“ Adaptable to Unexpected Situations ” : Nursing and Social Work Students Reflect on Interprofessional Communication and Teamwork

INTRODUCTION Undergraduate nursing students partnered with undergraduate and graduate social work students to implement school-based health promotion and empowerment modules in fulfillment of their practicum coursework. Of the four domains outlined by the Interprofessional Education Collaborative, two in particular were the focus of this nursing-social work collaboration: communication and teamwork. The purpose of this paper is to describe the perceptions of students regarding their experiences of interprofessional communication and teamwork. METHODS A sample of 26 nursing students and 5 social work students worked together across two academic semesters at an urban, primarily Hispanic middle school. Data collection consisted of reflective journals and end-of-semester evaluations. Conventional methods of content analysis were used to examine the narrative data for emergent patterns or themes. RESULTS Analysis of students’ reflective journals and evaluations revealed specific themes regarding the value of interprofessional education (IPE), the utility of TeamSTEPPSTM as a resource for improving communication and team performance, lessons learned, and recommendations for the future. CONCLUSION Nursing and social work students expressed positive experiences with IPE and shared insights beneficial for future planning. With advanced preparation and strategic partnerships, IPE projects may strengthen the collaborative skills necessary for students to be practice-ready upon graduation. Received: 05/30/2017 Accepted: 10/16/2017 © 2017 Alexander, Bashore, & Jackson. This open access article is distributed under a Creative Commons Attribution License, which allows unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. H IP & “Adaptable to Unexpected Situations” ORIGINAL RESEARCH 2(4):eP1134 | 2 Background/Introduction To prepare for effective interprofessional practice, nursing and social work students in an urban private university engage in diverse clinical and field experiences, building the core competencies of teamwork, collaboration, roles/responsibilities, and values/ethics (Interprofessional Education Collaborative Expert Panel, 2011). Of the four competency domains outlined by the Interprofessional Education Collaborative (2011), two in particular were the focus of a collaborative nursing-social work project: communication and teamwork. The purpose of this paper is to describe the perceptions of students regarding their experiences of interprofessional education (IPE) as they developed and implemented a school-based health promotion project.


Background/Introduction
To prepare for effective interprofessional practice, nursing and social work students in an urban private university engage in diverse clinical and field experiences, building the core competencies of teamwork, collaboration, roles/responsibilities, and values/ethics (Interprofessional Education Collaborative Expert Panel, 2011).Of the four competency domains outlined by the Interprofessional Education Collaborative (2011), two in particular were the focus of a collaborative nursing-social work project: communication and teamwork.The purpose of this paper is to describe the perceptions of students regarding their experiences of interprofessional education (IPE) as they developed and implemented a school-based health promotion project.

Literature Review
Academic leaders in nursing and social work call for innovative approaches in IPE, not only to provide unique educational experiences but also to transform practice (Angelini, 2011;Barnsteiner, Disch, Hall, Mayer, & Moore, 2007;Bridges, Davidson, Soule Odegard, Maki, & Tomkowiak, 2011;Jones & Philips, 2016).Recent reports of IPE best practices focused on partnerships among multiple disciplines, but some have outlined strategies to promote competency in collaboration and ethical decision-making between students in nursing and social work in particular (Groessl, 2013;Sims, 2011;Vandenhouten & Groessl, 2014).
Collaborative interprofessional teams that include nursing and social work professionals typically involve chronic illness case management and primary care in a variety of clinical settings, including communitybased clinics serving vulnerable populations (Brommelsiek & Peterson, 2015;Chan, Chi, Ching, & Lam, 2010).Some authors have described interprofessional teams in the home setting (Laughlin et al., 2015), while others have focused on nursing-social work partnership in the design of health promotion fairs at senior centers (Kolomer, Quinn, & Steele, 2010).A recent study described the potential for school-based health promotion through nursing and social work IPE initiatives (Lam, Chan, & Yeung, 2013).
Nursing-social work IPE collaborative partnerships are not new, but few studies have explored transdisciplinary IPE that focuses on the public health approach.Transdisciplinarity, the integration of conceptual frameworks from various disciplines to transcend traditional disciplinary boundaries, is a promising form of collaboration to address difficult scientific and social questions (Knerr & Fullerton, 2012;Stokols, Hall, Taylor, & Moser, 2008).The design of effective population-focused interventions requires an ecological awareness of health and transdisciplinary strategies to promote community engagement and improve outcomes (Gebbie, Rosenstock, & Hernandez, 2003).In fact, Derry and Fischer (2005) argue that a curricular emphasis on transdisciplinary competencies will prepare students more fully for the complex uncertainties and dilemmas that they will face in their careers.The current IPE project emerged as a response to the transdisciplinary call to prioritize primary prevention in all sectors of society and focus on strategies to

