The impact of learning styles on attitudes to interprofessional learning among nursing students: a longitudinal mixed methods study

Depending on individual preferences, individuals tend to use different approaches to learning, so-called learning styles. A concrete learning style is characterized by an active, concrete, explorative and experimental approach [4]. The concrete learner uses practical application, focuses on feasibility, usability, utility, and results; a pragmatic approach guides the learning process. The reflective learning style is associated with emotional involvement, intuition, based own experiences and takes place in dialogue and collaboration with others [4]. According to Kolb’s Experiential Learning Theory (ELT) [4, 5], learning can be seen as an endless cycle of four stages. The ELT is a holistic theory of learning based on a learning cycle that defines learning as a fundamental process of human adaptation, driven by the resolution of the dual dialectics of action/reflection and experience/abstraction [6]. Observations and concrete experiences form the basis for reflection. When the individual reflects on immediate and concrete experiences, the construction of a general theory about the meaning of the information is initiated. The learner then creates generalizations based on the hypothesis using abstract concepts. In the fourth and final stage, the learner tests implications of these concepts in similar situations [4]. Kolb’s Learning Style Inventory (LSI) is a well-known and widely used instrument and has been frequently used in nursing education research. The classification of learning styles is based on individuals’ preferred approaches to acquiring knowledge trough concrete experience, abstract conceptualization, reflective observation and active experimentation [6]. In view of the LSI learners can be categorized into four learning styles: Accommodator, Diverger, Assimilator and Converger [4]. Accommodators actively engage in new experiences, implement their plans, adapt, and perform well under changed conditions. Divergers have an ability to see concrete situations from different perspectives, are creative and show an awareness of meaningful values. Assimilators reason inductively and create theoretical ideas. Convergers reason deductively, apply practical ideas, and perform well when there is an answer to a problem. Nursing students are commonly described in research as concrete and linear thinkers focussing on facts, preferring pictures, diagrams, flow charts and enjoying working in groups to try out different solutions to problems [7]. Learning activities based on learning styles has been found to facilitate the education of professional nurses, but there is a need for more research in this area [8].

Interprofessional collaboration (IPC), is considered to be an effective care model bridging task-related gaps that require efforts by various healthcare professionals [9]. Both international organisations and key agencies agree that IPC competencies are a key aspect for future health care workforce [10, 11]. The experiential learning in clinical setting has as its ambition to provide students with the opportunity of integrating theoretical understanding provided by academic courses with skills and knowledge acquired in practical settings. Part of the training in the clinical context involves practising collaboration both within and between professions [12]. Interprofessional Learning (IPL), promotes cooperation between students in two or more healthcare professions, for example between medical students and nursing students; thus students develop skills in communication and understanding of roles, resulting in improved collaborative patient-centred care [10, 13]. Supervisors support IPC and IPL, but there are challenges for implementation in clinical settings [14]. In terms of practical and logistical challenges, for instance, there may be a lack of space and encounters with vulnerable patients may require a limited number of caregivers [15]. Furthermore, young healthcare professionals appears to have positive attitudes towards interprofessional collaboration and undergraduate nursing students have reported a more positive attitude to IPL than have medical students [16, 17]. A previous Swedish study found no correlation between learning styles and attitudes towards interprofessional teamwork among medical students suggesting that further research could benefit from a combination of quantitative and qualitative research methods [18]. Research investigating the influence of learning styles on attitudes towards IPE and interprofessional collaboration is scares. To the best of the authors’ knowledge, there are no published studies exploring the correlation between learning styles and attitudes towards IPE among nursing students using a mixed method approach.

To explore nursing students’ experiences of professional development with a focus on the relationship between attitudes to IPL and learning styles.

A longitudinal parallel mixed-methods study design [19] was used to obtain different perspectives and build a comprehensive understanding of students’ attitudes to IPL and learning styles.

