Changing Student Attitudes Toward Interprofessional Learning and Collaboration: Evidence for the Effectiveness of Partnering with Healthcare Mentors in the Academic Setting.

PURPOSE: Individuals living with chronic health conditions serving as healthcare mentors (HCM) allow the creation of high impact, authentic learning experiences. The purpose of this study was to examine the effectiveness of a 6-hour curricular experience involving HCM in changing student attitudes toward interprofessional learning (IPL) and collaboration (IPC). METHODS: Thirty-eight students from clinical psychology, nursing, physical therapy, and social work programs participated in either the learning intervention (n=19) or the control group (n=19). Students in the IPL group examined the HCMs, who were diagnosed with multiple sclerosis, shared the findings during an interprofessional team meeting, and collaboratively developed consensus-based interprofessional care recommendations. The Interdisciplinary Education Perception Scale, Readiness for Interprofessional Learning Scale, and Attitudes Toward Health Care Teams Scale were completed pre- and post-IPL. In addition, discipline-specific focus groups were also conducted. RESULTS: The IPL experience resulted in positive changes in student attitudes toward teamwork and collaboration. Teamwork among the students was reportedly characterized by open communication, mutual respect, and the incorporation of ideas from other disciplines. CONCLUSIONS: Positively changing students' attitudes and skills for IPC prior to licensure is an important first step in providing coordinated interprofessional care to patients/clients living with chronic health conditions.

Effects of High-Fidelity Simulation on Physical Therapy and Nursing Students' Attitudes Toward Interprofessional Learning and Collaboration.

BACKGROUND: The study purpose was to examine changes in physical therapy (PT) and nursing (RN) student attitudes toward interprofessional learning (IPL) and interprofessional collaboration (IPC) following a high-fidelity code simulation. METHOD: PT (n = 42) and RN (n = 35) students, while working together to transfer a simulated patient, had to respond to a sudden and unexpected medical emergency. Pre- and postsurveys included the Interdisciplinary Education Perception Scale (IEPS), Readiness for Interprofessional Learning Scale (RIPLS), and Attitudes Toward Health Care Teams Scale (ATHCTS). A control group (PT, n = 41; RN, n = 33) of students were also surveyed. RESULTS: Statistically significant between- (p < .003) and within-group differences (p ⩽ .006) occurred for the IEPS (competency and autonomy, perceived need for and perceptions of actual cooperation), the RIPLS (teamwork and collaboration, professional identity), and the ATHCTS (team value and efficiency). CONCLUSION: The IPL experience using high-fidelity simulation fostered the development of attitudes necessary for effective IPL and IPC. [J Nurs Educ. 2017;56(8):456-465.].

Validity and Reliability of 2 Goniometric Mobile Apps: Device, Application, and Examiner Factors.

CONTEXT: Smartphones are being used in a variety of practice settings to measure joint range of motion (ROM). A number of factors can affect the validity of the measurements generated. However, there are no studies examining smartphone-based goniometer applications focusing on measurement variability and error arising from the electromechanical properties of the device being used. OBJECTIVE: To examine the concurrent validity and interrater reliability of 2 goniometric mobile applications (Goniometer Records, Goniometer Pro), an inclinometer, and a universal goniometer (UG). DESIGN: Nonexperimental, descriptive validation study. SETTING: University laboratory. PARTICIPANTS: 3 physical therapists having an average of 25 y of experience. MAIN OUTCOME MEASURES: Three standardized angles (acute, right, obtuse) were constructed to replicate the movement of a hinge joint in the human body. Angular changes were measured and compared across 3 raters who used 3 different devices (UG, inclinometer, and 2 goniometric apps installed on 3 different smartphones: Apple iPhone 5, LG Android, and Samsung SIII Android). Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to examine interrater reliability and concurrent validity. RESULTS: Interrater reliability for each of the smartphone apps, inclinometer and UG were excellent (ICC = .995-1.000). Concurrent validity was also good (ICC = .998-.999). Based on the Bland-Altman plots, the means of the differences between the devices were low (range = -0.4° to 1.2°). CONCLUSIONS: This study identifies the error inherent in measurement that is independent of patient factors and due to the smartphone, the installed apps, and examiner skill. Less than 2° of measurement variability was attributable to those factors alone. The data suggest that 3 smartphones with the 2 installed apps are a viable substitute for using a UG or an inclinometer when measuring angular changes that typically occur when examining ROM and demonstrate the capacity of multiple examiners to accurately use smartphone-based goniometers.