Implications for Interprofessional Practice
• Using an evidence-based model, such as Team STEPPS TM , may promote effective communication and conflict resolution among members of the interprofessional team.
• Capitalizing on team members' strengths in role assignment is pivotal to improving efficiency and outcomes.
• Engaging in reflective exercises regularly can reinforce the value of interprofessional teamwork and collaboration.

Interprofessional Skill Development
Regardless of the setting, a cross-cutting theme in the growing field of IPE is the need to cultivate the knowledge, skills, and attitudes required to support genuine teamwork and collaboration (Barnsteiner, 2007;Bridges et al., 2011;Jones & Phillips, 2016).Learning how to communicate clearly, how to assign roles, how to assess team function, and how to use these data to modify role assignment and enhance team performance are among the key competencies that students must learn to be effective in practice (Buring et al., 2009).A persistent irony of the traditional intraprofessional, silo-based approach is that students are socialized to acquire these fundamental communication and team performance skills in isolation from other disciplines, as opposed to practicing them together in a collaborative, purposefully interprofessional manner (Angelini, 2011;Barnsteiner, 2007).
This propensity toward intraprofessional communication undoubtedly continues once students transition to practice.In fact, communication barriers are posited as an outcome of our complex healthcare system that relies on layers of specialized training; overcoming those barriers is essential for safe, coordinated care (Jones & Phillips, 2016;Keller, Eggenberger, Belkowitz, Sarsekeyeva, & Zito, 2013).To enhance patient and professional outcomes, interprofessional teams will prioritize open patterns of communication and practice effective conflict resolution skills (Buring et al., 2009).

TeamSTEPPS TM : A Framework for Improving Team Performance
The foundation for teamwork and collaboration principles for this project consisted of the  (Brock et al., 2013;Horsley et al., 2016).Additional research supports the use of TeamSTEPPS TM as a strategy to improve attitudes toward teamwork and support the development of communication skills necessary for interprofessional practice (Jernigan et al., 2016).Furthermore, Team STEPPS has the potential to build confidence in conflict resolution skills among IPE small groups consisting of medical and nursing students (Keller et al., 2013).
The current study is the result of a partnership among nursing and social work faculty and the coordinator of an after-school program for middle school students.
The specific aim of this study was to describe the perceptions of nursing and social work students regarding their experiences of IPE as they developed and implemented a school-based health promotion project.In the fall semester, the students met together on a weekly basis to assess the middle school population, design health promotion lesson plans, and implement two pilot sessions in preparation for full implementation the following semester.

Study Design
In the spring semester, the students implemented the health promotion modules, which were designed using a Photovoice format with findings reported elsewhere (Bashore, Alexander, Jackson, & Mauch, In press).The setting of this project was the after-school program of an urban middle school with a largely Hispanic population.The purpose of the project was to explore the adolescents' perceived environmental influences on mental and emotional health.Specific modules included stress/ coping skills, healthy communication with parents/ adults, healthy relationships, anger/aggression, bullying, and goal setting.During the semester, the students met together on a weekly basis to develop lesson plans, which they implemented and evaluated for improvement the following week.

Team STEPPS TM : Evidence-Based Strategies to Support Team Performance
Each week, the nursing and social work students met for approximately two hours for planning purposes.At the beginning of each semester, the meeting time was dedicated to orientation and introductions, so that the students could get to know one another and gain a better understanding of the school population and the Photovoice-based health promotion project.This orientation process occurred once in the fall and once in the spring, when a new cohort of nursing students joined the team.
During orientation, the students spent time discussing their experience working with adolescents and any previous background in teamwork.The social work and nursing faculty introduced them to the core competencies of teamwork, collaboration, roles/responsibilities, and values/ethics; discussion centered on the fundamental concept of interprofessionality (Interprofessional Education Collaborative Expert Panel, 2011).At the end of orientation, the students exchanged contact information and began reviewing the literature on adolescent health, Photovoice, and health promotion.
The following week, the faculty member who completed a TeamSTEPPS TM Master Trainer course led the students in a focused session on teamwork and strategies for communication, leadership, situation monitoring, and mutual support, using materials available in the public domain (Agency for Healthcare Research and Quality, 2017).In addition, students received a spiral-bound handbook (pocket guide, also available online) for easy reference to all of the material presented.During this training, the faculty trainer shared examples from clinical experience and also tailored examples for students to see the applicability of situation monitoring and mutual support to the middle school setting.Students shared examples from their own life, clinical, and field experience and reflected on the value of TeamSTEPPS TM strategies in their journals.
In successive weeks, students (referred to as the team or teammates in this section) met with one another for approximately two hours to build the Photovoice project.The team assigned roles, determined priorities, and established a clear division of labor.During this time, faculty shifted to a consultant role, allowing the team to establish work patterns that met their needs and preferences while challenging them to implement strategies to improve their performance each week.Faculty observed TeamSTEPPS TM strategies in action, and these observations appear in Table 1.

