Nurse Educator

Vol. 40, No. 1, pp. 16-20

Copyright * 2015 Wolters Kluwer Health |
Lippincott Williams & Wilkins

Nurse Educator

Infusing Interprofessional Education Into the

Nursing Curriculum
Joan Sistrunk Cranford, EdD, RN & Teresa Bates, MSN, RN
Education for interprofessional collaboration should begin early in the nursing program with a gradual infusion of interprofessional
competencies into the curriculum. The faculty developed an interprofessional education program for students in nursing, physical
therapy, nutrition, and respiratory care, which focused on sharing knowledge about each discipline, developing respect and value
for each others disciplines, and emphasizing techniques to improve communication and teamwork.
Keywords: collaboration; interprofessional competencies; interprofessional education; nursing curriculum

urses work with a variety of disciplines every day

in various health care settings. Each discipline has
a specific set of skills, and different disciplines bring
different viewpoints, values, and beliefs even when the central goal is quality care for the patient. These differences can
become a source of conflict, resulting in adverse outcomes
for the patient.1 For patient care to be effective, disciplines
must work together to make decisions and plan care. When
there is effective interprofessional collaboration, patient outcomes improve.2 Nevertheless, collaboration does not come
easy to all professionals; therefore, interprofessional education (IPE) is necessary to teach health and social care professionals about the benefits and skills required for collaboration.3
Interprofessional education has been defined as engagement of students from 2 or more professions associated with
health care in learning with, from, and about each other to enable effective collaboration and improve health outcomes.4
Interprofessional education is designed to prepare health care
students to work in interprofessional teams on graduation
and is characterized by principles of partnership, communication, collaboration, shared decision making, relationships,
and respect.4 The goal of IPE is to improve collaboration
between team members by focusing on cooperation, trust,
and respect while advancing skills in the use of collective
knowledge and decision making in academic and clinical

experiences. This article describes the steps involved in implementation of IPE in a nursing curriculum.

Background
Education is 1 of the best interventions for increasing skills in
teamwork, cultivating an appreciation for diversity, and developing mutual respect for colleagues.5 Inspired by a vision
of interprofessional collaborative practice, an expert panel of
representatives from the American Association of Colleges of
Nursing (AACN) and 5 other disciplines issued a set of core
competencies in a report entitled Core Competencies for Interprofessional Collaborative Practice.6 The AACN has now
included IPE as a basic essential for baccalaureate, masters,
and doctor of nursing practice graduates.7 However, if nursing faculty members are to accept IPE as a necessary part
of the nursing curriculum, they must understand its foundational tenets.
Interprofessional education includes 4 core competency
domains: values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork.6 These
domains include basic concepts of relationship building, team
dynamics, assertive communication, and knowledge of ones
own role and the roles of other professionals.6

Theories and Frameworks

Author Affiliations: Clinical Associate Professor (Dr Cranford), Clinical
Assistant Professor (Ms Bates), Byrdine F. Lewis School of Nursing and
Health Professions, Georgia State University, Atlanta.
The authors declare no conflicts of interest.
Correspondence: Dr Cranford, Byrdine F. Lewis School of Nursing
and Health Professions, Georgia State University, 140 Decatur St,
Room 918, PO Box 4019, Atlanta, GA 30311 (jcranford2@gsu.edu).
Supplemental digital content is available for this article. Direct URL citations
appear in the printed text and are provided in the HTML and PDF versions
of this article on the journals Web site (www.nurseeducatoronline.com).
Accepted for publication: July 6, 2014
Published ahead of print: August 22, 2014
DOI: 10.1097/NNE.0000000000000077

