June Alberto, DNS, RN
Kaye Herth, PhD, RN, FAAN
Interprofessional collaboration in education and practice has been promoted for over three decades by educational panels, professional/educational organizations, and grant funding agencies. Despite this long-standing focus on collaboration and the need for faculty to be highly productive in their teaching, service, and research roles, the literature remains sparse regarding the potential benefits and challenges of interprofessional collaborative efforts associated with each role. In this article, the authors review the literature by exploring terms associated with interprofessional collaboration, describing the collaboration imperative within healthcare, and presenting collaborative efforts within the academic setting. They also discuss interprofessional collaboration within faculty teaching, service, and research roles, sharing examples of their own collaborative experiences and some of the benefits and challenges of collaboration in each of these roles. The collaborating experiences they share illustrate how faculty, regardless of setting or nation, can themselves be successful both in collaborating activities and in integrating the three roles of teaching, service, and research, for the benefit of students, community, and professional practice.
Citation: Alberto, J., Herth, K. (March 31, 2009) "Interprofessional Collaboration within Faculty Roles: Teaching, Service, and Research" OJIN: The Online Journal of Issues in Nursing; Vol. 14 No.2.
Key Words: collaboration, faculty roles, interdisciplinary, interprofessional, multidisciplinary, teaching, research, service, teamwork, transdisciplinary
The term collaboration holds a positive connotation for today’s healthcare providers...collaborating is usually considered a necessary component of successful professional activities... The term collaboration holds a positive connotation for today’s healthcare providers. The act of collaborating is usually considered a necessary component of successful professional activities, whether among individuals or departments within a given organization or among other organizations. Educational panels, professional/educational organizations, and grant funding agencies promote collaboration within and across disciplines (American Association of Colleges of Nursing, 2002, 2002-2003; DHHS (n.d.); Heller et al., 2000; Pew Health Professions Commission, 1998). The outcomes of interprofessional collaborative endeavors are expected to be produced quicker and to be of a higher quality than solitary efforts (Figg et al., 2006; Garity, 2005; Kontzer, 2002). If nursing educators and practitioners are expected to seek interprofessional collaborative opportunities, the benefits and challenges associated with those efforts merit exploration and discussion. In this article, we review the literature by exploring terms associated with interprofessional collaboration, describing the collaboration imperative within healthcare, and presenting collaborative efforts within the academic setting. We will also discuss interprofessional collaboration within faculty teaching, service, and research roles, sharing examples of our own collaborative experiences and some of the benefits and challenges of collaboration in each of these roles. The collaborating experiences we share will illustrate how faculty, regardless of setting or nation, can themselves be successful both in collaborating activities and in integrating the three roles of teaching, service, and research, for the benefit of students, community, and professional practice.
Tenured and tenure-track faculty are generally required to focus on the three academic roles of teaching, service, and research. Although the focus of non-tenure track faculty differs from that of tenured/tenure-track faculty, interprofessional collaboration is important for all faculty so that students benefit from this collaboration and gain an interprofessional perspective early in their careers. Therefore, this article is directed toward all faculty.
Healthcare scholars have claimed that interprofessional collaborative endeavors can be traced to the ancient Greeks (Lattuca, 200l; Newell, 1998), but it has only been in the past three decades, beginning in the 1970s, that a steady and strong move toward collaborative practice has begun to unfold. Nurse educators face the challenge of preparing practitioners both to enter the field of nursing and to successfully collaborate with other healthcare providers in planning and implementing effective healthcare services. This review of literature section will discuss the historical progression of the meaning of terms related to collaboration, the progression of the concept of collaboration by health professional associations, and the progression of the emphasis on collaboration in academia. The databases used to complete this literature review were the Cumulative Index of Nursing and Allied Health Literature (CINAHL), The Cochrane Library, Medline, and PsychInfo.
Meaning of Terms related to Interprofessional Collaboration
Terminology used to depict collaboration over time has led to confusion for nurses interested in developing and participating in collaborative initiatives. Terminology used to depict collaboration over time has led to confusion for nurses interested in developing and participating in collaborative initiatives. Terms such as team, teamwork, and collaboration are found throughout the literature and are sometimes used interchangeably (Dyer, 2003; McCallin, 2001). Team, a term that has been found in both nursing and medical literature since the early 1960s, was used early on to describe a small, constant group of individuals with common skills committed to a unified purpose (McCallin). A team is not restricted to one discipline but may be made up of individuals from several different disciplines who work together to achieve the team’s goals. Teamwork describes performance and approaches for achieving the team’s goals (McCallin). In actuality, teamwork has seldom been practiced to its fullest extent (McCallin).
