Interprofessional Rural Preceptorship with Nursing and

Medical StudentsA clinical preceptorship initiative:

Dr Deirdre Jackman, Dr Olive Yonge, Dr Florence Myrick, Faculty of Nursing, University of Alberta

Dr Jill Konkin, Dr Fred Janke, Faculty of Medicine & Dentistry, University of Alberta

Jim Cockell, Research assistant

Funding

This study was funded by the Provincial Government of Alberta.

Additional Funding was provided by Covenant Health

Study Purpose

• Preparing students to learn competencies in their respective disciplines

• learning to work collaboratively within complimentary partnerships

• increasing awareness, appreciation, exposure to rural health professional teams/settings

Assumptions

Health Care in Canada is a Universal right

• Rural populations are entitled to health care regardless of :

• Geographic location• Age• Socio economic status

Assumptions cont

• Interdisciplinary teamwork in the rural health care setting indicates that in highly functioning rural communities physicians and registered nurses work together as a team.

• The uniqueness of the rural setting makes working together more likely and more effective.

Rural Context

Rural Population• 6.3 million people or 18.9 % of the population

• Provide agriculture and natural resource sustainability

Rural Context cont

The Number of Registered Nurses in Rural/Remote Regions

• The number of registered nurses working and living in rural/remote regions dropped from 17.9% to 13.7%

• The vast majority of this drop took place between 2006-2009

Rural Context cont

Physician Numbers throughout Alberta. As of 2011 in Alberta there were:

• 123 physicians per 100,00 population in the Edmonton zone

• 119 physicians per 100,000 population in the Calgary zone

• 97 physicians per 100,00 population in the south zone

• 92 physicians per 100,00 population in the central zone

• 81 physicians per 100,00 population in the north zone

State of Knowledge

• Evidence indicates that patients’ health conditions improve with rural interdisciplinary care

• An interdisciplinary approach leads to better environments, decreased workloads, cost benefits and increased efficiency

Preceptorship

• Traditionally preceptorship involves the one to one pairing of a discipline specific health professional with a student

• Preceptorship provides a well established clinical model for high quality teaching and learning outcomes

• Physicians and RNs who teach ( preceptor) are known to be happier with their work and more engaged in providing quality care

Interprofessional (IP) Practice

Working Together for HealthWorld Health Report 2006

• Shift from tertiary hospital to patient centred, home based and team driven care

• Increasing incidence of chronic conditions

• Core competencies include: patient centred care, partnering, quality improvement, information and communication technology and a public health perspective

Interprofessional Practice cont

WHO: Framework for Action 2010

The World Health Organization recognizes interprofessional collaboration in education and practice as an innovative strategy that will play an important role in mitigating the global health crisis.

Interprofessional (IP) Rural Preceptorship

• Provide students with a formal interprofessional (IP) collaboration in a rural clinical setting

• Institute an up-steam IP clinical opportunity prior to graduation

• Facilitate IP learning using educational modules during the preceptorship [ 1)IP collaboration and communication for health care professionals; 2)Today's learner; 3)Rural context; 4) Roles and responsibilities in nursing and medicine practice]

• Enhance rural IP exposure to contribute to recruitment ands retention needs in rural settings

Research Question

• “What is the social psychological process involved in a preceptorship that is specifically designed to foster interprofessional engagement of medical and nursing students in the clinical setting?”

Research Design

• Grounded theory

specifically Glaserian

Data Collectiono Sample

– three nursing students placed in the rural setting.– four medical students placed in the rural setting– three rural nurse manager preceptors.– four rural medical preceptors– one nursing faculty member– nursing and medical administrators.

• Setting and Population– The rural setting included a larger acute rural hospital and community centres

( medical clinic, PCN, long term care facility)in Alberta.

– The population for this study included key members of the interprofessional rural preceptorship.

Procedures

Data collection comprised the following:a) Individual semistructured interviews.

b) Focus group interviews

c) Memos, researchers’ journaling, field notes

d) Computer program coding.

e) Secondary data sources including any documentation appropriate to the study, documents such as literature, curriculum/course outlines, students reflections, self evaluations.