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A number of frameworks, theories, and models can aid

nursing faculty as they begin to explore IPE and the infusion
of this type of learning into the nursing curriculum. In some
theories, social identity is viewed as belonging to a profession.
Thus, professional socialization teaches members of a profession to hold certain goals and maintain shared values as part of
their professional identity. This can be a positive influence, or it
may result in barriers to change and an inability to work collaboratively.8 Another theory from social psychology addresses
the influence of situational factors on behavior. For example,
learning in IPE is influenced by team members and their
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different interpretations of the same event or situation. Finally,

situated learning is often used to explain certain beliefs and
behaviors. The view that the medical profession holds a
place of privilege may lead medical students to believe that
they should take on the role of leader; similarly, respiratory
therapists may hold the idea that they should lead patient
ventilation therapies. In contrast, interprofessional collaboration is characterized by flexible leadership shared by the health
care team8 and by leadership based on the situation at hand
rather than based on the beliefs and interpretations of a
discipline.
Transformative learning theory also can be used to frame
IPE. This theory is based on the belief that transformative
learning shapes people so that they are different in ways both
they and others can recognize after learning takes place.9 To
transform long-held beliefs and values, the values of the
profession to which an individual belongs must be examined and reexamined.10 Transformative learning involves
learning from experience, critical reflection, and personal
development. Understanding the meaning of experience
provides an opportunity for change in perspective and revision of assumptions.11 The student in IPE who experiences transformation will be better prepared to question
existing knowledge, develop new ways of learning, and
change roles, relationships, ideas, and perceptions to heighten
collaboration among all providers.12
Several models of IPE have been implemented based
on learning theories. They include the centralized and decentralized models used to describe the interprofessional
activities of medical and physical therapy students at a south
Florida university. The centralized model was implemented
in year 1 of the curriculum, with IPE concentrated in a core
set of courses for students from both disciplines and faculty
oversight from each of the professions. Years 2 and 3 were
decentralized with interprofessional learning experiences
designed by IPE champions without core courses or centralized oversight. The focus of IPE activities was on professional issues, primary care, and special populations. The
centralized model, however, was found to have the greatest
potential for sustainability.13 Scarvell and Stone14 implemented
an educational intervention for clinical educators in nursing,
biomedical and sports sciences, nutrition and dietetics, pharmacy, and physiotherapy. Students were placed together in
clinical facilities, and the IPE didactic included a variety of
teaching models and teaching/learning philosophies.
All of these frameworks, theories, and models emphasize relational capacities and abilities, competence in ones
profession, respect for others roles and perspectives, and
knowledge of group process skills, which align with the IPE
competencies.15 Implementation of an IPE program, however,
must begin with culture change and the education of faculty
on strengths, weaknesses, barriers, and opportunities.

Implementation
Our universitys strategic plan includes interprofessional
collaboration as 1 of its major initiatives. The School of Nursing and Health Professions (SNHP) faculty, in alignment with
the strategic plan, developed an innovative model that infused IPE into the curriculum for nutrition, physical therapy, respiratory therapy, and nursing. To begin the process,
Nurse Educator