The term collaboration is used interchangeably and in conjunction with teamwork (Garrett 2005, p. 160). The roots of the word collaboration, namely co-, and laborare, combine in Latin to mean “work together.” Henneman et al. (1995) stated that collaboration involves a partnership characterized by mutual goals and commitments in which participants willingly become involved in planning and decision making. Mattessich, Murray-Close, and Monsey (2001) described collaboration as “a mutually beneficial relationship that is well-defined and entered into by more than one organization or individual to achieve mutual goals” (p. 24). Henneman et al. have suggested that collaboration “is a process by which members of various disciplines (or agencies) share their expertise. Accomplishing this requires these individuals understand and appreciate what it is that they contribute to the whole” (p. 363).
...it is critical to collaboration that...members of the collaborating group share the vision and purpose...[and they] move from problem driven to vision driven, from muddled roles and responsibilities to defined relationships, and from activity driven to outcomes. Fullan (1993) stated that “effective collaborations operate in the world of ideas, examining existing practices critically, seeking better alternatives and working hard together at bringing about improvements and assessing their worth” (p. 57). The National Network for Collaboration (NNC) (1998) has developed a framework for collaboration. It has proposed that it is critical to collaboration that all existing and potential members of the collaborating group share the vision and purpose, and that several catalysts may initiate a collaboration – a problem, a shared vision, a desired outcome, to name a few. Regardless of what the catalyst may be, it is essential to move from problem driven to vision driven, from muddled roles and responsibilities to defined relationships, and from activity driven to outcomes. The NCC views collaboration as an inclusionary process with continuous engagement that reinforces commitment, recognizing the building of relationships as fundamental to the success of collaborations and effective collaborations as characterized by building and sustaining “win-win-win” relationships.
Terms, such as interdisciplinary, multidisciplinary, transdisciplinary, and interprofessional, which further delineate and describe teams, teamwork, and collaboration, have evolved over time. The earliest and most commonly used term was interdisciplinary. In academic discourse, interdisciplinary was the term used to indicate the combining of two or more disciplines, professions, departments, or the like, usually in regard to practice, research, education, and/or theory (Nissani, 1997). At about the same time, the term multidisciplinary began to appear in the healthcare literature; this often caused confusion as it was used interchangeably with the term interdisciplinary. Multidisciplinary refers to independent work and decision making, such as when disciplines work side-by-side on a problem. This is in contrast to interdisciplinary work in which individuals are enmeshed in practice, education, and/or research (Sternas, O'Hare, Lehman, & Milligan,1999). The interdisciplinary process, according to Garner (1995) and Hoeman (1996), expands the multidisciplinary team process through collaborative communication rather than shared communication. In this model, team members are involved in problem solving beyond the confines of their discipline. Garrett (2005) stated that “interdisciplinary endeavors assume a certain risk because all parties must give and take in the relationship (collaborate)” (p. 160).
Two other terms, found more recently in the literature in connection with the terms team, teamwork, and collaboration are transdisciplinary and interprofessional. Transdisciplinary efforts involve multiple disciplines sharing together their knowledge and skills across traditional disciplinary boundaries in accomplishing tasks or goals (Hoeman, 1996). Both Rosenfield (1992) and Mitchell (2005) have addressed the differences between multidisciplinary work and transdisciplinary efforts from the perspective of a continuum. In multidisciplinary work individuals in different disciplines work independently or sequentially, each from his or her own disciplinary perspective, to address a particular topic or problem. Transdisciplinary expands on multidisciplinary efforts in that in multidisciplinary work the participants remain anchored in their respective disciplinary perspectives and stop short of achieving the novel and integrative conceptual models that are the hallmark of transdisciplinary work. Transdisciplinary efforts reflect a process by which individuals work together to develop a shared conceptual framework that integrates and extends discipline specific theories, concepts, and methods to address a common problem.
...healthcare professionals are not able to effectively collaborate without having the educational background and experiences that nurture, support, and grow collaboration Interprofessional education (IPE) refers to practitioners learning together to promote collaborative practice (Barr, 2002; Barr & Watbrton, 1996; Hammick, 1998). Chapman (2006) stated that “development of contexts in which working relationships are collaborative requires a shift or a change in many traditional attitudes and in the perceptions and beliefs of people” (p. 302). Educational and community involvement in collaborative initiatives are gaining momentum; however, healthcare professionals are not able to effectively collaborate without having the educational background and experiences that nurture, support, and grow collaboration (Jeglin-Stoddard & DeNatale, 1999; Lowry, Burns, Smith, & Jacobson, 2000).
