Nursing - Research Proposal Example

Interprofessional Learning between Nurses and Doctors and its Pertinence in Clinical Practice: A Qualitative Research Abstract Competence in practice for nurses and doctors are now prescribed to be occurring as a result of interprofessional and collaborative practice in the clinical area. Literature suggests collaborative education provides better learning, but collaboration is a matter to learn. This learning can be initiated while doctors and nurses are both students in the clinical area, but research involving interprofessional learning for both nurse and doctor students is lacking. By questionnaire survey method developed by focus group analysis and pilot studies, groups of doctor students and nurse students will be trained in the clinical area, and at the end of the training, questionnaires will be responded by them. The responses will be analysed to examine the hypothesis, and if proved, this would serve as the future model for further research. Introduction: Active orientation and professional development while in service for nurses is a critical element of a delivery system that sets up high standards for quality of care delivery. Professional nurses are in the scenario of continuous learning, and therefore, they are responsible for their own continuing education. This generates personal and professional growths to the nurse and is a known incentive for persuasion of a higher academic degree. Continuing education is supposed to build on acquired knowledge, attitudes, and skills, where the nurse as a professional would be lifelong learners. Lifelong learning is essential to career development and competency achievement in nursing practice that builds on the scientific base for academic learning in nursing. This consists of competencies, attitude development, eye for evidence, and over all, biomedical knowledge. Additional competencies in collaboration, coordination, interdisciplinary and interprofessional practice activities also serve as media of exchanging knowledge and techniques, and these are critical to modern day health care delivery by the nurses as opposed to single, discipline-specific method of educating the nurses (Mathews, MB., 2003). Therefore, this framework if validated may raise the possibility of alternative learning method in nursing education. The strategies for teaching and learning then would involve educational teaming and exchange between different disciplines and other health professionals in similar categories. Theoretically, this format is expected to provide greater access to professional, interprofessional, and eventually education that entails competency in multiple areas. Obviously, the question arises, why interprofessional learning and education. Medical interventions are diverse, vast, and the health problems are becoming increasingly complex leading to a situation that needs continuous up-gradation and revision of educations (Johnson, AW. et al, 2006). These challenges can be solved, as has been suggested by the theorists, by interprofessional learning based on collaboration, team work, and learning together. Consequently, interprofessional learning can be defined as an educational approach which occurs in the form of exchanges between two professions or disciplines that interact in order to foster interactions leading to learning collaborations. An example would make things clear. A nursing student's academic learning for nursing activities and a medical student's academic learning, although based in the same area, revolves around different aspects of the medical science. If the students from both these professions are allowed to collaborate on the learning of clinical aspects of the disease and development of clinical skills related to that, both can gain learning and better understanding of the subject, although this process must be based on mutual understanding and respect for the actual and potential contributions of the disciplines (Furber, C. et al., 2004). Most effective healthcare is possible only through collaboration and teamwork. If this is the case, interactive learning between learners from different professions would strengthen that collaboration, and this could create an opportunity to examine each other's roles in collaborative practice, and if collaborative interdisciplinary practice is the future of medicine and healthcare, implementation of such educative procedures in preregistration programme in any discipline can be of value for post-registration practices. Literature also highlights the importance of separate professionally unique learning of the professionals and stresses that in preregistration programmes, collaborative interprofessional learning can be a part of the whole learning schedule (Ponzer, S. et al., 2004). It is an established fact that registered nurses and doctors collaborate well in the practice, and that is an essential requirement for competent and effective clinical practice. They often react to the interprofessional education experiences in a very positive manner. Questionnaires designed to assess such experiences have revealed that it produces highly rated educational experiences and high-grade learner satisfaction. Over and above that, the learners enjoy the interprofessional experiences. Adult learning theories suggest that positive learner reactions are crucial for a positive learning outcome. The nurses and doctors when collaborate in the real environment of the clinical practice area, can respond to the demands related to interprofessional collaboration when attempting to organize and deliver medical care to a group of patients (Barnsteiner, JH., Disch, JM., Hall, L., Mayer, D., and Moore, SM., 2007). In reality, such practices and learning environments are rare between the student nurses and student doctors. If doctors and nurses can engage themselves in interprofessional learning, the student nurses and student doctors can also collaborate based on the identical principles of interprofessional learning to produce better outcomes in education. While the literature is voluminous on different facets of benefits of interdisciplinary and interprofessional collaborations between the nurses and doctors in the clinical practice, despite the positive outcomes being known, curricula does not permit extensive use of such a tool among the students of different professions related to healthcare. Consequently, there is a perceived need for research in this area that involves preregistration training programmes in the clinical area in order to examine the benefits of such a programme in terms of learner satisfaction that is the single most dependent indicator of learning and education, when professional learning and education are most important determinants of competence in practice (Kyrkjebo, JM., Brattebo, G., and Smith-Strom, H., 2006). Aims and Objectives: 1. To examine learner satisfaction and ratings of learning and education of student nurses and doctors in an interprofessional environment that simulates near-reality clinical environment of the future practice. 