-tests

were also computed to compare HCFwho were currently engaged in IPE and those

who

were not, and between those HCF who were previously

engage

in

EPE

and those

who

were

not

for all research variables. There were statistically significant differences among

the groups

for

all variables. Details of the

r-test

analyses

are

presented in Table 11.



108

Table 11

Results of t-Test Analyses Comparing Groups fromDemographic Variables

on

the

Research

Variables

Research

Variable

Demographic

Variable

and Groups

n M

SD

t df

Attitudes toward

IPE

Currently

engaged

in

IPE

Yes

No

5.36 371.69

<.001

248

63.16 5.80

191

59.85

6.83

Previously engaged

in DPE

Yes

No

3.49 367.25

249 62.67 6.01

186 60.47 6.87

.001

Attitudes toward

IPHCT

Currently

engaged

in IPE

Yes

No

4.41 443 <.001

248

57.29 6.73

191 54.43

6.75

Previously engaged

in

IPE

Yes

No

2.91 433

249 56.89

6.86

186

54.97 6.81

.004

Intent

to

engage

in IPE

Position

Teaching

Administrative

-2.60 118.48

356

7.26

3.10

71

8.14

2.47

.010

Currently engaged

in IPE

Yes

No

246

8.99 1.95

190

5.32

2.96

14.79

310.15

<.001

(continued)



109

Research Demographic

Variable Variable

n

M

SD

t

df

p

and

Groups

Intent

to engage

in

IPE

Previously engaged 9.36

336.80

<.001

in

IPE

Yes 248 8.48 2.46

No 184

5.87 3.13

SN colleagues

SN

administrators

Position -2.09 112.10 .039

Teaching

343 5.77

1.54

Administrative

71

6.14

1.33

Currently engaged

9.74

296.63 <.001

in IPE

Yes 243 6.42 1.09

No 181 5.06 1.63

Previously

engaged 7.21

303.55

<.001

in IPE

Yes 245 6.27 1.22

No

175 5.21

1.65

Position -3.72

133.33 <.001

Teaching

346 5.85

1.49

Administrative 71

6.41 1.06

Currently engaged 10.99

280 15 <.001

in IPE

Yes

247

6.55 97

No 180 5.12 1.55

Previously

engaged

7.30

315.65

<.001

in

IPE

Yes 247 6.36 1.19

No 176 5 35 1.54



110

Non-Significant

Additional Findings

Pearson correlations were computed for age, years experience as a health

professional, and years experience

asa

health professional educator

for

the research

variables attitudes toward IPE, attitudes

toward IPHCT,

SN

faculty

colleagues, SN

school's

administrators, and intent to

engage

in IPE. None of the correlations were

statistically significant.

Based on independent r-tests,

there

were no statistically significant differences

between males and females or among the groups on employment status, current faculty

position, or highest level of education for scores on any of

the research

variables.

Independent

f-tests

also revealed that there

were

no statistically significant differences

between teaching

faculty

and

administrative

faculty

for

attitudes toward

IPE,

attitudes

toward

IPHCT,

SN faculty colleagues, or SN school's

administrators.

ANOVAs were computed

to

compare the various faculty ranks and tenure status

for all attitude, SN,

and

intent to engage in IPE

research

variables. There were no

statistically significant differences

among any

of the faculty rank

or

tenure groups.

MANOVA

was computed to explore differences

among the seven

HCF groups on

SN

faculty colleagues

and

SN

school's

administrators. Results indicated

there

were no

significant differences

among the

groups

of

faculty on

SN

faculty

colleagues

and

SN

school's administrators.

Positive

Factors

Influencing Engagement

in IPE

Using

the Survey Monkey™ text analysis feature, 26

initial

categories of

positive

factors that

influenced

engagement

in

IPE

were identified through

frequency counts by



I l l

the software. Categories that

were identified through use

of

this feature included the

15

words

or

phrases

that

were

used

by respondents most commonly. Details are presented in

Table

12.

This first step of

text

data analysis only counted the

frequency

of

words not

the

number

of subjects who

used the words.

Table 12

15

Initial

Categories

of Positive Factors Influencing Engagement

in

IPE

Category

Number

of

times the word

or Percentage of times the

word

or

phrase occurred

phrase

occurred

Care

103

28%

Students

89

24%

Patient

77

21%

Learning

65

17%

Team

58

15%

Education

30

8%

Perspectives

28 7%

IPE

27

7%

Teaching

21

5%

Support

16

4%

Respect 16

4%

Engaging 12 3%

Interprofessional 11

3%

Medical 11 3%

Programs

10

2%

"Care",

"Students", "Patient", "Learning", and "Team"were the five categories

counted

most frequently as positive factors. Nine other categories

were

identified that

occurred

less

than

10% of

the time,

while

12

categories were mentioned less than

2% of

the time.



112

Negative

Factors

Influencing

Engagement in IPE

Negative factors influencing engagement

in

DPE were also identified through the

same Survey Monkey™ text

analysis

feature. There were 28 initial categories that were

identified with 17 words or phrases being used by respondents most often. Details are

presented

in Table 13. This first step of

text

data

analysis

only

counted the frequency

of

words not the number

of

subjects who used the words.

Table

13

17

Initial

Categories of Negative Factors Influencing Engagement in IPE

Category Number of times

the

word or Percentage

of

times the word or

phrase

occurred phrase

occurred

Scheduling

67

18%

Professional

39

10%

Students

36

9%

Disciplines

29

1

Coordination 24

6%

IPE

22

5%

Faculty 21 5%

Health

Care

17 4%

Support

16 4%

Course 13

3%

Constraints 13

3%

Departments 12

3%

Curriculum 12 3%

Team Members 10

2%

Attitudes

10

2%

Limited 9

2%

Take

8

2%

"Scheduling", "Professional", "Students", "Disciplines", and "Coordination"

were

counted most frequently as negative factors. Twelve other categories were

identified

that

occurred

from

5%

to 2% of

the time.

An

additional

12

identified categories

were

cited

by

less

than 2% of

the participants.



113

Category Reduction

Electronic content analysis was

used

to reduce the number

of

initial categories

(Burns

& Grove,

2009). Quotes were

placed

in excel spreadsheets and sorted according

to

the

Survey Monkey™ categories. The quotes

were then highlighted and re-highlighted

with

different colors in an effort to collapse the

many

categories into fewer

major

categories and describe those categories. A complete listing of HCF quotes about

positive and negative factors influencing their intent to engage in IPE

is

presented in

Appendices F and

G,

respectively.

The three major categories of Positive

Factors

emerged as Patient Care which was

mentioned by 196 subjects or 54%

of

the sample, Student Learning which was mentioned

by

157

subjects

or 43%

of

the sample, and Healthcare

Teams

which mentioned by

88

subjects or

24% of

the sample.

Quotes

that

support

the

Patient

Care

major category

include:

"my

experience has been that

the

potential exists for improved patient

outcomes", "morecomplete

care

of the patient",

"holistic

care of the patient", "improved

patient care

by

a team able

to

communicate", and

"as

healthcare

is

a team concept,

positive patient outcomes improve when the

team members work

together".

Quotes that

support

the

Student

Learning major

category

include:

"potential for

enhanced

student

learning", "opportunities for students to be exposed to information outside our

discipline",

"learn

from other health professionals", "motivate students to

better

understand other health professions", and "the opportunity to offer students

a

positive

learning

experience".

Quotes

that

support

the

Healthcare

Teams

major category include:

"early role modeling of

working

in healthcare teams", "practicing

teamwork and



114

communication; learning

to respect what

each discipline brings to

patient care",

"understanding the benefit

of

learning as a team since healthcare professionals

work

as a

team to

care for patients", "I

have

played

several

roles in a healthcare

team through

my

past experience and understand the importance

of

knowing and utilizing

the

full

capabilities of all

team members for the benefit

of

the

patient",

and

"we

must

embrace

IPE and

the team approach".

The two

major categories of Negative Factors emerged

as

Scheduling and

Coordination which was mentioned by 230 subjects or 63%

of

the sample and Discipline

Culture

which

was mentioned by

103

subjects or

28%

of

the

sample. Quotes

that support

the Scheduling and Coordination major category include: "overcoming scheduling

difficulties",

"scheduling

challenges, resistance from other departments/professions",

"there is

often not a time to coordinate the team concept particularly in academic setting

where the colleges are on different schedules", "coordination can be difficult

if

all faculty

members are not engaged", "schedulingdifficulties

rying

to

get all

of the professions

together at

a

particular

time", "no time or incentive to

coordinate with

other healthcare

professions", and "difficulty

in

scheduling issues

with

various disciplines". Quotes that

support the Discipline Culture

major

category include:"turf wars", "discipline elitism",

"territorial disputes on common areas

of

practice", "the remaining attitudes of some

professionals that they

are the final

authority

in the healthcare inertia", "I guess the

main

factor

would

be the level of cooperation", "stronger focus

on

other professionals",

and

"people

being

territorial".



115

HCF

Percentages

of

Positive and Negative Factors Reported

Electronic analysis was conducted to determine percentages

of

HCF who offered

text

responses

for

positive and negative factors influencing their

intent toengage

in

IPE

(Table 14). Responses were placed in excel spreadsheets and sorted according to the

seven

HCF categories. The responses were then

color-coded

for each HCF group and

percentages

of HCF

group responses were calculated. MDs had the lowest response rate

for both positive

factors

and negative factors

at

76.3%. OTs

had the highest

response

rate

for both positive factors

and

negative factors at 90%. Percentages

for

identified

positive

and negative factors ranged from 76.3% to

90%. NU

responded at

a rate

of 81.2% for

positive factors and

a

rate

of

79.1% for

negative

factors.