Team STEPPS TM Strategy Faculty Observation
Brief Typically, the team held large group discussion (briefs) at the start of planning sessions; afterward, team members would divide into smaller groups to accomplish key tasks for the day.Huddle Task assistance Throughout the planning time, they would have huddles as needed to update one another on progress or offer task assistance to those in need of help.As they neared the end of planning time, they would report to one another before leaving to go to the middle school for implementation the module of the Photovoice project they had planned for the day.

Call-out
When an immediate clarification of plans was necessary, the team used call-out, often to help the large group facilitator make quick adjustments to the lesson plan.

Check-back
Teammates would use check-back strategies for closed-loop communication, especially when Photovoice prompts for the day were unclear or a middle school student was struggling to convey or understanding the concepts of focus.

Handoff
When an unanticipated problem emerged that required special attention, a team member would complete a handoff to another teammate as needed in order to have a smooth transition in the lesson plan.

Debrief
At the end of each session at the school, the team would debrief to focus on what worked and did not work that day, which they explored in greater depth through reflective journaling and again the following week as they developed the successive Photovoice module.Situation monitoring

Feedback
Over time, many team members became more comfortable with situation monitoring and exhibited a greater willingness to offer mutual support when needed by their peers.As expected in team-based projects, the students experienced episodes of miscommunication and conflict.To facilitate conflict resolution, the faculty emphasized the need for mutual support and focused on strategies for clear feedback to improve team performance quickly to avoid misunderstanding.SBAR (situation-background-assessmentrecommendation) When a new cohort of nursing students began, social work students played a pivotal role in the transition, which involved reliance on SBAR communication.

Data Collection
Data collection consisted of reflective journals and end-of-semester evaluations, all designed a priori by the authors to gather data supporting the purpose of the study.
The journal prompts were designed to assess the nursing and social work students' impressions of Team-STEPPS TM and their impressions of the interprofessional collaboration.The end-of-semester evaluations prompts were designed to assess the overall experiences of IPE and lessons learned (See Tables 2 and 3 for prompts).No specific guidelines were provided; each prompt was open-ended with the request of a thoughtful response by students.

Data Analysis
To analyze the narrative data in the reflective journals and end-of-semester evaluations, the authors assumed a constructivist-interpretive paradigm of naturalistic inquiry (Guba & Lincoln, 2005;Lincoln & Guba, 1985).Having this approach to data analysis allowed the authors to discover and develop meaning inductively from the narratives shared by the participants.The authors coded the narrative data using conventional methods of content analysis to read and re-read the text closely; key words or phrases were categorized by content, which generated many units of meaning, or codes (Burnard, 1991;Elo & Kyngäs, 2008;Hsieh & Shannon, 2005;Wolcott, 1994).
Through an iterative process of reading, analyzing, and coding the narrative data, the authors organized the codes into meaningful clusters or coding categories, which led to the emergence of underlying meanings, known as latent content, or themes (Burnard, 1991).To enhance the validity and trustworthiness of the qualitative analysis, three coders (the authors) engaged in active discourse regarding coding strategies and organization of coding categories.Differences in interpretation were resolved through discussion of each perspective and post-discussion consensus among all three coders.In addition, the authors reviewed Describe situations or issues that you think public health nurses and social workers may work together within a school or community setting.
What is your perspective on the value of Team STEPPS TM for your work together at the middle school?How do you think Team STEPPS TM may help you to deal with negative ideas you have about working together on a team?Which three strategies of Team STEPPS TM will you attempt to use in practicum next week?Include the rationale for your selections.
How were you able to communicate with students from the other profession?
How did you work as a team with students from the other profession?
How did your understanding of the roles/responsibilities of the other profession change as a result of this experience?
In your opinion, what worked well this semester for interprofessional education?What did you like the most about this experience?
What suggestions do you have for improving this interprofessional education experience?
Table 2. Reflective Journaling Prompts Table 3. End-of-Semester Evaluation Prompts the audit trail and explored decisions regarding data interpretation (Hsieh & Shannon, 2005).Threats to trustworthiness, including researcher bias, were minimized by this approach, with emphasis on researcher reflexivity and authenticity (Guba & Lincoln, 2005).Another strategy to increase trustworthiness and credibility is increasing reader access to primary data (Wolcott, 1994).Throughout this report, participant quotes are presented together with interpretative findings.Through careful analysis of the textual data, the authors noted the emergent patterns or themes that were most prevalent in the narrative.