Interrater and intrarater reliability and minimal detectable change of the Wisconsin Gait Scale when used to examine videotaped gait in individuals post-stroke.

BACKGROUND: Often, interventions targeting the kinematic and temporal and spatial changes in gait commonly seen after a stroke are based on observations of walking. Having the capacity to objectively identify such changes and track improvements over time using reliable and valid measures is important. The Wisconsin Gait Scale (WGS), which is comprised of 14 items, was developed specifically to examine and document gait changes occurring after a stroke. The purpose of the study was to explore the interrater and intrarater reliability and minimal detectable change (MDC) of the WGS when used by physical therapists to examine gait in adults post-stroke. METHODS: Fourteen physical therapists from 3 different acute inpatient rehabilitation centers rated videotapes of the gait of 6 adults post-stroke using the WGS. To minimize subject variability from fatigue, videotapes created by using 4 cameras provided right and left lateral, anterior, and posterior views of walking on a level surface. One complete ambulation trial from each subject post-stroke, which included 4 views of the same ambulation trial, was examined by the licensed physical therapists using the WGS. An opportunity was provided to review the tool and a practice trial was performed using an additional videotape not included in the analysis. Gait was examined on 2 different occasions separated by a period of approximately 21 days to minimize the effects of recall bias. Intraclass Correlation Coefficients (ICC) were used to examine the interrater and intrarater reliability of the WGS. RESULTS: Interrater (ICC = 0.83) and intrarater (ICC = 0.91) reliability were both good. The standard error of the measurement (SEM) was 1.47 and the MDC95 was 4.24. There was no statistically significant difference between the scores on the WGS when comparing the 2 different sessions. CONCLUSIONS: The WGS shows promise as an instrument that can make observational gait analysis more reliable. High intrarater reliability and low SEM suggests that the WGS is stable when administered across multiple sessions by the same rater. The ICC for interrater reliability was also good, which suggests that multiple examiners can effectively use the instrument. With minimal training, the physical therapists in the study were able to produce highly reliable results using the WGS to objectively document gait dysfunction.

The effects of aging on the attentional demands of walking toward and stepping up onto a curb.

Community ambulation requires the capacity to alter gait in response to obstacles within the path of travel that appear at a known location. Acquiring information from the environment to safely negotiate a curb may increase the cognitive demands of walking. The purpose of this study was to examine the attentional demands of walking toward and stepping up onto a curb in young, middle-age and older adults. Single and dual-task voice reaction time (VRT) was measured in community-dwelling young (n = 24), middle-age (n = 24), and older adults (n = 24) across 5 conditions: sitting in a chair, standing, level walking, and walking toward and while stepping up onto a curb. A 3 (group) by 5 (task condition) ANOVA was used to examine VRT. The interaction of group with task revealed statistically significant within group increases in VRT when comparing either sitting and/or standing to walking on a level surface and walking toward the curb and stepping up onto the curb. When compared to the other groups, older adults had significantly longer VRT for all walking tasks. Stepping onto the curb significantly increased the attentional requirements of walking for all of the groups when compared to level walking. The pattern of statistically significant between group and within group differences during the walking tasks indicate the effects of a curb located at a predictable place in the environment on attentional allocation.

Changes in student attitudes toward interprofessional learning and collaboration arising from a case-based educational experience.

Working effectively with other disciplines is an important and necessary skill for healthcare practitioners. Academic institutions can provide educational experiences that can begin to foster the prerequisite competencies needed to collaborate successfully with other healthcare professionals. The purpose of this study was to examine changes in attitudes toward learning from and collaborating with other healthcare students and professionals arising from an interprofessional educational (IPE) experience. A total of 123 graduate students from clinical psychology (n = 35), education (n = 17), physical therapy (n = 36), and social work (n = 35) were enrolled in the study and participated in a 6-hour IPE experience designed to improve their understanding of the roles played by other healthcare professionals on teams and to teach the skills necessary to effectively collaborate. Attitudes toward learning from and collaborating with other disciplines were examined prior to and immediately after an IPE experience using the Interdisciplinary Education Preparation Scale (IEPS), the Readiness for Professional Learning Scale (RIPLS), and the Attitudes Toward Healthcare Teams Scales (ATHCTS). A 4 (discipline) 3 2 (pre- vs post-IPE) repeated measures ANOVA was used to investigate between- and within-group differences. Statistical significance was set at p ≤ 0.05 for all primary analyses, and post hoc differences for any statistically significant ANOVA findings were explored using a Bonferroni procedure. Statistically significant increases in post-IPE scores on the IEPS, RIPLS, and ATHCTS were found, indicating positive changes in attitudes toward learning from and collaborating with graduate students and other healthcare professionals. A well-structured educational experience, consisting of 6 hours of interprofessional interaction, can change student attitudes toward learning from and collaborating with peers in other healthcare disciplines prior to graduation and professional licensure. The current study provides evidence that a relatively short educational intervention implemented prior to graduation can positively change attitudes toward learning and collaboration.

