Nurse Education Today 36 (2016) 348–353

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Nurse Education Today

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Capturing readiness to learn and collaboration as explored with an

interprofessional simulation scenario: A mixed-methods research study
Kelly L. Rossler a,⁎, Laura P. Kimble b,1
a
Louise Herrington School of Nursing of Baylor University, 3700 Worth Street, Dallas, TX 75246, USA
b
Piedmont Healthcare Endowed Chair in Nursing, Georgia Baptist College of Nursing of Mercer University, 3001 Mercer University Drive, Atlanta, GA 30341, USA

a r t i c l e i n f o s u m m a r y

Article history: Background: Didactic lecture does not lend itself to teaching interprofessional collaboration. High-fidelity human
Accepted 21 August 2015 patient simulation with a focus on clinical situations/scenarios is highly conducive to interprofessional education.
Consequently, a need for research supporting the incorporation of interprofessional education with high-fidelity
Keywords: patient simulation based technology exists.
Simulation Objectives: The purpose of this study was to explore readiness for interprofessional learning and collaboration
Interprofessional education
among pre-licensure health professions students participating in an interprofessional education human patient
Collaboration
Readiness to learn
simulation experience.
Pre-licensure Methods: Using a mixed methods convergent parallel design, a sample of 53 pre-licensure health professions stu-
Mixed-methods dents enrolled in nursing, respiratory therapy, health administration, and physical therapy programs within a
college of health professions participated in high-fidelity human patient simulation experiences. Perceptions of
interprofessional learning and collaboration were measured with the revised Readiness for Interprofessional
Learning Scale (RIPLS) and the Health Professional Collaboration Scale (HPCS). Focus groups were conducted
during the simulation post-briefing to obtain qualitative data. Statistical analysis included non-parametric, infer-
ential statistics. Qualitative data were analyzed using a phenomenological approach.
Results: Pre- and post-RIPLS demonstrated pre-licensure health professions students reported significantly more
positive attitudes about readiness for interprofessional learning post-simulation in the areas of team work and
collaboration, negative professional identity, and positive professional identity. Post-simulation HPCS revealed
pre-licensure nursing and health administration groups reported greater health collaboration during simulation
than physical therapy students. Qualitative analysis yielded three themes: “exposure to experiential learning,”
“acquisition of interactional relationships,” and “presence of chronology in role preparation.” Quantitative and
qualitative data converged around the finding that physical therapy students had less positive perceptions of
the experience because they viewed physical therapy practice as occurring one-on-one rather than in groups.
Conclusion: Findings support that pre-licensure students are ready to engage in interprofessional education
through exposure to an experiential format such as high-fidelity human patient simulation.
© 2015 Elsevier Ltd. All rights reserved.

Didactic lecture formats continue to be the conventional medium
used in educating undergraduate health professions students
(Banfield et al., 2012; Smith et al., 2012); however, the growing com-
plexity of health care warrants the need to effectively engage with all
members of the health care team. Educators must find better ways
to prepare students for professional practice. Interprofessional col-
laboration supports nursing students making the transition to pro-
fessional practice by gaining greater competency in engaging with
the health care team, which has the potential to yield better patient
outcomes (American Association of Colleges of Nursing , 2008, p. 22;
⁎ Corresponding author. Tel.: +1 214 818 7981 (Office); fax: +1 214 820 3375.
E-mail addresses: Kelly_Rossler@baylor.edu (K.L. Rossler), Kimble_LP@Mercer.edu
(L.P. Kimble).
1
Tel.: +1 678 547 6781 (Office); fax: +1 678 547 6777.
Stein-Parbury & Liaschenko, 2007). However, the didactic lecture does
not lend itself to teaching interprofessional collaboration. High-fidelity
human patient simulation with a focus on clinical situations/scenarios
is highly conducive to interprofessional education. Consequently, a
need for research supporting the incorporation of interprofessional ed-
ucation with high-fidelity patient simulation based technology has
been identified by multiple researchers, interprofessional collaborative
partners, and practice initiatives (Institute for Healthcare Improvement,
2012; Interprofessional Education Collaborative Expert Panel, 2011;
Patel et al., 2012; Titzer et al., 2011). A student enrolled in any type of
health professions’ program of study needs to successfully complete
program-specific requirements as well as gain a license or other re-
quired documentation to enter into the professional practice setting.
When enrolled in individual programs of study, these pre-licensure stu-
dents are not guaranteed exposure to interprofessional or collaborative

http://dx.doi.org/10.1016/j.nedt.2015.08.018
0260-6917/© 2015 Elsevier Ltd. All rights reserved.