Table 14

Percentage of

Positive Factors and

Negative

Factors

Influencing


Reported

by

Each

HCF Group

Open-ended NU MD PH PT OT PA SW

Questions » = 1 9 1 )

w = 3 8 ) n 46) n

=

50)

(n

=

40) («

=

38) n = 36)

n

n n

n n

n

n

Positive

155 81.2

29

76.3

36

78.3 40 80

36

90 34 89.5 30 83.3

factors

Negative 151 79.1 29

76.3

37 80.4 41 82 36 90 34 89.5 31 86.1

factors

Chapter Summary

The findings of

this research

study

are

presented

in

this chapter.

Descriptive

statistics

of

the

five main

variables

for research

questions

one through three

including



116

attitudes

toward

BPE, attitudes toward IPHCT, SN

faculty

colleagues, SN school's

administrators, and intent to engage in IPE were presented. Stepwise multiple regression

was computed to answer

research

question four. Attitudes Toward IPE was statistically

significant and the single best attitude predictor of intent to engage in IPE. MANOVA

was computed to answer research question five. There were no significant differences

among

HCF

groups regarding

attitudes

toward

BPE or

IPHCT.

Additional analysis revealed that the two

SN

variables were significantly related

to

intent

to engage

in IPE. Administrative faculty

reported

greater intent to

engage

in IPE

than teaching faculty, and HCF who were currently

or

had previously engaged in IPE

reported

greater intent to engage in or continue to engage in IPE,

and

had higher attitude

and

SN scores

than

faculty

without

IPE experience.

Multiple

regression analysis

revealed

that the combination of SN school's administrators and attitudes toward IPE

was

the

best

predictor

of

intent to engage in IPE.

HCF

text responses

to two

open-ended questions

concerning positive and

negative

factors influencing their intent to

engage

in IPE were analyzed. Three positive and

two

negative

major categories

were

identified and exemplars of HCF statements were

presented. Percentages of positive and negative factors identified by each of the seven

HCF

were

computed.



117

Chapter V

Discussion,

Implications, Conclusions,

and Recommendations

A discussion of the

findings

about

the research

variables of attitudes toward

IPE,

attitudes toward

IPHCT,

subjective norms, intent to engage in IPE, demographic

variables, and instruments used in this study are

presented

in this chapter.

Methodological issues, generalizability of the findings, conclusions

of

the study, nursing

implications, and recommendations

for

future research are addressed.

Discussion of

Research

Findings

Research

Question

One, Two, and

Three

The first

three

research questions, "What are HCF attitudes

toward

IPE and

IPHCT?"

"What

are the subjective norms

that

influence HCFintent to engage in IPE?"

and, "What

are

HCF

intentions regarding engaging in

IPE

within

the

next three

years?"

were addressed through descriptive statistics.

Research Question One. Attitudes

toward IPE

are faculty feelings

and

beliefs

about

IPE and

were measured by total

scores on the Attitudes

Toward

IPE instrument

adapted

by

Curran

et

al. (2008).

Participants in

this

study

scored high on

their attitudes

toward

IPE,

indicating all seven

HCF

groups had positive attitudes toward IPE.

Attitudes toward IPHCT are faculty feelings and beliefs about

EPHCT.

Attitudes

toward IPHCT were measured

by

total scores on the Attitudes Toward

IPHCT

instrument

adapted by Curran et al. (2008). Participants in

all seven

HCF

groups had

positive

attitudes toward IPHCT; however, scores on attitudes toward IPHCT

were

less positive

than scores on attitudes

toward

IPE.



118

According to O'Keefe (1990), attitudes are

a

significant predictor of behavioral

intent.

Based

on the theoretical

model

of

TRA, attitudes were proposed

to

influence

intentions to deliver IPE to healthcare professional students. Social work faculty

had

the

highest mean

of

the HCF groups for both attitudes toward IPE and attitudes

toward

IPHCT. Social

workers are typically required

to cooperate and

collaborate

with other

health professionals as

part of a

healthcare team (IOM, 2010). As social workers seek to

promote

positive

change for

patients through the

acquiring of

services and resources,

they

often interact with many other

types

of

professionals. Medicine faculty

had

the lowest

mean

on

attitudes

toward

IPE. Traditionally, physicians have been the dominant

members

of

healthcare teams.

This

is

true

in

many

countries, including the U.S. where

nurses have been seen as subordinates (Dimitriadou et al., 2008). Perhaps,

this is

due

to

the "captain of the ship" role

physicians

have

traditionally

held where

they

have

been

ultimately responsible for patients' outcomes and seen as being

"at

the

helm"

(Tabby,

2009).

Physical

therapy

faculty had the lowest mean on attitudes toward IPHCT.

Physical

therapists have generally worked

as part of

interprofessional

teams,

especially

rehabilitative

teams.

There is no

published

literature to

support

an explanation for

why

they would

exhibit

the lowest IPHCT mean

scores of the

seven types

of HCF.

Nursing

faculty had a

mean of 62.17

on attitudes toward IPE and

a mean

score

of 56.05

on

attitudes toward IPHCT. Both

means

were moderate

and balanced

between

high and

low

mean scores. Nurses have not always had optimal relationships with other healthcare

providers (Miller et al., 2008). Collaborative cultures are a vision of the IOM report



119

(2010) and

interprofessional

care

of

patients

is a

high

priority in

healthcare (Collins,

2005). Perhaps

the

literature

and

the

most

recent IOM

report

have begun to influence

nursing attitudes with regard to IPE.

To date, there

have only been two

articles

published

on

faculty attitudes

toward

IPE

and IPHCT. The

articles

by

Curran

et al. (2005,2007)

were described in Chapter II.

The 2005

study revealed overall positive

attitudes toward IPE

and

EP

teamwork.

The

2007 study did not report the means for each group

that participated.

Therefore, the

results of

this

study cannot be directly compared to

the

Curran

et

al., 2007 study with

regard

to

total mean scores.

This

study elicited

faculty

attitudes toward IPE and IPHCT

for

U.S. based

healthcare faculty

in

seven disciplines. The positive attitudes reported may be due to

sincerely

positive attitudes about

DPE and

the

benefits

brought

by

engaging in it.

Understanding attitudes

toward

IPE and IPHCT

is

the first step in advancement

of

IPE

in

academic

institutions in

the

U.S.

Negative

attitudes toward IPE and

IPHCT

present

barriers to IPE's effective

implementation

(Curran et al., 2007). U.S. HCF attitudes,

according

to

this

study's

findings, did not present

a

barrier to IPE implementation and

faculty

intent

to

engage in

IPE.

HCF

experience with

IPE

for

the

entire sample

varied

between 0

and

5 years.

Experience with IPHCT, however, did not vary greatly among the groups. Most HCF

(56.5%) stated they had more than five years experience with IPHCT. Therefore, most of

the HCF had several years of experience to draw from to form their opinions about

IPE

and IPHCT.



120

Another plausible explanation for

the

positive attitudes reported

by

subjects in

this study may

be

that the highly positive attitude scores could be, in part, due to a non-

response

error (Dillman et al.,

2009).

A non-response error occurs when subjects

selected by

the

researcher for a survey sample do not complete the survey because

they

may not

be interested in the topic.

The

non-responders' survey answers may have been

different

from those who

did respond.

HCF

who were

not interested in IPE,

or who held

negative

attitudes

toward EPE and IPHCT,

may

have ignored or deleted the survey and so

this study may be missing what could have been negative responses.

The anecdotal literature

proposes that there

are benefits of IPE;

however,

empirical support for such claims is lacking. There is no

published literature currently

available that cites negative

aspects

of EPE. Perhaps faculty awareness of the perceived

benefits

of IPE reported in the literature contributed to the positive attitudes

found

in this

study. Findings

in

this study were consistent

with

those

of

Curran

et

al. (2005), who

found that overall attitudes toward IPE and

IP

teamwork were positive and there were no

differences among the healthcare academic administrator groups regarding attitudes.

Research Question Two. Subjective

norms (SN)

are the

influences that motivate

healthcare

faculty to engage in

interprofessional

education. Subjective

norms are

the

perceived social pressures to perform

a

behavior (Ajzen & Madden, 1986) and

were

identified in

Questions

17 and 18 on the Demographic Data Form. The exploration

of

SNs was

originally

proposed

to

include

two

open ended questions

to

identify

subjects'

perceptions

of SN. Through further development and refinement

of

the

research

proposal,

a decision was

made

to measure SN quantitatively. Therefore, two

7-point



121

magnitude rating scale items

were added

to

measure

subjects' perceptions of

what they

believed their faculty colleagues (SN faculty colleagues) and their

school's

administrators

(SN

school's

administrators) thought they should

do

about engaging in

IPE.

Subjective norms were

HCF

self reports regarding

how

strongly faculty believed

their

faculty

colleagues and

school's

administrators think faculty should engage in IPE.

HCF

believed that their faculty colleagues and school'sadministrators think

they

should

engage in

IPE;

therefore, they perceived social pressure to engage in IPE. Believing that

faculty colleagues and school's administrators

want

HCF toengage in

IPE

is considered

social pressure

or

subjective

norms

within TRA.

Motivation

to

perform

a

behavior,

in

TRA, is related

to a

person's perception of what someone

of

influence wants them to do

(Fishbein & Ajzen,

1975).

Social and

situational surroundings

within TRA

are

considered the external influences that contribute

to

pressure to perform

a

behavior

(Fishbein & Ajzen).

Currently, IPE literature is expanding and

IPE is

the topic of

discussion and

debate

at

national and international conferences. HCF

are

becoming more exposed to

IPE through these and other methods

which

may affect

HCF

perceptions regarding

existing social pressures to

engage in IPE.

Research Question Three.

