Commentary on Pollard K (2009) Student engagement in interprofessional working in practice placement settings. Journal of Clinical Nursing 18, 2846–2856

Authors

  • Amanda Henderson

    1. Author: Amanda Henderson, RN, RM, PhD, Nursing Director (Education), Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Professor, Griffith Health, Griffith University, Gold Coast, QLD, Australia
    Search for more papers by this author

Amanda Henderson, Nursing Director (Education), Princess Alexandra Hospital, Ipswich Road, Woolloongabba 4102, QLD, Australia. Telephone: 617 3240 2780.
E-mail:Amanda.henderson@health.qld.gov.au

Pollard’s paper (2009) examines the interprofessional learning experiences of student nurses during their clinical placement. It is timely, given the emphasis by the UK National Health Service that Health and Social Care prequalifying programmes in the UK include interprofessional learning opportunities for students (DOH 2001). In Australia, specific requirements have not been mandated. However, the Australian Nursing Federation (ANF), in their submission to the National Health and Hospitals Reform Commission, has recommended that the Australian Government provide funding to universities for undergraduate nursing courses to move to an interdisciplinary model of education (ANF 2008).

The study by Pollard (2009), investigating the circumstances and the nature of interprofessional practice activities during the clinical placement period, is pertinent given these imperatives for health professionals to learn from and about each other. It is clearly recognised that there is no ‘off-the-shelf’ model and different settings lend themselves to different opportunities to engage in activities across professional groups (Stew 2005). The observation and interviewing of students and staff in their designated clinical setting is informative as many professional attributes required of health professionals are largely learnt through role modelling and supervised practice during clinical placements (Landers 2000, Anastasi et al. 2006). The environment that students work in subliminally shapes attitudes and behaviours (Russell et al. 2006). Pollard (2009) acknowledged the power of practice and this arguably provided the rationale for the study design.

The findings by Pollard (2009), consistent with the literature, identify that, unless interprofessional learning in the clinical context is a specified activity with assessment, the learning is variable (Russell et al. 2006, Steven et al. 2007). The researchers were experienced in the data collection techniques and also the subject matter being investigated. This ensured that professional activities being investigated in the wards/units were recognised and clearly described.

Pollard (2009) identified that there were particular teams where professional interactions across health disciplines appeared very pro-active, for example in the areas of mental health and midwifery practice. These teams collaborated around deciding the appropriate health interventions for patients, many of whom experienced health conditions with a social basis. In contrast, observations of interprofessional meetings in other areas identified interactions that were not so positive; for example, in the paediatric unit it was noted that the consultant ‘controlled the meeting and input from other groups’ (Pollard 2009, p. 2851). In another clinical area, reference was made by one of the researchers that the ‘doctor–nurse’ game was played by staff in an attempt to reach the desired outcome, namely engagement around collaborative professional practices to expedite patient care (Pollard 2009, p. 2851–2852).

Unless the students were facilitated to reflect on their experiences then it was dubious whether interprofessional ‘learning’ actually occurred. Of concern in these situations is: What exactly are students learning? Are students learning that the doctor has control of the health care team? Such situations may not promote interprofessional learning but rather inadvertently ‘condition’ nurses for practice on graduation. The example that concerns Pollard (2009) is that students may be ‘subconsciously’ learning that only senior nursing staff engages in interactions with other health disciplines.

The example of interactions, that Pollard (2009) provides, is a reminder that the real world of practice does not guarantee ideal learning for students (Pearcey & Elliott 2004). The professional practices on the wards/units that promote health professionals learning from and about each other as described by Pollard (2009) are variable. Ideally students are supported through less than ideal situations through clinical placement supervisors; however, this is not always the case, as identified ‘mentors maybe unaware of their own behaviour’ (Pollard 2009). These issues that arise around interprofessional learning lend themselves to the discussion (that I realise was outside the scope of this study) about the value of generic placement supervisors across all the health professional groups. Pollard (2009) although focused on nurses does acknowledge that this learning fits within the domain of all health professionals. These findings emphasise the need for the establishment and development of interprofessional clinical placement supervisor positions (Camsooksai 2002, Emerson 2004).

The article by Pollard (2009) focused on the observation and discussion of collaborative health professional interactions that enhanced student learning opportunities. A key finding was communication and engagement between the different professions is largely lead by the senior nursing staff. Pollard (2009), appropriately, advocates that junior staff need to be skilled in this area because the nature of change and turnover in the health service cannot wait until junior nurses become senior staff to foster engagement across professional groups. While this study acknowledges valuable opportunities are afforded to some students it advocates more active intervention is needed to ensure that interprofessional learning useful to practice upon graduation occurs systematically in clinical contexts, so all nursing students benefit learning from and about the different health professions.

The concerns around poor support for students and lack of engagement of the medical staff warrants strong recommendations to the UK National Health Service who are keen to maximise interprofessional learning during clinical practicums. If health professionals are to facilitate students to engage in such learning, it is imperative that the obstacles are critically analysed and that collectively learning and teaching teams together with leaders in health facilities explore and create processes that break down the impediments. Braithwaite et al. (2007) identify the importance of a co-ordinated push/pull strategy; for example, a push from the tertiary education sector through curriculum redesign and a pull from the health sector through the organisation of multidisciplinary health teams to provide care. The work by Pollard (2009) can certainly provide information around some impediments to the functioning of health care teams to assist ‘the pull from the health sector’.

Ancillary