Interprofessional collaboration has been described as involving “interactions of two or more disciplines involving professionals who work together, with intention, mutual respect, and commitments for the sake of a more adequate response to a human problem” (Harbaugh, 1994, p 20). Several authors (Biggs, 1997; Chapman, 2006; Fournier, 2000; Harbaugh, 1994) have noted that in multidisciplinary collaboration disciplines are working side-by-side anchored in their own respective disciplinary perspectives while transdisciplinary collaboration expands on multidisciplinary collaboration in that a shared conceptual framework is developed between traditional discipline boundaries to respond to common problems. These authors further suggested that interprofessional collaboration goes beyond transdisciplinary to include not just traditional discipline boundaries but also nontraditional disciplinary boundaries in that professional identities and traditional roles are no longer prescribed but are actively worked out and negotiated; interdisciplinary collaboration members transcend separate disciplinary perspectives and attempt to weave together resources, such as tools, methods, and procedures to address common problems or concerns.
...interprofessional collaboration goes beyond transdisciplinary to include...nontraditional disciplinary boundaries in that professional identities and traditional roles are no longer prescribed but are actively worked out and negotiated... A recent example demonstrates how an interprofessional research team focused on linking theory related to the concept of hope with clinical practice so as to develop interventions that would engender hope in terminally ill children. This group included professionals from a wide variety of disciplines including, among others, nursing, psychology, occupational therapy, massage therapy, medicine, and education. The traditional, disciplinary-specific roles and knowledge were actively negotiated and woven into a single framework by the team, with the result that disciplinary boundaries faded in importance, and the problem was studied in a broader and deeper manner.
As this team worked together the participants blended the competencies of all team members and performed functions outside of their normal scope of practice. The team searched for the commonalities rather than the differences in theoretical perspectives and relinquished their personal and discipline-specific approaches. Members generated a broad list of theories relevant to a hope intervention for children; then each member read about the theories, often in literature outside their own discipline. Members developed a shared understanding that increased their ability to function at an interprofessional level. The team developed a shared mindset; and an overarching theory was identified by the team.
As a result, the research that has emerged from this interprofessional collaboration reflects a true integration and synthesis of knowledge from each discipline, rather than a mere compilation of knowledge from various disciplines. This interprofessional collaboration has resulted in a new perspective, one greater than the sum of the parts. Knowledge gained is now in the early stages of being disseminated more broadly, because it applies to more than one discipline, and it is changing practice for the care for terminally ill children.
Interprofessional Collaboration Imperative within the Health Professions
...although clinical practice demands close cooperation among the different professions, interprofessional education and experiences are seldom a part of the curricula in the various schools in the United States. Interest in interprofessional collaborative practice proliferated in the healthcare arena during the 1990s (Institute of Medicine, 1998; O’Neil and Pew Health Professions Commission 1998; Pew Health Professions Commission 1995a, 1995b, 1998). More recently, the American Association of Colleges of Nursing (AACN) published a White Paper, Hallmarks of the Professional Practice Environment (2002), which included a focus on interprofessional collaboration; and the organization’s 2005 Annual Report included several references to productive collaborations. Additionally, the AACN held a conference titled Interprofessional Education and Research: Considerations for Nursing Education, in June 2005 that included models of beneficial collaborations among healthcare disciplines. The National League for Nursing’s initiatives included an Education Summit in 2003 that focused on interprofessional education, leading to a position statement, Innovation in Nursing Education: A Call to Reform, and a series of standards, known as Hallmarks of Excellence, that were designed to define excellence in 10 aspects of nursing education (Murray 2003, 2005). Varkey, Reller, Smith, Ponet, & Osborn (2006) noted that The Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education, and the American Association of Colleges of Nursing have recommended that graduates be competent in interdisciplinary collaboration. Varkey et al. further noted that although clinical practice demands close cooperation among the different professions, interprofessional education and experiences are seldom a part of the curricula in the various schools in the United States (US).
From a more global perspective, the Health Council of Canada recommended that an interprofessional education program among appropriate disciplines be established by 2008 (Kearney, 2008). In another Canadian article, Jansen (2008) argued that it would take strategic and influential use of power and knowledge by nurse leaders in practice, research, and administration to effect change for the development of collaborative and interdisciplinary practice. At the disciplinary level and from a nursing education perspective, McCloughen and O’Brien (2006) reported that issues with communication in interdisciplinary research could negatively affect research outcomes. McCloughen and O’Brien suggested that effective and regular multidirectional communication from inception to conclusion of collaborative processes between all members, including face-to-face interactions, electronic mail, telephone and conference calls, and/or faxes, is “necessary to gain and maintain trust and cooperation, promote informed decision-making and problem-solving, and to facilitate collective participation and individual responsibility” (p. 178) as well as “provide opportunities for members to examine progress and clarify expectations, cross-fertilize ideas, and gain consensus on problems” (p. 175).
