What were the main factors that were considered as influences on attitudes?

Questionnaires provided data for statistical analysis, which was valuable in measuring influences on attitudes, such as professional background.

What did the authors find to be the significant effect of prior IPE experience on staff?

These studies highlighted that prior uncertainties, doubt and ambiguity related to the value of IPE for students, decreased once staff experienced IPE as a facilitator.

What is the effect of previous experience of IPE on staff attitudes to IPW?

These findings suggest that a greater sense of professional identity and professional culture as well as a lack of understanding of roles and responsibilties may influences attitudes to IPW and IPE.

What is the effect of previous experience of IPE on staff?

As qualified healthcare professionals, staff with experience of IPE in their pre-qualifying training felt more prepared for IPW and had increased self-awareness of positioning in a team, compared to those without prior IPE experience (Pollard & Miers, 2008).

What other variables were considered to influence attitudes to IPE?

The effects of othervariables such as professional experience, income, job satisfaction, gender on attitudes were considered briefly by some researchers.

What influences were considered as possible influences on attitudes?

The differences in attitudes between regions and locality of hospitals was also considered as a possible influence on attitudes, although researchers acknowledged that this relationship would need to be further explored (Jové et al., 2014).

What factors were considered in some of the studies?

Other possible influencing factors such as age, gender, professionalexperience and income were considered in some of the studies, although the strength of these correlations were varied and inconsistent.

(Open Access) Health and social care professionals' attitudes to interprofessional working and interprofessional education: A literature review. (2016) | Veronica O'Carroll

Health and social care professionals’ attitudes to interprofessional working

and interprofessional education: A literature review

Abstract

The healthcare setting is a rich learning environment for students to experience

interprofessional working (IPW) and interprofessional education (IPE). However,

opportunities for IPE are limited, and student experiences of effective IPW are

varied. This raises the question of how IPW and IPE are valued by health or social

care professionals. A search of the literature was carried out to identify studies of

health and social care staff attitudes to IPW and IPE. This review provides a

summary of the main factors found to influence attitudes and the strengths and

limitations of these studies. Professional background and prior IPE experience were

identified as the influencing factors for which there is most evidence. The main

limitations of the studies accessed included a focus on the value of IPE for staff, as

opposed to students, and a limited number of studies considering the relationship

between attitudes to IPW and the value placed on IPE. It is important that health

and social care professionals lead by example by working collaboratively and

providing students with opportunities for IPE. Identifying the variables influencing

attitudes to IPW and IPE may assist in improving IPW and experiences of IPE for

students learning in the healthcare setting.

Introduction

The integration of health and social care in the United Kingdom (Health and

Social Care Act, 2012) is one of the most recent drivers for effective interprofessional

working (IPW) and for providing students with opportunities for interprofessional

education (IPE; Barr & Low, 2013; General Medical Council, 2009; Health and Social

Care Professions Council, 2009; Nursing and Midwifery Council, 2010; World Health

Organisation, 2010). This integration combines the services of health boards and

local councils to reduce the numbers of unecessary admissions to hospitals by

providing a more coordinated, cost effective approach to the provision of quality

health and social care. Integration has implications for the way that health and social

care teams collaborate and effective IPW is key to its success (Association of the

Directors of Social Work, 2013).

Although further high quality research is required to support the impact of IPE

and IPW on patient care (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013;

Zwarenstein, Goldman, & Reeves, 2009), previous inquiries have highlighted the

impact that ineffective IPW can have on patient safety (Kennedy, 2001; Laming,

2003). Twelve years after the Bristol Infirmary Heart Inquiry (Kennedy, 2001), the

Mid Staffordshire Report (Francis, 2013) highlighted that little progress had been

made in changing the damaging, target driven culture of the health service. Francis

(2013) recommended that this culture needed to change to put the patient first.

Time pressures, limited resources, lack of understanding of roles and

responsibilities, competing priorities, and access to other professionals prevent

effective IPW between professional groups (Bailey, Jones, & Way, 2006; Braithwaite

et al., 2012; Hughes & McCann, 2003; Kvarnström, 2008; Larkin & Callaghan, 2005;

Snelgrove & Hughes, 2000). Healthcare teams are capable of improvising and

developing strategies to work around such barriers (Baxter & Brumfit, 2008; Lingard

et al., 2012). However, ineffective IPW continues to affect the quality of care

provided by health and social care teams (Laming, 2003).