Intent

to engage in IPE is HCF'sdetermination to act

on and become involved in IPE.

Intent

to engage

in IPE

or continue to engage in IPE

within the next three years was measured on a 10-point Likert scale. On average, HCF

indicated

they are

very

likely

to

engage

in

or

continue to

engage

in IPE within the next

three years.



122

The results of research question three are consistent with the results of research

questions one and two and the framework

of

TRA. HCF

demonstrated

positive attitudes

toward IPE, positive attitudes toward

BPHCT,

and

believed

that their faculty colleagues

and

school's

administrators think they should

engage

in IPE. Within

the TRA model,

the


norms

predict

behavioral

intentions. In this case,

together they predict the intention to

engage in IPE or

continue

to engage in IPE.

Currently, there is no

published

literature

that

explores faculty intent

to

engage in

IPE. Perhaps

HCF

indicated

they

were very likely

to

engage in

EPE

due

to the

benefits

the

literature proposes

such

as in

the

synthesis

of the

literature

by

Olenick et

al.

(2010a).

Perhaps the

fact

that

HCF

indicated

they are very

likely to

engage

in IPE may

be

attributed

to the fact that accrediting

bodies

such

as the NLNAC,

CCNE, LCME,

CAPTE, CSWE, ARC-PA, ACOTE, and ACPE

are

now including statements

in their

standards concerning IPE and interprofessional collaboration. HCF

may

be better aware

of the

importance

of and the

urgency

to

participate and

substantiate IPE in order to

meet

current

accreditation

standards

and

to

adequately

prepare students for practice in

emerging healthcare environments.

The

2010 IOM report describes

its vision of

future healthcare systems

with

nursing playing a fundamental role. Based on

the

findings of this study, the nurse faculty

group, while still positive, are the least likely to engage in

IPE

within the next three years

compared to the other

HCF

disciplines.

This

does not put nursing in position to take the

lead and

transform

healthcare

education

as the IOM

recommends.



123

IPE is an undertaking that

requires

curricular integration, scheduling, time, and

effort that is beyond the control

of

any one HCF member. HCF volitional control or

control over their own behaviors with regard to

DPE

implementation may be difficult, if

not

impossible, to achieve.

Perhaps the

question

asking

HCF if

they

intended to

implement IPE

within

three years

would

have been

better written

as an open ended

question inquiring

how

long it

would take

to engage in IPE. Perhaps a three year time

frame was not seen as reasonable by HCF. Engaging in IPE

is

not

an individual decision,

it requires system wide changes and support.

Within

TRA, attitudes are

proposed

to be a good

predictor

of intent to behave.

Given that HCF groups demonstrated positive attitudes towards IPE, the question "why

aren't more HCF currently engaging

in

IPE?"

remains unanswered.

Within TRA,

behavior

is

not as well explained

as

intent

to

behave.

This

is

due to

the recognition

that

situational factors may limit behavioral actions even

when

a strong positive attitude and

desire to behave-is present. The additional analyses section in Chapter IV presented

negative factors that posed barriers to

HCF

engagement in IPE. The negative factors

identified serve as potential barriers to IPE engagement even

with

the most positive

of

attitudes.

Research

Question Four. In answering the question, "What are relationships

among HCF attitudes toward IPE, attitudes toward IPHCT, and intent

to engage

in

IPE?"

a stepwise

multiple regression analysis was computed.

Faculty intentions to engage

in

IPE were proposed to be

a

result of the combined influence of attitudes toward IPE and



124

attitudes toward

IPHCT. Attitudes

toward EPE were found to be the single best attitude

predictor

of

intent to engage

in

IPE.

TRA research

has shown that

attitude

is

a very

strong

predictor of behavior

(O'Keefe, 1990). However, the correlations in this study, although statistically

significant, were weak. This researcher offers several plausible explanations

for

the

current finding. It is

possible that,

despite

positive attitudes

toward

IPE and IPHCT,

the

negative

factors HCF identified served as strong barriers that adversely influenced their

intent

to engage or

continue

to engage

in

IPE.

Perhaps the colleges and universities

where

HCF were

employed were

not requiring,or

even

encouraging,

IPE.

It

is also

possible that

TRA,

while a

well

respected and confirmed

theory

in many instances,

does

not work as

well in

the context

of

IPE.

Nursing faculty in this study responded sooner and in higher numbers than any of

the other HCF. Nurses were

very

quick to participate

yet they had

the least IPE

experience

and

the

lowest scores

on intent

to

engage

in IPE

within the next three

years.

The

IOM report

(2010),

which calls

for

interprofessional collaboration,

has

attracted the

attention of

the

nursing

profession.

The

IOM's vision of future healthcare depends on

nursing to incorporate

IPE

early and continuously in the curriculum (IOM).

The fact

that

nursing faculty scored lower on intent to engage in

DPE

within the next three years may

be due,

in part,

to the time it takes to make curricular

changes in traditional nursing

programs and the time they anticipate needed

to find

and

form

partnerships with other

healthcare

disciplines.



125

Research

Question

Five. To answer the question,

"What

are thedifferences

in

attitudes toward IPE and IPHCT among healthcare faculty from various professional

healthcare

programs?" MANOVA was

computed. The

seven

HCF

groups did not

differ

significantly on attitudes

toward

IPE or IPHCT. On average,

they

all had positive

attitudes

toward

IPE

and

IPHCT.

Based

on the TRA framework,

positive

attitudes

contribute

to

HCF

intent to engage in IPE.

Contrary to Curran's et

al.

(2007) finding that medicine faculty

had

significantly

lower mean scores on attitudes toward

EPE

and IPHCT than nursing faculty, in this

research

study there

were

no significant differences

among

the

groups

of

seven HCF.

There are no other studies on faculty attitudes

toward

IPE and EPHCT in the

current

literature.

Over

the past few years, medicine has become

very

proactive with regard to IPE

implementation. This may

have

contributed

to

the MD group's

positive attitudes toward

IPE and

demonstrated difference from the Curran etal.

(2007)

finding.

Currently,

according to this study's results, MD faculty

are

implementing IPE at the highest rate

while

nursing

is implementing it

at the

lowest rate. Barker,

Bosio,

and Oandasan

(2005)

suggested that regulation

of

medical

education and support for IPE from the medicine

accrediting bodies

may

facilitate a positive shift

in perception

of

IPE

in MD faculty.

Accrediting bodies for most

of

the

HCF

groups in this study require

interprofessional teamwork and collaboration

as

part of their guidelines. Accreditation

requirements,

in addition

to the

positive

benefits of

IPE described in the literature, may



126

explain

why

all HCF groups in

this

study

demonstrated positive attitudes toward IPE and

IPHCT.

Discussion of

Research Question Findings

Plausible

reasons

why HCF

indicated

strong positive attitudes

toward

DPE and

IPHCT, strong

subjective norms,

and strong

intent

to engage or continue to engage

in

IPE

over

the next three years may be due in part to social desirability and acquiescence

(Dillman et al., 2009).

Social

desirability happens when subjects answer

questions

based

on what they know the researcher is hoping to hear. Acquiescence happens when

subjects

tend

to

agree

with others.

Acquiescence

is a

function

of subjective

norms. HCF,

in response

to the

influence from SN faculty

colleagues

and

SN

school's administrators,

may

perceive

and report that they should engage in IPE because they feel they should be

in agreement with their

peers and

organizational leaders. Social

desirability

and

acquiescence should

be

considered

when

explaining

why

subjects

reported

strong

positive

attitudes

toward

IPE

and IPHCT, beliefs that

their

faculty colleagues

and

school's administrators think

they should

engage

in

IPE, and strong

intent

to engage or

continue to engage in

IPE

over the next three years, yet are

not actually

implementing

IPE in

their curricula.

Additional

Analyses

Significant Findings

In

TRA,

the combination of attitudes and subjective norms lead to behavioral

intentions (Fishbein & Ajzen, 1975). In this study, the combination of scores on attitudes



127

towards IPE and IPHCT

and scores on

SN faculty colleagues

and SNschool's

administrators

were

explored

as predictors

of

scores on intent

to

engage in IPE.

Scores

on the

two SN

variables,

"My faculty colleagues

think I

should/should

not

engage in

IPE" and "My school's administrators think I

should/should

not

engage in

IPE"

were significantly

related

to

scores

on intent

to

engage

in

IPE. A multiple regression

analysis was computed for

the

two attitude variables

and the

two

SN

variables on

intent

to engage in IPE scores. The analysis revealed

that SN

school's

administrators

was the

single best

predictor

and

the combination

of

SN school's

administrators plus

attitudes

toward

IPE was

the best

multiple

regression

predictor

of

intent to

engage in IPE.

While

research

based

on TRA (O'Keefe,

1990)

has

shown attitude

is a

stronger

and more

accurate predictor of behavior

than

subjective norms, the data from the current

research

refutes

O'Keefe's conclusion. In

this

study, SNs

were

stronger

and

better

predictors

of

intention

than

attitudes. While

this

outcome is inconsistent

with

O'Keefe's

findings, it

is

consistent with

and

supportive

of

TRA since it was

the

combination

of

attitude

and

SN

that was the best predictor of intent. The revised application of the TRA model based on

statistical findings

in this

study

is

presented in Figure 6. All correlations presented

were

statistically

significant. The linear

combination

of the best predictors is

emphasized

in

bold print.

These findings are

consistent

with the

meta-analysis

by

Wallace

et

al. (2005)

which

found that social

pressures or

subjective norms

moderated the

relationship

between

attitudes and behavior.

