EFFECT INTERPROFESSIONAL EDUCATION MODEL ON TEAM WORK AND

COLLABORATION ATTITUDES OF NURSES STUDENTS IN THE INTENSIVE

CARE UNIT OF HOSPITAL
(Pengaruh Model Pendidikan Interprofessional Tim Kerja Dan Sikap Kerja Sama
Mahasiswa Perawat Di Unit Perawatan Intensif Rumah Sakit)

Eny Kusmiran, Istianah, Lisbet Octovia Manalu.

PSIK Sekolah Tinggi Ilmu Kesehatan Rajawali Bandung
Jl Rajawali Barat No 38 Bandung Jawa Barat 40184, Telp (022) 6079141
Email: enykusmiran@gmail.com , Istianahbdg@yahoo.co.id , lisbetpediatrik@yahoo.co.id

ABSTRAK
Pendahuluan: kebijakan International merekomendasikan Interprofesional Pendidikan (IPE) untuk meningkatkan praktek
interprofessional Dalam upaya untuk meningkatkan praktek perawat profesional, IPE adalah strategi membentuk perilaku
profesional perawat dalam kerja tim dan kolaborasi antara profesional kesehatan lainnya, terutama dokter dalam perawatan
kritis. Tujuan untuk mengetahui pengaruh model IPE kerja tim dan kolaborasi dari sikap mahasiswa keperawatan di unit
perawatan intensif Rumah Sakit. Metode: Penelitian ini dilakukan dengan Rancangan kuasi-eksperimental. Jumlah 30
subyek (15 intervensi dan 15 kelompok kontrol) oleh random sampling. intervensi terdiri dari: 1) pretest 2) pemberian
modul pendidikan interprofessional materi pada mata pelajaran keperawatan kritis selama 2 minggu, 2) posttest. tes t
berpasangan digunakan untuk menentukan dampak dari Pendidikan interprofessional. Kemerdekaan t-test digunakan
untuk mengetahui pengaruh perbedaan Pendidikan interprofessional. Instrumen yang digunakan adalah Sikap terhadap
Kesehatan interprofessional Tim Timbangan untuk mengukur sikap kerja tim dan Interprofesional Kolaborasi Timbangan
untuk mengukur sikap kolaborasi. Hasil: Ada tarif perbedaan kerja tim dan sikap kolaborasi perawat sebelum dan sesudah
pada kelompok intervensi. Ada werenot tarif perbedaan kerja tim dan sikap kolaborasi perawat sebelum dan sesudah pada
kelompok kontrol. Ada nilai perbedaan sikap kerja tim dan kolaborasi antara intervensi dan kelompok kontrol. Diskusi:
Memberikan modul IPE untuk perawat umumnya dianggap menjadi strategi penting untuk meningkatkan kerja tim dan
sikap kolaborasi pada siswa perawat di unit perawatan intensif rumah sakit.

Kata kunci: Interprofessional Pendidikan, kerja tim, kolaborasi, mahasiswa perawat

ABSTRACT
Introducction: International policy recommends Interprofesional Education (IPE) to improve the practice of
interprofessional In an effort to improve the practice of professional nurses, the IPE is the strategy of forming professional
conduct of nurses in team work and collaboration between other health professionals, especially doctors in critical care.
Objective to identify the effect of IPE model of team work and collaboration of the attitudes of nursing students in an
intensive care unit of Hospital. Methods: This study was conducted with The quasi-experimental design. The number of
30 subjects (15 intervention and 15 control group) by random sampling. The intervention consisted of: 1) pretest 2) the
provision of material interprofessional education modules on subjects of critical nursing for 2 weeks, 2) posttest. Paired
t tests were used to determine the effects of interprofessional Education. Independence t-test were used to determine the
difference effect of interprofessional Education. The instrument used was The Attitudes towards interprofessional Health
Care Teams Scales to measure the attitude of teamwork and Interprofesional Collaboration Scales to measure the attitude
of collaboration. Results: There were differences rates of team work and collaboration attitudes of nurses before and after
on intervention group. There werenot differences rates of team work and collaboration attitudes of nurses before and after
on control group. There were differences scores of the attitude of team work and collaboration between the intervention
and control groups. Discussion: Giving IPE modules for nurses are commonly regarded to be an essential strategy for
improving team work and collaboration attitudes on nurses student at intensive care unit of hospital.

