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Asian Journal of Healthy and Science

p-ISSN: 2980-4302

e-ISSN: 2980-4310

Vol. 3 No. 2 February 2024

A STUDY ON THE EFFECTIVENESS OF INTERPROFESSIONAL

COLLABORATIVE TRAINING IN ENHANCING INTERPROFESSIONAL

COMMUNICATION AND TEAMWORK AMONG NURSES AT X

HOSPITAL JAKARTA

Theresia Kurniasih

, Asnet Leo Bunga

, Sudibyo Supardi

1,2

RSIA Kemang Medical Care, Indonesia

STIK Sint Carolus, Indonesia

Badan Riset Inovasi Nasional, Indonesia

Email: teredave@gmail.com

Abstract

The establishment and maintenance of effective relationships between professionals

is referred to as interprofessional collaboration. This study aimed to assess the

effectiveness of multidisciplinary collaborative practice training in improving

communication and teamwork among professionals at RSIA X Jakarta. The study

used a quasi-experimental design with a sample size of 35 nurses who were given

Interprofessional Collaborative Practice training and 35 nurses as controls, with the

criteria of having held the positions of Supervisor, Nurse on Duty and Head of

Nursing department. Collaborative Practive Assesment Tool (CPAT) questionnaire

was used to collect data. For data analysis, chi-square tests and multiple logistic

regression tests were used to answer the research hypotheses. The study results

showed that Interprofessional Collaborative Practice Training was found to improve

nurse interprofessional communication (p=0,029) and nurse teamwork (p=0,000).

Nurses who received IPCP training increased their chances of teamwork 13.1 times

higher compared to nurses who did not receive training (control). This study

recommends the need to conduct additional study involving respondens from various

professions and the need to provide Interprofessional Collaborative Practice Training

to all professional teams in the hospital. Mapping the career path is necessary to

ensuring that the achievement of each level of clinical nurse structure are well

balanced. A strategic plan is necessary to be implemented to achieve nurse education

level up to the baccalaureate level and regulation must be reinforced to create

interprofessional collaboration culture in the hospital.

Keywords: Interprofesional Collaborative Practice, Training, Teamwork,

Interprofessional Communication

INTRODUCTION

Nursing services play a significant role in determining hospital quality. Hence,

all initiatives to improve hospital services also endeavor to enhance the quality of

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nursing services. The modern approach to health services involves a holistic approach

that looks at human in terms of their thought, emotions, lifestyle and social

environment as a whole (for Nursing et al., 2021).

The role of nurses as interpersonal collaborator among Professional Care

Providers (PCPs) is very crucial towards hospital services improvement. According

to the Indonesia Health Ministerial Decree No.HK.01.07/MENKES/1128/2022

regarding Hospital Accreditation Standards states that good multidisciplinary

collaboration between all clinical and non-clinical staff is expected to be able to

provide the best services to clients, working together as an interdisciplinary team with

interprofessional collaboration using applicable standards and regulations.

The 2022 Hospital Accreditation Standards state that the primary goal of

hospitals and their staff is to provide safe and effective care and services to their

patient. To ensure that care delivery is responsive to each patient’s individual needs,

effective communication, collaboration and standardization are among the variables

that must be implemented. All Professional Care Providers (PCPs) must work

together as a multidisciplinary team, collaborating with other professionals to

coordinate and integrate care and service delivery.

Different patients have different needs, each with its own complex of health

conditions. Overcoming the health problems that arise requires multiple scientific

disciplines. The Institude of Mediccine of the Committee on Quality Health Care in

2021 recommended that health care providers work in multidisciplinary teams and

communicate with each other to address patient’s complex needs. Through this

interprofessional approach, healthcare providers can pool their knowledge and

perspectives to work towards the common objective of restoring or preserving patient

health.

Collaboration among interprofessionals fosters effective interprofessional

relationships and strengthen the relationships between students, healthcare

providers, patients/clients/families, and the community to achieve optimal health

outcomes. (Canadian Interprofessional Health Collaborative, 2016). Mutual respect,

trust, and cooperation are essential components of such collaboration. In order to

support patients, families or communities through interprofessional communication,

interprofessional teams are expected to be able to work cooperatively, integrating

their individual roles and responsibilities, optimizing team functions, and exercising

collaborative leadership. Effective interprofessional communication depends on the

ability of the participants to see various types of transitions that differ according to

their profession and become more cooperative. This is supported by research

conducted by Engel et al., (2013) on the Interprofessional Education Collaborative,

which states that it is critical to increase knowledge about specific topics through

interprofessional collaboration in clinical practice.

