Indiana University-Purdue University Indianapolis (IUPUI) / Intraoperative adverse events (IAEs) due to interprofessional miscommunication continue to occur despite implementation of surgical checklists and focused communication trainings. Much of the previous intraoperative communication research has focused on the content and quantity of interprofessional communication instead of its context and quality, and current communication interventions seem to have varying levels of engagement, effectiveness, and persistence. The purpose of this dissertation study was to explore the psychosocial processes involved during the establishment and maintenance of interprofessional communication surrounding IAEs or potential IAEs in the intraoperative environment and to identify the perceived facilitators and barriers to communication. Twenty surgical team members participated in semi-structured interviews and described their experiences with interprofessional communication during IAEs. Grounded theory methodology was used to identify the central process, Testing the Water, and two subprocesses, Reading the Room and Navigating Hierarchy. Testing the Water describes the situational nature of interprofessional communication as surgical team members navigate factors influencing the context and probable trajectories of surgical cases and the perceptions of professional rights and responsibilities within surgical teams. Participants in this study experienced Testing the Water differently based on their professional roles and tenure; findings were organized around three emerging groups identified as inexperienced nurses, experienced nurses, and surgeons. Interprofessional communication surrounding IAEs occurred for study participants in fluid, iterative phases identified as 1) Recognition, 2) Reconnaissance, 3) Rallying, 4) Reaction, and 5) Resolution. Participants recognized IAEs or potential IAEs, gathered information through reconnaissance, rallied other team members, reacted to stabilize patients, and resolved IAEs through individual or surgical team reflection. Study participants reported using strategies during communication to accomplish two psychosocial goals, preserving the flow of surgical cases, and protecting the ‘face’ of themselves and other surgical team members. Supporting these psychosocial goals through increased psychological safety for all surgical team members potentially leads to more effective, timely surgical team communication. More effective interprofessional communication facilitates the improved situational awareness, collective sensemaking, and integrated team mental models that are critical to coordinated responses to IAEs. The findings of this study suggest practical implications to increase the effectiveness of interprofessional communication in the intraoperative environment.

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<p><strong>Background. </strong>Interprofessional collaboration is a cogent strategy to promote retention and safe, quality nursing care among new graduate nurses. This sandwich thesis describes a research project undertaken to understand how new graduate nurses engage in interprofessional collaboration.</p> <p><strong>Objective. </strong>The aim was to comprehensively understand the individual, team, and organizational factors that influence new graduate nurse engagement in interprofessional collaboration.</p> <p><strong>Methods. </strong>An integrative review of the new graduate nurse literature was conducted within the context of interprofessional collaboration. Applying the Structuration Model of Interprofessional Collaboration as a framework, a mixed methods study examined the team and organizational predictors of new graduate nurse engagement in interprofessional collaboration, and explored factors that influenced confidence among new graduate nurses toward interprofessional collaboration. Quantitative data were collected via mailed surveys. Follow-up interviews were conducted to explain the quantitative findings.</p> <p><strong>Results. </strong>The integrative review revealed individual, team, and organizational factors that were reported to influence new graduate nurse engagement in interprofessional collaboration. The review concluded a gap in the current knowledge of the issue, and literature that was weak to moderate in quality. The team and organizational predictors of new graduate nurse engagement in interprofessional collaboration were: satisfaction with the team, number of team strategies, participation in a mentorship or preceptorship experience, accessibility of manager, and accessibility and proximity of educator or professional practice leader. The interviews revealed respect, team support, and face-to-face interprofessional interactions as team facilitators. Supportive leadership and preceptorship or mentorships were organizational facilitators. Several variables had a relationship with new graduate nurse confidence in interprofessional collaboration. A model that explains this confidence was developed from the qualitative findings.</p> <p><strong>Conclusion. </strong>The Structuration Model of Interprofessional Collaboration was a valuable</p> <p>framework for understanding the structural elements of new graduate nurse engagement in interprofessional collaboration. This thesis identifies implications for education, practice and research.</p> / Doctor of Philosophy (PhD)

Introduction and Background: Interprofessional education (IPE) is outlined in many health professions education standards creating an increased demand for its inclusion in already crowded curricula with limited faculty and financial resources. The Interprofessional Education Collaborative (IPEC) developed “Core Competencies for Interprofessional Collaborative Practice” that outline a framework for meaningful IPE experiences. Case-based learning activities have been used to foster improvements in interprofessional role clarity, communication, and rapport among student groups. The authors describe one trial of incorporating interprofessional and team work activities in a shared professional course and report on student learning outcomes in the context of IPEC competencies. Course Design: In an existing shared professional course, athletic training (AT) and physical therapy (PT) students were exposed to an interprofessional teaching team and engaged in team work activities during lab sessions. Students were also assigned to interprofessional (IP) and uniprofessional (UP) teams to complete four case-based learning activities regarding the application of therapeutic modalities in various patient cases. Students then wrote critical reflections of their experiences working in teams. Instructors evaluated these reflections in the context of eight relevant IPEC sub-competencies. Outcomes: Both IP and UP groups of students were able to articulate the demonstration of each of the eight IPEC sub-competencies, suggesting that incorporating a variety of interprofessional and team work activities in a shared professional course may offer a valuable IPE experience that promotes development of students’ collaboration skills. Discussion and Conclusion: Embedding IPE in existing curricula could be a viable way to overcome many of the challenges faced by health professions programs, meet IPE accreditation standards, and prepare students for interprofessional collaborative practice.