Keywords: Interprofessional Education, team work, collaboration, nurses student

INTRODUCTION team has an important role in the patient

care. An effective teamwork is supported by
International policy recommends
education level and professional attitude, with
Interprofesional Education (IPE) to improve
mutual respect ability and contribution of
the practice of interprofessional (Craddoch
each profession in treating patients (Cullen,
et al., 2013). Health service system, nurse
Fraser, & Symond, 2003). This professional
and doctor partnership, as the executor

115
Jurnal INJEC Vol. 1 No. 2 Desember 2016: 115–121
attitude is formed professional education
and supported by practise environment that
allows the interprofessional collaboration. The
experience of team work among professions
and interprofessional relationship is very
low in each profession learning process,
therefore the curriculum of IPE enables
students to have interaction experience in
working and collaboration with other health
interprofessions.
This Interprofessional Education is
widely applied in higher education curriculum
of health profession (Wilhelmson, 2011),
however this education model has not been
widely applied in Indonesia, especially
in nursing. Team work ability in team and
collaboration with other health professions is
one of the competencies that must be possessed
by nursing students, therefore this IPE model
is righteously applied in the curriculum of
nursing education, as recommended by WHO
(2010) that there are a lot of benefits provided
by the implementation of this IPE.
Based on the above backgrounds, the
researcher was interested to study about
“The effect of Interprofessional Education
(IPE) model to the team work attitude and
collaboration of nursing students in the
intensive care unit of hospital”. The purpose
of this study is to identify the effect of
Interprofessional Education model to the team
work and collaboration attitude of nursing
students in the intensive care unit of hospital.
The theoritical benefit of this study result
is the basis for nursing education curriculum
in Indonesia and other health professions
education in general, in implementing IPE in
the curriculum especially in critical nursing
learning outcomes.
The practical benefit of this study result
is the basis for learning method change in order
to improve the capability of nursing students
during his/her practice by implementing IPE.
In addition, this research result is also used
as the basic info in improving the nursing
education research by impelemting IPE in
other learning outcomes in order to improve
the quality of nursing profession.
116
Literature Study
Interprofessional Education
Interprofessional education (IPE) is an
application of adult learning which interactive,
group-based, allowing collaboration practise
and mutual understanding of any involved
profession (Barr, 2001). IPE based learning
process is an education process which
involves two or more health profession so
the interaction among these professions can
encourage knowledge transfer and establish
a mutual appreciation of each competence in
teamwork and collaboration among professions
(Colyer et al., 2005). Some studies show that
the effect of IPE improved the satisfaction
of students and teamwork (Curran, 2010). In
addition, according to Pollard (2008) in the
interprofessional relation, exposed to IPE
students were more confident and had the
ability for better communication other than
non-exposed to IPE students.
The characteristic of learning process
in the IPE curriculum allows for knowledge
transfer, interaction among students through
practicum activity, allows students to give
feedback to each competence. Learning
process uses role play model and laboratory
practise. This represent teamwork condition
and collaboration among health professions. It
is expected that through this learning process
every student has partnership, so they support
each other and improve other shortage (Barr,
2001).
Nursing education is a professional
education which oriented to science, technology
and society, so it is expected that it can keep
up the current development and used in the
development of students’ learning experience.
According to (Nursalam 2015), profession
education concept consist of science and
technology mastery, natural problem solving,
attitude, behaviour and professional capability,
independent learning as well as community
learning, so the change of learning method
in higher education of nursing is expected
to improve the competency of professional
 Effect Interprofessional Education Model on Team Work (Eny Kusmiran, dkk.)

