ALTERNATIVAS DE SOLUCION

In their review of measurement scales used to investigate opinions of health care professionals, Kenaszchuk et al. (2010) identified that many of the existing instruments were limited in the number of professional groups that could be compared, and in their relevance to multiple professions. They adapted Adams, Bond, and Arber’s (1995) Nursing Opinion Questionnaire and designed the multiple- group measurement scale to measure interprofessional collaboration between multiple health care professions. In measuring the validity and reliability of this scale through exploratory factor analysis, Kenaszchuk et al. (2010) identified the following three sub-scales; communication, accommodation and isolation. The sub-scale of communication consists of four items related to communication between professions. In the sub-scale of accommodation, six items require respondents to consider how accommodating or considerate they felt other professions to be. Within the final sub-scale, respondents are required to respond to three items, and to consider how far they agreed or disagreed that professions work in isolation. The scale as a whole consists of a mixture of positively and negatively orientated items, requiring participants to respond using a 4-point Likert scale. Numerical values are attached to each response (1=strongly disagree to 4= strongly agree). For negatively orientated questions, this scoring is reversed.

The design of the scale, and specifically the wording within each item related to the sub-scales, enables respondents to rate more than one profession in a ‘round robin’ format. Within each item in the scale, it is made clear which profession are the rating group, and which profession are targets. In Table D, the items associated with these sub-scales, and how the wording in each item differentiates between professions as raters and targets, is illustrated.

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Table D. The multiple group measurement scale

Sub-scale Item

Communication

1. [We] have a good understanding with [them] about our respective responsibilities.

3. I feel that patient treatment and care are not adequately discussed between [us] and [them].

9. [They] anticipate when [we] will need their help.

10. Important information is always passed on between [us] and [them].

Accommodation

11. Disagreements with [them] often remain unresolved.

2. [They] are usually willing to take into account the convenience of [us] when planning their work.

4. [We] and [they] share similar ideas about how to treat patients. 5. [They] are willing to discuss [our] issues.

6. [They] cooperate with the way we organise [our] care. 7. [They] would be willing to cooperate with new [our] practices.

Isolation

8. [They] do not usually ask for [our] opinions.

12. [They] think their work is more important than the work of [us]. 13. [They] would not be willing to discuss their new practices with [us].

Permission to use Kenaszchuk et al’s. (2010) multi group measurement scale for the purposes of this study was sought from the main author. In its original form, three versions of the scale were created to enable nurses, doctors and AHPs to respond to the items as raters. As this study included more than three professional groups, it was necessary to devise four versions of the scale and to categorise the surveys according to the four main professional governing bodies: NMC, GMC, HCPC, and GPhC. Maintaining Kenaszchuk et al’s. (2010) ‘round robin’ design, and clarifying which professions were raters and targets in the wording of each item, ensured that the survey was relevant to multiple disciplines. As discussed by Sullivan-Bollyai and Grey (2002) a neutral response can often be the most common response in a survey.

61 This was found to be an issue in a study by Braithwaite et al. (2013) who reported that a high number of neutral responses in their questionnaire distributed to health care professions may have suggested that study participants were uncomfortable with commenting on some aspects of IPW. Their results may therefore be limited by the fact that participants may not have provided definitive responses to the questionnaire. A 4-point Likert scale was, therefore, used in this survey to encourage more definitive responses from participants, and to avoid a high rate of neutral responses.

In Section 4.5 of this chapter, it was previously highlighted that participants were provided with an electronic link to the online survey. This link, classed as the master link, directly opened a generic web page relevant to all professions. On this web page, instructions were provided for participants to check their eligibility for the study, and to select their governing body. By selecting their governing body, this directly diverted participants to the correct survey.

Following the same format as the original multiple-group measurement scale, the rating profession was clarified at the start of each item, followed by the target group. To ensure inclusivity, where possible, different disciplines were specified in this labelling. For example, in the survey for professions who identified with the NMC, the rating group were labelled as nurses or midwives. It is acknowledged that this same strategy was not applied to other professions, such as AHPs. However, considering the number of disciplines within this professional group, it was felt this would impact on clarity of the questions. Furthermore, the researcher was aware that it was not possible to represent every combination of discipline or profession within a health care organisation. For instance, within some contexts, it may be usual that only social workers and health visitors work together frequently, but not in other contexts. In considering this limitation in the design of the survey, an additional item was added to the demographic questions at the start of the survey, to enable participants to specify their profession and to indicate how frequently they worked with other professions. Thereafter, it was assumed that each profession would self- identify their own profession as a rater, and the professions that they worked with frequently. To facilitate the ‘round robin’ rating, the 13 items were repeated in the survey and the targeted profession changed accordingly. The rating groups and their targets are outlined in Figure 5.

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Figure 5. Structure of rating groups and targeted professions

4.6.1.2 Use of an adapted version of the readiness for interprofessional learning scale (RIPLS) to measure practice mentors’ attitudes to IPPL

In its original form, Parsell and Bligh (1999) designed the Readiness for Interprofessional Learning Scale (RIPLS) to measure students’ attitudes to shared learning. Through exploratory factor analysis, Parsell and Bligh (1999) identified 19 items consisting of three factors; teamwork and collaboration, professional identity, and roles and responsibilities. As shown in Table E, Curran et al. (2007) adapted the scale by removing some of the items to create a 15-item scale. They also amended the wording of each item so that it was relevant to tutors with a role in teaching health care students, and so that their attitudes to IPE for students could be investigated.

Nurse / Midwife (N/M) _{Doctor (D) Profession/Social Worker} Allied Health (AHP/SW)

AHP/SW N/M AHP/SW

N/M

N/M Pharmacist (P)

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Table E. The adapted readiness for interprofessional learning scale

Sub-scale Item

Teamwork and Collaboration

1. Interprofessional learning will help students think positively about other health care and social work professionals.

4. Patients would ultimately benefit if health care and social work students worked together to solve patient problems.

9. Learning with students from other health and social work professions helps undergraduates to become more effective members of a health care team.

6. Communication skills should be learned with integrated classes of health care and social work students.

10. Interprofessional learning among health care and social work students will increase their ability to understand clinical problems.

11. Interprofessional learning will help students to understand their own professional limitations.

12. For small-group learning to work, students need to trust and respect each other.

14. Team-working skills are essential for all health care and social work students to learn.

15. Learning between health care and social work students before qualification would improve working relationships after qualification.

Professional Identity

2. Clinical problem-solving can only be learned effectively when students are taught within their individual department/school.

3. Interprofessional learning before qualification will help health care and social work students to become better team-workers.

5. Students in my professional group would benefit from working on small group projects with other health care and social work students. 7. Interprofessional learning will help to clarify the nature of patient

problems for students.

8. It is not necessary for undergraduate health care and social work students to learn together.

13. Interprofessional learning among health care and social work students will help them to communicate better with patients and other professionals.

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