The World Health Organization states that there is a need to improve the

health-care system based on the first principle of health-care delivery, which is one of

the most significant challenges for those responsible for developing health-care

policies, managers, and citizens around the world. They are looking for an innovative

system of change that can improve the quality of the healthcare system by fostering

interprofessional collaboration (WHO, 2014).

In 2016, IPEC reintroduced core competencies aimed at enhancing existing

competencies in the domain of interprofessional collaboration and enhancing

competencies to better integrate health promotion efforts across all health professions

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while also increasing collaboration to improve the health of individuals and

communities. By fostering an understanding that interprofessional collaboration is a

key component of safe, high-quality patient-centered care. Emphasis on core

competencies is a result of Schumacher et al., (2013) who illustrate eight domains in

interprofessional practical collaboration, namely: values/ethics,

roles/responsibilities, interprofessional communication, and teamwork. All of this

adds up to patient and family centered care (Sevin et al., 2016).

King (1981) possessed a personal philosophy about humanity and life that was

primarily concerned with relationships to the environment, health, individuality, and

other people. King has a conceptual system and goal-achieving theory based on the

general assumption that human interaction with the environment affects people's

health and serves as a means of assisting them in fulfilling their social roles. King

Alligood, (2014) developed the Dynamic Interacting Systems theory, which builds

its interaction systems framework using a systems method. This theory aims to

understand and comprehend "Changes and Complexities in Health Organizations."

Tuffin, (2016) used the systemic approach to conceptual development and the middle

range theory, or goal attainment theory.

King discovered that several scientists have been studying the system, and that

the most effective way to learn about human interaction with the environment is to

develop a framework, a concept about a variable that is likely to be beneficial, and a

concept known as dynamic theory. Interacting System is made up of three systems:

1) Personal System, 2) Interpersonal System, and 3) Social System. The three system

of dynamic system theory is very much related to the daily challenges of

interprofessional collaboration with professional skills and ethics, role and

responsibility, interprofessional communication, and teamwork.

RESEARCH METHODS

This is a quantitative study that use a quasi-experimental pre-post test design to

examine the causal relationship between one variable in one (or more) experimental

groups and comparing the results to a control group that did not receive treatment.

The study was carried out in 2023 between June and August. RSIA X Tangerang

served as the control group, and RSIA X Jakarta served as the intervention group.

conducted following the acquisition of research authorization from the Director of

RSIA and ethical clearance from the STIK Saint Carolus Research and Development

Ethics Committee (No: 098/KEPPKSTIKSC/VI/2023).

In this study, the experimental group consisted of nurses working at RSIA X in

South Jakarta as the head of the nursing unit, Duty Officer, and Shift Coordinator,

while the control group consisted of nurses working at RSIA X Tangerang as the

head of the nursery unit, Duty Officer, and Shift Coordinator. Sample size was

calculated using Lemeshow's (1997) Quasi Experiment technique, utilizing a total of

seventy nurses who met the following inclusion criteria: PK Level 1, PK Level 2, and

PK Level 3; role as Head of Nursing Unit; Shift Coordinator and Duty Officer; and

Nurse working more than two years (Irish et al., 2021).

Pre-PK nurses and nurses who serve as executive staff are the exclusionary

criteria. The Collaborative Practice Assessment Tool (CPAT) was employed in this

study. The CPAT is deemed realisable since it has three open questions, 56 statement

items, eight subscales, and a Cronbach alpha value of 0.916 (YUSRA, 2017).

According to YUSRA, (2017), the CPAT instrument version of Indonesia has been

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pronounced realizable based on the validity and realisability test findings, which

show a Cronbach alfa value of 0.916.

