A glimpse into nursing discursive behaviour in interprofessional online learning

Background: The importance of interprofessional learning to provide quality patient care has resulted in the increasing use of asynchronous computer mediated conferencing in healthcare programmes within universities. The asynchronicity based on typed-written discussions in a virtual learning environment which provided flexibility in learning was used to increase opportunities for nurses and other allied healthcare professionals to participate in interprofessional learning in higher education. However, successful online learning relies on discursive practices in the virtual learning environment, embedded within discursive exchanges in practice are power relations in nursing language use; which had a negative impact on interprofessional learning and working relationships amongst nurses, between nurses and other allied healthcare professionals. This paper presents an analysis of the discursive practices of registered nurses in interprofessional learning based on asynchronous computer mediated conferencing. It aimed to ascertain if power relations were implicit in nursing language. Methods: Fairclough’s critical discourse analysis was used to analyse eight hundred and ninety typewritten online messages created in a 100% text-based online learning module at Master’s level in a University in North England between September 2004 and September 2009. Although the messages were created by 9 registered nurses and 4 other allied healthcare professionals undertaking interprofessional learning to learn about the issues surrounding e-learning in healthcare settings, this paper is part of a larger study focused on the messages by the nurses. Results: Nurses’ messages tended to appear as the first few responses in the discussion threads and their language was formal and objectifying. The genres resembled those found either in written assignment within higher education or in nursing documentation within practice. The virtual learning environment was an alternative social space for clinical practice where dominance of nurses was created, maintained and reinforced. Conclusions: Existing literature highlighted the incidents of problematic issues of interprofessional learning. In contrast, this paper explains the way nurses, through discursive practices, construct themselves in relation to their nursing and allied healthcare colleagues. Nurses need to be aware of the power-relations embedded in their language use and future research could usefully focus on the discursive aspect of interprofessional learning

Nursing care behaviour in interprofessional learning explained by critical discourse analysis

Aim: to demonstrate Fairclough’s critical discourse analysis as a way to understand nurse caring behaviour in asynchronous text-based interprofessional online learning within higher education. Background: asynchronous text-based learning experience of homogeneous nursing groups indicated nurse caring behaviour in a small number of studies. However, positive findings were not found in studies about interprofessional learning undertaken by nurses. Instead, nurses’ dominance which might be a result of professional boundaries was frequently reported as a barrier to interprofessional education, yet little is understood about the phenomenon. Design: a study which employed Fairclough’s critical discourse analysis was used to understand the translation of nurse caring behaviour in text-based online interprofessional learning within higher education. Data Source: the asynchronous online discussions produced by thirteen students undertaking an online interprofessional learning module at master’s level in a University in the North of England were the discourse data for analysis. Findings: By using Fairclough’s critical discourse analysis, understanding of the semiotic categories corresponding to genres, discourses and styles yielded information on nurses’ discourse in online learning. Through appreciating the subliminal way in which these three categories relate to social practices and social events, the dialectical relations between semiosis of the online text and its other elements were made explicit. In doing so, the way nurse caring behaviour in interprofessional learning were translated in an asynchronous text-based learning environment was explained. Conclusions: Fairclough’s critical discourse analysis was useful in explaining how nurse caring attributes when displayed online could result in the interprofessional learning space being used as a platform for nurses and allied healthcare professionals to co-construct power-relations. The analysis required researchers’ tacit knowledge, based on an emic (insider) position in healthcare practice and education, which is closely linked to the power-relations that is entangled in the social order and practices in healthcare. This explains why researchers outside of critical discourse analytic work would hold a strong view for an etic (outsider) perspective in discourse analysis. In this regard, one should consider triangulating critical discourse methodology with other qualitative theoretical frameworks

Interprofessional Relations

Medicine may be defined as the science and art pertaining to the prevention, cure or alleviation of disease. These principles or objectives apply regardless of whether we are concerned with human medicine or veterinary medicine. Not only is it possible to merge these two professions in a common definition, but actually in a very practical sense these two medical sciences are so interrelated that to obtain a knowledge of one it is necessary either consciously or unconsciously to utilize important information that has accumulated in relation to the other

Critical discourse analysis : an alternative but vital route to understanding how nurses' caring behaviour is translated in text-based interprofessional online learning in higher education

Paper presented at ProPEL international conference 2014, 24-27 June, Stirling, Scotland. ABSTRACT Aim: to demonstrate Fairclough’s critical discourse analysis as an alternative but vital route to the understanding of translation of nursing caring behaviour in asynchronous text-based interprofessional online learning within higher education. Background: Positive asynchronous text-based online learning experience indicating nursing caring behaviours were reported in only a small number of studies about homogeneous nursing groups. In addition, these positive findings seemed to be eroded by nurses’ dominance in interprofessional learning situations. The dominance which might be a result of professional boundaries is a critical barrier to interprofessional education, where little is yet understood about the phenomenon. Design: A study which employed Fairclough’s critical discourse analysis was used to seek understanding of the translation of nursing caring behaviour in text-based interprofessional online learning within higher education. Data Source: The main findings based on Fairclough’s critical discourse analysis of a text-based discussion is used to demonstrate the usefulness of the methodology. The asynchronous online discussions for analysis was produced by 9 students who were undertaking an interprofessional online learning module at master’s level in a University in North England Findings: By using Fairclough’s critical discourse analysis, understanding of the semiotic categories corresponding to genres, discourses and styles is gained. However, it is through appreciating on how these 3 categories relate to social practices and social events has helped in making explicit the dialectical relations between semiosis and its other elements. In doing so, how nurses’ caring behaviours in interprofessional learning were translated in an asynchronous text-based learning environment can be explained. Conclusions: Fairclough’s critical discourse analysis was useful in explaining how nursing caring attributes could result in the interprofessional learning space being used as an alternate platform for nurses and allied healthcare professionals to co-construct the power-relations. It is critical to appreciate that the analysis was based on the researcher’s emic position. Owing to the fact that tacit knowledge of the research in the power-relations which entangled in the social order and practices in healthcare is required in the analysis, the strength of an emic position could become a limitation. This is particularly perceived amongst researchers who hold a strong view for an etic perspective in discourse analytic work. In this regard, research exploring issues of interprofessional education should consider triangulating the critical discourse methodology with other qualitative theoretical frameworks