2. To discern the factors that promote interprofessional learning in the clinical area of student nurses and student doctors. 3. To examine the hypothesis that despite barriers, promoting interprofessional learning in clinical practice between student nurses and student doctors can offer better patient benefit, more competent care, and more efficient professionals for the future generation of nurses and doctors who will work on the principles of interprofessional collaborative care. Literature Review: Literature suggests four philosophical principles of interprofessional learning. The first point is the inter-relationships among various professional groups. This deals with the values, attitudes, and beliefs of one towards the other. Each professional involved would have their professional identities based on the beliefs about the other profession, prejudices, and stereotypes. While interacting, each participating profession would come to know about the knowledge of the other professionals. The second concept is that interprofessional education is based on the principles of collaboration and teamwork. To engage in collaborative learning successfully, each profession must possess skills and knowledge needed to implement and engage in the collaborative learning. For designing a holistic care to address the problems of the clients, the collaborators must understand what they actually do or what roles they play in the provision of such care, and collaboration occurs through coordination of these roles through teamwork. The outcomes of such an exercise are translated into benefits to the patients, but this also includes benefits to the professional practice and personal growth as a result of this experience. This can serve as a framework for such learning, and practically in the literature, there is evidence that consideration of this paradigm can assess the readiness of the students. Assessment of that readiness for shared learning had been done by Horsburgh and coworkers through a scale, named as readiness for interprofessional learning scale (RIPLS). Interestingly, this scale describes the attitude of the medical, nursing, and pharmacy students to shared learning to be positive. This scale assessed their competence in teamwork and examined if collaboration is important for holistic care (Horsburgh, M., Lamdin, R., and Williamson, E., 2001). Ker et al in 2003 performed a study in a simulated ward environment for second year medical and nursing students in Dundee, where students were placed in a simulated clinical environment where interprofessional experience was arranged for. The clinical situation was briefed; the students were divided into interprofessional teams to take responsibilities for the ward for a shift. The students' experiences were examined by questionnaires, and analysis of the data indicated that the students enjoyed working together, and they felt that the clinical scenario provided a sufficiently realistic environment to help them learn about the demands related to interprofessional collaboration. Although this study found out positive findings, there are many other studies done in this aspect of interprofessional learning based on reaction of the learners. Some had negative reactions reported, some had mixed positive and negative reactions, some neutral. Therefore learner reactions to interprofessional learning in a simulated environment are not conclusively positive. Although there may be several other factors than the perceived benefits in terms of learning and professional development, involved in generating a positive experience in this type of exercises, these factors remain to be elucidated by further research in this area (Ker, J., Mole, L., and Bradley, P., 2003). Literature reveals interprofessional learning is targeted at providing patient or client centered care from a variety of professionals in order to maximise patient outcomes in a holistic manner. This derives from the fact that most health problems are multidimensional in nature, and they often encompass economic, social, spiritual, and biomedical consequences with multilayered scientific and technical dimensions, difficult to achieve by a single discipline or a learner alone. It is not feasible for any one professional, irrespective of the quality of his/her education and training to cater for all of these dimensions. In the United Kingdom, the concept of interprofessional learning is an old concept, and that has permeated into the learning infrastructures and knowledge frameworks for over a prolonged period of time, and it is now a firm and established understanding that interprofessional collaborative learning in the preregistration education has the potential to facilitate interprofessional collaborative practice in healthcare in order to reduce fragmentation that would ultimately result in improvement in patient outcomes (Watts, F., Lindqvist, S., Pearce, S., Drachler, M., and Richardson, B., 2007). Perhaps the strongest evidence from literature in support of interprofessional learning has been sought from World Health Organization. For Health for All in 2000, the WHO published a document in 1988, interprofessional learning had been referred to as the key initiative to achieve such goals. This report called for collaboration and teamwork amongst health professionals in primary, secondary, and rehabilitative care