Ethical guidelines are followed when doing research to ensure that participants

are protected, benefit, and are not harmed. According to the National Health

Research and Development Ethics Committee (2020) in Agrawal & Gupta, (2022),

by using the ethical guidelines employed in health research

Data Analysis

1. Univariate analysis: data is presented as a frequency distribution (for categorical

data) or as statistical descriptors (mean values, defaults, minimum values,

maximum values) for numerical data.

2. Bivariate analysis: a non-parametric statistical test of the Wilcoxon test to

determine the difference between before and after intervention.

3. Multivariate analysis was employed, as well as multiple logistic regression testing.

RESULT AND DISCUSSION

Univariate

Table 1. Age distribution, career level and education of nurses at RSIA X

Jakarta, 2023

Characteristic

Case

Control

∑

Age

21-30 yo

31%

34%

31-40 yo

54%

43%

> 40 yo

15%

23%

Education

Nursing Diploma

89%

34%

Ners

11%

66%

Career Level

PK1

23%

PK2

49%

86%

PK3

28%

14%

Total

100

Table 1 demonstrates that the intervention group (54%) and control group

(43%), respectively, had the highest percentage of responders aged 31 to 40 years.

This demonstrates that the age group in both groups, experimental and control, is a

general category that includes the age range from late adolescence to nearing late

adulthood Kemenkes RI, (2007), where a person has the desire and willingness to be

able to develop yourself and follow current developments.

According to the educational level of nurses, the intervention group had the

highest proportion of Diploma 3 of Nurses (89%) while the control group had the

highest percentage of Bachelor's Degree in Nursing (66%). This demonstrates that

Diploma 3 of Nurses continues to dominate the fulfillment of the degree of Nursing

HR education in the intervention group.

The intervention group had the highest percentage of nurses in PK2 (49%),

while the control group had the highest percentage in PK2 (86%).

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Table 2. Distribution of Interprofessional Communication

Group

Interprofessional Communication

Improved

Not Improved

∑

Case

54%

46%

Control

29%

71%

A total of 54% of respondents reported an improvement in the interprofessional

communication variable for nurses following the intervention, whereas 5 statements

had the lowest outcomes (<80%). In contrast, sixty-three percent of respondents

reported an increase in the nursing team collaboration variable, and one statement

had the lowest result (less than eighty percent) in the team collaboration distribution.

This indicates that the age group is within the range of late adolescent to late

adulthood Chan, (2009), which is the age range in which an individual is eager to

follow current developments and has the desire and ability to grow personally.

Education continues to be dominated by Diploma 3 of Nurse has limited authority

and duty and is classified as a vocational nurse. completion of PK 2 professional

level, allowing you to offer comprehensive nursing care but still requiring supervision

when managing patients with challenging issues.

Table 3. Distribution of Teamwork

Group

Teamwork

Improved

Not Improved

∑

Case

63%

37%

Control

11%

89%

Table 3 presents statistics on the increase in the teamwork variable in the

intervention group, where 63% of respondents rose, implying that those who

increased outnumbered those who did not, whereas 89% of those in the control group

did not increase. This is consistent with Hani et al., (2021) affective training aims,

which suggest that training can improve a person's feelings, values, and attitudes,

allowing them to alter a person's attitudes or conduct. Meanwhile, the cognitive

category can help to boost understanding and analyzing skills. These are the points

at which someone must be able to create interprofessional teamwork.

Bivariate:

Table 4. Differences in Interprofessional Communication Scores of Nurses in the

intervention and control groups before and after IPCP training at RSIA X

Jakarta, 2023

Interprofessional

Communication

Mean

Pre-%

Mean

Post-%

Pre to Post %

Difference

% Increase

pValue

Case

12,73

19,08

6,35

0,50%

0,065

Control

11,9

9,1

-2,8

-0,23%

0,59

Table 2 showed that the average interprofessional communication score of the

intervention group's nurses was 12.73 prior to training, and it increased by 0.50% to

19.08 after training. The results show that there is no significant difference in the

interprofessional communication scores of nurses in the intervention group before

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and after Collaborative Practical Interprofessional training (pvalue = 0.065; > α =

0.05), indicating that Ha is rejected. In the meantime, p-value = 0.59 (> α = 0.05) in

the control group.

Elizabeth & Arnold, (2016) cites research that indicates that in addition to

training, system development, and strong support are also necessary for the creation

of effective interprofessional communication. To ensure interprofessional

communication is implemented effectively, all hospital professionals must participate

in its implementation.