Interprofessional Relationships in the Field of Obesity: Data from Canada

Background: While it is generally acknowledged that an interprofessional approach is necessary to treat and prevent obesity, there have been few empirical studies examining the working relationships of professionals in the obesity field.Methods: In this article social network analysis is used to examine the working relationships of 111 attendees, representing eleven different health professions, at the first National Obesity Summit in Canada. We assessed the extent of engagement in interprofessional relations across four activities: discussion, gathering information, providing care, and conducting research. We also examined attitudes toward interprofessional practice.Findings: On average, respondents reported that approximately 75% of the people they work with are from other professions. Attitudes toward interprofessional practice were generally positive, and did not vary significantly across professions. Interestingly, attitudes were not related to actual interprofessional relations in our sample. In terms of work type, we found that respondents who were engaged in both clinical and research work had the largest networks and had the highest percentage of interprofessional contacts in their discussion and research networks.Conclusions: Overall, the results suggest that within our sample of professionals working in the field of obesity, interprofessional practice is held in high regard as a concept. The results also suggest that members of professions that combine both research and clinical work are most likely to engage in interprofessional relationships. This article illustrates the utility of social network analysis to assess the extent of interprofessional relationships among those working in a particular healthcare field

Theorising interprofessional pedagogic evaluation: framework for evaluating the impact of interprofessional CPD on practice change

This paper outlines the development of a conceptual framework to guide the evaluation of the impact of the pedagogy employed in continuing professional development for professionals in education, health and social care. The work is developed as part of the Centre for Excellence in Teaching and Learning: Interprofessional Learning across the Public Sector (CETL: IPPS) at the University of Southampton. The paper briefly outlines the field for pedagogic research and comments on the underpinning theories that have so far been used to guide research into interprofessional learning (IPL). It maps out the development of interprofessional CPD in its specific context as part of the CETL: IPPS with its links to a local authority undergoing service reorganisation and the role of the continuing professional development (CPD) in effecting change. It then brings together a theoretical framework with the potential toexplore, explain and evaluate the essential features of the model of pedagogy used in interprofessional CPD, in which professionals from education have for the first time been included alongside those from health and social care. The framework draws upon elements of situated learning theory, Activity Theory and Dreier’s work (2002, 1999) on trajectories of participation, particularly Personal Action Potency. By combining the resulting analytic framework with an adapted version of an established evaluation model, a theoretically-driven, practicable evaluation matrix is developed. The matrix has potential use in evaluating the impact of pedagogic input on practice change. The paper models a process for developing a conceptual framework to steer pedagogic evaluation. Such a process and the resulting matrix may be of use to other researchers who are similarly developing pedagogic evaluation

What fosters or prevents interprofessional teamworking in primary and community care? A literature review

Background: The increase in prevalence of long-term conditions in Western societies, with the subsequent need for non-acute quality patient healthcare, has brought the issue of collaboration between health professionals to the fore. Within primary care, it has been suggested that multidisciplinary teamworking is essential to develop an integrated approach to promoting and maintaining the health of the population whilst improving service effectiveness. Although it is becoming widely accepted that no single discipline can provide complete care for patients with a long-term condition, in practice, interprofessional working is not always achieved. Objectives: This review aimed to explore the factors that inhibit or facilitate interprofessional teamworking in primary and community care settings, in order to inform development of multidisciplinary working at the turn of the century. Design: A comprehensive search of the literature was undertaken using a variety of approaches to identify appropriate literature for inclusion in the study. The selected articles used both qualitative and quantitative research methods. Findings: Following a thematic analysis of the literature, two main themes emerged that had an impact on interprofessional teamworking: team structure and team processes. Within these two themes, six categories were identified: team premises; team size and composition; organisational support; team meetings; clear goals and objectives; and audit. The complex nature of interprofessional teamworking in primary care meant that despite teamwork being an efficient and productive way of achieving goals and results, several barriers exist that hinder its potential from becoming fully exploited; implications and recommendations for practice are discussed. Conclusions: These findings can inform development of current best practice, although further research needs to be conducted into multidisciplinary teamworking at both the team and organisation level, to ensure that enhancement and maintenance of teamwork leads to an improved quality of healthcare provision. © 2007 Elsevier Ltd. All rights reserved

Interprofessional communication with hospitalist and consultant physicians in general internal medicine : a qualitative study

This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes

Benefits of interprofessional education in health care.

This article examines some of the literature regarding the benefits of interprofessional education (IPE) in the field of health care. These benefits in relation to service users (and carers), higher education institutions, service providers and students are all explored. Barriers to IPE are being broken down by many of the various stakeholders working towards a similar agenda. However, currently there remains some doubt as to whether IPE has a direct positive impact on the health gain of service users and carers. Research is needed to demonstrate if service users and carers benefit directly from IPE and if they do not, the reason for pursuing it needs to be questioned