When behaviors were

desirable

and politically correct,

people



128

Intent to

Engage

in

IPE

SN School s

Administrators

0* =

,52)

SN Faculty

Colleagues

Attitude Toward

IPHCF

r=.23)

Attitude

Toward IPE

(r

=

.31)

Figure

6

Revised application of the TRA

model

based on study

findings

tended

to

perform

the behaviors. Attitudes

predicted

behaviors better

when

there

were

weak

social

pressures

surrounding

the

situation.

Independent /-tests computed to compare teaching faculty and administrative

faculty

on intent to engage in

IPE

scores

revealed

a

statistically

significant

difference.

Administrative

faculty

reported

that

they

were more

likely

to intend to engage

in

EPE

than

teaching

faculty. This may be

due, in part,

to

administrators

being more

involved

in

accreditation processes and having greater awareness of the EPE requirements

of



129

accrediting bodies.

It is also possible that administrative faculty are

more acutely

aware

of

IOM recommendations since they

are

more likely

to

be responsible for carrying them

out. There have been no studies reported in the literature about this finding; therefore,

explanations at

this

time are only speculative.

Independent r-tests were computed for HCF who were currently engaged in IPE

versus those who were not

and those HCFwho

were

previously engage

in

EPE and those

who were not for

all

research variables. There

were

statistically significant differences

for all

variables.

HCF who were currently

engaged

in

IPE or previously

engaged in IPE

had

more positive attitudes toward IPE and IPHCT,

were

more likely to

engage

or

continue to engage

in IPE, and had beliefs

that

their faculty colleagues and school's

administrators believe

they should engage in BPE.

These

findings are consistent with

Curran et al. (2007) who found that faculty with prior IPE experience had better attitudes

toward

DPE and IPHCT. This is also consistent

with

TRA which proposes that attitudes

and

subjective

norms

predict behavioral intention. Positive attitudes

and motivation

to

engage

in EPE

lead

to increased

IPE

engagement and continuation

of

engagement in IPE.

Perhaps familiarity

and

a

real world sense of IPE's

benefits

contributed to the

likelihood

for

engaging in

or

continuing

to engage

in

IPE. HCF

faculty quotes support their

perception that IPE has both patient

and

student benefits.

Non-Significant Findings

Pearson's

correlations were computed for age, years experience as

a

health

professional,

and years experience as

a

health professional educator for the research

variables

attitudes toward IPE,

attitudes

toward IPHCT,

SN

faculty colleagues,

SN



130

school's

administrators, and intent

to

engage

in IPE. None

of

the Pearson correlations

were

statistically significant. Age,

years

experience

as

a

healthcare

professional,

and

years

experience as

a

health

professional

educator are

not related

to any

of the research

variables. The findings

of

this

study are consistent

with Curran

et al.

(2007)

findings that

indicated age, years of

practice experience,

and years of

experience

as

an

educator

were

not

significantly

related to

attitudes

toward EPE.

Curran

et al. did not

study

all of the

research variables included in this current

research.

Curran

et

al.

focused on

attitudes

toward IPE and IPHCT but did not include

SNs or

intent to engage in IPE

as

part

of

their

research.

Findings

regarding HCF

age

and

experience suggest

that HCF

should not meet

generational resistance

in

implementation

of

IPE since all

ages

of faculty were supportive

of IPE. This is a

positive

interpretation and should facilitate IPE implementation.

Independent

r-tests

were computed

to

compare

teaching

faculty and

administrative faculty on

attitudes toward

IPE, attitudes

toward

IPHCT, intent

to engage

in IPE, SN colleagues, and

SN

administrators.

There were no

statistically

significant

differences found

for

any

of

these variables. Independent

r-tests

were also computed

to

compare groups on demographic variables for

all

research

variables. There

were

no

statistically significant differences among gender

type, employment

status, current

faculty position,

and

highest level

of

education

on

the

research variables.

The

finding

based

on

gender

is

not

consistent with

Curran

et

al.

(2007),

who found

that

female faculty

had

significantly

better attitudes toward IPE and IPHCT than male faculty.



131

ANOVA were computed

for

faculty

rank and

tenure status

for all research

variables. There were no statistically significant differences among any

of

the faculty

rank or tenure groups on the research variables. Since

faculty

rank and tenure did not

influence attitudes, SNs, or intent to engage in EPE, future research on IPE should include

all HCF.

Discussion ofPositive and Negative Factors that Influence HCF Engagement in

IPE

Within the

model

of TRA,

positive and negative factors influencing

engagement

in IPE may be considered as internal and external

influences

on attitudes. A review

of

the literature revealed only one article by Barker et al. (2005) regarding factors that affect

IPE implementation.

Positive

factors.

Factors in this

category

were organized

into

three major

categories. Subject responses most often

identified improved

patient care,

student

benefits, and healthcare teams as the most common factors

that

influenced their intent to

engage in IPE.

Category One: Patientcare. When

the

words patient

and

care occurred

in

the

quotes,

they most

frequently occurred together and

most

commonly referred to improved

patient

care

or

optimal patient

care. According to the responses, subjects in this study

believed that IPE contributes to better, patient centered, quality healthcare for patients,

which

supports

a

proposition

that

was made

by D'Amour

and Oandasan

(2005).

Improved patient

care

is

central to the

vision

and

goals of

healthcare, healthcare

professionals, and healthcare organizations.



132

Positive factors

associated

with

IPE

are supported in

the literature. Available

literature identifies

improved patient

outcomes as a result

of

IPE

and

or

interprofessional

teams.

Morey

et

al. (2002) described a

significant

reduction in the amount of clinical

errors as a

result

of

an

interprofessional teamwork program. The non- empirical literature

also cites improved patient

outcomes

as a benefit of IPE; however,

there

is a

large

gap in

the

empirical literature

to support this claim.

Despite

the lack of

scientific evidence that

patients

benefit from IPE, it was clear from the quotes in this study that HCF continue

to

believe this

is

true.

Category Two:

Student learning. When

the

words student and

learning

occurred

in the quotes, they most frequently occurred in the contextof student

benefits,

learning

opportunities,

learning

other

perspectives,

and learning

experiences.

According to the

responses, subjects

in this study

believed that IPE contributes to

overall

enhanced student

learning. Optimal student

learning

is central to

the vision and goals

of

HCF

and

educational institutions. "The interface between the learner and the educator is an

essential element

of IPE" (D'Amour

& Oandasan, 2005,

p.

12). Socializing students into

IPE will affect their

performance in

healthcare teams

(D'Amour

& Oandasan).

Category Three: Healthcare

teams. When the words healthcare and team

occurred in the quotes, they most frequently occurred in the context of integrated

healthcare teams,

working

in

teams, and

preparation

for actual practice as

healthcare

providers since providers

function

in

teams. According

to the

responses, subjects in

this

study believed

that IPE

contributes to

embracing a team approach

to healthcare for

the

betterment

of patient

outcomes.

There

is

an interdependency

between EPE and



133

collaborative

practice

in

the

form

of

healthcare

teams (D'Amour &

Oandasan, 2005).

"IPE requires collaborative

practice

settings where learners can

be exposed

to educational

experiences" (D'Amour &

Oandasan,

p. 12).

Negative

factors.

Factors

in this category were

organized

into two major

categories. Subject

responses

most often

identified

scheduling and coordination, and

discipline culture as the

most common

factors that prevent

them from engaging

in

IPE.

Category One: Scheduling and coordination. According

to

the

responses,

the

coordination of

schedules

with other healthcare professional programs and

students can

be a

daunting

task

especially when territorial, turf, and

non-optimal

cooperation

between

disciplines exists. According to the responses, subjects in this study believed that the

time,

work,

effort,

challenges, difficulties,

and

logistics

in

combination

with the

levels of

cooperation between professionals

in differing

disciplines

is the number

one

reason

why

IPE is not implemented effectively.

Negative factors

identified in this study

are consistent with

reports in

the literature

where logistics, including timetabling, geography, and physical space

were

identified

as

factors that presented barriers

to

IPE implementation. Curran et al.

(2005)

identified

scheduling

as

a

perceived major

barrier to IPE implementation.

Awareness of

factors that

inhibit EPE

will allow

for

generation of

solutions to

known problems or issues.

Scheduling and coordination are

logistical

challenges, however, not

impossible

for

school's

administrators

and general HCF to

overcome

if they wish

to engage

in

IPE.

Category Two: Discipline culture.

According

to the responses, territorial

issues,

and attitudes between and toward other disciplines were the main factors that prevented



134

HCF

from effectively engaging in IPE. Subjects in this study cited territorial disputes,

the lack

of

cooperation

between disciplines, and

discipline elitism as factors impeding

IPE.

Issues such as

ultimate

accountability for patient care,

reimbursement

for

patient

care services, compensation for

IPE

efforts, and territorial concerns perpetuate

miscommunications, disagreements, and disrespect between healthcare providers.

The

natural

overlap

of healthcare providers

should be nurtured

and supported

in

education and

in the healthcare industry if there is

ever

to be

a shift

in discipline culture.

Negative factors identified in this study

are

consistent with those reported in the

literature

where

professional cultural beliefs were identified as factors

that

presented

barriers to IPE implementation that prevent

healthcare

professional

groups from

cooperating and collaborating

(Barker et al.,

2005). Curran

et al.

(2005)

also identified

curriculum turf concerns, and perceived value of IPE as barriers to IPE implementation.

Positive and

Negative

Factors

Discussion

Traditionally, healthcare disciplines were taught within their own silos where they

were grouped

within

their own ontologic perspectives, where

they related

within

a

hierarchy,

and were

subdivided

according

to

similarities and differences among them.

Based

on TRA, IPE

is an

entirely new

way

of considering education cooperatively among

the

various HCF disciplines.

The

positive and negative factors

revealed

in this study are

consistent

with the available

literature and

may

affect attitudes and subjective norms as

internal and

external factors.