Table 5 Differences in Teamwork Scores of Nurses in the Intervention and

Control Groups Before and after IPCP Training at RSIA X Jakarta, 2023

Teamwork

Mean

Pre-%

Mean

Post-%

Pre to Post %

Difference

% Increase

p Value

Case

12,3

18,41

6,11

0,50%

0,008

Control

7,55

7,38

-0,17

-0,02%

0,59

In the intervention group, there was a statistically significant difference in

nursing teamwork scores before and after Interprofessional Collaborative Practice

training (p value = 0.008) Ha.

This demonstrates how interprofessional collaborative practice training can

help you develop the competencies needed for effective teamwork, such as self-

awareness of your professional strengths and limitations, an appreciation of

individual diversity, the capacity to create a system of perspectives, professional

policies, and problem-solving abilities. advantageous (Elizabeth & Arnold, 2016).

Multivariate

Table 6. Multivariate Test Result

Variable

Sign

Exp B

CI 95%

Lower

Upper

Step 1

TRAINING

2.505

.753

.001

12.246

2.799

53.583

Career Level

-.199

.605

.742

.820

.251

2.680

Education

-.185

.802

.817

.831

.172

4.005

Step 2

TRANING

2.599

.644

.000

13.446

3.807

47.488

Career Level

-.202

.603

.737

.817

.250

.2665

Step 3

TRAINING

2.574

.636

.000

13.115

3.770

45.629

As an extension of the previous test, the Multivariate test results are shown in

Table 1 in order to assess the variables that have the greatest impact on raising the

nurse teamwork score from the Interprofessional Collaborative Practice Training

variable. With a sign value of 0.000 and an Exp (B) value of 13.115, the multivariate

logistic regression test's final results demonstrate the influence of Interprofessional

Collaborative Practice training on enhancing teamwork among nurses. This means

that nurses who receive Interprofessional Collaborative Practice Training can

increase teamwork by 13.12 times more than control nurses. The rise in nursing

teamwork was unaffected by the findings of the confounding variable study.

Teamwork in nursing entails communication and cooperation among nurses,

doctors, and other health-care professionals. Arnold et al., (2022) further states that

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staff expectations, norms, attitudes, and beliefs are all part of the collaborative

culture. In order to establish a health team that works, there needs to be a greater

understanding of the importance of teamwork over individual liberty. Thus, in order

to develop this, extensive and ongoing training across all professional domains is

required. This statement is also consistent with Kandouw, (2021) research, which

shows that employee performance is positively impacted by cooperation.

The researcher also believes that training can help people become more

knowledgeable, but it can also help them become more skilled, which in turn helps

them perform and behave more differently. Raising awareness of the fundamental

skills required to enhance cooperation will foster a work environment that

encourages coordination and collaboration through effective teamwork. will enhance

an individual's performance.

CONCLUSION

At the research location, the majority of nurses were between the ages of 31 and

40, with a career level of PK 2. Those in the intervention group were more likely to

have a Diploma 3 in Nursing. Five statements had the lowest outcomes (<80%) in

the interprofessional communication variable for nurses, with 54% of respondents

reporting improvement after receiving the intervention. Sixty-three percent of

respondents reported an increase in the nursing team collaboration variable, and one

statement had the lowest result (less than eighty percent) in the teamwork

distribution.

The interprofessional communication scores of the intervention and control

groups' nurses did not differ significantly before and after Interprofessional

Collaborative Practical training (p value = 0.065). The nursing teamwork scores of

the intervention group showed a significant difference (p value = 0.008) Ha between

before and after Interprofessional Collaborative Practice training. Following

Interprofessional Collaborative Practice training, there was a substantial impact on

the intervention group's score for improving nurses' interprofessional communication

(p value = 0.029). There is a signification effect on the score of increasing teamwork

among nurses after Interprofessional Collaborative Practice Training in the

intervention group (p value = 0.000). Nurses who received Interprofessional

Collaborative Practice Training increased their chances of teamwork 13.1 times

compared to nurses who did not receive training (control).

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Theresia Kurniasih, Asnet Leo Bunga, Sudibyo Suparadi (2024)

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