nursing. This interprofessional education of lectures amd students for the role play,
(IPE) is one of the study in the development teamwork practise, and work performance as
of nursing study program curriculum. a team. The domain of IPE implementation
consist of: teamwork, role models and
Framework Interprofessional Education
responsibility, communication, learning and
lectures amd IPE students
concept isfor
a process
the role in preparing
play, Australian Governmant
reflection, Officerand
interconnection foridentification
Learning
teamwork practise, and
collaboration work performance
practise that supportashealth
a and of
Teaching
patients(2014)
need, itand
wasethics.
explained that IPE- in
Meanwhile,
team. The domain
lectures
services amd of improve
IPE for
so it students
can implementation
the role
health play,
outcomes. based education
Australian process
Governmant consist
Officer for
the Curriculum Renewal for Interprofessional of
Learning
consist of:
teamwork teamwork,
practise, and role
work models
performance
Collaboration practise occurs in service and as a interprofessional learningit was
and Teaching (2014) (IPL) activitythat
explained andIPE-
Education in Health published by The
responsibility,
team. The communication,
domain of IPE learning and
implementation
environment that involve several people interprofessional
based practiceprocess
education (IPP). consist
In this of
reflection, Australian Governmant Officer for Learning
consistinterconnection
of: teamwork, and identification
role models of and process,
interprofessional learning (IPL) activityits and
the role of tutor also determines
with different profession background. IPE and so
Teaching (2014) it was (IPP).
explained
patients need, and ethics. Meanwhile,
responsibility, communication, learning in the and success, tutor should
interprofessional understand
practice In that
the purpose this
implementation phase consist of: preparation IPE-based education
Curriculum
reflection,Renewal for Interprofessional
interconnection and identification of of learning
process,(Sharpe, of tutor also determinesofits
the role2009). process consist
of IPE-based
Education
patients in
need,Health
andcurriculum,
published
ethics. identification
by The
Meanwhile, in the interprofessional
success, learning
so tutor should (IPL) activity
understand and
the purpose
Curriculum Renewal for Interprofessional of learning (Sharpe, 2009).
Education in Health published by The

Figure 1. Figure 1 Framework

Framework Interprofessional
Interprofessional EducationEducation
From WHO From WHO (2010)
(2010).

Knowing ‘how toFigure 1 Framework Interprofessional Education From WHO (2010)

go on’
Knowing ‘how to
go on’

Inform

Theorising Inform
Practising Embodying
theory
Make sense of
‘Making sense’ of
experience
Theorising Practising Embodying
theory
Make sense of
‘Making sense’ of
experience

Figure 2 Model Practice as Embadied Theory

Source: Helme (2004), with reference to Gadamer's hermeneutic circle (Gadamer 1989) and Ison,
Figure 2 etModel
Blackmore Practice
al. 2003 (dalamasColyer,
Embadied Theory
2005)
Figure 2. Model Practice as Embadied Theory.
Source: Helme (2004), with reference to Gadamer's hermeneutic circle (Gadamer 1989) and Ison,
TeamSource: Helme (2004), withBlackmore
Work Attitude reference to Gadamer’s
et al. hermeneutic
2003 (favorably)
(dalam Colyer, circle
or 2005) (Gadamer
negatively 1989) and Ison,
(unfavorably) to
Blackmore et al., 2003 (dalam Colyer, 2005) certain objects.
Attitude, according to Hodges (2012)
Team Work Attitude Teamworkor isnegatively
(favorably) an act that can be to
(unfavorably)
had more to do with feelings, and individual
conducted
certain by a group as a team to achieve
objects.
reactions Attitude,
to incidents in theto surrounding.
according Hodges (2012) goals (Boller, 2005). isTheanactivities
Teamwork act thatin can
this be
Attitude is alsotoa disposition
had more to reactand
do with feelings, individual 117
positively
collaboration
conducted consist
by a groupof: as
mutual
a teamhelp and
to achieve
reactions to incidents in the surrounding. sharing
goals (Boller, 2005). The activities into this
of expertise, sharing of information
Attitude is also a disposition to react positively
collaboration consist of: mutual help and
sharing of expertise, sharing of information to
Jurnal INJEC Vol. 1 No. 2 Desember 2016: 115–121