They include HCF perceptions about skills, abilities,

information, and emotions and perceptions about situational and environmental factors

that contribute to

the way

HCF act or

react

in relation to IPE.



135

Nurses

and

physicians reported the lowest

percentages

of negative factors

about

IPE.

Occupational therapists

and physician

assistants

reported

the highest

percentages of

negative factors about IPE.

U.S.

HCF

identified

negative factors

that

have

or

would have

prevented them

from

engaging in

IPE.

Attitudes

toward IPE

and

EPHCT

were

not

factors

identified

as

preventing faculty from engaging

in

IPE.

HCF in this study

reported

positive


IPHCT. Negative

factors impact the implementation of IPE. The identification of these negative factors

that impede IPE

in

the U.S. is

the

first step

in overcoming them.

However, shifts in

beliefs regarding

territory

and

turf

concerns may take time and energy and displays of

improved

cooperativeefforts between and

among disciplines

before these

types

of

negative

factors start to dissolve. The

Barker

et al.

(2005) article

offered an

analogy

stating

that

changing curriculum in the healthcare disciplines is similar to trying to move

a

graveyard, in

that

it

is

not

the

physical

movement

of

the

graveyard that

is

the issue,

rather

it

is the attitudes and perceptions

of

the move

held by

friends

of the

dead.

Professional cultural

beliefs

protect disciplinary territory,

protect

disciplinary bodies

of

knowledge, are difficult to

change within

entrenched programs, and require sensitization

because professionals within entrenched programs

hold

specific

beliefs

about who they

are

and have great difficulty accepting

that

anything about them

should be changed

or

different (Barker

et al.).

Methodological

Issues

One possible explanation for the low response rate

of

8.6% is

that

the emails were

sent out in bulk through Survey Monkey™ .

Some

emails may

have

been screened out as



136

spam or

quarantined

for a

time

before they were released

into

HCF

email inboxes.

This

was noted

because

this researcher, after

the

survey was

closed and

no

invitations

were

being sent out any longer,

received

emails from

potential participants

saying they

just

received the email with

the

link

and

note

that the survey is

now closed. In the future, as

a

recommendation, emails should be

sent out

individually to avoid identification

as

potential spam and quarantine. Spam filterscan prevent many potential subjects from

receiving a survey (Dillman et al.,

2009).

Another

possible

explanation for the low response rate

may

have been the non-

response error (Dillman et al., 2009) mentioned

earlier

in this

chapter. Perhaps only

HCF

interested in EPE

responded

to

this

survey.

If that

were true, then that

would mean

over

90%

of

potential subjects who received emails are not at

all

interested in

DPE.

A

recommendation for future research would be an opt out

from

the survey

where

potential

subjects state

that

they do not

wish

to

fill

out

the

survey because

it

is not

of

interest to

them.

Another recommendation

for

future

research would

be the use

of

incentives.

Incentives

reduce non-response bias because

they pull

in

those

who would not have

otherwise

answered (Dillman et al.).

In addition, Dillman et al.

(2009)

recommend the stop, return,

and go

back

features in

surveys even

if

only

a

few subjects use it.

The

option

to

stop,

return, or

go

back was not available

in

this

research

study.

In light

of the low response

rate, perhaps

subjects

were interrupted when completing the survey and had to stop. The survey would

not allow pausing

or

re-entering the survey even

if

internet connection was

lost

or

interrupted; therefore, potential subjects

may

have

been lost in this way

also.



137

Generalizability

of the Findings

Generalizability

of

this

study's

findings is

limited

to

a

sample

of

the seven

healthcare

professional

groups, who were primarily female, doctorally

prepared

and

between the ages of 46 and 54.

Generalizability

is also

limited to

primarily

full time,

non-tenured,

assistant and

associate professors with an average

of

20 to 31 years of health

professional experience and

11 to

17

years of

experience

as

a

health professional

educator.

Conclusions of the

Study

The researcher drew the following

conclusions based

on

the findings

of

this

study:

1) HCF have positive attitudes

toward

EPE.

2)

HCF

have positive attitudes toward IPHCT.

3) HCF

have

less

positive attitudes toward

BPHCT

than they do about IPE.

4)

HCF believe their faculty colleagues

(SN

faculty colleagues) and

school's

administrators (SN

school's

administrators)

think they should engage

in

IPE.

5)

Most

HCF report that they are

very likely

to engage in IPE

or

continue to engage

in IPE within the

next

three years.

6)

Attitudes

toward

IPE are the best attitude

predictor

of

intent

to engage in IPE.

7) Subjective norms for school's

administrators

are the best SN

predictor of

intent to

engage

in

IPE.

8) The combination

of

SN school's administrators and attitudes toward IPE predict

intent

to engage

in IPE

better than

any

one variable

alone.

9)

There are

no differences in

attitudes

toward IPE or

IPHCT among HCF.



138

10)There

are

no

differences in SN faculty colleagues, SN school'sadministrators

among HCF.

11)

Administrative faculty

are

more likely

to engage

or

continue

to engage in

IPE than

teaching faculty.

12) HCFwho are currently engaged in

IPE

or

have previously been engaged in IPE

have better attitudes toward IPE, attitudes toward

IPHCT,

and are more likely

to

engage in or

continue to engage in IPE.

13)HCF who are currently engaged in IPE

or

have previously been engaged in IPE

report that faculty colleagues and school's administrators believe they should

engage in IPE.

14) Age, years experience as

a

healthcare professional, and years experience as

a

health

professional

educator are not related to attitudes

toward IPE, attitudes

toward IPHCT, SN facultycolleagues,

SN school's

administrators, or intent to

engage in

IPE

or continuing to engage in IPE.

15)

Groups

on

faculty rank and tenure, gender, employment status, current faculty

position, and

level of

education

do

not differ on attitudes toward IPE, attitudes

toward

BPHCT,

SN faculty colleagues,

SN school's

administrators,

or intent to

engage

in

IPE

or

continuing to

engage in

IPE.

16) Most HCF identify enhanced patient

care

and improved patient outcomes as

positive factors relating

to

IPE

that

influence

them

to engage in

IPE.

17) Most

HCF

identify scheduling

issues

as

a

negative factor

preventing them from

engaging in IPE.



139

18)

The

use of TRA in this study was very relevant and appropriate.

Nursing

Implications

IPE intentions and effective engagement in

IPE

are influenced by attitudes toward

IPE, attitudes toward

BPHCT,

and subjective norms.

This

study

is

the first and only study

to explore faculty attitudes toward

IPE

and DPHCT in

the U.S.

and has

a

nationwide

sample from

seven

HCFdisciplines with analysis of data from 439 respondents. A large

gap

in

the literature still exists

concerning

IPE

in American health professions education.

Contribution to

Nursing Education

In this study, IPE generated categories

of

positive collegial relationships, giving

students

a

broader perspective, positive socialization, improvement in communication

among healthcare professionals, sharing of knowledge

within

and between disciplines,

and improving understanding

of

differing discipline contributions to patient care.

Participants reported beliefs that IPE isengaging and

beneficial

for students, improves

student outcomes and experiences, and that

IPE is

consistent

with

actual practice

expectations.

In relation

to

IPE implementation in nursing, IPE requires the co-operation of

several healthcare disciplines. Schools may benefit from doing gap analyses and/or

needs assessments

to

determine the inventory

of

resources they have and the

resources

they need to acquire. They

may

also wish to consider the negative factors that were

identified

in the

additional analysis findings

in

this study

in an

effort to try to

overcome

existing barriers to IPE implementation. Barriers such

as

scheduling and

coordination

may be overcome by identifying physical space, cooperating when creating course



140

semester schedules,

and identifying

opportunities

when

various

healthcare

discipline

students are available

in the community

or clinical situations to bring

them together.

Specific efforts to nurture an interprofessional culture

may

include efforts to avoid

miscommunications,

disagreements,

and disrespect

among

healthcare

providers.

In

IPE,

students

from different

disciplines

learn from one

another,

have a more

holistic

view of patients, improve

their own role

development,attain a

better

understanding and appreciation of the roles

of

other

healthcare providers, attain access

to

multiple perspectives

and shared

resources,

develop student

leadership, demonstrate

value

of other

professionals in

healthcare.

The

many positive outcomes associated with IPE are posited to be positive

student

attitudes toward other

healthcare disciplines,

increased

confidence,

better valuing

of other professionals, less negative stereotyping, improved socialization and

relinquishment

of

professional prejudices.

This is especially

important in nursing

since

IPE

may

counteract the negative

nursing stereotypical images, decenter

the healthcare

environment allowing

nursing

to overcome the long time social, political, and economic

forces that

led to the

inequities

and

hierarchies

that

have,

for so

long,

overshadowed

nursing's contributions

to

healthcare

(Olenick

et

al.,

2010a).

IPE

has become necessary for meeting

accreditation

standards in healthcare

professional education.

Positive

factors generated by

IPE,

as

identified

by subjects in

this

study, included

IPE's

importance for gaining

university

and curricular support for

the

purpose of more relevant and effective use of resources in healthcare.



141

In

a

recent

non-empiric article,

Salfi,

Solomon, Allen, Mohaupt, and Patterson

(2012) proposed a framework for

integrating

IPE competencies into

nursing

curriculum.

"Nurses are an integral part of the health care team, so it is critical that their education

prepare them for

interprofessional

collaborative practice" (p. 106). The framework

describes the four following focus levels: 1. Know about own

role

as nurse and

know

about groups and

group

dynamics; 2. Know

how

by knowing

own role

as nurse and

knowing

when

and how to involve other

healthcare

professionals

in patient

care;

3.

Show

how by demonstrating collaboration with other health professionals; and 4. Do by

consistently demonstrating

collaboration and

contributing

to the overall healthcare

team.