Effective communication in multisite collaborative interdisciplinary research increases the likelihood of “attracting funding, provides greater accessibility to practice settings and clients with diverse diagnoses, facilitates increased sample sizes that improve statistical power and enhance the generalizability of findings, improves access to resources such as research and clinical expertise, and enhances possibilities to establish institutional links" (McCloughen & O’Brien, p. 172). Rossen, Bartlett, and Herrick (2008) also noted difficulties associated with interdisciplinary practice, but considered it necessary for students to learn if they are to succeed. They implemented a case study approach in their mental health course to educate students about interdisciplinary practice.
Collaboration across disciplines to improve healthcare outcomes is a world-wide imperative... [and] many global-level collaborative initiatives are underway.Collaboration across disciplines to improve healthcare outcomes is a world-wide imperative. The United Kingdom, nearly two decades ago, set up the Centre for the Advancement of Interprofessional Education (CAIPE, 2009). CAIPE, with an international membership of over 300, is a resource for interprofessional education in both universities and workplaces. This organization has developed an extensive evidence base for interprofessional education, provided numerous workshops and conferences, and published extensively. An international journal, Journal of Interprofessional Care, published in the United Kingdom through CAIPE and written by individuals representing health and social work disciplines worldwide, is dedicated to furthering whole-person care through collaboration between and among disciplines.
It is evident from this review that many global-level collaborative initiatives are underway. Most noteworthy are the initiatives in Canada to prepare the health professions to engage in interprofessional collaboration. The movement, although slow, has been strongly supported by various disciplines’ professional associations. The changes required to implement interprofessional collaboration involve educational preparation for the role, commitment of resources, and insight and willingness from all stakeholders.
Interprofessional Collaboration within Academia
Cooper, Carlisle, Gibbs, and Watkins (2001) conducted a systematic review of the literature to summarize the evidence for interprofessional education of undergraduate health- professional students. These authors found the literature on interprofessional education “to be diverse including a relatively small amount of research data and much larger amounts of evaluation literature” (p. 229). Thirty articles were found between 1994-1999 that focused on interdisciplinary initiatives aimed at undergraduate health professionals and met the inclusion criteria of “published in an English language journal....These initiatives were aimed at undergraduate health professionals, and educational initiatives included one of more of the following aims: to increase interdisciplinary understanding and co-operation, to promote competent team work, to make effective/efficient use of resources, to promote high quality, comprehensive patient care” (pp. 230-231). The majority (47%) were published in the United Kingdom, with the largest proportion (27%) of the papers published in 1998. There were 16 evaluation studies and 14 research studies. Cooper et al. noted that “there was great variation in both the quality and type of education interventions” (p.233). Cooper et al. reported that the “largest effects were on students’ knowledge, attitudes, skills and beliefs, in particular on understanding of professional roles and team working and the smallest effects were for transfer of learning into student’s experiential [actual clinical experience] practice, and on effects on students’ learning environments [instructional settings]” (p. 235).
More recently, Ireland, Gibb, and West (2008) completed a review of literature to assess the evidence on the efficacy of skills-based interprofessional education (IPE). The search focused on United Kingdom (UK)-based, English language, interprofessional-education studies and publications appearing between 2000 and 2006. The justification for the study was that the findings and inferences made from non-UK health education systems may not have been applicable to education in the UK. Numerous databases and resources were searched including Medline, CINAHL, ERIC, The Cochrane Library, PsychInfo, and others. Each abstract obtained from the searches was evaluated by asking whether the study described IPE and if the education had been evaluated in a systematic manner (i.e. through research). Authors stated that answers to the first question were guided by the following definition of IPE: “When members (or students) of two or more professions associated with health or social care meet to be engaged in learning with, from and about each other” (Freeth , Hammick, & Koppel, 2002, p.12). The electronic search retrieved 225 articles. After removing duplicates and those not meeting the inclusion criteria, 31 remained. After reviewing abstracts and papers, 17 papers were included in the final review. The researchers concluded from this review of the literature that evaluations of IPE programs are often positive but it is not clear to what extent the interprofessional nature of the program affects the outcomes.
A review of the prominent nursing education journals that have been published within the last decade in the US identified far fewer articles than did international journals that had within their title the words collaborative, interdisciplinary, and/or interprofessional. Several of the recent U.S. articles were in Nursing Education Perspectives (formerly Nursing and Health Care Perspectives), published by the National League for Nursing (1999, 2000, 2001, 2003, 2005). The foci of these articles were collaborative testing, collaborative problem-based learning, creative clinical collaboration, cooperative learning, and collaborative track option for baccalaureate education. A recent issue of an international educational journal published in the UK, Nurse Education in Practice (Issue 5, 2005), was devoted to articles addressing interprofessional education and interprofessional learning. The articles were informative but gave limited examples of collaborative teaching, service, and research projects and did not specifically address the benefits and challenges of collaborative work.