Results
Through content analysis, the authors identified six primary themes.These themes are presented in detail, including representative quotes.

Valuing the Perspective of another Discipline
In their reflective journaling, several students shared the perceived benefit of interprofessional collaboration, both for their project and for practice in general.One student wrote, "I feel that both professions go hand in hand and are able to offer the [middle school] students different services that are both crucial." In addition to noticing the complementary nature of the two professions, another student emphasized the strategic value of the distinct contributions of each: "…we (nursing students and social work students) can present information from different viewpoints to better the school." This recognition of the compounding value of IPE and its potential for practice was echoed by another student who emphasized that: "Working closely with another profession forces an understand-ing of what both parties can offer the team." When reflecting on the best ways for social workers and nurses to collaborate in the school environment, one student shared that: "I think they probably both work together to solve the entire problem instead of just working on one piece of it.The public health nurse and social worker working together is [sic] probably more effective at solving the problem than just one person." Others agreed with this approach; one student commented that: "Overall, I think teaming up is a great opportunity for both groups of students to learn about the other's jobs as well as their strengths as a community worker." Having the chance to engage in meaningful IPE teamwork was valued by others as well: "I liked being able to share in the experience with another profession just like you will have to do in [a] real job."

Building Communication Skills through Team STEPPS TM
In response to the reflective journaling prompts, sev- eral students expressed the belief that TeamSTEPPS TM was an approach that they could use to improve their patterns of communication.One student said that: "Team STEPPS will give us the skills to work together in a sufficient manner with our teammates…[to] make sure that all of us are on the same page and that we have the same training and perspective.This will make communication much easier than it would be without this training and hopefully will make working together to complete a common goal simple." Another was confident that this model would enhance planning efforts: "Team STEPPS improves communication.Effective communication is a critical aspect of forming a relationship with the school and successfully implementing our plan…" Another student envisioned the model as an asset that would enhance team performance overall: "Team STEPPS is highly valuable.It maps out a good structure for communicating and working together effectively as a team." The most frequently mentioned TeamSTEPPS TM strategies were task assistance, huddle, and the shared mental model.Students expressed the benefit of task assistance and mutual support as a mechanism for "keeping myself and everyone accountable for our tasks and recognizing if someone is falling behind or needs help." Another echoed this statement, clearly seeking to avoid an unequal work burden: "Task assistance is important…because we need to ensure that no one is overloaded with work.We should all be willing to offer assistance to another group leader or member when necessary.It is also important to make sure that everyone has something to do.If we work together, we will create a strong team." When reflecting on the value of teamwork and mutual support, another student shared that "…we all support each other and want to be successful in this journey. . ." Several students indicated that using huddles would enable them to make adjustments in their plans as needed, while making sure that all team members shared the same vision, thereby reinforcing a shared mental model.One asserted that "We will. . .huddle with our interprofessional counterparts…Getting on the same page about what our goals and progress are each week is essential…" Another student expressed similar insights, indicating that: "We all have to be on the same page about what is going on . . . .Team STEPPS has many tips and tricks to make teamwork work more successfully . . . ." Still another student conveyed the need for a shared mental model: "We all make sure we're on the same team and that everyone has a common goal . . . ."