 K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348–353
education pertaining to other practice disciplines. The purpose of this
mixed-methods study was to explore readiness for interprofessional
learning and collaboration among pre-licensure health professions stu-
dents participating in an interprofessional education human patient
simulation experience. Specifically, the research questions were:
1. Do perceptions of readiness to learn among pre-licensure students
enrolled in a health professions program of study change following
an interprofessional education simulation experience?
2. Are there differences among health professions pre-licensure stu-
dents in perceptions of readiness to learn and collaboration following
an interprofessional education simulation experience?
3. What are the pre-licensure health professions student partici-
pants’ perceptions of the interprofessional education simulation
experience?
4. To what extent do the quantitative and qualitative results converge?
Interprofessional Education and Readiness to Learn with
Simulation Technology
Interprofessional education (IPE) is increasingly recognized as a
necessary tool in transforming the education of health care
professionals (Frank & Chen, 2010; Institute of Medicine, 2010; King
et al., 2012). Specifically, interdisciplinary collaboration is identified as
a necessity for improving patient outcomes through competency in
performance of clinical skills and patient safety initiatives. An ability to
effectively collaborate among health care disciplines in the areas of
communication, role identification, team working skills, and conflict
resolution are critical components of practice for health care profes-
sionals (Poore et al., 2014). Demands from hospital systems for novices
entering the health care professions to think critically as fully engaged
members of the health care team has led to the need for alternative
teaching strategies in health care education (Gore & Schuessler, 2013;
McLaughlin, 2010; Norman, 2012; Wellard & Heggen, 2010; Wolfgram
& Quinn, 2012; Yanhua & Watson, 2011). Interprofessional education
collaborative experiences taught in the educational setting help pre-
licensure students to enter the health care setting better prepared to
engage in an interdisciplinary environment (Thibault, 2011).
Creating substantial interprofessional collaborative educational ex-
periences within colleges of health professions is challenging. Over the
past 10 years, research has demonstrated that interprofessional educa-
tion can be implemented within nursing education with high-fidelity
human patient simulators. Institutional barriers to interprofessional ed-
ucation have been identified as workplace infrastructure, location,
teaching in silos, “turf protection,” issues with mutual respect, and
lack of administrative support and funding (Gore et al., 2012, p. e128).
However, student-focused barriers to interprofessional education have
not been thoroughly investigated. Specifically, readiness of both pre-
licensure and practicing health care professionals to engage in interpro-
fessional education formats.
Academic programs exploring the potential to cross curricular
boundaries to develop collaborative teaching experiences would need
to examine readiness of the student to engage in such activities. Readi-
ness, also associated with competence, can vary for every student learn-
er (Bandali et al., 2012). Critical elements of readiness have been
identified as psychomotor skills specific to discipline, core competency
skills, and reflective practice. Even when these critical elements are ad-
dressed, student preparedness and readiness to engage in IPE activities
can be impacted by knowledge and attitudes toward this type of learn-
ing platform (Lamb & Shraiky, 2013). If a student is not ready to engage
in IPE, then interactions essential for meaningful collaboration to take
place may be lost. Faculty need to consider how to create an interprofes-
sional learning environment promoting characteristics of relationships
among professional groups, teamwork, role identification, and a benefit
to personal growth, professional practice, and patients. Exploration of
the readiness to learn and understanding of how high-fidelity patient
349
simulation as a teaching methodology can positively enhance interpro-
fessional collaboration among pre-licensure health professions students
enrolled in their unique programs of study is necessary.
Theoretical Framework
David A. Kolb offered his experiential learning theory as a new ap-
proach incorporating “a holistic integrative perspective on learning
that combines experience, perception, cognition, and behavior” to de-
fine the nature of what constitutes experiential learning (1984, p. 21).
Learning involves human adaptation “whereby knowledge is created
through the transformation of experience” (Kolb, 1984, p. 38). The
learning process consists of (a) adaptation rather than content;
(b) knowledge transformation which was continuously recreated, not
acquired; and (c) learning. During experiential learning, knowledge is
transformed from an encounter with an experience. A learner trans-
forms from the knowledge gained and from participating in the learning
experience set in an environment conducive to learning.
Educating with simulation has offered the capability to promote
learning by opening up cognitive processes of students of various learn-
ing styles through sociocultural dialogue during communal lived expe-
riences in a safe learning environment (Jeffries, 2007). Simulation also
aligns with theories based on constructivism. Interprofessional educa-
tion affords students from different professions the capacity to come to-
gether to learn not only about, but from one another in an active and
collaborative manner. Kolb’s experiential learning theory supports an
active process for interprofessional education whereby those engaged
in the process work with one another to gain knowledge of individual
health care roles. A learner participating in a simulation activity involv-
ing interprofessional education can immerse themselves during the
simulation, reflect on transactions which occurred during the simula-
tion experience from multiple perspectives, and integrate knowledge
gained to transform their own practices.