Several universities within the US have taken the initiative to incorporate allied-health disciplines and the geographic communities they serve into the collaborative process. The impact of interprofessional education in healthcare-underserved areas has been documented and the approach has shown to improve client satisfaction and outcomes, cost effectiveness, access to care, and community involvement in the care of its work force and its citizens (Edwards & Smith, 1998; Massey, 2001; Sternas et al.1999).
Summary of the Literature Review
This brief literature review has considered terms associated with collaboration, and more specifically interprofessional collaboration, and the historical development of the concept of collaboration by professional associations and academia. The findings have suggested that there remains significant work still needing to be accomplished to understand more clearly the benefits and challenges of interprofessional collaboration on those involved and the manner in which interprofessional collaboration affects outcomes. More rigorous studies are required to inform faculty of the learning outcomes students need to achieve to become effective interprofessional healthcare providers and to inform faculty themselves how to engage in interprofessional collaboration.
This review of the nursing literature over the past decades has revealed frequent references to the importance of collaboration and interdisciplinary/interprofessional collaborative practice. However, a few specific examples across the three academic roles of teaching, service, and research that delineated both the benefits and the challenges have been offered. The next section of this article will describe interprofessional collaboration in teaching, service, and research, discuss the benefits and challenges of this collaboration, and illustrate our professional experiences of interprofessional collaborative efforts in teaching, service, and research.
Interprofessional Collaboration: Teaching
...interprofessional collaboration is important for all faculty so that students benefit from this collaboration and gain an interprofessional perspective early in their careers. Faculty, whether on non-tenure or tenure tracks, are expected and encouraged to provide collaborative experiences to enhance student learning. However, until interdisciplinary programs are commonplace in the educational setting, faculty who do provide these experiences often do so as pioneers. The second author’s (K.H.) experiences with interprofessional collaboration began with teaching ethical issues in biomedicine with a professor of philosophy from the same university. The philosophy professor presented the philosophical and ethical principles and she developed and presented practical healthcare case studies that were readily applicable to nursing practice.
The experiences of the first author (J.A.) began with a grant proposal to develop an online course and continued through development and implementation of three online courses. These grant-funded courses were developed by faculty from two disciplines, Nursing and Health and Kinesiology, both within the same university, and in collaboration with their program chairpersons. The title of this grant was “Teaching and Learning Grant, Model Technology–Infused Course Development.” Funding was provided by the Board of Regents, University System of Georgia. One component of the grant’s funding was compensation for content experts to meet with students in the courses’ chat sessions. The collaborating faculty recognized that students would benefit from interacting with experts who would generally not be available in the conventional classroom. Due to the easy accessibility of the online environment, many content experts were excited about collaborating with the faculty to provide unusual opportunities for students to interact with them on a variety of topics. The first collaboratively developed online course, Complementary Therapeutic Modalities, was offered to RN-BSN students and junior or senior level students of any major. The course involved several chat-session content experts from various professions when it was first offered in 1999 and continues in the same vein today. The topics discussed in the chat sessions included holistic health, culture, T’ai Chi, massage therapy, therapeutic touch, humor, chiropractic therapy, and herbal therapy.
We authors believe that the benefits of these interprofessional collaborative efforts in teaching were enumerable. Students were exposed to experts in areas that they would otherwise have only read about and discussed with the faculty. Their comments and evaluations supported the notion that professional and interprofessional collaboration enhanced their learning experiences. Comments about their “chats with the experts” included the following:
– It certainly added another dimension.
– What would have been a problem at work yesterday morning, I saw as a challenge this morning after the chat session. Perception does make a difference!
– This was very enlightening.
– It was an honor to meet her.
– She really opened my eyes to culture right here.
The students recognized the many benefits of this interprofessional collaboration.
While the benefits of interprofessional collaboration were many, at least one potential challenge was identified; this challenge was related to the amount of time to develop these courses. The preparation involved in arranging the content experts’ chat sessions could be considered by some to be too time-consuming. However, J. A. took the following simple steps to keep this preparation time from becoming too costly. J. A. first identified the desired course content and specified the dates on which to present the various content elements. Next she decided upon the number of chat sessions to offer during the semester. At that point, based on planned course content and activities, she established the specific topical areas to enhance with chat sessions led by content experts (See Table 1 for additional details). Just as Ireland, Gibb, and West (2008) concluded that interprofessional educational programs are often evaluated as positive, these authors found that chat sessions with content experts from varied disciplines and professions enhanced selected courses and that the benefits outweighed the challenges.
Table 1. Course Enhancement through Chat Sessions with Content Experts
Arrange the course calendar with topical content.
A calendar with content allows a quick review for additional planning.
Decide the number of chat sessions to offer during the semester.
The number of chat sessions offered might vary with the type of course and student population. If most students work and attend school, required chat sessions might even be inadvisable. Alternate assignments to be posted at the Discussion Tool are beneficial for students who cannot attend chat sessions.
Determine which topical areas will be enhanced by a chat session with a content expert.