interprofessional practice (IPP). In this process, Some research suggested that IPE-
the role of tutor also determines its success, based education curriculum encouraged to
so tutor should understand the purpose of the establishment of attitude and readiness of
learning (Sharpe, 2009). students to work with a team which consist of
several health professioncs, such as Mandy
Team Work Attitude
et al. (2004), Regmi (2010), and Wilhelmson
Attitude, according to Hodges (2012) (2011). Based on the social identity theory,
had more to do with feelings, and individual students who have a positif look to their
reactions
support each to incidents
other, so in it
thecansurrounding.
encourage a group
and and other groups
other groups showed
showed a positive
a positive
Attitude is
relationship also a disposition
that can to react positivelythe
improve interprofessional
interprofessionallearning
learningresult too.too.
result The The
(favorably)
communication; or negatively feedbackstothat
(unfavorably)
to give positive implication is that the IPE process encourage a
implication is that the IPE process encourage
certain objects.
can smooth the process or outcomes; to receive positiveattitude
a positive attitudeofofstudents
studentsininthe
thereadiness
readiness for
suggestion
Teamwork fromis an others
act that canto beimprove
conductedself forteamwork.
teamwork.
bycapability;
a group as to a teamconduct group
to achieve goalsdecision
(Boller,for
team’s problem solving, to give ideas and Collaboration Attitude
Collaboration Attitude
2005). The activities in this collaboration
mutual trust.
consist of: mutual help and sharing of Collaboration
Collaboration is isa complex
a complex and and
The attitude of teamwork is the
expertise, sharing of information to support multidimensional
multidimensional activity, involving
activity, nurses,
involving nurses,
willingness of individuals to conduct team
each doctors,andand other profession whowhoworkwork
workother,
and soactive
it can communication
encourage a relationshipwithin the doctors, other profession
that canActive
improve togetherto to provide services to individual
team. hasthe communication;
a meaning to give
to give suggestion together provide services to individual
positive feedbacks that can smooth
and encourage each other to achieve team’s the process patients, families, and communities (Cox,(Cox,
patients, families, and communities
2010). Futhermore, according to Curran
orgoals.
outcomes; to receive suggestion from others 2010). Futhermore, according to Curran (2007),
(2007), collaboration in nursing is a process
to improveThe self main components
capability; to conduct of group
attitude collaboration in nursing is a process that focues
that focues on patients with two or more
formation according to (Notoadmodjo
decision for team’s problem solving, to give 2011) on interactions
patients withof two or moretointeractions
professions of
share knowledge,
are: and
ideas religion
mutual or trust.
belief, idea, and concept of professions to share knowledge, skills, and
skills, and decision making in patient care.
attitude;
The attitude life
emotional of orteamwork
evaluation is of people
the decision making in patient
There are severalcare.
factors that able to
to an object; as well as tendency to act.
willingness of individuals to conduct team Therethe
increase arepractise
severaloffactors that ablesuch
collaboration, to as:
Some research suggested that IPE-
work attitudes, knowledge, skills, and organizational
basedand active communication
education curriculum encouraged within theto the increase the practise of collaboration, such as:
team. factors.knowledge,
An effective communication is the key
establishment of attitude and suggestion
Active has a meaning to give readiness of attitudes, skills, and organizational
and encourage
students to work each other
with to achieve
a team team’s of
which consist factors. An effective communication is2003,
of collaboration success (Laming, the in
goals.
several health professioncs, such as Mandy et key of collaboration success (Laming, 2003,inter
Cox, 2010), in addition, an effective
professional collaboration can improve
The main
al. (2004), Regmi components
(2010), and of Wilhelmson
attitude in Cox, 2010), in addition, an effective inter
teamwork, working satisfaction, and reduce
(2011). Based
formation accordingon the social identity2011)
to (Notoadmodjo theory, professional collaboration can improve
patients’ level of pain.
are: religion or belief, idea, and concept group
students who have a positif look to their of teamwork, working satisfaction, and reduce
attitude; emotional life or evaluation of people patients’ level of pain.
to an object; as well as tendency to act.
THEORETICAL FRAMEWORK

Nurse student
Education Learning
Outcomes
Knowledge
Interprofessional
Competency Attitude
Education
Skills
Interprofessional
Learning
Interprofessional
Practice

Figure 3. The Formation Process of student’s Competency.

Figure 3 The Formation Process of student’s Competency
118 of Interprofessional Education model to the
METHOD team work and collaboration attitude of
nursing students in the intensive care unit of
This research was a quantitative hospital.
research with an experimental quasi design The population of this research was all
Effect Interprofessional Education Model on Team Work (Eny Kusmiran, dkk.)

METHOD
This research was a quantitative
research with an experimental quasi design
with pre-test and post-test to identify the
effect of Interprofessional Education model
to the team work and collaboration attitude of
nursing students in the intensive care unit of
hospital.
The population of this research was all
nursing students in STIKES Rajawali at the
final grade as many as 70 people. The sample
was divided into two groups: 15 people of
intervented group and 15 people of control
group. A drop out criteria was the absence
student or sick during the practical period of
critical nursing subject.
Team work attitude instrument used
The Attitudes towards Interprofessional Health
Care Teams Scale and collaboration attitude
used Interprofessional Collaboration Scale.
The scale of questions used Likert scale (1 =
strongly disagree, 2 = disagree, 3 = doubt, 4 =
agree, 5 = strongly agree).
RESULTS
The results study were conducted through
two phases. The first phase was the development
of critical nursing module with IPE approach.
The development and preparation of module
was based on the identification of IPE material
needs and assessment to lectures and perceivers
as well as literature study such as a referral from
Interprofesional Working in Acut Care (IWAC) by
Holland (2003) in March–April 2016. The second
phase was the implementation of critical nursing
module material provision with IPE approach in
June 2016.
The provision of IPE module about critical
nursing with experimental quasi approach was
conducted to 15 nursing students as control and 15
nursing students as treatment. The implementation
of critical nursing module material provision
was conducted for two weeks in June 2016. The
assessment was conducted a week before the
implementation of IPE module provision about
critical nursing module to intervented group and
standard material to control group. The evaluation
was conducted after the implementation of