Methodology
Design
In this QUAN and QUAL type of methodology, both strands of the
quantitative and qualitative processes occurred concurrently and were
prioritized equally (Creswell & Plano-Clark, 2011). For the quantitative
data, an exploratory, descriptive design was used to explore the readi-
ness of pre-licensure health professions students to participate in an in-
terprofessional simulation, examine if readiness to learn changed after
the simulation experience, and evaluate the effectiveness of the simula-
tion experience as a teaching modality.
Qualitative data were collected and analyzed using a descriptive
phenomenological approach. The focus of the analysis was on describ-
ing the meaning of the experience from the perspective of the health
professions’ students (Giorgi, 2009). Phenomenology provided a mech-
anism to examine the “how” and “what” of the individual study partic-
ipants’ experiences of participating in an interprofessional simulation
scenario (Creswell, 2007). Quantitative and qualitative findings were
merged to address the mixed-methods question.
Setting and Sample
The setting for the research was the simulation laboratory in a col-
lege of health professions located in the Southeastern United States. A
non-probability, convenience purposive sampling method was used to
recruit an interprofessional sample (N = 53) of pre-licensure health
professions students. All participants met the following inclusion/exclu-
sion criteria: (1) enrolled in a health professions program of study;
(2) having the ability to comprehend, read, and write in English;
(3) and being greater than 18 years of age. Students were excluded
from participation if they had previously participated in an
350 K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348–353

interprofessional student learning simulation or multidisciplinary role each interprofessional group were provided a 10-minute pre-briefing
play scenario. with an introduction to the study to include operational definitions, sce-
nario objectives, and their discipline-specific roles in the scripted sce-
Data Collection Quantitative Strand nario. Participants were provided a packet containing the pre-briefing
materials and numerically coded study instruments in paper/pencil for-
All participants completed a demographic data form and two quan- mat. All participants completed the demographic data form and RIPLS
titative self-report instruments: the revised Readiness for Interprofes- pre-simulation. The investigator facilitated the 20-minute high-fidelity
sional Learning Scale [RIPLS, (McFadyen et al., 2005)], and the Health patient simulation from a computer control panel located in the simula-
Professional Collaboration Scale [HPCS, (Reese et al, 2010)]. tion laboratory. Student roles included a primary and/or secondary
nurse, a respiratory therapist, health care administrator, and physical
Readiness for Interprofessional Learning Scale therapist. Fifteen simulations with interprofessional student groups
were conducted. The investigator attempted to have two participants
The revised RIPLS was used to measure readiness for interprofes- from nursing and one participant each from respiratory therapy, physi-
sional learning. It consists of 19 items on a five-point Likert scale re- cal therapy, and health care administration for each simulation group
sponse format yielding four subscales for which reliability data are experience. However, because of scheduling conflicts, it was not possi-
available (McFadyen et al., 2005). The subscales are teamwork and col- ble to have the targeted interprofessional representation in all groups.
laboration with a Cronbach’s alpha value of 0.88, negative professional All 15 groups included representation from nursing, and a total of 4
identity with a Cronbach’s alpha value of 0.76, positive professional groups had representation from all disciplines. The post-simulation
identity with a Cronbach’s alpha value of 0.81, and roles and responsibil- RIPLS and HPCS were administered upon completion of the simulation
ities with a Cronbach’s alpha value of 0.43. Cronbach’s alphas for the scenario.
total RIPLS have been reported as 0.84 and 0.89. For each subscale,
higher scores indicate more positive attitudes about interprofessional Data Collection Qualitative Strand
education (McFadyen et al., 2006).
Data collection for the qualitative strand occurred within the context
Health Professional Collaboration Scale of a 30-minute debriefing session for each of the simulation groups.
Focus group interviewing was conducted during each group debriefing
The HPCS measured perceptions of collaboration during the simula- to obtain data about participants’ perceptions of the interprofessional
tion experience (Resse et al, 2010). This instrument consists of 12 items profession education high-fidelity simulation. Focus group data were
with a five-point Likert scale response format. Internal consistency reli- collected using methods recommended by Creswell and Plano-Clark
ability of 0.95 was reported by Reese et al. (2010). The possible range of (2011). The focus group format permitted data to be collected from
scores is 12–60 with higher scores indicating more positive perceptions multiple interprofessional viewpoints in an efficient amount of time
of collaboration. (Polit & Beck, 2012). The focus group interviews were audio taped and
transcribed verbatim.
Demographic Form
Results
A demographic form collected data about the age, gender, individual
program of enrollment, and semester of enrollment of the study Table 1 summarizes the demographic characteristics of the sample.
participants. Approximately 50% of the sample was nursing students with similar
percentages of respiratory therapy, health administration, and physical
Interprofessional High-fidelity Patient Simulation Scenario therapy students.