faculty from the 4 disciplines in SNHP each sent 1 member to

the Interprofessional Education Collaborative (IPEC) Institute
Building Your Foundation for Interprofessional Education, a
national interprofessional conference. The IPEC conference
provided the faculty with ideas about team building and the
need to stimulate enthusiasm among the health professions.
As the faculty began to reflect on adoption of new ideas
and changes in behavior, a decision was made to introduce
IPE and frame it in Diffusion of Innovations Theory.16 The
aim was to spread IPE throughout the SNHP and, later, to the
Schools of Law and Social Work.
The first step in the process was to educate the educators.
Faculty members are key to the success of IPE. However, focus group interviews with faculty revealed a lack of respect
between professionals and a silo approach to health education. Most faculty members were products of an educational
system whose perspective was limited to that of their discipline, and they were not practicing in an interprofessional
environment. Therefore, faculty needed to learn together about
the skills required to be effective.17
The work began with a business proposal to support
the case for a program of IPE in the curriculum. The proposal included background information about IPE and an
explanation of factors promoting IPE at the university. The
phases of the proposed work were outlined and presented
to the dean of the SNHP for approval. A group was then
formed with members from each of the 4 disciplines, and
they reviewed the IPE competencies and identified competencies specific to their individual disciplines. This was followed
by review, merging, and adoption of a set of competencies
that would be appropriate for all students. In the process,
SNHP faculty discovered that dissonance existed between
faculty values and educational practice and transformation
would be required to change faculty attitudes. The 4 faculty
members reviewed different frameworks, theories, and models
for implementing a program and, on that basis, developed
an interprofessional course that would cross all 4 disciplines. The Figure reflects the educational process that served
as a guide.
The 4 faculty members who had attended the IPEC conference then expanded the team to include other faculty
members who expressed an interest in IPE. This broader
team adopted a working definition of IPE from the Center of
Advancement for IPE.18 The decision was made to infuse IPE
into an existing course in each discipline. This led to a process of curriculum mapping to determine which courses had
the flexibility to delete some existing content and add a new
component. The faculty team decided that incorporating IPE
into the curriculum should be similar to a continual infusion
rather than a bolus. Just as patients often cannot tolerate
a bolus of fluids, faculty and students do not tend to accept a
large bolus of change as well as a more gradual process of
change.
The team also decided to begin with a 1-day class event
and, in addition, to have students engage in a shared clinical
experience that would include simulation. Given time constraints, the 1-day seminar was agreed on as the least difficult
method of providing a community of learning while also
providing a forum for practicing communication skills. The
Figure, Supplemental Digital Content 1, summarizes the process model, http://links.lww.com/NE/A163.
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17

Figure. Educational process for IPE. IPEC, Interprofessional Education Collaboration.

Goals were set and a course proposal was drafted that

included team-building exercises, video, introduction to IPE
competencies, group assignments, and case studies. During
the combined class, students would be randomly selected
and asked to describe the role of another profession. This
would be followed by a PowerPoint presentation highlighting the 4 disciplines. A proposed implementation date was
set and the team developed a timeline.
Faculty assignments involved work on simulation, including scenario development; formulation of plans for the
class day, including individual session tasks such as teambuilding exercises and jeopardy games; logistics and facilities; and development and implementation of an evaluation
of the interprofessional experience. The final course plan included classroom teaching, simulations, and real-world practice in the use of interprofessional collaboration.

was a heightened awareness that faculty buy-in would be

key to success. Two nursing faculty were identified who
were using simulation activities that could easily be adapted
to incorporate IPE. The nursing faculty members learned
that nutrition faculty in the SNHP were interested in highfidelity simulation and collaboration. This led to the development of an initial collaboration, which enhanced the realism
of the simulated experience and increased awareness of the
innovation.14 This joint effort became the foundation for a much
larger endeavor.

The development of the interprofessional curriculum for nursing and health professions students was championed by the
representatives from the 4 departments within the SNHP.
The team engaged in refining, restructuring, and developing
the implementation plan. Each team member role was identified at the formative stage, so all members were aware of
expectations and goals. Communication and cooperation
among members were necessary to persuade faculty and
students to participate in a new innovation. This was accomplished through a 6-step educational program.

Building an Interprofessional Team

Because the SNHP contains 4 health care professions, nutrition, respiratory therapy, nursing, and physical therapy, finding other professional partners to work with nursing and
nutrition faculty was not difficult. Within 2 semesters, the
innovation had diffused to all of the disciplines, and they
were ready to work collaboratively. The team demonstrated
compatibility in values and experiences that supported
initial implementation of the innovation.
Early in the process, it became apparent to the team that
faculty involvement at all levels would be essential to success.
There were numerous activities for faculty members, including
participating in the class agenda and welcoming and signing in
students for the simulation event, observing a simulation group
and assisting with debriefing, and observing faculty and critiquing their work. Faculty participation created an atmosphere
for sharing knowledge and skills to influence student learning
and generate a sense of excitement and interest.