Table 2 Collaboration atttitude between intervention and control group

Mean
Collaboration attitude n Mean±s.d. CI95% p
difference ± s.d.
Intervention group
Collaboration atttitude before intervention 15 73,2 ± 5,3 4,1 ± 4,4 1,7–6,6 0,003
Collaboration atttitude after intervention 15 77,3 ± 3,2
Control group
Collaboration atttitude before intervention 15 71,1 ± 8,9 5,5 ± 11,5 0,8–11,9 0,083
Collaboration atttitude after intervention 15 76,6 ± 4,7
*paired-t-test

Table 3 difference changes of mean scores of team work and collaboration attitude between
intervention and control group
Mean
No Variables Intervention Control CI95% p
Difference
1 Team work attitude
Mean 7,0 4,4 2,6 2,3–7,5 0,285
Standard Deviation 4,3 8,1
2 Collaboration attitude
Mean 4,1 5,7 1,6 4,9–8,2 0,614
Standard Deviation 4,2 11,3
*independence t-test

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Jurnal INJEC Vol. 1 No. 2 Desember 2016: 115–121
treatment once nursing students completed their
nursing profession practice for six weeks.
The test results table 1 showed that there
were significant differences mean teamwork
attitude the student nurses before and after
between intervention and control groups
p < 0.05.
There is on table 2 showe a significant
difference in the mean attitude of collaboration
student nurses before and after the intervention
group. There are differences between the mean
attitude of the average attitude of collaboration
student nurses before and after in the control
group but indicated no significant difference
p > 0.05.
The results of the table 3 shows that the
average change in attitude of team work and
collaboration among student nurses before and
after the intervention and control groups was
not significant p > 0.05.
DISCUSSION
In this research, it can be identified that
the assessment of team work attitude to nursing
students in the intervented group increased
towards team work attitude. The change of
team work attitude showed a good quality
as many as > 80, referred to the assessment
of attitude perception. The change of team
work attitude was also identified in the control
group however its change was in sufficient
limit (75–80). These results showed that IPE
material provision in critical nursing improved
the team work attitude of nursing students.
The collaboration attitude in intervented
group showed a significant change while the
change of collaboration attitude in control
group was not significant. However, the
change of collaboration attitude has not in a
good quality < 80.
The model of pre-profession briefing
to achieve critical nursing learning outcomes
with interprofessional education approach
in nursing profession program has not been
widely implemented in nursing institutions.
The provision of IPE module in this research
was focused on the capability of nursing
students to cooperate and collaborate during
their practice in intensive care unit. In this
120
research, IPE module consist of the following
materials: 1) the concept of material and
skills of partnership among nurses and other
health workers; 2) interprofession team
work, this material consist of integrated and
interdiscipline learning, which conducted
through study, seminars, and working in a
group, 3) collaboration among nurses and
doctors; 4) communication in nursing and 5)
implementation of the IPE in nursing clinical
practise.
CONCLUTION AND
RECOMMENDATION
Conclusion
In this study, it can be concluded
that there was a significant change of team
work and collaboration attitude of nursing
students before and after the provision of IPE
module. There was no significant difference
of collaboration attitude of nursing students
before and after the treatment in control group.
The change of team work attitude in nursing
students before and after the IPE module
treatment in intervented group was higher
than control group. There was no significant
change of collaboration attitude in intervented
group and control group.
Recommendation
IPE module in critical nursing can
be implemented to improve the capability
of nursing students for teamwork and
collaboration attitude during their practice in
intensive care unit, The assessment of team
work and collaboration attitude of nursing
students requires a minimal performance
standard > 80. If the assessment has not
reached the standard, a provision of material
and reassessment is required.
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