An exploration of the experiences and perceptions of ... · An exploration of the experiences and...

An exploration of the experiences and perceptions of

health and allied health care students regarding

interprofessional collaboration and education in a

rural clinical setting in South Africa

Stellenbosch University

Sustainable Rural Health Research Day 2014

Me. Annalie Theunissen & Supervisor: Mrs. Anneleen Damons 1

Study conducted in Avian Park, Worcester, South

Africa.


The children of Avian Park Me. Annalie Theunissen & Supervisor: Mrs. Anneleen Damons 3

Students in Avian park Me. Annalie Theunissen & Supervisor: Mrs. Anneleen Damons 4

https://mail.google.com/mail/?ui=2&ik=32901da2ed&view=att&th=1453b51d2684176e&attid=0.7&disp=inline&realattid=deae4084460fb21a_0.7&safe=1&zw







Introduction and Background


The Department of Health (2010) identified shortcomings in the implementation of PHC in South Africa. A new strategy was proposed and will be known as “Re-engineering of PHC in South Africa. The Department of Health (2010) stated in the draft document that the success of the new strategy would depend on competent health care workers, working together as a collaborating team. The researcher identified this opportunity to explore current levels of collaboration that may give an indication of future intervention to enhance the IPC and IPE while the health care students were working together in a rural clinical setting in Avian Park, Worcester. Inter professional team members who participated in the study were from the departments of Medicine, Nursing, Physiotherapy and Speech and Hearing.

The aim of the study


To explore the experiences and perceptions of health and allied health care students regarding interprofessional collaboration and education in a rural health care context in South Africa during their clinical placement.

Objectives


The specific objectives included: 1. The exploration of experiences of students regarding interprofessional collaboration within an interprofessional education context in a rural health care setting in South Africa 2. The establishment of the perceptions of students regarding interprofessional education within the interprofessional education programme in a rural health care context in South Africa

The research questions were:


1. What were the experiences of students regarding interprofessional collaboration within an interprofessional education context in a rural health care setting in South Africa? 2. What were the perceptions of students regarding interprofessional student education in a rural context in South Africa?

The Research Problem


Students learn that there is an assumed hierarchy and social standing amongst the students of various interprofessional disciplines. In order to establish whether this assumption carried value, the researcher explored student perceptions of interprofessional education in a rural context within the clinical environment.

The Research Methodology


Qualitative research methodology with a descriptive, interpretive design was applied.

The descriptive, interpretive design contributed to the successful investigation of the phenomena of perceptions and experiences as it occurred naturally within the study. A phenomenological research design would not have been appropriate to apply as it is not a deeply personal experience such as grief or deep-seated anger as explained by Creswell (2009:58) Ethical approval was obtained from the Ethics Board, University of Stellenbosch. Specific ethical principles, based on the Helsinki Declaration, pertaining to voluntary participation, privacy and confidentiality were maintained. Consent to conduct the study was obtained from Dr. S. Snyman.

Philosophical underpinning;


Paradigmatic perspective as explained by Guba and Lincoln (1194:108) includes; The ontological question “form and nature of reality and, therefore, what is there that, that can be known about it?” What can there be to talked about? The epistemological question “what is the nature of the relationship between the knower and would be knower and what can be known”? What information can be obtained related to the nature of humans regarding their knowledge and understanding through investigation? The methodological question is “how can the inquirer go about finding out whatever he or she believes can be known?”

Conceptual map and theory


The researcher applied the Newman’s systems theory as reference or basis to the research. The researcher developed a conceptual map for the implementation of IPC and IPE within the context of the Department of Health’s ideals within the “Re-engineering of Primary Health Care in South Africa”

Research setting


Participants worked in a clinical rural health care setting under the supervision of interprofessional mentors, guided by the CHW during home visits. It was a natural environment, in a real life setting without any measures of control.

The population


The accessible population over a four week period averaged as 31 students. Most frequently only two medical students attended for that period of time. The latter indicated the total of two participants per discipline to ensure fairness and consistency.

Sampling


Purposive sampling as described by de Vos, Strydom, Fouché and Delport (2011:392) proved to be the most suitable choice; they explained it is a typical choice in qualitative design as the participants shared the same characteristics as the typical population it represents. The sampling was done by obtaining names from potential participants from all disciplines and asking participants to voluntarily agree to participate. The first two participants, per discipline, who agreed were included.

Data collection and data collection tool


Focus group interview were conducted during the pre-test and formal study. The pre-test was conducted during November 2012 and the formal study 23 May and 27 June 2013. The semi-structured interview was adjusted following the pre-test to enable a more focussed approach by altering the questions. During the formal study a semi-structured interview guide was used with two central questions which focussed on the study objectives. All interviews were recorded and translated with the consent of all participants.

Trustworthiness


As explained by Brink, van der Walt and van Rensburg (2006:118) Validity and reliability is related to the accuracy and truthfulness of the study. Specific steps were taken to avoid bias and to enhance trust worthiness such as applying the principles of bracketing and including experts during the interview and data analysis process.

Literature control


A preliminary literature control was conducted to exclude bias or to form preconceived ideas about a phenomenon during the data collection and analysis. The data analysis and finding were supported by an in-depth literature review.