Accepting the Challenge

The first step was to gain momentum.14 After setting the
expectation that IPE would be a priority at our school, there

Creating the Objectives

To keep our endeavors manageable, nursing and nutrition
faculty initially agreed to 2 simple collaborative objectives.

ABCs of Infusing IPE into the

Curriculum6 Steps to Success

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First, students would increase their knowledge of the educational requirements and function of each health profession in patient care. Second, students would demonstrate
effective communication with the interprofessional team to
improve patient outcomes. As other SNHP disciplines adopted
the innovation and became involved, those 2 objectives remained the same for all IPE initiatives.

Developing the Game Plan

The initial IPE endeavor between nursing and nutrition
faculty involved a high-fidelity gunshot wound simulation
that nursing faculty had been using with senior undergraduate students. The nursing faculty worked with nutrition
faculty to modify the simulation by changing the patient
from a new admission to the emergency department to a
2-day postoperative patient who experienced hemorrhaging during the simulation. Nutrition students began the
simulation with an alert, stable patient to interview. In a room
adjacent to the patients room, nutrition students and nursing students collaborated on the dietary plan of care. Faculty
members assessed the students communication style and
respect for diverse opinions.
When respiratory therapy and physical therapy faculty
joined nursing and nutrition faculty in the school-wide IPE
effort, a decision was made to change the simulation activity
and to implement 3 learning activities over the course of the
semester. Planning time for the IPE activities was limited.
Therefore, faculty had to learn quickly and adopt team collaboration as a personal value to role model the desired
behaviors for students.
The final plan for implementation of IPE in the SNHP
included the 1-day 6-hour class event in addition to simulation activities that were scheduled at the beginning of
the semester. At the 1-day event, students were divided
into small groups that included students from each profession. The session began with an ice breaker that promoted
communication and teamwork within the groups. Two prerecorded patient care skits were created for the students to
discuss; 1 demonstrated good communication and the other
demonstrated very poor communication. A second learning
activity during the semester involved collaborative work to
answer questions about 2 case studies (Table). The students
worked with other students from their previously assigned
seminar group to complete this activity outside the classroom.
The final activity of the semester was a high-fidelity simulation. The students continued with their same group and

provided care for the 2 patients in the case studies they had
worked on during the semester. Both patients required all
4 professions to work collaboratively to achieve optimal
patient outcomes.

Evaluating the Collaborative Effort

The desired outcome was a change in student behavior from
a shared experience. This could only be determined through
some type of evaluative process. Students from the 4 disciplines took part in a preimplementation assessment to determine their level of preparedness to meet the overall learning
outcomes. Because of time constraints, a tool developed by
the faculty allowed students to self-evaluate their ability to
communicate their professional role and responsibilities; engage other health care professionals in developing a plan of
care; explain the roles and responsibilities of other health
care providers; manage disagreements about values, roles,
and goals for the patient and family; and share accountability
with other professions for patient outcomes. The evaluation
tool also afforded students an opportunity to give feedback
and input for redesigning or changing the current course.
Thus, the evaluation was used to identify deficiencies as well
as to determine the usefulness of the program.
Students were asked to identify the most meaningful
components of the course. Students rated the opportunity to
learn about other disciplines and the explanation of professional roles, team-building exercises, communication, and
simulation exercises as the most useful components of the
1-day session. Simulation activities were rated highly effective even though they were time-consuming. One suggested change made by most students was to provide the
course earlier in their program of study and make it a separate
credit-hour course. Other evaluation methods included
completion of an anonymous evaluation form after the last
simulation activity. Faculty from the 4 disciplines also conducted a faculty debriefing to determine what changes need
to be made and what opportunities for improvement were
apparent.
Following up and Going Forward
It is important to keep the momentum going. This program
was implemented in fall 2012 with the 1-day seminar, group
assignments throughout the semester, and simulation activities as a final component. Each semesters course activities
build on the previous semesters accomplishments and on
information gleaned from the evaluation forms. To infuse

