Interprofessional collaboration in the ICU : facilitating progress in teams of learners

Abstract

Background: Looking across research on health care education, few studies have explored processes of collaboration in interprofessional teams of participants at an interprofessional training unit (ITU) in intensive care. In particular, little is known about the active and evolving interplay between supervisors guiding groups and the learners’ progress in becoming a team in their collaborative work in patient care.

The aim: Is to contribute to the understanding of the collaborative interplay in teams of learners and facilitative actions of supervisors in interprofessional activities at an ITU in intensive care. The inquiry targets the progress of residents and specialist nursing students’ participation in their collaborative interplay and the supervisors’ strategies to facilitate the team of learners to gain control in their interplay.

Methods: The thesis draws on qualitative data. Study I. Was a focused ethnographic study which aimed at exploring the collaboration in teams of learners during a rotation in an interprofessional education unit in intensive care from a sociocultural learning perspective. The interplay of eight teams of learners and supervisors (n=28) was explored and 100 hours of ethnographic observations, informal interviews, reflective sessions were analyzed through a constant comparative approach. Study II. A semi-structured interview study which described issues that facilitate collaboration in teams of learners at the same IPE unit. 19 participants were interviewed and the interview transcripts were subjected to a qualitative content analysis. Study III. Investigated support-seeking interplay in teams of learners during rounds. Observations, informal and semi-structured interviews, sound recordings of reflective sessions were reanalyzed and unused sound recordings of rounds were added. A framework approach was used to analyze material capturing the interplay among 46 participants. Study IV. Used the same material and method of analysis as study III to describe supervisors’ strategies for facilitating learners’ control in their collaborative interplay during interprofessional rounds at an ITU in intensive.

Results: The results capture diverse aspects of the learners’ collaborative interplay and the supervisors’ facilitative actions. Study I. Suggests that the learners’ collaboration progress in three main steps during the week. In particular, learners´ progress from groups of individuals to becoming teams and the supervisors guide the work of these teams, gradually step back as the teams take control of the clinical work. Study II. The team of learners being in control is at the core and motivation, time, experiences and reflection are critical issues for facilitating collaboration. Study III. Revealed important variations in the learners’ support seeking interplay during the round. In successful situations they explore, analyze, fill the interprofessional gaps by seeking confirmation, information and expertise and move on together as a team. Study IV. The supervisors’ strategies develop from being present and gradually understanding the challenges that the learners face in their interplay. Losing control forms a natural part of the process of becoming a team and supervisors encourage, confirm and challenge the learners to regain interprofessional control and move on together.

Conclusions: Learning and training how to collaborate successfully in intensive care involves a facilitated progress where more research is needed on suggested development and the long term benefits of training together in IPE settings.