We open this column heeding the wise counsel from Epictetus, who said, “We have two ears and one mouth so that we can listen twice as much as we speak.” In our pursuit of the meaningful interprofessional learning environment in the clinical setting, we bring to your attention strategies from disciplines outside the traditional healthcare professions. Is there anything there that can meaningfully inform our approach to this topic? We hope so. In this column, we explore two strategies to advance the interprofessional learning environment borrowed from the Professional Coaching and Business worlds.
STRATEGY: TALK LESS, LISTEN MORE
In our basic nursing and other healthcare education programs, we are taught active listening skills, such as establishing rapport, reflecting, and paraphrasing for understanding. We are taught to refrain from thinking about what we want to say next while the patient (or any other person) is talking. Though these skills seem simple enough, if we were to evaluate ourselves on how well we embody them, we would likely agree that we all have room for improvement.
The Nursing Professional Development (NPD) Scope and Standards of Practice describe one of our roles as mentor (Harper & Maloney, 2016). Often, the role “mentor” is conflated with a similar term “coach.” This is understandable given most of us have had “coaches” who have “mentored” us through various phases of our lives. Although the two terms share several similarities, the intent with which the two approach their learners differ in material ways. Let us explore.
The International Coach Federation (ICF) defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” (ICF, n.d.-a). A professional coach uses a variety of questioning and reflecting techniques to help clients identify their potentially self-limiting beliefs (sometimes called blind spots), which could be standing in their way of optimally achieving their career and/or life goals. Whereas a mentor shares their personal experiences and provides suggestions and advice to mentees on how to progress in their careers, a coach helps clients identify and develop their own solutions to situations and dilemmas. The theory behind coaching is that if the client identifies and develops their own plan, rather than hearing it from someone else, they are more likely to adhere to it and see progress.
Though it is beyond the NPD scope of practice to become a certified coach and earn various coaching credentials, studying and applying these important coaching communication principles can add depth and perspective to one’s practice and potentially create deeper connection with learners and others that we collaborate with on a daily basis. For example, one of the core competencies delineated by the ICF includes the ability to “ask questions that reveal the information needed for maximum benefit to the coaching relationship and the client.” Essential to this competency is the ability of the coach to ask questions that “evoke discovery, insight, commitment, or action” challenging the client’s assumptions. It also includes the ability and courage to ask open-ended questions that “create greater clarity, possibility, or new learning” (ICF, n.d.-b).
The ability to evoke discovery, insight, commitment, or action can be a powerful skill for the educator to practice in the interprofessional learning environment. During and after most simulation-based training, a dedicated debriefing period encourages learners to reflect on what happened in the scenario, how individual and corporate performance could be improved, and how this might result in improved patient care. In order to successfully integrate these coaching techniques, NPD practitioners need to be courageous and persistent during the inquiry aspect of the debriefing, while simultaneously displaying empathy and understanding. Because the questions can sometimes evoke uncomfortable emotions, they must be framed with the highest regard for the learner (called “client” in coaching terms), with every intention of helping the learner improve rather than coming from a place of judgment, which will only serve to alienate the learner.
Another competency delineated by the ICF includes developing a “coaching presence.” This is described as the “ability to be fully conscious and create a spontaneous relationship with the client, employing a style that is open, flexible and confident.” Essential to this competency is the ability to remain present in the moment with the client, to make the necessary adjustments based on what transpires (often called “dancing in the moment”), confidently shifting perspectives, and demonstrating confidence in working with strong emotions (ICF, n.d.-b).
Such “presence” or “mindfulness” skills can be used when working with learners in simulation scenarios or other interprofessional team training learning sessions where group emotions can be strong. These skills must be deliberately cultivated and routinely practiced in order to be optimized.
As with all coaching principles, the overarching skill of talking less and listening more is what ultimately elevates the interprofessional learning environment into a dynamic interchange that promotes lasting knowledge, skill, and attitudinal change.
STRATEGY: HORIZONTAL INTEGRATION—ADDING A BUSINESS MINDSET TO THE EDUCATIONAL ARENA
What thoughts come to mind when you hear the term “horizontal integration”? How about terms such as “teamwork,” “collegiality,” “flattening of hierarchy,” or “shared mental model”? If you chose any of all these terms, you are in good company. NPD practitioners naturally think in educational terms. However, when we adhere too tightly to only educational paradigms, we fail to realize the abundant opportunities that the interprofessional learning environment readily provides. A few examples of such opportunities from the business perspective are professional networking, information dissemination, technology integration and cross training, resource optimization, and demonstration of institutional relevance.