Prior to analysis, data were examined for missing values. Minimal
The investigator developed a high-fidelity patient simulation scenar- missing data were noted. Nominal and ordinal data were examined
io translated from a geriatric role play case study already identified as with frequencies and percentages. Interval/ratio data were examined
appropriate for interprofessional use for pre-licensure students. The pa-
tient simulation scenario and participant assigned roles were reviewed
for accuracy and validity with experienced interprofessional committee Table 1
Sample demographic characteristics (N = 53).
faculty members from the disciplines of nursing, respiratory therapy,
health care administration, and physical therapy. The scenario involved Characteristic n %
a 68-year-old widow admitted into the hospital setting with complex Age in years
health care issues to include an acute ankle sprain, high blood pressure, 18–27 32 60.4
dementia, chronic cough, and osteoporosis. Socio-economic challenges 28–37 12 22.6
38–47 05 09.5
presented in the scenario included living alone in a two-story building
48–57 04 07.5
on a limited income, social isolation, and a daughter who lived out of Gender
town. During the pre-briefing and through the simulation, participants Female 45 84.9
were provided access to a comprehensive medical chart complete Male 08 15.1
with current physical exam, physician order sets specific to each disci- Program of enrollment
Nursing 25 47.2
pline, laboratory values, arterial blood gas data, pulmonary function
RT 10 18.9
test results, and an ankle x-ray. The simulated patient interacted with HA 10 18.9
the study participants verbally via pre-recorded scripted responses. PT 8 15.0
Semester of Enrollment
1st semester junior 20 37.7
Procedures
2nd semester junior 14 26.4
1st semester senior 11 20.8
Prior to the initiation of the study, approval was obtained by the In- Fall 1st year semester 04 07.5
stitutional Review Board. Participants were recruited during fall of their Fall 2nd year semester 03 05.7
first or second year of study via face-to-face overview of the study dur- Missing 01 01.9

ing classroom time, distribution of flyers, and via-e-mail. Participants in Note: RT = respiratory therapy, HA = health administration, PT = physical therapy.
 K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348–353
with measures of central tendency, and normality assessment was con-
ducted. Subscale scores for the RIPLS demonstrated non-normal distri-
butions. Consequently, non-parametric statistical analyses were
conducted to address the quantitative study questions. Internal consis-
tency reliability of each study instrument was examined using
Cronbach’s alpha. Cronbach’s alpha was acceptable for all RIPLS sub-
scales except roles and responsibilities, which had low reliability for
both pre-simulation and post-simulation.
To address the first quantitative research question, a Wilcoxon
signed rank test was used to examine change over time in the RIPLS
from prior to and post the simulation scenario experience. Table 2 pro-
vides descriptive statistics demonstrating change in perceptions of
readiness for interprofessional learning pre- and post-simulation. Pre-
licensure health professions students reported significantly more
positive attitudes about readiness for interprofessional learning
post-simulation in the areas of team work and collaboration (Z = 3.7,
p b .001), negative professional identity (Z = 3.4, p = .001), and posi-
tive professional identity (Z = 4.4, p b .001). Readiness for professional
learning in the area of roles and responsibilities (Z = .008, p = .99)
was unchanged.
To address the second quantitative research question, a Kruskal–
Wallis test, the non-parametric equivalent of a one-way ANOVA, was
used to test for differences among the four different pre-licensure health
professions groups on the post-simulation RIPLS and HPCS scores.
Table 3 summarizes these comparisons. The health professions student
groups demonstrated statistically significant differences in the RIPLS
subscale of negative professional identity and health professional col-
laboration. Post hoc analysis with Mann–Whitney U revealed pre-
licensure nursing and health administration groups reported signifi-
cantly more positive attitudes about readiness for interprofessional
education and greater health collaboration during simulation than
physical therapy students. The respiratory therapy groups were not sig-
nificantly different from any other health profession groups.
The qualitative research question about perceptions of the interpro-
fessional simulation experience was addressed with the focus interview
data. Data were analyzed using a three-step phenomenological process
of naive reading, structural analysis, and interpretations (Creswell,
2013). Verbatim transcriptions of the qualitative data were collected
via audiotape. Data were organized by student study groups, and
codes were developed. Subsequent exploration of the transcripts and
identified codes led to the discovery of meaningful patterns related to
the true essence of the phenomena (Creswell, 2013). Analysis of the
qualitative data concluded with interpretations expressed in three
themes: “exposure to experiential learning,” “acquisition of interaction-
al relationships,” and “presence of chronology in role preparation.” Each
of the themes will be discussed individually.
Exposure to Experiential Learning
Within the focus groups, students emphasized how simulation of-
fered a safe environment where students could interact with students
from other disciplines in a short period of time. Specifically, a PT student
spoke of how “I liked the concept of simulation to get people familiar
with what everybody does.” A nursing student verbalized how
Table 2
Pre-simulation to post-simulation change in readiness for interprofessional learning subscales (N = 53).