Data analysis


Data was analysed according to the five steps as explained by Terre Blanche, Durrheim and Painter (2006:322-325) namely: Familiarisation and immersion Inducing themes Coding Elaboration Interpreting and checking Familiarisation and immersion commenced during the focus groups and the transcription of the data therefore this approach followed naturally. The researcher continued to immerse herself in the data to obtain greater insight.

Main findings


A. Organisation with subthemes A1-A3

A1 Rotation and student schedules A2 Structure and function A3 Preparation for IPC in an IPE context


B. Perception and experiences related to interprofessional team structures prior to following interprofessional collaboration and interprofessional education with subthemes B1- B3 with B4 only in the formal study B1 Experiences and perceptions during IPC B2 Prior experiences and perceptions B3 Challenges During the formal study an additional subtheme was identified namely; B4, Community health worker as a team member.

Responses related to IPC and IPE (B1)


N1:“…we can learn so much from each other. I enjoyed working with all the people and we learnt to adjust to each other, we adjusted to the team.” M1:“It is definite art to learn to work together with all the different personalities.” M1: “I like going into the patient's home, you understand your patient better. We learnt a lot about other professions.” SH1: “It is so nice to get to know everybody. You get to know people at work and then you even get together socially and do extramural activities together.”



SH2: “… you can work with the patient in his home you do not need to take him to hospital.” N1:“… following the visit we all went back to the clinic and we discussed the case. We decided together. I learnt there that we can work together in a multi-disciplinary team…” N1: “There was collaboration between the team members. IPC worked.”



M1:” For me I learnt, until now, the most from social workers and the social problems that are in the community. So many people do not have ID books, older people living with children who abuse drugs and the social workers trying to get the children out those homes.” P2:”… we had a speech therapist who presented a talk about what they do in the field… It was nice that it was us students talking to another group of students. It was not a lecturer telling us this is what you can do.”



N2: “…It was nice to help each other and you felt the freedom to ask for help from other team members.” N1:“The other interprofessional team members listened to us and we were able to teach them. It was the first time that we all came in contact with each other and we can learn so much from each other.”



SH2: “You do not realise how much you need the community care worker (CHW). Before I came to Worcester I did not understand about community care workers (CHWs).” SH2: “The CHW sort of keep the team together.”

C. Team cohesion IPC and IPE at Avian Park with subthemes C1 – C2 with C3 only in the formal study


C1 Referral practices C2 Advantage of team cohesion During the formal study and additional subtheme was identified namely: C3 The need for further IPC and IPE

D. Advantages of practices within the re-engineering of PHC with subthemes D1 in pre-test and D2 included in the formal study


D1 Home visits; student insight development and professional growth During the formal study and additional subtheme was identified namely: D2 Quality of home visits

The significance of the study


To the University, it is the first study of this nature conducted by the Nursing Faculty To Research, an addition to a field where not much data from a South African perspective is available To Health Care, the findings supports the ideals of the “Re-engineering of Primary Health care in South Africa” In general the data can be used to influence policy makers and curriculum designers, contribute to interventions in healthcare where the focus can now be placed on interprofessional learning and collaboration which in turn affect the provision of health care in South Africa.

Limitations


Prejudice towards nursing from physiotherapy department Inability to facilitate participation from occupational therapy department The absence of one of the medical students during the focus groups in both the pre-test and formal study. In both cases the participants were voluntarily recruited and agreed to participate but chose not to attend.

Interpretation and recommendations – Brief

description


IPC and IPE proved to be an extremely valuable learning experience in more than one way. It contributed to academic development, personal growth and professional development. One of the most important aspects was that collaboration took place as the hierarchical barriers and prejudices were “resolved” and mutual respect emerged instead. Participants felt valued and their self-esteem improved.

Recommendations


IPC and IPE should be the norm and not the exception. All faculties should work together and interdepartmental barriers to collaboration should be addressed. The formal inclusion of Nursing Education Institutions in future IPE and IPC

Further research opportunities; (brief account)


How to overcome prejudice and disrespect amongst established health care professionals? Establishing a combined curriculum to facilitate collaboration

There is an endless flow of thought and ideas for recommended research that could be done but the most urgent are as follows:

Further research opportunities; (brief account)


The restoration of flawed relationships between doctors and nurses and other health care professionals, so that the primary health care approach as planned, can be given a chance to succeed in South Africa. The perceptions and experiences of the communities relating to interprofessional collaboration and the effectiveness of the services rendered in the light of the plight of people sharing similar socio-economic circumstances as the population group living in Avian Park. The exploration of the needs as seen by the community.

Conclusion


The chosen research methodology and design proved to be most suitable. The research objectives were reached and the research questions answered. Previous prejudices, such as the perceived hierarchy, as explained by the participants, were altered and they valued and respected each other’s contribution to patient-centred care. Nurses have proved to be professional and highly capable to perform successfully within the interprofessional team as an essential and equal contributor to holistic, quality health care.

Acknowledgements


SURMEPI – financial assistance DEPARTMENT OF NURSING STELLENBOSCH UNIVERSITY Dr E. Stellenberg Mrs A. Damons – Research Supervisor Prof M. Clarke Dr S. Snyman, Mrs Jana Muller and all the personnel such as the CHW. All the study participants

Thank you very much.

For additional information please visit:

www.sun.ac.za


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