IPE

is

challenging todeliver since differences in professional cultures, beliefs,

and

prior healthcare

experiences

exist

(Barnsteiner, Disch,

Hall, Mayer,

& Moore, 2007).

Barnsteiner et al. state "Developing a

culture

for

IPE

requires

faculty from multiple

disciplines who value IPE and are

willing

to

work

together to co-create a

shared

vision,

common goals,

and

a

curriculum" (p. 147). The

authors describe

IPE

strategies

they

identified

in a

review

of the

literature

such as

creating interprofessional common clinical

experiences,

facilitating

teamwork

and

joint problem solving, matching

faculty interest

and expertise,

and promoting

the

value

of shared learning.

Criteria to

promote

full

engagement in

DPE

include:

creating

an explicit IPE philosophy that is observable,

measurable,

and permeates the educational organization;

requiring faculty from

differing

disciplines to

collaborate

oncreation

of

learning experiences; creating

integrated and

experiential learning opportunities for collaboration, teamwork,

and

safe

patient

care;

embedding IPE into curriculum and student caseloads; creating and utilizing



142

interprofessional

competencies such as

those promoted

by

the

IOM; and creating an

organization

infrastructure

that

fosters

IPE.

Flynn, Michalska, Ham, and Gupta (2012)

suggested

that IPE experience in

healthcare education

should occur at an early stage and with

multiple

exposures.

Their

study sample included family

medicine,

occupational

therapy,

clinical psychology,

nursing

theology,

and behavioral psychology

students (N

= 123)

from

bachelor's master's

and

residency

programs

in Canada.

Subjects attended a one day

interprofessional

cognitive behavioral therapy workshop

and

answered

a

14-item questionnaire to evaluate

the

interprofessional

experience. The family

medicine

group scores were

significantly

lower on appreciating learning

with

peers

of

other disciplines (p

<

.001) and appreciating

the

roles

of other

groups members (p

=

.01).

The family

medicine group

also scored

significantly

lower

(p

.002) on

their evaluation of

the

interprofessional

learning

experience. Findings indicated

that

initiating IPE

at later

stages in curricula, such

as in

residency, compared

to bachelor's and master's

level, may limit healthcare professionals'

abilities to learn with, from, and about one another. At

later

stages in education,

identities have developed and are more difficult to change.

The findings of this study are important because they provide nurses and nurse

educators with an awareness of other HCF attitudes toward IPE and IPHCT and the

perceived

positive

and negative factors that facilitate

or

inhibit engagement

in BPE.

Knowledge

of

these

attitudes and factors can

help

guide

nurses

and

nurse

educators in

stressing the

positive

value

of IPE and

overcoming

the

negative

barriers to

effective IPE



143

implementation

by

HCF.

Nursing

faculty

will

be able to develop and implement

strategies

that

encourage IPE implementation.

The

NLN

(2012) has

begun an

Interprofessional

Education

webinar series

consisting of three topics: an overview of IPE, interprofessional obstetrics and pediatric

simulation learning, and interprofessional exemplars from pharmacy.

The

NLN

webinars

are based on

a

teamwork system to promote patient safety. The first of

the

webinar series

slides are available and directed toward nurse educators in an effort to

clarify

understanding

of

IPE.

Contribution

to

Nursing Research and

Science

IPE research is

a

way

to discover, explain,

and

gather information

about

IPE

and

HCF attitudes that affect its delivery. Determining faculty attitudes toward IPE and

IPHCT, and identifying subjective norms that influence behavioral intent may

be

the first

step in understanding behavioral intentions for effective IPEdelivery.

In this study, research was

a

category that

was

generated under the positive

factors that contribute to engaging in IPE. Participants stated that engaging in research

with other healthcare professionals

was

essential and leads

to

improved solutions and

outcomes for patients.

Identification of the negative factors that prevent HCF from engaging in

IPE

are

essential since addressing those factors may facilitate the

possibility

to reduce negative

factors or barriers. In this study,

HCF

identified

that increased

workload and the lack

of

administrative

support contribute

to the negative factors that

prevent

them

from

engaging

in

IPE.

Other

factors

that

have negatively

affected faculty and

prevented

them from



144

engaging in IPE include lack

of

availability or opportunity

of

interacting with other

health professions.

Perhaps

varied

healthcare

disciplines

do not exist at

their

particular

school

or perhaps

other disciplines

do not show interest in

collaborating to initiate

IPE.

Lack of communication,

issues

with the

way

curriculum

is set up

including finding space

within

current curriculum, clinical demands,

barriers and resistance

when dealing with

various health professionals secondary to historical

or

stereotypical perceptions, attitudes

toward other

disciplines,

lack of funding

or

monetary support for IPE,

and no incentive

or

reward for engaging

in IPE were

also factors. Logistics,

planning,

time, and

scheduling

were very commonly identified as barriers to engaging in IPE. Politics and resistance of

change

were

other factors

identified

by the participants in this study

as negative

factors

that

prevented them

from engaging

in IPE.

Lack of ability or knowledge about

IPE

was also identified as a factor that affects

engagement in IPE. Most faculty have not

previously

been subject to orhave

not

taught

in an interprofessional education

type

educational system since

traditionally

healthcare

professionals were taught in

their

own professional silo from their

own ontological

viewpoint.

IPE

is

very different

from

the

traditional method of learning

ontologic

elements from an instructor

and

being

socialized

exclusively into one defining role.

Carper (1978) described ways of knowing in nursing as empiric, aesthetic,

personal, and moral

knowing.

This

study

was

significant

to nursing

science because

it

generated empiric and

aesthetic

knowledge about IPE and

DPE's

social

and collaborative

nature.

Empirically, this study

of

nurse faculty


IPHCT,

perceptions

of IPE subjective norms, and intentions to engage in

IPE was

the first study



145

on nurse faculty in the U.S. Aesthetically, this study explored the expressive components

of

IPE

which included

attitudes, perceptions, and intentions.

In

IPE,

shared

values,

shared

decisions, and

a sense

of respectfulness between disciplines is

essential.

Contribution to

Nursing Practice

This

study found

that many HCF

believed

that

IPE has

the potential to influence

patient safety, quality of care,

and

health systems improvement. HCF

indicated

that IPE

enhances patient centered care, enhances patient care

in

general, contributes

to

improved

continuity of care, contributes to healthcare cost savings and the future

of

team

based

healthcare, and enhances patient outcomes.

HCF

indicated

that

EPE prepares healthcare

professional students for practice. HCF identified personal and

professional

experiences

are consistent with the concept

that IPE

improves patient

outcomes and improves patient

safety.

These

findings are also consistent with the literature

(Ladden

et al., 2006; Reeves

et al., 2009).

Baerg

and Lake

(2012) found common themes related to

the

skills and knowledge

required

for

interprofessional collaboration. They

stated

that

providing

interprofessional

collaboration

education

and training to improve

communication

skills

and

interpersonal

relationships,

address practice

issues such as knowledgeof other

disciplines

and their

roles in practice, develop leadership

skills that

include

problem

solving and negotiation,

develop

professionalism, improve and maintain interprofessional goals,

and

garnish

appropriate

resources

will contribute to the development

of

interprofessional

collaborative practice.



146

The

2010 IOM report called for and specifically

cited

the need for

interprofessional collaboration. The report described a

vision

of

the

future

of healthcare

in the

U.S.

with interprofessional collaboration

as

the

norm. The role of

nurses in this

vision

is very

specific.

The

IOM recommended that nurses design and implement early

and continuous IPE

through

collaborative

classroom

and clinical opportunities

and

recognizes that IPE can only be

achieved through

committed collaborative partnerships

across professions.

The importance

of

collaborative cultures

in

this IOM vision will be

vital in sustaining

and

continuing improvements

in

quality

of care.

In

an

editorial about

the

IOM report, Gennaro (2012) pointed out

that many U.S.

nursing

organizations and

nurse residency programs are

now

promoting interprofessional collaboration.

Nurses have had longstanding issues and non-optimal working relationships with

physicians and

other

healthcare providers which has led

to a

lack

of

appreciation

of

nursing's contribution to

optimal patient

care (Miller

et

al.,

2008). Participants

in

this

study identified mutual

respect and

understanding,

teamwork

and collaborative

practice,

and breaking down barriers

between

and among healthcare disciplines as positive factors

that encouraged

them to

engage

in IPE.

With IPE,

the

status of the

healthcare

environment

can become

a shared,

collaboratively focused entity where nurses become members

of

highly integrated teams

and add value

to the optimal care of the patient. IPE may decrease fragmentation in

healthcare delivery,

and relinquish

hierarchies, misperceptions,

and

miscommunications.

IPE contributes

to

a

holistic

approach

where

all

healthcare providers recognize one

another's contributions.



147

Recommendations

for

Future Research

As

a

result

of

this

study,

the following recommendations for future

research are

suggested:

1.

Replicate this study based on TRA model measuring

HCF

actual engagement in

IPE.

2. Explore

IPE

and IPHCT in

relation to

actual

patient

outcomes.

If patient

safety,

quality

of

care,

and enhanced patient outcomes

can be

linked

to

IPE this

would

begin to build

a

base

of empirical literature to support its

incorporation

into

healthcare professional curriculum.

3. Explore

HCF

perceptions

of SNs

concerning accreditation requirements.

4. Identify strategies that

are

most effective

in

eliminating barriers

and negative

factors related to IPE.

5. Identify strategies

to

effective IPE implementation.

6.

Investigate

faculty attitudes in

countries outside

the

U.S.

where socialized

medicine and healthcare exist and where IPE seems

to

flourish.

7.

Identify


attitudes (those

who

are employed in healthcare

and

not

teaching)

toward

IPE

and

IPHCT and determine

if

they differ

from

faculty

attitudes

since

full

time

faculty may not

be

actively practicing.