A course that is offered early in the major might focus on concepts specific to that major's curriculum and therefore the faculty of record will probably be the best person to lead chat sessions. A course such as Complementary Therapeutic Modalities is ideal for the inclusion of content experts due to its varied topics, e.g., massage therapy, therapeutic touch, and humor. Research courses are also ideal to include content experts. Those chat sessions can enhance students' understanding of research in many ways, such as (a) how research questions are developed, (b) the value of research participants, and (c) the benefits of developing a program of research. Content expert selection could be based on topics that need enhancement due to content comprehension difficulty or because a content expert of note is willing to share his/her expertise with students.
Using the Course Calendar with Topical Content, check those that will benefit from a content expert.
This information will need to be in hand when the content experts are contacted regardless of contact method.
Contact the content experts as soon as possible after preparing the course calendar.
Content experts are busy and you will want to confirm the chat session as early as possible. This action will also prevent last minute planning – uncertainty causes frustration among students.
Follow-up with content experts.
Provide written directions and information to content experts including the date, time, topic, course URL and password, students' course-related activities and reading assignments, and the general format of the chat session. It is useful to tell the content experts how they will be introduced, how many students they can expect, and if the faculty and/or others beyond the students will be present.
End with a “Thank You” note.
A note of thanks is expected and welcomed by content experts. Providing evaluative comments made by students is also a plus since most individuals appreciate knowing their services were valued and of benefit to others, especially to students.
Interprofessional Collaboration: Service
Faculty are expected to provide professional service to others...outcomes of interprofessional collaborative endeavors are expected to be produced quicker and to be of a higher quality than solitary efforts Faculty are expected to provide professional service to others (Des Moines University, 2008; Georgia Southern University, 2008; University of Virginia, 2008). When the opportunity to serve others includes broad collaborative efforts, the experience can have unexpected outcomes. For example, the first author, J. A., in collaboration with academic and community professionals, developed a Better Breathers Support Group (BBSG) for persons with chronic lung disease. This initiative led to more than a decade of monthly meetings that informed and provided support for the community’s citizens.
This interprofessional service endeavor began with a state-affiliate, program-planning committee of the American Lung Association, which was comprised of nursing faculty at the local university and two community members. A needs assessment indicated the health-related faculty at the university, local physicians, and leaders of health agencies and community groups were willing to collaborate to benefit the county’s citizens who had chronic lung disease and also their families. The local hospital served as an important co-sponsor. Just as with any successful venture, publicity for the BBSG’s meetings that involved collaboration with local newspapers, television stations, physicians, and healthcare facilities, was an important factor in the startup and longevity of the group.
Numerous factors combine to make any group successful; however, the BBSG members have reported year after year that they continue to attend meetings because they learn something new each time. Clearly, without the collaboration among the many entities involved (especially the speakers), the group could have dissolved. The speakers have represented various professions including nursing, medicine, respiratory therapy, health, dietetics, and social work. Topics have included arterial blood gases, breathing exercises, diet and lung disease, hope and humor, stress and coping, glaucoma and cataracts, yoga, and relaxation. While the majority of presentations at the meetings have addressed chronic lung disease, it is important to note that support group members expressed additional interests unrelated to their chronic illness. As a result they have also enjoyed learning about other topics such as foot care, massage therapy, diabetes mellitus, and assertiveness.
From the early beginnings of the BBSG, interprofessional collaboration was its hallmark. This collaboration provided many benefits. One benefit was the support and educational programs provided for persons with chronic lung diseases and their families. Work with the support group provided opportunities to not only offer educational programs for them but also to include them, if they voluntarily and confidentially chose to participate, in Institutional Review Board-approved research studies, which could eventually help improve their lives. Regardless of whether group members participated in the studies, they benefited from reports of the research findings. Additionally, group members and the meeting coordinator benefited from exposure to different ideas and new ways to improve daily lives. The speakers benefited from interacting with the group members and from recognizing that they had contributed to the well being of others. These benefits of interprofessional collaboration are supported by Williams, Young, Nikoletti, and McRae (2004), who studied the reasons recipients of implantable cardioverter defibrillators (ICDs) and their caregivers attended a support group. They found the groups’ speakers, who represented physicians, manufactures of the ICDs, and related support agencies, provided valuable information related to many topics. Without interprofessional collaboration, the valued information sharing could not have occurred.