The term horizontal integration comes from the business sector where a company merges with or acquires another company in order to reduce cost and to improve profits by increasing efficiency and optimizing economies of scale. So, as a hypothetical question, if you were a business in the corporate world, would your NPD services be so desirable that you would be sought out by a well-funded company looking to expand their customer base? If the answer is yes, you are probably doing a great job of horizontal integration. But if the answer is no, you may want to read on.
To build a strong interprofessional learning environment, one should recognize that much of the educational world still trains in a “silo” or “semisilo” setting. The reasons are numerous and multifactorial. Furthermore, typically there are deep cultural and institutional biases sustaining such ethos. Ironically, the same educational systems that have been educating in silos are now demanding that educators place greater emphasis on “interprofessional learning environments.” Why the sudden change of heart? Look no further than to Kolb’s seminal work on the experiential learning theory introduced in 1984.
Kolb proposed that the experiential learning theory works at two distinct levels: stages of learning (four) and learning styles (four). Although his theory places heavy emphasis on the learner’s internal cognitive process, it also highlights the fact that an effective learning environment provides opportunities for the learner to seamlessly interface with the four stages of the learning cycles, according to each learner’s preferred learning style without regard to where one chooses to enter the cycle. Fortuitously, the interprofessional learning environment provides the ideal setting for this to occur (see Figure 1).
So, how can NPD practitioners who have already embraced the goal of the interprofessional learning environment integrate Kolb’s theory on learning styles and experiential learning cycle with the concept of horizontal integration to improve learner engagement, faculty participation, and institutional validation? The following are a few practical suggestions to help achieve this goal.
First, get to know your “influencers and drivers” within your organization. In our previous columns, we discussed the terms “influencers and drivers” as individuals who wield influence within an organization. Their support plays a vital role in achieving enduring skills, knowledge, or attitudinal improvements.
Second, arrange regular meetings with the “influencers and drivers” to brainstorm new ideas and to assess the effectiveness of prior educational venues. Be mindful to solicit frequent feedback from both the learners and the instructors on how to improve learner engagement, teaching efficacy, course sustainment, identification, and documentation of “early indicators” of beneficial changes taking place within the organization as a result of the education offering.
Third, invite your interprofessional educator colleagues to participle in the development of the educational training goals and objectives and encourage them to take an active role in leading the session with you as the cofacilitator. This will demonstrate your commitment to interprofessional practice and to foster mutual respect and collegiality. By their mere involvement in the training session, these “influencers and drivers” in their professions external to nursing will lend instant legitimacy and value to the training. Note, this will also enhance the likelihood that the training will result in Kirkpatrick Level III (behavior change) and Level IV (institutional impact) outcomes.
In order to mindfully take on the challenge inherent to creating and optimizing the interprofessional learning environment, we recommend working toward this goal of improving horizontal integration from a business perspective. By approaching this endeavor collaboratively with “influencers and drivers” and seeking ways to add value to your organization, the work is more likely to be enjoyable and the process more efficient. In turn, this is more likely to lead to lasting change and demonstrate your NPD department’s value to the organization as an entity that others would want to acquire!
LOOKING BEYOND TRADITIONAL HEALTHCARE PROFESSIONS
Have you employed strategies in your NPD practice that are external to those we generally use in health care? What other non-healthcare-related professions have you learned key insights from and how have they informed your thought processes? Please e-mail us at firstname.lastname@example.org and email@example.com to continue with this exploration.
Harper M., & Maloney P. (Eds.) (2016). Nursing professional development: Scope and standards of practice
(3rd ed.). Chicago, IL: Association for Nursing Professional Development.
International Coach Federation. (n.d.-a). About ICF
. Retrieved from https://coachfederation.org/about
International Coach Federation. (n.d.-b). Core competencies
. Retrieved from https://coachfederation.org/core-competencies
McLeod S. A. (2017). Kolb’s learning styles and experiential learning cycle. Simply Psychology
, Retrieved from https://www.simplypsychology.org/learning-kolb.html