Chapter Summary

Discussion of

the

findings, methodological issues, generalizability of the findings,

conclusions of the study,

nursing

implications, and recommendations

for

future

research

were

presented

in

this chapter.

Research

variables of attitudes toward IPE,

attitudes



148

toward EPHCT,

subjective norms

regarding faculty

colleagues, subjective norms

regarding

school's

administrators,

and

intent

to engage

in

IPE

were

explored

and

discussed.

The

findings of this study contributed to the body of knowledge

for

the nursing

profession

about IPE. Nurses responded favorably

regarding

their attitudes toward IPE

and IPHCT. IPE is promising for the profession of nursing since it has the potential to

influence patient

quality

of

care and lead to better working

relationships

with other

healthcare providers.

Recommendations

from this

study provide an

opportunity for

further scholarly

research

related to IPE.



149

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169

Appendix A

Letter of Explanation

Dear Potential Research Participant,

Purpose: You are

being

asked to

take part

in a study because you are

faculty in

a

healthcare discipline

program.

The aims of this study are to explore healthcare faculty

(HCF)

attitudes

toward interprofessional education (IPE) and interprofessional healthcare

teams

(IPHCT), to

explore

HCF

perceptions of subjective

norms'

influence on

HCF

intent to

engage

in IPE,

to explore HCF

intent

to engage

in

IPE,

and

to explore

differences among types of HCF

in

attitudes

toward

IPE

and

DPHCT and

intent to engage

in IPE.

Procedures:

It

will

take

you

approximately 20 minutes to complete

a

total survey

including demographic questions

and

questions

about

your

attitudes toward IPE

and

IPHCT. Your informed consent

is

implied

when you enter the

Survey Monkey™ website

and submit

your

completed survey.

Risks and

Benefits:

There are no

anticipated

risks associated

with participation in this

study.

You

are free to exit the survey

at

any time for

any

reason. There are no

anticipated

direct benefits

to you for your participation in

this

study. However,

participation in the study may encourage some faculty to actively consider IPE if

they

have not

considered

it

previously.

Data from this study will advanced nursing's and



170

other

health

professions'

knowledge

of


IPE

and IPHCT.

This

information may assist

in

the advancement

of

interprofessional education

within

health

professions.

Costs: There

is

no cost to participate in this study.

Compensation. Incentives and/or Payment to Participant:

You will

not

receive any

compensation, payment

or

incentives for participating in this study.

Confidentiality:

All

documents

and information pertaining to this research study will be

kept confidential in accordance

with all

applicable federal,

state,

and local laws and

regulations. Data generated by the study

may

be reviewed by Widener University's

Institutional Review Board, which

is

the committee responsible

for

ensuring research

participant welfare and rights,

to assure proper

conduct of

the

study and compliance

with

university

regulations.

Any presentations

or

publications resulting

from

this research

will

not identify

participants

by name. SPSS

raw

data

files

will be accessible to the

membersof

the

researcher's dissertation

committee.

Your anonymity and confidentiality

will

be

preserved

since

your name will not be

attached

to the online submitted surveys.

Alternatives and Rieht to Withdraw: The alternative is

not to participate in the

study.

Participation in this study is voluntary.

You

have the right to withdraw, skip

any

questions

or exit

the survey at any time without penalty. However, once

you

submit the



171

survey online, you are then unable to withdraw from the study. Your completionand

submission of the survey constitutes

your

consent to be

a participant

in the

study. Please

print a copyof this letter for your records.

Thank you for your participation. It is

greatly appreciated.

If you have

any

questions,

please feel free

to

contact me

at

the telephone number or email listed below.

If you

have

questions

about

your rights as a research

participant,

you

should

contact the

Chairperson

of

the

Widener

IRB

at (610) 499-4110.

Participants

may also email

this

researcher

and

request study results.

Sincerely,

Maria Olenick MS, CRNP, PhD (candidate)

Widener

University

chool

of

Nursing

(305) 919-4420 or email at [email protected]

Widener

University's

IRB

has

approved the solicitation of participants for the study

until

.



172

Appendix

B

Demographic

Data

As

part

of

the above

project,

this

survey

will assess

faculty

attitudes towards

interprofessional education, interprofessional health care

teams

and interprofessional

learning in academic settings. Your responses are anonymous. Thank you for your

participation.

Definition

of Terms:

Interprofessional health care teams (IPHCT)consist

of

health professionals from

two or more different

disciplines

or professions who share a common purpose

and

work

together collaboratively and

interdependently

to serve a specific

patient/client population and achieve the team s and organization s goals and

objectives.

Interprofessional

education (IPE)

is an interactive experiential learning and

socialization

process. IPE occurs when two or more members

of

a

healthcare

team

(who participate in either patient assessment and/or management) learn

with, from,

and about each other as they collaboratively

focus on

patient centered

care.

In IPE, knowledge and value

sharing

occurs within

and across

disciplines.

1. Are you:

•

emale

•

male

2. What

is

your age? years

3.

Your highest

level of

education completed?

•

Bachelor's

degree

•Master's degree

•Doctoral degree

4. How

many years experience

do you have as a

health professional? years

5.

In

which health professional program(s) area do

you primarily

teach and/or

supervise students?

•

Nursing

•Medicine

•

Pharmacy

•Physical Therapy

•

Occupational Therapy

•

Physician Assistant

•

ocial Work



173

6.

At What

level

do you primarily teach? (check

all that

apply)

•Bachelor

•

Master

•Doctoral

7.

What

is your

employment

status?

(check all

that apply)

•

Part-time

•

Full-time

•

ermanent

•emporary

8. How

many years experience

do

you have as a health professional educator?

years

9.

What

is

your current faculty position?

•

eaching

Faculty

•

Administrative Faculty

10. What

is

the nature

of your

academic appointment?

•

Full

Professor

•

Associate Professor

•

Assistant Professor

•

Clinical faculty/Instructor/Lecturer

•

Other

11.

What is

the nature

of your academic

appointment

with

regard

to tenure?

•Tenured

•

Tenure

track

•Non-tenure track

12. How

likely

are

you

to

engage

in

or to

continue

to engage in

IPE

within

the

next

3

years

using the rating

scale from 1

(not

at

all likely

to engage in

EPE

within the

next 3 years) to

10

(very

likely to engage

in IPE within

the next 3 years)?

scale

rating

13. Are

you

currently implementing IPE

as

defined above?

• es

•o



174

14. Have

you

previously implemented IPE

as

defined above?

•

es

•

o

15. How

much

experience

do you

have

with


•

None

•ess than 1

year

• - 2

e a r s

• - 4

e a r s

• years or more

16. How

much experience do you have with

interprofessional healthcare

teams?

•

None

•

ess

than

1

year

•

- 2

e a r s

•

- 4

e a r s

•

years or

more

For items #17 and #18 please place

a

mark :_Xj on the scale

to

indicate the strength and

direction

of

your response. A mark

closer

to

either

end indicates

a

stronger response

towards that

statement.

If

your response

is neutral_you

should place

your mark

in the

middle

space.

17. Mv faculty colleagues think

I should

: : : : : : : :

I should not engage in IPE

18. My school's administrators

think

I should : : : : : : : : I should

not

engage in IPE

19. What are the POSITIVE

factors that have influenced/would influence

you to

engage


education?

20. What are the NEGATIVE factors that have prevented/would prevent you from

engaging in interprofessional

education



175

Appendix

C

Attitudes Toward IPE

Please read

the

statements

below

and indicate

your agreement with each of

the

statements, by checking the space

following

each

statement.

Use

the

scale:

SD = strongly disagree

D

= disagree

N neutral

A

=

agree

SA = strongly agree

STATEMENT:

SD

D

N

A

SA

1.

Interprofessional

learning

will help students think

positively about other

health

care professionals.

2. Interprofessional learning before qualification

will

help

health professional students

to

become

better

team-workers.

3.

Patients

would

ultimately benefit if health

care

students worked

together to solve patient

problems.

4.

Students in my professional group would benefit

from working onsmall group projects with other

health

care students.

5.

Communication skills should

be

learned

with

integrated classes of health care students.

6.

Interprofessional learning

will

help to

clarify

the

nature

of

patient problems for

students.

7.

It is

not necessary for undergraduate health

care

students to learn together.

8.

Learning with

students in other health

professional schools helps undergraduates to

become

more

effective

members

of a

health

care

team.

9.

Interprofessional learning among health

care

students will

increase their ability to understand

clinical problems.

10.

Interprofessional learning will help students to

understand

their own professional

limitations.

11.

For small-group learning to work, students

need

to

trust

and respect

each

other.



176

STATEMENT:

SD D N A SA

12. Interprofessional learning among health

professional students

will

help them to

communicate

better

with patients

and

other

professionals.

13.

Team-working skills are essential for

all

health

care students to learn.

14. Learning between health care students before

qualification would improve working

relationships after qualification.

•

Adapted from: Parsell, G., & Bligh, J. (1999). The development

of

a questionnaire to

assess the

readiness

of

health

care students for

interprofessional

learning

(RIPLS).

Medical Education,

33,

95-100.



177

Appendix D

Attitudes Toward Interprofessional Health Care Teams

Please read

the

statements below and indicate your agreement with

each

of the

statements, by checking

the

space

following

each statement.

Use the scale:

SD

=

strongly

disagree

D

= disagree

N

= neutral

A

= agree

SA

=

strongly agree

STATEMENT:

SD D

N

A

SA

1.

Patients/clients

receiving interprofessional

care are more

likely than others to be treated as whole persons.

2. Developing an interprofessional

patient/client

care plan is

excessively time consuming.