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Teamwork is essential to provide quality services to individuals with disabilities (Morrison & Gleddie, 2019). Deficits across a variety of domains make interprofessional practice even more crucial (Dobbs-Oates & Morris, 2016). Interprofessional education (IPE) provides preprofessionals the opportunity to gain experience collaborating with various disciplines, better preparing them for interprofessional practice (Anderson et al., 2011; Ruebling, et al., 2014). Most IPE research has been completed with preprofessionals engaged in medical cases. The existing evidence for IPE in school-based settings is limited, which creates a gap for speech-language pathologists (SLPs) who are pursuing work in school-based settings. The first purpose of this study was to examine the perceptions and attitudes of participants following an IPE experience of a medical case with both quantitative and qualitative data. The second purpose of this study was to determine if a case could be adapted to a school-based setting. Seventy-one participants completed a survey following an IPE experience with eight later participating in a focus group. Preprofessionals self-reported interprofessional learning from the experience and recognized the importance of team interactions. The IPE experience was successfully adapted to a school-based case and in an initial program evaluation, perception of teamwork and interactions were also important. In both settings, preprofessionals rated themselves as having less bias towards others than others have towards their own disciplines. This study provides essential information regarding IPE for school-based settings that will ultimately benefit children with disabilities by encouraging interprofessional practice.

Occupational therapy (OT) and applied behavior analysis (ABA) practitioners often collaborate when working with children and young adults with disabilities (McGinnis, 2013). OT and ABA practitioners are primed to collaborate due to many areas of overlap among each respective scope of practice; however, there is limited research to guide best practice for this collaborative partnership (Welch & Polatajko, 2016). According to a review of OT and ABA literature, in addition to the literature of other community-based, social services, and health care professions, there are four major barriers to interprofessional collaboration (IPC): (1) biases, (2) differing cultures, values, and professional languages, (3) overlaps in scopes of practice, and (4) poor communication and relationship-building skills (Kim et al., 2016; Peck & Norman, 1999; Rice et al., 2010). Due to a limited amount of accessible OT and ABA training interventions on collaboration, there is a need for an online, interactive, educational training to present evidence-based and theoretically-sound solutions for the barriers to collaboration. The proposed program is called Supporting Interprofessional Partnerships: An Educational Training for Collaboration Between Occupational Therapy and Applied Behavior Analysis Practitioners. The program’s educational content targets: (1) the definition, benefits, and barriers to IPC, (2) context-based information on ABA’s culture, values, professional language, and scope of practice, and (3) strategies to improve collaboration with ABA providers. Supporting Interprofessional Partnerships explores the working relationship between OT and ABA to improve collaboration as well as client, family, provider, and organizational outcomes.

INTRODUCTION: Interprofessional education (IPE) is the organized integration of health care disciplines. IPE provides an environment for students and faculty from multiple disciplines to learn collaboration and communication skills for future clinical practice. In the 1970s, United States health institutions began focusing on team-based health care and IPE. IPE was viewed as a solution to the growing burden of health care costs and the increasing ratio of diseases to available resources. IPE was formed around four competencies--Ethics, Communication, Teamwork, and Roles and Responsibilities--to provide students with the necessary tools to work efficiently in health care teams upon entering the workforce. FOCUS AND GOALS: USF Health currently has five major pre-professional disciplines on its campus--medicine, physical therapy, pharmacy, nursing, and public health. An IPE initiative began in 2010 in order to eventually integrate portions of all disciplines and their curricula. The central question of this thesis is, "Has there been a change within the student and faculty populations of USF Health in terms of IPE awareness and opinion since before the IPE initiative began in 2010?" This thesis aims to evaluate the changes in both student and faculty perspectives across several health disciplines at USF Health when compared to previously recorded perspectives from 2010. This information will be recorded to provide a guide for improving the current IPE initiative at USF Health. METHODS: Using data from a 2010 survey, the researchers created an updated survey and released it to the students and faculty of all five disciplines. The results provided a comparison for the original 2010 data. A general literature review was used to supplement the collected survey results and guide the analysis and discussion of data. Results: The qualitative data from the original student (n=29) and faculty (n=58) surveys was quantified and compared against the data from the updated student (n=83) and faculty (n=16) surveys. Several consistent themes were found in responses from selected questions. The following themes were found within the literature: student and faculty perspectives of IPE, barriers and opportunities to IPE, and implementation methods. CONCLUSION: The study found that changes in opinion occurred between both student and faculty participants. Both students and faculty showed an increase in IPE awareness and alluded to several barriers that were also found within the literature. This study will serve as a continued method of evaluating IPE at USF health in order to maintain a continued improvement of IPE implementation amongst all colleges. LIMITATIONS: The initial student data set was significantly smaller than the new student data set and represented a different distribution of disciplines. This may account for some of the changes observed between both groups and should be considered in any future analysis of this data. Because the data presented in this thesis project is a preliminary sample of the future, complete survey results, a follow-up analysis of the complete data will be required to draw any comprehensive conclusions from this study.

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