Table. Sample Case Studies Used for IPE Simulations

Case Study 1

Case Study 2

Mrs Multie was admitted 4 days ago with bronchitis, severe constipation, and
Mr Aire is an intensive care patient. He was admitted with pneumonia,
decreased appetite related to lower abdominal fullness. She has a complex
AIDS, chronic diarrhea, wasting syndrome, peripheral neuropathy, and
medical history of respiratory difficulties related to multiple sclerosis,
an unhealed ankle fracture from 5 weeks past. The patient experienced
swallowing difficulties, decreased appetite, vegetarian diet, chronic muscle
respiratory failure and was intubated overnight. During morning
fatigue and nocturnal cramping, progressive weakness of extremities, and mild
interprofessional rounds, a new plan of care needs to be devised
incontinence. The patient is scheduled for discharge later in the day. The
and implemented by the team.
interprofessional team needs to assess the patients and familys readiness
for discharge and provide any teaching deemed necessary.

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IPE throughout the curriculum, specialty lectures have been

conducted by faculty from other disciplines at all levels of
the program, and student-led skills demonstrations are held
in Fundamentals of Nursing and Nutrition courses. For example, physical therapy students teach nursing students in
the proper use of ambulatory devices, and nursing students
teach the physical therapy and nutrition students about intravenous lines and tubes. One research course has been
redesigned to make it interprofessional. This provides an opportunity for students to meet early in their program of study.
In the coming semesters, the team will be expanding
interprofessional activities for all disciplines in SNHP to include first responder and emergency department mass casualty
simulations. The program will begin in the second semester of
the curriculum with Disaster Preparedness Training. Students
will practice mass casualty preparation in the third semester
and participate in a mass casualty event in the fourth semester.

Conclusion
The content and activities described here can be easily translated to other nursing and health professions curricula. A
recent study by Hudson et al19 suggested that baccalaureate
nursing students professional development may be enhanced
through IPE, which also provides clarity on the unique contributions of nursing to health care. Interprofessional education
allows for innovation and breaks down traditional disciplinespecific and institutional barriers. Student outcomes focus on
acquisition of knowledge and an understanding of all the
professions that are a part of the health care team.
When embarking on the IPE journey, certain elements
must be a part of the infusion process. Each discipline needs
to evaluate the curriculum to determine where IPE best fits.
There should be committed leadership from administration
and faculty and adequate resources, including community
and clinical partners, classroom space to accommodate a
large class, and laboratory space for simulation. Scheduling
issues also need to be resolved to provide adequate time in
the curriculum. Simulation experiences should be created with
interprofessional activities emphasized in the development of
the scenarios. The institutional culture must be open to change
and collaboration with multiple partners and willing to provide
real-life clinical experiences where students work together in a
respectful, honest, collaborative environment. Completion of
the infusion will require follow-up evaluation to determine
whether understanding of the functions of the health care team
has changed and whether attitudes and values have been
transformed.
In our school, the evaluation process is ever-evolving. The
goal of the team is to begin using a valid and reliable evaluation
tool, the Interdisciplinary Education Perception Scale, which
will be administered before the IPE classes (pretest) and on
completion of the simulation activity (posttest) to rate students
perceptions of their profession and other disciplines. Another
tool, the Readiness for Interprofessional Learning Scale Questionnaire, will be administered at the beginning of the 1-day
seminar to examine the attitudes of health care professionals
toward interprofessional learning. These tools will assist in
reshaping and improving the IPE program.
Although barriers exist to the development of IPE, the
positive outcomes for students are evident through their

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Volume 40 & Number 1 & January/February 2015

anecdotal comments and the debriefing sessions. Students

describe the experience as having taught them how to
work together in preparation for practice. They also report
that they gained a clear understanding of the concept of
working together to help the patient in the end.

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