Pre-simulation
M (SD)
RIPLS 41.4 (3.4)
Teamwork and collaboration 13.5 (1.8)
Negative professional identity 18.1 (1.8)
Positive professional identity 11.4 (2.0)
Roles and responsibilities
Note. RIPLS = Readiness for Interprofessional Learning Scale.
⁎⁎ Statistically significant change from pre-simulation to post-simulation using Wilcoxin signed rank test.
351
simulation allowed for “…a bunch of pieces of little puzzles coming to-
gether” and a RT student commented “…exciting, being the first time
being around the patient just interacting…” during the simulation.
Most students were positive about the simulator providing feedback
and realistic, real-time interaction. However, not all health professions
had the same perception. This was particularly true of PT students
who viewed their interactions with patients and other health profes-
sions as occurring more one-on-one. One PT student remarked, “a PT
might have one other person in the room with them at the time . . . it
wouldn’t be five people in the room trying to assess.” Student percep-
tions were consistent with current literature promoting simulation as
a means to enhance student learning in a safe and realistic educational
environment (Roche et al., 2012; Seybert et al., 2012; Woflgram &
Quinn, 2012).
Acquisition of Interactional Relationships
Participants wanted to acquire interactional relationships through
communication and appreciation of other disciplines. The IPE simula-
tion helped them gain “the communication skills that we would need
to develop.” One student stated, “I think the point is learning how to
communicate with one another and we just kind of winged it.” Students
consistently expressed the desire to learn to communicate effectively
during a patient care situation and on an interprofessional basis. The
scenario made one cognizant of the fact that they did not share a com-
mon language. A health administration student expressed how “it was
like talking Greek to me. I was just hearing Greek.” These comments
reflected the absence in universality of vocabulary among professions.
One student stated how he/she wanted to “see what the different pro-
fessions do . . . being to being.” Another nursing student remarked,
“it's good in nursing to get to know all the people in the different roles
. . . what they do and to form relationships.” Students recognized that in-
terprofessional interactions were often rare in the educational setting,
with one student stating, “you don’t interact exactly one-on-one with
each other before you’re actually in a clinical setting.”
Presence of Chronology in Role Preparation
The third qualitative theme focused on students’ perceptions of role
preparation and how this preparation evolved over time on an individ-
ual basis as each student progressed within their program of study. A
nursing student reported how pulling information from past semesters
helped during the simulation experience. A respiratory therapy student
reported how “it was my first year and everything and they're seniors”
to communicate feeling unprepared to enter into the learning opportu-
nity with students who had progressed farther in their program of
study. A nursing student expressed how the simulation “scared me in
a way because . . . I really don’t know how other professions work and
how I am supposed to work together” prior to even knowing all aspects
of the nurses role. “I’m a brand new baby something” and “it was my
year and everything and they’re seniors” were used to communicate
feeling unprepared to enter into the learning opportunity based on pro-
gression of their program of study and learning role boundaries.
Post-simulation
Median M (SD) Median
42.00 42.8 (2.8) 44.00⁎⁎
15.00 14.2 (1.2) 15.00⁎⁎
19.00 19.2 (1.3) 20.00⁎⁎
11.00 11.4 (2.1) 12.00
352 K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348–353
Table 3
Comparisons of health professions groups on readiness to learn and collaboration following a high-fidelity patient simulation.
Nursing Respiratory therapy
(N = 25) (N = 10)
Variable Mean rank Mean rank
RIPLS subscales
Teamwork 28.22 29.20
and cooperation
a a
Negative professional identity 30.18 29.45
Positive professional identity 27.82 26.75
Roles and responsibilities 28.98 24.85
HPCS 29.62a 21.79
Note. RIPLS = Readiness for Interprofessional Learning Scale; HPCS = Health Professional Collaboration Scale. Mean ranks with differing superscripts significantly differed at p b .05.
The mixed-methods question focused on convergence of the quanti-
tative and qualitative findings. Quantitative and qualitative data were
examined and similarities and differences were identified (Creswell &
Plano-Clark, 2011). The significant increase in readiness for interprofes-
sional learning observed in the quantitative data was supported by the
qualitative themes revealing students' views that the experience pro-
vided a realistic environment for communicating and collaborating
with students from other professions. The quantitative data also re-
vealed that physical therapy students had less positive attitudes about
interprofessional learning than nursing and health administration stu-
dents. The qualitative provided insight into this finding as physical ther-
apy students expressed that the scenario was not necessarily consistent
with physical therapy practice which they perceived to occur one-on-
one with patients and other health care professionals.