settings with the premise that learning together would foster and enhance working together (WHO, 1988, Health for All in 2000). Many studies have reported changes in attitudes or perceptions towards another profession or towards interprofessional collaboration. These studies have also assessed outcomes of interprofessional learning by the use of questionnaires. The attitudes of the participants to other professional groups, teamwork, and towards working with other professions in different studies have been reported. The attitudes were likewise inconclusive, having been a mixture of positive, negative, and neutral with no changes in attitudes with most of the studies reporting changes in the respective collaborative skills and knowledge and development of teamwork skills. The last one could be attributed to be the best outcome parameter, since most studies reported these to be positive outcomes of interprofessional collaborative learning (Freeth, D. et al, 2001). Jackson and Bircher in 2002 reported a study where the use of the European Foundation Quality Management EFQM excellence model of quality assurance provided the foundation for an interprofessional initiative that aimed to enhance the delivery of care to the patients of a general practice near Salford. Using EFQM model, an external facilitator worked with the team members of a disorganized primary care team, both individually and collectively to identify their current challenges and to develop an implementation plan to resolve them. The findings of this collaboration points to a number of benefits in patient care in terms of more targeted health promotion advice to the patients, a reduction of blood pressure for patients with chronic heart disease, higher proportion of older patients receiving the influenza vaccine, reduce waiting times for prescribed drugs, and a reduction in patient waiting times to see a doctor or a nurse at the practice (Jackson, S. and Bircher, R., 2002). Therefore, generally there is an agreement in the literature that the benefits of interprofessional learning include increasing the understanding of each profession's expectations, roles, and responsibilities, gaining knowledge and skills that are appropriate to the workplace, the exploration of various strategies to enhance collaboration and team work, and improved communication within and between professional groups. Research and evaluation of interprofessional learning has focused mainly on changes in attitudes, knowledge and skills, rather than impact on the quality of patient care and health outcomes. The first focus that has been emphasised most often in prequalification interprofessional education, is mainly limited to building the process in order to create a foundation of future practice. Therefore the goals or aims would be different than those in reality in the future practice life. The goal of interprofessional education is to acquire common and comparative knowledge bases for collaborative practice at present or in the future involving a common understanding of the social context of the practice, the organization, policies, and their applications. Collaborative interprofessional learning introduces learning through comparative and healthily competitive means. This as expected would enable the participant professionals to probe into the reciprocal understanding of the roles, responsibilities, and relationships; joys and sorrows; benefits and deliverables in the respective working worlds. This understanding is required for future practice life in each participating professionals. It creates an opportunity create interrelationship between professionals and provides an avenue to subjectively examine the anxieties, tensions, and rivalries played out in relationship between professionals (McKinlay, E and Pullon, S., 2007). Comparative learning can expose positive and mutually supportive attitudes towards each other. On the other hand, it has the probability to ignorant, prejudiced, stereotypical about the others. These are barriers to interprofessional educations, and appropriate measures to rectify such attitudes can overcome the impedance to interprofessional education and hence interprofessional collaborative practice. World Health Organization proclaims that interprofessional education is the key area of health professional development. The opponents argue that there has been a tradition of training health professionals in isolation, and this method reinforces autonomous and separate roles and decision making. The proponents argue, on the other hand, that health professionals should be educated to deliver patient-centred care as a member of the interdisciplinary team. Hilton and Morris support this proposition and confirm on the basis of their study that the clinical setting is the idea learning environment for collaborative interprofessional learning skills. Central to the success of interprofessional learning seems to be the issue of timing, that is, how early in the professional education process, interprofessional learning may occur. Some authors suggest that it should take place within the first two years of professional training before the stereotypes can develop about other professional groups, stereotypes having been long known as the greatest hindrance to interprofessional learning (Hilton, R. and Morris, J., 2001). Research Need: With a paucity of studies in the area of interprofessional learning between nursing students and student doctors, while the literature supports the rationale of interprofessional learning early on in the professional education, there is a strong need for research at least to throw some light on this area so further research can be carried out in order to form a policy. If the hypothesis in this research proves to be correct, it can as well serve as the nidus on which further truth about this can be exposed by other workers. Research Question: Does interprofessional education create learner satisfaction when applied to the preregistration nurses and doctors' Methodology: This design here is a quasi-experimental design where the approach is to provide a quantitative significance to the qualitative data. There are certain distinct benefits, such as, generating meaning out