Sharing Responsibility through Strengths-Based Role Delineation
In addition to expressing the desire for improved communication, several students also wanted to assign an even workload among team members.As one student commented, "Teams become ineffective when work is not evenly split between members and everyone doesn't adequately contribute.However this is avoided when using a Team STEPPS model by establishing a leader and assigning role/responsibilities [that] team members are able to effectively perform based on their strengths and abilities." The recognition of individual strengths was not an isolated comment; another student indicated that: "By knowing who is strong at what, it definitely benefits us on what to expect from one another and when we each might need help." Another motivation for clear role assignments was the desire for productivity among all team members.One student conveyed that: "It's also important to make sure that everyone has a specific role so that each individual is contributing…"

Improving Efficiency and Outcomes through Teamwork
Several students recognized that teamwork could enable efficient work patterns and increase the likelihood of positive outcomes.When expressing the benefit of an initial team brief, one student said that: "We will also use this time [in team briefing] to delegate specific roles to each member of the team.This will allow us to use our time productively and efficiently." In addition to the efficient use of time, students recognized the potential for improved outcomes.One student wrote, "I think the more people you can get from different backgrounds, who can also work to a similar goal, the better and stronger an outcome you can have." Another student alluded to the benefit of safety and quality care: "Improving the communication skills and teamwork through something like Team STEPPS leads to fewer errors and better outcomes."

Learning to Manage Conflict
Several students shared their concerns about team conflict and the desire to achieve conflict resolution.
One student aptly commented that: "Conflict tends to arise when team members have disagreements.Team STEPPS offers a conflict resolution script to manage and resolve team conflict." This student was eager to use the tools offered by TeamSTEPPS TM , a sentiment that was echoed by a peer: "It is important to be respectful of one another in order to accomplish our goal.Also it is good to know how to approach one another when there is something [about which] we do not agree with one another or are not understanding [about] each other.STEPPS [sic] has a good framework to follow in order to accomplish a form of communication." These insights were common in the narrative, as students recognized that different personalities among team members can lead to conflict.One student wrote, "I think the Team STEPPS approach is a reminder that teams can work better given the fact that most often team members are all very different.Issues will arise and there may be arguments but there are strategies and tools to overcome these things.
Working as a team is hard but…a lot of good can come out of working with others!"Numerous students' comments revealed a primary desire to avoid conflict while also learning how to resolve conflict successfully.For example, one student shared, "Another tool I think is useful is the conflict resolution.Hopefully, it won't be necessary but if it is we have something that we can all follow to work out any disagreements." Another student expressed the opinion that conflict may emerge if team members are not completing assigned tasks: "Trusting that each person is going to be responsible for their part, and if they aren't then we can effectively address that without creating conflict." Other students conveyed subtle hints of conflict avoidance, expressing their preference for individual work over team-based projects: "I am a person who will bite off more than I can chew because I' d rather do it myself than have it done poorly." This student's preferences were echoed by another: "I am someone who enjoys working alone and always feel like team work can bring out some negative qualities in people; however, if [Team] STEPPS is truly utilized, conflict should be minimized."

Opportunities for Improving IPE/Lessons Learned
Several students offered clear recommendations to improve nursing-social work collaboration and IPE in general.Some highlighted the need for sustained schedule alignment.One student wrote, "Make sure social work and nursing are on the same page regarding meeting times so people don't overextend themselves with their schedules." Another was direct and simple: "I think there needs to be more work on the scheduling." A few students requested clarification of the workload, roles, and expectations for the IPE experience.At the end of the project, one student shared that: "It felt like the role assignments and expectations were not balanced between the degree plans [nursing and social work]." Another student wrote, "I feel like the roles were uneven, I do not feel like enough team work was done." Still another reflected on a perceived imbalance in the decision-making: "The social work and nursing students did not communicate well.It felt like nursing had a lot more input." One student made a simple recommendation regarding the unbalanced ratio between nursing and social work: "Provide a more even distribution of social work to nursing students." Another student echoed this comment: "We need more social workers on the team!"One recommendation focused on the patterns of socialization and seating that students used when planning: "Encourage the nurses and social workers to mix themselves up and not always sit together even in interdisciplinary teams.There was definitely some divide from the two majors that could be seen even from how everyone sat.It made it difficult to work together when nurses only talked to nurses and social workers only talked to other social workers."