Discussion
The purpose of this study was to explore pre-licensure health profes-
sions students' readiness for interprofessional learning and perceptions
of health collaboration when participating in a high-fidelity human pa-
tient simulation. Findings demonstrated that students had more posi-
tive attitudes about interprofessional learning following simulation.
Findings from this research study suggest how pre-licensure students
are ready to engage in interprofessional education through exposure
to an experiential format such as high-fidelity human patient simula-
tion. They experienced interactions which can enhance communication,
an appreciation for other disciplines, and the ability to contribute to the
whole when providing care in practice. These findings are consistent
with prior studies where use of a standardized patient facilitated com-
munication skills and promoted teamwork (Barnett et al., 2011) and
collaborative relationships between academia and hospital institutions
(Waxman et al., 2011). The importance of effective communication
strategies during interprofessional collaboration (Berg et al., 2010)
was also supported by the qualitative data.
When examining the revised RIPLS pre-simulation and post-
simulation data results, there was not a significant change in the sub-
scale for roles and responsibilities. This was likely related to the low in-
ternal consistency reliability of the subscale. Roles and responsibilities
vary for the different health professions and the low Cronbach’s alphas
indicate items within this subscale were not homogenous.
Findings from the HPCS around how the different health professions
viewed each other with respect to interprofessional collaboration need
closer examination. Findings indicated that perceptions of collaboration
were different among the student groups with pre-licensure nursing
and health administration students reporting greater collaboration
than physical therapy students. Likewise, findings from the RIPLS
post-simulation revealed how the different health professions
viewed each other in relation to negative professional identity
whereby nursing and health administration students reported less
negative attitudes toward learning with other health care profes-
sionals than physical therapy students. While the simulation scenar-
io was translated from an existing role play scenario currently
Health administration Physical therapy Test
(N = 10) (N = 8) statistic
Mean rank Mean rank X2 p value
29.60 17.19 4.28 0.23
b
28.60 12.00 11.60 0.01
32.30 18.13 5.32 0.15
22.00 29.75 1.97 0.58
29.55a 10.81b 11.42 0.01
utilized for interprofessional education, the scenario might not
have translated accurately for use with a high-fidelity human patient
simulator to meet the educational needs of a physical therapy stu-
dent. The negative professional identity subscale of the RIPLS con-
tains questions such as “I don’t want to waste my time learning
with other health care students” and “It is not necessary for under-
graduate health care students to learn together”(McFadyen et al.,
2005, p.1). Physical therapy students in this study appeared to
view group interactions as not consistent with current physical ther-
apy practice. Bridges and colleagues reported how pre-licensure stu-
dents need to understand “their own professional identity while
gaining an understanding of other professional's roles on the health
care team” (Bridges et al., 2011, p. 1). These physical therapy stu-
dents may already have had a strong sense or knowledge of both col-
laboration and professional identity which would not have changed
after participating in the simulated learning experience. This aligns
with findings from Ateah et al. (2011) where physical therapy stu-
dents were identified as having the traits of interpersonal skills and
confidence as a profession prior to and post an interprofessional im-
mersion experience.
The logistics for implementing this study were challenging. Despite
being a part of the same college of health professions and administrative
support from college administration, it was difficult to schedule simula-
tion sessions when all health professions could attend. Differences in
class schedules and clinical rotations limited the times when health pro-
fessions could be together. The study was conducted in one site by a sole
investigator; consequently, findings should be generalized with caution
to other colleges of health professions. Since the predominant health
professions group represented in the simulation groups were pre-
licensure nursing students, it remains unclear how findings would
have differed if a greater proportion of other health professions students
had been represented. The low reliability of the roles and responsibili-
ties subscale of the revised RIPLS is problematic, and in future research,
the items may need to be analyzed separately.
Conclusion
Findings from this research study support pre-licensure students are
ready to engage in interprofessional education through exposure to an
experiential format such as high-fidelity human patient simulation.
They perceived the interprofessional interactions during the simula-
tion-enhanced interprofessional communication, increased their
appreciation for other disciplines, and delineated their discipline's con-
tribution to the whole when providing care in practice. As pre-licensure
students transition to professional practice, the ability to successfully
collaborate with other disciplines will be key to assuring quality patient
outcomes. A high-fidelity patient simulation was the conduit for the oc-
currence of interactional relationships among study participants. Identi-
fying the existence of readiness to learn in an interprofessional manner
starts dialogue on how to best prepare students for engaging in an inter-
professional learning experience with high-fidelity patient simulation
as a teaching modality which can in turn impact entry into practice.
 K.L. Rossler, L.P. Kimble / Nurse Education Today 36 (2016) 348–353
Acknowledgements
Dr. Tanya Sudia
Associate Dean for Research and Scholarship
Interim Graduate Program Director and Professor
Louise Herrington School of Nursing of Baylor University
Dr. Lisa Broussard
Acadian Ambulance Endowed Professor in Nursing
Hamilton Medical Center Endowed Professor in Nursing
Department Head and Associate to the Dean
University of Louisiana at Lafayette
College of Nursing and Allied Health Professions
References
American Association of Colleges of Nursing, 2008. The Essentials of Baccalaureate Educa-
tion for Professional Nursing Practice. Author, Washington, DC.