of quantitative data, and it also enables the researcher to better understand the characteristics of the sample. The use of numbers can help documentation and confirm conclusions. The reader is assured that the assertions in the study are valid. This can also address some of the major pitfalls in a purely qualitative study, and data can represent important features of the sample (Christensen, L. M., 1991). Pilot Interprofessional Education Event: A pilot interprofessional education event will be designed. Depending on availability of rooms and time of both the groups, the timing of the learning session will be adjusted accordingly. The first session of formal curricula will be optional, and this session will not be substituted. The format for the pilot session will include a lead lecture from a lecturer who shares the philosophy of interprofessional learning, small group work on different case scenarios in the clinical area and labour and delivery, and a nurse and medical student feedback from each of the groups (Montgomery, D. C., 2000). To evaluate the effectiveness of this event from the perspective of interprofessional learning, pre and post session questionnaires will be distributed among the participants. The group work will be observed by an obstetrician and a nurse preceptor, and both of them will be joining the research group for this purpose. The results of the questionnaires will be analysed. If they demonstrate evidence that the students see a value in working small interprofessional teams and perceive that it will improve working relationships, then the pilot study supports the worth of carrying out the research. The process and outcome of this pilot event will be recorded, and after discussion with the appropriate authority, will be implemented weekly once in the curriculum as a compulsory part for both the student groups during the whole duration of their placement in Obstetrics and Gynaecology. Pilot studies are excellent means to know a rough estimate of the effect size. Since population effect size is never known, available evidence from pilot studies can be used to study whether the actual study would be feasible or not (Hall, P et al., 2006). Interprofessional Learning Module: Following the pilot study, different educational strategies will be tested, and resources and practical issues will be solved. This will lead to a course module as the most effective interprofessional learning strategy for medical and nursing students. Both the groups will be made familiar with structured clinical examination, but not in the interprofessional learning format. This will follow an interactive teaching session. The students will be divided randomly into teams of about 8 students, ensuring an equal mix of nursing and medical students chosen randomly. During instructions, the instructor will spend time on team building. An ice-breaking exercise in the beginning of session, interactive workshops, participation in discussion groups, all will be designed to promote teamwork. In the afternoon, each team will spend 20 minutes at each of the five stations where case scenarios of intrapartum events will be presented for learning. In each of these stations, facilitators will be present. All members of each team will participate at each station and will engage themselves in role play, practical skills, and problem solving. After this action, the facilitator at each station will provide feedback on performances as groups, not as an individual (Goelen, G., Clercq, G De, Huyghens, L., and Kerckhofs, E., 2006). Data Collections and Measures: A great deal of studies in this area has used surveys, interviews, or questionnaire to determine the learner reaction and attitudes in collaborative learning. Although personal interviews are one of the best means to collect authentic information, it needs face to face meeting and interviewer training that are both time consuming and costly. They yield high-quality information, but in the context of this study this appeared not to be feasible. Questionnaires are self-administered, since the respondents read the questions in a written form, and need to answer in writing. It is important to take great care to frame the questions, since respondents are expected to differ in their reading levels and in their ability to communicate in writing (Cook, T. D., & Campbell, D. T., 1979). The wording of the questionnaire needs to be clear, simple, and unambiguous. This would be a data collection tool where a structured questionnaire would be used. These would consist of a fixed set of questions that are needed to be answered in a specified sequence and with predesignated response options with limited opportunities for the participants to express their comments. Self-report questionnaire has been used by researchers who are interested in qualitative data, and a structured self-report questionnaire tool can provide answers to a specific set of questions. The item scores from this instrument will be dichotomized so that the two most positive response alternatives on the point scales will be coded as a positive score. Similar assignment will be made for three most positive responses on the 10-grade scales. Differences between professions will be tested for statistical significance by Pearson's chi-squared test. There is a possibility of differential effects of the set of explanatory variables. To study this possibility, a set of regression analysis linking satisfaction of learning with interprofessional collaboration to each of the work environment variables classified. If the dependent variable is strongly skewed, it will be dichotomized, and the value 1 representing the two most satisfied response alternatives on the five-point scale and analysed by binary logistic regression. Explanatory variables will not be dichotomized. To test whether effects were different for doctor and nurse students, interaction variables will be entered and inspected for statistical significance (Kempthorne, O., 1961). Where interaction variables were borderline significant, the significance of the difference in the -2LL goodness of fit values for the models with or without the interaction term will be checked. All statistical analysis will be done by