Does the attentional demands of walking differ for older men and women living independently in the community?

BACKGROUND AND PURPOSE: Walking has been shown to be an attentionally demanding task. For older adults, gender-specific differences in gait and falling reported in the literature could arise as a result of the attentional demands of walking. However, differences in how older men and women allocate attention to walking have not been investigated. The purpose of this study was to use a dual-task voice reaction time paradigm to examine gender-specific differences in the attentional demands of walking in older adults who are independent in community ambulation. METHODS: A dual-task paradigm was used to measure voice reaction time (VRT) in older community-dwelling men (n = 29; mean age = 78.40, SD = 6.17 years) and women (n = 33; mean age = 77.01, SD = 6.07 years) under 3 task conditions: sitting in a chair, standing, and walking on a level surface. Between- and within-group differences in dual-task VRT were examined using a 2 (men vs women) by 3 (task condition) repeated-measures analysis of variance. The level of statistical significance was set at 0.05, and a Bonferroni procedure was used for post hoc analyses. RESULTS: Sitting VRT was similar for men (mean = 454.90, SD = 140.05 milliseconds) and women (mean = 454.49, SD = 94.27 milliseconds). While standing, men had a slightly faster VRT (mean = 444.90, SD = 125.31 milliseconds vs mean = 452.09, SD = 92.82 milliseconds). When walking, VRT increased for both groups in comparison to sitting and standing and older men (mean = 509.11, SD = 142.19 milliseconds) responded faster than older women (mean = 537.55, SD = 122.43). However, the main effect of gender (P = .665) and interaction of gender with task (P = .433) were both not statistically significant. A statistically significant main effect for task (P < .001) indicated that walking VRT (mean = 524.25, SD = 131.71 milliseconds) was significantly longer than both sitting (P < .001, mean = 454.68, SD = 116.89 milliseconds) and standing (P < .001, mean = 448.36, SD = 108.37 milliseconds) VRT. DISCUSSION: The results demonstrate that the attentional demands of walking are not different for older adult men and women who are independent in community mobility. However, support was provided for the idea that walking is an attentionally demanding activity. In comparison with sitting and standing, walking was more attentionally demanding for both men and women. CONCLUSIONS.: A dual-task voice reaction time paradigm revealed that walking is not more attentionally demanding on the basis of gender when comparing community-dwelling older adult men with women.

Changes in dual-task voice reaction time among elders who use assistive devices.

PURPOSE: Assistive devices are prescribed for a variety of reasons and have the obvious benefit of enhancing gait performance for some individuals. However, the use of an assistive device may make walking a more complex and cognitively challenging task. The purpose of this study was to use a dual-task voice reaction time (VRT) paradigm to examine the attentional demands of walking with an assistive device in a group of elderly adults. METHODS: Standing and walking VRTs were measured in a sample of 105 elderly adults who ambulated independently with either a rolling walker (RW; mean age = 87.8 +/- 5.5 yrs), a straight cane (SC; mean age = 84.1 +/- 5.6 yrs), or used no device (ND; mean age = 79. 9 +/- 4.5 yrs). A 3 (group) by 2 (task condition) ANOVA with repeated measures on the last factor was used to examine between and within group differences in VRTs. RESULTS: The main effects of group (p = 0.004) and task (P < 0.001) and the interaction of group with task (P = 0.025) were all statistically significant. There were no statistically significant between group differences in standing VRT. Between group differences appeared during the walking task, VRT for the RW group was significantly longer than for the ND group. When examining within group difference, walking VRT was significantly longer than standing VRT for the SC and RW groups. CONCLUSIONS: The results demonstrated that there is an increase in the attentional demands of walking for elderly adults who are experienced assistive device users. The increased attention required to walk with an assistive device may be a factor leading to increased fall risk.