Ateah, C.A., Snow, W., Wener, P., McDonald, L., Metge, C., Davis, P., Fricke, M., Ludwig, S.,
Anderson, J., 2011. Stereotyping as a barrier to collaboration: does interprofessional
education make a difference? Nurse Educ. Today 31, 208–213. http://dx.doi.org/10.
1016/j.nedt.2010.06.004.
Bandali, K.S., Craiz, R., Ziv, A., 2012. Innovations in applied health: evaluating a
simulation-enhanced interprofessional curriculum. Med. Teach. 34, e176–e184.
http://dx.doi.org/10.3109/0142159X.2012.642829.
Banfield, V., Fagan, B., Janes, C., 2012. 2009–2012 Spacelabs innovation project award:
charting a new course in knowledge: creating life-long critical care thinkers. Dynam-
ics 23, 24–28.
Barnett, G.V., Hollister, L., Hall, S., 2011. Use of the standardized patient to clarify interdis-
ciplinary team roles. Clin. Simul. Nurs. 7, e169–e173. http://dx.doi.org/10.1016/j.ecns.
2010.01.004.
Berg, B.W., Wong, L., Vincent, D.S., 2010. Technology-enabled interprofessional education
for nursing and medical students: a pilot study. J. Interprof. Care 24, 601–604. http://
dx.doi.org/10.3109/13561820903373194.
Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V., Tomkowiak, J., 2011. Interprofes-
sional collaboration: three best practice models of interprofessional education. Med.
Educ. Online 16, 1–10. http://dx.doi.org/10.3402/meo.v16i0.6035.
Creswell, J.W., 2007. Qualitative Inquiry & Research Design: Choosing Among Five Ap-
proaches. 2nd ed. Sage Publications, Inc., Thousand Oaks, CA.
Creswell, J.W., 2013. Qualitative Inquiry & Research Design: Choosing Among Five Ap-
proaches. 3rd ed. Sage Publications, Inc., Thousand Oaks, CA.
Creswell, J.W., Plano-Clark, V.L., 2011. Designing and Conduction Mixed Methods Re-
search. 2nd ed. Sage, Los Angeles, CA.
Frank, J., Chen, L.C., 2010. Health Professionals for a New Century: Transforming Educa-
tion to Strengthen Health Systems in the Interdependent World. Harvard University
Press, Cambridge, MA http://dx.doi.org/10.1016/S0140-6736(10)61854-5 (Retrieved
from www.thelancet.com).
Giorgi, A., 2009. The Descriptive Phenomenological Method in Psychology: A Modified
Husserlian Approach. Duquesne University Press, Pittsburgh, PA.
Gore, T., Schuessler, J.B., 2013. Simulation policy development: lessons learned. Clin.
Simul. Nurs. 9, e319–e322. http://dx.doi.org/10.1016/jecns.2012.04.005.
Gore, T., Van Gele, P., Ravert, P., Mabire, C., 2012. A 2010 survey of the INACSL member-
ship about simulation use. Clin. Simul. Nurs. 8, e125–e133. http://dx.doi.org/10.
1016/j.ecns.2012.01.002.
Institute for Healthcare Improvement, 2012. What is open school? Retrieved from http://
www.ihi.org/offerings/IHIOpenSchool/overview/Pages/default.aspx
Institute of Medicine, 2010. A Summary of the February 2010 Forum on the Future of
Nursing: Education. National Academies Press, Washington, D.C. (Retrieved from
http://www.iom.edu/Reports/2010).
Interprofessional Education Collaborative Expert Panel, 2011. Core Competencies for In-
terprofessional Collaborative Practice: Report of an Expert Panel. Interprofessional
Education Collaborative, Washington, D.C.
353
Jeffries, P.R. (Ed.), 2007. Simulation in Nursing Education: From Conceptualization to
Evaluation. National League for Nursing, New York, NY.
King, S., Greidanus, E., Major, R., Loverso, T., Kowles, A., Carbonaro., M., & Bahry, L., 2012. A
corss-institutional examination of readiness for interprofessional learning.
J. Interprof. Care 26, 108–114. http://dx.doi.org/10.3109/13561820.2011.640758.
Kolb, D.A., 1984. Experiential Learning: Experience as the Sources of Learning and Devel-
opment. Prentice Hall, Upper Saddle River, N.J.
Lamb, G., Shraiky, J., 2013. Designing for competence: spaces that enhance collaboration
readiness in healthcare. J. Interprof. Care 27 (52), 14–23. http://dx.doi.org/10.3109/
13561820.2013.791671.