Discussion
Of the nursing and social work students who participated in this IPE project, the majority expressed positive impressions and insights, which suggests that they responded well to the process and the activities.
Although some conveyed reservations about conflict, most were able to see the value of a different perspective and the merits of learning to manage conflict.and skills necessary for successful interprofessional collaboration in the future (Hammick, Freeth, Koppel, Reeves, & Barr, 2007;Park, Hawkins, Hawkins, & Hamlin, 2013).
Similar to the findings from the current study, other researchers have conveyed the potential benefits of nursing-social work IPE in the school setting.Lam et al. (2013) report the firsthand experiences of nursing and social work students, asserting the increased capacity to identify and serve at-risk schoolchildren before problems emerge.The authors further convey the potential to promote children's health on a larger scale if collaborative models and academic-practice partners engage in creative school policy to effect change over time (Lam et al., 2013).
The nursing and social work students in the current study communicated the value of increased efficiency and the potential for improved outcomes that results from effective IPE and collaborative practice.In addition, many conveyed the benefits of enhanced communication skills and strategies.However, students expressed concerns at the lack of clarity in roles and expectations, and some were wary of team conflict, which could impede communication and honest feedback.Bridges et al. (2011) assert that criteria for team effectiveness include autonomy, open communication, and the perception by all team members that their unique role is important.Close monitoring of these criteria may facilitate the identification of problems early on during an IPE project.
Other investigators similarly report the need for faculty oversight to support beneficial IPE projects for service-learning.Kolomer et al. (2010) assert that meaningful IPE projects increase the likelihood that the IPE participants will translate the experience into practice after they graduate, multiplying the benefits of IPE over time.Research is necessary to evaluate the long-term effectiveness of IPE to determine whether institutions of higher education are preparing students for interprofessional practice, or IPP (Reeves Perrier, Goldman, Freeth, & Zwarenstein, 2013).
Students in the current study reported the value of Team STEPPS in supporting communication and program implementation.Others have conveyed the merits of Team STEPPS as a platform for students to use across disciplines to promote patient safety.Jernigan et al. (2016) documented student acquisition of Team STEPPS knowledge and skills; furthermore, the participants reported a greater sense of readiness to collaborate with others after graduation, thus advancing the likelihood of IPP.
In this nursing-social work collaboration, a transdisciplinary model of interprofessional education was promoted, in which the role and expertise of social work students and nursing students combined in the development and implementation of the health promotion project, the findings of which are reported elsewhere (Bashore et al., In press).The effect of transdisciplinary IPE may naturally result in some role confusion because of the blurring of boundaries; however, the benefits of adaptability and flexibility are important for the transition to practice (Jones & Phillips, 2016).Moreover, the collaborative skills required of transdisciplinary IPE will enable students to cultivate new approaches to solve social dilemmas rife with uncertainty and complexity (Stokols et al., 2008).To promote student engagement and buyin, faculty members have the opportunity to create meaningful incentives, such as awarding certification to students who complete all components of a transdisciplinary program (Jensen et al., 2017).
Although the students expressed overall satisfaction in this IPE project, they shared concerns about implementation and scheduling conflicts.Without sufficient face time for team discussion and planning, the IPE becomes less interprofessional and more intraprofessional, which amounts to the status quo in healthcare and academic settings.These concerns are universal; many academic leaders express the need to address persistent barriers to meaningful IPE, including rigid curricular programs, disparate course scheduling among the disciplines, lack of administrative support, and lack of perceived value among faculty and students (Angelini, 2011;Buring et al., 2009;Jones & Phillips, 2016).

Limitations
This qualitative study relied on a descriptive study design with no control group; findings were based upon the perceptions of 31 participants, which is a small sample with limited generalizability.than generalizability to other populations (Lincoln & Guba, 1985).Another limitation of this study design is that the focus was on student perceptions; there was no concurrent examination of other IPE-related outcomes.
Some participants shared more narrative than others; the journal questions and end-of-semester evaluation items were open-ended, allowing participants the freedom to write as much or as little as they preferred.
Future studies may benefit from a protocol that includes systematic recording of participant comments during meeting times and a face-to-face interview for those who prefer verbal communication.

Conclusion
This collaborative nursing-social work project focused on two competency domains in the IPEC framework: communication and teamwork.Analysis of students' reflective journals and evaluations revealed specific themes regarding the value of IPE, the utility of Team-STEPPS TM as a resource for improving communication and team performance, lessons learned, and recommendations for the future.With advanced preparation and strategic partnerships, IPE projects will strengthen the collaborative skills necessary for students to be practice-ready upon graduation and further address accreditation requirements in social work and nursing programs (American Association of Colleges of Nursing, 2008;Council on Social Work Education, 2015).