SPSS 16 for Windows. Lastly in the questionnaire, an opinion poll of the participants about possible factors facilitating education or hindering interprofessional education will be listed, and they will be analyzed and weightage given according to evidence in literature. After data are collected, a few preliminary activities must be performed before data analysis begins. For instance, it is normally necessary to look through questionnaires to determine if they are usable. The data themselves do not provide answers to research questions. Data need to be processed and analyzed in an orderly, coherent fashion (Aiken, L. R., & Aiken, L. A., 1996). Quantitative information is usually analyzed through statistical procedures. The underlying logic of statistical tests is relatively easy to grasp, and computers have eliminated the need for detailed mathematic operations. Sample: Considering the scenario, a convenience sampling would be the most ideal sampling method for this study. For sampling plan, it is important to remember that a sample in contrast to the greater number of candidates in the population decreases the likelihood of nonsampling errors such as measurement errors, nonresponse biases, and recording errors. In this study, it is evident that a convenience sampling would be used depending on the available number of candidates, since there is no option to exclude based on any criteria. Those who did not fit the inclusion criteria were only excluded, and any professional student nurse or doctor that participated in the programme was included (Evaneshko, V., 1985). Most researchers think of sampling as important for accurately representing the population in descriptive terms, that is, external validity or generalization. Sampling, however, also is concerned with the relationships found. Therefore, sampling errors or biases may threaten internal validity as well. Experience questionnaires for survey will be designed, and at the end of a 10-week period, each participant will be requested to answer the questionnaires. The total number of participants will be 40 doctor students and 40 nursing students who will be placed in the Obstetrics and Gynaecology Department in the hospital where this researcher is posted. After explanation of the study and its intents, both verbal and written consent will be collected before the project will begin. There will be no coercion to participate, and any participant can withdraw at free will without fear of any discrimination. Although the identity of each of the participant will remain undisclosed, names and addresses of the participants were filled up by themselves. In the data file will not include personal identification. Convenience samples, or nonprobability samples, are frequently used in nursing research. However, it is not possible to estimate sampling errors with such samples. Therefore, the validity of inferences drawn from nonprobability samples to the population remains unknown. Moreover, whenever nonrandom selection is used, the potential for serious sample selection biases exists. It is well-known that sample selection bias may threaten internal as well as external validity (Strauss, A., & Corbin, J., 1990). Ethical Clearance: Ethical clearance will be obtained from the ethical review board and the local authority of the hospital after submission of this proposal and questionnaire. All participants including the student doctors, student nurses, lecturers, observers, and facilitators will be explained the aim and utility of the study, and temporary modification of the curriculum will receive clearance from the appropriate university and NHS authority. The interprofessional learning sessions will be open to the observers from the ethical committee and review board, University, and NHS. Ethical issues of the participants will be addressed in a manner that has been described above. The conduct of research with humans imposes strong moral obligations on nurse researchers. In addition, subjects' comprehension of information about the study and the informed consent process should be ascertained initially and throughout the study as indicated. The participants can stop participating at any point based on principles of autonomy. The ethical conduct of research also focuses on the ethical principles of doing no harm (Munhall, P. L., 2001). Timing of Inclusion: The intrapartum scenarios have been identified by the students as learning scenarios. On a short obstetrics attachment, the early stage nursing students will be naturally anxious about their knowledge and confidence, whereas medical students would demonstrate confidence in anatomy and physiology despite practice experiences being limited. Thus student doctors will be brought into the programme towards the middle of their placement, and the collaborative groups are made with second or third year nursing students to match the knowledge and experiences. Resources: Clinical skills laboratory, class rooms, and practice stations will need to be arranged. Instrument: The survey questionnaire will be designed considering all the factors that have been explored in the literature review. Standard questions and scales from earlier learning satisfaction questionnaire with new questions designed to tap experiences of work organizations, leadership, collaboration and cooperation, satisfaction, barriers, competition, stereotypy, perceptions of quality of education, and implications for future collaborative practice will be incorporated. New items will be generated in a multi-step procedure (Creswell, J. W., 1998). Participant observation and with informal interviews will be conducted in the Obstetrics ward. A first draft of dimensions and items will be discussed with a focus group of five student doctors and five student nurses. A second draft will be distributed to the prospective participants in the Gynaecology and Obstetrics ward requesting comments to be written on the questionnaire. These comments will be discussed in a team of researchers for writing up the third draft. Qualitative inquiries can also be used to refine research instruments or to assess the validity of existing ones. Such inquiries can play an important role in identifying problems in the use of