McFadyen, A.K., Webster, V., Strachan, K., Figgins, E., Brown, H., McKechnie, J., 2005. The
readiness for interprofessional learning scale: a possible more stable sub-scale
model for the original version of RIPLS. J. Interprof. Care 19, 595–603. http://dx.doi.
org/10.1080/13561820500430157.
McFadyen, A.K., Webster, V.S., Maclaren, W.M., 2006. The test-retest reliability of a revised
version of the Readiness for Interprofessional Learning Scale (RIPLS). J. Interprof. Care
20, 633–639. http://dx.doi.org/10.1080/13561820600991181.
McLaughlin, M.P., 2010. Medical simulation in the community college health science cur-
riculum: a matrix for future implementation. Community Coll. J. Res. Pract. 34,
462–476. http://dx.doi.org/10.1080/1068920903235811.
Norman, J., 2012. Systematic review of the literature on simulation in nursing education.
Assoc. Black Nurs. Fac. J. 24-28 (Retrieved from http://www.ncbi.nlm.nih.gov/
pubmed/22774355).
Patel, E., Nutt, S.L., Qureshi, I., Lister, S., Panesar, S.S., Carson-Stevens, A., 2012. Leading
change in health-care quality with the institute for healthcare improvement open
school. Br. J. Hosp. Med. 73, 397–400.
Polit, D.F., Beck, C.T., 2012. Nursing Research: Generating and Assessing Evidence for
Nursing Practice. 9th ed. Lippincott, Williams, & Wilkins, Philadelphia, PA.
Poore, J.A., Cullen, D.L., Schaar, G.L., 2014. Simulation-based interprofessional education
guided by Kolb’s experiential learning theory. Clin. Simul. Nurs. 10, e241–e247.
http://dx.doi.org/10.1016/j.ecns.2014.01.004.
Reese, C.E., Jeffries, P.R., Engum, S.A., 2010. Learning together: using simulations to devel-
op nursing and medical student collaboration. Nurs. Educ. Perspect. 31, 33–37.
Roche, J., Schoen, D., Kruzel, A., 2012. Human patient simulation versus written case stud-
ies for new graduate nurses in nursing orientation: a pilot study. Clin. Simul. Nurs. X,
e1–e7. http://dx.doi.org/10.1016/j.ecns.2012.01.004.
Seybert, A.L., Smithburger, P.L., Kobulinsky, L.R., Kane-Gill, S.L., 2012. Simulation-based
learning versus problem-based learning in an acute care pharmacotherapy course.
Simul. Healthc. 7, 162–165. http://dx.doi.org/10.1097/SIH.0b013e31825159e3.
Smith, K.V., Witt, J., Klaassen, J., Zimmerman, C., Chen, A., 2012. High-fidelity simulation
and legal/ethical concepts: a transformational experience. Nurs. Ethics 19, 390–398.
http://dx.doi.org/10.1177/0969733011423559.
Stein-Parbury, & Liaschenko, J., 2007. Understanding collaboration between nurses and
physicians as knowledge at work. Am. J. Crit. Care 16, 470–477 Retrieved from
www.aacn.org.
Thibault, G.E., 2011. Interprofessional education: an essential strategy to accomplish the
future of nursing goals. J. Nurs. Educ. 60, 313–317. http://dx.doi.org/10.3928/
01484834-20110519-03.
Titzer, J.L., Swenty, C.F., Hoehn, W.G., 2011. An interprofessional simulation promoting
collaboration and problem solving among nursing and allied health professional stu-
dents. Clinical Simulation in Nursing X, e1–e9. http://dx.doi.org/10.1016/j.ecns.2011.
01.001 (March).
Waxman, K.T., Nichols, A.A., O’Leary-Kelley, C., Miller, M., 2011. The evolution of a state-
wide network: the bay area simulation collaborative. Simul. Healthc. 6 (6),
345–351. http://dx.doi.org/10.1097/SIH0b013e31822eaccc.
Wellard, S.J., Heggen, K.M., 2010. Are laboratories useful fiction? : a comparison of Norwe-
gian and Australian undergraduate nursing skills laboratories. Nurs. Health Sci. 12,
39–44. http://dx.doi.org/10.1111/j.1442-2018.2009.00481.x.
Wolfgram, L.J.B., Quinn, A.O., 2012. Integrating simulation innovatively: evidence in
teaching in nursing education. Clin. Simul. Nurs. 8, e169–e175. http://dx.doi.org/10.
1016/j.ecns.2010.09.002.
Yanhua, C., Watson, R., 2011. A review of clinical competence assessment in nursing.
Nurse Educ. Today 31, 832–836. http://dx.doi.org/10.1016/j.nedt.2011.05.003.