This study took place at a Swedish university from August 2015 – January 2020. The nursing program followed the national guidelines, a three-year program (equivalent to 180 credits, according to the European Credit Transfer and Accumulation System, ECTS), of which clinical practice accounted for 60 ECTS. The main subject, nursing science, corresponded to 109 ECTS credits and medical science 71 ECTS credits. The program led to a professional degree as a Registered Nurse (RN), as well as a bachelor’s degree. The nursing program in Sweden is free of charge for citizens from Sweden, EU, EEA, and Switzerland. The first year consisted of theoretical training. During the second year of the education, approximately one third was made up of clinical training in elderly and medical care. The third year consisted mainly of clinical training within psychiatric, palliative, and primary health care, except for writing a bachelor’s thesis in the fifth semester. In the final semester students did their clinical training in advanced medical care, and in surgical care including two weeks at a clinical interprofessional training ward.

At the time of the interviews the mean age was 32.9 ± 9.1, ranged 22–53 and 83.2% (n = 28) were women and 17.6% (n = 6) were men. All students were Swedish citizens, 8.8% (n = 3) was born abroad and 20.6% (n = 7) students had parents from other countries. 41% reported studying fulltime, while 35.2% (n = 12) planned to work for salary at a maximum 10 h/week and 23.5%s (n = 8) planned to work 10–20 h/week. A total of 20.5% (n = 7) reported having an RN in the family while 44.1% (n = 15) had family members working in other professions in health care. 47% (n = 16) reported having previously attended higher education and 29.4% (n = 10) stated having completed a university degree in another subject.

Questionnaires were distributed via the university’s learning platform at the start of the program and at the start of the final semester. The first questionnaire included demographics, the Swedish version of the LSI [20] together with the Swedish version of the Readiness for Interprofessional Learning Scale (RIPLS) [21]. The second questionnaire included the Swedish version of the RIPLS [21]. RIPLS is a well-known and widely used questionnaire [22] that has been translated into many languages, including Swedish [21]. RIPLS builds on 19 questions concerning attitudes on interprofessional collaboration that generate four subscales. Higher scores indicate a more positive attitude towards interprofessional education [21, 22]. A 7-point Likert scale (1 corresponding to strongly disagree and 7 to strongly agree) were used for all questions instead of the original 5-point Likert scale [23].

Towards the end of the final semester, participating students were invited to an individual, semi-structured interview carried out in an undisturbed room at the university. Students were also informed about whom to contact if they had questions prior to the interviews. A semi-structured interview-guide was developed to capture students’ attitudes to interprofessional collaboration. The interview-guide included the following questions:

All interviews were carried out by the first author and lasted 30 min on average, until all questions had been covered and the student declared there was nothing more to add. The interviews were audio recorded and transcribed verbatim [24, 25].

Questionnaires were analysed using The Statistical Package for Social Sciences, SPSS [26]. Calculation of the LSI scores was performed according to the model defined by Marke and Cesarec [20]. Sample percentages were calculated for learning styles. Mean scores and standard deviations (SD) were calculated for variables of the RIPLS at the start and in semester six. Scoring adhered to the convention used in RIPLS translation by reverse-scoring items 10, 11, and 12. Results are reported for the Swedish version of the RIPLS [21]. This scale is divided into four subscales; Teamwork and collaboration, item 1–9); Negative Professional identity, item 10–12; Positive Professional identity, item 13–16; Roles and responsibility item (17–19). To validate internal consistency reliability of the RIPLS four subscales Cronbach’s alfa was defined. Paired T-test was used to compare the RIPLS at the start with result in semester six in the whole sample and according to learning style. A p-value lower than 0.05 was regarded as statistically significant in present study.

The interview transcripts were read several times to make sense of the data as whole [27] and then analysed using qualitative content analysis with a manifest inductive approach [28], using NVivo software [29]. Identified codes were grouped into sub-categories labelled with a phrase that described the meaning content. Sub-categories were grouped by contextual meaning resulting in four main categories. From this categorization, an abstraction was derived describing an overarching theme [28, 30], Table 1. During the analysis, the findings were discussed within the research group, until consensus was established.