3. The give and take among team

members helps

them make

better

patient/client

care decisions.

4.

The

interprofessional approach

makes

the

delivery

of care

more efficient.

5. Developing a patient/client care plan with other team

members

avoids

errors

in

delivering care.

6.

Working in

an

interprofessional manner unnecessarily

complicates things most of the time.

7. Working in an

interprofessional environment keeps

most

health professionals enthusiastic and interested in their

jobs.

8. The

interprofessional approach improves the quality

of

care to

patients/clients.

9. In

most instances,

the

time

required

for interprofessional

consultations could be better spent in other ways.

10. Health professionals working as teams are more

responsive

than

others

to

the emotional and financial

needs

of

patients/clients.

11.

The

interprofessional approach permits

health

professionals to meet the needs of

family

caregivers as

well

as

patients.



178

STATEMENT:

SD

D

N

A

SA

12. Having

to

report

observations to a

team helps

team

members better understand the work of other health

professionals.

13.

Hospital patients who receive interprofessional team care

are better

prepared for

discharge than other patients.

14. Team meetings foster communication among team

members

from different

professions

or

disciplines.

Adapted from: Heinemann,

G. D.,

Schmitt,

M.

H., & Farrell, M. P. (2002). Attitudes

toward

health

care

teams. In G.

D

Heinemann

and

A.

M. Zeiss (Eds.).

Team

performance

in health care: Assessment

and

development,

(pp. 155-159). New York, NY: Kluwer

Academic/ Plenum.



179

Appendix E

Institutional Review

Board

Approval

Widener University

Officeof the Provost

emorandum

To:

Maria

Olenick

Date:

From:

Dr.

Barbara Patterson

Chairperson,

Widener University Institutional Review Board

January 3,2012

RE:

Protection of RightsofHainan Subjects

Review

This letter serves

to

informyou

that

your research,

(70-12) Attitudes of Healthcare

Faculty

Toward

Interprofessional

Education

and

InterprofessionalTeams hasbeen reviewed and

approved

bydie Widener University

Institutional

Review

Booed (IRB)

for the

protection ofrights

of humansubjects. You may begin data collection asproposed in your application.

The authorization tosolicit

participants

for thisstudy is ineffect

for

one year from

the date

of

approvalcontained in this

letter

and iseligible

at

that time

for renewal.

The WidenerUniversity

IRB

must receive continuing reviewrequests

no

later than 14days prior to

the

meeting date before

the expirationof

approval

tobeplacedonthe IRBagenda. This form can be found on the

IRB

website

www.widener.edu/lib. Should you

fail to

obtain approval

of die

study prior to die

expiration

date, all

research

activity

must cease

until an approval

to extend

the

study

is

obtained.

If, for any reason, the approved research data

collection

method

changes,

regardless of how

minor,

except toeliminate

apparent immediate

hazards

to

subjects,

you

nrequited

tonotify

the

IRB, in

writing.

Please,

remember

that

the IRB

and

Widener University

accept

no

responsibility for

liabilities

associated

with this study. Ultimately, responsibility rests with the investigators).

Upon

completion of the study,

a

final written report of the research is to be submitted to the IRB.

This form can beobtainedondie IRB website. Themembersof the IRBextend

their

best wishes

for your successful

completion

of

this research

project. If you

have any

questions, please email

irtxgimail.vvidener.edu orcall

610-499-4110.

BarbaraPatterson,

RN,

PhD

CC:

Dr.

L.

Allen

WidenerUniversity,One

Univmity

Place, Chester,

PA 19013-5792

1610-499-4110 f:

610-499-4108

www.widener.edu

http://www.widener.edu/lib

http://www.widener.edu/lib



180

Appendix F

Examples of Positive

IPE

Quotes of Initial 26 Categories

Discipline Quote

NU "ipE teams are learning to collaborate and make less errors in patient

care.

Students are also learning

about

roles and capabilities

of

students from other

disciplines."

NU "Broader

perspective

and better outcomes."

NU

"Students would

learn the importance

of

collaboration with other disciplines;

also recognize what

those

disciplines

do

hat their role

is

in the

care

of

patients as well as the other disciplines understand

what

nursing does."

NU "It's how

health

care

world

operates. I am

an NP and have been part

of

health

care

teams in that role, and even in the hospital, we worked together,

even if it wasn't overtly described as that."

NU "Growth,

positive attitudes and mutual understanding, benefits to

patients."

MD "Accelerated learning, better

team-based care,

better

development

of care

teams

of

this decade.

More

enthusiasm

in

the clinical learning enfironment,

better integrated learning across professions (horizontal spread

of

curricular

content."

MD

"Perceived improved patient outcomes."

MD

"I

have always collaborated with other disciplines to care for

my

patients.

Doesn't everyone?"

MD "More completecare of the patient."

MD

"Interdisciplinary

teamwork is

essential in

my field

eriatric

Medicine."

PH

"It is

important that all health professioansl learn

to

work together and

see

each others points of view

so

that patients benefits and

egos

do not get in the

way.

There

is too much waste in education and health care due

to turf

battles."

PH "Ultimately,

better patient

care.

Learning from other disciplines. Mimics

actual practice. Helps remove myths/misperceptions

about

other

professions."

PH

"Development of teamwork and

respect

between the

different

students."

PH

"Necesssary to teach students to work

together

as a team. Shows

them

each

their

role

and how they work collaboratively."

PH "The chance to

be part

of a team

positively affecting patient

care."

PT

PT

"Patient outcomes."

"Broadens the

scope

of students expertise

in treating

patients."



181

PT "The opportunity to offer students a positive learning experience. The opportunity

to offer improved health care services to clients and patients."

PT "Student

learning

outcomes. Ultimately

patient

care outcomes."

PT "The

real

world

requires health

care

professionals

to

work

in teams

herefore

we

owe it to our

students

to give

them

some preparation

relative

to this."

OT "My

experience has

been

that the

potential exists

for improved patient outcomes

at

lower cost and with better cohesiveness

for

those served. All team members gain

skills in

clinical procedures/activities and

in

leadership/organization. These

factors

compel me to keep this model

on

my radar

as

I

engage in

program development."

OT "Getting

to

know coworkers

better; higher quality

patient care;

more appropriate

use of other professions expertise."

OT "Greater understanding of our

role

in the team and

to

pass this understanding along

to

our students."

OT

"Exposing

students to the real world "

OT "I can learn from

others'

expertise and perspectives. IPE enhances

quality

of care."

PA :The students find the experiences more engaging. They get more realistic learning

than

traditional classes."

PA

"Benefit

to students."

PA

"I feel

this

would

ultimately benefit

the

patient with better

care. Care

teams would

be

more knowledgeable about other professionals

on

the

team."

PA

"Mutual

benefit. Interprofessional respect."

PA "Critical to

my

profession. Better outcomes. Good modeling

of

IP teams for

students."

S

W

"Social

workers engage with other professionals

in their

jobs and must be able

to

interact effectively with other

healthcare

professionals.

Therefore,

students

need

to

learn how

to

work across

disciplines."

SW "Opportunity to coordinate

various perspectives, increased effectiveness in

teaching by

broadening

information

beyond my own

expertise, role

modeling

interdisciplinary

efforts/collaboration,

and

teaching

comprehensive

care for future

practitioners."

SW "Superior student training."

SW "Preparing students to be productive members

of

healthcare teams."

SW "There is a

need

to

share information across

disciplines."



182

Appendix

G

Examples ofNegative IPE Quotes of Initial 26 Categories

Discipline Quote

NU "Time,

focus, logistics."

NU

"Time

is needed to include added curriculum in

courses."

NU "University departments are not completely integrated."

NU "Resistance to change

(not

personally, but generally) and time constraints for

making changes."

NU "Difficulty

in

scheduling issues with various disciplines. Changing the long

standing

belief

that all students

need

to get through IPE instead

of

focusing

on the

purpose

of IPE."

MD "Lack of cooperation among other professions."

MD

"Expensive."

MD "Lack of school

support, particularly

financially/administratively and lack of

buy-in by

some

departments."

MD

'Territory conflicts between different disciplines (eg

ENT

vs OMFS,

Orthopaedics vs Podiatry)."

MD "Lack

of functional care models

for

truly integrated patient centered care."

PH "We are the only health professionals on campus, so

it

is difficult to engage

in IPE."

PH "Work

load."

PH "Currently at

non-teaching

hospital. Separate

nursing,

pharmacy,

medical

schools. No

history

of IPE. Time commitment

to

setting up, maintaining,

assessing IPE."

PH

"Time

constraints, any bureaucratic issues involved in setting up

such

a

program."

PH "Scheduling. Resources."

PT

"Faculty

feel

that it

will take

a

lot

of

work and scheduling is difficult due to

different curriculum schedules. To me these are barriers

not

negative

factors."

PT "Time.

Accessibility."

PT "Administrative

complexity. Increase work

load."

PT "Time. Challenging

coordinating

different

programs for availability

at same

times."

PT "Extra

time/effort needed to work with faculty from other departments to

plan

experiences. Difficulty scheduling

experiences

involving

students

from

more than

one

program."



183

OT "Scheduling."

OT "Politics, competition, steal ideas."

OT "Scheduling.

People being territorial. More interest on my part than on the

part

of

the other

person in another discipline."

OT "Lack of

time. Difficulty

coordinating schedules."

OT

"Lack

of time.

Lack

of

programs to alter schedules to include IPE

opportunities.

Lack

of support by some faculty."

PA

"Logistics."

PA

"At times, egos can

get

in the

way

of effective teams."

PA "Time

and

effort

(both

surmountable)."

PA

"Bad

attitudes

of

team

members."

attitudes of healthcare faculty toward interprofessional education and interprofessional healthcare...

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