Data Analysis

• Substantive coding

• Theoretical coding

• Memoing

Rigor

• Creditability

• Fittingness/transferability

• Auditability

• Confirmability

Ethical Considerations

• Ethical Approval

• Informed Consent

• Confidentiality

• Anonymity

Findings

THE OVERALL THEME

‘Committing’ to interprofessional learning in the rural setting

Includes the key elements of:

• seeking opportunities to promote authentic interprofessional learning

• protecting the time in order to attend to interprofessional practice

• focusing on the patient in a rural teamed approach

Seeking opportunities to promote authentic interprofessional learning

The psychosocial process involved in seeking opportunities included:

• A relational commitment (students, preceptors, staff)• It’s a journey ( students, preceptors)• Trusting the journey• Self direction ( students)• Motivation( students) • Attitude ( students, preceptors)• Committed to roles, learning ( students and preceptors• Engaged ( students and preceptors at times)• Confidence building related to individual roles responsibilities• Additions/advantage to learning about the other and self ( students)• Take the best of the traditional and combine with IP ( students, preceptors).• Building on traditional preceptorship ( students, preceptors)• Allowing student some scheduling flexibility and self scheduling for learning (

students, preceptors)

Protecting the time in order to attend to interprofessional practice

The psychosocial process involved in protecting time included :

• Carving out time

• Scheduling in advance

• Planning weeks before

• But planning on the day, hour, moment ( all needed)

• Rural setting provides supportive environment

• Support IP as worthwhile

Focusing on the patient in a rural teamed approach.

The psychosocial process involved in focusing on the patient in a rural context included:

• Prioritizing face to face interaction as a central component to collaboration and communication

• We’re a team ( staff and students)

• Prior to this experience we (students) lived 2 separate lives

• I know who they are ( students)

• Not just a uniform but a person ( students)

• I seek them out ( students, staff)

• Interacting is better than reading a chart ( students, preceptors)

• Additions/advantage to learning as a holistic approach to patient care

• Increases patient care outcomes ( students, preceptors)

• Staff role modeled IP behaviors ( students)

References

British Columbia Medical Association. Working together: Enhancing multidisciplinary primary care in care in BC (October 2005). http://www.bcma.org

Canadian Institute for Health Information (CIHI). Regulated Nurses: Canadian trends, 2007 to 2011. Ottawa: CIHI: 2011.Canadian Institute for Health Information (CIHI). Supply, distribution and migration of Canadian Physicians, 2010.Ottawa: CIHI: 2002.Canadian Institute for Health Information (CIHI). Supply and distribution of Registered Nurses in rural and small town Canada. Ottawa:

CIHI: 2002.Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K.Denzin Y. S. Lincoln (Eds.), Handbook of qualitative

research (2nd ed., pp. 509-536). Thousand Oaks, CA: Sage.Chaulan, T., Jong, M., & Buske, L. (2010). Recruitment trumps retention: Results of the 2008 CMA rural practice survey. Canadian Journal

Rural Medicine, 15(3), 101-107.Dey, I. (1999). Grounding grounded theory: Guidelines for qualitative inquiry. San Diego, CA: Academic Press.Glaser, B. G. (1998). Doing grounded theory: Issues and discussions. Mill Valley, CA: Sociology Press.Jackman, D (2011). How the relational process shaped rural preceptorship. Unpublished Dissertation, University of Alberta, Edmonton, AB.

Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage Publications.Morse, J.M. (1992). Qualitative health research. Newbury Park, London: Sage Publications.Myrick, M., & Yonge, O. (2005). Nursing preceptorship: Connecting practice & education. New York, NY: Lippincott, Williams & WilkinsSedgwick, M., & Yonge, O. (2007). We’re it’, we’re a team’, we’re family’ means a sense of belonging. Journal of Clinical Nursing, 16, (8),

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Suter,E., Deutschlander,S., Mickelson,G., Nurani,Z., Lait,J., Harrison,L., Jarvis-Selinger,S., Bainbridge,L., Achilles,S., Ateah,C., Ho,K., & Grymoupre,R. (2012). Can interprofessional collaboration provide health human resource solutions? A knowledge synthesis. Journal of Interprofessional Care, 26(4), 261-268.

World Health Organisation (2010) Framework for Action on interprofessional education and collaborative practice