The challenges associated with collaboration involved with the BBSG were and continue to be limited. The time involved in planning the meetings and collaborating with the speakers and members might be considered a challenge since the time could be spent on other activities. Program coordinators who find it difficult to make requests of other professionals might consider the collaboration involved in planning this group’s meetings very challenging since a diversity of topics and speakers was identified by the BBSG as important to the group’s satisfaction. This potential challenge was prevented by holding a BBSG planning meeting each January to evaluate the previous year’s programs. The group members offered suggestions for topics to be covered over the following 11 months and offered names of possible speakers. The members occasionally made the initial contact with suggested speakers. Follow-up contacts were made by phone, email, and/or facsimile (FAX). We found that the best way to plan for the year ahead was to plan the entire year’s program as early as possible. This allowed the BBSG members to know what to expect, the speakers to plan their presentation well in advance of the meeting, and the publicity efforts attract new members to the group. Interprofessional collaboration in this service area both provided community education and contributed to BBSG members’ satisfaction.
Interprofessional Collaboration: Research
Interprofessional collaborative efforts can enhance faculty scholarship and maximize such use of faculty time. Tenured and tenure-track faculty are expected to conduct research or scholarship in their disciplines and disseminate the findings/innovations through presentations and publications. Difficulty in finding time to conduct research, due to increasing classroom and clinical teaching loads, has been related to declining numbers of nursing faculty (Brown 2006; Cooke, Owen, & Wilson, 2002). Interprofessional collaborative efforts can enhance faculty scholarship and maximize such use of faculty time.
Examples of successful collaborative studies abound as evidenced by research journal articles with multiple authors. For example, the Fourth Quarter 2008 issue of Journal of Nursing Scholarship included only two single-authored articles while eleven articles were authored by two or more persons. The November 2008 issue of Applied Nursing Research demonstrates further the success of collaboration with seven of its eight original articles having multiple authors, four of which included international authors. The articles in these two nursing journal issues represent a total of eighteen articles that demonstrate professional collaboration, eight of which were interprofessional collaborations, leaving only three single-authored articles
...choosing a compatible colleague is an important step in successful collaborative scholarship...one should consider whether one works better alone or with a group and how well one is able to handle timelines, disagreements, and distance collaboration. The literature supports, however, and we also found that choosing a compatible colleague(s) is an important step in successful collaborative scholarship (Maglaughlin & Sonnewald, 2005). Casual conversations with colleagues, reviews of the literature, and suggestions from colleagues can all help in finding compatible collaborators. The conduct of research through collaboration, whether professional or interprofessional, adds the benefits of intellectual depth and greater likelihood of completion by virtue of the division of labor. In our case a collaborative research colleague was suggested when J.A. discussed a grant proposal with a grantor. This new relationship resulted in two small funded research grants: “Self-Care Behaviors of Persons with COPD in Southeast Georgia: A Pilot Study,” funding courtesy of the Center for Rural Health and Research, Georgia Southern University, 2001-2002; and also “Self-Care Behavior, Hope, Optimism, and Pessimism of Persons with COPD,” Faculty Research Grant, funding courtesy of Georgia Southern University, 2004-2005. Three presentations at scholarly conferences, two presentations for a local support group, and one publication in a nursing research journal were based on these collaborative research studies. These collaborative efforts did not end with dissemination of the findings. When another Health and Kinesiology colleague joined the research group, a third small research grant was funded, with the added colleague as primary investigator. This Faculty Research Grant, titled “Health Literacy Levels among Adult Support Group Members and the General Adult Public,” was funded by Georgia Southern University, 2006-2007, and resulted in a publication and two presentations.
...conduct of research through collaboration...adds the benefits of intellectual depth...Each learn[s] from the other in multiple ways during different phases of the collaborative process.Since teaching and research are integral to the nursing profession, essentially everyone associated with the described interprofessional collaborative efforts in research benefited. We, and our research collaborators from Nursing and Health and Kinesiology, benefited from the very act of working together. Each learned from the other in multiple ways during different phases of the collaborative process. Also, with each step of the process, ideas for future projects arose -- collaboration led to additional collaborative opportunities.
K. H.’s experiences illustrate an even broader benefit from interprofessional collaboration. These benefits have included over 35 collaborative research studies with colleagues in the fields of psychology, theology, medicine, education, counseling, social work, and public health from across the world. Hope and humor interventions identified through these studies are being integrated into healthcare, community, and school settings. Additionally this collaboration has included international collaborative writing and the sharing of research tools which now have been translated into 18 languages and used in over 340 faculty and/or students’ studies and more than 125 practitioners’ studies around the world. Those studies and others led to collaborative manuscripts with professionals from six countries and nine different professions. Furthermore, the studies’ findings led to numerous professional presentations to professional colleagues; undergraduate and graduate students; and cancer, Alzheimer’s disease, stroke, chronic lung disease, transplant, and caregiver support groups.
Beneficial as we have found interprofessional collaboration to be, we have identified several points to consider before making the decision to begin an interprofessional collaborative project. For example, one should consider whether one works better alone or with a group and how well one is able to handle timelines, disagreements, and distance collaboration. Table 2 presents a number of potential challenges and suggestions for preventing or handling challenges related to interprofessional collaboration.