quantitative instruments for certain populations or within certain contexts (Sandelowski, M., 2000). Demographic and administrative data are neutral and unthreatening commenced the questionnaire. Items will be thematically organized in a sequence that is logical. Varying response scales and layout will be used to reduce automatic response. The questionnaire has either yes or no response, five point Likert scale or 10-grade scale with anchoring that are unique (Sandelowski, M., 2001). Results: The results will be analysed to find out support for the hypothesis that interprofessional learning improved their learning and provided satisfaction in education. There would be as expected variations in the levels of satisfaction in different participants across different participant groups. This kind of differences would be there in all variables questioned, but overall, analysis should show that there were overall satisfactions of most of the participants (Gubrium, J. F., & Holstein, J. A. (Eds.), 2001). The predictors of satisfaction with student doctors and nurses will be listed to examine whether all these influenced their satisfaction with their mutual cooperation in the interprofessional learning programme. Most of the predictors may not affect one group's satisfaction with interprofessional cooperation significantly more strongly than other's. Conclusions and Recommendations: Clinical placements have been considered to be an important location of interprofessional learning and collaborative approaches. This study is limited by the fact that a valid instrument has not been used, and instead a questionnaire designed by focus group analysis has been used. Collaboration presupposes agreement on a joint mission. Nurse and doctor students share a wide field of knowledge, observations, and objectives despite having different perspectives and tasks related to the patient, and patients and their welfares are the common goals of both the professions in formation. The difference in professional culture and pride are often rooted in perceived or formalized competence monopolies tending towards the doctors. Although the interprofessional cooperation takes place at a junction crossing interests and expectations leading to activities that centre around patient outcomes and is expected to lead to quality of care. This study does not highlight the patient outcomes, mainly due to the fact that study design does not accommodate real-life patient management in the clinical placements, and the participants are students (Stetler, C. B., & Marram, G., 1976). This study on interprofessional learning would not be able to provide direct evidence about the effectiveness of such placements, despite the fact that this study has been proposed to be undertaken in the clinical placement scenario (Morse, J. M., & Field, P. A., 1995). However, it has been observed from different studies that clinical placements have formed the core of health professionals' prequalification training with the purpose development of the students' clinical competence, and consequently to know the effects of interprofessional collaboration in learning, there is no other better place than a clinical area. .Certain other factors that have not been included in this study could be important. For example the role and quality of the clinical supervisors have not been included, although those have been identified as important factors in the success of the placement. From the findings of this study it is expected that the student nurses and doctors will learn better in their clinical placements through interprofessional collaborative learning, and from their comments and analysis of the data, this can be proved in a qualitative manner, and the factors that the participants think hindrances and facilitators would provide a guide to further research and course planning during clinical placements, so interprofessional education through clinical collaboration become a practiced procedure as suggested by NHS. This study is not matured enough to be accepted as a policy guideline, but definitely can serve as the nidus for further research in this area with patient outcomes included as a dependent variable for collaborative learning. Appendix 1 Questionnaire Table 1 Questions and response scales used in this article Scales In general, how satisfied are you with the interprofessional learning' 1 = not at all - 5 'very satisfied Did you experience unrealistic expectations from your own profession' 1 = yes, often - 4 = no, never Did you experience hostility and competition from other professions' 1 = yes, often - 4 = no, never Did you ever feel down or depressed because of criticism from nurses during this programme' 1 = yes, daily - 5 = no, never Did you ever feel down or depressed because of criticism from doctors during this programme' 1 = yes, daily - 5 = no, never How often did members of your own profession praise you for good work' 1 = never - 4 = often How often did members of other professions praise you for good work' 1 = never - 4 = often Co-operation between team members was very good at this programme 1 = quite wrong - 5 = quite right Help and explanation were always available when needed from the team members 1 = quite wrong - 5 = quite right At this ward, all professional groups have common aims for the patient 1 = quite wrong - 5 = quite right The interactive learning between team members was exciting 1 = quite wrong - 5 = quite right Co-operation between professions is very good at this programme 1 = quite wrong - 5 = quite right At this programme, the other professional groups have better clinical knowledge 1 = quite wrong - 5 = quite right I discussed learning with other professions many times during a day in this programme 1 = quite wrong - 5 = quite right Information from other professional groups was very important in this programme 1 = quite wrong - 5 = quite right Physical workload 1 = intolerable - 10 = very easy Emotional workload 1 = intolerable - 10 = very easy Competence of nurses at this programme 1 = very lacking - 10 = fully adequate Competence of doctors at this programme 1 = very lacking - 10 = fully adequate Reference List Aiken, L. 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