As part of the practice placement agreements between health boards and

higher education institutes, health and social care students spend a proportion of

time learning within healthcare settings. Francis (2013) highlighted how vital it is that

students are exposed to positive experiences in these settings:

“Good practical training should only be given where there is good clinical care.

Absence of care to that standard will mean that training is deficient. Therefore,

there is an inextricable link between the two that no organisation responsible

for the provision, supervision or regulation of education can properly ignore”

(p.60).

Effective IPW is essential for maintaining quality care and improving

patient safety (Francis, 2013; Gordon, 2012; Laming, 2003; The Joint Commission,

2013). The healthcare setting can be an invaluable opportunity to learn with students

from other professions and to gain first-hand experience of how health and social

care teams work (O’Carroll, Braid, Ker, & Jackson 2012; O’Carroll, Smith, Collinson,

Jackson, & Ker, 2013). However, opportunities for IPE and students’

experiences of IPW within the healthcare setting can be varied and limited (Pollard,

Miers, & Rickaby, 2012; Stew, 2005). The logistical difficulties of coordinating

student timetables, negative attitudes and uncertainty of the value of IPE have been

identified as reasons why support for IPE within the academic setting falters (Curran,

Sharpe & Forristall, 2007; Freeth, Hammick, Reeves, Koppel, & Barr, 2005; Rees &

Johnson, 2007). These are challenges that have been identified within the

academic setting, but it is possible that similar ambivalent attitudes exist with the

healthcare setting.

The relationship between attitudes and behaviour is considered within the

field of social psychology (Azjen & Fishbein,1977; Bem, 1970; Festinger, 1957).

Kraus (1995) argued that there is significant evidence that attitudes can predict

behaviour. It can be argued that investigating the attitudes of health and social care

teams to IPW and IPE, may provide an understanding of the value that is placed on

IPW and IPE for students learning in healthcare settings. It is important that these

issues are studied directly, within a relevant context, and from the perspective of

staff working within these settings. This literature review provides a summary and

critique of the existing literature related to two main constructs:

• The attitudes of health and social care professionals, working in healthcare

settings, to IPW

• The attitudes of health and social care professionals, working in healthcare

settings, to IPE for students

Methods

A systematic search was carried out using The Cochrane Database of

Systematic Reviews, Education Resources Information Centre (ERIC), MEDLINE,

and the Cumulative Index to Nursing and Allied Health Literature (CINAHL).

Relevant papers were also identified from a hand search of the Journal of

Interprofessional Care and by interrogating references from relevant papers. As the

turn of century was a significant turning point for IPE and IPW (Barr, Helme &

D’Avray, 2011), the search focused on literature published between 2000 and 2014 .

Table 1 provides a summary of the search strategy, including the inclusion and

exclusion criteria. The terms ‘interprofessional,’ ‘multidisciplinary,’ and

‘interdisciplinary’ were used in combination with the following key words; learning,

education, working, collaboration, attitudes, staff and healthcare. Boolean operators

and truncations were used to allow for variability of terms adopted in the literature.

Table 1. Summary of search strategy

Figure 1 reports on the number of studies included and excluded at different

phases of the literature search. On initial identification and screening of titles and

abstracts, 59 papers met the inclusion criteria. Thirty five studies were selected after

excluding the following: studies within the context of an academic setting; student

attitudes to IPW and IPE; and the attitudes of only one professional group.

Inclusion criteria

Exclusion criteria

Studies measuring and comparing health and

social work staff attitudes within hospital and

community healthcare environment to IPE and

IPW

Studies using quantitative, qualitative or mixed

methods

Year 2000 to 2014

Published in peer reviewed journals

Studies written in the English language

Students’ attitudes (only) to IPE and

IPW

Academic staff attitudes (only) to IPE

and IPW

Studies exploring the attitudes of only

one professional group

Editorials

Descriptive articles

Opinion pieces

Search terms Key words