Summary and Recommendations
...if faculty are to successfully teach, participate in service activities, and conduct research...the benefits of interprofessional collaboration outweigh the challenges. In this article, interprofessional collaborations have been identified as a positive way to reach educational, service, and scholarship outcomes. It is important to recognize that participation in these publications, presentations, and grants was not coincidental but rather resulted from integrating our work of service, research, and teaching. Suggestions have been offered to prevent undue associated challenges. We have found in our work that if faculty are to successfully teach, participate in service activities, and conduct research or other scholarly projects, the benefits of interprofessional collaboration outweigh the challenges. However, studies that produce empirical evidence of the benefits compared with the challenges of collaboration are warranted. We propose that interprofessional collaboration studies that are quantitative and qualitative, prospective and longitudinal with lengthy follow-up periods be conducted.
Table 2: Potential Challenges: Points to Consider about Interprofessional Collaboration
Do you work better alone or with others?
If you enjoy being in the presence of others, collaborative activities should be ideal for you. Even if you believe you work better alone, collaboration can be very beneficial because a great amount of each person's work is done alone, with sharing and collaboration as needed and desired. For example, one person usually takes the lead in preparing a research proposal and will be the primary investigator. The second person could make suggestions prior to the first draft of the proposal and later edit it while identifying its strengths and weaknesses. Therefore, both collaborators benefit from the process while having a great deal of time to think alone.
Are you able to voice disagreement and offer and accept constructive criticism?
To collaborate effectively, the ability to disagree and work toward consensus is essential. Both (or all) collaborators must be able to openly discuss the work while respecting the other(s) regardless of status or position.
Do timelines bother you?
Setting and keeping timelines when working with others is a priority. For example, if you agree to write a manuscript with a colleague and one of you is always on time while the other is generally late with assignments, the likelihood of disagreements developing, and even failure to produce a manuscript, is high.
Will the benefits to you outweigh the challenges?
If you are asked and/or encouraged to collaborate on a project or manuscript and the colleague is recognized as a person who completes projects/tasks, your chances for a good outcome are high.
What issues might you experience if you collaborate with someone located at a distance, even in another country?
If you have never met the person who asks you to collaborate, language and/or culture concerns could develop. Even if you are acquainted, different work schedules and time zones can create communication problems. However, the joy of working to a successful outcome from afar can certainly outweigh any potential problems.
How does one prepare to ask a colleague to collaborate on a manuscript?
Have a fairly well developed topic, one that is of interest to both of you. Think through the steps that you will follow while making the request. Indicate how the collaboration could benefit both of you and why you chose the individual as your collaborator. Indicate at that point that you will take the lead in writing and who will to be first author. After initial agreement, provide an outline of the manuscript to be sure both agree on its focus. Then, divide the work as appropriate. Based on the time each author has to devote to the work, it could be equally divided. However, the first author is often expected to produce the majority of the work.
Acknowledgment: The authors wish to acknowledge everyone who contributed to the success of their professional and interprofessional collaborations.
June Alberto, DNS, RN
June Alberto, Professor and RN-BSN Program Director at Georgia Southern University, earned nursing degrees at Indiana University (DNS), the University of Kentucky (MSN), and Spalding College (now University) (BSN), and a Diploma at St. Joseph Infirmary School of Nursing, Louisville, Kentucky. She has held faculty positions at Spalding College, the University of Louisville, and Georgia Southern University. Each faculty and leadership position and the associated teamwork, both clinical and academic, contributed to her knowledge and ability to collaborate successfully with colleagues from other disciplines. Serving on committees at college and university levels at each academic institution also facilitated the development of collegial relationships, which in turn fostered her interprofessional collaborative endeavors.
Kaye Herth, PhD, RN, FAAN
Kaye Herth, former Chair, School of Nursing at Georgia Southern University, and current Dean of the College of Allied Health and Nursing at Minnesota State University, Mankato, earned a Doctorate in nursing from Texas Woman’s University, a Master of Science degree in nursing at the University of Minnesota, a Bachelor of Science degree in nursing from Northern Illinois University, and a diploma in nursing from St. Luke’s Hospital School of Nursing; Racine, Wisconsin. She joined Minnesota State University in 1998, having served in leadership positions at Georgia Southern University, Northern Illinois University, and Clemson University. Dr. Herth has extensive clinical, teaching, and administrative experience that has involved successful collaborative work across disciplines in a variety of capacities. Her scholarly work has involved collaborative research projects, publications, and presentations with students, faculty, colleagues, and research scientists from around the world, including the translation of her tools to measure hope into 18 foreign languages. Dr. Herth has received numerous honors and awards for her collaborative scholarship, leadership, and professorship activities.
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© 2009 OJIN: The Online Journal of Issues in Nursing
Article published March 31, 2009
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